RUBIX 2014

RUBIXMagazine of the

New South Wales

Medical

Students’

Council

On behalf of the New South Wales Medical Students’ Council (NSWMSC) I would like to welcome you to Rubix, our inaugural state publication for medical students.

NSWMSC was founded with the ambition of representing, engaging and uniting the medical students of New South Wales. Throughout 2014 we have been listening to your opinions, and working to strengthen the voice of medical students wihin our state. Our executive has been working with key health stakeholders to represent your interests while also facilitating more opportunities to unify the power of the NSW medical societies.

Each university medical society has been represented at our state Council meetings by an elected represenative and we have valued their input and advice. With their help we have stregthened the foundations of our organisation, improved the internal management and rejuvenated the external branding.

We believe this new publication will go futher to improving the awareness of NSWMSC while offering a new avenue to unite our desires and ambitions. With a united voice we are better able to advocate for you and your vision of medical education within our state and we look forward to seeing Rubix become another tool to empower medical students in this regard.

As always we welcome your comments and feedback and would love to hear how our new publication could better inform and represent you.

We hope you enjoy the following pages and look forward to seeing you at a NSWMSC event soon!

John Cherry, NSWMSC Chair

foreword

The aims of the New South Wales Medical Students’ Council areto inform and connect the 4000 medical students in New SouthWales, as well as advocate on their behalf.

• To foster cooperation and communication between medicalschools and students in NSW

• To advocate on behalf of NSW medical students to stateand federal governments and other NSW-specific bodies

• To provide a forum for NSW medical students to voice theirviews and opinions

• To promote communication between NSW medicalstudents and their community.

NSW MSC is the formal means of communication betweenNSW medical schools and students, and has evolved to providea forum for effective communication and discussion betweenstudents on a variety of issues. Additionally, NSW MSC activelyparticipates in forums and committees for a number.

NSW MSC’s social activities promote collegiality between themedical students in NSW. These have proven an excellentmeans of keeping up to date with each other, and are supplemented by updates found on our website and in our publications.

RUBIX is the anual publications put together by the NSWMSC to inform students about the events and activities going on in other NSW medical schools, in addition to showcasing the creative and writing talents of NSW medical students.

For more information or to learn more about NSWMSC, contact [email protected].

nswmsc:

about

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Ready for the realworld? We know howto get you started.

BOQS000253 08/14

CSW was not just a learning experience, we have made connections all around the world, including with these fantastic medical women doing amazing things in Nigeria

In March this year, myself and an extremely fortunate group of final year students embarked on an adventure of a lifetime – flying across the world to attend the 58th Commission on the Status of Women, held at the United Nations Headquarters in New York. It was one of the busiest weeks of our lives, as we tried to soak up as much knowledge as we could from the sessions, and meet as many influential and inspirational people as possible. We were also able to share our passions to other delegates, delivering a few talks and presentations, having posters on display at various consulates, and participating in roundtable discussions with people like Elizabeth Broderick, the Sex Discrimination Commissioner of Australia.

As final year medical students, we have gained a lot from this a week and a half. We would probably all agree that is was a life changing experience and while pursuing careers in medicine it has also opened our eyes and made us aware that we should not forget the role we can play as advocates for peace, freedom, and of course women. After our CSW experience, it is no longer possible to turn a blind eye to violence against women and gender inequality that is prevalent internationally but also often flies under the radar in our own nation, Australia. Following intensive talks and discussion at CSW we were pleased with the conclusions and agreement relating to gender equality and women’s empowerment; reaffirming that prevention, treatment, care and support is available for people living with and affected by HIV and AIDS and acting to reduce gender-based violence.

Myself and a few of the girls attended CSW as representatives of Medical Women’s International Association and the rest through International Health Awareness Network. These NGOs work tirelessly in the areas of women’s health and human rights, and I believe I speak for all of us when I say we’d all be eager to assist these organisations with all of the amazing work they do into the future. We are all inspired to advocate for change and inform the community about global medical and humanitarian issues, including gender equality and violence against women.

Continue 6

Miranda Norquay, UNDS

status of

women

commission

on the

5 Continued

We would like to give a very special thank you to Professor Casper, whom without this journey would not have been possible. Her hard work preparing for this event and organisation ensured we had an incredible time and got the most out of the week and a half. Thanks must also go to the School of Medicine Sydney, for allowing us to take the time out of our busy clinical rotation schedule and a special mention to Professor Mavis Duncanson who took the time to edit and approve each of our posters and speeches.

If you’d like to know more about our trip, or read our more extensive report on our time at CSW58, feel free to contact me: [email protected].

STUDENT REFLECTIONS

“Spending a week and a half at the United Nations in itself was incredible, but seeing CSW in action was an experience of a lifetime. There were literally thousands of passionate people from the most diverse of backgrounds, all linked by their common goal: gender equality. Some would share their country’s stories of success, while others highlighted areas of improvement with which they aim to work on in the post-2015 development agenda. There were reports from people working from the grassroots, coupled with policy-makers who advocate at a governmental level. It highlighted to me how important this energy is, coming from both sides, and we should capture it within ourselves to help advocate for change. We are at a pivotal stage, between the end of the Millennium Development Goals and planning the Sustainable Development Goals, and being a part of CSW58 has reinforced that I want to be a part of this era of change, where we will see the empowerment of women, prevention of gender-based violence and with these, improvement in women’s health outcomes around the world.“

- Miranda Norquay

“ Attending the CSW really opened my eyes to the issues that face women internationally and also in Australia. Particularly the epidemic of violence. I gained a greater understanding of the processes required for change to occur at a grassroots level and at a political level. The role of advocacy is paramount and this was demonstrated through the presentations of many inspiring and noble causes. Other valuable lessons that I gained were around the practicalities of advocacy, the need for data collection and recruiting people in positions of power to champion your cause as well as holding positions of power and influence, It made me appreciate even more what we do have as women in Australia compared to other women in the world, but even in Australia there is still a lot of work to be done, I feel more inspired to be a part of that.”

- Katherine Smith

“Attending CSW 2014 was an incredible experience, one that I will cherish for many years to come. As a woman in medicine, my understanding of the many issues facing women in Australia and around the world has been expanded. This knowledge has equipped me with skills to incorporate into my profession. I met many like-minded woman working in medicine, law and politics and know that together, we are all making a difference. My interest in woman’s health and rights has increased and I hope to learn more in this area in the future.”

- Claire Nogic

“CSW58 was a humbling and thought-provoking conference which I was incredibly privileged to be a delegate at. I was inspired, hearing first hand from passionate women about the work they have done in their countries to advance the social, economic and health status of women and girls. Upon reflection, I have realised that despite enormous progress being made, there is still a long way to go in achieving gender equality, including within Australia. Importantly, I realised that as Australians, we accept a degree of gender-based violence as a normal component of society, and this is unacceptable. My experience at CSW58 has reinforced for me the importance of maintaining a bold agenda for the future, to ensure that the goal of gender equality is progressed.”

- Emily Nash

“The opportunity to engage collaboratively with women and men from all around the world, all striving with passion and commitment to promote The Millennium Development Goals, has been both inspiring and humbling. Participation in CSW58 has highlighted the importance of coming together to acknowledge our common humanity, and in so doing, to collectively seek solutions to global issues that affect all of humanity, regardless of gender, age, race or creed. I suspect that many of the new connections and networks of mutual support formed at the United Nations will become life long friendships, and I am indebted to Professor Casper for her tireless efforts in facilitating this incredible opportunity.”

- Renata Fliegner

“The commission on the status of women opened my eyes to the fact that regardless of colour, race, religion or nationality women worldwide face the same challenges. We need nourishment and health for our families. We cherish the opportunity for education, gainful employment and to live within a sustainable environment. We want gender equality to allow women to succeed in line with their male peers. This is not possible without a unified effort by both sexes, because these topics extend beyond gender, these are human issues. From the way we care for our young, our old, our sick and our less abled members of society through to the policies and laws we enact. These set the standard for what we as humans value, what we are willing to invest in and work towards generating the future we want to create. The commission on the status of women was a truly enlightening experience with the privilege of meeting extraordinary women from around the globe, all working towards a communal goal of a better world.”

