Tuesday, 2 December 2014

New model to ease rural doctor shortages

An innovative model designed by two Monash School of Rural Health (SRH) researchers has underpinned major changes initiated by the Australian Government to ease doctor shortages in rural and remote communities.

The Australian Government recently announced an overhaul of its workforce classification systems as part of an effort to allocate retention grants more equitably, based on what rural doctors do and the different contexts in which they practice.

The new scheme, known as the ‘Modified Monash Model’, is the result of research undertaken by Emeritus Professor John Humphreys and Dr Matthew McGrail, both Chief Investigators of the Centre of Research Excellence in Rural and Remote Primary Health Care at Monash University School of Rural Health.

Federal Assistant Health Minister Fiona Nash has facilitated the changes, working closely with doctors and residents of regional, rural and remote communities. She described the existing system as “outdated” and in need of “a complete overhaul”.

She said the current ASGC-RA scheme held back progress in encouraging doctors to work outside big cities. “We need to get doctors to where they are needed most with the right doctor, with the right skills, in the right place,” she added.

Professor Humphreys described the existing basis on which retention grants are currently allocated, set up in the 1990s, as “seriously flawed”, a claim supported by Senator Nash.

“In north-west Victoria, for example, doctors practising in small towns such as Elmore are eligible for the same amount as doctors in Bendigo,” he said. “This is clearly quite inequitable, something about which the Rural Doctors Association in particular is very concerned.”

Professor Humphreys and Dr McGrail have been undertaking research on issues of access and equity in primary health care in rural areas for many years. Professor Humphreys trained as a geographer, moving to the Monash SRH in 2000, while Dr McGrail has a strong background in statistics, specialising in mathematics.

“The previous scheme was not evidence-based so it has been difficult for the Australia Government to adjust anomalies,” Professor Humphreys said. “Our research focuses specifically on medical workforce retention. If the government is prepared to offer incentives to keep doctors practising in rural and remote areas, then it is vitally important to allocate them equitably.”

Both he and Dr McGrail work with academics from the University of Melbourne in the Medicine in Australia: Balancing Employment and Life (MABEL) Project – Australia’s national longitudinal survey of doctors. Annual data from the project formed the basis for creating an alternative classification for rural doctors.
MABEL research explores factors such as working hours, specialties and life influences including the importance of employment for partners and children’s education.

The survey data were melded with geographic data across rural and remote areas of Australia.
“This proposed alternative scheme was shown to be much fairer and more statistically significant in terms of differentiating between doctors doing different activities in different contexts,” Professor Humphreys said.
The two researchers made a submission to a Senate Inquiry on Rural Medical Workforce issues in 2012. Since then, rural doctor organisations have supported and actively promoted the alternative model.

The final report of the Review of Australian Government Health Workforce Programs (the Mason Review), publicly released on 24 May 2013, recommended the Modified Monash Model be adopted.

Professor Humphreys said the government now planned to ‘fine tune’ some modifications to the model. Senator Nash is establishing an “expert panel”, to oversee and recommend changes by the end of the year.
“The real motivation for us is is to maximise access to quality medical and health care, no matter where people live,” Professor Humphreys said. “If they are given good life chances, then people have better health outcomes.”

Background
The current Australian Government systems in place to encourage doctors to work outside big cities based on the District of Workforce Shortage (DWS) and the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) systems.

According to Federal Assistant Minister for Health, Fiona Nash, concerns about the DWS have been expressed by both doctors and communities. They told her DWS relied on “outdated population data and is not accurately reflecting the workforce needs in towns that have experienced recent population growth”.

Senator Nash said doctors and communities also said the ASGC-RA was not working for rural Australia.
“It is creating perverse incentives for doctors to move to large, coastal towns and does not recognise the challenges of recruiting doctors to small rural town,” she added.




Monday, 6 October 2014

Indigenous health focus



It’s a long way from Bangalore in India to Gippsland but Dr Anton Isaacs has identified some synergies.

His work in public health in India helped improve the lives of many disadvantaged people and the same is happening in Gippsland’s Indigenous community.

