Volume 22 | Issue 6 - Supporting and improving Indigenous health outcomes - RACS
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Volume 22 | Issue 6 Page 8 Page 12 COVID-19 impact on Indigenous Supporting and improving health Indigenous health outcomes
Surgical News | Volume 22 | Issue 6 3
RACS leadership
President’s perspective 4
Vice President's perspective 6
Spotlight on
Advocacy
Indigenous Surgeons stepping up to help 24
COVID-19 induced anosmia and smell
health retraining therapy
Role of near peer teaching
30
34
First Australian languages 10
Dr Melanie Walker Advocacy update 38
An advocate for better
Breast surgeon, VIC RACS advocating for appropriate reform
Indigenous health 11
to Prostheses List 39
Supporting and improving
Indigenous health 12
Leading support in your Community is at the heart of
Indigenous surgical Trainee's work
Building rapport with patients is key to
15
Articles of interest
Introducing the ANZ Hernia Society
RACS volunteers provide critical
27
times of need – it’s why
success for new Indigenous surgeon 19 help in Fiji 28
Indigenous Surgical mentorship 21 Domestic violence - A surgeon's
Surgeons call for greater protection for perspective 36
more doctors choose Avant
Indigenous communities 22 Capacity building in Samoa 40
RACS hosts the first post COVID-19
global health forum 41
COVID-19 plays havoc on cancer
patient's surgery 42
When will Australia's regulator start
When the moment arrives, how confident are you in the quality of support protecting patients? 45
Dr Bal Krishan honoured with RACS
you’ll receive? Avant offers unrivalled protection. Rural Surgeons Award 46
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News should be sent to: surgical.news@surgeons.org
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surgical Trainees 43
Cover image: Sumaya Harare
4 Surgical News | Volume 22 | Issue 6 5
I believe that we have to learn more about
our Indigenous communities in order to be
more effective surgeons. We have some
courses in this area available at RACS.
I recently attended an interesting one-
day course at the University of Otago’s
Māori Indigenous Health Institute (MIHI).
The course was organised by Professor
Suzanne Pitama, a highly respected
child psychologist. The course supports
health practitioners to feel informed and
confident in the development of Māori
competencies, with a special focus on
the application of the Hui Process (a
framework to enhance the doctor-patient
relationship with Māori) and the Meihana
Model, a framework that facilitates
the fusion of clinical and cultural
This was a particularly challenging I also take this opportunity to competencies to better serve Māori
examination to deliver due to the congratulate our new Fellows. I wish within mental health service delivery.
constantly changing COVID-19 you every success as you embark on this Dr Maxine Ronald and Professor Yin
restrictions. Exam participants had to new phase of your surgical journey. I Paradies also conducted a course on
be COVID tested, wear N95 masks, and encourage you to take time to learn more Indigenous Health Cultural Safety for the
eye protection. Some of the changing about your College and reach out to us chairs of Surgical Training programs in
circumstances meant that we had where you need assistance. October. We will include more Indigenous
to cancel the plastic surgery exam in As we look forward to 2022, the RACS healthcare education in surgical training
Auckland because of border closures. Council has been busy working on our as part of the RACS Cultural Competence
An enormous amount of work went into strategy. We will have more to share on and Cultural Safety Competency.
ensuring that the exams were conducted this when it is finalised. One of the key We also welcome announcement
successfully with as many candidates as pillars of the strategy is the focus on by Ahpra and the Medical Board of
possible able to sit for them. More than supporting Indigenous health, so I am Australia to conduct an external review
170 examiners, 30 local coordinators and pleased to see a Surgical News issue that of patient safety issues in the cosmetic
50 RACS staff and volunteers delivered the is dedicated to highlighting the many surgery sector. For far too long we’ve
President’s perspective
exam over the weekend. I thank everyone initiatives and people who work so hard in had a system that allows anyone with
involved. It was an example of true this area. a medical degree to call themselves a
collaboration between our staff, specialty Improving the health of Māori and surgeon. It is time to close the loopholes
societies, the Court of Examiners and Aboriginal and Torres Strait Islander that bring harm to patients.
many volunteers working together to people is a national priority in both our I am pleased to end my message with my
achieve a successful event. countries. Despite government initiatives,
It is hard to believe that the year is ICU cases presents an ideal window of warmest congratulations to Dr Annette
patients for soldiering on in the face of so There are so many people who provide health and social inequities persist
almost over. It has been a tumultuous opportunity for government to restore Holian on her recent appointment as the
many challenges. their time generously to the College from between Indigenous and non-Indigenous
and eventful one, framed by the ongoing surgery to full capacity. president of the Australian Orthopaedic
I also extend my gratitude to the many managing examinations, working in the communities. Association. As a woman president, this
pandemic. It is pleasing to see so many
We called on the Victorian government who went out of their way to support Asia-Pacific to support healthcare to appointment also gives me much pride to
communities in Australia and Aotearoa To address this, the College made
to address this issue urgently and we their communities. If there is one positive contributing their ideas through College see the increasing diversity in our surgical
New Zealand coming out of lockdowns. Indigenous health a priority by
are pleased to say that elective surgery we can carry forward, it is the spirit of committees and Council. We would not be profession. I wish Annette every success
incorporating it in our strategic planning.
Despite this positive step forward, we capacity was increased to 75 per cent and generosity that has been so evident in the able to run many of our activities without in her endeavours and remain committed
We want to address the health inequities
are faced with the challenges brought hopefully full capacity by the time this last two years of the pandemic. their valuable support. The pro bono to supporting her and other women in
of the Aboriginal, Torres Strait Islander
about by the pandemic that have magazine goes to print. contribution of Fellows has been, and their leadership journeys.
