The Auricle Vol 4 Edn 2

THE AURICLE VOLUME 4 EDITION 2

LETTER FROM THE EDITORS Time’s flying by and we’re almost halfway through 2015. How did the year pass by so quickly?

A watched kettle never boils, and we’ve been watching our calendars eagerly for the bumper events coming up: AMSA Convention, MedBall, MedRevue and, for those in the final year boat, the ever-elusive internship offers.

So whether you’re studying for mid-year exams, battling through your Women’s Health logbooks (where the speculums at?) or reading cover letters until you’re crossed eyed – rest assured that this edition of The Auricle has something for you.

We’ve got a bumper issue on our hands.

From the publication vaults, we’ve unearthed and reprinted one of our best pieces in the last few years –written by students who are now firmly in their doctor years, this is a write-up of a two week volunteer experience undertaken in Papua New Guinea by a fourth and final year medical student. It’s confronting, highly interesting and a beautiful read.

We’re also shining a spotlight on elite athletes currently studying medicine at Monash. Talk about burning the candle at both ends! These students are absolute powerhouses who are juggling two impressive workloads at the same time.

Later on in the edition we hear from pre-clinical students who are participants in the John Flynn Placement program – going to places as far as Batchelor in the Northern Territory to Broome in Western Australia. They’ve worked with rural, remote and Indigenous communities and have fascinating insights to share on the disparity of healthcare experienced there, as well as the wonderful things on offer for people interested in applying in the near future.

There’s also an O-Week and MedCamp wrap-up. They say it better than we can. Wow. Your editors, Michelle Li (Clinical) Kai-Xing Goh (Pre-Clinical)

CONTENTS Worlds Apart......................................................................................................................................................................3 Engines Running..............................................................................................................................................................7 Out There...........................................................................................................................................................................12 O-Week and Medcamp 2015.................................................................................................................................16 Introducing MUPPITS.....................................................................................................................................................26

WORLDS APART:

TWO WEEKS IN PAPUA NEW GUINEA REPRINT: 2012 EDITION IDA WHITEMAN SARAH SIMON It is difficult to capture in words the impact that our time in Papua New Guinea has had on us. Two weeks in the labour ward of Port Moresby General Hospital (PMGH) brings with it a spectrum of emotions, from confronting sadness to ecstatic joy, and indeed an amazing opportunity to learn. Not only medically, but also about the culture of our closest geographical neighbour. Of one thing we are sure: Papua New Guinea andAustralia are worlds apart.

The labour ward at PMGH is the most sophisticated in the country. It has 24 beds and four midwives, as well as a small room for neonatal resuscitation. Within ten minutes of nervously opening the front doors on our first day we were witness to a woman at full dilatation having an eclamptic seizure. Assisting to restrain a mother in her post-ictal disorientation while the registrar performed a difficult vacuum delivery was an emotionally harrowing introduction to PNG obstetrics. Eclampsia is a rare complication of pregnancy in Australia, however by our third day on the ward we had witnessed a second mother have an eclamptic seizure minutes after admission. This poses the question; why is a life-threatening yet preventable complication of pregnancy occurring this often?

The lack of global antenatal care means that severe pre-eclampsia occurs in PNG and many women are given magnesium sulphate and hydralazine as they labour. Another significant contributing factor is understaffing of the labour ward. With an average of 50 deliveries per 24 hours and only 4 midwives, chaos can ensue. The fact that the ward was so busy allowed us to gain incredible practical experience, and within a few days we were delivering babies alone.