Dr Isaacs, a qualified medical practitioner who lives in Warragul with his wife and two children, has worked with the Monash University Department of Rural and Indigenous Health (MUDRIH) in Moe for seven years.

A researcher and lecturer, he has been awarded the 2014 Medicine, Nursing and Healthy Sciences Faculty ECR (Early Career Researchers) Publication Prize for Social and Educational Research. His publication was titled “Help seeking by Aboriginal men who are mentally unwell: A pilot study”.
As part of his PhD research, Dr Isaacs developed a Koori men’s health day. The outcome has seen four Gippsland Koori men secure funding for, and now run, that pilot program, started by Dr Isaacs with the help of colleagues and the local Koori community.

“When we finished implementing it, the men took over which is the outcome I wanted,” he said.  “I would like to see it run monthly around Gippsland rather than two-monthly.”

Dr Anton Isaacs and five men from the Koori Men's Health Day team
Team work: Dr Anton Isaacs (back left) from MUDRIH in Moe with members of the Gippsland Koori Men’s Health team (from left) Tony Carson, Cliffy Wandin, Berwyn Lampitt (LRH) and Paul Cruickshank (LRH) with front, Rex Solomon

He was supported in his efforts by the Latrobe Regional Hospital mental health service, mental health nurse Berwyn Lampitt and the four Koori men – Laurie Marks, Cliffy Wandin, Rex Solomon and Tony Carson.

He said building trust in the Indigenous community was the key driver to success. A program for men was chosen because of the cultural difficulties in working with women too.

“My colleague Hilton Gruis, a community facilitator, has worked closely with the local Indigenous community and introduced me,” he added. “We identified three people as cultural consultants who in turn introduced me to other people within the community. Once you win trust, there are few issues with people coming forward. I have made many friends within the community which I value.”

Dr Isaacs would like to see every Aboriginal organisation run a men’s mental health program, similar to the local one which he believes is making a difference.

His work in Indigenous mental health has won national recognition. The Victorian Government asked him to evaluate its Aboriginal youth suicide prevention program and the West Australian Government has now asked for his help with its suicide prevention program which includes Aboriginal health.

He has received a $50,000 grant from Beyond Blue to conduct more research into mental health.
Dr Isaacs’ interest is developing services for niche areas in the health sector, especially in communities which are disadvantaged and under-serviced.

“There are two aspects to my work; designing the service then getting the people to come and use it,” he added.

He intends continuing to work in Aboriginal health. “When you work together you get the real success. That's my big hobby horse...get Aboriginal people and mainstream people working together and you get the best outcomes.”

From Bangalore to Gippsland…

Anton Isaacs wanted to be a surgeon from the time he was a young child.

“I was always very good with my hands and my lecturers (at medical school) told me I would make a great surgeon,” he recalled. “It’s all I ever wanted to do.”
That was in Bangalore, a bustling city of seven million people in India. A long way from Gippsland where the Dr Isaacs is now based; living in Warragul and working in Moe at the MonashUniversity Department of Indigenous and Rural Health (MUDRIH).
As part of medical training at St Johns Medical College, students must work in a medically under-served area for two years. That’s when Dr Isaacs’ life changed.
He was in a village in the southern state of Kerala, known as the spice centre of India, sparsely populated hill country also famous for its tea.
He was drawn to the local people, working in a rural area where health services weren’t readily available. “You must understand the social determinants of health,” he explained. “It’s not easy to get to a large metropolitan hospital. People get chest pains, go to work in the fields then on the way home, drop into the small hospital. They have no money to pay for medicines.”
There were two distinct types of people; those who worked on the land and those who owned the land. The first group would be likely to present with infectious diseases, cuts and fractures while the second group would have diabetes, hypertension and heart disease.
“Their health was linked to their socio economic status,” Dr Isaacs added. “I became very attached to these poor village people who would often pay for services with fresh vegetables.”
One and a half years into his rural placement, Dr Isaacs literally woke up one morning and decided surgery was not for him so he applied to specialise in community medicine and public health, working with socially and economically disadvantaged people.
While assisting the professor of community medicine at St John’s Hospital, Rotary International, together with the Rotary Club of Bangalore and the Rotary Club of Columbia (US) offered $250,000 to set up a rural mental health service. Unfortunately, 9/11 put paid to that grant.
“It was some time later that Rotary International sent us $25,000 and my boss gave it to me to do what I could with it in the rural area,” Dr Isaacs added.
That money was the start of a successful rural mental health program that still exists today – the Maanasi Project in the village of Mungalur. Maanasi means “intellectual woman” in the local language.

