Working HUGS Adventures
- Tamblyn Devoy
- Erica Longhurst
- James Smyth
- Marian Dover
- Dominique Fergusson
- Caitlin Chehade
- Arupam Raman
- Tom Patterson
- Kaalya De Silva
- Ruth Huo
- Phyliss Tay - Muswellbrook
- Andrew Cepak - Armidale
- Yequin Huang - Alstonville
- Renee Morley - Nowra
- Marianne Dowsett - Coolah
- Luiza Peculis - Boggabri
Spending a week at Lennox Head Medical Centre during January was an incredible start to the 2017 year. My name is Tamblyn Devoy (Year 2 student) and I completed a Working HUGS at Lennox Head Medical Centre under the very capable hands of Dr Ann Staughton, a fantastic GP to her community and casual doctor at Ballina Hospital’s ED and John Flynn Hospital. Whilst only a short week, it is hard to believe how much I could see, hear and do – and if I didn’t keep a track of what I did each day I almost wouldn’t believe it myself.
Lennox Head is a beautiful coastal town with a population of about 7,500 people. Not something someone would expect when told they are going on a ‘rural placement’. This experience was designed to show me two things:
- the work-life balance of a career and family; and
- to develop my clinical skills with hands-on experiences where possible.
The time at Lennox Head Medical Centre with Dr Ann was invaluable to my learning. It was great to see how a GP communicates with their patients, and further, their role in referring patients and continuity of care. You really feel a part of the team and always welcomed by the patients, who are happy to allow you in on their consultations. Memorable moments included my first injection on a patient, prior to which I had only practiced on fake arms. As the staff at Lennox Head Medical Centre said, “You never forget your first injection.”
Uniquely, it was also fortunate that Dr Ann was involved in the nearby hospitals, where I could shadow her for one night. Little did I expect to be feet-first, compressing a man’s neck from bleeding. Whilst I could not have fathomed my need of extra hands that night, it was a great experience that I truly loved as time in metropolitan EDs at this stage of learning can be hard to come by.
One of the greatest fears perceived by ‘going rural’ is the isolation from colleagues and support from the entire healthcare team. This is so far from the truth! Lennox Head supports a range of specialists, nurses, podiatrists, physiotherapists, optometrists, dieticians and more who all work together on a whole delivering health care to the region. It was a great pleasure to spend some time with the local physiotherapist and podiatrist during my stay to follow the referral process of GPs to this speciality. In particular, I am immensely grateful to Simon Prior (Physiotherapist) and Matt Frogley (Podiatrist) for giving me the time to join in with their consultations.
Amongst all the experiences I was immersing myself in, Dr Ann also ensured that I saw Lennox Head and the surrounding areas – which was best seen hang gliding off the Pat Morton Lookout. A truly incredible way to view the coastal town. Despite the sharks, I managed to spend a bit of time in the water, visit nearby Byron Bay and viewing a few of the sights and towns coastal New South Wales offers.
I would like to thank RMFN for organising this opportunity; the staff and patients at Lennox Head Medical Centre; and Dr Ann Staughton. It has been an invaluable experience. I look forward to visiting Lennox Head again soon.
How can a place that is famous for its cold weather leave you feeling incredibly warm and fuzzy? I had the wonderful pleasure of spending my week long placement in the small town of Cootamundra with the Fry family. Stacey and Dan and their four beautiful children welcomed me into their home and kindly took me on a week long tour of medicine in a NSW rural practice. I was given opportunities to put theory into practise, to challenge myself, and to develop relationships with a really wide range of people.
My first day started with a round of the Cootamundra nursing home, where Dr Dan Fry introduced me to some of his patients who were now residing in the town’s aged care facility. There is a unique continuation of care in small country towns that I was really able to appreciate in Cootamundra. In this community, there is the potential for a General Practitioner to be present at the births, deaths and significant life moments of one family. It is a very unique privilege to develop such a connection with someone, and something that would definitely be something that I would absolutely cherish if I am lucky enough to be a rural GP one day.
On Tuesday we spent a busy day at the surgery, starting with a rounds of the hospital and some discussions with the nurses about care options for a few patients. We then walked over to the clinic, where we spent a busy day seeing a wide range of patients. People came to see Dr Fry for so many more reasons than to get a clinical diagnosis - often their visits were full of moments where they were seeking advice on important aspects of their lives and even work. This was a fantastic learning experience for me, as I have begun to appreciate that medicine is about having a heart as much as it is about having a brain. We need to listen to people - how else can we find out about the determinants in their life that have such a direct impact on their health? Over the week, the clearer this became to me, the more passionate I felt about rural medicine.
Wednesday was another fantastic day - with one of the patients presenting with 28 week old twins. I have to say, this was definitely a highlight of the week for me, as we have just finished a term studying Beginnings Growth and Development at UNSW - so it was a real treat to be able to actually palpate the young woman’s abdomen. We had a lovely lunch at the local pub where I tried a very interesting Cauliflower and Four Cheese’s soup, and then we had a tour of the town. Before the sun set, we went for an energetic walk through the paddock of bushland opposite the Fry home. It was glorious to see the pink and orange hues of the sunset over the bushland. In the evening I joined Stacey for some Muay Thai - which was fantastic! I really enjoyed the experience of doing some martial arts - it was rewarding and enriching. I was told that it was a great way to burn off any frustration! Not that I actually had any to be honest, but it was definitely a very relaxing and exciting experience.
