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AMSA Rural Health Magazine Issue 1, 2016Contents 2.Letter from the Editor3.Report from the Co-Chairs5.AMSA National Convention7.Keeping doctors in the bush9.Out in the open27. Groote Eylandt - The Pinnacle of Remote Locations 29. JFPP:West Wyalong 30. Inequality and mangoes in the Wild West: an elective perspective1 0. It's time to pay more attention to international medical students33. Nine valuable lessons in nine hours1 3. Acknowledging the ‘elephant in the room’: Why we need to work with, not against, complementary and alternative medicine38. Rural conferences to watch out for1 5. Fracture healing in a new climate 1 8. The importance of access and equity in the treatment of eating disorders36. A Rural adventure in Canada40. Rebuilding Des Bowen’s Healing Place – a ROUNDS Initiative 44. The eyes have it 45. The Alliance welcomes the new Frontier!20. AMSARural Elective Bursary winners, 201 5 24. Honey Ant Dreaming 25. From the city to the desert; Remote Health Placement in Central Australia1Letter from the Editor Bhagya Mudunna It is with great pleasure that the AMSA Rural Health team introduce our first rural health magazine FRONTIER! FRONTIER! aims to bring together medical students throughout regional Australia as well as students who are interested in rural health. As you may be aware, there have been many heavily debated issues highlighted in the press this year such as the new proposed rural medical school, lack of rural specialty training opportunities and funding for rural hospitals. AMSA Rural Health and many of our members have been actively advocating for rural students so that their experiences and learning can be improved. This magazine provides all our budding writers a platform to voice their opinions on these issues and other topics that concern healthcare in rural Australia. FRONTIER! also hopes to bring the large community of Australian rural medical students together and allow them to share memorable rural placement experiences such as the John Flynn Placement Program and rural electives. It is remarkable to see how much we learn from short placements like these in remote locations with very few resources. AMSA's 2015 Rural Elective Bursary winners are also featured with an account of their experiences in rural Australia. I would like to thank the Publications Subcommittee for all their tireless efforts in sourcing and editing articles, the AMSA Rural Health General Committee and the Excecutive Committee for their continued support. A special thanks should also go to Grace Ng for designing the logo for Frontier! and the front cover. And a very big thank you must go to all our writers and contributors for the excellent quality of the submissions, and for bearing with us while we edited their articles and put this magazine together. You have made the first edition of FRONTIER! very exciting. On behalf of AMSA Rural Health, we hope you enjoy our magazine. If you have any queries or comments, please email me at:
[email protected] Here is to many more issues of FRONTIER! Bhagya Mudunna2Report from the CoÂChairs Skye Kinder and Sophie Alpen AMSA Rural Health came from humble beginnings in 2015, with little more than the passion and ambition of a few. Experiencing exponential growth in the two years since its creation, AMSA Rural Health has continued to connect, inform, and represent rural-background students, rural clinical school students, and students interested in rural health. Our structure in 2016 consists of a 12-person Committee and two Subcommittee teams, one of which is the Publications team responsible for the creation of this first edition of FRONTIER! At the time of writing we have also begun the exciting process of electing new faces to our 2017 Committee, and we can’t wait to welcome them on board. Due to popular demand from you, our members, this year we have launched an AMSA Rural Health newsletter that provides updates on our all our activities each and every month. Our newsletter will serve as your one-stop rural health shop between FRONTIER! editions, and we would encourage you to subscribe and send in your events, activities and advocacy. We are pleased to see so many of our activities reflected in these pages, including reports from our 2015 Rural Elective Bursary winners. Our Rural Elective Bursary has grown to be a huge success, with a 350% increase in applications from previous years. In 2015 the Bursary awarded $1000 worth of funding to support AMSA members to undertake a rural elective, and in 2016 we doubled this to $2000. This is one of the only forms of elective financial support that is open to both domestic and international students, and we are proud to provide rural opportunities to our international student members, we hear you. Many of our members have also contributed opinion editorials and other advocacy pieces, which we feel embody the true spirit of AMSA Rural Health. Our Committee