Monday, 23 February 2015

Flying start to a final year

Monash medical student, Julia Buras discovered remote health first-hand during her placement
with the Royal Flying Doctor Service

NOT so long ago Julia Buras was a Trafalgar High School student hoping to secure a university place after year 12.  Now a fifth year medical student with the Monash School of Rural Health, the Gippslander is close to becoming a doctor and she has recently spent a fortnight with the Royal Flying Doctor Service (RFDS) Western Operations.

From the Jandakot base south of Perth in Western Australia, Julia accompanied medical teams flying to airports servicing remote areas. The teams provided levels of care from stable patient transfer to critical care in the aircraft.

This year Julia, in her final year with Monash SRH, will be largely based at Latrobe Regional Hospital in Victoria, but will rotate through Melbourne and other rural Victorian areas. Julia organised the RFDS placement herself, seizing an opportunity to broaden her experience and learning opportunities.

Among the many highlights of her time in WA was the “privilege of working with some really amazing doctors, nursing staff and pilots”.

“The end result of the actual flight is the combination of effort from many people including medical officers, nurses, pilots and administrative and co-ordination centre workers,” she said.

“Together they ensure there is an aircraft available, it is equipped with everything that may be needed, it is staffed appropriately, they consider the crew’s flying hours and the weather and ensure the altitudes being travelled are appropriate for the patient’s condition.

“There are so many factors to consider because the crew needs to be completely self-sufficient when caring for the patient.  It was fantastic to watch these teams in action.”

Julia’s experience was often supplemented with geography ‘tutorials’ to provide a context for the flight logistics planning and journey.

 “I had firsthand experience of seeing not only how finite resources impact upon remote health outcomes, but also of how vast Australia is,” she said.

 “For me it was important to have a visual concept of the distances between locations, so I had a close look at the maps of WA, which helped me to appreciate the time and effort that goes into providing this service.

“The RFDS provides services to one third of Australia and the system differs depending on the state they are operating in.  There are so many sparsely populated communities in WA, many without medical care and some without good road access. The RFDS is critical to reducing the time taken for a patient to receive urgent medical attention.”

It was a steep learning curve for the Gippsland student in the first days of her placement. “During one handover a doctor was telling me about a patient who had presented at the Hollywood Hospital and who had come in from Denmark, so I thought the patient had been in three countries,” she laughed. “But Hollywood and Denmark are actually two locations within about a 400 kilometre radius of that was truly a ‘local’ geography lesson for me.”

Reflecting on her placement, Julia said “I was made to feel part of the team, there was a lot to learn and the clinicians were always happy to provide in-flight tutorials on a topic.”

Julia encouraged other students to pursue their interests through placements a little out of the ordinary.

“I found my placement to be absolutely amazing.  I know a placement with RFDS may not be for everyone, but it is great to follow what you enjoy and explore it further.”

Monday, 2 February 2015

Geoff Solarsh farewells the School of Rural Health

Working in rural areas of South Africa as a young doctor only reaffirmed Geoff Solarsh’s desire to work in paediatrics…and in regional areas.

When he found himself in Australia, many years later, those passions were still very much at the forefront of his career choices.

Now moving into another phase of his life, the retiring Director of the Monash School of Rural Health Bendigo will maintain his strong association with paediatrics and teaching.

Professor Solarsh cites the current School of Rural Health medical student training model as the most significant achievement of his tenure at Bendigo.

“The rural medical course in north western Victoria was a win-win situation for students and regional centres,” said the co-head of the North Victorian Regional Medical Education Network (NVRMEN).
Professor Solarsh was an undergraduate medical student at the renowned University of Witswatersrand which had its main medical school in Johannasburg. After graduating in 1973, he worked in remote communities where he pursued his specialised interest in paediatrics and introduced child health programs.

After spending three years at the Red Cross War Memorial Hospital in Cape Town, he then went on to become the first regional paediatrician at Pietermaritzburg, most famously known for being the town where Mahatma Ghandi was “thrown off the train” because he was a non-European. “This was an absolutely seminal event in this town,” Professor Solarsh recalled.

Then followed a position as Professor of Maternal and Child Health at the Nelson Mandela School of Medicine in Durban.

He described this position as “massively formative” and largely responsible for his career choice at Bendigo.

“I was mainly responsible for establishing child health programs in the large catchment area, developing community-based teaching programs for medical students and programs of population-based research,” he recalled.