Thursday morning was spent seeing patients, but in the afternoon I was able to visit the speech pathologist and spend time with her. I found that engaging with the other specialities in the practise was a real highlight. Often it’s easy to forget that medicine would not work if there wasn't a team approach - there would be no such thing as good quality patient care. There are not many opportunities to get a good understanding of what everyone in the medicine team does though, and so I was very grateful to learn more about the roles of nurses, midwives and speech pathologists at the Cootamundra Health Clinic.
The final day was quite busy - and so it was a chance for me to appreciate how concise and to the point that a GP has to be a times, but at the same time maintaining great interest in each patient and ensuring that their needs are fully addressed, as Dr Fry does every time. There are so many valuable lessons that I have learnt from my time in Cootamundra, and many important moments of piecing together different pieces of information. Dr Fry taught me a lot about how medicine brings together so many different people from wide and varied paths together. He also showed me how one can keep their humanity - sometimes we lose who we really are when we get caught up in medicine textbooks and procedures. What made my time in Cootamundra so special was the people that I met; they showed me such genuine warmth and care, making my stay an absolute pleasure and a true highlight of my mid-year holidays.
My week in Scone was fantastic and I enjoyed every moment of it. I couldn't have hoped for a better GP to shadow or hosts that could be more accommodating. I really enjoyed getting to know Dr Steve Sylvester and Jenny Sylvester and learning about life as a rural GP. I was very happy with Liz Wragge, the HUGs programme co-ordinator, who was able to schedule some ideal dates for to me stay. Not only did I really enjoy the experience and medical opportunities, I was inspired by the lifestyle, culture and warmth of the Scone community.
My first day involved a trip to ED at Scone hospital where I was welcomed by many of the local doctors and nurses. I was immediately struck by the friendliness of the GPs, registrars and staff at the hospital. In the evening Steve and Jenny took me out to Lake Glenbawn, a 15 minute drive out of town, where we kayaked and later enjoyed the sunset with a BBQ dinner. Steve also took me on a tour of Scone, it was interesting to learn about the amazing horse stud industry that surrounded the town. Scone has one of the largest Vet clinics in the Southern Hemisphere and is home to the Emirates stud which charges up to $40,000 a hit!
On Tuesday I was lucky enough to spend time with another local GP, Dr Peter McInerny, whose sub-specialties included gastro, obstetrics, anaesthesia with bouts of ED visits in between. He has quite a reputation in Scone, even other local doctors come to see him. He also makes monthly visits to a small town called Coonabarabran, West of Scone using his own small aeroplane to do a list of scopes, sadly my timing for a flight wasn't quite right. I spent the day in the operating room watching everything and helping anaesthetist, Dr Larissa Bourke, with sedation for Gastroscopes and Colonoscopes. Peter also gave me a great tutorial on how to use a scope. I really enjoyed linking all my recent study of gastro anatomy and pathology to a real clinical setting. Later I learnt that many GPs in Scone have sub-specialities and that most participated in ED work. It was interesting to learn about the satisfaction this extra work added to their working week.
On Wednesday and Thursday I sat in Steve's clinics, I enjoyed taking histories and was able to participate in many of the physical examinations. I was impressed with the rapport Steve had with his patients and the sheer number of people he knew in the community. Managing a large base of patients as a GP, being involved in the local school and church meant that together Steve & Jenny knew just about everyone in town. Close family friendships and connections with so many people was so nice to see. We also made an afternoon visit to the local nursing home, I was glad to see that in-house residents were well cared for, it was a relief to see this compared to much larger city based homes that I had visited in the past. It's nice to know that although the latest facilities aren't always available in rural areas and specialists aren't always close by, the attention to holistic, individual patient care is exceptional.
On Thursday evening Steve took me down to the local Scone tennis club where we joined a local tennis social night. It was good to see so many people turn up and get involved. On Friday morning I was able to spend an hour with the local radiographer, who gave me a good run down of CT scans and their use in general practice. An hour with a physio and time with the nurses was also extremely useful. After lunch, Steve & Jenny took me on a magnificent tour of the Hunter Valley and the region. We visited a number of wineries, a cheese factory and an olive tree estate, it was fantastic.
The week had gone way too quickly and I was sad to say to goodbye to Scone and the Sylvesters. I had a great time, a massive thank you again to Steve and Jenny for having me to stay, showing me around and organising my week. I hope that I will visit Scone again in the near future. My only regret is that this glowing report might send all future HUGs students to Scone and the Sylvester family.
I was very excited to hear that the location of my working HUGS adventure was Scone, a town of approximately 5000 people, located north of Muswellbrook, about 270km north of Sydney. I was hosted by Dr Isobel Lang and her husband Ross, and I promptly "googled" their names to find out as much as I can. To my delight, I read that Dr Isobel Lang arrived in Scone to do a 6 month locum position and loved it so much, she was still there 5 years later.
My week in Scone was riddled with so many great clinical experiences and I've attempted to list some of them here. They included observing colonoscopies and gastroscopies in the search for premalignant polyps, assisting in skin lesion excisions and punch biopsies, neonatal and antenatal visits, insertion of Implanon and Mirena, giving vaccinations, INR and BGL checks, diabetes checks, recording ECGs, doing nursing home and home visits to patients with a wide variety of chronic and mental health conditions, triaging patients in Scone Medical Practice, and watching the full labour and birth of a beautiful baby girl. And that was all in 5 short days!