Today, Dr Isaacs still follows two important concepts he used back then; the first is to get the design of the project right ensuring it’s feasible, sustainable and affordable. The second is to get people to come.

There were no services in the village at all and he identified “mental health problems everywhere”.
He persuaded four local women who all showed leadership qualities to help him. He gave them a week’s training in recognising mental health problems then sent them house to house, conducting a simple survey as a means of identifying mental health issues. The women then suggested to the women they met that free help was available.

The first clinic attracted five people, the second had 10, the third 12 and from then it grew to have 1500 clients.

Dr Isaacs had contacted a local pharmaceutical company which donated medicines.

Eventually Maanasi extended to 25 villages with 15,000 people surveyed. It became sustainable with all patients eventually paying for their medicines.

Rotary International awarded him the highest honour in Rotary, the Paul Harris Fellow, for his work. “I was very honoured,” Dr Isaacs added.

He started to get overseas grants for more research and one day “stumbled” on the Monash School of Rural Health and its work in mental health. He asked to collaborate on a project which eventually resulted in an invitation for him to move, with his family, to Australia and complete his PhD, focusing on Aboriginal mental health. The invitation came from Dr Mark Oakley-Browne, how chief psychiatrist for Victoria, who was working with SRH at the time.

He was based at the school’s MUDRIH site in Moe.

“Socially, the situation for Aboriginal people is far worse than the people I worked with in India,” Dr Isaacs said.


Dr Isaacs immediately fell in love with Gippsland and its people. “Many Dutch families in particular who I met through St Marys Church in Newborough took me under their wing,” he recalled. “I love being part of my community. I open the front door every day and still love the beautiful colours of the countryside.”

Wednesday, 17 September 2014

IVF pioneer speaks in Gippsland

IN vitro fertilisation pioneer and international stem cell researcher, Professor Alan Trounson, will speak on stem cell research and regenerative medicine in the Latrobe Valley on Monday 29 September 29.

In a coup for the local community, internationally renowned Professor Trounson will give a “Community Conversation” in an event hosted by Monash University School of Rural Health Churchill and Federation University Australia, Gippsland campus.

Professor Trounson’s recent comments in Melbourne were widely publicised when he challenged fertility specialists “to put people ahead of profits” by significantly cutting the cost of IVF treatment. His topic in the Valley will be “Stem cells and regenerative medicine: Australia’s place in the global revolution in treatment of cancer, diabetes, blindness, spinal cord repair and potential cure for HIV/AIDS”.

Prior to his public address, he will speak to first year Monash graduate entry students at the School of Rural Health Churchill.

According to School of Rural Health head, Professor Judi Walker, Monash is privileged to co-host Professor Trounson’s visit to Gippsland. 

“His work, not only in Australia but around the world, has changed the lives of thousands of people,” she said. “It is a great opportunity for our medical students in Gippsland to hear him speak and also generous of his time to address the wider public.”

Head of campus at Federation University Churchill, Dr Harry Ballis, said it was a privilege to co-host a speaker of Professor Trounson’s calibre.


“We are delighted for this opportunity to host an international scholar of Professor Trounson’s standing,” Dr Ballis said. “This is a wonderful opportunity for the community to gain first-hand information in relation to some of the cutting edge medical and technical innovations in relation to IVF.” 

“A Community Conversation with Professor Alan Trounson” will be held in the Auditorium, Building 3E, Federation University Australia, Mary Grant Bruce Drive, Churchill from 6-7.30pm. It is open to the public and there will be an opportunity for questions. 

Light refreshments available. RSVP by Friday September 19 to sarah.j.russell@monash.edu or phone 5122 7445.

