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Community health in healthy communities

Volume 11 Number 7 July 13 - August 9 2015

“What you can learn in General Practice with the same people for two years is sensational.” – Simone Allen
“What you can learn in General Practice with the same people for two years is sensational.” – Simone Allen

ABC’s Doctor Blake Mysteries series, filmed in Ballarat, depicts Dr Blake as the local GP who grew up in the area, knows the town and its inhabitants, and who has just taken over his late father’s practice.
Murders aside, this series presents a somewhat romanticised picture of medical care in the 1950s when the local doctor and district nurse took care of everyone in the area. A true, albeit outdated, picture of integrated care that is delivered largely through community networks.
Even in our busy modern times rich with medical discovery, specialities and emerging illnesses, a personalised and contextual model of care is not a thing of the past but something that continues to be refined with the advances of technology and with a truly engaged community. Christina Tait and Lisa Mamone explore the importance of community plays in having a healthier region.

It doesn’t come as a surprise that medical students at the clinical schools in Shepparton, Epping and Sunshine relish the medicine they experience, although it’s interesting to see how a strong sense of community influences their approach to medicine and is becoming embedded in their lives.

When Ed Siauw moved to Shepparton as a student in 2008 he was impressed by how much he learnt from the variety of medical conditions doctors treated, but didn’t imagine he would one day work as a doctor, training students like himself.

“The diverse medicine we were exposed to made learning interesting and gave us a really good overview of things,” he says. “We got a lot of exposure to patients.”

Ed also noticed the versatile workload rural clinicians manage and felt it gave them a holistic view of a patient, which he found useful to learn from.

After completing his medical training at the University of Melbourne’s Rural Clinical School, Shepparton Campus, and his internship and residency at the Goulburn Valley Health Hospital, Ed now practises as a Trainee GP at the University of Melbourne Shepparton Medical Centre.

“I chose to work at the Shepparton Medical Centre because of its association with the University and the fantastic learning culture, which really appeals to me,” says Ed.

“The diversity of patients we see is incredible, all ages and backgrounds, and each day you don’t know what you are going to see or how critical the cases will be.”

“Sometimes the students just observe me and other times they will be seeing one of my patients in another room where I can duck my head in to see how they are going. I enjoy teaching and it can help my own learning.”

“If you work rurally it is important that you get involved in the community – people are eager for better doctors and clinicians and are very welcoming”.

Annie Tan, in her final year of the MD at the University of Melbourne’s Western Clinical School at Sunshine Hospital, has passionately embraced her community. Born at Sunshine Hospital, she feels strongly about how community engagement positively influences the relationship between doctor and patient. Her involvement as co-director of the Western Community Cookout Program demonstrates her commitment. This student-run program aims to empower and educate people in the community to take care of their own health.

Student volunteers are invited to people’s homes or community halls where cooking is used as a gateway to talk about health. After being taught to prepare a meal, which they share with community members, medical students set up booths where they can begin discussions and activities focused on the health of the community.

“It’s important to have a conversation and encourage people to ask us questions and discuss things. This helps to break down the barrier between patient and doctor, and hopefully makes it easier for them to talk about their needs,” says Annie.

“I have learned that different cultures understand healthcare differently and expect different things from it.”

Annie explains there are many opportunities for students to become involved in community work at the Western, including the Sons of the West Men’s Health Program and Building Healthy Communities in Melbourne’s West for the primary school community.

She points out there also is a strong sense of community within the clinical school.

“Everyone is like family. I feel free to approach senior staff and I don’t feel any sense of hierarchy. People are willing to teach and take medical students on ward rounds or in clinic, and the more initiative you show the more you get out of it.”

Andrew Feehan is originally from Shepparton and wanted his first clinical year to be in a smaller rural hospital. He was keen to have access to one-on-one teaching and to practise procedural skills. In his first clinical year at the University of Melbourne’s Rural Clinical School, Shepparton and Goulburn Valley Health, he can already see his confidence and skill level improving faster than he expected.

“We tend to see the very common ailments such as airways disease, heart attacks, heart failure and managing chronic conditions and acute exacerbations of these conditions,’’ describes Andrew. “Its good experience because it’s the ‘bread and butter’ of medicine.

“I feel very lucky with the quality of teaching we have received and the willingness of the doctors to spend their time with us to explain things. Sometimes learning can be very spontaneous – you can be at the right place at the right time, and if a consultant sees you’re keen and motivated they might drag you along to whatever they are doing.

“I enjoy living in Shepparton and have joined the local gym and local SES to try to get involved in the community as much as I can, and assist with any accidents wherever the SES is called out.

“Involvement with the community is important. It makes you feel like you are a part of the town.

“Half the medical students in the course tutor every Wednesday night at the Smith Family.’’

Simone Allen had the opportunity to connect with many doctors during Year 12 when her father was critically ill. Some years later, after a career as a wedding planner, she embarked on a Bachelor of Biomedical Science at Deakin University with plans to become a doctor.

“Quite the change,” she says, “I came in a little differently.”

Now in her final year with the Clinical School at Northern Health, Simone has been enriched and inspired by the value of community involvement.

The Community Screening Program “Prevention Express,” run out of Centrelink offices, is a prime example.

“We practise defensive medicine and ensure we make the right diagnosis and do all the right things, but going out in the community is an opportunity to practise preventive medicine – maybe 30 people of the hundreds we saw at Centrelink might not go to hospital because they went to see their GPs,” says Simone.

“The cost minimisation of prevention is important. We are a curative culture, not a preventive culture, so to get out there and do something with these community programs felt really good,” she adds.

“We were seeing people who were not usually health-conscious and helping them to become aware that, even at 25, they can do something about their health by addressing their at-risk behaviours.

“I learned so much during the Primary Care Community Base Program where I spent one day a week with the same GP for two years. Delivering babies, taking ante-natal care the whole way through, managing cancer patients, mental health – the breadth of what you can learn in General Practice with the same people for two years is sensational.”

As the recipient of a bursary from the Melbourne Medical School last year, Simone is acutely aware of the pressures that affect the early careers of young doctors and recently wrote a letter which her local MP read out in Parliament, voicing her concerns about the shortage of funding available for graduates to qualify and specialise.