One of the challenges we faced during and Māori populations of Australia and
impacted negatively on the health of our continues to be, one of the College’s most
This successful outcome is the the year was running our Fellowship New Zealand. Our goal is to achieve this May the holiday season end the present
communities. For example, in Victoria, valued assets and resources.
result of the great efforts of surgical examinations. The Fellowship Clinical and by increasing the number of Indigenous year on a cheerful note and make way for
we have had elective surgery restrictions
directors, Victorian chairs of colleges Viva examinations took place for seven My thanks also to our Fellows who Trainees , building workforce capabilities, a fresh and bright New Year.
imposed intermittently over the last 18
and specialty associations, and the surgical specialties with 151 candidates participated in the Council elections. and increasing services to better meet
months, resulting in a growing waiting
Victorian perioperative consultative in Australia and Aotearoa New Zealand I encourage you to communicate with the health needs of these communities
list for elective surgery in both the public
council comprising of surgeons and between 5 and 7 November 2021. The your specialty elected Councillors, and in culturally appropriate ways. More
and private sectors. We believe that the Dr Sally Langley
anaesthetists. examinations were delivered in a hybrid indeed with any of us on how you can information on our approach is detailed
current stabilisation of the COVID-19 President
I would like to thank our Fellows, model across 23 venues involving a mix engage with and support your College. in our Indigenous health position paper,
situation with high vaccination rates, fall
Trainees, Specialist International of in-person and remote examiners and Congratulations to the re-elected which can be found on our website.
in the number of COVID-19 cases, and the
Graduates, staff at the College and our observers. councillors and new Councillor, Professor
gradual reduction in hospital in-patient
Deborah Bailey.
6 Surgical News | Volume 22 | Issue 6 7
Vice president’s perspective
Another year is rapidly coming to an end or experiencing poor behaviour. We recently achieved the Department
and despite the accompanying challenges of Foreign Affairs and Trade (DFAT)
There is another extremely important
and disruptions, I hope that you and your basic accreditation and aim for full
relationship, that I would like to
families are safe and well. accreditation, which will create new
highlight: that of between Fellows and
It is heartwarming to see Australia staff. Council has guided the evolving funding opportunities. As we continue
and Aotearoa New Zealand emerging governance structures and it is important to meet the evolving regulations and
from difficult circumstances and into a to explain the implications for Fellows standards of DFAT, we need to ensure
sense of normality as vaccination rates and staff. compliance with DFAT and institutional
increase and a decrease in the severity of donor requirements to attract funding for
Your Board represents members and our growing programs in the Asia-Pacific
COVID-19 cases.
delegates the responsibility to progress region.
I would like to highlight a few thoughts in board set strategic direction to board-
this message to you. related committees. Many committees A recent independently facilitated
are predominantly operational and are donor-mapping activity involved Fellows
We recently conducted an evaluation of and staff as part of a strategy to grow
the short-term outcomes of the RACS critically reliant upon the diligence,
support, and high-level expertise of RACS programs and diversify funding sources.
Building Respect and Improving Patient RACS has a highly skilled team with more
Safety initiative. The evaluation focused staff. Our staff are the engine room of
our strategy delivery, and my experience than 100 years of development expertise,
on program governance and oversight, which we Fellows can harness for a
awareness of standards of respectful of board governance reflects the
importance of the team in developing and brighter future. Together, we can make
behaviour, and identifying program this happen.
deficiencies. This would not have been maintaining relevance for our members,
possible without the contribution of and more importantly to our community. As we look into the future, it is
our Fellows, Trainees and Specialist A recently held workshop, facilitated increasingly important for RACS to
International Medical Graduates (SIMGs) by an industry expert external reviewer explore surgeons’ growing interest in
whose insights will be invaluable in provided an update of appropriate robotic assisted surgery with implications Finally, I warmly congratulate Dr Annette
formulating the upcoming Action Plan. governance of RACS, our roles and how to for training, standards and accreditation. Most working group members favoured Holian, an esteemed member of Council,
RACS extends its gratitude to all who best add value. Surgery delivery is changing as are the the second name as it was closest to on her election to president of the
contributed. Fellows must lead by example in barriers to adoption of robots such as the current name. Options featuring Australian Orthopaedic Association (AOA).
acceptable standards of behaviour and cost and availability. I have little doubt ‘ANZAC’ were avoided given the military I have known Annette for a long time,
The evaluation found that more than that in the future, Trainees and surgeons
interactions with Trainees, SIMGs, other connotation. Council approved a vote of and she is popular, focussed and diligent.
90 per cent of members support our will become increasingly technology
healthcare workers and RACS staff. members on the proposed name change. Annette has proven to be a wonderful
work in this area, the leadership role that dependent. RACS has a responsibility to
I have observed the lack of appreciation This will be conducted via (electronic) leader and will continue to bring immense
RACS has taken and the commitment develop our members with the necessary
of power differentials that exist in these postal ballot in 2022. More information value to AOA.
to improve the culture in the surgical skill sets for the digital future. We are
relationships and perhaps it is time to will be provided in due course.
workplace. This aligns with community working with the Australian Medical I wish you all a relaxing and safe
awareness and expectations of the recognise the effect this has upon those Council also recently decided to transition holiday season – a welcome chance to
with whom we interact. Being aware Robotics Academy in Melbourne to
need to improve workplace behaviour, our well-regarded member magazine, enjoy family and friends, and a happy,
of nuances such as these is a sign of explore future relationships.
which is increasingly part of workplace Surgical News, to a digital format in the successful and enjoyable 2022.
policies. respect. I am saddened by reports of On other Council matters, the proposed second half of 2022. There is a growing
poor behaviour by Fellows towards staff, name change for the College was expectation that as the world embraces
Almost all (99 per cent) Fellows, Trainees Dr Lawrence Malisano
and we need to appreciate the negative mentioned in my message in the October digital platforms, our offerings should join
and Specialist International Medical Vice President
impacts of this behaviour on their 2021 issue of Surgical News. A working the ever-increasing list of publications
Graduates (SIMGs) believe in the need function and physical wellbeing. party scoped a proposed College name adopting a digital platform. We currently
to demonstrate respectful behaviours, and recommended to the Council to put
I highly commend College staff who, receive a hard copy and a flip book version
and 96 per cent recognise the need to this forward to members. The working
despite the difficulties imposed by but plan to move to a fully digital version
address unacceptable behaviour in group identified two viable alternative
the pandemic, have performed above hosted on a microsite within the RACS
colleagues and peers. However, there is names:
expectations, for the benefit of the website.
a knowledge and behaviour gap as while
knowledge of respectful behaviours is College. RACS staff are highly trained and • Royal College of Surgeons of Australia A paper-based version will be available
widespread, and attitudes are changing, qualified professionals, experts in their and Aotearoa New Zealand (RCSAANZ) upon request. This change is in tandem
‘calling it out’ is a challenge for many. field and employed to progress College • Royal Australian and Aotearoa New with the recent decision to go digital with
We recognise that behaviour change is goals and aspirations. RACS staff are the Zealand College of Surgeons (RAANZCS) the ANZ Journal of Surgery.
a long-term goal, but many of us need ether for the College's success.
more confidence to act when witnessing
8
Made for doctors
and their families
news in brief I switched to Doctors’ Health Fund because it was
the only fund created for doctors and their families.