- Shelley Stokes

Attending CSW58 has given me new insight into the challenges and achievements of the Millennium Development Goals for women and girls. The Commission was a fantastic opportunity to witness the way that gender equality is promoted at an international level as well as to engage with passionate and well-spoken women from all around the world. I really enjoyed gaining exposure to issues that I had not previously been aware of, such as paid versus unpaid work and gender-based violence against women with disabilities. I have returned from this trip truly passionate about gender equality and, in particular, preventing gender-based violence, both in Australia and abroad and I now feel empowered with information to advocate for these outcomes. Being able to attend the commission was a once in a lifetime opportunity and I am incredibly grateful to the Medical Women’s International Association, UNDA School of Medicine, Dr Gabrielle Casper, Dr Mavis Duncanson for the opportunity.

- Hannah Kluckow

ABOUT THE COMMISSION ON THE STATUS OF WOMEN

The Commission on the Status of Women (CSW), initially founded on 21st June 1946, is a functional commission of the United Nations Economic and Social Council (ECOSOC). At any one time, forty-five Member States of the United Nations serve as members of CSW. The CSW itself consists of one representative from each of the 45 Member States elected by the ECOSOC Council for four-year terms.

Over the past 60 years responsibilities of the Commission include provision of promotion of women’s human rights in political, economic, societal and educational realms . As such, CSW is the main global policy-making body dedicated to gender equality and the advancement of women worldwide. Each year, delegates representing UN Member States meet to examine issues relating to progressing gender equality, and to formulate policies to promote gender equality and women’s empowerment worldwide.

CSW’s main output is the agreed conclusions on priority themes set for each year. Agreed conclusions contain an assessment of progress, gaps and challenges. Importantly, they also contain a set of concrete recommendations for action by governments, intergovernmental bodies and other institutions, civil society and other relevant stakeholders. It is intended that the recommendations be implemented at the international, national, regional and local level.

Each CSW meeting has a review theme, a key focus for discussion to launch from. Since 2010 themes have included elimination of discrimination and violence against the girl child, eradication of poverty and hunger, equal sharing of responsibility between women and men including caregiving in the context of HIV/AIDS through to the 2014 review theme “Access and participation of women and girls to education, training, science and technology, including for the promotion of women’s equal access to full employment and decent work” (which were the agreed conclusions from the CSW 55th session).Australian Delegation to CSW58

The Australian delegation to CSW58 was led by the Minister Assisting the Prime Minister for Women, Senator the Hon Michaelia Cash, and included: Australia’s Ambassador for Women and Girls, Ms Natasha Stott Despoja AM, the Australian Sex Discrimination Commissioner, Ms Elizabeth Broderick, Assistant Secretary Office for Women Ms Mairi Steele, and two NGO representatives Dr Susan Harris Rimmer and Ms Julie McKay.

In the Australian National Statement : Challenges and Achievements in the Implementation of the Millennium Development Goals for Women and Girls delivered by Senator the Hon Michaelia Cash, Australia renewed their commitment to achieving the millennium goals with highlights including:

• Australia’s appointment of an Ambassador for Women andGirls (Ms Natasha Stott Despoja AM)

• Working both at home and abroad to support women inleadership roles to bring violence towards women to anend. Through the National Plan to Reduce Violence againstWomen and their Children 2010-2022, violent practicesthat are considered to be cultural, religious or historical (inparticular female genital mutilation) are illegal and moveswill be taken to strengthen the legislation against thesepractices. Further, early and forced marriages have beenrecognised as a violation against women.

• Gender equality has been recognised as a platform onwhich women may be empowered in the realms of finance,health and education

avada

cadavar

’That’s right guys, you will be seeing cadavers on your first week!’ exclaimed Evan, the first year rep, beamingly on our first day of uni. Immediately, animated murmuring began to fill the lecture theatre. I turned to the friend beside me,

‘What organ is a cadaver?’ I whispered. She shrugged.

‘I dunno,’ she whispered back,

‘Someone always faints every year,’ Evan continued, ‘and it’s usually one of those tall, gangly guys.’

This cadaver organ was really beginning to mystify me. Soon, Evan moved on to other news for us first year medical students and my little conundrum was dropped for the time being.

A few days later…

‘A cadaver is a dead body, you idiot,’ snapped my other friend, ‘do you have NO general knowledge at all?’

‘W-WHAT?!’ I stammered.

A dead body on our first week? In no way was I ready for this. However, not wanting my friends to question my Med-liness, I immediately followed up with,

‘That’s… so cool!’

I had seen plenty of corpses before… in the form of rat dissections in Year 11 biology, images on the news and in movies. Seeing one in real life wouldn’t be too far from that. I hoped.

When the day finally arrived, I had managed to come to feel relatively comfortable with the thought of seeing, perhaps even dissecting, a cadaver. Although I did not have much of an idea of what to expect, I was pretty sure I would be able to cope. After all, I wasn’t the ‘tall, gangly guy’ who was fated to faint. (In fact, quite the opposite.)

Yet, when I strolled into the cold anatomy room, heavily fused with the acrid odour of formaldehyde, and saw the long, grey towels draped over the contours of a body, suddenly the breath caught in my chest and my legs froze mid-stride.

If confidence was a muscle that one could exercise, then at that moment I was experiencing severe and extremely rapid confidence dystrophy.

‘Are you alright?’ asked my friend,

‘Yes… yes, I’m fine.’ I laughed shakily, forcing myself to walk again as we took our seats towards the back of the classroom before the lesson commenced.

Soon, the words ‘glenoid humerus joint, greater omentum, peritoneal cavity, proximal and distal phalanges...’ began pouring

Helen Zhang, UNSW

out from our tutor’s lips with incredible speed and ease. As I struggled to note them all down, I felt my attention continually being drawn towards the body on the metal bench. It seemed almost like another presence in the classroom.

At last, it was time to unveil the body. Cautiously, I drew closer to the bench. We stood as a small, tentative huddle around the cadaver. The sound of the ventilation suddenly became deafening. Our tutor scanned our faces before he slowly, gently pulled away the towel. The smell of formaldehyde intensified as a yellowy-brown, preserved male torso met our eyes, starkly lit by the stale lights. I felt a wave of vertigo pass through me.

Don’t faint, I thought, don’t faint.

A silence ensued as we let the sight sink in. When no one passed out, everyone seemed to let out a breath which they had not realised they were holding. Our tutor moved along the bench and began lifting away the next grey towels, revealing a leg, followed by an arm. Yet the more I looked on, the more absurd it felt for me to be afraid.

Before, I had only considered my own fears- perhaps of seeing a reflection of my own mortality laid out before my eyes. Probably because I have lived in such a protected, insular world, where my exposure to the concept of death was fairly limited to movies (a side effect of Voldemort yelling ‘AVADA KEDAVRA!’), to confronting images relayed daily on the news until I had become relatively desensitised, to a distant, teleologic notion

about my life. In short, nothing as real as this.

I realised too, that my lack of familiarity with, and the almost dehumanising effect of the term ‘cadaver’ had cushioned me from realising that ‘it’ was really ‘him’ or ‘her’. ‘Cadaver’ was really ‘human being’. Once living. Once breathing. Once seeing. Once feeling. Once, just like you and me.

It was a shell of full consciousness.

How much courage it must have taken for these people to consent to donate their bodies to the poking and prodding and inquisitive eyes of medical students. To give their bodies, despite the plethora of religious and sociocultural extrapolations about the unknown realms beyond death. To give away the one thing which they have possessed for their entire life. To give - literally - their all, to the future of medicine. To us.

As our tutor began to point to the various structures on the cadaver, which just a few minutes ago were only convoluted words to me, I felt my shoulders loosen a little as I stood a little taller and really began to listen.

This was never meant to be a fear-inciting experience. This was, and always will be, an immense privilege. A gift of a lifetime.

Em Jansen, UNSW

game of

bones

Amidst a war that has been raging for centuries is the struggle for valour and wellbeing.

