The Hidden Rewards of Rural Medicine: One Doctor's Journey

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Rural general practice is often seen as a frontline of medicine where broad skills, strong relationships, and clinical independence come together in some of the most rewarding yet challenging environments.

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But what does a career in rural GP really look like?

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Where can it take you?

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In this episode of Aussie Med Ed, we're exploring the journey from rural general practice to specialist roles with a spotlight on how working in the country can lay a powerful foundation for diverse career paths.

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Joining us today is Dr. Chong Han Lim, known as Han to his friends.

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He began as a rural GP in Tumby Bay in South Australia, and is now a dual trained pain and palliative medicine physician.

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We'll unpack his unique story, the skills rural practice can develop, and what opportunities exist beyond the bush for those starting their careers in rural medicine.

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In this episode, we'll explore Han's journey, the challenges of rural medicine, and the lessons he's learned along the way.

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Welcome to Aussie Med Ed.

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Good day and welcome to Aussie Med Ed, the Australian Medical Education Podcast designed with a pragmatic approach to medical conditions by interviewing specialists in the medical field.

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I'm Gavin Nimon, an Orthopaedic surgeon based in Adelaide, and I'm broadcasting from Kaurna Land.

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I'd like to remind you that this podcast is available on all podcast players, as also available is a video version on YouTube.

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I'd also like to remind you that if you enjoy this podcast, please subscribe or leave a review or give us a thumbs up, as I really appreciate the support and helps the channel grow, I'd like to.

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Start the podcast by acknowledging the traditional owners of the land on which this podcast is produced to the Kaurna people and pay my respects to the elders both past, present, and emerging.

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I'd like to remind you that all the information presented today is just one opinion, and there are numerous ways of treating all medical conditions.

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It's just general advice and may vary depending upon the region in which you're practicing or being treated.

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The information may not be appropriate for your situation or health condition.

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And you should always seek the advice from your health professionals in the area in which you live.

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Also, if you have any concerns about the information raised today, please speak to your GP or seek assistance from health organizations such as Lifeline in Australia.

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But it's my pleasure now to induce Dr.

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Chong Han Lim.

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Han to Aussie Med Ed.

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Originally from Singapore, he obtained his medical degree from Adelaide University Medical School.

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Initially working as a rural GP in Tumby Bay in South Australia before becoming a dual qualified pain and palliative medicine Physician.

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Outside of medicine.

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He is also the chef and owner of Kantong House a Singaporean restaurant in Adelaide.

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Han, thank you very much for coming on Aussie med Ed.

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It's great to have you here.

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Thank you for the invitation.

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It's brilliant to have you along.

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Perhaps you can first of all start us off by walking us through your medical journey from training as a rural GP in Tumby Bay into your current roles in Adelaide as a pain and palliative physician.

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Yep.

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So, well, my journey is a bit convoluted.

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It's, it is a bit strange, not your typical journey.

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So, came from Singapore originally and went through well Adelaide University Medical School.

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Graduated in 2009, started an internship in 2010 at the Lyell McEwin Hospital.

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Um, initially I wanted to be a surgeon, so I actually did the Masters in surgical science and realized that I'm not really cut out to be a surgeon.

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Um, because I have too much interest in life.

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Um, and by a stroke of luck, I, I, I was the intern for palliative care and, um, and subsequently I got another stint as a RMO in palliative care up at Lyell McEwin.

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Um, and that was when I was really interested in palliative care and thought really seriously about doing palliative care.

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Now, to get into palliative care, there's two streams.

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So you can either do, um, Med re, and, you know, basic physician training and get into palliative care training, or you can go through other colleges.

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So fellows from other colleges can also attend the advanced training in palliative care.

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So I tried as a medical, well, started as a medical registrar and um, and it was quite difficult because back then straight off internship, I was trusting to like a registrar role doing night registrar, um, 15 years ago.

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It's a bit different from now.

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So it's, it was quite daunting and I thought that if I just wanted to do palliative care in future, I could just.

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You know, going do, do it through the GP pathway.

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So I signed up to do a, um, the GP fellowship without actually really knowing if I would enjoy it.

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I thought it would be interesting to just to find out a bit more.

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So I wanted to go somewhere really rural, 'cause I was from Singapore.

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Adelaide at that point in time was most, was a rural country town to me.

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And I thought that no, I needed to immerse myself in this, so I should go somewhere really rural and, um, then somehow end up in, in Tumby Bay.

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So I went to Tumby Bay with um, um, for an interview and Karen Speed was the manager at.

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Point in time of the practice, um, sold the practice to me by saying that, you know, we have our GP's over here, Dr.

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Dennis Eaton, Dr. Graham Fleming, and Dr.

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Judith Degner in combination, they have over a hundred years of medical experience from, you know, for you to learn from.

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So I thought, oh, that's good.

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So I basically signed up for six month stint just to see how it is, whether I really enjoy it and stuff, and.

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Ended up finishing my entire training in rural medicine over there and, um, staying on for six years.

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So that was how I got into rural medicine, and again, practicing as a rural GP in Tumby Bay.

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Yeah, that's amazing.

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Just to put it into perspective, how far away is Tumby Bay from Adelaide?

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Um, it's about 700 and 750 kilometers away.

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So it's a decent distance.

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It is, it's a decent distance like driving.

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And for those listening from overseas, they really, Adelaide is the next major hospital scenario Really?

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From the tertiary hospital.

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Yeah, yeah, yeah, yeah.

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There's Who would you refer to?

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Is there any backups from Tumby Bay?

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So Port Lincoln would be our, uh, secondary referral center.

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Yeah.

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Um, from the Tumby Bay Hospital.

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And there is, well, it start by a general physician, Dr. Rufus McLeay and a general surgeon, Dr. Quentin Ralph.

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And, um, basically they do, like us, being rural practitioners, they do everything right.

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And it's, it's quite interesting.

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And how far away was Port Lincoln?

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Tumby Bay?

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It's about 50 kilometers.

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Half an hour away.

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Yeah.

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Yeah.

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On the highway.

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Yeah.

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So it's not exactly near.

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Um, but to, to the country people, that's quite near.

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And the population of Tumby Bay.

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So our coverage is about 2000, um, thousand 500 to 2000 people around the region.

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Yeah.

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Um, because we don't just cover the town in itself, um, because in the surrounding region there's like farmlands and, and unfortunately some of the other towns have no doctors, . So we tend to have a bit of spillover from the other surrounding areas.

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Yeah, yeah.

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In the town.

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Excellent.

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Yeah.

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Right.

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So in that area of 2,500 people, what sort of, uh, distance would that be covering?

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That'd be a few.

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A fair few Ks, I would imagine.

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Yeah.

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Well.

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It's, it's, it depends on how far you want to drive, like, so, yeah.

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So it really is quite rural.

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It is.

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And what lessons did you learn from being, being a rural gp?

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I, well I learned to actually be, I think in a way, a better doctor.

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Um, not so much based on technology, based on back to basic clinical skills.

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Do you remember the first.

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Week I was there.

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Um, Dr. Eaton brought, you know, an arrhythmia, um, an ECG with an arrhythmia for me to have a look.

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And he's like, what would you do?

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And, you know, I just came from the city.

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I would say, all right, we need a cardiologist.

