Celebrating a game-changer in Rural Health

A milestone birthday can be as good a time as any to look in the rear-view mirror and consider the road that has been travelled.

The one taken by the University’s Department of Rural Health, which will celebrate its 20th birthday next year, is marked by achievement.

The Department began with a research, Aboriginal health and student placement program, followed a few years later by the establishment of a new Rural Clinical School and purpose-built student accommodation.

Then came the Centre of Excellence in Rural Sexual Health, which works to sustainably develop sexual and reproductive health services capacity in rural Victoria, and the Extended Rural Cohort Program, hailed as both innovative and successful, in which students are trained in GP practices.

In addition to its Centre in Shepparton, the University has established major nodes at Ballarat and Wangaratta and forged associations with nearly 40 smaller towns across country Victoria.

More than 950 medical students have passed through the Department, with more than 10,000 nursing allied health students being supported to complete rural placements in the region. Four Indigenous students in Shepparton are undertaking PhDs, five more who live and work in rural areas are studying for their Masters in Public Health, and an additional seven have been supported to undertake training in nursing.

“We have brought the University of Melbourne to the country,” says Professor Lisa Bourke, Director of the University’s Department of Rural Health Program. “And we’ve had a huge impact not just on our students but on the local community.”

When Professor Bourke began working in the Department 18 years ago, she was the ninth staff member to be recruited. Today, she is one of more than 100.

“It has been a fabulous initiative and a great place to work,” she enthuses. “It’s an environment that is dynamic. We have been able to trial things, to do things differently and that has been really exciting.”

From the beginning, the journey was aspirational. In an effort to address the health workforce shortages in country areas, and to correct particular disadvantages among the local population, the Commonwealth decided to establish a university Department of Rural Health in each state.

The University of Melbourne’s Department was located in Shepparton. Two of the more compelling reasons were the enthusiasm of Goulburn Valley Health for university training in its hospital, and the fact that Shepparton was home to the largest Aboriginal community in Victoria, outside of Melbourne.

The sorts of health issues presenting in the bush are very often different to those affecting city people. Rates of chronic ill-health are high in rural areas, where the population is generally older and where obesity levels are also high, while cultural barriers can sometimes inhibit people from accessing treatment for mental health issues.

In its 20 years of operation, the Department has made significant gains on these fronts. “When I came here, there was a massive shortage of GPs in Shepparton and there’s no longer that shortage,” says Professor Bourke. “We have evaluated health services and changed the way they are delivered.”

Last year, the Department received funding for the establishment of a junior doctor training program which will enable them to do internships and registrar years in key specialties in the country. It has also been recently funded to provide first-year medicine teaching, meaning a full medical degree will now be taught in Shepparton.

“The evidence shows that the longer students spend in the country, the more likely they are to work there,” adds Professor Bourke.

Rural Health  – A country practice

She has roamed the globe, but for Skye Kinder all roads lead back to Bendigo. This is the place Victoria’s Junior Doctor of 2017 calls home – personally and professionally.

Dr Kinder (MD 2016) is passionate about rural and regional healthcare. From the earliest age, she understood the difficulties faced by many patients who were forced to seek treatment in the city. Her father, Geoff, was one of them. He required three-monthly visits to a specialist in Melbourne because of his poor lung function.

When she decided to study medicine at the University of Melbourne, Dr Kinder also determined that she would return home to practise it.

“I was given a lot of international opportunities during my years of study,” she explains. “I went to places like South America and Africa as an Australian delegate at meetings of the International Federation of Medical Students’ Associations.”

She was one of the drivers around the creation of an international policy on rural health. And while she was excited to learn more about the wider world, her heart always drew her back to the more pressing issues on the home front.

“I started at a really broad base and have narrowed in,” she says. “Almost all the work I do now is state-based. It’s actually harder to address local issues because very detailed solutions are demanded for the problems.”

Dr Kinder completed her internship year at Bendigo Health, one of the jewels in Victoria’s healthcare crown.

She believes she might like to specialise in psychiatry and is now undertaking a 12-month residency at St Vincent’s Hospital (Melbourne) for subspecialty experience, hoping to take her skills back to central Victoria.

She is also interested in further research and has already looked at the ‘financial toxicity’ of cancer patients in Bendigo having to travel to Melbourne for care.

Even in the short years since she began her studies, much has changed on the medical education landscape. “I think the emphasis on regional and rural health has expanded greatly,” Dr Kinder says. “Most medical students are expected to do a rotation in a rural centre. The type of training available in these places is very advanced.”

In addition to being able to establish close relationships with senior doctors and mentors, working in rural and regional settings also provides young doctors with great training opportunities and more exposure to clinical work.

“While studying at the Rural Clinical School, I married my fellow medical student, Ed. We lived around the corner from the hospital/university campus. It was a fantastic time. We had all sorts of hands-on experience that I’m sure wouldn’t be possible in a large city hospital. Learning was fun. In a lovely completion of the circle,  I’m now teaching clinical skills to the medical students at the Shepparton campus, and equally having so much fun helping them to learn medicine.

“We have continued to live and work in Shepparton since graduation. I find the Shepparton community to be really genuine people who are so grateful for the contribution we make as doctors. It’s a fantastic feeling to be appreciated for what you do.”

Dr Kylie Siauw (BBiomed Sc 2005, MBBS 2010) General Practitioner, Shepparton
Dr Ben Jacka (BSc 2007, MBBS 2012) Emergency Department Registrar, Ballarat Base Hospital

“I have an interest in global health which stems from my personal experiences in Africa, both before and during my medical training. On completion of Medicine at the University of Melbourne in 2012, my goal was to work and live in resource-poor and less-developed parts of the world. After I completed my intern year at Goulburn Valley Health, as well as a year at St Vincent’s Health in Melbourne, I worked for the next two years at a rural hospital in Malawi.

“There is a steady stream of medical students who shadow my work in our Emergency Department in Ballarat. I think it’s important to try to impassion them to think about working with those disadvantaged and marginalised in our community, here in Australia and overseas.” MELBOURNE MEDICAL SCHOOL

“I spent my first year of clinical medicine in my hometown of Shepparton. One of the best things was the sheer number of practical skills I gained. One morning, for example, I was the sole assistant for a full nephrectomy for the local urologist. In a tertiary metropolitan hospital, there would be five doctors clambering to be part of this before the medical student. The country is full of opportunities like this.

“I then spent a year in Echuca as part of the Extended Rural Cohort and a final six months in Bendigo. One of the best features of the Rural Clinical School is the amount of hands-on learning.”

Dr Katie Pilkington (MBBS 2012) Paediatric Emergency and Community Registrar, Monash Health