SYNOPSIS

Noble lords put themselves on the line in a ferociously nerdy battle of responsibility and suffering.

EPISODE 1: PREPARING FOR BATTLE

Banners in full flight, essential equipment in hand1, I looked with wondrous eyes upon the fort in which I prepared to conquer; I speaketh of St Vincent’s Hospital, in the quaint shire of Darlinghurst.

My road there was long and laborious; a one-hour commute from Campbelltown upon a wearisome cityrail stallion2 would put any warrior on edge. Not to mention that my eyes had not closed last evening3, for I had been tormented by thoughts of the upcoming battle4. It had also been many moons since I had sunk my teeth into sufficient nourishment5: Instant coffee and Migoreng are not adequate food to sustain a warrior6. Though I was fatigued, I shouldered my bag, put foot before foot7, and made my way up t’wards yonder gate, prepared to lay siege.

EPISODE 2: THE SIEGE

The limp forms of casualties were already scattered before me. I nodded reassuringly to those who made eye-contact8. A warrior is always a warrior, and I choose to lead by example.

A messenger brings word of some administrative matters that I must address9. A new assignment?!10 Will this battle ever end?11

Word comes from Medfac (the throne and capital). Hospital allocations?12 Another siege?! I preference, knowing that the stronghold of Medfac is far and impenetrable, and that their carrier pigeons will not return me an answer for many weeks to come13.

My commander comes forth. ‘Consultant’, we call him14. He hands me my orders and reminds me of my duties. ‘Now get it done’15, he says, reminding me of my charge.

I tell myself that I am a soldier, and I fly under the banners of greatness. I grit my teeth and get on with it.

EPISODE 3: THE OATH

I line up on the frontier, peers beside me16. All of them fine soldiers of esteem and valour, and I feel honoured to be serving with them17.

We advance, united under a common banner. But what is it?! What cause could be so worthy? Who do we serve? Our Medsoc18? Our institution19? Some even clad in the orange of a veteran AMSA ranger20?

No, we and stand proudly under the flags of medicine worldwide, founded on our loyalty to the Hippocratic Oath21 and the Realm of Medicine. We are leading the fight against disease, and we are martyrs for the struggle of health22.

I feel inspired, and wave my stethoscope in pride.

EPISODE 4: THE ART OF WAR

So much suffering, so many casualties23. I wonder how much one (wo)man can be expected to do, and if it will ever end24.The battle rages on and on, and part of me wished to collapse and be done with it25. Moreover, I check my phone (carrier pigeon/raven/messenger boy/smoke signals/whatever) and my beloved26 hasn’t yet replied to my plea for comfort and mother27 asked me to collect milk on my way home.

So much stress! It affects me acutely!28

‘What are we even fighting for?!’ I ask my comrades, the carnage of our plight making me churn in my insides. ‘We are commanders on the frontier of the battle, and we are waging a war on disease’, they reply.

I muster at their words. I am a warrior, and I should be leading the charge29.

EPISODE 5: THE BATTLE DONE.

How does one maintain hope in the midst of an endless battle? How does one earn glory when each small victory appears fruitless?

I look at my comrades, unwavering in dedication. I look at my casualties, I look at those recovered from their maladies, and I recall with a warm feeling in my belly the Oath under which I serve.

“…If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.”

I clock off for the day, inspired by my work. I look back upon he small ground in which I have advanced30. I climb aboard my cityrail stallion and zone out to the sound of minstrels in the twilight31, the battle done for today, looking forward to a nice glass of mead32 when I get home.

Then I remember. Damn I forgot the milk33…

It may be because… it may be because… It may be because I’ve been watching far too much Game of Thrones to sustain a sane mind.

FOOTNOTE

(01) Pack your bag the night before.(02) Prepare for delays in your commute.(03) Get your 8 hours.(04) Don’t ignore anxiety.(05) Eat.(06) Don’t cut corners.(07) Attend as much class as you can.(08) Always remember the patient.(09) Try to be diligent in checking your uni email.(10) Start your assignments as early as possible.(11) Prepare for the fact that there are more to come- Be prospective.(12) Familiarise yourself with the clinical allocation policy,

learn how to stack them. Start thinking about where you want to go in advance.

(13) Medfac takes their time. Accept it.(14) Use correct titles for doctors.(15) Try to get as much done at hospital/uni as you can to

save the extra work later.(16) Remember your friends, see them whenever you can.(17) Remember that you are NOT your friends; don’t

compare. Everyone has their own struggles.(18) Get involved with Medsoc.(19) Get involved on campus. (20) Get involved with AMSA. Definitely go to convention.(21) Read the Hippocratic Oath if you haven’t, else find

something that inspires you to push on when it gets rough.

(22) Don’t be a martyr for the sake of other’s health- you come first.

(23) If you find yourself affected by things you see at hospital, seek help.

(24) Medicine is a long path, but it’s not straight- you have MANY options.

(25) Be aware of burnout and compassion fatigue. Use your time off and holidays wisely.

(26) Practice safe sex.(27) Don’t neglect your family.(28) Be aware of the signs of depression and other mental

health concerns. Don’t put off seeking help.(29) Know your responsibilities, but don’t be too hard on yourself.(30) Acknowledge your achievements.(31) Get some downtime.(32) Keep alcohol to a minimum.(33) Know that stress is going to come and go, but battles

aren’t won by a single sword. Take it a day at a time.

Ananya Chakravorty, UNSW

If you’re lucky enough to be on an 11am flight out of Cairns heading south, late enough that the ground-hugging morning cloud has lifted but not so late for it to have disappeared altogether, make sure you look out the window. As the aircraft makes its initial east-west ascent across the Trinity Inlet, you’ll see a sprawling township speckling the tip of the skinny peninsula that looks back at Cairns.

Yarrabah, surrounded on three sides by the lapping waters of the Coral Sea, separated from Cairns on the fourth by the Murray River Ranges, disappears as suddenly as it appears.

Then you’ll break through the ever-present cloud-line heading due-south, the southern stretches of the Great Barrier Reef somewhere below you, and Far North Queensland’s “Paradise by the Sea” will be long gone.

*

Yarrabah lies 12 kilometeres east of Cairns, across the Trinity Inlet of the Coral Sea, but is separated from the city centre by 90 kilometres of road that winds through fields of sugar cane and spirals around the Murray River Ranges (traveled at break-neck speeds) in the shadow of Mount Yarrabah itself. It is home to Australia’s largest mainland Indigenous community, with a township that fluctuates between 3000 and 4000, depending on the time of year.

In February of this year, I spent the last couple of weeks of the summer break on my first John Flynn placement in this very paradise, where every day of the monsoon is green and lush and the daily minimum barely scrapes 29 degrees. The entire community, approximately a third aged between 10 and 24 years, is serviced by the Gurriny Yealamucka Health Service, a half-way-house between Queensland Health and the Aboriginal Medical Service.

Like any place, it is impossible to separate the sociocultural and political state of the present from the past. Yarrabah’s history is compellingly unique. Post-colonially, Yarrabah was originally an Anglican Church mission, however the deeds to the land were handed back to the people in 1985, and it is now a self-managed community under the Yarrabah Aboriginal Shire Council, a “Deed of Grant in Trust Community”.

While the traditional owners of the land are the Gunggandji people, who finally won native title in 2011 after a 17-year-long battle, approximately 85% of the community are so-called “historical residents” – not traditional owners of the land, but descendents of displaced people who came from all over Australia, forcibly removed from their own land and homes. And so, though many people no longer remember where their ancestors came from, Yarrabah is far from homogenous – it is incredibly culturally diverse, an attribute which seems to be severely underappreciated by the relatively disinterested mainstream on the other side of the Trinity Inlet.

by the

sea

yarrabah

paradise

One great-grandmother told me during her GP consultation – “the fact that we have so many languages says something,I reckon. I’ve got Sri Lankan, Scottish, Irish, and five different Aboriginal tribes’ blood running through my veins, but no one knows or remembers anymore.”

*

To dichotomise the Yarrabah experience, it is beautiful and frustrating in equal parts.

