Monday, 6 March 2017

PNG placement motivates medical student

His two-week placement in Papua New Guinea over the summer break, was the most confronting thing medical student, Tim O’Hare, has ever done. But while it was emotionally exhausting, it was also motivating. “Having the opportunity to do a medical degree in a place like Australia, you want to make the most of that because it’s such a privilege and you just get such valuable skills from it.”

Confronting: Tim O'Hare spent two emotionally-exhausting weeks in PNG over his summer break based at Garoka hospital, and spent New Year with a local family.


Now in the third year of his studies with the University of Melbourne, raised in Gisborne Tim spent last year with Monash Rural Health Bendigo as part of a unique partnership between the two universities. Students from both institutions complete their first year of clinical training together at Bendigo Health.

During that year, Tim decided he wanted to expand on the cultural safety training that was part of his studies and organised a cultural awareness seminar for students. “We did cultural safety online modules, but nothing that involved actual people.” So he contacted the Bendigo District Aboriginal Corporation (BDAC) who were delighted to have someone ask for their help.

Tim had tried to gauge students’ prior knowledge of Aboriginal health. Some of the responses questioned the need for an Aboriginal co-op: why can’t they just go to a normal GP? A social worker and family counsellor from BDAC came for an afternoon and talked about local issues. “It’s really close to home, but a lot of people in Australia don’t fully understand yet. It doesn’t get taught in high school that well,” he said.

Music for Cambodia

For many years Tim and his family have organised the annual Macedon Ranges Music Festival in March to raise money for the Cambodian Kids Foundation.

All the performers donate their time (including the band that Tim plays in) and all ticket sales go to the Foundation.




Growing up, Tim never had plans to study medicine. Then about four years ago, he accompanied a local Gisborne doctor to Cambodia as a volunteer and saw what you can do with a medical degree. “I kind of thought you worked as a GP or you worked in a hospital, but then saw the breadth of it and that got me interested,” he remembered.

He’s since been to a few countries in Asia and back to Cambodia volunteering. It was to Cambodia he wanted to return over his summer break. “But the timing wasn’t right.” So through a contact of his mother’s he learned about PNG. “I look into it and learned more about the highlands and the history of PNG. It sounded really interesting. I’d read about PNG back when I was doing my science degree. It’s really interesting in terms of anthropology; there’s over 600 languages still spoken there.”

The Highlands Foundation put him in touch with Garoka hospital. “They were rapt to have me visit and help out and learn, and teach if there was anything I could teach,” said Tim. “You had complete freedom to work wherever you want. You could introduce yourself to the doctor or the surgeon or the nurses or the midwives. So I just tried to do a bit of everything. I met the Public Health Director of the hospital and that’s who I went out to the rural clinics with.”

In the emergency department he saw extreme presentations that you wouldn’t see in Australia. “Ill kids were the hardest to see, especially when most are cases that would be easily treatable if the resources were there.”

He saw that the problem was not lack of skill on the part of doctors or staff, but lack of money. “It might have only been a couple of dollars for a certain drug but the hospital ran out and they just couldn’t get it. You’d see kids with something like typhoid or meningitis – they’d only get partially treated one day and the next day they wouldn’t have any drugs, so they’re just suffering and not getting better. That was pretty hard.

“Seeing such extreme suffering and poverty as the cause, not necessarily any other cultural thing. All these complicating things play a role, but at the end of the day it was just an equity thing.”

He found it hard coming back. “You can get there in a day. You learn the history a bit. PNG was a part of Australia and then got independence in the 70s. And then just seeing how poor access is for so many people to just really basic healthcare. That was pretty challenging.

“Doing something in global health or education or development have always interested me. But it [PNG] has definitely made me sure that’s something worth doing.”

As he gets further into his studies, his PNG experience keeps things in perspective. “There’s a lot of stress in medical school which is a shame because it makes people feel busier than they need to be. But it’s actually been really relaxing to get back to medical school. Every day I think: wow, what a great opportunity I’ve got!”

Many disciplines make productive research

Only medical students get summer research scholarships in the medicine faculty goes the thinking, but Biomedical Science/Law student, Katherine Allman, thought she’d have a go applying anyway.

The project she was offered, looking at advanced care plans for patients in a regional primary care setting, appealed to an interest awoken during a public health unit offered by Dr Helen Ackland. Far from being a disadvantage, the project’s supervisors, Dr Bernadette Ward and Pam Harvey, welcomed the legal perspective Katherine could bring to the project. She was in.

Through an audit of patients who had had an over-75 health check at the Bendigo Primary Care Clinic, the project team was looking for a correlation between chronic diseases and where advanced care plans were in place.

Multi-disciplinary team L-R: Pam Harvey, Katherine Allman, Nidhushie Tilak Ramesh, Dr Bernadette Ward, Dr Dennis O'Connor


Complementary skills

Interdisciplinary skills led to a natural split in the research tasks as Katherine worked closely with a final year medical student. “It was great fun. Nidhushie [Tilak Ramesh] was fantastic.” During the audit, Nidhushie was able to group patients into one of the eight chronic disease categories identified by the Australian Institute of Health and Welfare. “Having her able to do that and me not having to Google everything was brilliant.”

Katherine brought a completely different perspective. “We were reading through the literature, not just looking at the patients medically, but also legally: Who were the patients? Were they more vulnerable people?”

On the clinic’s side she was asking: “What are the obligations of a GP under the new legislation that will be introduced in March next year? What are the implications for best practice? Really trying to understand the tension between the demands of working in a GP clinic, but also trying to do the best thing for your patient,” she said.

Her ability to interpret legislation was valuable as was her training in statistics. “I basically become the stats monkey because I’d done quite a bit of stats training through my biomed degree. I did a lot of work with SPSS doing the data analysis, so I got very familiar with that. That was good to refresh those skills.”

Her law skills came into play most in the final analysis looking at how it all fitted into the framework. How do they make this meaningful?


Advanced Care Planning close to home

Katherine has firsthand knowledge of advanced care planning. “My mum has just been through making an advanced care plan. She’s had a few unexpected turns with her health in the last 12 months. So we’d gone through the medical power of attorney, all the ‘person responsible’ things as well as looking at getting an advanced care plan put into place for her. So it was something that was quite close to home, but because of that it had really inspired me to learn more about it because there’s not a lot of public awareness there.”

The research project also tapped into what she’d learned during a student project on euthanasia and the law. In Australia, she points out, death is a big taboo, so there is not much research around death. “The heavy lifters are really the US and Netherlands. When you come to Australia, everything is in the ICU and a little bit in emergency, which is where you’d expect it to be because they’re more the end of life stages. Nothing’s been done in a GP setting.”

Staying focussed

It’s a new field in Australia and as someone whose interests are so broad, Katherine found it easy to stray into related areas that intrigued her. “It’s very important to have a clear idea of what you want to achieve,” she laughed. “The time you’ve got, the funding you’ve got; you’ve got to come back to that one original idea.”

That focus enabled the team to come to some conclusions based on the data they'd collected. “Despite a government push for ACPs, medical powers of attorney are still predominant,” she said. They were also able to make recommendations about the need to review advanced care plans all along a patient’s health journey. Katherine’s final task was to draft an article for possible publication. “We’ve written the method we used in a way that we hope can be replicated in other clinics,” Katherine said.

While she’s leaning towards a career in health policy, Katherine has always been interested in medicine. Now she’s considering extending her studies to tackle graduate entry medicine. Whether she does end up in medicine, Katherine has at least proved that the “closed shop” reputation of research scholarships in the Faculty of Medicine, Nursing and Health Sciences is undeserved. Other disciplines have a lot to contribute to health care research.