We recently expanded our family, and it gives me
assurance that they are all covered under the policy.
College of Surgeons welcomes review contributions in encouraging medical identification of the best researchers
specialists to adopt digital technologies. and best research institutions in each
of cosmetic surgery
field, based on the excellence of their
RACS President, Dr Sally Langley, said Her extensive contributions to digital
research and the impact it has in
that Australians rightly expect all health include formerly chairing the
discovery and scholarship.
surgical procedures to be performed Australian Health Digital Agency’s
to the highest possible standards and Specialist Toolkit Steering Group, The End of Life Choice Act 2019
meet nationally established surgical instigating the Australian Medical The End of Life Choice Act 2019 (the Act),
standards. Associations Digital Health Committee came into effect in Aotearoa New Zealand
and collaborating with government on 7 November 2021. The introduction of
“We call on the enquiry to focus on the
groups, regulators, and professional assisted dying means that a person with a
transparency of training. Any surgery
organisations to deliver digital health terminal illness who meets the eligibility
entails risk, and it is critical that the
implementation projects improving criteria can request medication to relieve
enquiry establishes clear guidelines
safety and quality in Australian health their suffering and end their life.
into the training required to conduct
care.
surgery. The practices of some health The Medical Council wrote to RACS
practitioners have caused significant Leading the way highlighting that some doctors may
harm to patients. The Australian’s annual Research not be familiar with the requirements
“We also welcome the Health Ministers’ Magazine acknowledges the best of the new Act, and may be unsure of
commitment to national consultation researchers and research institutions the implications, whether or not they
on changing the national law to protect across Australia, in 250 individual fields are willing to participate in medically
the title of ‘surgeon’. We have been of research. assisted dying.
advocating for a long time that only RACS congratulates the following In response, the Medical Council has
those registered in specialties that Fellows for being listed in Australia’s top prepared a resource document (https://
undergo Australian Medical Council 250 researchers in 2021: bit.ly/3FBSweM) to assist doctors as they
(AMC) accredited training program, seek to understand and apply some of the
which includes a significant surgical • Professor Zsolt Balogh key provisions in the Act. Dr Wilson Petrushnko
component, should be allowed to use • Professor Paul Bannon General Surgeon
The Ministry of Health has also
‘surgeon’ in their titles,” Dr Langley • Professor Jeffrey V Rosenfeld
created e-learning modules (https:// Doctors’ Health Fund member since 2015
added. • Professor Anand Deva
bit.ly/3nGlDHG) about assisted dying
• Professor Jonathon Golledge
A smarter way of working services. There are three 20-minute
• Professor Declan Murphy modules, which they encourage all
Congratulations to RACS Fellow Dr Jillian
Tomlinson on being a successful recipient
• Professor Richard Harvey
• Professor Julian Feller
medical practitioners to complete. Choose the cover that’s right for you and your family.
of Telstra Health’s inaugural 2021
Brilliant Women in Digital Health awards! Talent discovery and research analytics
firm League of Scholars in conjunction
Speak to our expert Member Services Team today.
Dr Tomlinson believes digital health
with The Australian, comprehensively
initiatives allow all to work smarter,
measured online data about Australia’s
not harder. She was recognised for her
research output, leading to the
1800 226 126
2022 membership renewal
Your 2022 College membership fee renewal notice is now available for review. Payment is due by 1 January 2022.
doctorshealthfund.com.au
Please visit the member portal to view the schedule of fees and subscription category options or to renew your membership.
Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including
waiting periods, limitations and exclusions) of the individual policy. DHF 324_ 11/21
10 Surgical News | Volume 22 | Issue 6 11
First Australian languages An advocate for better
Indigenous health
Combining science with helping people is Mikayla Couch’s mantra
Before colonisation took full effect, there RACS use of Aboriginal words
were between 290 to 350 Aboriginal Mina – means ‘knowledge’ in the Dr Mikayla Couch is a proud Bundjalung straight with one day off. We have to keep material. Dr Couch acknowledges the
language nations in Australia. When language of Gathang-speaking nation. woman and an Obstetrics and talking about this until it changes.” generous support given by RACS to AIDA’s
considering different dialects in each It is also the language nation of Australia’s Gynaecology registrar currently working conferences in encouraging Indigenous
language, the number of languages Dr Couch believes that unaccredited
first Aboriginal surgeon Professor at Lismore Base Hospital in New South doctors to consider training as surgeons.
spoken are estimated at 500. Trainees have been left behind and lack
Kelvin Kong, a founding member of the Wales. Dr Couch appears regularly in
the workplace protection available to In the meantime, Dr Couch is excited
Similar to cultures such as the Vikings, RACS Indigenous Health Committee social and web media advocating for
others. It’s a gap that she is concerned and looking forward to the launch of her
which relied on the verbal transmission and an Indigenous health advocate and better Indigenous health. She has an
will discourage other Indigenous doctors podcast, which will be called BLA.C.K
of history and culture, Aboriginal champion. Instagram page, and her podcast will be
from become surgeons. “I would love to Medicine (the ‘c’ is emphasised as an act
peoples' history and cultural practices The ‘Mina Advisory Group’, is used to launching in December.
come back to surgery one day,” Dr Couch of reclaim; it represents colonisation).
