Nicole Milanko
Year 3, University of Melbourne
Cunnamulla, QLD
Nicole describes her day in the life of being a John Flynn Placement Program (JFPP) scholar and provides both an insightful and exciting perspective into a career in rural medicine.
JFPP Placement 1
As the first placement of the JFPP, I did not know what to expect. Though I grew up in a regional area of Victoria for the first 19 years of my life, this placement meant travelling a long distance to an isolated town within which I had no personal contacts.
The John Flynn team were incredibly supportive and alleviated much of my concerns, putting me in contact with our practice manager and emailing me prior to my departure to make sure all details were in place. For this, I was incredibly grateful. After just under two weeks in Cunnamulla, I formed wonderful relationships with the medical and allied health teams. Furthermore, I was able to complete the placement with a friend, who had also been allocated to the same spot as I. Future placements are now nowhere near as daunting and I look forward to my return there.
On placement, my colleague and I were given the opportunity to participate in ward rounds at the local hospital in the mornings and then spend the day in clinic, shadowing one of the two doctors who worked there. We were also given the opportunity to shadow the practice nurse, which gave us a huge range of practical experience. Activities we performed included taking many blood samples, giving vaccinations of all types to both adults and children. We also observed skin incisional and excisional biopsies as well as Implanon insertions, pessary insertions and neonatal management.
Due to the high prevalence of socioeconomic disadvantage, we observed many patients with difficult circumstances ranging from financial hardship to drug and alcohol abuse as well as poor mental health.
We also observed a lot of end stage disease which would have otherwise been picked up in a less remote area. This highlighted the privilege we as medical students have both in terms of our health literacy as well as geographical advantage learning in large, well equipped hospitals.
I also observed the restraints medical practitioners have with regards to working rurally. Many procedures and investigations I took for granted at the regional hospital I currently study at in Victoria were unable to be performed due to lack of services and instruments. Furthermore, I observed the patient’s frustration at constantly having to be referred to geographically distant hospitals which was the only way to provide the resources for their medical problems.
In saying this, however, it was encouraging to speak to other staff within the clinic who had observed much improvement and positive change over the years. The clinic is well funded by government initiatives due to its geographical isolation and high proportion of First Nation’s people in the area. Much progress had been made in the way of improving First Nation’s living conditions as well as providing specialised services to the clinic. There were many fly-in fly-out specialists which serviced the area as well as a travelling dentist clinic. New services such as a neonatal and child health nurse were being introduced and a consistent GP had just been employed by the clinic.
Though there is along way to go before the rural and First Nation’s health gap is bridged, a positive and promising start has been made.
JFPP Placement 2
Day 1
Have had some wonderful opportunities to branch out from GP medicine and experience the roles of allied health and CACH services including mums and bubs programs where we interact with toddlers in a classroom and an aquautic environment It is very rewarding to see parents trusting us with their children in the pool and express their gratitude towards our involvement. Days 2 to 14
Have seen the ups and downs of being a rural GP. A patient recently diagnosed with cancer has proven to be more difficult for the doctor to admit to a larger regional hospital due the inability to provide blood results taken that day (services close Friday after 11 o'clock, which is when the consult took place, until Monday the following week). This difficult process, already made hard by having to break the news of cancer, makes me appreciate the same day results we are able to obtain at tertiary hospitals. I also have an appreciation for geographical isolation and how a simple referral can mean travelling for hours sometimes days, requiring accommodation and increased expenses. A missed fracture now means a drover must find someone to mind his animals in order for him to see an expensive private orthopaedic surgeon to rebreak and realign a malunion fracture that has already started to healHealthcare is much more complex both due to the number of co morbidities and patient circumstance.
Doctor continuity is a luxury here. It makes it easy for abnormal results to slip through the cracks and communication to go astray. Notes by all healthcare workers; doctors, allied health and nurses alike, are fundamental in providing the best healthcare possible. Unfortunately, notes are not always as informative as they should be. I also suspect the lack of a familiar face partially contributes to poor patient appointment attendance for the few patients that have a habit missing their consults. It may also impact patient compliance. However, both these themes have a huge variety of contributing factors, some of which (i.e. social determinants of health) may play a greater role than doctor familiarity.
Day 15
Today opened up my eyes to the possibility of locoming rurally. After some discussion with one of the doctors, he explained the process of becoming a locum as well as the pros and cons to participating in this kind of practice. The more I am here the more appealing it becomes. Day 16 to 22
Was provided with some fantastic resources for next year. Also spoke about the pre-screening requirements for women wishing to become pregnant. One such resources was a template created by Venturafamilymed.org (Cener), ScriptApp and quickbooks. Day 23
What an adventure we had today! Tried to head to Charleville with a car, little known to us, that was completely unreliable. 30 minutes in, the car failed and we flagged down a lovely gentleman on his way to Canberra whilst help was on the way. He offered us a bottle of coolant and water for the reservoir. When help arrived, they topped up the coolant and reserve and sent us on our way. About a minute down the road, we heard a bang and pulled over immediately. We popped the hood to find the radiator had completely split down the middle. The car was towed the rest of the way into town and left for repairs. The whole ordeal took about 4 hours with us waiting in the sun for 2... we had planned earlier in the week for a car breakdown and bought substantial water. Goes to show the importance of communication and water in the outback, two key components for survival. Day 24 to 26
This afternoon we had a wonderful Christmas lunch complete with Secret Santa, more presents and speeches. It was a lovely way to bid farewell (for the time being). On our last day we waved adieu to a week of 40+ degree heat and lightning storms, heading back to a frosty 19 in Melbourne. What a wonderful second experience!