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AMSA Blog: A Medical Student’s Reflection on Closing the Gap

4 Close the Gap

By Victoria Smith, Monash University

Alice Springs, March 2015

*names and any identifying features have been changed to protect patient privacy and confidentiality

Alice Springs Hospital sits on Gap Road. The irony is not lost on me. As I cycle to the hospital early each morning, the sun is already hot and beads of sweat glisten on my forehead. Seeing the lush green lawn of the town parks always surprises me. It sticks out like a sore thumb, incongruent with the characteristic red dust that lies baking on the nature strip.

A sore thumb is the complaint of our first paediatric patient for the day. A two-year-old girl is curled up in the hospital bed with her mother. Her aunties, cousins and siblings sit around on another mattress on the floor. They arrived late last night, after being transferred from Tennant Creek hospital some 500 kilometres away. A humble spaghetti tin is the culprit for a nasty laceration to the thumb that has since become infected down to the level of the bone. Surgery is now essential. Heinz has a lot to answer for, as does the inability to access fresh food. A weakened immune system from the lack of fruit and vegetables, and an iron-deficiency anaemia due to a reliance on breast milk at an age where adequate iron is critical to brain development and physical growth, leaves this little girl incapable of staving off even the mere hint of an infection.

Mum is reticent to speak to us, clearly overwhelmed as our medical team stumbles into the room, switching on harsh fluorescent lighting and flicking through files that are far too thick for a patient so young. The yarning of the family in language stops as soon as we enter the room. Mum avoids eye contact, and only nods a few times in the entire interaction. It is difficult to ascertain how much of the conversation she has understood. For so many of the patients at Alice Springs Hospital, English can be a third, fourth, even fifth language. The conversation is conspicuously one-sided, yet another white person dictating what needs to be done to this woman’s child and how. Uncomfortably I trail out after the team, pulling the curtains to open up a gap as I do so. To this green Melbourne girl, the cultural divide between Aboriginal Australians and myself feels more like a chasm.

I skim down my patient list. Names like Barry, Kenneth, Doreen and Brenda are present along with various combinations of letters strung together with some apostrophes and hyphens thrown in for good measure. It’s not just the names that are from the nineteen fifties. Health statistics are comparable to or worse than this time. Just one example is that rates of acute rheumatic fever in northern Australia are similar to those reported in urban Australia in the decade 1938-1948.[1] Tragically, these little people will be lucky if they make it to their fifties.

A gap-toothed five-year-old grins up at me. With my otoscope I inexpertly examine his ears. Inexperienced as I am, I know this ear doesn’t look right. My registrar confirms that yes, I am in fact visualising the ossicles, the tiny bones of the inner ear. The tympanic membrane has been all but destroyed by a chronically pus-oozing ear. The boy is hyperactive and zigzags around the ward at high speed. Perhaps he could have Foetal Alcohol Spectrum Disorder, or it’s probably just that his hearing is so badly damaged that he doesn’t hear his mother’s calls to him. School will be difficult for him, the gaps in his learning growing each day. It’s hard when you can’t hear the teacher.

On Friday night a group of us head to the local hangout, for burgers and a beer. The fairy lights in the beer garden glitter in the warm air of the evening, the hum of the chatter gradually increasing as darkness descends. Across the road in the park, groups of Aboriginal people sit in small circles under the cool shade of the trees. They eat, drink and yarn, living life how they have always lived it…outside. They are outside both literally and figuratively, living on the fringes of Australian society. They are the first and true Australians, but are unable to access so much of what I have grown up with and take for granted.

You can see the stars here. The sheer vastness of the night sky is mesmerizing. The wide empty space can be terrifying at first, but then liberating. The hospital services a geographical area of 1.6 million square kilometres. Utterly mind blowing. The building is a monument to the momentous and disastrous failing of successive governments and policy-makers to ‘close the gap’ between Aboriginal and non-Aboriginal Australians. Step off Gap Road, and in through the doors of the hospital, and the devastating health status of Australia’s first Peoples is undeniable.

I don’t pretend to be an expert on the state of Aboriginal and Torres Strait Islander health. I have no idea how to fix the problem. What I do know is that hollow words like ‘self-determination’ and ‘empowerment’ are drowned out by louder, fiercer war cries of ‘mining boom’ and ‘budget emergency.’ I know that I live and work within a broken system, based on the glorification of profit and the worship of endless fiscal growth. Such idolatry comes at the cost of those left behind. Our Prime Minister suggests it is a ‘lifestyle choice’ to live in a remote Indigneous community. I would suggest that the children of the Alice Springs paediatric ward have very few choices in life, if any.

