My Rural Story | Week Four | Allegra Boccabella

AUSTRALIA’S RURAL, REMOTE AND INDIGENOUS HEALTH #MyRuralStory

Featuring Interviews from the brand new 3rd edition of Australia’s Rural, Remote and Indigenous Health by Janie Dade Smith

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-Week Four -

A llegra Boccabella Third Year Medical Student - Bond Universityy

W hat T o T ake O n Y our R ural P lacement BRING I

Toys Make sure that you bring toys with you. You’ll be dealing with lots of little kids!

Knowledge of the Community It’s not just about the patient and the medicine, it’s everything wrapped around it.

An Open Mind While we like to think that medicine and science is an absolute and that wherever we go it will be the same, it’s not

Something to Fill Your Quiet Times There are no cinemas, often no pubs so explore your hobbies and spend that time learning to develop yourself

Reference Texts Because you can’t leave home without them!

Contact With Home It can get stressful so make sure you keep in touch with friends and family

Your Favourite Snacks Be sure to pack yourself a care packa ge

Allegra Boccabella

My name is Allegra Boccabella and I’m a third year medical student at Bond University in Queensland. My remote experience started in 2012. I was on a gap year and I can’t really remember why I decided to do it, but I wanted to experience something different. So, we had a family friend who was an Ear, Nose and Throat Surgeon who did specialist outreach in Cape York in Queensland. So, I asked him if I could come along for a trip and he said yes and I’d be coming along as the Audiological Assistant. So, I did that for a week and I absolutely loved it, it was great and I managed to convince him to let me go again. It’s been four years now and I’ve managed to go back six times into a whole

bunch of different communities. I’ve been to Arukun, Pormpuraaw, Kowanyama, Lockhart River and Napranum. Basically the setup is that we have the Ear, Nose and Throat Surgeon, the Practice Manager, the Audiologist and the Audiological Assistant, which is me, that goes up in the group. We basically fly into Cairns the night before the clinics start, and on the morning of the first clinic we get up nice and early and fly in a little plane from Cairns Airport to the first community. At the end of the first clinic, which is at the end of the first day, we fly back to Weipa, which is a remote centre, and we stay there overnight.

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On the second day, we fly from Weipa to the second community and we’ll do a clinic for the whole day and then at the end of that day, we fly back to Weipa. And then on the third day we fly from Weipa to the third community and fly back to Cairns at the end of it, and then we come home the day after.

Another thing that’s different is the investigations and the sorts of things that you can actually do. In a big urban hospital, you can send someone for scans and you can send someone for tests and you can send them for small procedures. But, when you’re actually making those decisions in a remote area you have to factor in: How far away is that test? Does that person have to fly to Cairns? Is that flight three hours? How much is that flight going to cost? And does this patient really need this or can we make do with something else? So, there’s a certain sense of compromise that you wouldn’t see in a larger tertiary hospital in a city. Another thing is the distribution of staff that you see. So, for some of these smaller communities it will actually be a small primary health care clinic and often there won’t be a single doctor in the actual clinic. So, you’ll have a mix of Indigenous Health Care Workers, Nurses, Nurse Practitioners, and other staff. You’ll also have a lot of specialists that fly in and fly out so they’ll just be there for the day, just like we are, in our specialist outreach team. I think that’s really different because you’ve really got that different team dynamic but it’s also smaller and a lot more friendly, so you get to know a lot of faces, you see people regularly. Sometimes with the fly in - fly out, you actually fly into one community with a group and then see them two days later at a different community, so it is quite fun and you do end up on a similar circuit.

What is different about working in rural and remote areas?

The first thing would be that you’re really working under a strict time frame. Not to say that things aren’t busy in urban hospitals, they definitely are, but in remote areas, when you’re flying in and flying out of a community, you have to be finished by a particular time at the end of the day so you can fly out. So there is that time pressure to make sure that you’ve seen the children, because most of our patients are children, and have everything done within that time frame. So, I think that is quite different.

‘If you want to see the social determinants of health in practice then going to a remote Indigenous community is a really great thing to do.’

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And I think that in an urban context, even though you will see the same people every day, the comradery isn’t the same as you see when you’re in the remote fly in - fly out circuit, and that is quite exciting. What advice would you give to students going on a rural or remote placement? Make sure that you bring toys with you. Particularly, plastic ones that you can easily clean, because often you’re dealing with lots of little kids, certainly in ear health, that’s something that we deal with a lot. So, you need to have something to entertain the kids and then the parents are happy and you’re happy and the kids are happy. And also, stickers and that sort of thing. Just having that with you at all times means that if you do have a patient and you are a bit nervous you can make the atmosphere a lot less tense, and you feel more comfortable,

and you obviously build rapport at the same time, so that’s quite good. The second piece of advice I would give is to make sure that you walk in and introduce yourself to all of the local staff that are working in the health clinic. Whether that be the Nurse, the Indigenous Health Worker, the Doctors or even the cleaner, the locals really do know so much about their community. This can range from practical questions like ‘have you seen this child?’ to ‘I didn’t really know if I could ask this patient this question’ or ‘they looked a bit strangely when I said that, is that ok for me to say?’. Often I’ve found in all of the communities I’ve been to they’ve been really helpful and always really happy to help out whenever you ask. It is really important to remember, in these clinics, that for a lot of these communities, they have different health services coming in