Fresh out of second year, I felt as though I learned more in the two weeks of GP clinic, the odd ED procedure and community home visits than I did in the last two years put together. I added rheumatic fever, rheumatic heart disease (with triple valve replacement!), hepatitis B, pilonidal abscess, an expanding keloid scar and chronic tophaceous gout of the most debilitating kind to my limited base of urban Sydney clinical experience.

I saw more young children receive the excruciatingly painful Bicillin injection by the wincingly sympathetic hand of the Irish nurse, Mark, than I ever care to again. I looked over the shoulder of a renowned gastroenterologist-cum-general physician with a side-interest in cardiology as he ran 25 echocardiograms in a row on his monthly travelling cardiology clinic. I spent time with incredibly skilled GPs from Kenya, Adelaide, Scotland, Sydney and rural Western Australia, who, by some baffling twist of globalisation, all call Yarrabah home now.

The beauty of Yarrabah is this. It is an extraordinarily close-knit community where all 3000-odd members know exactly where every other person is at any given time, where they live, what car they drive. It is land that the locals take incredible pride in,

and it is beautiful. The people are friendly, welcoming and open. On a drive from Hospital Road down to the Mission you’ll see kids running around by the watering hole, a couple of semi-wild horses, more than few dogs napping in the middle of the road, and if you’re with a local, every face along the way will be familiar.

All it takes is for me to say “Hi, I’m up from Sydney” and I’m met with a “Gee! You’ve come a long way”, and there is another friendly face.

And yet, as I sit with one of the GPs and see probably the tenth kid under five with abscess-ridden, rotting teeth, I ask the doctor why kids so young have so many dental problems. Surely, even if the kids aren’t brushing their teeth, it can’t be normal for teeth to degenerate so quickly with fluoride-treated water. He responds with a wry smile.

“You haven’t been drinking Yarrabah water, have you?” he asks.“I had a cup yesterday – why?”

“It’s not drinking water!” he laughs.

If you stand on the western coast of Yarrabah, you can almost see Cairns, about 12 km across the other side, and where most people from Yarrabah do their weekly groceries. Yet, in a community this large, there is no safely drinkable tap-water. To stay hydrated, people drink soft drink, fruit juice and cordial. Considering that on the other end of the spectrum are extraordinarily high rates of diabetes, obesity and heart disease, the fundamental problem here is nothing short of ludicrous. How is it possible that the barrier to preventative healthcare in 21st century Australia, an hour’s drive from Cairns, is fluoride-treated, drinkable tap-water? I am floored.

yarrabah

paradise

The GP consult rooms, overlooked by the Murray River Ranges

Later, I ask why I never have reception in Yarrabah, even though there is a huge Telstra tower that looms near the mountains.

“Ah yes. Ages ago Telstra managed to rent land from Yarrabah to build a tower that services all of Cairns, without servicing Yarrabah itself. There isn’t really mobile reception here…” another doctor tells me. Without functional mobile reception, it is almost impossible to follow-up patients who might not (unsurprisingly) be glued to a landline at home.

These are Yarrabah’s frustrations – that the barriers to access and a standard of living most Australians would take for granted are ridiculously basic, barely a stone’s throw away from the fourth most popular tourism destination in Australia.

*

Of all the experiences I had in those two weeks, this is one that moved me most.

It’s a Thursday afternoon, my second last day of placement. A grandmother has come in with her 8-year-old grandson and prefers not to have me in the room during the consultation. I’m sitting outside the door which opens every 5 minutes as her peripatetic grandson wanders in and out of the consult room, disconsolately carrying a finger-marked iPad. He looks at me with neutral regard, ignoring my smiling “Hey!”and hands me the iPad.

“The volume isn’t working,” he informs me.

“How come?”

“There’s probably something wrong with it,” he replies, drolly. (Yep, I walked into that one). He kneels on the other chair as I fiddle with the mute and volume level. “You’re not very good at using iPads, are you?” he muses.

“ Nope.” I agree. He laughs. We give up on the iPad and I get out my phone instead. “Do you want to listen to my music?” I ask.

“What’s your favourite band?” he asks.

“At the moment, it’s The National. Have you heard of them?” He hasn’t, but he listens to I Need My Girl and Apartment Story anyway.

“Not bad. Not as good as Timberland though.”

I chuckle, and our tentative friendship rolls on. He scrolls through Bob Dylan, Talking Heads, Lilly Allen (“she sings funny”) and Beyonce (“why do you only have old songs?”) and we sit looking onto the little garden that glows an almost fluorescent green in the afternoon sun.

The door finally opens and his grandmother emerges slightly teary. “Thanks for keeping him busy,” the doctor smiles at me. As they leave, the boy winks a “seeya!” at me, and I wink back.

Later, on the daily drive across the Murray River Ranges back to Cairns, the GP tells me about the case. The boy’s grandmother had come in about her grandson, stressed to the point of absolute distress about her inability to curb his unruliness, his unwillingness toward self-preservation, and his continual determination to put himself in dangerous situations.

She says he has something called “Oppositional Defiance Disorder”. “Unfortunately, almost a hundred per cent of these kids end up in jail,” she adds. “Usually on a background of some kind of trauma or difficulty in their early childhood.”

She tells me he is living with his grandmother because his father is out of the picture, and his early life with his mother was dominated by violence and abuse at the hands of various people.

“His grandmother just can’t cope. He’s such a handful that she’s at the point of breaking down.”

I think about a little boy who was friendly, inquisitive, engaged and respectful toward me, someone who bore no significance to him. A boy who probably suffered from undiagnosed Post Traumatic Stress Disorder, whose mental health was unsupported, who was surrounded by people perhaps themselves unsupported. I can’t help thinking that there were so many points in this boy’s life where a little more support, someone caring, experienced and trustworthy to talk to, could have made a lot of difference. And I can’t help but question the therapeutic value of a diagnosis that seems destined to condemn an 8-year-old boy to hopelessness.

*

I am lucky enough to be returning to Yarrabah in only a couple of month’s time for the second of four two-week placements. While I take with me barely 4 months’ more clinical experience, it serves as a reminder that a medical education is as much a lesson in life as it is in science.

The Gurriny entrance on Hospital Road

Yarrabah Aboriginal Shire

On 3rd April I hesitantly attended an open invitation movie night hosted by ASPIRE (Armidale Students Promoting International Rights and Equality). The movie, a documentary film entitled Mary Meets Mohammad. Now why hesitantly I hear you ask? Well upon plugging the title into imdb I was kindly asked if I meant, “There’s Something About Mary.” It’s safe to say alarm bells were ringing. However against my better judgement I attended, and let me be the first to say I’m glad I did.

The film turned out to be a documentary following the changing attitudes and perceptions of a local Tasmanian community. A community that had suddenly found itself next to a newly opened asylum seeker detentions centre. The documentary centred on Mary, a local pensioner and devoted Christian who was opposed to both the opening of the centre and acceptance of asylum seekers. It followed her over the course of a year as her attitudes, preconceptions and opinions were challenged through her regular visits to the centre and friendship with Mohammad, a 26 year-old asylum seeker.

Overall the film was a beautiful blend of entertaining, educational and inspiring, and was to everyone’s surprise, quite funny. It debunked numerous myths and provided great insight into the issue of asylum seekers and mandatory detention. I found my own beliefs and ideals were challenged by the film and many of the Aspirites who hosted. The night contained all that was needed for a good time.

Good food, good conversation and great people. It’s now fair to say that I now find myself thinking I should go against my better judgement more often.

Arran Lemon, UNE

movie

night

aspire

induced

narcolepsy

lecture

induced

narcolepsyAnonymous, UNE

Since early 2013, First year Medical students at UNE have been crippled by the ongoing pandemic of lecture-Induced Narcolepsy (lIN). Previously studious, attentive and alert students have been struck down by lIN, being unable to keep their eyes open during even the most riveting of lecture presentations.

lIN remains idiopathic. Some have theorized that the aetiology is linked to the contentand presentation of lectures; that studentsare becoming “bored and sleepy” during the drawn-out hours of Monday lectures. The School of Rural Medicine has debunked this proposal, suggesting that lIN is instead the culmination of multiple factors; namely “the altitude, the microclimate of lecture theatre P1, the time of day, and the radiation emitted from iPad minis”.

lIN has caused a severe loss of productivity among medical students, with an estimated cost to NSW Health “4 times that of the white- coat initiative” – Prof. McKeown.