were transmitted through songs and denote the English translation ‘Aboriginal Dr Couch wanted to study surgery from said, “it’s my dream.” Dr Couch hopes the 30-minute episodes
ceremony. and Torres Strait Islander Knowledge a young age because she wanted to will have a broad audience with guests
While Australia is doing well in terms of
Each Aboriginal language nation had its Advisory Group’. combine science with helping people, such as Dr Justin Cain, a Gomeroi
policy development around improving
geographical region, language, cultural Common words that originate from particularly in her own community. Her and Yuin man and a Vascular Surgery
Indigenous Australians’ health, in
beliefs, laws, and political systems. Aboriginal words: grandmother developed breast cancer unaccredited registrar, and Professor
reality there are still many barriers that
In some regions, sophisticated hand-sign at age 75, and refused to go to hospital. Kelvin Kong, a proud Worimi man, the
Yakka – means physically draining work. prevent people from accessing and
languages were also developed. “So many of my people are terrified of first Aboriginal surgeon in Australia,
It comes from the word 'yaga', meaning receiving quality medical care. “I really
Although geographical boundaries hospitals. They are regarded as places full and an Otolaryngologist, Head and Neck
'work' in the Yagara language of the like the Closing the Gap framework,” Dr
separated language nations, they were of white people where you go to die,” Dr surgeon. She hopes RACS will talk about
Brisbane area. Couch said, “but we need more action
connected by trade and exchange of Couch said. “Maybe if there had been an their outreach program and the work
until Indigenous people have the same
information. Songs were sung during the Cooee – originates from the Dharug Indigenous doctor available to help my being done to encourage Indigenous
longevity in life expectancy and the same
journey capturing details of the trade language of Aboriginal Australians in the nan, she would have received treatment surgeons.
standards in living, employment and
routes connecting neighboring nations, Sydney area. It means ‘come here’ and for her cancer.”
education as non-Indigenous people.” If you would like to keep in touch with
including information on landmarks and has now become widely used in Australia
Dr Couch is a recipient of the RACS ASC Dr Couch and her work, follow her on
directions, backgrounds to ceremonies, as a call over distances.
Award, which provided funding so she … “we need more action Instagram: https://www.instagram.com/
and details of the locations of water and Other well-known Aboriginal words could attend the 2015 College's Annual until Indigenous people dr.aboriginal.woman/
food sources—known as song lines. include: Scientific Congress (ASC) as a final have the same longevity
year medical student. The Award was
Twenty eight Aboriginal languages are Ballarat in life expectancy and the
still spoken today. Due to trade between Bilby invaluable because it enabled her to
network and meet with many surgeons, same standards in living,
language nations and marriage, it was Bunyip
common for Aboriginal people to be Coolabah attend educational programs, and it employment and education as
multilingual and speak up to three or Dingo helped to demystify the activities of non-Indigenous people.”
more languages. Galah the College. It helped build Dr Couch’s
Jarrah confidence in pursuing a surgical career. Moving to Obstetrics and Gynaecology
Just as lawyers and doctors have their
Koala When she explained her history and meant she could keep up her surgical
technical language, Aboriginal medicine
Kookaburra commitment to improving the health of skills and learn new skills. Colleagues
people also had technical words to
Quoll Aboriginal Australians to other attendees often turn to her for advice, and she feels
describe medicines created using
Wallaby and speakers, she recalls being met with her presence has an informal influence
various plants. Sadly, where languages
Wallaroo interest and encouragement. in encouraging more positive behaviour
have disappeared, so too has essential
Waratah Dr Couch became an unaccredited around Aboriginal patients. She often
knowledge of plant use and medicine
Wombat Neurosurgical Trainee at the Royal Prince encourages other Aboriginal people to
making.
Billabong Alfred Hospital in Sydney, but left after study medicine and pursue careers in
In some language nations, such as the Min-min lights (ground-level lights of health.
three months due to burnout, despite
Warlpiri people, when a family member uncertain origin sometimes seen in supportive supervisors who tried to Dr Couch thinks most surgeons
dies, the women of the family enter a remote rural Australia) dissuade her from leaving. She had two want to help, but they’re not sure
vow of silence, which can last between
To find out more visit: car accidents within a week due to falling how to go about it. They can join
three to 12 months. During that time,
asleep at the wheel. “The hours were the Australian Indigenous Doctors’
sophisticated sign language is used to https://bit.ly/3DVgOjt insane. For example, I was rostered on Association (AIDA) as an associate
communicate. https://bit.ly/3nKLOgp for 21 days straight with one weekend member, attend conferences, and
off and then I worked another six weeks access training and educational
12 Surgical News | Volume 22 | Issue 6 13
Supporting and improving
Western biomedical approaches. Training for trainers in Aotearoa New Torres Strait Islander eLearning courses.
They also learned about how racism is Zealand These courses have been specifically
impacting Indigenous Health outcomes developed with the requirements of
RACS has collaborated with the Hui
Indigenous health outcomes
and considered what they can do surgeons in mind. They were designed and
Process/Meihana Model to deliver the
differently in their practice to address developed in collaboration with a range
MIHI course customised for surgeons.
these disparities. of Aboriginal and Torres Strait Islander
The course entails a range of components, partners to ensure they provide an
The RACS Fellows participated in a yarning
including online learning, onsite learning, authentic Indigenous perspective.
RACS supports the implementation of the new Cultural Competence and Cultural Safety competency circle with the facilitators to talk about
and assessment modules. The topics will
what they are going to implement in their More information on the courses and
explore the context of Hauora Māori and
practice. access to them is available through
professional development courses for our include Te Roe within a clinical setting and
Lindy Jeffree, a neurosurgeon from understanding the context for studying the RACS Indigenous Health webpage
members. The Indigenous Health team
Queensland said, “It was a fascinating Māori health. Orientation to the Hui Process (https://bit.ly/3HPmvSC). These courses
has also been developing and providing
and enjoyable interactive session that and Meihana Model and its application can are designed to be completed over an
a range of training across all sectors of
synthesised the challenges faced by help reduce clinical bias and improve health extended period and are broken down into
RACS, including targeted professional
Aboriginal and Torres Strait peoples literacy along with the role of Whakateres. self-contained 30-minute self-contained
development for training boards, Cultural
within our health system. We learnt modules. Members will be issued a
Safety and Indigenous health sessions— The objective of the course is to support
the strategies that non-Indigenous certificate on completion of the full course
through Indigenous providers and the health practitioners to feel informed and
doctors can use to improve the clinical along with 10 hours of CPD for the new
new Aboriginal and Torres Strait Islander confident in the development of Hauora
experience. The stories and examples of Cultural Competence and Cultural Safety
courses—and the Maori Indigenous Health Māori competencies, specifically focusing
how to provide culturally safe clinical Competency. The courses can be used
Institute (MIHI) training with the University on the Hui Process and Meihana Model.
encounters left me inspired to improve each year towards the CPD requirements
of Otago in Aotearoa New Zealand. The different components of the training
recognition, access, and outcomes for for the Learning Plan related to the new
The most appropriate training was are: competency.