I was able to be quite involved in assessing and triaging patients from all walks of life. Hearing diastolic and systolic heart murmurs through my own stethoscope and examining a patient with severe heart failure and ascites are the sorts of things that will stay with you for a long time. But what has really captured me is the spirit of generosity and the sense of humour of the patients and friends I have made in Scone. There wasn't a single person who refused being examined or treated by "the medical student" and I was very grateful for the stories and experiences shared with me.
In every sense of the word, it has been a privilege to learn from Dr Lang and the incredible community of nurses, midwives and doctors in Scone and I am so thankful for my time there. It is important for medical students to realise that there is a whole new world in rural medical practice and you will never know what you're missing until you seize the opportunity to immerse yourself in a community and learn from them. A huge THANK YOU to Liz Wragge who arranged my perfect week in Scone and to Dr Isobel and Ross Lang for welcoming me wholeheartedly into their home. I really hope to visit again one day. Country life and medical practice has won me over.
In December, I was fortunate enough to spend a week in Lithgow with Dr Asaad Baraz, his wife, Nikki and their 2 playful young boys, Joseph and Ben. I had passed through Lithgow many times on my way to and from Sydney but I had never taken the time to stop and visit the town. The HUGS experience not only allowed me to explore the Lithgow area but most importantly, it exposed me to the inspiring work of Dr Baraz and his colleagues and also gave me a real appreciation for the integral role the general practitioner plays in a rural community.
My week started off with Dr Baraz in the general practice where I got to witness lots of skin biopsies, sutures, excisions and cryotherapy treatments as well as management of chronic medical conditions. What I found most valuable was how Dr Baraz treated the patient rather than their condition and how rewarding general practice is in terms of developing patient rapport and the opportunities it affords for patient education and preventative health practices.
During the week, I also sat in on consultations with Dr Zolfaghari and Dr Golder which provided a terrific opportunity to see different approaches to patient care and education. I spent time with the practice nurse who performed diabetes assessments, wart treatments, general health assessments, blood pressure and INR checks. Another morning was spent with the visiting psychologist, an experience that I valued as I feel as medical students, we do not always get exposed to the range and roles of the various health care providers to which we may refer our patients to in future years. In addition, I went to see patients at the nursing home with Dr Golder and even went to the funeral home with Dr Baraz!
Outside of the practice, Dr Baraz and Nikki really welcomed me into their home and were wonderful hosts. I got to play and laugh with their 2 young sons and also got to meet some of their local friends at a big BBQ. I did go for plenty of sight-seeing walks with the highlight being Hassans Walls Lookout which was still spectacular even if there was a lot of cloud cover and mist!
I could not recommend the HUGs program more highly to medical students wishing to experience what it is really like to live and work as a general practitioner in a small community. It was a very rewarding experience and I know that in the coming years when I feel weighed down by the mountains of exams and study, I will remember my time in Lithgow and know that it is all worth it! A big thank-you to Liz Wragge for organising the experience and to Dr Baraz and Nikki for making it so enjoyable.
Over the mid-year break I was privileged to spend a week in Gerroa, with Dr Emma Gilchrist and her family! Albeit very nervous when I first arrived, Emma, Glenn and their two gorgeous children made me feel very welcome and comfortable.
After having lunch with Emma’s extended family overlooking a beautiful river, we headed back to their house. The whole area is incredibly picturesque, and the coastline is stunning! After settling in at the house, I headed out to the local Lions club with Glenn to hear him speak about his time in Timor with the Australian Army. It was a really interesting night and the locals were very welcoming!
Emma works at a Kiama Medical Practice, approximately 20 minutes away from Gerroa. The days at the practice were so busy! I couldn’t get over the variety of patients who walked through the door. We seemed to see a patient with a problem from every specialty in only one week! I was so amazed at the breadth of knowledge needed in rural general practice. It was so great to see so many different medical problems, and also to watch how Emma dealt with each one. I also really enjoyed getting an experience of women and children’s health and seeing prenatal and antenatal visits. It was really lovely to see the close relationship and rapport Emma had built with so many of her patients, which is so special to rural general practice!
On the weekend we headed down to Jervis Bay, which was absolutely beautiful! With white sand and gorgeous blue water it was so serene. We had a yummy picnic before having a walk on the beach and then narrowly escaping the rain!
Overall it was a really fantastic week and I gained such a new insight into rural medical practice! Thank you so much to Liz Wragge for organising this great week, HUGS is a fantastic program and I highly recommend it. Thanks also the staff, nurses and doctors at Kiama Medical Practice for having me and being so kind. I appreciated your willingness to show me anything exciting that came through the door. And, of course, thank you to Glenn, Emma, Nicholas and Lara for having me in your home and helping me to have a wonderful week enjoying the rural lifestyle!
This summer holidays, I was lucky to attend a weeklong Working HUGS placement, organized by NSW RDN’s Rural Medical Family Network. I was in contact with Liz Wragge- the coordinator, who arranged for me to go to Muswellbrook and stay with my lovely hosts, Dr Trasi and his wife Arti. In one short inspiring week, I was able to experience the life of a rural G.P, learn about the benefits and challenges of working in a rural area, while discussing topics and techniques that have not been covered as of yet in my medical education.
After a very long drive, I arrived in Muswellbrook on Monday night, and was eagerly looking forward to the events that this placement would hold. Dr Trasi and Arti warmly welcomed me into their beautiful home and we enjoyed a wonderful South Indian meal while getting to know one another.