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We need this, we need that.

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We need CCU, we need monitoring, continuous.

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He came up with all the standard hospital answers and, and, and Dennis just went and said, well, the nearest, the nearest cardiologist is 750 kilometers away.

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So yeah, it, um, and, and, and he just said, went panic slowly.

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My son, panick slowly.

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And, and then, you know, that was how I was taught.

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So I was their very first registrar in a hundred years.

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They never had registrars before.

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And so when I was there that year, they just celebrated the hundredth year anniversary of the local hospital, so, so that was my introduction to rural medicine.

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I then realized that, yeah, you can call for help, but really in reality, the nearest tertiary hospital is over 700 kilometers.

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And you really have to be dependent on a lot of things, what you have and you know what you can do with the resources that you have, and basically diagnose patient based on real clinical skills.

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The nearest MRI scan at that point in time was in Whyalla.

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About 350 kilometers away.

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Yeah.

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Yeah.

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So, so it's not near Right.

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Right.

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So really, uh, you would've learned resilience from being in that sort scenario, having worked now in the, , city practice.

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, Perhaps we we'll draw on that in the future, but what other things do you notice are the difference and what would you say are the main benefits for a young medical student coming through.

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The, , programs.

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Okay, so I guess the main difference would be you are actually part of a community.

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So you see the patient, you interact with the patient both professionally, socially.

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You go to the pub, you see them at the pub.

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Um, there's always what I call, um, um, supermarket, um, consults.

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Like you go to the supermarket and you're like, oh, Dr.

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Lim.

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Um, you know, the results.

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How's that going?

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I and, and sometimes you just don't want to, you know, you don't wanna talk about it in public 'cause it's just not professional, but you are part of the community nonetheless.

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And certainly when you, um, need to intervene in something, for example, if you need to arrange for, let's say a site visit to see how you can, you know, modify some of the jobs, uh, for patients, that is much easier because, you know, within town itself it's quite.

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Easy to get to, and it's a phone call where you know them, you can arrange something, whereas over in, in, in town, in, in Adelaide or in the city environment, then you have to organize it through maybe a third party.

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It's much more difficult to get there, even though it's much bigger, but there's more bureaucracy to get through.

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So in a certain way, it's, it provides better, um, holistic, um, services in whatever limitations we have.

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Um, obviously there are limitations, like Allied Health, um, is quite limited in the country as you can imagine, whereas over here, if you talk about physiotherapy, there's many clinics around Glenelg area, but in, in town we have a visiting physiotherapist, and then now currently we are lucky enough in Tumby, one of our GPS over there, the wife is actually a physiotherapist too, right?

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Yeah, yeah.

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But it's just limited in resources.

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Right.

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And , were there a difference in presentations too that you might see in the country?

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Yeah, plenty.

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So over here you see like your chronic diseases management.

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You see, um, like your sick clinic, uh, acute presentation.

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But over there you could be doing a flu vaccination and getting a call from the hospital with someone having a MI and then rushing to the ED to manage that.

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Um, we have had many instances that that has happened and we are quite lucky in Tumby Bay.

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We, um, most country towns have problems retaining doctors.

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Some country towns don't even have a doctor, whereas in Tumby Bay we are quite lucky that we have, you know, Dr. Eaton, Dr. Fleming, who has been around for 40 over years.

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Providing continuity.

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And we also have like newer doctors like us who stay around.

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So, um, after me, the, uh, doctors, Dr.

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George, um, Sara Georg is a registrar after me and Dr. Emmy Hennell, who is actually, her story is quite special.

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We might touch a bit on her because she was a graduate from here, did internship and became a teacher's wife.

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For the next 20 years.

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Right.

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And then finally went back into medicine after her, her children went, um, into school.

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Her youngest, she had, she had eight kids.

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Really?

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And yeah.

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Yeah, yeah.

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So then when the youngest went back in, uh, went to school, she started at Whyalla Hospital as an intern and then went through the training fellowship.

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So then obviously they all stayed on.

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So there were quite a few of us, five of us actually.

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Yeah.

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And when something major happened.

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Um, it's very collegial, so we all help each other and in that way we have the support.

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So in a way, Tumby Bay was very lucky.

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We were very lucky that there was enough doctors and, and we were very supportive of each other.

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Um, whereas sometimes I find in urban practice it can be more isolating.

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Like you would think that in country practice it's isolating.

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But in our situation, we were lucky if, let's say you are a single gp, for example, 24 7 right On call.

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Yeah.

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And so that could be certainly very difficult.

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But I guess we were lucky in a way, in Tumby Bay.

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So I presume the, it is not just about the types of medicine you give to, it's also about the community you're in.

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Mm-hmm.

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I presume it's like that every day of the week in, in working in a country practice.

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Is it?

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Uh, yeah, it is.

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So again, because of our unique situation.

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Our, um, we had wind downs, so almost every day.

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Um, we had what we call wind down with the doctors, the nurses of the practice, and the receptionist.

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It's a good way to debrief about the day if there's any problems or any difficult challenging patient.

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Um, you know, you sought advice from everyone, and it's not just a person, one new single person.

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So then in the morning, the doctors start doing ward rounds together in the hospital, so we know all the patients that are inpatient at present, and subsequently, if you're on call, you can deal with anything that come, comes your way because you are, you've been brief.

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So it's, it's, it's rewarding in that situation.

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And then after that.

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Um, you know, the pub.

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And so in a way it's a simpler way of life, whereas over here, if you want to meet up with friends, you have to make an appointment.

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Whereas over there, most of the time you call up and say, oh, you want to go dinner tonight?

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Oh, sure.

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Yeah.

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And, and there's not much choice.

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There's only two pubs, so you don't really have to rack your brains about, you know, where to go or, or make a booking somewhere, way in advance.

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And, and in a way it's a simpler life.

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It's actually, um, I actually appreciate that quite a lot.

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Excellent.

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So obviously as a, as a, you put down as one of your hobbies, as of being a foodie.

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Yes.

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And you're, you are now a chef of your own restaurant.

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Does, but working in a country town actually help you develop your cooking skills and your, your abilities that way.

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I was that saying that you had before that?

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Well, um, I actually, I converted, so I, I have a property over in Tumby Bay and I converted a shed.

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Into a dining hall.

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Right.

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Okay.

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For, 'cause I love cooking and I love having friends over.

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So my, my friends, um, will come over often, you know, for barbecue or I'll cook something and the practice, my, you know, the doctors, the nurses who all get invited.

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I think we do that quite, um, frequently, and it helps with, in a way, it did help my cooking skills a lot.

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And, and apart from that, most of the, our nurses, , our practice manager after that, Michelle, uh, she's a great cook.

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So, you know, you learn tips, she comes across and then she helps out.

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And, um, and yeah, so it, it's, it did help me, um.

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And obviously because I'm from Singapore and I want to show them what Singaporean food is, um, and so I cook a lot of my own food to let them try like curries and ang and stuff like that.

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Um, because yeah, there isn't much ex exposure to Asian food in Tumby Bay.

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In fact, there is no.

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Well, no Asian restaurant in Tumby Bay.

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I think that's my house.

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So yeah, it did help hone my, my, my, my, my skills in cooking and my passion in cooking.