On our second day a young primiparous mother was admitted to the ward with vaginal bleeding and labour pains at 20 weeks gestation. In PNG babies born younger than 34-36 weeks toften don’t survive due to the severe lack of resources. Respiratory distress syndrome is a common cause of neonatal death, as there are no ventilators, surfactant, or neonatal ICU facilities available. was an example of late recognition of a twin pregnancy, where a quick ultrasound scan revealed two small fetuses, only one with a heartbeat. Unfortunately the mother was in active labour and it was clear to all involved that the baby would not survive at 20 weeks. As she gave birth it became apparent that twin-to-twin transfusion syndrome was the cause of spontaneous premature labour. An extremely dark and heavy twin was born first, with no pulse nor attempted respiration. Following this, a pale, lighter twin was born who was only briefly alive. The placenta was diagnostic – shared vessels between the umbilical cords could be easily appreciated.

The mother’s grief was distressing to us, as it was the first obvious display of emotion we had seen in a woman in this country and it provoked us to share her sorrow. Most of the women endeavoured to keep their emotions private, enduring labour in stoic silence with no overt display of joy when their babies were born or grief when their babies died. It was a stark reminder of how important it is to remember the humanity and vulnerability of each patient, in spite of how well they hid it.

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tStillbirth and neonatal death are tragically common in PNG, particularly in village deliveries where no medical assistance is available and the nearest health centre may be several days walk away through rugged terrain. We were reminded that the women who give birth at PMGH are the luckiest in the country.

Another confronting case was that of a neonate born to a woman that was HIV positive. Like far too many women in PNG, the mother had not received the benefit of antenatal care so was not being treated with anti retroviral medication and had arrived at the ward in active labour. At PMGH fetal monitoring is highly reliant on observation of the fetal heartbeat by Pinard stethoscope and the presence or absence of meconium staining of the liquor, with CTGs being used sparingly and intermittently in only high risk labours. The membranes had not been ruptured to prevent vertical transmission and so it was not until delivery that thick meconium-stained liquor was discovered. Unfortunately the baby was only making shallow, irregular gasps and was cyanosed and hypotonic. Though he was taken quickly for resuscitation, before long he was no longer making attempts at respiration and was declared to be deceased. In a setting such as PNG, where social support for disorders such as cerebral palsy do not exist, it must be difficult to know how aggressively to resuscitate a baby who has undoubtedly suffered significant perinatal hypoxia. The social obstacles increase when the baby’s mother has untreated HIV with a questionable prognosis.

One especially striking difference we noticed is that the caesarean rate at PMGH was as low as 3% last month compared to the 32% rate for first time mothers we had in Australia in 2008. Unnecessary Caesareans are avoided because of the risk of uterine rupture and maternal death in a subsequent vaginal birth (VBAC) if a woman labours next time in her village without a skilled attendant and no access to emergency healthcare. In 2009 PNG’s maternal mortality ratio was 733 per 100,000 live births, the second highest in the Asia Pacific region. However the routine use of partograms, active management of labour and the ongoing struggle to encourage all women to seek antenatal care translates into many mothers and babies saved with very basic principles.

Furthermore, as each subsequent pregnancy increases the risk of maternal mortality, something as simple as contraception suddenly has enormous potential to save the lives of a mother and all of her children, who may well die without her care. During ward rounds we were witness to the skillful way that registrars and residents could encourage a woman to comprehend the risk to her health that future pregnancies pose and what the best contraceptive decision 6

Above: Ida with two local children Below: Sarah performing a newborn check would be. No doctor would tell the woman what to do, however, instead they would guide her decision in a way that allowed her to comprehend her own mortality and the importance of her health to herself, her husband, children and community.

During our time in PNG we have been overwhelmed by the vast differences in health outcomes and living standards, but we have been struck more by the kindness of those we have met. Every doctor, nurse and medical student has gone out of their way to make us feel welcomed to their country.

Each question we asked was answered with careful consideration, every interest we showed embraced and every smile we gave was returned.

We will never forget the incredibly interesting medical cases we have seen or the practical skills we have gained, but even more memorable has been the broad smiles of the children, the warm handclasps of mothers, the invaluable teachings of the healthcare workers and the overwhelming hospitality of this beautiful nation.