Biography

Professor Alan Trounson was a pioneer of human in vitro fertilisation (IVF), introducing fertility drugs for controlling ovulation, embryo freezing techniques, egg and embryo donation methods, initiated embryo biopsy, developing in vitro oocyte maturation methods and the vitrification of eggs and embryos.

He led the Australian team for the discovery of human embryonic stem cells in the late 1990s.
With colleagues, he founded the not-for-profit foundations, Low Cost IVF and Friends of Low Cost IVF, to enable wider access to assisted reproductive technology and fertility education for all people across the globe.

Professor Trounson held a Chair in Paediatrics/Obstetrics and Gynaecology and also a Chair in Stem Cell Science at Monash University.  He was Director of the Monash Centre for Early Human Development and also founding Deputy Director/Director of the Institute for Reproductive Biology.
He was the founding Director of the Monash Immunology and Stem Cell Laboratories at Monash University. He also founded seven not-for-profit life science companies and the National Biotechnology Centre of Excellence – Australian Stem Cell Centre (2002-03).

Professor Trounson, Emeritus Professor Monash University, has just returned from America where he has been President of the Californian Institute for Regenerative Medicine. This is California’s $3 billion stem cell agency, driving research in stem cell biology and facilitating the translation of stem cell discoveries into clinical therapies.

Tuesday, 16 September 2014

Grant boosts e-Logbook development


A $35,000 research grant will boost ground-breaking work already underway to transform the learning experience of medical students with Monash University’s School of Rural Health (SRH) Latrobe Valley and Warragul sites.

The grant, awarded by the Faculty of Medicine, Nursing and Health Sciences , is to further develop an innovative e-Logbook currently used by Gippsland medical students – a tool its creators believe has the potential to be marketed widely in the future.

Already the introduction of the e-Logbook has streamlined the way senior medical  students on clinical placement are reviewed. This year there are 30 of these students working in 15 General Practices and hospitals across the Latrobe Valley and West Gippsland.

SRH Latrobe Valley & West Gippsland Deputy Director Dr Cathy Haigh, who is also the Year Level Coordinator, said “on-the-job” learning was a valuable and long standing tradition in medical education.

Recognising this, Bill Haigh, the Simulation and Blended Learning Coordinator, set out to improve this learning process; to answer how medical students’ learning on-the-job matched the medical curriculum, and supported relevant knowledge and skill acquisition. The e-Logbook is the result.

Prior to the e-Logbook, student placement tracking was paper-based. Recordings were not standardised and it was difficult to collate the data to assess learning and to monitor delivery. The e-Logbook supports students to record against a standard and collation of learning experiences is automatic.

Mr Haigh’s background is in cognitive science. He constantly asks: “Why do we do it that way? Is there a better way?”

The idea of an electronic program made sense to the team: students would receive daily reports and supervisors three-weekly reports which are produced and accessed electronically.

Mr Haigh developed the concept of the e-Logbook in a weekend, adapting the idea to suit local needs. There is an international template, the International Primary Care Classification codes that he used to underpin the e-Logbook design.

The e-Logbook was ready to be piloted in 2010.

The ease of reporting allows students and their supervisors to see and address any problems early in a placement. The e-Logbook also ensures that students are being exposed to a wide range of presentations across four clinical specialty areas: Women’s Health, Children’s Health, Medicine of the Mind (Psychiatry) and General Practice.

The intention of the e-Logbook is to support learning in situ and the aim is to reduce the administrative burden on students and supervisors.

It should take a minimum of 45 seconds to enter details about patient conditions seen and managed under supervision while on placement (no names or other identifying data are used).

Dr Haigh said the grant would allow further expansion of the e-Logbook. It will assist in automating the logbook’s reporting function and enhance its presentation on the small screens of hand-held devices like smart phones, improving students’ access to this resource. The money will also support refinement of the psychiatric placement component of the e-Logbook in line with the release of the latest version of the diagnostic and statistical manual for this specialty.

“Medical training in Gippsland matches national and international standards,” she said.

“We are very fortunate to have two major training hospitals (Latrobe Regional Hospital and West Gippsland Healthcare Group in Warragul) and GP clinics who all want to assist students gain practical knowledge.”