Close the Gap Day is this Thursday, the 19th of March. We must walk alongside our Indigenous brothers and sisters if this is ever to become a reality.

[1] Couzos S and Murray R for the Kimberley Aboriginal Medical Services Council. Aboriginal Primary Health Care: An Evidence-based Approach. 3rd ed. South Melbourne: Oxford University Press; 2008. p448

Victoria Smith is a final year medical student at Monash University who has a keen interest in Public Health and Global Health. Check out Victoria’s personal blog here.

Press Release: Medical students welcome continued funding for mental health services

Media Release | 08 April 2015

The Australian Medical Students’ Association (AMSA) welcomes Health Minister Sussan Ley’s announcement that funding of community mental health services will be renewed for another 12 months.

AMSA President, Mr James Lawler, said this was particularly important in order to provide certainty for the mental health sector until the release of the National Mental Health Commission report.

“AMSA congratulates Minister Ley on this decision – without it, the mental health sector and its clients faced an ambiguous future after June 30.

“Forty-five per cent of the Australian population will suffer from one or more mental health conditions during their lifetime.

“Young people in particular are at risk of poorer mental health, and services which provide early intervention, long-term treatment and public health awareness are vital.

“Preventing long-term impacts of mental illness will alter the trajectory of a young person’s life, as mental illness is the number one cause of lost quality of life in young people.

“BeyondBlue data suggests suicide is the leading cause of death in young Australians, eclipsing even motor vehicle accidents.

“Whilst we are pleased essential mental health services are able to continue for another 12 months, there needs to be a more long-term commitment from the Federal Government.

“AMSA urges the government to invest further in mental health services on a national and regional level with a focus on preventative action – by far the most efficacious intervention – including the provision of a Mental Health First Aid course for all university students.

“Mental Health First Aid skills will equip students with the ability to deal with crises, to identify when their peers are in distress and will allow students to recognise when they need to seek help themselves.

“AMSA calls on the Health Minister and Treasurer to ensure that there is adequate, long-term funding allocated in the upcoming Federal Budget to continue to provide these services – particularly to vulnerable populations.

“AMSA once again calls on the government to release the Review into Mental Health Services and Programmes.


Media Contact:
Maria Bilal


Follow AMSA on Twitter.

AMSA Blog: Climate Change: The Forgotten Med School Subject

3 Climate ChangeBy Millicent Burggraf, Monash University

I am a Monash medical student. As an experienced surgical consultant once told me on my clinical placement, this will mean that I will graduate from medicine knowing no anatomy, but with an amazing capacity to empathise. Although said in jest, this consultant had a point. It’s true that they ‘don’t teach medicine like they used to.’ The Monash curriculum embraces the biopsychosocial model of health, and bases its teachings around that. As such, we all learn pretty quickly that disease and illness are not direct consequences of biomolecular dysfunction – there are more pieces to the puzzle. Our patients are humans, not bodies; as such, it is not sufficient for us to learn our anatomy and physiology in isolation if we are to treat them to our best ability. It is true that medical courses are starting to do a good job of preparing us for the complexities of clinical practice, where it is essential to consider the psychological and social factors that contribute to disease, as well as the purely biological ones. However, there is one particular area that is neglected in our medical degrees. Unfortunately, it also happens to be the area that we must understand the most thoroughly if we are to continue to adequately fulfil our role as advocates for human health.

The medical profession is beginning to recognise climate change as a health issue, and a pretty significant one at that. In 2009, the Lancet, one of the world’s largest and highest-esteemed medical journals, stated that climate change is the ‘biggest global health threat of the 21st century.’1 Just last year, the British Medical Journal published an editorial stating that when it comes to climate change mitigation, ‘those who profess to care for the health of people perhaps have the greatest responsibility to act.’2 Our climate is in upheaval, and we are about to start our careers in the midst of this, most of us with limited knowledge on the specific challenges we will face. If we do not act now, by 2050, the number of temperature related deaths in Australia per year is projected to increase by approximately 33%.3 Even today, we are experiencing the stresses that increasing temperatures place on our healthcare system – in the summer of 2013-2014, there was a 700% increase in the number of call outs for cardiac arrests on the hottest day, with paramedics receiving a call every 6 minutes at one point.4 Increases in air-borne particulate matter and allergens from a warmer climate will increase the frequency and severity of respiratory disease and asthma attacks,3 and it is predicted that the number of Australians exposed to Dengue fever will increase from 43,000 today to 5-8 million by the end of the century. And these predictions only scratch the surface of what we could potentially face. There is no debate that the physical environment in which we practice medicine is changing. Extrapolating on this, it is logical to predict that the health issues we will tackle in our careers are also changing, both epidemiologically and in terms of how they present. So why aren’t we learning about climate change and how important a stable climate is to our health? And why aren’t we learning what we can do about it?