00:17:10.174 --> 00:17:16.684
And that's why when I came back here in 2021, I, I thought that I'll just take the leap and started my own restaurant.

00:17:17.404 --> 00:17:18.005
Brilliant.

00:17:18.134 --> 00:17:21.974
Obviously COVID sort of taught us all that there's more to life than just working and.

00:17:22.575 --> 00:17:27.434
Whilst, you know, us as doctors, we all like to work and like the reward of helping patients.

00:17:27.765 --> 00:17:32.234
It sounds like Tumby Bay in a rural life, it actually brings out in a lifestyle.

00:17:32.325 --> 00:17:33.224
, Would you agree with that?

00:17:33.285 --> 00:17:35.204
Yeah, absolutely.

00:17:35.204 --> 00:17:45.884
It's, um, it's, it's the, the, I mean, work is important obviously, and, and you are there to provide service to the community.

00:17:46.275 --> 00:17:50.595
Um, however, at the same time people want you to be involved in.

00:17:50.954 --> 00:17:52.365
In, in the community too.

00:17:52.365 --> 00:18:00.585
So I remember when, um, when I first went there, you know, people start knowing you and then you get invited to go on fishing trips.

00:18:00.615 --> 00:18:06.224
I don't fish, but I get seasick, so I have to politely decline.

00:18:06.224 --> 00:18:10.785
But you know, people will be asking you say, oh, come along, we'll bring you out, we'll bring you exploring.

00:18:11.174 --> 00:18:19.335
And um, and, and, and there's all these activities that people try to make you feel welcome.

00:18:19.845 --> 00:18:20.535
Um.

00:18:20.609 --> 00:18:23.609
Uh, at the same time you make your own friends.

00:18:23.609 --> 00:18:42.150
So I was very lucky to have my group of friends over there that I, I, I, there is a local group called, um, um, yap, which is Young TAPs um, and Professional Association, um, which, which I initially joined and got to know a close group of friends over there.

00:18:42.150 --> 00:18:47.339
And so, um, and that helped too because I can imagine if you are.

00:18:47.789 --> 00:18:56.849
If you by yourself move to a place and, and no friends, so you might actually feel quite isolated and that's actually quite stressful.

00:18:57.150 --> 00:19:04.560
But I was lucky that I made friends, um, who are of similar age group and similar interests, and we still remain great friends now.

00:19:06.119 --> 00:19:14.759
Brilliant but a large percentage of South Australia is not even covered by councils and that most of the services are provided by everyone mucking in and helping each other out.

00:19:14.849 --> 00:19:15.210
Yeah.

00:19:15.480 --> 00:19:15.720
Yeah.

00:19:15.809 --> 00:19:17.730
That, that, that is actually very true.

00:19:17.730 --> 00:19:24.960
That's very, um, how the country people think they, they actually help each other out a lot.

00:19:24.960 --> 00:19:33.210
I, one example, and that really touched me at that point in time, I'm not sure if you remember, but a couple of years ago we had this massive.

00:19:33.539 --> 00:19:39.029
Blackout throughout the state, and we were without power in Tumby Bay for a couple of days.

00:19:39.299 --> 00:19:40.589
You know, things didn't work.

00:19:40.890 --> 00:19:43.109
Um, mobile, there was no reception.

00:19:43.109 --> 00:19:43.920
We couldn't charge.

00:19:44.160 --> 00:19:45.839
We had a generator in hospital.

00:19:46.740 --> 00:19:51.000
So when there was an emergency, what would, what, what would happen?

00:19:51.000 --> 00:19:54.660
We, we, we then had, you know, a contingency plan with everyone in town.

00:19:54.660 --> 00:19:55.200
So then we.

00:19:55.680 --> 00:20:05.910
Um, the hospital will have to call the police on the walkie-talkie, and then he'll come and knock on the door of the, the doctor on call, um, to alert him to the need to get to hospital.

00:20:06.359 --> 00:20:13.109
Um, and there was no lights, so most garages wouldn't work, so then we might have to go in a police car.

00:20:14.640 --> 00:20:22.289
Um, uh, but the, the, the problem was the, the hospital generator runs on diesel.

00:20:22.994 --> 00:20:31.904
And I remember we were running very low on diesel and to the state that if we don't get power back that day, um, we will most likely be out.

00:20:32.535 --> 00:20:49.515
And without asking anyone, we had volunteers like the farmers because they have their own silos and they actually called the hospital and said, you need diesel 'cause you know if you need any, we are ready to come in and fill up the hospital 'cause it's needed at the hospital for the inpatients and stuff.

00:20:49.515 --> 00:20:51.555
And I found that really touching.

00:20:52.109 --> 00:20:58.470
Um, I'm not sure, I'm sure if something like that happened in Adelaide, there will be people who would do that.

00:20:58.470 --> 00:21:09.779
But these are, you know, the farmers, the, the, the local, um, resident of Tumby Bay, um, planning ahead and looking after each other without no one asking.

00:21:09.779 --> 00:21:16.049
And, and the pub was providing like, um, um, free meals because I think because the.

00:21:16.410 --> 00:21:26.190
The fridge was out, so they had to clear stuff and there were, there were people who, if generators at home that were opening their, their house out for like hot showers for people and all that.

00:21:26.190 --> 00:21:30.359
And they were just, it created a community of help within the community.

00:21:30.720 --> 00:21:33.240
And, and I don't remember anyone asking for it.

00:21:33.269 --> 00:21:34.619
They just opened up.

00:21:34.619 --> 00:21:35.634
It's amazing.

00:21:35.910 --> 00:21:36.750
It is, it is.

00:21:36.750 --> 00:21:39.509
I think the country spirit is really alive in the country.

00:21:39.900 --> 00:21:43.230
Um, which unfortunately sometimes I don't see that much in.

00:21:43.799 --> 00:21:44.519
Urban areas.

00:21:44.670 --> 00:21:44.789
Yeah.

00:21:44.819 --> 00:21:47.279
But in, in the country town, it's, it's just that.

00:21:47.549 --> 00:21:48.150
That's brilliant.

00:21:48.150 --> 00:21:48.539
Yeah.

00:21:48.930 --> 00:21:53.640
What happens in an emergency, you, you're looking after a patient and you really are struggling.

00:21:53.640 --> 00:21:54.255
Know you've done all the.

00:21:54.884 --> 00:21:55.454
The right thing.

00:21:55.454 --> 00:22:06.224
So you've got someone who may have an acute appendicitis and you are, you're concerned there's actually more, more complicated or a severe heart attack that needs to be transferred into town in Adelaide.

00:22:06.434 --> 00:22:06.674
Yeah.

00:22:06.674 --> 00:22:10.154
What actually happens in that scenario for acute appendicitis is simple.

00:22:10.154 --> 00:22:17.025
We just call Quentin Ralph and tell him that we're sending a patient down, and then we, we, we, we manage that locally.

00:22:17.085 --> 00:22:18.255
And so that's simple.

00:22:18.644 --> 00:22:24.015
But for things like a mi um, a heart attack, you know, or, or something a bit more.

00:22:24.789 --> 00:22:52.809
Requiring retrieval to, to the tertiary hospital, then we can always call, um, for cardiac stuff iCARnet Um, otherwise you can always call the retrieval services, um, which is like, you know, royal doctors flying services and, and, and, and communicate with like the on-call hospital and the, um, specialist who was on call, like the ED specialist or the ICU specialist that's on call and get help in that situation.

