“Warami” I am Brianna St John, a proud Darug woman from the Burramatta clan. 2020 has been a year we have never seen before bringing hardship – even devastation – to so many with still no end in sight to the coronavirus pandemic. Being involved in medicine as a medical student I have realised how an important service we provide to our wider community. Nursing has been my passion; I finished my degree in two years, where an inspired lecturer saw more in me than I aspired for.I am a resilient and determined woman to be an example to my clan and wider community to succeed as an Indigenous Doctor.

My personal belief is that prevention, education, and empowerment have greater importance than cure. My biggest driving influence was my parents, stemming from my childhood having a dysfunctional family with an alcoholic mother that is so entrapped with her disease and my estranged father with addiction problems with substances. If it wasn’t for how I grew up, then it wouldn’t have led me in the direction I am in today which is mental health which contains a wide range of conditions that affect mood, thinking and behaviour. Rural communities in Australia have an additional set of challenges in terms of relapse prevention and importantly home to Aboriginal and Torres Strait Islander people. While facing challenges in terms of mental health care, rural communities have less access to services than metropolitan areas. A common barrier to relapse prevention in rural communities is fear of stigma, reducing awareness and acceptance of mental illness because it is difficult to maintain privacy in small communities.

With ‘rural stoicism’, stigma makes it likely that they will withdraw rather than seek help from appropriate mental health and support services. Improving community attitudes toward mental illness and encouraging appropriate help-seeking behaviour are priorities in rural communities. I want to be able to give access to mental health and community services and have a positive impact on planning for and providing the support services that are required for preventing relapse. I want to draw special attention to Doctors within rural communities. I want to be able to continue care for people who have experienced a mental illness in rural areas to prevent relapse. I want to be able to shorten wait lists, heighten the rates of bulk-billing and create initiatives to support Doctors working in other rural communities to provide relapse prevention. I also want to be able to have the support of all members of the community as it is paramount for supporting relapse prevention in rural communities and we need to work in close partnership to provide a positive attitude toward and an integrated network of support for those who are vulnerable because they have been affected by mental illness.

I want to play my role to ‘Bridge the Gap in Indigenous Health’. I want to be a part of facilitating better health outcomes. I want to fund more clinics and facilitate a culturally safe empowering environment for Indigenous and Torres Strait Islander people

Ready, set, go was the theme of semester one for my fourth year of Medicine in Armidale. My first semester consisted of three different rotations being research, paediatrics, obstetrics, and gynaecology. Each rotation was six weeks in total, being in Armidale as well as other locations such as Inverell, Glen Innes, and Moree.

The year commenced with an orientation at the Tablelands Clinical School (TCS) where you meet everyone in your cohort as well as your first point of contacts and zoom into some sessions regarding the year ahead. It was nice to see that Armidale had 14 students in total completing fourth year as it is a small clinical school/hospital and a hard year ahead. Orientation week was a great way to get to know everyone before the clinical placements kicked in.

My first rotation was a six-week block of research in which carried over from third year. This is where the group and I were able to continue to work on our paper “Identifying the Utility of an Educational Smartphone Application (App) to Minimise Illicit Drug-Related Harm at Australian Music Festivals: An Explorative Qualitative Study”. Prior to writing this paper we performed semi-structured interviews to obtain qualitative data pertaining to our research question. Leading up to the data collection phase, we performed a scoping review of 271 relevant studies through COVIDENCE to identify current themes and gap in the literature. After conducting this review, we developed an interview protocol separated into four parts with questions covering general participant information, festival experience, minimising illicit drug-related harm, and overall opinions on the utility of a smart phone app to minimise drug related harm. As the interviews were semi-structured, the participants were able to direct the interview to ensure their perspective and ideas were covered as well as addressing our themes.

The second six-week block was my paediatric rotation in Armidale hospital. I thoroughly enjoyed this area of Medicine as you were able to look after very sick children in the ward as well as in the Emergency Department and get to know their families and friends. During my time on paediatrics, I was very fortunate to be able to be invited to attend Inverell, Glen Innes, and Moree outpatient clinics with my consultants. Moree was a highlight of this rotation. We were able to fly out from Armidale with the Royal Flying Doctor Service to Moree and spend the day seeing all different cases of children in need of health care in which they cannot access in that area as well as meet their families, then we flew home the same day. It was a turning point for me as I felt as though, I had found my calling for rural and remote healthcare especially in the paediatric field. This then sparked my interest in a university prize that had become available being the Carl Mason Memorial prize which consisted of writing a 1500-word essay in the field of diabetes in children and the winner will be announced in early October this year.

My third and final six-week block for semester one was my obstetrics and gynaecology rotation. I must admit this was not my favourite rotation, but I took every day of placement as a new day to learn something new. I did have the fortunate experience of watching mothers throughout the labour process and give birth in the maternity unit which is something I had not been involved with before. I was able to watch the mother, baby and family bond after the birthing process which was nice to see. I was able to see a range of gynaecology cases in the emergency department which got me out of the maternity ward at times for a change of scenery. I got to attend high risk ante-natal clinics in which I thoroughly enjoyed as I was able to improve my sonography interpretating.

After finishing the above rotations, I then went into my exam block and integration week. This was a multiple-choice quiz of 50 questions in relation to paediatrics, obstetrics, and gynaecology. After sitting this exam, I then had two days of classes that were face to face at the Tablelands Clinical School with the rest of the cohort that are in fourth year this year which was nice as we hadn’t seen each other since the start of the year with clinical placement being quite busy. After this week was completed, I was able to enjoy a week off with my fur baby at home prior to commencing semester two. I also found out that I had passed my first year four exam which was really rewarding to know and has motivated me to study more to be able to complete my end of year exams in semester two.

Throughout the chaos of commencing my fourth year, I was able to do some extra-curricular work on the Kruki Program which is now known as the Kruki Medical Academy at the University of New England. Kruki inspires Indigenous and Torres Strait Islander students in high school to consider a career in Health and Medicine at the University of New England by getting the chance to come to the campus for a week and experience life as a first-year medicine student. This year we have around 15 students from various areas of the New England along with their care giver which is a great turn out already considering this is the first year the program has re-commenced since 2019 and COVID. I am looking forward to the Kruki Medical Academy week on campus as I get to play the big sister role and be a role model for future students.