Although its aetiology remains a mystery, incidents of lIN seem to be centred arounda handful of students. Mr Howard Chan (henceforth referred to as “Patient Zero”), has been the victim of numerous attacks of lIN, with reports placing the first known

case of lIN during an Infection Control lecture by Dr Flynn. Several students around Patient Zero were also affected by lIN, with onset times varying from 5 to 45 minutes after the original incident. The students had no physical contact with Patient Zero prior to developing lIN, which, according to the students who exhibited apparent immunity for the lecture, indicates the possibility of airborne transmission.

Freshers are advised to guard themselves against lIN; maintain focus at all times. Vice-President External and resident Gunner Adelaide Pratt has advised “you should definitely stay awake in lectures because they’re soooooo important. It’s not like you have to research everything yourself anyway.” When further comment was sought; Ms Pratt was found to have succumb to lIN.

“At this point in time lIN is considered endemic to the UNE region and is not predicted to become an epidemic. Extensive research has identified that individuals are able to decrease their susceptibility to lIN by undergoing prophylactic caffeine treatment.”

– World Health Organization (WHO)

WHO estimates that 385000 women die annually during childbirth, with developing countries accounting for 99% of this statistic. On the 10th and 11th of May, ASPIRE tried to make a dent in these horrifying realities of global maternal health by organizing a Maternal Health Weekend. On a Saturday, we put together 800 birthing kits, to be sent to developing countries where they will facilitate safe and hygienic childbirth. Each kit contains basic equipment that will significantly reduce the risk of infection during childbirth, with things such as soap, twine (for tying up the umbilical cord) and gauze.

Thanks to the 50 students who came along, and a fantastic production line, we were able to put together the 800 kits in just over two hours (127 minutes to be exact)! This was followed by a delicious morning tea of baked goodies and a screening of the documentary “The Mountain Midwives of Vietnam”, where local women are trying to reduce infant and maternal mortality rates in regions that have rates ten times higher than their national average.

ZONTA Armidale, a prominent women’s health organization, and UNE SSAF were kind enough to help ASPIRE fund the event, and donations from the day went to both the Barbara May Foundation, also involved in developing sustainable maternal care in developing countries, and helping fund the Birthing Kit Morning Tea in 2015. The Sunday

Maternal Skills Day was also a great success, running stations in neonatal resuscitation, shoulder dystocia and postpartum haemorrhage where students were instructed on how to deal with these situations as well as being given the opportunity to perform maneuvers themselves on the mannequins.

We were very lucky to have Dr Abu-Asab (Obs/Gyn in Armidale), Dr O-Jo (GP specializing in Obs/Gyn in Narrabri) and fourth year students David Ferreira, Elizabeth Morrison and Yvette Etherden trained by Dr Cotterell, giving their time up to instruct on the day. Students hopefully, were given a greater appreciation of the difficulties of childbirth, even without the problems of hygiene and limited access to medical assistance that many women in developing countries have to face.It was overall, a very educational, productive and exciting weekend for everyone involved, we were able to use our own hands to make a contribution to solving global inequalities and look forward to another birthing kit assembly day in 2015.

Aspire, UNE

health

weekend

maternal

commission

on the

South Africa is a country of extremes. 13.8% of the population lives on less than US $1.25 per day, yet South Africa has the highest income disparity of any country in the world (as measured by the Gini coefficient of income distribution). This implies that income, life expectancy and access to healthcare have a huge gap between the wealthy and the poor.

During my 6-week elective placement, my fellow Phase 4 student Josh and I witnessed this first-hand. We were placed in the trauma unit of the main hospital in the Johannesburg CBD – Charlotte Maxeke Academic Hospital. Unlike Australia, there are both public and private: ambulances, paramedics and emergency departments in South Africa. Being placed in a public hospital trauma unit, we saw some the most disadvantaged and badly injured patients that Johannesburg had to offer.

During our first night shift, we saw three patients with gunshot wounds, multiple patients with stab wounds and one patient with a depressed skull fracture due to blunt trauma with a metal bar. According to the local staff, this was a “slightly busy night”. This set the precedent for the remainder of the placement where we encountered high volumes of trauma that were mainly attributed to violence and Motor Vehicle Accidents.

My most memorable case highlights the poor care some patients receive in Johannesburg and unfortunately; the following case was not surprising to any of the local doctors. On a Saturday afternoon after refusing to part with his wallet, a young man was stabbed in the face with a hunting knife. The wound was a 2cm vertical laceration

under his left eye. The patient went to his local clinic, where they sutured the wound and sent him home. He presented again on the Monday and Tuesday and on both days, was sent home with no further investigations. On Thursday, he began to have persistent epistaxis from his left nostril and attended his local emergency department. They imaged the skull and immediately referred the patient to our hospital.

I was asked to see the patient and review his images. After examining the patient, I confirmed the diagnosis from his local clinic- the problem was “all in his head” ...The knife blade was still lodged in his face! I was amazed that someone with 4cm of (palpable) knife blade in his face was not identified until day 5 after his initial injury. For our efforts in the trauma unit, the patient was sent home with paracetamol until he could attend the maxillo-facial clinic the following week.

If you are thinking of undertaking a trauma placement in South Africa, you will undoubtedly have an amazing, but confronting experience. You will see cases that are rarely seen in Australia (we saw a bedside thoracotomy within the first week). You will get amazing clinical experience and become confident in the management of trauma. We were lucky enough to attend the Early Management of Sever Trauma (EMST) course as observers and get some realistic looking makeup applied.

Being a country of extremes, you will see magnificent sights in your time off, but be exposed to terrible hardship while working in the hospital. I had an amazing time and have used the term ‘eye opening’ many times to describe my placement. I would highly recommend an elective trauma placement in South Africa.

Dan Stone, Wollongong

trauma in

jo-burg

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cappuccino

cowboy

Sai Ruthirakumar first left home when he moved to Broken Hill for his Phase 3 placement. Despite having to learn to cook for himself, he managed to grab the experience by the horns.

Four students were allocated the Broken Hill placement. The fun started before they arrived. A primitive communication system consisting of two walky talkies was arranged to alert the convoy of approaching hazards and coffee stops. The trip was nearly over when the man up front was too focused on the size of this roo that the trailing car nearly wiped out. After the near miss the convoy recovered in a coffee shop in Yass. It was when Sai’s order for a Hazelnut Skim Latte was met with a strange look that he realised he was no longer at home.

A huge party broke loose when Sai arrived in Broken Hill, coincidence? The four med students knew what to do. They joined in and had a great time with the 60 other students of various professions that they would share accommodation with for the next year. The accommodation was free and visually pleasing, not to mention it included wifi and mountain bikes to share. You share a kitchen; laundry and lounge with six others, and a bedroom all to yourself.

The town tour highlighted the strong rivalry between north and south, the courthouse and most important for med students, the best coffee shop. The ‘Caff’ is directly across the road from the hospital, ideal.

Dr Malcolm Moore is the director of clinical medicine and runs the University department of rural health for Sydney Uni. He was working in Nepal prior to this role and now works for the Royal Flying doctor Service (RFDS).

Sai got down to business in no time. Within a week he had started parallel consulting in his GP clinic. In the ED the medical students were as involved as they could be. They were first to see any patient except category 1’s. They would take a history, examine, order first line investigations and then consult with the doctor before commencing treatment. They had an autonomous role in the trauma settings under the direction of the trauma leader.

Sai realised that as a medical student or a doctor, one must be constantly aware of their own capabilities to ensure best patient outcomes. It is up to the individual to decide how well suited to a task they are as it is difficult for others to constantly assess anothers experience. This idea is a constant consideration for rural generalists. For example: A difficult labour may require a ceasarian, it may be in the patient’s best interests to have the surgery immediately by a GP who hasn’t performed the operation for 2 years than to arrange a retrieval team to take the patient to an obstetrician. The doctor has to assess what is best for the patient given travel time and the emotional cost of going away combined with their own ability to manage a patient.