my Aboriginal and Torres Strait Islander
identified by BSET and the Specialty patients and colleagues.” - onsite training seminar in Christchurch,
RACS is one of the first medical colleges to will provide a framework for everyone To support delivery of the eLearning courses
Training Boards to support the including team-based learning
identify the need to introduce a dedicated in the College implementing the new Associate Professor Bernard C.S. Whitfield the RACS library has purchased access
implementation of the new competency activities to orientate learners to the
Cultural Competence and Cultural Safety competency. The framework identifies said, “The AIDA session in Brisbane to a range of online and hard copy books
and the Professional Skills Framework. Hui Process and Meihana Model
Competency. learning outcomes across the three significantly enhanced my understanding highlighted in the courses for members to
This training commenced with BSET on - simulated patient sessions to practice
This new competency was developed in stages of surgical training, including of ‘sorry business’ and its implications.” use. The RACS library page provides access
14 October and the Board of Vascular application of Hui Process and Meihana
collaboration with the Indigenous Health statements identifying what a Trainee to the Informit – Indigenous Database along
Surgery on 22 October. Training will be Professor Yin Paradies' Indigenous Health Model to clinical practice
Committee and Indigenous surgeons in should know and be able to do in early, with a range of suggested articles, books
delivered to other Boards in early 2022. and Cultural Safety sessions in Australia - face-to-face courses assisting learners
Australia and Aotearoa New Zealand. mid and late SET. and other relevant resources for Australia
RACS has also developed and delivered to apply these models within their
AIDA Aboriginal and Torres Strait Islander and Aotearoa New Zealand. If you would like
It was introduced to support The final draft of the framework was a customised online Indigenous Health clinical practice alongside Māori
health in clinical practice access to other books or resources, please
improvement of Indigenous health presented to the Board of Surgical and Cultural Safety session delivered patients and/or whānau. These
The first AIDA Aboriginal and Torres contact the RACS Library.
outcomes and guide members on how to Education Training (BSET) on 15 October by Professor Yin Paradies. These were models promote positive engagement,
Strait Islander Health in Clinical Practice
provide culturally safe care. 2021, and will be presented to the delivered to the Melbourne Fellows on appropriate care and treatment, and Next steps
(ATSIHICP) session was held in Brisbane
Specialty Training Boards for review. The 9 October and to the Sydney Fellows on health advocacy that support Māori The focus for 2022 will be on finalising the
The new competency was introduced in on 17 July with a broad range of RACS
next stage of the framework development 6 November. health equity. Assessment Framework and implementing
June 2020 and is available on: https://bit. Queensland Fellows attending. The
will include an appropriate Assessment the Professional Skills Curriculum into the
ly/3CMpuHs session was delivered by Associate Professor Paradies is an Aboriginal-Asian- Learners will receive feedback about their
Framework to support specialty boards specialty Board curriculum documents.
Professor Shannon Springer and Dr Anglo Australian of the Wakaya people progress through assessment modules,
Having a dedicated Cultural Competence and trainers implementing the newly The Indigenous Health team will provide
Ngaree Blow (pictured above left) at the from the Gulf of Carpentaria. He is also which require them to demonstrate their
and Cultural Safety Competency identified Learning Objectives. support for training our members, inclusion
RACS Queensland office. the Chair in Race Relations at Deakin ability to use the Hui Process and Meihana
framework highlights to RACS members Training our Fellows to implement the of questions in the surgical education
University and is developing this training. Model in clinical practice. They also
the importance of improving Indigenous The session provided RACS Fellows training entry process, and the curriculum
new competency complete a case assignment involving
health outcomes by providing appropriate an opportunity to learn more about Professor Paradies said, “Providing documents. The RACS Indigenous Health
To support the implementation of a virtual patient case that allows them
culturally safe care to Aboriginal, Torres connection to country and how holistic optimal healthcare requires an team will work closely with BSET and the
the new competency, RACS has been to demonstrate how they apply the Hui
Strait Islander people and Māori. It also health perspectives are different to understanding of colonisation, the Boards to ensure they have the support to
developing and delivering a range of Process/Meihana Model.
highlights the need to provide culturally nature of health disparities, aspects implement the competency in a culturally
safe care to all Indigenous patients, of Indigenous culture, and effective If the learner chooses to continue their safe way.
families, communities and colleagues. approaches to addressing the detrimental learning past Assessment 1, they can If you need assistance please contact
impacts of racism and privilege in medical complete another written assignment.
Developing the Professional Skills the RACS Indigenous Health team on
contexts. Surgeons have found this This involves interviewing a Māori
Framework indigenous.health@surgeons.org
in-depth exploration of cultural safety patient with whom they are working and
The implementation of the new
engaging and influential in relation to completing the assignment.
Cultural Competence and Cultural
their ongoing practice.” This program is funded by the Australian
Safety Competency is supported by eLearning training (Aborginal and Torres
the Professional Skills Framework. Strait Islanders) Government Department of Health through
Cultural Safety Training
This framework was developed in the Specialist Training Program (STP).
Funded by the Australian Government To support delivery of the new
collaboration with the Indigenous Health Department of Health through the competency Fellows, SIMGs, Trainees, and
Committee and Indigenous experts in ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH
IN CLINICAL PRACTICE
Specialist Training Program (STP). JDocs can undertake the Aboriginal and
Australia and Aoteraroa New Zealand and
Launched in 2019, AIDA’s cultural safety training Aboriginal and Torres Strait
14 Surgical News | Volume 22 | Issue 6 15
Community is at the heart of
Indigenous surgical Trainee's work
Dr Rachel Farrelly had a very different in Orange, first suggested she consider a
upbringing to many of her peers in medical career in medicine.
school. She had only encountered medical
The orthopedic surgery Trainee grew up professionals through her brother, who grew
on a farm outside the country town of up with a disability and her grandmother who
Orange in New South Wales, where she was suffered from oesophageal cancer.
homeschooled. “I didn’t grow up wanting to be a surgeon. The
While that background might not have medical profession was quite foreign to me at
been the typical pathway towards a career the time and I didn’t take much notice of it.”
in surgery, Dr Farrelly believes it will be an After her father had planted the idea of
asset when she becomes Australia’s first studying medicine in her mind, she spoke to a
female Indigenous orthopedic surgeon. family friend who was a general practitioner.