ENGINES RUNNING: ELITE ATHLETES IN MEDICINE

featuring: KATIE BLUNT JACK GERRARD

KATIE BLUNT YEAR 2 WATER POLO

I donned my first water polo cap nine years ago when I was introduced to the sport while living in Northern California. Although I loved playing in field, I was better suited to the position of goalkeeper (I couldn’t swim very well!) and soon took on the responsibility full-time.

During peak times, I train or compete about 11 times a week with the Victorian Institute of Sport and my National League club, the Victorian Seals.

One of my greatest achievements was leading Victoria to our first-ever gold medal and taking out the Goalkeeper of the Tournament award at last year’s 20&Under National Championships.

I have also been part of the Australian Junior (20&under) squad since 2013. We spent six weeks together at the Australian Institute of Sport last summer, and come together in Sydney for “mini” training camps whenever the National League schedule permits.

I’m hoping to be selected to compete at the World University Games and FINA Junior World Championships later this year.

Water polo has taken me all around the world (Canada, Japan and Hungary to name a few!) and I feel incredibly fortunate that I am able to pursue both my hobby and my degree at the same time!

Did you know?

Water polo is a team water sport requiring an ability to swim. Field players must swim end to end of a 30-meter pool non-stop many times during a game without touching the sides or bottom of the pool. The front crawl stroke used in water polo differs from the usual swimming style in that water polo players swim with the head out of water at all times to observe the field. The arm stroke used is also a lot shorter and quicker and is used to protect the ball at all times. Backstroke is used by defending field players to track advancing attackers and by the goalie to track the ball after passing.

JACK GERRARD YEAR 2 SWIMMING

Fun fact: Swimming started in the 1st century and has been part of the Olympics since 1896.

Hi, my name is Jack, I’m 20 years old and I’ve been swimming competitively since I was nine. Like many kids living in Far North Queensland (at the time), I had heard how much fun my swimmer friends were having… and I wanted in!

I can’t narrow down my motivation to one particular source; it’s a combination of things. My sometimes-over-competitive nature, and a good group of friends are some of the big reasons why I continue to enjoy the sport and improve.

My weekly routine involves 9 swimming and 3 gym sessions, which amount to just over 25 hours of training per week. Balancing my training schedule whilst trying to study medicine is something that I regularly struggle with. Things which have helped me manage include extensive planning before each semester, constant support from my year level coordinator and student administrator and importantly, finding even the smallest amount of time each weekend to do something I enjoy and that takes my mind off whatever stresses I have (technically mindfulness?).

My biggest sporting achievement so far are my results from the past two Australian Open National Championships, where I placed from 4th to 8th place in multiple events. Ultimately, swimming, like most sports, is a pursuit to achieve perfection. I easily relate this commitment to my studies, and like all medical students I strive to be the best I can be in the future.

OUT THERE: Reflections from pre-clinical students in the John Flynn Placement Program

Rachel Van Zetten Year 2 Batchelor, NT Tell us a bit about the community you visited.

Batchelor is a small town of under 1000 people, about 100km south of Darwin. The local amenities include a general store, post office, take-away shop, pub and swimming pool. It is also home to the Batchelor Institute of Indigenous Education, which sees Indigenous students from all around Australia flown in to study different courses.

What’s been the highlight so far?

Australia Day is a significant town event, and I was lucky enough to be involved in local festivities. The day started off early with a community breakfast of bacon and eggs at the primary school. This was followed by a ceremony that featured horses, the local scouts and lots of awards. I was then properly welcomed to the NT with a ‘dog and duck show’ that was extremely entertaining. The afternoon consisted of a town cricket match in which I stand 1 not out, as our match was cut short due to rain. Luckily the pub is just a few metres from the oval so we celebrated the rest of the day in true Aussie style!

What’s been the coolest med thing you’ve done or seen?