00:22:53.444 --> 00:23:14.055
Um, in saying that there are many, many interesting experiences that I, I had, um, which would be quite, um, amusing to listeners, uh, and, and, and showing how sometimes it's quite difficult to transfer patient.

00:23:14.684 --> 00:23:20.204
For example, one patient had a, a, a, you know, metastatic cancer cauda equina syndrome.

00:23:20.775 --> 00:23:24.525
And I called out requesting, um, to transfer.

00:23:24.525 --> 00:23:33.194
So I actually, at that point in time, we had to get the approval from a, from a receiving specialist in Adelaide, so called Royal Adelaide called neurosurgery.

00:23:33.615 --> 00:23:46.065
Um, unfortunately registrar wasn't, there was an arm RMO that answered who was taking calls, and I explained the situation to the RMO and the RMO was like, yeah, how do you know It's called Equina syndrome?

00:23:46.394 --> 00:23:46.994
Um, yeah.

00:23:46.994 --> 00:23:48.404
Have you done an MRI scan.

00:23:48.555 --> 00:23:49.724
How, why can you be, I'm like.

00:23:50.130 --> 00:24:00.539
Well, I stuck my finger in and, and, and, and they can be quite, um, obstructive at times and in.

00:24:01.049 --> 00:24:12.335
And so very often when we go nowhere with like the junior doctors, um, we then call the consultant straight, which are usually much more accepting and they understand the situation we are in.

00:24:13.200 --> 00:24:21.900
Um, yeah, it's a bit unreasonable to ask about MRI scan when your nearest MRI machine is 350 kilometers away.

00:24:22.349 --> 00:24:32.579
And, and, and, and so, so I think everyone from medical students or even people who are training in, in their various specialties should spend some time in the country.

00:24:33.029 --> 00:24:34.049
Yeah, yeah.

00:24:34.109 --> 00:24:37.230
But other challenges like getting crash blood.

00:24:37.230 --> 00:24:42.329
So the blood bank is in Port Lincoln Hospital that is 50 kilometers away.

00:24:42.599 --> 00:24:56.130
And I still remember we had a time with, uh, a patient came in with haematemesis and his, and we had very basic, like haematocrit and blood test, you know, point of care testing and there was a big dramatic drug.

00:24:56.130 --> 00:24:59.609
His hemoglobin was like eighties and, and he was hypotensive.

00:25:01.230 --> 00:25:05.880
Um, and then I had to get blood, so called Dr. Fleming.

00:25:07.109 --> 00:25:13.230
He rushed down to grab crash blood and race up, and he was on the highway and he was going quite fast.

00:25:13.230 --> 00:25:23.769
He got stopped by the police who obviously knew him, and, and, and, and the police knew of the situation and the police grabbed the blood and raced back to Tumby.

00:25:23.789 --> 00:25:27.839
And that's again showing how, you know, it's not.

00:25:28.244 --> 00:25:34.875
If you need crash blood over here in the tertiary hospital, you write a request form and the orderly would send it here.

00:25:35.204 --> 00:25:35.295
Yeah.

00:25:35.325 --> 00:25:40.095
But over there we had to get in police escort, a police escort, and it was half an hour away.

00:25:40.095 --> 00:25:47.924
So you have to manage the patient and stop the patient from, from literally bleeding out and dying within that time while you wait for the crash blood to come.

00:25:48.404 --> 00:25:50.625
So it's, it has its challenges.

00:25:51.224 --> 00:25:55.035
With, I think with technology has improved because you're able to get help.

00:25:55.035 --> 00:25:58.454
And now with the, so back then we didn't have the.

00:25:58.964 --> 00:26:10.005
Uh, the video consult, but now there is a video consult available so the, the ED consultants can actually see what's happening in your ED and give advice based on what, what, what they can see.

00:26:10.454 --> 00:26:16.394
Is that something that's happened since COVID started or just before COVID that they, COVID really kicked it off right.

00:26:17.535 --> 00:26:18.315
On that basis.

00:26:18.315 --> 00:26:21.164
What is the access to specialists like in the, in that area?

00:26:21.224 --> 00:26:21.559
Is it, uh.

00:26:21.825 --> 00:26:23.174
Do they come up and visit?

00:26:23.325 --> 00:26:24.075
They do.

00:26:24.315 --> 00:26:25.994
So they do come out and visit.

00:26:26.055 --> 00:26:32.025
Um, but obviously it's not very, um, not as often as we would like.

00:26:32.355 --> 00:26:40.095
And because when they do come and visit, they cover wide area and not just in Tumby they other towns.

00:26:40.095 --> 00:26:47.565
So they usually stay in Port Lincoln who is bigger and get the patient's referral from all over the region.

00:26:48.285 --> 00:26:52.545
But like I said, we were, we were lucky with the general surgeon and the general physicians.

00:26:52.545 --> 00:27:10.065
They do everything like, like, you know, Quinton, what we call appendix, or he would, you know, do something like a colonoscopy and Dr. McLeay might then, you know, do a Scope two and read an ECG at the same time.

00:27:10.125 --> 00:27:16.755
One of the other things I would notice that might be different, uh, perhaps in the rural area is that as I understand, a lot of the gps do a lot of procedures like.

00:27:17.295 --> 00:27:19.154
Removal or lumps and bumps and other things.

00:27:19.184 --> 00:27:19.335
Yeah.

00:27:19.365 --> 00:27:21.315
Did you have any experience with that when, when you were there hand?

00:27:21.345 --> 00:27:22.394
Oh, plenty.

00:27:22.394 --> 00:27:34.694
So, um, again, I was, I was very lucky to be taught by, um, you know, experienced gp and there were things that I have never even thought about doing in medical school.

00:27:34.694 --> 00:27:42.134
So, for example, we had a lot of builders and a lot of, you know, um, laborers who were using grinding machines and all that stuff.

00:27:42.855 --> 00:27:48.105
They have eye injury from, from not wearing proper safety glasses.

00:27:48.375 --> 00:27:48.555
Yeah.

00:27:48.585 --> 00:27:52.154
And, and so you just have to blow out the, the rust from the cornea.

00:27:52.904 --> 00:27:56.055
So basically you anaethetise the eye putting in a local anesthetic.

00:27:56.055 --> 00:27:56.325
Really?

00:27:56.505 --> 00:27:56.865
Yeah.

00:27:56.865 --> 00:28:04.035
And then, and then just burr it out or, you know, take out the stones or splints or whatever they have in their eyes and remove that.

00:28:04.035 --> 00:28:07.575
So, um, that's just one of the minor procedures we do.

00:28:07.994 --> 00:28:12.045
Um, which I don't think a lot of urban GPS would actually do.

00:28:12.045 --> 00:28:21.795
They'll send them straight to the ophthalmologist and we have other, like in the emergency situation, we'll put in things like chest tubes or in palliative care too.

00:28:21.855 --> 00:28:34.335
Sometimes we just have to be a bit more creative and do, like, for example, if, let's say I have, um, it's like from, um, a patient with a, then I have to do a ascitic tap with.