“Moving to Sydney to study medicine was She was advised about the rigour of the
daunting and initially, I didn’t really feel like training and the steps towards becoming a
I belonged there. Most of the other medical doctor.
students were from schools in Sydney, and At university, Dr Farrelly was drawn to
I was from a small country town,” she says. anatomy for its practicality. She finished
“But growing up in the country gave me an at the top of the class in the subject, with
ability to communicate and build rapport another student.
with patients, and that is one of my She feels great satisfaction in being able to
strengths. I can talk in a straightforward
Matariki - the Maori New Year - declared a public
make a difference to patients through her
manner and understand the complex career in the orthopedic specialty.
backgrounds of patients.”
holiday in Aotearoa New Zealand
“I enjoy that in six weeks to three months,
Dr Farrelly believes that along with I can help someone go from being
procedural skills, communication is key to incapacitated to being able to walk out the
success as a surgeon. door.”
“Medicine is all about connecting with Her advice for other Indigenous women
Matariki refers to a large cluster of stars, also known as the Pleiades
people to the benefit of the community. interested in a career in medicine is to foster
The procedural side of things is valuable, relationships with those who can provide
Aotearoa New Zealand is preparing for an by thousands of years of observation, Matariki is an abbreviation of ‘Ngā Mata but if that’s all you’re interested in, you advice and encouragement during what can
annual celebration of Matariki with the recording and practice. o te Ariki Tāwhirimātea’ (The Eyes of might as well be studying veterinary be a challenging journey.
recent government announcement of a the God Tāwhirimātea) and refers to a medicine.”
According to the maramataka, Matariki “The way I progressed was by building
Māori new year public holiday. large cluster of stars, also known as the The Royal Australasian College of
brings the old lunar year to a close and relationships. Our history and culture are very
Matariki, the Māori new year, is a season marks the beginning of the new year. Pleiades. Surgeons (RACS) has outlined the role word-of-mouth and relationship based. My
when people, culture, language and The predawn rising of Matariki in the communication plays in health care advice is to reach out to teachers and friends
This highlights the importance the nation
the spirit of those beneath the stars of mid-winter sky marks the changing of the and its importance in the care provided to get an understanding of what is involved,
places on Indigenous knowledge and is
Matariki are celebrated. seasons and the beginning of the Māori to Indigenous communities in its RACS and to learn about the steps you need to take
demonstrating, in a very real way, how
new year. A Matariki public holiday will be Indigenous Health Position Paper. It to get you where you want to be.
Also known as the constellation of Aotearoa New Zealand can engage with
our first public holiday that recognises Te recognises the importance of a holistic
Pleiades, Matariki is a star cluster that mātauranga Māori (Māori knowledge “You need to be very dedicated because
Ao Māori. This day signifies: view of health—encompassing wider
first appears in the night sky above systems)”.* during training you have to work hard and
aspects like family, community, kinship
Aotearoa during mid-winter. • Remembrance – honouring those don’t always get to do some of the ordinary
The New Zealand government has
we have lost since the last rising of “Medicine is all about networks and connection to land,
things like chilling out at a pub. Instead, you’ll
It is a time to remember those who have introduced the Matariki Public Holiday Bill culture, traditions, waterways, and other
passed throughout the year and reflect on to Parliament. The Te Pire mō te Hararei Matariki connecting with people be at the library studying.”
resources.
ancestral knowledge to guide us into how Tūmatanui o Te Kāhui o Matariki /Te Kāhui • Celebrating the present – gathering to the benefit of the However, for Dr Farrelly—who would like to
RACS also aims to support more First
we can live our lives today. o Matariki Public Holiday Bill is only the together to give thanks for what we community.” Nations people from Australia and inspire Indigenous women to follow her into
When Matariki will appear is knowledge fifth dual language Bill to be introduced have surgery— the benefits of a career in surgery
Aotearoa New Zealand to follow in Dr
that comes from the maramataka—a to the New Zealand Parliament. The first are far-reaching.
• Looking to the future – looking forward Farrelly’s footsteps into a career in surgery.
calendar informed by the moon, the public holiday to celebrate Matariki will
to the promise of a new year. “Trying to help my people is one of my drivers
be on Friday 24 June 2022. Along with being a trailblazer in the
stars, and our natural environment. and to be a role model is also important to
Indigenous community, Dr Farrelly is the
Within it navigation, planting, fishing, me. Our experience of health care has often
*Wikitera, K. A. (2021, P1). first in her family to attend university.
and many other practices are determined been negative, and if I can change that I will be
However, it was her father who,
recognising her interest in helping people very happy,” she says.
Surgical News | Volume 22 | Issue 6 17
Audits of surgical mortality data identifies Case summary
An Indigenous patient in his 60s lactate 2.7 to 3.9 to 6 mg/dL). It was Given the severity of this bacterium’s
common surgical themes in Indigenous
presented to hospital in the evening and decided among the surgical consultant, pathogenicity and the poor health
was admitted medically with cellulitis. ICU consultant and family members to reserves of the patient, it is likely the
He had multiple comorbidities including palliate the patient. path to death was predetermined even
communities congestive heart failure, ischaemic
cardiomyopathy, alcoholic liver cirrhosis
Discussion
This patient was admitted with and
before admission.
Clinical and cultural lessons
with varices, atrial fibrillation, gout and died from overwhelming sepsis due to a Surgeons, doctors, and other healthcare
stage IV chronic kidney disease. He had Serratia marcescens infection in the leg. providers are faced with multiple
previously had a coronary artery bypass Serratia marcescens is an uncommon challenges, including societal and
In 2021, an estimated 33 per cent of • were more likely to have fluid balance and performance guide to include a 10th
graft and had a defibrillator in-situ. but known cause of skin and soft tissue cultural differences, when managing
Indigenous Australians (292,100) live in issues when in hospital competency: Cultural competence and
Intravenous antibiotics were started. infections and necrotising fasciitis. It Indigenous patients’ healthcare.