The nurses always ensured that if there was excitement– I was there! From toenail resections to skin cancer excisions, there was never a dull moment. I was taught how to take bloods, and involved in some consultations with the midwives – it was amazing to feel twins in utero, and very special to conduct the first check-up on a newborn.

What messages would you like to share with other med kids that you’ve learnt from the program?

The JFPP is a truly unique experience and provides so much clinical experience that you would never otherwise have.

It enabled me to put my learning into context and gave me an insight into a large range of clinical realities. It was great to build relationships with the regular patients, and it was a real privilege to become involved in their lives.

Is there anything else you’d like to add?

It was amazing to be given the opportunity to explore Australia. I was able to visit Litchfield National Park and see the iconic magnetic termite mounds and spectacular waterfalls. Also, the NT program involves an initial orientation in Darwin with medical students from all around Australia. Living in a share house with a generous allowance (from JFPP) meant we had the best time exploring Darwin. From dinner and drinks at sunset, to finding l ocal bands down alleyways, it was great to be able to share some of the experience with newfound friends.

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Sunjuri Sun Year 2 Gapuwiyak, NT Tell us a bit about the community you visited – what makes it special?

Gapuwiyak is a remote Aboriginal community in northeast Arnhem Land with a population of approximately 900 people. It’s situated on the shore of an enormous lake – Lake Evella – and it’s honestly the most beautiful place I’ve ever seen (my backyard looked like something out of Jurassic Park!). The best thing about Gapuwiyak though is the sense of community and strong cultural traditions.

What’s been the highlight so far?

Definitely getting adopted by an Aboriginal family, who I met at a billabong. Every time I’d go to the pre-school for health checks it felt like I’d have new brothers and sisters clinging onto my legs like koalas. Besides, it also meant that whenever I went to the local groceries or walked around the community, I wasn’t just the random medical student but part of the ‘family’.

What’s been the coolest med thing you’ve done or seen?

This is a hard question because you get to see so many interesting conditions that aren’t as common in metropolitan Melbourne, like rheumatic heart disease and post-streptococcal glomerulonephritis. Looking after a child with febrile convulsions whilst trying to coax their pet dingo out of the emergency room is something I’ll never forget.

However, the coolest thing would have to be getting flown to an outstation called Dhoyndji for maternal and child health checks. Not only was the plane so small that I got to sit next to the pilot and enjoy the stunning views, but weighing babies and poking around with auroscopes was surprisingly fun.

What messages would you like to share that you’ve learnt from the program?

The first thing I learnt was that there is actually a difference between rural communities and remote communities. A huge difference. The second thing that really struck me was how friendly and welcoming everyone in the community was. Even though the community was extremely remote geographically, the people in Gapuwiyak made sure that I never felt isolated; I was always involved in their activities, from having coffee with the dental team at the Arts Centre, to going to a “small get-together” of teachers which unbeknownst to me involved bonfires and firecrackers.

Is there anything else you’d like to add?

Do it! It’s an amazing experience and I highly recommend doing an Indigenous health placement (but of course, I may be slightly biased). Not only do you get a chance to improve your clinical skills, like giving injections of doing ECGs, but you also get a chance to see a different side of Australia that is otherwise hidden away from the rest of the world. Be careful though, you might never want to leave!

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Jessica Paynter Year 2 Broome, WA + Bidyadanga + One Arm Point + Beagle Bay + Looma Tell us a bit about the community you visited – what makes it special?

Broome is located in Northern Western Australia, and is a popular tourist destination due to its amazing beaches (e.g. Cable Beach, Roebuck Bay). The subtropical climate was a big change. But the most striking thing was the rich cultural diversity with its large Indigenous, Asian and Anglo-Saxon population that has an incredible history!

What’s been the highlight so far?

The flights we get to do to the Indigenous communities. It’s amazing how far we have to travel to get to them; this demonstrates how resilient these people are to survive in such remote, isolated locations.

What’s been the coolest med thing you’ve done or seen?