works tirelessly to advocate on a variety of rural health issues, and we hope to empower our members to contribute to these discussions. Much of our advocacy this year has focussed on regional and rural vocational training with our Committee developing the Doctors For Rural Communities proposal to this end.3We championed this proposal in visits to Parliament and received significant media coverage, coordinating a social media campaign as well (can anyone say #RuralDocsNow?). AMSA Rural Health continues to raise other items under rural advocacy such as a reduction in the BMP return of service, flexibility in the MRBS contract, and scholarship support for rural-background students. Finally, this year we are preparing to hold our first national event known as the Rural Health Colloquium. This event will consist of plenaries, panel debates and workshops that allow delegates to upskill and become engaged in AMSA activities in rural health. It will also be the first time in two years that those who are engaged with AMSA Rural Health will physically be in the same room. While RHC16 won’t feature in this edition of FRONTIER!, we can’t wait to see it in the next one. A big thank you to Bhagya and her Publications Team who put in solid hours to deliver such a phenomenal magazine which we hope will inspire students to seek rural experiences and be treasured at rural campuses. Our address would also not be complete if we failed to acknowledge the contributions of our AMSA members to this edition. From opinion pieces, to reflections, to reports, every contributor played an important role in bringing this edition of FRONTIER! to life. As outgoing Co-Chairs we would like to take a moment to thank all of the AMSA members who have supported us in 2016, and we know that there are only bigger and better things to come for our next FRONTIER! in 2017 and beyond.Skye KinderSophie Alpen4AMSA National Convention, Townsville 2016 Satyen Hargovan, Sajid Chowdhury, Sophie Manoy, Annabelle Chalk and Isabel Guthridge on behalf of the Townsville 2016 Convention Team Between the 2nd-9th of July, 2016 our team was thrilled to host the 57th Annual AMSA National Convention in Townsville, Queensland. This was the first time in AMSA’s history that its premier event had been held in a rural/regional location – a fact that our Convention team is proud of, and actively embraced. As one of this nation’s fastest growing regions, Townsville is a bustling cultural centre where cutting edge metropolitan living meets an idyllic tropical lifestyle. Its ample nightlife, restaurants, bars and world-class entertainment precincts provide the perfect contrast to the regions pristine beaches, warm waters and lush rainforest. Home to James Cook University, delegates got to experience a taste of socially accountable medicine with a particularly strong focus on rural/remote medicine and lifestyle. Isabel Guthridge and Annabelle Chalk, our fantastic Academic Convenors found that “Convention was one of the most special weeks of our lives! We always knew that we wanted our academic program to have a rural and remote health focus, with a tropical twist. We dedicated an entire academic day to ‘Bring Back the Bush’. With plenaries from Prof Richard Murray on social accountability and the maldistribution of doctors, to Dr Damien Brown on the similarities and differences between his work in Tennant Creek and his work with MSF in South Sudan. We were especially lucky to have Jenna and Mitch contact us from AMSA Rural Health with a proposal to run a panel session on ‘Bush-ing the Limits’. The session was a total hit and included rural doctors from around Australia discussing everything from rural medical schools and bonded medical places, to sending overseas-trained doctors to rural areas, to raising a family in remote Australia. But it wasn’t all about lectures! We tried to pack the day with as many skills as possiblefrom airway management, to skin flaps and suturing, to hands on with hearts, toads and venoms. It wasn’t just one day of rural medicine though, we really tried to keep a regional focus running throughout the week- with a majority of our speakers coming from5Townsville, Cairns or up on the Cape. As the week wrapped up, we felt like we’d achieved our goal; to shake up the Southerners and show them that rural health is fun and fulfilling, and to inspire the development of 1000 new rural generalists (one can live in hope)”. Our Deputy Co-convenor Sophie Manoy, born and raised in Far North Queensland was “thrilled that Convention was held in a regional location this year! It gave us the opportunity to highlight what is great about holding an event outside of a big city and we were able to feature local speakers who are experts in rural health such as Professor Richard Murray and Professor Tarun Sen Gupta. It was heartening to see students engaged and interested in rural health as they asked questions and challenged our