00:28:34.829 --> 00:28:47.609
And I have done many ascitic tap with just, um, a large bore IV cannula, um, and then connecting it to a, a IV giving set and reversing it into a bucket.

00:28:48.089 --> 00:28:48.720
Oh, really?

00:28:48.750 --> 00:28:49.650
Yeah, yeah, yeah.

00:28:49.650 --> 00:28:52.230
Because we don't actually have the, the whole setup.

00:28:52.230 --> 00:28:55.890
But it is not something that, it's difficult.

00:28:55.890 --> 00:29:00.734
It just needs a bit of creativity as long as it's not causing harm to the patient and it's safe.

00:29:01.440 --> 00:29:14.549
Um, and yeah, we, we tend to do it more just because we, we don't have the facility to, to have all that and we certainly, we are not going to send a patient 700 kilometers just to get a acidic tap done.

00:29:14.555 --> 00:29:14.805
Yeah.

00:29:15.210 --> 00:29:15.450
Yeah.

00:29:15.450 --> 00:29:17.519
So it's something that you just have to learn.

00:29:17.519 --> 00:29:24.420
And I was very lucky that, that, um, I had good experience, um, GPS to teach me that.

00:29:24.839 --> 00:29:25.859
What about orthopedics?

00:29:25.859 --> 00:29:27.930
Did you get any, uh, fractures or trees?

00:29:28.410 --> 00:29:28.799
No.

00:29:28.799 --> 00:29:30.210
This is a story you enjoy.

00:29:30.210 --> 00:29:33.000
So this is, um, an even older.

00:29:33.390 --> 00:29:34.230
Generation.

00:29:34.230 --> 00:29:41.849
So, um, so Graham and Dennis told me this story when they were registrar, so that was a good 40 over years ago.

00:29:42.269 --> 00:29:49.140
There was a rural general practitioner, a rural doctor that, um, 'cause that was before the age of x-ray.

00:29:49.380 --> 00:29:54.910
So if a patient comes with a, with a fracture, he would get the matron to drop ether.

00:29:54.990 --> 00:29:59.430
Like, you know, that's how old it is, eater to put the patient under and then he would.

00:29:59.579 --> 00:30:00.529
Scrub in.

00:30:00.575 --> 00:30:02.825
Open up, look at the fracture.

00:30:03.184 --> 00:30:04.055
'cause there was no x-ray.

00:30:04.055 --> 00:30:16.234
So he had a physical look at the fracture, scrub out, go into his workshop, fashion out a, a plate, and then sterilize that while the patient's still under come back and fix everything in I, I take it.

00:30:16.234 --> 00:30:17.045
It's not like that now.

00:30:17.075 --> 00:30:20.134
No, no, no, no.

00:30:20.134 --> 00:30:22.295
But that story is stuck like, you know how.

00:30:22.785 --> 00:30:27.734
How resilient country g and that's how rural gp, rural medicine evolved.

00:30:28.244 --> 00:30:35.055
Um, but, but in our situation, like if we have a fracture and stuff, we, we had to do our own x-ray.

00:30:35.325 --> 00:30:35.535
Yeah.

00:30:35.654 --> 00:30:42.285
So we have our own x-ray machine, and I used to have, I've given that up now, I'm fortunate, but I used to have a a a X-ray license.

00:30:42.619 --> 00:30:50.000
Um, and we, we had to use our do an x-ray and before that we even had to develop our own film in a red room and have a look.

00:30:50.509 --> 00:30:56.390
But now we have the modern, um, reusable plates and everything's quite automated.

00:30:56.730 --> 00:31:07.579
So we had to read our x-rays back then and um, and if there's a fracture then we have to call, um, for retrieval so they are usually centered across the fracture clinic in, in town.

00:31:07.970 --> 00:31:10.400
Um, yeah, just like plastics and all that stuff.

00:31:10.730 --> 00:31:14.644
Um, depending on whether it's an urgent thing or whether if it's stabilized, then we can.

00:31:15.319 --> 00:31:22.369
Um, wait for transport or they can even go on a commercial flight, for example, if it's all neurovascularly intact.

00:31:22.849 --> 00:31:26.750
Um, but if it's an emergency and stuff, then they get retrieved over.

00:31:26.990 --> 00:31:28.910
Your backslab skills would've come in handy though.

00:31:28.910 --> 00:31:31.519
Oh, you think of everything like back slab you.

00:31:31.670 --> 00:31:37.880
You think of ways to make the back slab from cardboard from whatever you can find.

00:31:38.210 --> 00:31:39.140
Um, yeah.

00:31:39.440 --> 00:31:40.130
Excellent.

00:31:40.250 --> 00:31:43.490
Is there anything else you'd like to add to that for the listener at all?

00:31:43.609 --> 00:31:57.134
I think there, there is a common misconception that, uh, that that, that rural GPS could be a bit of a cowboy and, um, and, and a bit like very gungho right, um, to deal with stuff, but.

00:31:58.474 --> 00:32:00.454
I, I don't, I didn't perceive it that way.

00:32:00.454 --> 00:32:02.494
So that's, you don't, no, I, I took my hat off to you.

00:32:02.494 --> 00:32:03.035
It's brilliant.

00:32:03.125 --> 00:32:06.365
So I think we should talk a bit about rural training.

00:32:06.599 --> 00:32:06.890
Yeah.

00:32:06.894 --> 00:32:12.244
So like, it is a bit distinct, um, from urban GP training.

00:32:12.515 --> 00:32:15.994
So usually it's, it's, um, additional training.

00:32:16.355 --> 00:32:19.085
So we have two colleges in Australia.

00:32:19.085 --> 00:32:23.211
One is the Royal College of, um, Royal Australian, Australian College of.

00:32:24.115 --> 00:32:30.144
Um, general practitioner, and then one is ACCRM, which is the Australian College of Rural and Remote Medicine.

00:32:31.345 --> 00:32:35.785
So the time is quite different from being a rural generalist.

00:32:35.785 --> 00:32:41.664
So that's the term now that we use in the past as rural gp, but now the term is rural generalist.

00:32:41.664 --> 00:32:42.025
So.

00:32:42.559 --> 00:32:46.880
A, a general practice, um, or a GP P training is three years.

00:32:47.390 --> 00:32:58.369
Um, in, in general, while rural general practice is an additional year, so it's four years and an additional year of training in, in an area that, that, that might interest you.

00:32:58.369 --> 00:33:09.349
For example, there are, um, gp, um, obstetrician or GP anaesthetists, so then they have to do like a diploma in obstetric or diploma in anesthetic.

00:33:10.309 --> 00:33:11.420
To be able to do that.

00:33:11.779 --> 00:33:18.829
So in a lot of areas, so you do have to do additional training, um, to be a rural generalist.

00:33:19.549 --> 00:33:34.190
There are also rural generalist, um, surgeons who, um, I, they, they're training slightly longer, so rather than being just one additional year, they might have an, I think there are additional two or three years.

00:33:34.714 --> 00:33:40.355
And they could then do things like simple appendicitis and know appendectomy and stuff like that.

00:33:40.894 --> 00:33:51.484
So, so it is a rewarding career, but it has additional training to be a rural generalist, additional requirement, um, to be a rural generalist.

00:33:51.484 --> 00:34:02.434
So, um, yeah, in a, we, we, we do have that extra training and not just all gungho and, and, and, and do it so.