The students go on tour with RFDS on several occasions. This is fun. Turning up to a really rural town with the team has a rock star appeal. Sai was shocked by the huge distances people travel

Buzz Tilley, Wollongong

broken

hill’s

cappuccino

cowboy

to the medical clinics. Should they need specialist attention the travel involved in arranging care in a regional centre (let alone Sydney or Adelaide) is massive.

There was no shortage of fun to be had in Broken Hill. With multitudes of sporting teams to partake, ukelele classes and weekly two up, one of our students even found love.

Combined with an excellent practical educational experience it was a great place to be for phase 3. Sai would encourage anyone to go Broken Hill. Seeing Rural generalists work from their side is very important whether you want to be a rural doctor or not. It may be a chance to go somewhere you would never otherwise go, just take Broken Hill’s Cappuccino Cowboy.

Trent Stapleton, Wollongong

roadtrip!

On a cold and brisk morning, 38 of the Year 1, Phase 1 Students embarked upon a week long Indigenous road trip for ICE. On day 1 we trekked out to Mudgee for our first overnight stop via Lithgow. By the time we reached Lithgow, the temperature had dropped 10 degrees and it was a balmy 8 degrees at noon on the Monday. Luckily, Sharon Gray (and self appointed Mother Hen of the trip) had prepared us well and we were well equipped with enough warm clothes to keep us going. In Mudgee we stopped and visited one of the 2 medical centres in town. This was a great example of a medical service that is well integrated into the community. It worked closely with the hospital and the local community health centre to deliver a wide range of services. In additon, we visited two of the UOW Phase 3 students who were more than happy to share their highlights

of Mudgee. Going on their reports, I think that many people in our year will be putting Mudgee high up the list when we select our Phase 3 rotations to experience all that Mudgee has to offer (including its great wine).

Day 2 saw us treck out to Walgett, where we headed to the local AMS (Aboriginal Medical Service) who enlightened us with some of the important history of the area. One of the interesting pieces of history we learned about Walgett was the 1965 Freedom Ride. This was a group of students from the University of Sydney who embarked upon a road trip around NSW to highlight the poor state of Aboriginal housing, health and education. When they reached Walgett, their bus was run off the road by locals who did not agree with what the students were doing. They even managed to film the vice president of the Walgett’s Returned Service League Club who stated that he would never allow an Aboriginal to become a member of his club (for more information see http:// indigenousrights.net.au/civil_rights/ freedom_ride_1965). This helped reinforce the importance of the close the gap campaign to reduce the health inequality difference amongst Indigenous and non-Indigenous Australians.

Day 3 saw us head to Brewarrina and help out at the local school where we donated and cooked a BBQ for the kids. We even got to participate an intense game of 15 v 15 basketball where we saw some future LeBron James in action. Day 4 saw us head out to Bourke where we visited a Medicare Local and saw how it integrated specialists from Sydney such as cardiologists,

psychologists and nephrologists. On the topic of nephrologist, we visited several Hospitals over the week whichall had a dialysis service.

The more rural we went, the more dialysis machines were being used. This was important for us to see as student doctors into the vast impact diabetes and kidney disease has within Indigenous communities. Scott also highlighted the impact of food security, some of the more remote towns would only get one delivery a week of fresh fruit and vegetables. And more than often this fresh food would all be gone within a couple of days.

Our final day in Dubbo saw us head to the Royal Flying Doctor Service (RFDS) and see the good work they do for rural communities. This trip was quite inspiring for many who have

had dreams of one day working for the RFDS. If anyone is keen to help support the Royal Flying Doctor Service we have created a UOW student team for the 9km run over the Sydney harbour bridge as part of the Sydney Running Festival. You can join the team to participate in the run or just donate and all proceeds go to the RFDS. Join at; http://bsrf2014.gofundraise.com.au/ page/KateHatzopoulos

A big thank you to Dr Karl and Scott Winch who came along on the roadtrip with us over the 5 days and shared their knowledge. Thanks to Sharon Gray who is the Indigenous Project Officer in the GSM who helped with the preparation of this article and organise the trip!

WUMMS, Wollongong

‘UNCONVENTIONAL’ was what we were promised, and that’s certainly what Adelaide delivered. On the 6th July, over 1800 medical students from around Australia and New Zealand converged on the Adelaide Convention Centre for a whirlwind week of inspiration, challenges and excitement beyond what anyone could have anticipated. Things kick-started with a bang (literally) at the Opening Ceremony with Hugh Jackman officially opening the week with an eruption of fireworks!

Our 17 Wollongong ‘Rangers’ wasted no time getting amongst the social events. Monday morning was when the real action started, and I found myself sitting next to Bob Brown in the front row of the massive auditorium. When he got up to speak he didn’t disappoint, being one of my favourites of the week. He shared stories of his days as a medical student and a young doctor, as well as lessons he’d learnt throughout his career (both medical and political). “Don’t ever believe there is no time” was one of his key messages, as he spoke about how each one of us can take action to affect positive change. He also stressed the importance of caring for our planet, since “its fate will be determined by us”.

Julian Burton (Bali Bombing survivor) was another crowd pleaser and had us all on our feet yelling and hugging. Not sure if that was all part of his original plan or whether we all looked under the weather from the social night beforehand! In fact, I remember a certain few absences that morning... Julian’s two main reminders were that; a) “life is about giving” and b) “it’s a choice”.

“Life is about giving...And I’m not talking about money, I’m talking about giving your love! Give that high five, give

a smile! ... It’s a choice. Chose to be grateful. Chose to be passionate. Chose to be giving.”

– Julian Burton, 2014

Vyon Sharma, a qualified doctor AND professional magician, was an incredibly entertaining speaker, but I won’t say too much as he will be speaking at our very own Inspiration Lecture later this month!

On Wednesday the academic program took a break to make time for the indoor Sports Day, which included the Emergency Medical Challenge! As Tim Peacock (Team Captain) described, the EMC was a “challenge devised to test the ability to follow the alphabet (ABCDE) and be able to back up after a night out. Team ‘Gong Massive’ killed the challenge without killing too many patients. Solid effort guys!” In all seriousness though, UOW should be super proud that the team came 4th overall out of 20 medical schools! They were up against teams comprised of mostly final year students with heaps more clinical experience!

At the start of the week when we were meeting new friends from around the country, we got a lot of weird looks when we said we were from Wollongong. Many didn’t know UOW had a med school, some didn’t know where Wollongong was, and some couldn’t even pronounce the name. But by Sports day we’d really made a name for ourselves and had quickly become

convention

-al

un-

popular as ‘the friendly kids in the lifesaving outfits’. With all the extra support our team went on to become overall runners up in the tug-of-war, and many of us promptly lost our voices the following day from all the cheering! The same couldn’t be said for the inaugural boat races, although the girls’ team at least made it into the quarter finals. Word on the street was that the Adelaide Fish (that’s how they drank) had been training for months.

Thursday and Friday we were back to the convention center for more fantastic speakers and workshops. Next time you think you can’t do something, just ask Karni Liddel what she thinks about that. Born with a muscle wasting disease her parents were told she wouldn’t live past 3 years of age, and that exercise is contraindicated in her condition. Palliative care was all the doctors could offer her. But despite all odds, she is now a 35 year old retired Paralympic swimmer with a gold medal under her belt and she says she has the positive attitude of her parents to thank for that.

“I like to think that in life we’re all dealt a deck of cards – and you have no control over what they are going to

be... The only thing we have control over in that deck of cards, is our attitude”

– Karni Liddel, 2014

She also had an important message for us as upcoming young doctors, “Hope is the most valuable thing you can give to a person”.

In between speakers throughout the week there was never a dull moment. There were always about 5 different workshops happening at the same time, and if you were quick enough you could learn to suture, take bloods, put on casts and hear from various organisations such as the RFDS and Médecins Sans Frontières. There was also free barista coffee and lounges if you were feeling worse for wear or just wanted to make new friends or try to piece together the happenings of the night before.