New South Wales, 28 per cent (246,300) • were more likely to have acquired an cultural safety.0
live in Queensland, and 9 per cent (79,571) infection before admission to hospital. The following day, he was referred to is unusual for overwhelming sepsis to It is possible that there were other
The following case study spotlights the
live in the Northern Territory. However, the surgical department in a state of result from an infection such as cellulitis significant factors that could
The NTASM has published data showing surgical journey of an Indigenous patient,
the Northern Territory has the highest septic shock with an erythematous and (in the absence of necrosis). have contributed to this patient’s
surgical care is equitable for both revealing challenges and asking relevant
proportion of Indigenous residents (31 swollen right leg. Necrotising fasciitis His leg was swollen and erythematous, comorbidities, including:
Aboriginal and Torres Strait Islander and questions.
per cent – 79,600 people).1 Similarly, the was suspected, and he was resuscitated. but at surgery there was ‘merely
non-Indigenous patients.6 References: • the patient’s ability to access
proportion of the population who identify He was sent to theatre; however, cellulitis’ and no necrosis found.
QASM’s 2021 annual report includes
7 1. Australian Institute of Health and Welfare. appropriate primary healthcare
as Indigenous is generally higher in more Profile of Indigenous Australians [Internet]. surgery was delayed for one hour when
remote areas.1 In Australia, Aboriginal and data from 2015 – 2020 and shows all Is it possible there was a site of necrosis in • the patient’s education level
Canberra: AIHW. 2021 [accessed 15 October the anaesthetist was called to another
Torres Strait Islander people experience Aboriginal and Torres Strait Islander 2021]. the leg that was not identified at surgery?
urgent case. His 15-minute surgery Could there have been necrotising fasciitis • the influence of environmental factors
poorer health outcomes compared to non- patients admitted under vascular Available from: https://bit.ly/3kxCiLC
2. Australian Institute of Health and Welfare. included a right ankle and lower leg deeper or higher up in the leg, or even that may have contributed to the
Indigenous people.2 or paediatric surgeons received an
Cardiovascular disease, diabetes and debridement with excision of ‹1% of the osteomyelitis? development of some of the patient’s
operation. Aboriginal and Torres
In January 2011, the Australian and chronic kidney disease—Australian facts: wound area. The appearance was not comorbidities.
Strait Islander patients admitted This case highlights the need for early
New Zealand Audit of Surgical Mortality Aboriginal and Torres Strait Islander people. typical for necrotising fasciitis. Shortly
under a neurosurgeon were 20 per Cardiovascular, diabetes and chronic identification of such infections. It is important for surgeons to review
(ANZASM) included Aboriginal and after surgery, he arrested in theatre.
cent more likely to have an operation kidney disease series no. 5. Cat. no. CDK 5. Indigenous patients holistically and
Torres Strait Islander status in the data Canberra: AIHW. 2015 [accessed 16 August Cardiopulmonary resuscitation was Is it possible that if the patient was
than were non-Indigenous patients. understand that disease development
it was collecting on in-hospital patient 2021]. performed, and he was transferred to admitted under a surgical team the
Fewer Aboriginal and Torres Strait may not rest solely on the patient.
mortality. The Northern Territory Audit Available from: https://bit.ly/3qCMfv3 the intensive care unit (ICU). path to surgery would have commenced
Islander patients were admitted under
of Surgical Mortality (NTASM) and the 3. Royal Australasian College of Surgeons. sooner (perhaps on the day of
orthopaedic surgeons than non- Australian and New Zealand Audit of Surgical He required high inotropic support and
Queensland Audit of Surgical Mortality Indigenous patients. developed refractory acidosis (pH 7.34 admission)?
Mortality National Report. 2016.
(QASM) have the most comprehensive Available from: https://bit.ly/3cfcob3 progressing to 7.23 then to 7.0, with
datasets in this regard. NTASM and QASM Aboriginal and Torres Strait Islander 4. Royal Australasian College of Surgeons.
reviewed 28 per cent and 34 per cent patients who had an operation, compared Northern Territory Audit of Surgical
(respectively) of all Indigenous cases to non-Indigenous patients, were nearly Mortality Annual Report (July 2010–June
twice as likely to die following vascular or 2020). 2021.
notified to ANZASM from 2015–2020.
cardiovascular operations. Available from: https://bit.ly/3ne7CAM
Recommendations regarding Aboriginal 5. Royal Australasian College of Surgeons.
and Torres Strait Islander patients have ANZASM will continue to review and Queensland Audit of Surgical Mortality
been included in annual reports for report on the differences between (QASM) Report (2007–2016). 2018.
ANZASM, NTASM and QASM.3–5 Aboriginal and Torres Strait Islander and Available from: https://bit.ly/2YKrG4k
6. Treacy PJ, North JB, Rey-Conde T, Allen J,
These reports have identified common non-Indigenous patients. Ware RS. Outcomes from the Northern
themes when compared with non- Aboriginal and Torres Strait Islander Territory Audit of Surgical Mortality:
Indigenous patients. Aboriginal and patients could benefit from a model of Aboriginal deaths. ANZ Journal of Surgery. A Surgical Audit eLearning module has reporting surgical mortalities and the regions, specialities and career stages to
2014;85(Numbers 1/2):11–15.
Torres Strait Islander patients who die in care that includes early recognition of been added to the RACS professional logistics of using the Fellows Interface. access information and gain CPD points
Available from: https://bit.ly/3kWXc7l
hospital under the care of a surgeon: health decline at primary care centres 7. Royal Australasian College of Surgeons. development activities (eLearning course This is delivered in four practical sections: (by completing the course assessment
• are at least 19 years younger and early transfer for appropriate Queensland Audit of Surgical Mortality and resources). The module has been and award of certificate).
1. The Audit of Surgical Mortality
surgical intervention. These approaches (QASM) Report (2015–2020). 2021. developed in a collaboration between
• were more likely to be transferred to The eLearning module is anticipated to
could lead to better outcomes for these Available from: https://issuu.com/ ANZASM and the RACS Professional 2. The audit process
another hospital maxgecko/docs/4043_qasm_annual_ 'go live' in early 2022.
• were more likely to be admitted to a patients. report_2020_final
Development department. It is available 3. The Fellows Interface
public hospital In 2020, RACS published an Indigenous 8. Royal Australasian College of Surgeons. to all surgeons and takes about 40
4. Feedback and evaluation.
• were twice as likely to have three Health Position Paper that reaffirms Indigenous Health Position Paper June 2020. minutes to complete.