00:34:02.930 --> 00:34:10.969
So, so in Australia, that's, that's, that's what you need, um, um, to be a Rural generalist, right?

00:34:10.969 --> 00:34:11.210
Yeah.

00:34:11.210 --> 00:34:16.579
For those overseas, uh, listening, it's, it's, it's, um, who want to have an experience.

00:34:16.579 --> 00:34:20.989
Maybe you could come in and, you know, have an experience in the country yourself.

00:34:21.019 --> 00:34:22.400
Go and experience that.

00:34:22.550 --> 00:34:22.880
Yeah.

00:34:22.940 --> 00:34:23.960
Um, provide that.

00:34:23.960 --> 00:34:26.659
You could get your, at least come and observe anyone.

00:34:26.664 --> 00:34:26.835
Yeah, exactly.

00:34:26.894 --> 00:34:27.755
Did a visitation.

00:34:27.905 --> 00:34:28.195
Yeah.

00:34:28.195 --> 00:34:29.114
Yeah, yeah, yeah.

00:34:29.144 --> 00:34:29.434
Yeah.

00:34:30.260 --> 00:34:34.699
Obviously you, you went there with the idea of mo moving towards palliative medicine as well.

00:34:34.730 --> 00:34:35.150
Yes.

00:34:35.150 --> 00:34:37.969
Did you get any experience with the palliative medicine in, in the rural setting?

00:34:38.780 --> 00:34:39.349
Yeah.

00:34:39.409 --> 00:34:45.510
Um, so we were lucky we had a visiting, um, um, palliative care specialist, so Dr.

00:34:45.510 --> 00:34:53.659
Roger Hunt, um, who sort of dragged me into palliative care training and he's my mentor in palliative care.

00:34:54.230 --> 00:35:02.900
Um, and so, um, back then a lot of those skills, like I told you about, um, ascitic tap, um, I learned from him too.

00:35:03.530 --> 00:35:03.860
Um.

00:35:04.340 --> 00:35:12.050
And because of the procedural skills we had as CHI General practitioners, um, we did nerve blocks over there.

00:35:12.409 --> 00:35:20.420
Um, for example, if I needed, if let's say a patient had a Sarcoma in the leg, um, we, we did a femoral block.

00:35:20.780 --> 00:35:29.360
'cause the patient wasn't mobilizing anyway, and, and rather than just a single block, we will connect that to a continuous pump.

00:35:29.929 --> 00:35:30.349
Um.

00:35:30.829 --> 00:35:32.539
And, and that's what we did.

00:35:32.539 --> 00:35:39.170
So we basically blocked it with, again, an IV cannula and just left it in as the end of life care.

00:35:39.559 --> 00:35:42.260
Um, and, and that managed pain in that way.

00:35:42.260 --> 00:35:45.800
So again, creativity with what we have in the country.

00:35:45.860 --> 00:35:49.849
And a lot of times patients actually prefer not to, um.

00:35:51.364 --> 00:35:54.215
Not to be transferred, obviously, because there are families over there.

00:35:54.215 --> 00:35:55.565
Support system is over there.

00:35:55.775 --> 00:36:06.215
The community support is very strong and we are lucky that we can actually manage to move patients into, we have a little palliative care ward set up in the hospital.

00:36:06.394 --> 00:36:18.034
So from the community, from home, um, if they need to be admitted, we have the ability to admit them into hospital and yet just close to their family because there's a little family room in there and the family could be there.

00:36:18.425 --> 00:36:22.054
So it's really a quite a nice setup from a palliative care point of view.

00:36:22.594 --> 00:36:25.474
Um, but the whole Tumby Bay Hospital is amazing.

00:36:25.534 --> 00:36:27.784
Every single room faces the, the sea.

00:36:28.144 --> 00:36:28.835
Oh, really?

00:36:28.835 --> 00:36:29.554
Oh, that sounds great.

00:36:29.559 --> 00:36:29.885
Great view.

00:36:30.030 --> 00:36:30.635
Great view, great view.

00:36:31.355 --> 00:36:31.894
Yeah.

00:36:31.894 --> 00:36:34.625
I, I teach the medical students that palliative medicine.

00:36:34.684 --> 00:36:34.894
Yeah.

00:36:35.135 --> 00:36:37.659
I think Orthopaedics have got a reputation of being.

00:36:38.239 --> 00:36:41.559
Tough buggers around the place,, because we, we fix broken bones.

00:36:41.559 --> 00:36:46.179
But really, I think palliative is really, you, you're very strong to be able to do that.

00:36:46.179 --> 00:36:49.599
And the Orthopaedic, we are soft and I think it's brilliant that you've got that.

00:36:49.989 --> 00:36:52.119
We interviewed , professor Greg Crawford about it.

00:36:52.179 --> 00:36:52.389
Yeah.

00:36:52.389 --> 00:36:55.570
He talked about the importance of a rural palliative medicine approach as well.

00:36:55.574 --> 00:36:55.775
Yeah.

00:36:55.960 --> 00:36:56.050
Yeah.

00:36:56.050 --> 00:36:57.190
He was from Kangaroo Island.

00:36:57.429 --> 00:36:57.760
Yes.

00:36:57.760 --> 00:36:57.849
Yes.

00:36:58.780 --> 00:37:00.789
So, so he said that really helped as well.

00:37:00.789 --> 00:37:03.550
So yeah, I think it's a,, great approach to it.

00:37:03.789 --> 00:37:04.000
Right?

00:37:04.000 --> 00:37:09.280
It's, it's actually, um, so Professor Crawford, um, was the one that actually.

00:37:09.789 --> 00:37:18.969
Um, taught me this, that you can, you can, you can't always try as long as it's safe for the patient, because then, um, as long as you're not causing harm.

00:37:19.539 --> 00:37:19.750
Yeah.

00:37:19.809 --> 00:37:22.570
Because if that's what you have, that's what you have.

00:37:23.050 --> 00:37:24.400
You can't have anything more than that.

00:37:24.400 --> 00:37:27.130
So that's just what you have and you what you have to think about.

00:37:27.130 --> 00:37:29.585
But as long as it's not causing harm to the patient.

00:37:30.280 --> 00:37:31.000
That's fine.

00:37:31.239 --> 00:37:32.320
We can always try.

00:37:33.070 --> 00:37:33.610
Brilliant.

00:37:34.059 --> 00:37:37.239
So it sounds like you've maintained a connection with Tumby Bay.

00:37:37.239 --> 00:37:38.469
You've still got a property there, have you?

00:37:38.474 --> 00:37:39.550
Yeah, yeah, yeah.

00:37:39.980 --> 00:37:43.159
, But you had to move to Adelaide for training as a palliative physician.

00:37:43.159 --> 00:37:43.820
I did.

00:37:44.059 --> 00:37:54.019
So in 2018, I, um, you know, with the support of Dr. Hunt, um, came back here to do my advanced, started my advanced training in palliative care.

00:37:54.409 --> 00:37:55.190
'cause you know.

00:37:55.835 --> 00:37:58.264
That was part of what I was thinking.

00:37:58.295 --> 00:38:05.885
Uh, I was always interested in palliative care, but then I thought being a rural gp that was, I was quite happy with that.