speakers. Additionally, Elise Buisson, our lovely AMSA President, was able to speak on the merits of rural health to open our Convention”. Our other Deputy Co-convenor Sajid Chowdhury was glad to see that “Townsville shines!!! It provides this intersection that we do not really see elsewhere in the country. Geographically, politically, culturally and economically there is juxtaposition between the old and the new, the well off and the under-served, rural and urban life. Convention we hope was the spark that ignites the passion for all our delegates. As doctors we are very fortunate to have a myriad of ways of helping people in life. Many of us decide to make a change in the big centres as specialists and some of us even try to make larger change and will get into politics, but we are losing the value of the rural country doc who can do everything and anything. The doctor who is at the GP clinic in the morning resuscitating a patient in ED in the afternoon and delivering a baby at night. Delegates definitely found their moment in Townsville 2016, we can only hope that moment is the start of 1000 new rural generalists who want to explore and change the world, one country town at a time”. Myself, as someone who was born and raised a city-slicker in Sydney city, I had never even heard of Townsville before I made the move to JCU. Now, Townsville holds a special place in my heart. Whilst somewhat different to the big cities, it is just as good in its own unique way if one is open-minded and ready to embrace it. The fantastic lifestyle, warm community vibe, genuine people and stunning scenery you find in rural/remote areas sells itself. It was fantastic to see the QLD medical student fraternity rally around our local event and help out. There have already been many new friendships made, great memories created, vital skills learned and leaders that have emerged. This will bode well for the future of healthcare in rural Australia. It was a privilege to be able to welcome guests to my adopted home and showcase our slice of paradise. I hope delegates enjoyed it - they are welcome back at any time.6Keeping doctors in the bush Morgan Jones Many doctors who want to live and work rurally cannot due to the structure of the training system we have here in Australia. The majority of medical training (apart from general practice) is metro-centric which forces the hand of young doctors with rural aspiration to relocate to the city when it comes time in their training. In the face of poorer health outcomes for rural communities compared to their metropolitan counterparts, this is baffling. Latrobe and Charles Sturt Universities are desperately pushing for their $43 million ‘Murray Darling Medical School’, despite a plethora of evidence to suggest it will not solve any of Australia’s medical workforce maldistribution. We have seen a drastic increase in the number of medical students - an increase of 150% since 2004 - however there has not been a commensurate increase in vocational training places to produce fully qualified doctors. In order to become a specialist, such as an emergency physician, surgeon or general practitioner, you need to complete 5-10 years of additional training once you graduate from university, but there are now proportionally fewer opportunities and places within training programmes than ever before. In real terms, this means fewer doctors can complete training to become fully-qualified specialists. There is an emerging mismatch between the number of domestic medical graduates and vocational training opportunities, which will extend to a shortfall of over 5000 places by72030. This will only be exacerbated by the addition of the Liberal government’s new Curtin University Medical School, as well as the many other medical school proposals currently on the table for funding. A lack of training places is a concern for everyone, but will most significantly affect the many Australians who live outside of major metropolitan centres. Approximately 31% of the Australian population live in regional, rural or remote areas but only 14.6% of practicing surgeons live in these areas and this percentage is even lower for most other medical specialists. The success of Government programs that deliver positive experiences to students who rotate through rural areas has been well noted. As students become doctors in training it is important such experience and opportunities are continued so the end goal of boosting the rural health workforce is achieved. It is my hope that the investments in the rural training pathway through “Building a Health Workforce for Rural Australia” will ensure that doctors in training who wish to undertake their longerterm vocational training in rural areas are able to. It is paramount that doctors in training can be based rurally to continue connections to rural communities. Doctors may currently have an opportunity to visit a regional or rural area for around six months during their