Tristan Scott

Rural Medical Scholarship 2016/2017

Western Sydney University (NSW)

Bathurst Rural Clinical School
Scholarship Awarded July 2016-June 2017

Sponsored by: S’Team Foundation

How would the Australian Rotary Rural Health Scholarship help with my studies at the Rural Clinical School?

Every individual has something to contribute to the community. Thats something I firmly believe, and its been strengthened by my exposure to people in and outside of the hospital setting. I am currently in my 4th year studying the Bachelor of Medicine and Surgery, which is honestly one of the most challenging endeavours I have ever put my mind to. Clinical placement involves an average of 40 hours a week in different settings where healthcare is delivered, ranging from GP clinics to operating theatres and community organisations. It is a privilege to be let into each patients lives and to gain an intimate understanding of their private medical history, but more than this to be compelled to empathise with their suffering as well as gain a more holistic idea of who this person is to their family and wider community “ a mother, a husband, a daughter, a brother, a mentor, a leader, an advocate, a participant. So many roles in the network that builds a cohesive community.

In July I will begin 12 months placement at Bathurst Rural Clinical School. To tell the truth I still have some reservations about making the move, as the first of my siblings to move away from home in Western Sydney and the first to pursue university studies away from the support of family. The bulk of my understanding of the rural context comes from studying agriculture at Hurlstone Agricultural High School. During this time I and four other medical students will conduct a research project investigating use of advanced care directives in nursing homes & aged care facilities in the district.  I hope to come away from the experience with an expanded appreciation of diversity in rural areas and form my own ideas about pursuing or tailoring my training and career to practice medicine in rural/regional Australia.

In the past I have represented my year group at various academic committees within the School of Medicine. In 2014 I served as the Chair of the community arm of Global Health Awareness Western Sydney, a student-led group advocating for issues like refugee detention, environmental initiatives, sexual health and mental health. I am an active member of the Western Sydney Medical Society.  Late last year I completed a 5-week placement at The Parks Community Network, Fairfield where I got to work with groups from Arabic & Assyrian speaking backgrounds, the Mens Shed project, children’s school holiday programs and Alzheimers Australia outreach events.

I hope to use this scholarship to help me with the expenses of living independently in Bathurst and also undertake a 5-week international elective placement in South Africa or Nepal in late this year. Were taught that the value of studying medicine is to understand the context with which your patient presents, and to do this I need to broaden my own experience, keep meeting people and continually seek to empathise with their challenges.

Rural Placement – 1st Report

Hello from Bathurst!

The long-term placement at Bathurst has allowed me to participate and experience more outside the hospital and learning environment.

Things I have so far done in Bathurst and Central West NSW surrounds:

  • Volunteer providing free health checks at Mudgee Field day
  • Volunteer at Bathurst 12-Hour motor race
  • NAIDOC week celebrations at Bathurst Base Hospital
  • Teddy Bear Hospital volunteer at Royal Bathurst Show
  • Outreach GP clinic to Sofala and Hill End monthly
  • Farm safety training day at Cottie’s Run, Bathurst
  • Race in the annual Bathurst-Edgell Jog
  • Weekly participation in ParkRun (timed 5km)
  • Rock-climbing and bouldering at Evans Crown, Tarana
  • Dragonboating at Chifley Dam with the Bathurst Snapdragons
  • Trivia at Bathurst RSL
  • Visited Tarana and Bathurst farmers’ markets
  • Orange food & wine festival
  • Horse riding in O’Connell
  • Community research project surveying use of end-of-life care directives in residential aged care facilities

On top of this the clinical experience I have gained has been second-to-none. The scholarship has allowed me to focus on these to gain the most out of each term. I have completed placements in general practice, emergency, ICU/anaesthetics, paediatrics, oncology, general medicine and surgery since July 2016, at locations across Bathurst, Blayney and Orange. I was exposed to more patients, performed lots of procedures and practised refining my clinical acumen every day. Undoubtedly, I can say I am better prepared for my future as a junior doctor than my peers who remained at metropolitan hospitals.

I have and will continue to provide input to the Western Sydney University Bathurst Rural Clinical School team’s proposal to introduce a junior doctors’ internship program based at Bathurst Health Service in the next few years. Hopefully this will encourage future graduates like myself to see a path going forward for a career and life based in Central West NSW. If one were available for next year I would apply for it in a heartbeat.

My dream is to become a general surgeon or rural generalist. I’m absolutely certain that a career in regional or rural Australia lies in my future. I’ve been too spoilt by the opportunities and lifestyle during my time out rural so that now I’m not looking forward to returning to Sydney!

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Rural Placement – 2nd Report

Every day since concluding my placement in Bathurst I have drawn on the experience I’ve gained from the wonderful clinicians, researchers and staff that supported us throughout the year.

It was a major change from where I grew up in southwest Sydney. While not an advantaged area, access to healthcare in Sydney is not limited in the same ways as it is in and around Central West NSW. Geographical barriers to care and the limitations of rural practice were highlighted in ways that I could never appreciate without experiencing first-hand. Watching clinicians judge when they’d reached the extent of their professional boundaries and decide to evacuate critical patients to larger centres was a valuable and eye-opening experience. I was involved in the care of a few such patients including a premature newborn with immature lungs and a gentleman with a large blood clot in his leg. Neither would have survived without the appropriate immediate intervention of the clinicians in Bathurst.

Outside the hospital and in a broader sense, the services delivered by primary care physicians are often more involved in the rural setting. I travelled with my GP supervisor to Hill End, an isolated community nestled in the Great Dividing Range, to provide essential medical and prescribing services for patients whose opportunity for medical attention is primarily at these monthly clinics. I met an elderly lady with dementia continuing to live alone with little contact apart from her doctor’s house visit. I found this confronting when we traditionally agree that our elderly should be cared for with respect.

The rural setting is often overlooked in the study of health outcomes. Myself and four peers investigated the question “What are the current practices, barriers and enablers to Advanced Care Planning in residential aged care facilities in Western NSW?”   We have all heard the warnings about the ageing of the Australian population and this is a visible truth in rural areas. Our research found almost three-quarters (71%) of aged care staff thought that ACP was necessary. Formal training was seen as beneficial by most (81%) but the importance of practical experience was acknowledged. The rural setting was found to be a facilitator of ACP completion. We have prepared a poster for presentation at the RMA17 conference and are preparing to submit our manuscript to journals for publication.

Since completing my time in Bathurst I’ve been on Aboriginal Health placement at Port Macquarie, furthering my understanding of culture and connection to country through face-to-face contact with patients and elders at Werin Aboriginal Medical Service. Chronic disease is debilitating Aboriginal communities but the slow fight back is being led by passionate people whose ranks I will soon join.

It would be naïve to think that all the discrepancies between rural and metropolitan health delivery can be solved. Special clinics for outreach, specialist services and tailoring for Aboriginal patients’ care are in need across rural communities across NSW. Australia is a unique place and part of that story is the wide geographical landscape where Australians live. I hope in my career, addressing part of this divide will become a recurring theme. Thanks to this Rotary Scholarship I’ve been able to unlock opportunities and experiences for myself which have changed my perspective and will shape my future. Since going rural I can better see how to make this a reality.