00:38:05.885 --> 00:38:12.420
But yeah, somehow fate intervened and I came back and started training, um, in 2018.

00:38:13.130 --> 00:38:13.610
Right.

00:38:13.610 --> 00:38:14.059
Yeah.

00:38:14.269 --> 00:38:24.800
And then halfway through that I realized I don't actually know a lot about pain, um, 'cause we give opioids, but they are more than opioids to deal with pain.

00:38:25.219 --> 00:38:33.320
So then I did a stint in pain medicine for six months as a, um, elective, and then decided to go ahead.

00:38:33.724 --> 00:38:36.125
Uh, and do the full training and, and yeah.

00:38:36.724 --> 00:38:38.224
Did both training at the same time.

00:38:38.375 --> 00:38:39.155
That's brilliant.

00:38:39.394 --> 00:38:40.625
As well as being a chef.

00:38:41.375 --> 00:38:41.704
Yeah.

00:38:41.795 --> 00:38:43.355
As well as maintaining a connection with Tumby Bay.

00:38:43.355 --> 00:38:43.414
Yeah.

00:38:44.315 --> 00:38:46.775
So, so you've got kept busy.

00:38:47.074 --> 00:38:47.885
You kept busy.

00:38:48.454 --> 00:38:54.364
You've got three, three homes, I take it you've got Adelaide, Tumby Bay, and I presume Singapore is still a connection.

00:38:54.875 --> 00:38:55.144
Singapore.

00:38:55.204 --> 00:38:55.565
Yeah.

00:38:55.565 --> 00:39:03.184
So yeah, ironically, I presume the distance between uh, one length, one side of Singapore to the other is probably smaller than a lot than 700 kilometers.

00:39:03.244 --> 00:39:07.985
I presume from, you know, Singapore is six times smaller than Kangaroo Island.

00:39:09.875 --> 00:39:10.329
There you go.

00:39:10.565 --> 00:39:10.775
Yeah.

00:39:10.775 --> 00:39:15.945
And so, so your friends at home in, in Singapore too,, would, , find it interesting.

00:39:15.945 --> 00:39:19.155
Your, your next closest tertiary center was 700 kilometers from Tumby.

00:39:19.170 --> 00:39:19.460
Yeah.

00:39:19.465 --> 00:39:20.025
Yeah.

00:39:20.025 --> 00:39:30.105
They, um, so my friends in Singapore who are, who are doctors who can appreciate that have, they're always amazed by some of the stories or some of the challenges that we face.

00:39:30.525 --> 00:39:32.625
Um, and the, and the, and the.

00:39:33.045 --> 00:39:40.965
The, the chance that you can actually experience that is quite rare in Singapore because nowhere is rural in Singapore, so you can appreciate that.

00:39:41.380 --> 00:39:42.644
Right, right.

00:39:43.065 --> 00:39:46.454
How do you feel about palliative medicine and pain pain work now?

00:39:46.454 --> 00:39:48.974
Does it say it's a different side of life?

00:39:49.275 --> 00:39:52.844
I would assume those two areas are also close community.

00:39:53.144 --> 00:40:00.855
And looking after not just the patient, but the relatives of, of people going through palliative care and those requiring pain relief as well.

00:40:01.244 --> 00:40:06.224
It's probably as similar in some ways as a local community in Tumby Bay, in, in that way, isn't it?

00:40:06.824 --> 00:40:11.114
Um, from, from my observation.

00:40:11.445 --> 00:40:17.894
Um, I think in the country, even though they're limited, like I said, the community spirit is strong.

00:40:18.554 --> 00:40:19.815
So in a way.

00:40:20.190 --> 00:40:35.219
There is more, um, support, whereas being in the urban centers, even though they're, um, the population is bigger, but sometimes the isolation from the community is actually greater.

00:40:36.059 --> 00:40:45.000
Um, we see a lot of patients in, in, in Adelaide who are not able to have, um, you know, end of life care at home because.

00:40:45.795 --> 00:40:47.505
It's, it's, it is very involved.

00:40:47.505 --> 00:40:50.144
If you think about end of life care at home, it's actually very involved.

00:40:50.144 --> 00:41:02.300
You need the equipment, you need, you know, the nursing specialty, you need the, um, I mean, they can't be there all the time so they can come and draw medications for you and help with certain basic nursing in care.

00:41:03.195 --> 00:41:05.864
Um, and then you need a lot of family support.

00:41:05.894 --> 00:41:14.054
You need the pa, the, the family to be there to support the patient, to, to provide, um, PRN medication, for example, to move them, for example.

00:41:14.355 --> 00:41:32.835
Um, and it's actually quite taxing, whereas in the country, the community can come around into that, especially if, let's say, um, you know, the family is a bit stressed or the family needs to go and work on the farm, for example, the neighbors might come in and step in and help look out during that period.

00:41:33.405 --> 00:41:38.894
Um, whereas that in urban areas, I find it's sometimes lacking.

00:41:39.164 --> 00:41:43.545
So even though the population is bigger, but the isolation might be greater.

00:41:44.505 --> 00:41:45.255
Very interesting.

00:41:45.255 --> 00:41:45.525
Yeah.

00:41:45.525 --> 00:41:46.695
That's my observation.

00:41:46.724 --> 00:41:47.565
It's sad, isn't it?

00:41:47.625 --> 00:41:48.135
It is.

00:41:48.135 --> 00:41:48.644
It is.

00:41:48.704 --> 00:42:00.505
So, so unfortunately in, in, in palliative care, especially in end of life care, um, the, the, the, so you can understand the public system is quite stretched.

00:42:01.034 --> 00:42:01.514
Um.

00:42:02.250 --> 00:42:14.099
The amount of need in the, in, in the community, um, and, and, and what they're funded to do, and the number of doctors and nurses and, and allied health expertise is available for the community.

00:42:14.099 --> 00:42:18.630
Palliative care team is quite limited, so that has its own challenges.

00:42:19.139 --> 00:42:29.070
Whereas in the country, you have, you know, the rural GP doing everything, coordinating stuff with the help of the family, even though it might be.

00:42:29.625 --> 00:42:38.204
You might think that the resources are also very limited, but you know, you're drop in for a cup of tea and, and, and have a look at and chat with the patient.

00:42:38.204 --> 00:42:42.465
And that to them it's, is, it is calming, you know, it's, it is kind of support.

00:42:42.824 --> 00:42:51.735
So, so in a way, I think in the country, in a smaller community, um, that might be sometimes easier, right?

00:42:52.034 --> 00:42:52.364
Yeah.

00:42:52.514 --> 00:42:52.934
Yeah.

00:42:52.994 --> 00:42:53.505
It's strange.

00:42:53.505 --> 00:42:53.804
I know.

00:42:53.804 --> 00:42:55.394
But yeah, that's my observation.

00:42:55.784 --> 00:42:56.264
Right.

00:42:56.264 --> 00:42:59.920
So it's, so in some ways it's more challenging in Adelaide than it It is, yeah.

00:42:59.925 --> 00:43:01.425
It is, it is.

00:43:01.485 --> 00:43:05.414
Um, and also I think the country people are more resilient.

00:43:05.954 --> 00:43:15.284
Um, they, they, they, they, they acknowledge and understanding that there is a limitation to the resources and, and they, they, they make do of it.