training, but they will always be based at a metropolitan centre.This means that training specialists can never be based rurally or regionally for all of their 5-10 years of training outlined above. By the time doctors become fully-qualified specialists most will be into their thirties and beyond, with partners and families who cannot simply uproot their lives to move. The recruitment and retention challenges in rural and regional areas mean that it is crucial that we foster and develop pathways to fill workforce gaps. This is a complex issue that at its core is being exacerbated by a lack of supportive training infrastructure. It is important to consider past initiatives that have failed when assessing whether new policy will be successful, or whether it is simply political point scoring - something we see all too often in the health sector. A number of rural incentives and programs for trainees in the past have not worked, therefore it is imperative that the government and colleges adopt an evidence-based approach. The Royal Australasian College of Surgeons themselves agree that there is a shortage of appropriate post fellowship training opportunities in generalist practice as would be appropriate for rural and regional surgeons, however it remains to be seen the direct action the college is taking to counter this.At this stage, it seems unlikely that the government will engage in any legitimate discussion around directing colleges to expand rural training programs. This issue will also require leadership from the colleges, who themselves can do more to correct this ever increasing imbalance. For the colleges, along with the government, the primary focus should be in meeting population needs for this part of our country that is too often neglected. It is crucial that the government works towards a targeted program to facilitate the medical workforce to train in regional and rural areas. There needs to be a concerted focus on the expansion and development of vocational training places for doctors in rural and regional areas, because the desire to train and work rurally as a doctor is already present. A new medical school will clearly not address this, and will only create more medical students, not more rural doctors. No person’s health outcomes should be determined by their postcode, so with all this considered, why are we sending our country doctors to the city? Morgan is a third year medical student at the University of Notre Dame Australia, and a Committee member of AMSA Rural Health.Knowing that the colleges themselves have failed at recruiting rural doctors, it is concerning that the government is not engaging specialty colleges to change base training regionally.8Out in the open Asiel Adan Lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) individuals are every nook and cranny in Australia, no matter how isolated, small or remote the community may seem. So, whether you have done a rural placement or are considering rural practice, chances are you'll come across LGBTI individuals no matter where you’ll be practicing medicine. Rural healthcare settings need to be safe spaces for people to come out. Many LGBTIQ people report either experiencing outright discrimination or having to educate their doctor about their healthcare needs. While in metropolitan centres, LGBTIQ people can go to other healthcare services if they have a negative experience, in regional, rural and remote settings, they might not have that luxury. This is a real barrier to primary healthcare and worsens clinical outcomes for LGBTIQ people. For LGBTIQ young people in rural places, a supportive environment is vital. Isolation, lack of community engagement and poor social access often lead to decreased mental health outcomes for LGBTIQ young people compared to people in metropolitan regions. All it takes is five supportive individuals to change the outlook for LGBTIQ young people. With less than five supportive individuals in their lives, LGBTIQ young people are more likely to internalise homophobia and have a destructive notion of self, leading to depression, anxiety and selfharm. On the other hand, with five or more supportive individuals in their lives, LGBTIQ young people are more likely to be accepting of themselves, build resilience and avoid internalising homophobic abuse. A friendly GP clinic could make the biggest difference in supporting young LGBTIQ people, connecting them with wider LGBTIQ community groups and resources. Creating safe and inclusive spaces can sometimes be tricky- we have to be able to give people the opportunity to come out without dragging them out of the closet. Practically, this translates to small things in day to day clinical practice. This could range from ensuring admission forms acknowledge transgender and gender diverse individuals, which is best done by simply leaving a blank line when asking for gender. Similarly, there could be a small rainbow flag somewhere or a poster