Head of the School of Rural Health, Professor Judi Walker, said the school’s rural health research program focused on improving the health status of rural and Indigenous communities.

“We are proud to lead and foster a program of rural health research,” she added.

The local research project team includes all the medical disciplines covered by the e-Logbook. It comprises Mr Haigh, Dr Haigh, SRH Latrobe Valley & West Gippsland Director Associate Professor Joseph Tam (also a paediatrician), Traralgon GP Dr Paul Brougham, local paediatrician Dr Cathy Coates and Director of Mental Health Services at LRH, Associate Professor Paul Lee. The team members meet monthly to review work on the project.

They hope the final resource can be marketed outside Monash. A prototype is now being developed to facilitate integration of learning across the years of medical training. There has also been interest from other sections of the medical profession.

Health visit for Myanmar women

Study trip: 20 representives of Myanmar's health sector visited Mildura as part of a 10-week visit to Victoria.

A group of women from Myanmar hope information they gained from a visit to Mildura this week will help improve community health issues in their country.

The 20 senior representatives of Myanmar’s health sector were hosted for three days by Monash School of Rural Health Mildura.

Organised by the Monash Sustainability Institute, the 10-week visit to Victoria is funded by a range of organisations including the Australian and Myanmar Governments, and the United Nations.

The women have been to various Monash campuses including hospitals and rural health care facilities. Monash researchers are keen to learn about current issues in Myanmar community health while the Myanmar group is learning of Monash initiatives in community health and related areas.

According to the Head of the School of Rural Health Professor Judi Walker, maternal and child health, and HIV/AIDS present serious health issues in Myanmar.

‘However, mortality and serious illness can often be prevented through adoption of primary health care interventions,” Prof Walker said.

Monday, the visiting fellows toured the Mildura clinical school which included time in the simulation and women’s health training facilities. They also toured the Mildura Base Hospital and at dinner that night, spoke to medical students about HIV/AIDS issues in Myanmar.

Mallee District Aboriginal Services (MDAS) hosted the group on Tuesday which included a visit to Coomealla Health Aboriginal Corporation. Wednesday saw a visit to the Robinvale Medical Clinic followed by a cruise on the River Murray.

Professor Walker said understanding the social context in which community health care was extended was as important as understanding conventional medical practice.

“Monash and Myanmar will establish an enduring collaborative relationship which is responsive to improved health outcomes,” she added.

Arrangements for the Myanmar visitors were organised by SRH Mildura’s Regional Manager,” Kendall Livingston.

“It was a pleasure to meet these outstanding women and we hope that one day some of them may return to Mildura for a follow-up visit,” she said.

Regional pathway to chosen career


Growing up, Derk Pol always wanted to be an airforce pilot but at 197 centimetres, was too tall.
The aviation industry’s loss, however, turned out to be the medical profession’s gain.

Derk is one of seven Gippsland born and bred medical residents working at Latrobe Regional Hospital in Traralgon this year.
While different pathways led each to their new profession, they share a deep appreciation of the “regional experience”.

 “Growing up in Gippsland was fantastic,” said Derk who was born and educated in the Moe area. “I felt extremely lucky and it was wonderful to be able to do this course so close to home,” he added.

“If you are from a rural background you are more likely to go back to the rural area. You can tell some kids from the city feel as though they are being forced to the country but rural kids don’t need any incentive to return.”

Educated at Tanjil South Primary School then Presentation College in Moe, he transferred to Marist-Sion College in Warragul when Presentation College closed, before doing a degree at Melbourne University.

Derk did his first year of Monash University’s graduate entry medical degree at Churchill, his second year at Latrobe Regional Hospital in Traralgon, his third year at Warragul Hospital and his final year at regional hospitals including Mildura, Bendigo and Frankston. He completed his internship at LRH last year.

He praised both the Monash School of Rural Health and LRH. “The School of Rural Health has done a great job at attracting regional students as has LRH in retaining interns,” Derk said.

“LRH is only going to get bigger. It offers a great exposure to ICU medicine in particular. You get exposed to the real emergency medicine and there is more opportunity to do more cases.”