The next morning, I accompanied Dr Trasi for rounds at the hospital in the maternity ward where I was able to see an ultrasound of a baby for the first time! On arriving at the Brook Medical Center afterwards, I was greeted by the staff and doctors and learnt about the practice and the services available.
I spent the first day with Dr Trasi, whose consultations mainly focused on Obstetrics and Gynecology. I really enjoyed observing the doctor-patient consultations and learning about different cases and the management plans. I also was able to learn and practice some practical skills such as taking blood pressures, listening for a fetal heartbeats and locating the position of a baby on ultrasound. Between consultations, Dr Trasi was keen to answer any of my questions and discuss the cases- my empty notebook began to fill up with all of the new information I was learning.
I really enjoyed the holistic and continuity of care aspect of general practice; most of the patients had been seeing the same doctor for many years, so they had a strong doctor-patient relationship. I now have an understanding of the important role that rural General Practitioners have in their local communities.
For the remainder of the week, I was rotated between different doctors, and also spent time in pathology and with the sisters. I was even able to assist with some minor operations involving the removal of skin lesions, performing punch biopsies, and a knee aspiration.
It was interesting to see the practical side of the theoretical knowledge we learnt at university. I performed dipstick tests, looked at hematology slides, and learnt about blood and urine collections. The sisters were surprised at how quickly I was able to fold surgical drapes for sterilization!
I also learnt about some of the challenges that rural doctors commonly face, for
example during my stay, there was limited anesthetic cover for the maternity ward, which meant that many women had to be transferred to Maitland to deliver their baby. The challenges and medical issues are difficult to comprehend unless one actually experiences life as a rural GP firsthand, which I have
now been able to do.
I really enjoyed my stay with Dr Trasi and Arti, who made me feel welcome as soon as I stepped into their home. From dinnertime conversations about Muswellbrook and the practice, to telling me their favourite places for lunch and laughing over My Kitchen Rules, I was really glad to have spent my time with great hosts. Arti also took me for a drive and showed me some of the things Muswellbrook has to offer, such as the increasing coalmines, a beautiful golf course, the racecourse, along with the schools and churches.
I would like to thank Liz Wragge who organized the Working HUGS
placement, my hosts Dr Trasi and Arti, and the staff of the Brook
Medical Center who helped me experience as much as possible during my stay. With their help, I have now gained an understanding and appreciation of rural general practice and patient centered care.
Last summer I was fortunate enough to be selected for a week long a ‘Working HUGS’ placement run by the NSW RDN’s Rural Medical Family Network. I spent the week in Cowra, living and working with the rural GP Dr Dave Richmond and his lovely family. I can happily say that this placement was one of the most enjoyable and inspiring experiences of my medical education thus far.
I arrived in Cowra on the Sunday afternoon before the week of the placement and met Dave and Jen Richmond at a BBQ lunch at a gorgeous vineyard owned by their friend. I was immediately made to feel extremely welcome by Dave and Jen and the BBQ provided a great opportunity to meet some of the locals who were all very keen to have a chat. We then headed back to the Richmond’s lovely family home and I quickly settled in over dinner and good discussion about the joys and challenges of rural medicine and life in the country.
Over the week that followed, I could not have been much more impressed with the medicine that I witnessed. Dr Richmond and his colleagues at Cowra Medical Associates not only serviced the town as GPs but they also collectively ran Cowra Hospital. I was amazed that these local GPs were able to conduct so many procedures as well as manage the anaesthetics in the operating theatres and also act as the town’s obstetricians. As such, I was very fortunate to have the opportunity to ‘scrub up’ in theatres for the first time in Cowra as well as see my first full childbirth, a truly amazing experience. I quickly learnt two things about country doctors; they work really, really hard and they can do just about anything!
Dr Richmond was a fantastic mentor and he was all too happy to teach me something about every case we saw together. Given the huge workload and sheer volume of patients that we saw, I felt as though I was learning more each day of the HUGS placement than I was each full week of uni! Some of the cases that we saw were also quite complex and I quickly gained an appreciation for some of the numerous challenges that face both rural doctors and patients. Yet, despite the volume and complexity of the patients we saw, the holistic nature of care provided by Dr Richmond was quite inspirational. There were no ‘throw away’ cases, for every patient Dr Richmond efficiently came up with a plan that was tailored to the patient’s own circumstances. I loved seeing this kind of patient centred medicine in practice and it certainly made an impression on me.
Whilst I thoroughly enjoyed learning about all of the wonders of rural medicine during the HUGS placement, I learnt some lessons the hard way when it came to cycling. In my correspondence with Jen Richmond before the placement, I had heard that Dr Richmond was a keen cyclist so I thought I would be a good idea to bring my new road bike along with me so I could join in on some of early morning group riding sessions. Dr Richmond was all to happy for me to come along so at the crack of dawn on the second morning of the placement we met up with 20 or so other cyclists and set off on the ride. As it happens, I had never cycled with a group before but I felt I was dealing quite well with the pace of the group so I took it on myself to work my way to the front of the pack, chatting with people as I went as if it was all going smoothly. Unfortunately, I had severely underestimated the fitness of the Cowra cycling group and after a solid 15 minutes of sitting at the front of the pack, and busting a gut to stay there, I was forced to retire to the back of the pack, and then to several km behind the pack until I could no longer even see them. Luckily Dr Richmond cycled back to get me for I am not sure I would have made it back otherwise! We went cycling on two other mornings during the placement although after this first experience I sat humbly at the very back of the group and focused all of my attention just to keeping up.