Available from: https://bit.ly/3kC241e The course will provide an adaptable
or more co-morbidities per patient the College’s commitment to improving 9. Royal Australasian College of Surgeons. The eLearning module will provide
teaching and learning platform for a
(co-morbidities were typically renal health outcomes for Aboriginal and Updated Surgical Competence and training around the sensitivity of
broad range of users from different
disease, diabetes, and hepatic disease) Torres Strait Islander people.8 In 2020, Performance Guide February 2020.
RACS updated its surgical competence Available from: https://bit.ly/30mMyzH
18 Surgical News | Volume 22 | Issue 6 19
Building rapport with patients is key to
success for new Indigenous surgeon
A childhood split between Australia and He completed his surgical training in
South Africa provided Dr Andrew Martin Aotearoa New Zealand, where he lived for
with an appreciation of difference. He seven years. This year he moved back to
brings this to his work as an Ear, Nose and Australia to start his Fellowship in Head
Throat (ENT) surgeon. and Neck Surgery.
Dr Martin lived in South Africa between Dr Martin says that the hard work of
the ages of nine and 14 during a surgical training is part of a journey that
tumultuous time in the country’s is satisfying not just in its destination, but
history, towards the end of apartheid also in itself.
and the beginning of Nelson Mandela’s
“Overall, I think it’s a hugely positive
presidency.
Indigenous program grants
experience, with a number of stressors
“It was very confronting to see what was people. I also see a variety of conditions,
and challenges along the way. There are
happening in South Africa. But being an from hearing problems to cancer or sinus
a lot of hurdles to jump over with training
Indigenous Australian gave me sympathy surgery. I get great satisfaction from the
and exams, and life can throw you curve
Indigenous program grants – building careers in surgery to support Indigenous health for what people were going through,” he balls that are not always timed to fit in
whole patient experience—from seeing
says. people in the clinic, operating on them
with your plan.
and their follow up. It gives me a buzz
Together with the Indigenous Health As a new Fellow with RACS, Dr Martin “Training is a very long journey, so you when I see people who have achieved a
ASC Peer Support Award Career Enhancement Grant Junior
Committee, RACS is committed to attributes his understanding of the value have to really enjoy it and not be too good result.”
Registration, airfares, travel, and doctors
increasing the participation of Aboriginal, of cultural sensitivity to this experience, obsessed with the result. I made a lot of
accommodation costs up to $5000 $5,000 (multiple grants) In his surgery career, Dr Martin believes
Torres Strait Islander and Māori doctors in combined with his Indigenous heritage, great friends and mentors in training—
(multiple grants) This grant supports junior doctors to communication is more than half of
a surgical career by providing education, and his time living and travelling this is what made for an awesome
training and research opportunities. By This grant supports final year medical acquire knowledge and skills that will internationally. the job and that building a successful
experience.”
prioritising Indigenous Health, building students and doctors interested in strengthen their surgical career pathway. relationship with patients is crucial to the
RACS is working to ensure more Dr Martin encountered a hurdle of a role.
the surgical workforce and increasing surgery to attend the RACS Annual Who can apply? Indigenous Australians have the different kind during the year, when he
services, we can better meet the health Scientific Congress in May 2022. “The most important thing is to try
Aboriginal, Torres Strait Islander and opportunity to become Fellows. RACS and his family contracted COVID-19 and
needs of Māori, and Aboriginal and/or Who can apply? launched its Indigenous Surgical Pathway to understand and bond with those
Māori junior doctors. he found himself isolating at home with
Torres Strait Islander peoples. Program Australia in August 2021 to who have a different background.
Aboriginal, Torres Strait Islander and his wife and three children.
The following grants open for application increase Aboriginal and Torres Strait Learning some phrases or words from
Māori junior doctors and final year Career Enhancement Grant - Medical Fortunately, he and his wife had been
in January 2022 for Aboriginal, Torres Islander surgeons in the workforce. their language and having a broad
medical students who have previously students vaccinated and the family only suffered
Strait Islander and Māori junior doctors understanding of their cultural norms
attended an Annual Scientific Congress. $2,000 (multiple grants) Dr Martin says his journey towards mild symptoms. But it did mean that
and final year medical students with an helps you develop a rapport with them.
This grant supports final year medical Fellowship has been long and challenging Dr Martin was responsible for some But essentially, it is always important to
interest in surgery. Davison Family Grant but rewarding.
students who are interested in pursuing a homeschooling of his young children. treat each person as an individual.”
Indigenous Program Grants on offer for $2,500 surgical career.
junior doctors and final year medical
“Training is a very long “It was definitely a challenge!” he says.
This grant supports doctors who have the Who can apply?
students potential to inspire and attract similar journey, so you have to really Spending time with his family and his love
young people to the field of surgery and Aboriginal, Torres Strait Islander and enjoy the journey and not be of the natural world, ignited amid the
Māori final year medical students. bounteous wildlife of Africa, provide him
ASC Award who, without financial assistance, may be too obsessed with the result.” with respite from the stress of his job.
Registration, airfares, travel, and unable to contemplate a career in surgery.
accommodation costs up to $5000 Who can apply? Before moving to South Africa, he spent He considers his birdwatching hobby to
Applications are open via
(multiple grants) his younger years in Benalla in the north be an obsession, something he was able
Aboriginal and Torres Strait Islander surgeons.org/scholarships from 17
of Victoria. to indulge in during a trip to northern
The grant supports final year medical junior doctors wishing to undertake January to 16 February 2022.
Spain following an Ear Surgery course and
students and doctors interested in postgraduate surgical training. Further information: He attended high school in Frankston,
while training in New Zealand.
surgery to attend RACS Annual Scientific Tricia Quek, Learning and Development Melbourne, and enrolled in Pharmacy at
Congress in May 2022. Monash University, where he completed Dr Martin also gets great satisfaction
Grants coordinator
an honours year researching medicinal from helping a wide range of patients—an
Who can apply? E: scholarships@surgeons.org.
chemistry. element of his specialty that originally
Aboriginal, Torres Strait Islander and www.surgeons.org/scholarships
attracted him to pursue a career in ENT
Māori junior doctors and final year However, his ultimate ambition was
surgery.
medical students. to become a surgeon and he embarked
on a four-year post graduate degree in “What I love about ENT is the variety of
Medicine at the University of Queensland. people you treat, from babies to olderYou can also read