I got to intubate a patient, watch some amputations and help drain a huge abscess on my first visit to theatre!

What messages would you like to share that you’ve learnt from the program?

Most rural communities have typically experienced some form of health work-force shortage and are therefore really, really happy to see you! I also found that they’re more than willing to let the “medical student” do really hands-on things such as vaccinations and taking blood – more so than metropolitan patients!

Is there anything else you’d like to add?

I’d encourage everyone to apply; it’s a fantastic opportunity!

O-WEEK & MEDCAMP 2015 A RETROSPECTIVE INTERNAL MONOLOGUE

Convenors: NICOLE YOUNG & TIM YANG Author: TIM YANG

Figure 1.

PHASE 1: PREPARATION October, 2014 Yay! Congratulations! You have been crowned MUMUS O-Week/MedCamp Convenor along with your friendly, funny, fabulous friend Nicole Young. This is thanks to a brief but punchy election campaign, “Vote ‘Young & Yang’” (see Figure 1). You are so excited. WOW. YOU ARE SO. EXCITED. November, 2014 Your exams come and go (oops) and you sit down with your O-Week/MedCamp predecessors. They tell you to get excited (little do they know how very excited you already are). You run through the events of O-Week:

- MedFest

- Futures Forum

- Bounce Inc

- MedCruise

- International Forum

- BBQs

- The O-Week Stall…

This sounds totally manageable – you can so do it!

December – January 2014 You et al plan stuff.

February, 2015 All systems go – flashing lights, delirium, missed calls. Check your venue bookings. Guest speakers confirmed.

Blur. Bleh. Do the paperwork. Write up the budgets. Procrastinate by trawling through the VTAC offers list and Facebook stalking first-years-to-be so you can add them to the Monash Med 2019 Facebook group and expose them to your advertising propaganda. Come to our events. Pls.

PHASE 1: SUCCESS! Now to see if it all actually works…

PHASE 2: O-WEEK O-WEEK DAY 1: February 23, 2015 MedFest: new students sign up for med societies and more indemnity insurance than they could ever ask for.

You lead your sponsors to the nice, open lawn you have booked for your event. They get set up and everything looks perfect. Their gift bags are out; their flyers are stacked; their banners are flying. And then… it starts to rain.

Fat, mocking water droplets fall on your sponsors’ faces. You don’t know what to do. The up-side is that no one can see your tears because IT’S BLOODY RAINING. After some time, your event is relocated. You threaten the first years until they’re convinced to come. They love all the free things and all the medical interest clubs. They are happy. The sponsors are happy. You are happy!

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Futures Forum: guest speakers galore – be inspired! Professor Jeffrey Rosenfeld, Dr Andrew Cuthbertson, Dr Gillian Farrell and Professor John Murtagh speak to the new students. They talk so fascinatingly about neuroscience, rural practice, research and plastic surgery. You wish you did med. Oh wait – you do! Everyone is reaffirmed that they picked the right course and can’t wait to start being doctors.

O-WEEK DAY 2: February 24, 2015 Bounce Inc: new students hit it off by hitting each other in dodgeball. Nostalgia overwhelms as you watch the first year students adorably and awkwardly poke at new friendships. You can’t help but feel as if their jumping motions imitate your heart as you reminisce about the friends that you made in the very same place last year.

MedCruise: the who’s who of cruises. New students dress up as Emojis and form life-long friendships. Introduce the option of cheap alcohol and the first years make even more friends in even less time! Also they put in a top effort to abide by the Emojis dress code you have enforced. Refer to photos on the next page. My personal favourite is the poo.

O-WEEK DAY 3: February 25, 2015 Interstate & International Forum: this attracts a larger audience than you expect and you are absolutely delighted to see everybody’s smiling faces! Everyone is super excited to be in Melbourne and 100% keen to start university. They are told that it’s the best thing ever. In your opinion, this is no lie. Everyone eats pizza and is merry (even the vegetarians, because Dominos now does Spicy Veg Trio #dietaryreqs).