Aside from the cycling expeditions, every day I made the time to fit in some local sight-seeing and in the week I was there I grew quite fond of the Cowra community and its surrounds. I particularly enjoyed seeing the historical site of the Cowra breakout and the Japanese gardens and also driving out to the neighboring towns of Greenethorpe and Canowindra. Yet despite all of these amazing experiences, the one part of the placement that made it really great was getting to know the Richmond family. Over the course of the week I was taken aback by the hospitality of Dave and Jen and their three lovely girls Grace, Phillipa and Sophie and I hope to remain in contact with the Richmonds in the future.
I’d also like to say a big thanks to Liz Wragge who organizes the Working HUGS placements. I really appreciate her support both in the lead up to the placement as well as afterwards. If it were not for her hard work then I would never have had this opportunity. I thoroughly recommend the Working HUGS placement program to any 1st and 2nd year students who would like to learn more about rural medicine, who enjoy a bit of an adventure and who love to have a great time! I can guarantee you will be amazed at the people you will meet and the things you will discover!
The eight hour train and coach trip to Mudgee offered ample time to contemplate and become suitably nervous about my weeks stay with the Hawkins. The magical hues of the sunset playing on the highlands served as a welcome distraction. However, any remaining feelings of trepidation were swiftly swept away when I was greeted by Nikki, and later at home by Peter. Much to my relief, I felt right at home from ‘hello’, so much so that I forgot to let my parents know that I had arrived!
After a well-deserved nights rest, it was straight off to the practice. Before I even had a chance to take out my blank notebook, the first patient had already arrived. It was truly humbling to see the mutual respect and trust Peter has built over his many years of practice. I feel privileged to have witnessed such patient-doctor interactions early in my studies, as they set a standard which I aim to meet. Each consultation was accompanied by the sound of rapid scrawling and furious page turning, and as the week progressed my stiff and shiny notebook took on a progressively scruffier appearance. Peter and the staff at South Mudgee Surgery took every opportunity to expose me to as many ‘hands-on’ experiences as possible. I was a perfectly happy onlooker of a toenail removal, but was given the task of performing local anaesthetics and cryotherapy in the removal of skin lesions; two successful firsts in my career!
My time with Peter also afforded me the chance to learn more about issues regarding patient assessment and management in a rural setting. Between consultations, we often discussed attitudes towards health in Mudgee and problems arising from long waiting times to see specialists including delayed diagnosis and treatment. A nursing home consultation demonstrated the scope of Peter’s responsibility as a health practitioner in Mudgee, serving not only patients at his practice but also in the wider community. An added bonus to my learning experiences was a generous invitation by fellow medical student, Vanessa, to a video conference with peers stationed at Broken Hill. The detailed breakdown of an infantile cystic fibrosis case and ensuing discussions about similar clinical experiences further triggered my itch to start more intensive clinical-based learning, which I hope to pursue this year during my hospital placements.
A varied and fast-paced day at the practice was never complete without an equally thrilling evening spent with the entire family. A scenic drive with Nikki let me in on Mudgee’s best-kept secret; its vineyards, and later I struggled to stifle my inner ‘finger-pointing’ tourist when seeing wild kangaroos around the block. The following afternoon I assumed a time-keeping role for the children’s swimming races which left me impressed by their competency but a touch too wet for my liking! Great food and great company made for a wonderful mid-week dinner with Vanessa and Peter’s mother, who spoke candidly about her experiences as a general practitioner in Alice Springs. Spending the full day with Peter made me appreciate the flexibility that being a general practitioner affords. From dropping off the children at school to tucking them in at night, a general practitioner’s life really does allow one to have it all.
My week in Mudgee proved to surpass all that I had previously envisaged. I was truly inspired by observing a doctor practising in a manner which embodies the values and qualities I strive to develop throughout my career. My experiences have also more clearly defined the balance I aspire to achieve between my career and family life. Aside from my clinical learning, my time with the Hawkins has forged a friendship that I have no doubt will continue for many years to come. I cannot express my gratitude enough towards Peter, Nikki and their three children for their hospitality, as well as the patients and staff of South Mudgee Surgery who were most accommodating, and Liz Wragge for organising such a memorable and life-changing week.
My placement with Dr Saab Baraz at Lithgow Valley MedicalPractice was one week which has changed the way I think about being a General Practitioner in a rural community. He and his lovely wife, Nikki Baraz welcomed me into their beautiful home with their two adorable sons who are only 18months and 3 years of age! I learnt a lot about what it takes to be a rural GP, the advantages, the challenges as well as the community - Lithgow!
The 5 days were jampacked and very exciting, where I was rotated between different doctors, the practice nurse and the nursing home visit. I got to view and assist with excisions of skin cancers such as SCC and BCC, punch biopsies and injections. Although it was very hands on and put my practical skills to the test, the most interesting was talking to the doctors alone after a patient consultation about the differential diagnoses. It amazed me that with just a symptom that the patient described, the doctor was able to draw out a list of differential diagnoses, organize blood tests to exclude the top options. This skill amazed me and I hope one day, I will be able to do that without looking like I’m in extreme contemplation or thinking mode!!!
The accommodation with the doctors was amazing, learning about what it’s like balancing the medical career with children. The two boys were such a handful – from laughs and giggles to suddenly a tantrum and then back to laughing in a blink of an eye. This provided another perspective about the life of the rural doctor and family outside of the medical practice. I think this was the most important and unique opportunity the HUGs programs gives you. To be able to imagine your life as a rural GP not only in the medical practice, but at home. This holistic perspective really motivates me to become a rural GP in the future.