Derk may specialise in cardiology but admits it is “a long road ahead”. And that dream to fly still remains with a long term goal to get his private pilot’s licence.

Shane Robbins from Maffra worked in Melbourne for almost eight years when he decided on a career change.

Educated at St Mary’s Primary School in Maffra and then Catholic Regional College in Sale, Shane said “medicine ticked all the boxes”.

He believes “life experience” helped him make a decision about what he really wanted to do in life. “You become more focused on that choice,” he added.

Shane wanted to return to Gippsland so the idea of studying at Churchill through the Monash School of Rural Health “was perfect”.

“I love the variety of work which is hard, but satisfying,” he said. “Working in a major referral hospital such as LRH provides opportunities that are not available in large metropolitan hospitals. You learn quickly as there are not as many staff.”

Shane said he always felt Gippsland was “home” and now intended specialising in GP training after his residency, then working in Gippsland.

Andrew Thomas from Churchill attended Kurnai College.

Currently living in Moe, he joined the navy and was a navigator for 12 years when he also wanted a career change.

The navy is putting him through medical school and on completion, he will serve five years as a navy doctor before returning to the country as a GP. “It will be either Gippsland or regional Western Australia where my partner is from,” he said.

“I saw the opportunity to return home to study through Monash’s School of Rural Health as a major bonus. I love this area. And when I fulfil my obligation to the navy, the country is where we want to be.”

According to Andrew, working at LRH gave him the opportunity to be “actually involved” in a variety of situations which broadened his training.

Danielle Winkelman attended Morwell Park Primary School then Kurnai College in Morwell. Because her ENTER score was not high enough for direct entry into medicine, she chose a science degree at Melbourne University with the plan to transfer to a medical degree.

“It was then (after completing the science degree) I heard that Monash University was opening the medical school at Churchill so I had an interview for the first course entry and took a year off while waiting for the school to open,” she said. “I didn’t like Melbourne and couldn’t wait to get back to the country.”

Danielle agreed with her fellow resident doctors that experience in a major regional hospital exposed young medical students to more opportunities.

“I did several placements in metro hospitals and felt like a potted plant – just sitting in the corner, growing and watching,” she said. “I have been fortunate to work at hospitals in Wonthaggi, Sale, Heyfield as well as LRH. You just don’t get that hands-on opportunity (in the city) and I loved it.”

Danielle, who currently lives in Newborough, has 12 week old twin girls. She returns to LRH in August after maternity leave, planning to apply for GP training next year. “I want to work in this area when I am finished,” she said.

Gippsland nurtures new doctors

Local heroes: Four of the Gippsland born and bred medical residents working at Latrobe Regional Hospital this year. They are (from left) Shane Robbins, Derk Pol, Ruth Briggs and Andrew Thomas.

Efforts to train and retain doctors in Gippsland are taking significant steps forward because of the opportunity to study medicine with Monash University in Gippsland.

Seven of the eight doctors completing their residency at Latrobe Regional Hospital (LRH) in Traralgon this year are Gippsland born and bred.

Six completed their entire medical degree in Gippsland through Monash University’s graduate entry medical degree, doing their first year of study at the School of Rural Health – Churchill and the bulk of their three years practical training  at the School’s clinical academic sites throughout the region.

The doctors are Derk Pol from Moe, Shane Robbins from Maffra, Andrew Thomas and Sharon Johnson from Churchill, Danielle Winkelman from Morwell, Sarah Wilmot from Paynesville and Ruth Briggs from Tyers. They are joined by Tom Walsh from Sale, who did his first two years at
Monash University’s Clayton campus and the remaining years in Gippsland. They were all interns at LRH last year.

The medical residents said the opportunity to live and study in their “home area” and the exposure to a diversity of experiences offered at LRH, had enhanced their training.

According to LRH Chief Medical Officer, Dr Simon Fraser, the number of interns eager to take up a 12 month residency at the hospital has increased.

“The intern training program is increasingly competitive but attracts a high standard of applicants, as a result,” Dr Fraser said. “There are definite advantages in students continuing their training at LRH which has made a significant investment in teaching medical students. I think the fact that many want to stay on reflects that they enjoy the work.