All in all though, it’s hard to describe the atmosphere at Convention. There’s something pretty unique about having 1800 like-minded, enthusiastic young doctors-to-be all in the same place at the same time. Although I’m sure everyone took away something different (including Influenza A and possibly mumps), I think we all left Adelaide feeling like we are a part of this buzzing community that is Medicine.convention

-al

Nikhil Autar, UWS

and a med

student

a cancer

patient

“The good news is you’re 17 and you have leukemia, but the bad news is you’re 17 and you have leukemia.”

That’s how I was told I had cancer.

It’s news thousands have to hear every day. And so I asked that one question all cancer patients dread.

“What are my chances?”

A man I’d met only 12 hours ago pulled down his glasses and sighed.

“10 - 20% chance that you’ll live beyond 5 years.”

I cried. For ages.

Everyone kept telling me not to... that I should keep my head up... that I could do it.

But how could they understand? I’d just been told I would probably not live to see 22!

I couldn’t stop asking myself WHY ME? I hadn’t done anything wrong to anyone. I was fit, at healthily and was doing well at school. For God’s sake, I was only 17! Wasn’t cancer for old people? Or those who smoked, or been exposed radiation or something?

I spent days clinging to that pillow in the same clothes and sheets, asking those questions.

But after a while, I started to hate that feeling. The deep, dark hole I’d dug myself into. The fear of what was to come. The wet pillows from all the crying.

And so I took a step back and looked at what had happened to me again - as if it had had all happened to someone else. It was then that I realised that I had the cancer now. No matter how much I wanted to, I couldn’t go back in time and change that.

And I realised that it was me - MY brain that was making me feel that way.

a cancer

patient

And I realised that going forward, I HAD A CHOICE.

I could either stay down and depressed and harm only myself.Or I could try to see what had happened to me in another, more positive way.

At that time, though, only days before chemotherapy, it wasn’t easy to see anything but the pain and tears to come...But that changed after I started thinking about others’ reactions to this sort of news and asking 1 simple question.

WHY

Why were they acting as if cancer was a death sentence? As if they were already goners?

Why were they getting down over something they couldn’t control?

Why were they fearing the chemotherapy when it was the thing that could cure them?

Why was I thinking like them?

From that point onwards, I realised, that I would always have a second way of looking at things. And that I could get to a point where I could see it if I kept asking myself, WHY.

My doctor’s diagnosis still loomed over me though... He was the one I trusted, the one who knew most about the disease and I couldn’t get past my horrible prognosis. His words mattered most.

And so I asked myself why, once more.

Why had I been seeing my diagnosis at such a young age as a curse, when in truth, it was a blessing?

So maybe the bad news was that I was seventeen and I had cancer. But the good news was, I was seventeen and I had cancer.

Being young and healthy meant I could take the hardest treatments possible and recover from them. I wouldn’t have to worry about a family or a job while going through treatment; hell - my family would be there every step along the way! And in the end, I could get back to living a normal life after all this was done.

And you know what? After five Rounds of chemotherapy, a fatal dose of radiation, a relapse and two bone marrow transplants - I’m almost there!

I’m not saying that you can cheat death by simply changing your, or someone else’s attitude. You can’t “think positive” your way out of everything...

But you will ALWAYS be able to choose how you view things. Because only YOU - YOUR MIND can decide if you’re happy or not. And once you realise that, looking at your challenges and fears in that second, more constructive way, won’t require “bravery”, “wisdom” or “strength”... taking that second path will be the only logical thing to do.

So if you’re thinking that what I did is extraordinary, if you’re thinking “I, in fact, most people, could never have done that...”what I want you to do is take a step back and ASK YOURSELF WHY.

Because all I did was 3 simple things.1. I took a step back and examined what I was doing from

another perspective; to take all those useless emotionsaway.

2. I asked WHY of all my doubts until3. I realised that going forward, I had the power to choose

how I viewed and took my life.

And that’s something anyone can do.

It won’t be easy to do that.

You’ll probably need to talk to someone to get to a point hwere you can do that.It will take time to make seeing your obstacles in a different way, a habit.

But I guarantee you that if you do all those things, that all your problems - whether they be medical, like mine, whether you’re struggling to achieve your dreams, or whether you be going through things like depression, will seem easier.

And this needn’t just make your life better... We medical students are in a fortunate position, where we can help people when they’re suffering the most. Like my doctor, your words and actions, every day, have the power to make the lives of your patients happier and healthier.

Sometimes all it takes is 1 helping hand, one open ear, to change someone’s perspective on life.

So if you find yourself, or those under your care, struggling with anything tough... take a step back... and ask yourselves WHY.And you’ll give yourself the best chance of being happy with life.

If you, or someone you love, ever need that other way of looking at things, or need someone to talk to - feel free to contact me and read about my challenges, physical and emotional on my blog at:

www.nikhilthegrizzlybear.blogspot.com.au

the

challenges

in medical

hx-taking

Stephanie Carlsson , UWS

the

challenges

in medical

hx-taking

Being bilingual has always been something I’m immensely proud of, even if my my mother-tongue is a little rusty. I excitedly look forward to the day when the consultant looks around, desperate and panicking, pleading “For the love of all things holy, does anyone speak Swedish?!”.

Considering I’m in Western Sydney, however, that day won’t come anytime soon. A recent placement at Bankstown Hospital was a reminder of just how diverse our community is; 2011 Census data found that 34% of people in the area come from a Non-English Speaking Background (NESB). This I found was a particular hurdle with older patients, who often spoke little to no English (and unfortunately no Swedish either).

Trying to get a history out of a patient who doesn’t speak English can be a bit of a challenge, to put it mildly. I’m sure watching a fellow medical student struggle would make for a good laugh (think Charades...) however it might not the best for extracting pertinent information from someone who is about to undergo major surgery.

If you’re lucky, you’ll be like me and have a Fellow who speaks Farsi, a Registrar fluent in both Cantonese and Mandarin plus an Intern who knows Vietnamese. Such a mix meant we were pretty much set, it was all smooth sailing...until the lovely old Spanish lady turned up. I like to say I’m learning Spanish, which I am, but at most I can introduce myself and point at body parts asking “Dolor?”.

It’s times like these that you need to pull in a bit of outside help. In emergency situations you may have to use family members to translate, however you should aim to use a professional interpreter service whenever possible to maintain confidentiality and ensure

both you and the patient are able to express yourselves without censor. Public hospitals provide a Healthcare Interpreter Service, either in person or via telephone. As non-verbal body language is an important part of communication, it is encouraged to have an interpreter attend in person, but a little thing called ‘the real world’ can sometimes preclude that; in times like these a telephone interpreter is definitely better than Charades!

When conversing with a patient via an interpreter it is important to remember that you’re still talking with the patient, not the interpreter. Make sure to avoid using slang or cracking jokes as, however hilarious they may be in English, they may not translate well. In order to facilitate the best possible conversation, allow the interpreter to speak at the end of each one of your sentences; this will help prevent any information being accidentally left out and gives the interpreter enough to work with before constructing their translation.

If you’re going to be seeing the patient regularly, or see many patients speaking that particular language, maybe try learning a few words yourself; a basic greeting, however poorly pronounced, will likely be much appreciated by both your patient and their family (and may even result in them piling yummy South American treats into your arms...mmm, Alfajores).

Lastly, keep in mind that the language barrier may not be the only difference between you and your patient; they likely come from a culture vastly different from your own and it is worth taking that into account when communicating with them. Keep mindful of any possible cultural differences and be as accommodating as possible; being in hospital is intimidating enough for those who know the language and likely infinitely worse for those who don’t.

Rachael Zuzek, Newcastle

do not

burn

Burnout. Most of us have experienced it before. And considering that the end of semester is fast approaching, burnout seems to be hot on everyone’s toes.

So what exactly is burnout? And more importantly, how can we deal with it?

Burnout is basically a state of both mental and physical exhaustion related to work, in our cases, the perils of studying medicine. It is quite common among students, with systematic reviews from the US estimating that over 50% of med students will be affected by burnout at some stage during their degree. If not recognised and addressed, can lead to significant consequences, especially if it continues after graduation.