The patients who came into the clinic were very welcoming, curious and just lovely people in general. In my free time during the lunch breaks and weekends, I visited the sights around the town. The was a road filled with boutique cafes, a reserve for endangered animals, a glow worm cave and lookouts that would take your breath away. I loved the fog in the mornings, the frost on the grass and then around 10am, the sun would peak through the fog and bring about a warm sunny day.
I had been eagerly anticipating my placement with the RMFN for nearly a year, and was very excited when Liz Wragge, the coordinator told me I would be heading to Muswellbrook over my winter break. It was raining heavily while I travelled there, but as Muswellbrook approached, the rain cleared a little and I was delighted to see the rolling hills and the herds of wallabies grazing in the fields. Dr. Trasi and his wife, Arti, were my hosts who warmly welcomed me to the town. I was initially surprised when I first arrived in the evening to head out again straight away with Dr. Trasi for a brief round at the hospital, but enjoyed being so quickly immersed into the routines of rural medical practitioners.
When we arrived at the Brook Medical Centre the next morning I was warmly welcomed by the staff and doctors there. In the first morning alone, I saw and learnt more clinical knowledge from the doctor and patients than I had before. There was a wide variety of patients presenting for many reasons and it was exciting to not know who would walk through the door next. Over the next week and a half, as I was rotated around the various doctors in the medical centre, I learned the different techniques and skills each doctor was unique in and observed how they built rapport with their patients. I had not realised before how flexible a rural general practitioner was with their skills and their vast knowledge base.
In my short time there, I saw many different cases I would not have otherwise seen for a few years yet in the urban hospitals, and had the chance to talk to and examine many patients first-hand. The patients were all very friendly and willing to share their stories with me. It really felt like I was becoming part of the community especially when I would bump into patients down at the shops and they would recognise and greet me!
I was also given the opportunity to travel with the community health services to surrounding areas with a community health nurse and an occupational therapist. It gave me the chance to see different households and the spread of people over the local area. In addition to this, I spent some time with the diagnostic imaging area and was taught many new things about diagnostic skills, and had a brief morning in the operating theatre assisting the surgeon. There was always something to do and learn there and I even participated in an evening class regarding cardiopulmonary resuscitation (CPR) with the staff at the medical centre, learning many more skills while having a lot of fun!
I especially enjoyed my stay with Dr. Trasi and Arti where I was privileged enough to get a taste of different indian foods over many stimulating dinner time talks that ranged over medical, rural and World issues. Dr. Trasi had extensive experience in gynaecology and obstetrics and was on call the weekend I was there for any obstetric patients. On the Sunday night, he was called in to check on a woman who had just began labour. I accompanied him in the early hours of Monday morning and was able to witness for the first time a delivery of a baby! Not only that, but the midwives allowed me to participate and catch the newborn as he was birthed, and the family gave me the honor of cutting their child’s umbilical cord. This was something I would not have witnessed for at least another year or more in the urban teaching hospitals and I felt incredibly blessed to have been present for it.
I am very thankful for Liz Wragge who was the main coordinator for this placement, and also to my hosts, Dr. Trasi and Arti. I am also grateful to the doctors and staff and patients in Muswellbrook who helped make this experience so memorable and valuable. It was with great reluctance that I said good-bye to the people I had met in Muswellbrook. I had an amazing taste of what it is like to be a rural general practitioner, and hope to one day return to stay as part of the rural community!
The location of my HUGS Placement was Armidale in the Hunter New England region, which is approx. 8 hours on the train from Sydney. It was an unconventional placement as I was not living with my mentor but that did not change the fact that it was fantastic, and it was one of the fastest moving weeks of my life.
My placement was with Dr Rod Martin, a very enthusiastic local GP who has a few areas of expertise. The experience that I gained was what I had hoped: an understanding of the significant and crucial role that rural GP’s play in their communities.
When talking to individuals in the community in Armidale, and in other rural areas, a recurring theme was the need to express the feeling that there are not enough GP’s in Australian country areas. It dawned on me that this is an understatement. It is not something completely understood until one integrates into the life of a rural GP. I gained a lot of respect for the role as it requires utter devotion and a continuous desire for better health – I found myself leaving the practice after 8pm, and I was leaving early! The practice was very busy throughout the whole day.
In the clinical setting, I observed a variety of procedures from suturing to finding foetal heart beats to circumcisions. There were also some very interesting clinical presentations. An observation of the doctor patient relationship was the importance of the development of mutual trust and rapport. Being from Sydney originally, I did not understand the wide encompassing expectation of some GP’s in Armidale. Dr Martin was not singularly a GP, but also an obstetrician, requiring lots of antenatal visits.
This experience has improved my understanding of clinical medicine. The whole picture of medicine is becoming clearer, and my studies now have more meaning and greater relevance in the context of seeing where I will be in 10-15 years.
I would like to take this opportunity to thank Dr Martin for taking me for this placement, as well as the Practice Manager at Rusden Medical Centre, and the nurses for being so supportive and trying to show me as much as possible. I would also like to thank Liz Wragge for organising the placement. Without her I would not have been able to improve my skills and understanding as a student.
Also to any medical student thinking of acquiring some rural medicine experience, I strongly recommend that you organise spending some time in a rural area to widen your horizon. I put it off for a year and a half and now wish I had done it earlier!