In order to protect human health, both in our careers as doctors and for future generations, our first step is to start acknowledging that this global health issue is going to have implications on how we practice medicine. Not on how our children or grandchildren or great-grandchildren will, but on how we will. Because these issues are affecting us today. Not only our careers as doctors, but our ability to live a happy, healthy life in equilibrium with the earth and its resources.

Our profession ensures that we will be unable to hide from the human impacts of climate change, and so the importance of this issue should be reflected in our medical education. As such, our next step is obtaining adequate preparation for the challenges we may face. But in addition (and perhaps more importantly), we need to learn the skills we can employ to change the trajectory we are on. The skills to advocate for human health at a societal level, and utilise the influence we have as medical professionals to protect our future patients and ourselves from the consequences of inaction. It is only with this knowledge that we will be truly equipped to practice medicine in the 21st century.

By Millicent Burggraf

  1. Costello A et al. Managing the health effects of climate change. The Lancet. 2009;373(9676):1693-1733.
  2. McCoy D, Montgomery H, Arulkumuran S, Godlee F. Climate change and human survival. British Medical Journal. 2014;348:2351.
  3. Climate Commission. The critical decade: climate change and health. Canberra (AU);2011. 48p.
  4. Australian Broadcasting Corporation. Canberra ACT: ABC; 2014. Heatwave death toll expected to top almost 400; 2014 Jan 23 [cited 2015 Mar 19]; [about 3 screens]. Available from: http://www.abc.net.au/news/2014-01-23/heatwave-death-toll-expected-to-top-almost-400/5214496

3 Bio

Millicent Burggraf is a BMedSci student at Monash University, having completed fourth year in 2014. She sits on the Climate and Health Action Network (CHAN) committee and is involved in the health industry superfund divestment campaign. To find out more about CHAN, contact her at millie.burggraf@gmail.com



Review: Medivention Tendon Hammer


UPDATE: Medivention tendon hammer can be purchased directly in Australia from the University of New South Wales’ Medsoc Bookshop. More information here

The Medivention tendon hammer is a compact tool that fits easily into any pocket. Once extended, the hammer operates and feels similarly to any other tendon hammer with the rubber head having a nice weighted feel. Unfortunately the extendable nature of the shaft means it doesn’t feel as robust as say a non-extendable metal shaft, however this is a small payoff for something that is extremely portable. Indeed you shouldn’t be hitting the patient so hard that this would ever be a problem, although clearly the tester was not able to test the long term durability of the extendable shaft.

Don’t make the same mistake the reader did – a collar locking mechanism prevents the head snapping back too easily in the parallel plane of the shaft. Without utilising this mechanism the head snaps back too easily whilst using the hammer clinically.

So in all, the Medivention tendon hammer is a tendon hammer that fulfils all the requirements necessary of the tool with all the added benefits of portability. Anyone who uses a tendon hammer regularly on the wards should consider this alternative.

For more details on the Medivention tendon hammer, click here.

This product was reviewed by Timothy Martin, Monash University.

PRESS RELEASE: Sexual misconduct a barrier to ensuring gender equality for future doctors

Media Release | 12 March 2015

The Australian Medical Students’ Association (AMSA) stands strongly in support of gender equality in the medical profession in light of recent reports of sexual harassment among doctors.

AMSA President, James Lawler, said today that the medical profession was founded on principles of respect and integrity, but the current culture does not appear to be upholding these values between male and female doctors.

“The discussion has centred on whether to report inappropriate behaviour and how well reporting structures have handled it,” Mr Lawler said.

“Sadly, this is missing the main point – which is that this harassment is occurring at all.”

Maria Bilal, the AMSA representative to the Royal Australasian College of Surgeons Women in Surgery Committee, said there is an urgent need to work on improving the gender divide in surgery.

