New role for trailblazing Orthopaedic surgeon

Dr Annette Holian is the first female President of the AOA in the organisation’s 85-year history

It takes courage to travel to the scene of a natural disaster and operate without running water or reliable electricity. But for Annette Holian, the same level of courage has been required to break the many glass ceilings she has encountered as an orthopaedic surgeon. Dr Holian has in 2021 become the first female President of the Australian Orthopaedic Association (AOA) in the organisation’s 85-year history. The appointment comes 35 years after Dr Holian was one of the first two women to enter the Australian orthopaedic training program in 1986. In her new position, she plans to create a profession that demands less courage and welcomes greater diversity among the surgeons of the future. Growing up in Reservoir in Melbourne’s north, Dr Holian was originally inspired to pursue a career in medicine as a child after reading the novel Hills End. In the book, an isolated group of children confront extreme challenges. A boy whose friend is injured decides to be a doctor so he can help others. Dr Holian identified with the character and set her sights on becoming a doctor and helping in adverse conditions became part of her story. Dr Holian’s parents had met as patients in a polio clinic and this history also drove her interest in medicine. The disease had left her mother unable to walk unaided and damaged her father’s arm. “I was very aware of the challenges they faced, and particularly the motor challenges,” she says. After following the typical orthopaedic surgery pathway into private and public practice, Dr Holian embarked on a road less travelled when she began to work providing pro bono surgery for Papua New Guinea children in 1996.

She carried out surgery in Melbourne alongside her colleagues at the then Monash Medical Centre and helped teach local surgeons in PNG. In this role, she derived great satisfaction from improving the lives of people who had suffered from diseases like polio, club foot, infections of bones and joints and neglected. These patients would have been unlikely to have received adequate care without the work of Dr Holian and other Australian surgeons. Among her most memorable cases was that of a 29-year-old woman whose tight Achilles tendons had confined her to a wheelchair from infancy. After a simple 20-minute operation under local anaesthetic, she could walk up a set of stairs.

“Everything we taught and did had a huge impact on the people we were caring for and I found it incredibly rewarding.” Dr Holian was part of the first Australian medical team on the ground after the Boxing Day tsunami in Banda Aceh. She remembers seeing people everywhere searching for family members and witnessing trucks moving bodies into open tips. Her team operated in extremely challenging conditions, without reliable power or access to running water. In 2000, she joined the Royal Australian Air Force for service in East Timor and subsequently shifted towards trauma surgery, later serving in the Solomon Islands, Indonesia, and the Middle East. She has undertaken five deployments to war zones, including three in Afghanistan. While the work is rewarding, it can also be extremely confronting. “I remember trying to help save an eightyear-old boy who had been shot, but who died on the operating table despite our best efforts. I was doing the CPR for his arrest, and we had to call it, on a pink warm child in asystole. “As a first responder at natural disasters, you can rationalise that it wasn’t of human making, but it’s very confronting to see people hurting other people in this way. And it is particularly emotionally laden when your patient is a child.” Dr Holian was also deeply affected by a helicopter accident that killed members of the medical team providing assistance following an earthquake in Indonesia. After the crash, she had to recover the bodies of her colleagues. “There were 50 Australians working there and we lost five of them. That accident was a seminal part of my story,” she says. Her work has provided her with first-hand experience of the sense of isolation soldiers feel when they return from a war zone. “When I got home, I remember being asked if I had ‘had a good time’. It made me realise that only people who have been there know what you went through. “I can’t burden others by talking about those overseas experiences, but I love spending time with those who were there with me. We can just be together and know that part of our story is shared. We are not alone.” Her chosen mode of relaxation from an emotionally taxing job is gardening, and she is looking forward to getting her plants that are currently potted into the ground. Dr Holian’s military service was recognised in 2006 when she was appointed a Governor at Melbourne’s Shrine of Remembrance.

A circle closed in a surprising way when the author of Hills End, Ivan Southall AM, DFC was featured in a recent exhibition at the Shrine. The writer had been a RAAF pilot in World War II, later becoming an author. Dr Holian stood open-mouthed before the exhibition, astounded that years

after Southall had inspired her to pursue medicine, she had found herself looking after aircrew and keeping them flying. In 2018, as RAAF Group Captain, she was the first woman serving in the Australian Defence Force to have addressed the ANZAC Day dawn service at the Shrine of Remembrance. She embraced the opportunity to call for better support for returned service people and encouraged greater dialogue between veterans and the wider community. “My identity as a military person is very important to me as it proves to me that I am capable of some pretty extraordinary things,” she says.

Dr Holian’s humanitarian and military work has also provided her with an understanding of the importance of access to adequate health care—a primary concern she aims to tackle in her role as a RACS Councillor.

“I am passionate about improving access to medical care as access to health services and outcomes are much worse for people living in regional and rural areas.” She considers it to be a significant problem that while about 29 per cent of Australians live regionally or rurally only 12 per cent of surgeons live outside metropolitan areas. She is also committed to creating a more supportive profession for women and promoting diversity. … she encountered significant challenges juggling parenthood and her career when she became a mother.

The issue came close to home after she encountered significant challenges juggling parenthood and her career when she became a mother during her third year of medical school.

The requirement to be ‘on-call’ day and night for the junior doctor was a grueling experience for the new parent. “No one cut us any slack because we had a young child and there wasn’t any before or afterschool care at the time. It required a lot of organisation and support from my mum. It was a very challenging time.” It was 12 years later, after completing her surgical training that she had the second of her three children, and another four years post an overseas Fellowship that she was able to have her third child.

In her career, Dr Holian says that she has constantly had to rail against the bias women face in a male-dominated profession. “In many ways, women can’t win. They are punished for behaving like men, or on the other hand, for being authentic to their femininity. They are extremely reliant on their—usually male—superiors for selection and training and that means there is a fine line that they have to walk.” Women currently constitute only five per cent of Orthopaedic Surgery Fellows; it is the lowest proportion across all medical specialties. However, there is cause for optimism, with women constituting 22 per cent of the intake for the 2022 Orthopaedic Surgery training program. This is an all-time high, and up from around 15 per cent in previous years. Dr Holian has now set her sights on the treatment of those female Trainees in their workplaces and whether they will be judged on the male interpretation of ‘confidence’, or the more valid qualities of competence and safety. The barriers Dr Holian faced as a trailblazer in the profession have provided her with the impetus to drive change through her role with the AOA. “It’s a great opportunity and I don’t want to waste it,” she says. For Dr Holian, countering the additional barriers she faced as a woman in her profession meant writing her own script. “I took great courage from my mother and made the decision not to do what was expected of me.” It is a decision that has resulted in an extraordinary career so far and one that will pave a more better-supported pathway for the orthopaedic surgeons of the future.

Images (this page, from top-left): Annette with CDR Martin Richardson, orthopaedic surgeon; AUSMAT Operating theatre-tent, Tacloban 2013; Annette in uniform.