On arriving in Ballina airport, I was picked up and driven to North Coast GP training office, where Dr Linda Brown worked as an educator there on Wednesday and Friday. We discussed the plan for the week in the car. I was delighted to find out I was not only going to gain medical experience, but also I was going to experience life of a rural GP.
I felt so welcomed at North Coast GP training office. While Linda was replying some emails, I looked through the information given by other staff there. Once sorted, we went back to her house, where I met her husband Ross, and their children, Katie and Gus.
I was lucky enough to sit in with Linda for three days in Alstonville medical centre during the week. Within this period of time, I appreciated that rural general practice is much more interesting than I expected. Rural GPs are required to have more skills and broader knowledge of every discipline, including neurology and dermatology. After all, it is inconvenient for many patients to travel a long way to meet a specialist. I could understand that referring to appropriate specialists for further investigations is so important. One of the most exciting experiences during that week was that I saw a skin graft done by Linda’s colleague, Dr John Watts. It was the first time that I saw a real minor procedure. I was motivated by John’s skills. The skin graft was done nicely but quickly.
The medical experience I gained in Alstonville medical centre was a good introduction to a variety of problems that may be present in rural general practice. I was shocked to see so many patients coming for mental health issues, such as depression. I was told the statistics of prevalence of mental problems in Australia in lectures, but I couldn’t comprehend how serious this problem is nowadays until I really saw so many patients every day. Everything became real to me. As a second year medical student, I did not have much experience about dealing with depression or anxiety. However, I definitely gained some insights into how to approach and comfort an emotional patient. It was particularly great to see how Linda talked to patients and how she thoroughly assessed the patients from verbal and non-verbal clues. Unlike many urban GPs, I felt that doctors there were spending more time with patients. Linda always explained test results to every patient in non-medical terms clearly to make sure that they understood their health status. In this way, from my perspectives, patients had more trust in her.
In addition to precious clinical experience I obtained, I also got a taste of country life. I was warmly welcomed by the Wilson family and their neighbours and felt at home straight away. They live on a farm, where I have never been before. I could not access the internet on my computer at their house. Initially, I thought I would ‘die’ without internet for a week. However, in fact, there was much more fun in country life. Katie and Linda are very fond of cooking. In the free time, we baked some biscuits and cakes together. It was great to taste the food you cooked. On that Sunday, we went to Byron Bay, where I appreciated the most as someone who grew up near ocean. In my free time, I was also fond of reading books under the sun. I enjoyed the warmth and peace there.
It was certainly one of the most exciting and precious learning experiences I have ever had. Besides clinical experience, I also learnt a different way of life. I would like to say a huge thank you to Liz Wragge for arranging my trip and also to Linda, Ross and Katie and Gus for making me feel so welcomed and teaching me different things, as well as to all staff at Alstonville medical centre and North Coast GP training for making my learning experience more enjoyable. This trip certainly provided me a precious outlook on rural general practice and I will definitely consider being a rural GP in the future.
On arriving in Nowra, on the NSW South Coast, I was generously welcomed into the home of Dr Dominic Frawley and his wife Maggie, in preparation for a week long rural medical experience in Dom’s General Practice. Not really knowing what to expect, I was made to feel at home straight away over a family dinner with lots of chatting about living in Nowra, and getting to know the family! My welcome to Nowra and my introduction to the peaceful rural lifestyle was made complete when I was treated to a sunset tour of the local Showground and the Shoalhaven River by Maggie and Dom’s kids, Malachy, Niamh and Seamus.
It wasn’t until Monday morning though, when I left with Dom to head to the surgery, that I really appreciated the convenience of living in a small town. After living in Sydney my whole life and being very used to a lengthy commute in bumper-to-bumper traffic, I realised how much more usable time you can have in your day when your morning commute to the surgery is only a 100 metre walk down the street!
The medical side of my experience in Nowra was a great introduction to the variety of things that present in a rural General Practice. During my few days at the Junction Street Practice, I had the opportunity to observe numerous consultations with patients presenting with a huge variety of medical conditions, and was able to get some hands-on involvement with different types of physical exams, skin biopsies, giving vaccinations, and setting up ECG’s.
The most useful thing for me during my time with Dom was seeing the way he communicated with patients, particularly with those presenting with Mental Health issues. As a second year medical student, I haven’t yet had much hands-on experience with dealing with depression and Mental Health plans, especially in a general practice setting. Although it was a little confronting to begin with, I learnt a huge amount by seeing interactions between the Doctor and Patient in dealing with these issues, and definitely gained some insight into how a patient can be put at ease, especially when talking about their problems for the first time. It was really nice to see how thoroughly patients can be treated in a rural setting where the doctors seem to have a bit more time – despite being a busy practice, from my perspective, it certainly never felt like the doctors were trying to “push their patients out the door”, which is certainly a feeling I’ve had as a patient when visiting GP’s in Sydney!
My final “medical” day in Nowra was spent doing home visits and seeing patients in some of the Nursing Homes around the area (which doubled as a guided tour!), which certainly gave me a more rounded experience of general practice, and an opportunity to learn a bit about the workings of Aged Care Facilities – certainly a large part of practicing in a smaller town!
My visit was made complete by a trip to explore the beautiful beaches around Jervis Bay, a very pleasant 20 minute drive from the centre of town. As someone who has grown up near the coast and has a huge appreciation for the ocean, the prospect of spending more time here certainly is tempting!