“LRH provides them with a variety of presentations and encourages them to take greater responsibility for clinical decisions while still having full supervision and support of senior doctors.”

The Monash School of Rural Health has a footprint stretching from Orbost to Mildura with four regional clinical academic units and the Department of Rural and Indigenous Health based at Moe.

In Gippsland, there are clinical teaching sites at Traralgon, Churchill, Warragul, Sale, Bairnsdale and Leongatha with the first year of the graduate entry medical degree program taught from the school’s Churchill site.

According to the School of Rural Health’s Associate Professor of Early Rural Medical Education, Shane Bullock, Monash is committed to improving rural health and developing a sustainable rural health workforce.

Associate Professor Bullock is proud of the achievements of all medical students who come through the School of Rural Health and particularly pleased to see the number of Gippsland students undertaking the course.

He said feedback from students was positive. “The quality of medical education in rural areas is on a par with the city. In fact students have said that in rural areas there are more opportunities for hands-on learning compared to sitting on the sidelines observing. They feel there are real benefits in being part of a smaller workforce.”

Students have spent time at hospitals and GP clinics in Traralgon, Warragul, Sale, Bairnsdale and Wonthaggi. As the major referral hospital in Gippsland, LRH also has links with major institutions in Melbourne.

The students’ clinical training can include inpatients and outpatients, acute presentations, chronic presentations, GP work, maternal and child health services, immunisation and fertility clinics.

Associate Professor Bullock said that where in the past, city students were very reluctant to work in a country hospital, there are now seen to be many advantages.

“It is rewarding for Monash School of Rural Health staff to follow the careers of all our students. Those who return to work here often do so because the experience when they studied here influenced their decision.”


Dr Joseph Tam joins School of Rural Health

The Monash University School of Rural Health has appointed Gippsland paediatrician Dr Joseph Tam to lead an exciting new phase of rural medical education in the region.

Head of School, Professor Judi Walker announced his appointment as Associate Professor of Rural Medicine (Hospital Medical Education) and  Director School of Rural Health - Latrobe Valley and West Gippsland. Associate Professor Tam joins a team of senior Gippsland-based academics to implement innovative models of integrated medical education in partnership with regional hospitals and health services.

The models aim to advance pathways to ongoing rural and regional medical training to ensure a sustainable rural health workforce.

Professor Walker, said Associate Professor Tam, who has been a paediatrician with Latrobe Regional Hospital since 1998 and Director of Paediatrics since 2004, came to the position with “outstanding credentials” including extensive experience in the development and delivery of regional medical education.

“He has substantial clinical and administrative leadership experience and has established strong working relationships with his patients and their families, allied health professionals, colleagues, students and health service executives,” Professor Walker said.

“These are complemented by strong professional links within the health industry, the medical colleges and medical community.”

Associate Professor Tam came to the Latrobe Valley in 1998 from the Royal Alexandra Hospital for Children in Sydney, becoming the only visiting consultant paediatrician at Latrobe Regional Hospital in Traralgon. Over 16 years, he established a thriving practice, spearheading the development of the small paediatric service at LRH into a department of five paediatricians and six paediatric hospital medical officers who provide 24/7 on-site services at LRH.

Professor Walker said Associate Professor Tam was regarded as a passionate teacher who has been actively involved in education, training and assessment of medical students and t, international medical graduates, Hospital Medical Officers and paediatric trainees at LRH.

Associate Professor Tam has a long association with Monash University and the School of Rural Health.

In his position as the Children’s Health Program Clinical Coordinator, and as a Monash Child Health Management Group member he worked closely with senior Monash clinical academics across the state.

Associate Professor Tam is represented on national and local medical organisations and is involved in clinical research.

Professor Walker said as incoming Director of the School of Rural Health Latrobe Valley and West Gippsland, Associate Professor Tam looked forward to working with all stakeholders to develop ongoing medical training pathways in Gippsland.

Associate Professor Tam takes up his role on 19 May 2014 and will be based  at the School of Rural Health – Latrobe Valley (Latrobe Regional Hospital).