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every single day and sometimes people come and can be short and not very respectful, that this is their clinic. They often appreciate that you’ve made the effort to introduce yourself and get to know a little bit about them. I would definitely say do that, because it’s the respectful thing to do and also, they really help you out when you need them. Ask questions, be happy to be there, be enthusiastic and don’t be worried about getting out of your comfort zone... The third piece of advice would be to make sure that you’re really open with the parents and the community in general. Ask questions, be happy to be there, be enthusiastic and don’t be worried about getting out of your comfort zone and doing that sort of thing. If you talk to the parents, if you ask them questions, if you join in on their jokes, that’s going to make you feel more comfortable and that’s going to make the experience much better for you. What has been one of your best experiences working in these remote communities? We were on a clinic up in, I can’t remember the name of the community, it

was probably Arukun, but basically there was this gentleman who came in with this large sebaceous cysts and the option was that we sent the him to Cairns or that the surgeon did the operation that day. I think I was first year medical school, really excited, but I’d actually never seen a procedure like this done before and the surgeon said ‘we’ve got a medical student, let’s get her in’. So I got to stand in and just before he was like ‘It’s ok, it’s going to be good, I’ve done this surgery so many times, this is not a big surgery so I want you to be able to see everything. This is really going to be something exciting for you.’ So, I stood in there and watched the whole procedure andhewas askingmequestions and drilling me. As a medical student, that’s a moment you dream about for your entire life until you get to that point and being in that situation, that it was just me, him and the patient, was so special. And actually, I’d never considered doing surgery up until that point but we got to the end and I thought: yeah, maybe I could do that. I think if my first experience was in a big hospital with a whole bunch of nurses, a whole bunch of doctors, a whole bunch of people in the room, I wouldn’t have felt as comfortable. I wouldn’t have been able to see so closely, I wouldn’t have been so involved. So, that really was a really special experience that I don’t think you can get outsideof the rural andremoteexperience.

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What have you experienced in remote Australia that has changed your world view? My first experience seeing remote Australia was probably the biggest life changing moment, in terms of my experiences with rural and remote health. I was raised in Brisbane, I’m a self- confessed city girl, that’s something that I really like and I’d never been anywhere like that before. If you want to see the social determinants of health in practice, then going to a remote Indigenous community is a really great thing to do. However, it can be really sad and I certainly found that it was really sad. We live in Australia, that has so many things to offer, and we have this huge inequality in terms of health and educational outcomes with Indigenous Australians and yeah, you hear about it and you read about it, but it’s so different to actually seeing it. The communities that we were going into, some of them are classified as being the most disadvantaged communities in both the state and Australia. So, you really do see a lot of poverty. From the moment we actually got off the plane and went to the health clinic you could really see it. You could see that the houses were run down, some of the places didn’t have doors on them, therewas a lot of pollution, there were a lot of mangy dogs running around and they looked quite sick.

Then when we got into the clinic, I remember that there was a scabies outbreak at the time, so a lot of the kids had scabies. I saw a lot of head lice, not that you don’t see these sorts of things in Brisbane or in urban contexts, you do, but it was much more prevalent there. That really changed my world view and, with a lot of the kids, you saw that certainly they were quite sick and you could really see that there was a disparity in health. Another thing that I remember is that you didn’t see a lot of old people. I didn’t really understand why until I was driven, from this first experience, to go and study public health and I learnt that I didn’t see any old people because Indigenous Australian’s don’t tend to live until they’re very old, particularly those who live in those remote communities. So, I think it’s quite interesting that my first experience was also my most life changing.

‘These communities, some of them are classified as being the most disadvantaged communities in both the state and Australia. So, you really do see a lot of poverty...’

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As a result of working in a remote area, what are your future plans? My plans are to be involved in remote health for the rest of my career at varying levels. After studying public health, I definitely have a strong interest in that side and I really do hope to go on to become a specialist. I hope to participate in specialist outreach, similar to the outreach model that the Ear Nose and Throat Surgeon I’ve worked with does. I don’t want to be an Ear Nose and Throat Surgeon, so it will be something different. But I definitely hope to be able to do that and I wouldn’t mind doing some time even before that as a Registrar or as a

Training Doctor, doing some remote work and maybe some work with the Royal Flying Doctors in the future as well. I would also like to get involved with health policy, particularly in terms of remote and Indigenous health. I think I do have a reasonable understanding of what it feels like to be on the ground and not many people have that experience of actually beinginthosecommunities,beingadoctor and then also having the policy aspect of it. So, that’s all a bit of a dream. I don’t know how much of that I’ll actually get to be involved in but, definitely, I would absolutely love to continue going on with the specialist outreach and really can’t wait until it’s me there in the Doctor position.

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Featuring Interviews from the brand new 3rd edition of Australia’s Rural, Remote and Indigenous Health by Janie Dade Smith

Share your rural experience now to win a copy of the book @ElsevierAUS #MyRuralStory Please note, the transcripts featured within this publication have been taken from live interviews. Any alterations have been made for the purpose of clarity and do not change the overall meaning of the speaker.

To find out more about this, and many other local Elsevier titles, visit elsevierhealth.com.au