I’d like to say a huge thanks to Liz Wragge for organising my trip, and also to Dom, Maggie, Seamus, Niamh, Malachy, and all the staff at Junction St Medical Practice for making me feel so welcome during my stay, and making my experience so enjoyable.
As I drove the last 100km towards Coolah at sunset the words from an email my host family had sent me were reverberating around my head “make sure you’re here before dusk as that’s when the kangaroos start coming out”! Worried at the thought of having to confront a kangaroo, which I had only seen pictures of, I was keeping my eyes peeled for any sign of one while hoping that around every corner I would come into Coolah. After what felt like forever I arrived and following the directions sent to me found my host family’s house without any kangaroo incidents.
I was welcomed into the home of Dr Tilak Dissanayake, his wife Donna, and two children, Hamish (4) and Eromi (2), and was quickly made to feel very welcome. I learnt that as well as being Coolah’s only GP Tilak was also the VMO for the Coolah Hospital which many evenings and weekends he was on call. As I accompanied him around the next day I saw what a full and varied day a rural practitioner had; we started with a ward round at the hospital, then a morning at the GP surgery, on the way home for lunch popped in to see a couple more patients at the hospital and after lunch it was back to the surgery to see more patients. It was interesting to observe how Dr Tilak treated different patients and also to receive insight into how different practicing rurally was. For example with no practice nurse things like blood taking were done by the doctor during the consultation. I enjoyed how people weren’t so rushed and I found all the patients very welcoming. However I was also exposed to the challenges of rural practice which mainly involved lack of resources, for example the hospital didn’t have x-ray so if an x-ray was required the patient had to travel about an hour away to get one. This meant having to rely more on signs and symptoms as opposed to investigations to decide a course of treatment for a patient.
As Dr Tilak had considerable surgical experience I was also lucky enough to assist for a day in his ‘lumps and bumps’clinic where he took biopsies of suspicious moles, froze precancerous lesions and removed more sinister moles. This again emphasised the breadth of services rural practitioners can provide without which people may have to travel well over an hour away to receive.
As well as spending time at the hospital and GP surgery I got a taste of country life. I spent some very enjoyable afternoons in the community pool with the children as one thing I never quite adjusted to was how high the temperatures were! I ate out at the local bowling club, went to the Binnaway Races, visited the Dissanayake’s farm and had a lovely evening out at a vineyard in Mudgee!
I had a fantastic time away with the Dissanayake family and am very lucky to have completed the HUGS program. It has motivated me in my studies and taught me techniques particularly in communications. I cannot thank Tilak and Donna enough for hosting me, the town of Coolah for welcoming me or Liz Wragge for organising the placement. Most importantly my trip has given me a very positive outlook on rural practice and the variety it can bring and is a option I would consider once I’m qualified.
By Luiza Peculis - Boggabri
Expecting to solely spend a week with local GPs Janet and Philip Briddon, I was surprised and delighted to find out Janet had other plans for my week in Boggabri.
Upon arrival at Boggabri train station I was picked up and driven to the hospital to observe as Janet swiftly dealt with some not so average Sunday afternoon emergencies. Once sorted, we went to meet her husband Philip and their kids, Ross and Lara, at the local golf course, where the ‘greens’ are sand and the only danger of using the toilets are frogs in the bowl!
I was fortunate enough to sit in with both Phil and Janet at their clinic for two days during the week where I realised rural general practice is so much more interesting than I had expected. From baby checks to skin checks and from every specialty problem including neurology and haematology, I could see how important it is to have a broad knowledge of everything in such a rural setting. After all, referring a patient to a specialist two to three hundred kilometres away for regular check-ups isn’t always feasible.
Having had my fill of medicine for the holidays, Janet organised for me to spend a day at ‘Kilmarnock’ – a cotton plantation just out of Boggabri – owned by Robyn and John Watson. I spent Tuesday learning not only about the challenges and rewards of cotton farming, but also about the important conservation work that Robyn has been doing with LandCare to help preserve the 35 odd kilometres of river that runs through the family’s various properties. To top off the experience I was asked to help John with some irrigation, hard work in the scorching Boggabri sun!
The highlight of my week was when I spent the day with local drovers Robert and Anita Grothe. With my limited riding experience, I was to ride Josie, a gentle natured mare who at times had more interest in eating grass that getting up to a trot! We were to help move 600 head of cattle near Breeza, but Josie had other ideas! When not moving the cattle we were determined to stay out of the sun and remain cool in the 45 degree heat. Chatting to Robert and Anita was definitely an eye opener into the real drover and country lifestyle and as the sun began its descent from the sky I found myself reluctant to leave. I had only one day left in the country and I was getting used to it!
Tamworth country music festival was fantastic! The atmosphere was electric with buskers lining the main street, reptile shows to please all ages and more Akubra hats than I’ve ever seen in my entire life! Having bought my obligatory festival tshirt we quickly swung past the golden guitar for a few photos and then were off to Tamworth Base Hospital for a guided tour of the emergency department. We finished the day in Narrabri for dinner at the Outback Shack where my week in country NSW would come to an end.
Chatting with Janet and Philip throughout the week I was able to learn, from genuine rural GPs, the advantages and challenges of both rural practice and the country lifestyle. My week in ‘Boggy’, as I fondly came to know it, was definitely a week to remember and I only hope that one day I’ll be able to return and catch up with the Briddons and all the friends I made during my very short stay.