Medicine is a demanding course and profession. Whilst it has been traditionally held that burnout occurs more frequently as doctors progress through their careers, it is now being more readily recognised that burnout occurs early in the medical journey. Considering the shift in university medical courses from didactic-based learning to those focused on self-directed learning and patient-centred care, this places a greater amount of stress and expectations on students. Attention needs to paid to the experience of burnout as this could lead to decreased personal health and wellbeing of students and ultimately having an indirect impact on the quality of patient care.

Burnout incorporates three main characteristics: a decreased sense of accomplishment, emotional exhausation and

depersonalisation. [For those who are interested, the gold standard for measuring burnout is the Maslach Burnout Inventory (MBI)].

Factors that increase the likelihood of burnout include:• Experiencing a major illness• Low perceived levels of support from faculty staff• Exposure to cynical residents and doctors• Extended hours spent at hospital• Personality factorsNB: Interestingly, a recent Australian study found that emotional exhaustion was significantly more prevalent in single students compared to students in relationships

Signs to watch out for:• Poor concentration• Insomnia• Poor productivity and lack of motivation• Guilt• Depression• Denial

Which may lead to:• Frustration• Feelings of isolation• Irritability• Indecision• Avoidance

How to deal with burnout:• Be self-aware: recognise how stress manifests in you and

look out for the signs• Talk to people: having a strong support network to help you

in times of stress can definitely be helpful• Prioritise your time: recognise limitations and be realistic

about goal setting• Keep a good study-life-work balance: you all know this one,

but it is important to remember that medicine is not yourwhole life

• Look after your own health: sleep well, eat well, fit in somephysical activity, socialise

• Don’t be too hard on yourself

Potential interventions• Programs to promote student well-being and self-care• Education about preventing and reducing burnout• Structured mentoring programs• Social support• Relaxation• Physical exercise

With exams coming up soon make sure that you look after yourself and other students to prevent burnout and keep your cool!

Reference:2013, W. IsHak et al., ‘Burnout in medical students: a systematic review’, The Clinical Teacher, John Wiley & Sons Ltd, 10: 242-245

Joshua Darlow, Newcastle

barrier

exams

national

The National Barrier Exam has been floated regularly from around 1996, as proposed, it would be a common exam taken by all students at Australian medical schools sometime in their final year. Passing the exam would be a pre-requisite to practice as an intern.

The current system of Australian Medical EducationCurrently, the Australian Medical Council assesses and accredits each medical school against a set of common standards and certifies its graduates as competent interns (or not).

Currently, the AMC accredits 18 Australian medical schools programs , offering M.D., MBBS, BMBS, B. Med (whaddup), and MChD programs. Each school has differing emphases, but all are assumed to create desirable graduates as defined by the AMC.

Why Change?

Why change this process?

PRESSURE FOR A NBE IS COMING FROM THREE SOURCES:

(i) Intern PlacesAs described many times in this august journal, the traditional guarantee of an intern place for all domestic students may end. This raises the question of who should miss out. The general answer to this is ‘the least deserving’ . If your definition of ‘the least deserving’ is those people who performed the worst at medical school, then a common examination of medical school knowledge looks like a good bet for prioritizing intern spots.

(ii) Medical MishapsEach of the states, but especially Queensland , has suffered from some very public mishaps including the hiring of unregistered interns, fraud, negligence, and manslaughter. Although very few of these events involve junior doctors, there is a perceived need to reassure the public with a new, national layer of accreditation aimed at guaranteeing minimum safety standards (as distinct from ranking graduates).

(iii) StandardisationThe Productivity Commission has been pushing to reduce costs in medical education, and to create a national market for interns and for health professionals. A National Barrier Exam would allow the comparison of graduates in a national market. A national exam would also facilitate international recognition of Australian graduates, and the entrance of overseas-trained interns and residents.

WOULD A NATIONAL BARRIER EXAM WORK?

If we do decide to rank graduates based on a NBE, would it work? Would a test serve as an accurate predictor of ‘being a good doctor’? Statistically, the answer is ‘yes’: meta-analysis does find correlations between performance on standardized tests (predominantly the American USMLE examination) and measures of future clinical performance. However, the same meta-analysis finds NBE-like tests are poorer predictors than OSCE marks, GPAs or a good old letter from your Dean.

These results rather undercut the arguments for an exam as a means for ranking interns.

As well as an NBE’s relative ineffectiveness in predicting clinical performance, an exam would likely lead to changes in the medical school ecosystem. Currently, the dogma is that one medical school education is as good as another. The absence of any statistics proving otherwise has allowed medical schools to develop their own flavours and areas of innovation. A national barrier exam, however weakly linked with clinical reality, would result in a definitive ‘best’ and ‘worst’ medical school. The likely result: medical schools increasingly teaching to the test (some U.S. medical schools explicitly structure their curricula around the USMLE ) and intense competition within medical schools.

ALTERNATIVES

These concerns appear to have dampened earlier enthusiasm for a national exam in favour of increased collaboration between medical schools. Medical schools are increasingly standardizing their assessment whilst preserving the options for each school to retain its own teaching priorities such as indigenous health or tropical medicine. Newcastle has experimented with the Australian Medical Schools Assessment Collaboration, where twelve medical schools shared fifty anatomy and physiology exam questions, with the aim of benchmarking and sharing scarce assessment expertise.

Indeed, Medical Deans Australia handed down a report in March explicitly aimed at increasing medical school collaboration and providing an alternative to a National Licensing Exam.

So, what should we do? In the current environment of internships for all, and a public that trusts the current system, extensive effort to rank medical students in the absence of a good predictive metric seems folly. Closer medical school collaboration seems to have the potential to increase standardization and efficiency, satisfying the Productivity Commission’s concerns. My personal solution, should the intern crisis come upon us, is to select for lucky interns by randomly binning excess applications – after all, who wants an unlucky intern?

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for

anythingAnonymous, Newcastle

You walk into the foyer of John Hunter Hospital, ID badge emblazoned on your chest; the badge that reminds all allied health and nursing students that you are a medical student. It’s your first time on the wards, and you know you can take a history of the presenting complaint like the best of them. SOCRATES is your philosophy.

You’re a medical student, and you’re dressed for the part.You’re looking for “orthopaedics” - you know it’s on level 1. A fitting place to start your career as a doctor, orthopaedics is your passion . . . it’s either that or neurosurgery.

A Littman Cardiology III hangs around your neck at all times. Consultants will ask you to auscultate at the drop of a hat, and everyone must know that you’re going to be a doctor.

You’ve picked out your favourite tie; navy blue silk with a subtle paisley-patterned stitch. Not so conservative that it screams “accountant”, and not so loud that it shouts “high school music teacher”. It says: doctor.

Infection hazard be damned, that’s what tie clips were invented for.

Your blazer is newly pressed; pure wool. Even the most stylish neurologist will be green with envy. You’re a man of power – a giver a life – and you’re dressed to show it. You know it. You’re a medical student.

You arrive on the ward: orthopaedics. There is one girl here you recognise – the blonde from PBL. She looks different to how you remember.

The difference is cleavage. Definitely cleavage.

The top three, maybe four, buttons of her blouse are undone. She’s wearing a fragrance that blows you off your feet, and while you’re off your feet you notice her stiletto heels. You wonder if they are the same ones she wore to First Incision. She’s wearing a Littman Classic II – it’s burgundy. A colour that compliments her outfit nicely, but an inferior instrument to your own.

“I think we’re early,” she says. “Should we ask the nurses to ring the doctor or should we wait?”

“My dear, we are medical students” you retort. “We do not ask. We do not wait. We do.”

You see tears beginning to grow in her eyes. You wonder if you have said something to offend but then you realise they are tears of pride. After years of oppression and the finest tuition her parents could find, she has made it. After months of UMAT preparation and interview training, she has made it.

You do it; you take initiative and step forward into the ward. As you walk past the nurses station you hear what might be laughter, and you’re not sure why. But it doesn’t matter. You’re dressed for anything.

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RUBIX 2014