“Evidence shows that, despite increased participation from females in the medical workforce, women are still under-represented in the upper tiers of leadership,” Ms Bilal said.

“Ensuring that female trainees have strong, supportive role models remains a challenge.

“Women in the medical profession, especially junior doctors, suffer from poorer mental health than men, with sexual misconduct a factor. It is essential that sexual misconduct, bullying, and other inappropriate behaviours are properly dealt with.

“Gender should not affect the way in which individuals progress their career – we need to foster a supportive system that allows trainees to thrive without the prospect of harassment.

“A true cultural shift requires effort from all stakeholders, especially males in leadership positions.

“As the new generation of doctors, medical students are committed to ensure that there is a change – beginning with a strong culture of transparency and accountability.”

AMSA will work with the AMA and the Colleges to develop a sustained, coordinated national response to address these issues.

Media Contact

James Lawler
0432 396 979

Follow AMSA on Twitter.

Press Release: Medical students concerned about Transforming Health proposals from SA Government

Media Release | 06 March 2015

The Australian Medical Students’ Association (AMSA) expresses grave concern at the South Australian Government’s ‘Transforming Health’ proposals.

Particularly troubling are suggestions the Repatriation General Hospital will be shut down and Noarlunga Emergency Department downsized.

“Medical students are concerned that these changes have been proposed without adequate and transparent consultation with the health sector”, AMSA President, James Lawler said.

Mr Lawler pointed to contrived anecdotes used to back up the proposals, saying that they were inappropriate for a discussion regarding health system reform.

“The proposals are not backed by evidence, and lack the kind of detail needed to properly access them.”

Mr Lawler was particularly concerned at the focus on cutting back essential services as a short-term money-saving measure.

“The Government’s proposals hit the vulnerable the hardest, by scaling down smaller hospitals and transferring vital emergency, rehabilitation and other services to large metropolitan hospitals.

“In life-threatening emergencies timely treatment is critical. Studies show that for every extra 10km travelled, there is a one per cent increase in patient death, so South Australians living in regional areas will be severely disadvantaged by having essential services in central Adelaide.

Mr Lawler added that in its proposal the Government appeared to have overlooked training arrangements for junior health staff, particularly doctors.

“Training future doctors in South Australia can’t be an afterthought – this should be an integral part of any health system reform.

“It looks as though these reforms will reduce internship positions, speciality training positions, and leave many medical students without an appropriate place to learn,” Mr Lawler said.

These changes are particularly worrying for medical students in SA, Flinders Medical Students’ Society President, Nicholas Stock, said “there is considerable uncertainty over placements and internships held at facilities which are on the chopping block.”

The Repatriation General Hospital (RGH) and the Noarlunga Hospital emergency department are important teaching facilities for the Doctor of Medicine course at Flinders University.

“If these changes go through, we will see further congestion of the training pipeline and fewer learning opportunities for future doctors, ultimately affecting the quality of South Australian doctors,” Mr Stock said.

AMSA calls for the South Australian Government to undertake proper consultations with health groups, and provide more details, evidence and economic modelling to support their proposals.

AMSA also urges the Government to ensure that training the future doctors of South Australia is given much greater consideration.

Media Contact
James Lawler
0432 396 979


Follow AMSA on Twitter.


INFO: Australian University applicants applying for PGY1 positions in NZ

The Advanced Choice of Employment (ACE) scheme is a collaboration of all the District Health Boards (DHBs) in New Zealand to employ first year House Officers.

Every year ACE receives submissions from Australian University applicants, and in order to assist with their application, ACE has created a dedicated page on Kiwi Health Jobs to ensure that graduates are provided with the correct information so that their application can be completed on time and without delays.

Access the Kiwi Health Jobs page here.

Applications have been open since 9am, February 16th 2015. Students will be able to create a login and begin to submit the documents required to support their application.

AMSA Blog: Asian female medical students are female medical students too

2 Women in Surgery

By Hui Ling Yeoh, Monash University

Recently, a male colleague and friend of mine was searching for a female medical student to speak about sexism in the medical workforce. He said he really wished he could ask me to speak because he knew it was an area I was passionate and thoughtful about, but he couldn’t. He explained that he couldn’t invite me on the basis that I was Asian Australian, and my ethnicity is a “confounding factor”. Were my experiences the result of sexism or racism? The distinction would be impossible to make, and it would weaken my persuasiveness with an unconvinced audience.

