Dr JOSHUA WAN
China on his mind
I work two days a week at Hornsby Station Medical Practice in a northern Sydney suburb, and two days a week in an inner-city clinic in Newtown, where I did my GP training. They are both really convenient as I live halfway between the two. I started working in the Hornsby clinic to help me understand Chinese culture a little better, as we have a lot of patients from mainland China and Hong Kong … it also helps me improve my Mandarin! The patient mix is quite different – the inner-city is younger with more mental health and drug and alcohol issues, while the suburban practice is more about chronic disease. I enjoy working four days a week, having a day off in the middle of the week, which gives me time to go surfing! It’s a big difference from the hospital system where you’re working around the clock. It’s really a great change of pace. I finished my exams in 2009, but I still feel like there’s so much more I need to learn in general practice. I was born in the UK and came to Australia with my family when I was three, growing up in Newcastle. I finished high school in Sydney and was accepted into the undergraduate medical degree at UNSW. I think I went into medicine not fully prepared for what it would entail and for the first few years I wasn’t really sure I wanted to continue. In my fifth year, I did my first trip overseas, spending four weeks in Nigeria and then four weeks in a leprosy clinic in Thailand, for my medical elective. Seeing diseases like malaria and tuberculosis, HIV and leprosy – things that you don’t come across here in Australia – was the defining moment when I decided medicine was definitely what I wanted to do. I did my internship at Royal North Shore and spent some time up the coast, in Port Macquarie. I really enjoy the coast as I’m a keen surfer! After my junior resident year, I was really struggling with the hospital environment, working long hours and not really making many clinical decisions. Then I found out about a volunteer role with an NGO in southwest China, working with people who couldn’t access medical services – minority groups and orphans – and doing HIV prevention work. In 2005, I spent about three and a half months in China. I took the Australian Society of HIV Medicine manual with me, but a lot of the medications we use here in Australia were not available. It was really difficult knowing what medication you might have used or tests you could have done, but just couldn’t access over there. Many of the patients were younger than myself and two passed away when I was there because they had such advanced disease. Learning about end-of-life issues – when and how to palliate somebody outside the hospital context – was a steep learning curve for me. It’s not something you see a lot as a junior doctor. I learned so much through that process. When I returned, I realised so much of what I could learn in general practice would be really helpful when applied to developing-country medicine. I spent a year at the Kid’s Hospital at Westmead, then enrolled in the Australian General Practice Training program. I started off in Burwood, which is a very multi-cultural area in
the west of Sydney, where I was able to see a lot of migrant health, as many patients are from Southeast Asia. My first GP mentor also shared an interest in HIV, so that was great. I had a term up at Laurieton, on the mid-north coast of NSW, which has a big geriatric population. Then I spent the last year at Newtown, where I’m currently based. Since then, I have gone over to China, to Yunnan Province, to work for four to six weeks each year. In general practice there’s a real advantage being able to take time off. Each time I go, I visit three or four different sites in the area. Yunnan is a really interesting place, in China’s southwest – bordering Tibet in the north, Burma in the south-west and then Vietnam in the south-east. Each of these sites have their own medical challenges. In the northern, more Tibetan area of Zhongdian, which is about 3,000 metres high, one of the big medical problems is TB. Then in the clinic at Nu Jiang, in the southwest of the province, near the Burmese border – a valley in a very mountainous area – there are high rates of infant mortality, malnutrition and hygiene issues ... and a lot of mental health issues, as well. Then in the south, I work in an area called Xishuangbanna, which has more of a warm tropical climate where there’s a lot of human and drug trafficking. The medical problems there are mainly HIV. It is really so rewarding to be able to use your skills and knowledge to help people in need. General practice gives me those skills – but also, so importantly, gives me the flexibility to take time off to make my trips overseas. I’m just getting ready for my next trip this September when I’ll be focusing on some preventative training programs. In future I’m considering doing some public health training. Each time I go to China, I’m constantly learning. It increases my thirst for learning more and using my skills to help people.
Photography: Mel Koutchavlis
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Going Places – ISSUE #6
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