O-WEEK DAYS 4 & 5: February 26 & 27, 2015 Transition Program:fun for everyone This was great.“High-five Nicole– that was such a great O-Week!” The first years love you (you think), and you are pretty happy with yourself. You absolutely cannot wait to get started on MedCamp!

PHASE 2: SUCCESS! Two down, one to go…

PHASE 3: MEDCAMP March, 2015 Medcamp is fast approaching, but the only (major!) problem is that seven days before camp the venue calls you up to kindly inform you they’ve been shut down due to safety concerns. So then it’s 7pm, a week before camp and you’ve got 150 thirsty first years sitting with tongues wagging, waiting to get their paws on some tickets.

You tell them the bad news and ask them to hang tight while you find an alternate venue. Some students vent their distress to you. One student offers to hold it in their apartment. You make a mental note to allocate them to your team later.

Over the next few days, you and your brilliant, committed, diligent, intelligent, persistent, wonderful team narrow down your options down to 42 possibly suitable alternative venues. You find your one. It is closer, prettier, nicer and has more space and less rules than your first venue. You book it. Students buy tickets (more than ever before), and you are once again right on track.

CAMP DAY 1: March 20, 2015 Kids arrive at camp. The ground rules are laid and the points system is introduced: points for winning activities, points for hook ups, points for helping drunk friends, points deducted for disorderly conduct, etc.

And so to the flirt’s first activity: Rubix Cube. All players to start the night in different coloured clothes, and then swap clothes with others throughout the evening to end up wearing just one colour. Later in the night, one student queries whether wearing no clothes at all qualifies as ending up in a uniformly coloured outfit. In the spirit of university life, you decide to let them have it – they deserve it.

CAMP DAY 2: March 21, 2015 The morning is a test of sheer physical strength – which man can perform the most push-ups? Which woman can hold a plank the longest? The students fight it out to win their team glory and points.

The afternoon transitions into a challenge of mental strength – who can drink and retain the most milk? The winner here is the ground: the unfortunate resting place for litres of bilious, regurgitated dairy.

And the night, you ask? Well this was a test of dignity – who loses the most of it? But the answer, of course, is to forever remain a mystery.

CAMP DAY 3: March 22, 2015 On this, the last day, you gaze upon the dreary-eyed, hung-over faces of your newfound friends. You think you can just make out faint hints of smiles under their drooping eyelids.

Welcome to medical school.

3/3 PHASES DESTROYED. YOU DONE. CONGRATS.

What is MUPPITS I hear you ask? A group of cuddly and colourful puppets that bring joy to children everywhere? Well yes, essentially… But MUPPITS is also the new paediatric medical student society at Monash University!

But what does MUPPITS mean? MUPPITS stands for “Monash University Paediatric Promotion, Interest and Training Society” (catchy I know - SHIELD helped out with the acronym…)

MUPPITS is a new subcommittee under MUMUS in 2015, and hopefully by now you have all seen the Facebook page. Please like and follow this to stay up to date with everything we are doing for the rest of the year! (To find it search “Monash University Paediatric” on Facebook).

Over the next few months MUPPITS is going to run as many paediatric events as we can.

These will include:

- A paediatric careers seminar

- A paediatric research information night

- A paediatric volunteering and electives information night

- Revision lectures

- A revision weekend, which will run like a mini-paediatric conference for medical students.

This will be very useful for Year 4C students coming up to exams, but will also be a great

crash course in paediatrics for interested students from all year levels, whether you are a

Year 3B student looking to get a taste of what’s in store for you next year, or a Year 5D

student who would like to revise your paediatric knowledge!

In the meantime we will endeavour to keep you up to date with all things paediatrics related via the Facebook page, and stay tuned for the launch of our website which will be packed full of information, resources and links to other useful websites!

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