Friday, 29 August 2014

Student medicine app wins world award

Two Monash medical students will sit down for a face-to-face meeting with Microsoft founder Bill Gates next month.

The meeting is part of the prize for winning the world-wide competition, Microsoft’s Imagine Cup, with an entry that has its origins in north west Victoria.

Monash medical students, Jennifer Tang and Jarrel Seah take a selfie with Microsoft chief executive, Satya Nadella after winning the Microsoft Imagine Cup, a world-wide competition.

It was while final year students Jennifer Tang and Jarrel Seah were on student rotations in Mildura, Swan Hill and Bendigo that the idea for a selfie app to detect anaemia took root.

What is anaemia?

Two billion people world-wide suffer from anaemia which is particularly dangerous for pregnant women. It is caused by a deficiency in red blood cells which can be the result of a poor diet or other diseases and disorders. Anaemia can predispose you to things but it can also be an indication of other underlying conditions.

Called Eyenaemia, the technology is now being trialled at Mildura Base Hospital and Cabrini Hospital in Melbourne. It has the potential to revolutionise access to health services in remote areas around the world. The app is simple, non-invasive and an easily accessible screening tool.

Eyenaemia users snap a picture of their lower eyelid with their phone alongside a thumb-size chart that allows a computer system to screen for anaemia based on the colour of the eyelid. The photographs can also be entered into a website or sent via email.

Both students met in their first year of medicine at Monash Clayton with Jennifer part of the External Rural Cohort with the Monash School of Rural Health. They kept in contact and met up again when they were on student placements  - Jennifer completed third year in Bendigo and fourth year, with Jarrel, in Mildura and Swan Hill.

“We both have an interest in medical technology,” Jennifer said.  “Jarrel is interested in software and has a background in technology while I’m interested in design, especially app design, and website development.”

This combination of medicine, technology and design saw them develop several medical-based ideas which they entered in Australian competitions, encouraged by other people in the medical technology field. However it was while working in the north west, particularly among the Indigenous population in Mildura and Swan Hill, the Eyenaemia app proposal developed.

“We recognised a need to find some way of detecting anaemia early and treating it,” Jennifer explained. “And no objective screening method for anaemia existed.”
Anaemia is caused by a deficiency in red blood cells which can be the result of a poor diet or other diseases and disorders.

According to Jarrel, while working in the north west region, they also saw the long distances many patients travelled for medical appointments. “We thought it (the app) might be a good to a way for people to screen themselves at home or to have outreach workers screen them on the spot when they visited outlying areas,” he added.

The app development timeline was “quite speedy”, Jennifer said.

They brain-stormed in June, worked heavily on the software from September and continued research and data collection into January. Work was done at weekends and of a night, on top of their medical studies. Jennifer spent the first three months of this year in Mildura however Jarrel returned to Melbourne so there was “lots of Skyping” and emails.

The students praised Monash School of Rural Health Mildura director, Associate Professor Fiona Wright, for her support and advice as well as Mildura hospital staff and the hospital’s ethics committee for assistance.

Assoc Prof Wright was full of praise for the students. She said their win demonstrated not only their capability and communication skills, but their vision for the role of technology in the delivery of health care, especially to remote areas such as those in the north west.

Mildura Hospital started a one year trial of the Eyenaemia app in January however the two students are hopeful of having this extended to five years.  Cabrini is taking part in a five year trial. They believe a five year study of the app will be more beneficial however data collection has already revealed a 95 per cent accuracy rate.

Jennifer is taking the lead in the Mildura trial and Jarrel in the Cabrini trial.

Despite being cast onto the world stage, both students are busy finishing their final year of medicine. Jennifer, born and raised in Melbourne, is currently on placement at Monash Health, specialising in rheumatology while Jarrel, born in Malaysia and raised in Singapore, is doing his Bachelor of Medical Science (Honors) year at Alfred Health, looking at Computer Vision applications in medicine.

Both students want to continue practising medicine, combining it with their desire to develop practical and useful medical technology. They have already set up their own company.
“Practising medicine in the field will help us to identify problems,” Jennifer said. “This is why we want to continue to do medical technology and have set up our own company. Our desire is to improve health care through technical solutions.”