It surprised me that he was so unapologetic and justified about his rationale for such blatant racism. But we have all accepted and contributed to this line of assumption: That sexism happens on a blank slate, and the slate is white.

Asian medical women are very often denied their femininity and humanity.

It is no secret that the parents of ethnic minorities encourage, often vigorously, their children to enter the medical profession. This pressure is amplified for daughters. Asian parents often believe that medicine is a reliable meritocracy, where their daughters need only work hard and follow the rules to succeed. They worry that in other professions, where the battleground seems more subjective, their daughters simply won’t have the ability to compete.

Throughout medical school, it has been assumed by colleagues, patients and teachers that my motivation to be in this profession is a materialistic one.

It seems that we are only thought of in one of two ways – either as a Christina Yang or a would-be housewife.

Christina Yang is a fictional doctor from the television drama, “Grey’s Anatomy’, who is characterised by her incredible genius, highly competitive drive, disastrously poor empathy and communication skills with patients, and romantic conflicts due to her lack of desire for children. I have often wondered whether Caucasian women face this stereotype, or do we just assume that Caucasians simply have an inherent charm and natural joie de vivre?

The flip side is the assumption that Asian women see this degree as a dating pool of aspiring doctors to make prosperous homes with, where our certificates will simply be nice decorations. After all, people will say, Asian cultures are more traditional (read: backward) than Western ones.

Both depictions are seen as less worthwhile, and less meaningful to those who feel entitled to judge. It’s a polarisation that happens to all women, but for Asian women, it feels like a personal attack on our cultures, which are characterised as more “materialistic”, and more mechanic. Worse, when people realise that I am more than these stereotypes, they provide the condescending reassurance: “Oh, but you are not very Asian.”

This is hurtful and unfair to me and all the Asian medical women I know who truly love what they do, and offensive to a heritage that I am proud to own.

The face of medicine is changing. Junior doctors and medical students are more culturally diverse than they have ever been.

It has taken me time to feel confident about the validity of my particular blend of experiences. I know now that I define what it means to be a medical student, a woman, an Asian, or all at once. This has given me incredible strength, but more importantly, it has also allowed me to be open fully to the complexities of other medical people too.

2 Women in Surgery HL

The Australian Federation of Medical Women seeks to ensure equity and equality for women doctors to achieve their full potential throughout all stages of their professional and personal lives. For more information, access to events, leadership development, networking and mentoring opportunities, please join your state branch at http://afmw.org.au and check out their latest newsletter here.

Hui Ling is the Co-Chair of AMSA Global Health and Monash University student representative for the Victorian Medical Women’s Society (VMWS). You can follow Hui Ling on twitter at @HuilingYeoh.

Press Release: Medical students concerned by TPPA reducing access to medications

Media Release
03 March 2015

The Australian Medical Students’ Association [AMSA] welcomes the report released by the Public Health Association of Australia [PHAA] detailing the negative impacts of the Trans-Pacific Partnership Agreement [TPPA] on the health of Australians.

‘The TPPA poses a significant risk to the affordability of medications and has the potential for major follow-on effects for the Australian, and global, population.’ said AMSA President, James Lawler.

‘The provisions in the TPPA may mean longer and broader monopolies on medicines and other health technologies, ultimately increasing out-of-pocket expenses for already vulnerable populations.

‘Increased cost of medicines will intensify medical non-adherence, with an Australian Bureau of Statistics survey finding 1 in 11 people delayed or did not fill a prescription due to the cost – the TPPA is a dangerous move in the wrong direction.

‘The government should be prioritising community public health needs, since equitable access to medications can have far-reaching benefits.

‘AMSA is calling upon the government to ensure that broader transparency is afforded to the Australian people, and for strong provisions to be included in the agreement which protect public health and keep medicines affordable.

‘This Health Impact Assessment has been put together by a large team of academics and non-government health organisations – AMSA urges the Government to listen to experts on public health policy.’

Mr Lawler also pointed out that medical students had taken particular interest in the negotiations and their potential impact on public and global health, to the point where Australian medical students had attended negotiations overseas.

AMSA calls on the Department of Foreign Affairs and Trade to apply the report’s recommendations in the final days of TPPA negotiations.


Media Contact
James Lawler
0432 396 979

Follow AMSA on Twitter.

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