“It was quite important background for the work I have been able to do here in Australia in so far as my real interest has always been not just clinical paediatrics but also population-based aspects of the discipline.”

Family in Australia prompted the move here. However Professor Solarsh was determined to develop a “life of his own”.

“I was not unhappy in South Africa – we had massive international funding for our work. But family was the primary reason for our move.”

According to Professor Solarsh, the public health problems in Australia are significantly different to South Africa and the resource base available to manage these problems is “extremely different”. But the overall approach in both countries is similar – to develop community based education with population-based research.

“One of the attractions here was the fact the School of Rural Health was at its absolute inception back then,” he said.

“Very significant funding was being provided and there was an opportunity to get involved in the development of a whole new institution in Australia on the ground floor.”

Professor Solarsh took over as head of school from its first head, Professor Roger Strasser, who established the school initially in Gippsland but wanted to expand to other Victorian regional areas.
“Bendigo was a huge regional centre in the North West and it gave us a wonderful opportunity to establish a hub for a whole set of activities.

“My decision occurred at a time when medical schools numbers were being increased by government to deal with the fact they (government) had really mis-assessed long term health care needs for Australia. It tried to address the problem by increasing student numbers.”

While Head of School, Professor Solarsh helped establish a new model in medical education in the north – the NVRMEN program.

At the time, Victoria needed to increase medical school numbers by 240. This was done by creating new medical schools at Deakin University in Geelong and at Monash University Churchill. Sixty places were allocated to northern Victoria where there were well established clinical schools at Bendigo and Mildura (Monash) and Shepparton and Wangaratta (University of Melbourne).

“We decided in North Victoria not to go the route of a new medical school,” Professor Solarsh said. “Instead we developed a new model of education based on the existing rural clinical school model already in place with collaboration between Monash and Melbourne.”

Years 3, 4 and 5 students undertook their clinical training in the north-west with an arrangement between the universities to use each other’s facilities.

“We had an enormous amount of infrastructure support from State and Commonwealth Governments. New facilities were created for both universities in Bendigo and Shepparton. Student precincts were created with rural GPs giving their support.

“All small sites were developed and this saw improved facilities at Mildura and a new clinical school built.

“So rather than a big central medical school, this model really paid off – it has grown and grown, and been good for these regional centres.”

“Students chose the Monash model because we have good concentration of clinical teachers in Bendigo and Mildura. We have a really fantastic distributed network of general practices and students benefit from the infrastructure we have helped create at each of those practices

“The real advantages for students is that we try and demonstrate that what they’re doing is looking after patients in many different contexts…they can see a patient right through the primary care system and have an understanding of how the region functions as a total system of care.”

According to Professor Solarsh, the early evidence is showing students return to regional areas to work. “It is too early to make a final judgement whether it will play into returning but there is some evidence it happens,” he added.

The fact the model had a positive impact for all parties involved was undeniable, he said.

“We are all sitting together on this site (Bendigo) so you have a hospital based around an education precinct.”

The next phase of Professor Solarsh’s life will see him move to Melbourne with his wife however he still remain an intrinsic part of the north-west.

“I wanted to move at a time when I felt a significant point had been reached in terms of establishing the model and getting the people and management structures right.

“It’s time to let someone else take it to the next stage.”

Also a paediatrics consultant with Bendigo Health, Professor Solarsh will work from the central faculty of Monash with the Bachelor of Medicine and Bachelor of Surgery (MBBS) program.

He was keen to “keep his hand” in with paediatrics and also do locums around Australia. That role will also see continued contact with students.

He also sees the next phase of his life as an opportunity to slow down a little.

He and his speech pathologist wife Barbara are looking forward to spending more time with their three children and three grandchildren – all in Melbourne.

However it is difficult to see Professor Solarsh not taking up new challenges.

“The biggest challenge in child health in Australia – and in other industrialised countries – is the large number of children with behavioural issues which are to some extent, but not exclusively,
linked to socio-economic difficulties and family breakdowns,” he said. “There is also an increasing number of children with development problems.

“A lot of paediatricians in this country are now really wrestling with what to do with these particular groups of children.

“Regions in particular need resources which are fewer in big cities. However there are opportunities in regional areas that don’t exist in Melbourne, particularly in Bendigo.

“The City of Greater Bendigo has the ability to have a whole-of-city approach to integrating services – home, school and health providers. If I had another 20 years here, that’s what I’d be working on.”