00:43:15.735 --> 00:43:17.925
Whereas there's a certain expectation.

00:43:18.269 --> 00:43:20.099
That you know, oh, this is not good enough.

00:43:20.250 --> 00:43:21.449
You know, we need this.

00:43:21.719 --> 00:43:24.929
We should be able to assess that because it's convenient.

00:43:24.929 --> 00:43:30.059
It has always been convenient for them to assess services and the expectation is different.

00:43:30.570 --> 00:43:37.139
So I think expectation or the difference in expectation actually makes a difference.

00:43:37.440 --> 00:43:38.010
Right.

00:43:38.039 --> 00:43:39.684
And obviously the resilience in it too.

00:43:40.005 --> 00:43:40.065
Yeah.

00:43:40.425 --> 00:43:41.054
Yeah.

00:43:41.355 --> 00:43:45.585
Where do you think palliative medicine's going both in the country and in in Adelaide?

00:43:46.184 --> 00:43:53.925
So, so in, in the country, um, the palliative care services are run mostly by, um, nurses.

00:43:54.405 --> 00:44:02.554
Um, so with the support from palliative care consultants or palliative care specialists, um, in the three services, NAHLN, CAHLN, SAHLN.

00:44:03.164 --> 00:44:09.405
So that's the local health network we have in Adelaide, and they provide specialist input if needed.

00:44:10.199 --> 00:44:15.150
Um, but by and large it's mostly run by the nurses.

00:44:15.630 --> 00:44:21.690
Now there are, there are very limited, um, nurses that, that, that do that.

00:44:22.349 --> 00:44:25.500
And the distances that they have to cover are quite great.

00:44:25.500 --> 00:44:30.510
So to see a patient, they might drive one, 200 kilometers just to see a patient.

00:44:30.659 --> 00:44:31.170
Geez.

00:44:31.320 --> 00:44:31.710
Yeah.

00:44:31.710 --> 00:44:37.920
So that kind of, um, help or that kind of service is obviously.

00:44:38.309 --> 00:44:42.449
Um, daunting and difficult to maintain in the long run.

00:44:42.750 --> 00:44:48.539
So, um, shout out to all the palliative care nurses and nurses of the country and all the rural doctors.

00:44:48.539 --> 00:44:52.889
They, they are actually quite amazing 'cause of the areas that they have to cover.

00:44:53.880 --> 00:45:01.679
Um, I, I think in future, once we, if we are able to get more like telehealth and with technology.

00:45:02.219 --> 00:45:04.019
Um, that would be good.

00:45:04.260 --> 00:45:11.070
Currently you need the nurses to go there because some of the older patients might not be able to have handle technology.

00:45:11.730 --> 00:45:15.239
Um, and also internet connection, reliability and stuff.

00:45:15.719 --> 00:45:23.159
But hopefully in future, because nowadays people are more, um, used to technology and if they can manage their own technology.

00:45:23.699 --> 00:45:28.199
The nurses don't have to drive 200 kilometers just to set up the system for them.

00:45:28.440 --> 00:45:28.559
Yeah.

00:45:31.019 --> 00:45:32.369
And that might be useful too.

00:45:32.670 --> 00:45:38.460
And maybe with like drones, um, delivery of, of, of equipments and all that stuff.

00:45:38.460 --> 00:45:45.420
Maybe one day the delivery of medication from the local pharmacy can be run by unmanned drones.

00:45:45.420 --> 00:45:45.809
I don't know.

00:45:45.809 --> 00:45:52.110
Maybe I'm thinking a bit too far, but, you know, I think technology is the way to, to overcome all these problems.

00:45:52.485 --> 00:45:56.864
And even monitoring, like, like you have your app now.

00:45:56.864 --> 00:46:03.074
You can monitor your heart rate, you can have a basic ECG done from your iWatch and stuff like that.

00:46:03.074 --> 00:46:15.764
So if you can with the, um, advancement of technology that might be able to help a doctor sitting here in Adelaide make a better diagnosis or plan based on what the patient can provide.

00:46:16.545 --> 00:46:21.764
Um, yeah, so I think technology to overcome all these challenges we have to, um.

00:46:22.320 --> 00:46:24.000
Wait for technology to advance.

00:46:25.170 --> 00:46:39.329
Well, I, I, I suspect I know what you're gonna say when I suggest this, but, and I suspect people would say in some ways, and one of your advertising points for working in the country is that you probably get as much out of it as you get, as you get for putting into it.

00:46:39.570 --> 00:46:40.110
You do.

00:46:40.260 --> 00:46:46.920
I think it makes you a better doctor and a better person, um, because you are able to relate to.

00:46:47.264 --> 00:46:52.184
To the actual situation over there, because we are all doctors by default.

00:46:52.244 --> 00:46:53.894
You do have a passion to help out.

00:46:53.894 --> 00:46:57.284
No one says, oh, you know, I, I hate helping people, but I want to be a doctor.

00:46:57.284 --> 00:46:58.755
I don't think that happens.

00:46:58.755 --> 00:47:06.735
So, so by default, um, most of us would be quite altruistic and we do want to help the community, help the patient, help the people out.

00:47:06.885 --> 00:47:14.565
So I think for a young, um, medical student or a young doctor, um, that would be quite useful because.

00:47:14.864 --> 00:47:19.065
Remember, you are there and you are able to make a difference, make an impact.

00:47:19.244 --> 00:47:24.764
And at the same time, you're able to hone your own skills, especially when you know, when you're just starting out.

00:47:24.764 --> 00:47:27.405
And with the right, um, supervision.

00:47:27.405 --> 00:47:44.385
With the right training, you're able to hone your own skills and improve on your yourself and, and, and also help, um, the community and at the same time being part of a community that, that you might not have the experience, um, being part of in Adelaide.

00:47:45.000 --> 00:47:45.420
Yeah.

00:47:46.170 --> 00:47:54.989
Well it probably brings us onto my last topic I wanna talk about, which is the enjoyment of helping other people is also a similar enjoyment of cooking for other people too.

00:47:55.320 --> 00:48:02.849
And your, your hobby of, of running a restaurant, not only the one in Tumby Bay from your, from your property, but also one locally in Adelaide.

00:48:03.000 --> 00:48:07.320
So I've, you went the next step, I dunno where you get all the time to do all this, but it's amazing.

00:48:07.469 --> 00:48:11.460
But you've gone the next step in actually now running your own restaurant and a chef for it as well.

00:48:11.864 --> 00:48:15.525
Well, um, one of my motto in life is you can sleep when you're dead.

00:48:18.315 --> 00:48:21.045
But yeah, but I mean, it's all an experience.

00:48:21.045 --> 00:48:27.014
I think life is all about an experience, and that's the same with, you know, anyone wanting to have a bit of a country experience.

00:48:27.255 --> 00:48:29.054
It depends on what you see life.

00:48:29.054 --> 00:48:30.644
So there's always two views.

00:48:30.675 --> 00:48:35.715
So you can go to the country and think, you know, I have no choice as part of the curriculum.

00:48:35.925 --> 00:48:36.735
I just have to.

00:48:37.440 --> 00:48:41.190
Do it for three months or do it for three weeks, you know, as part of my rural week.

00:48:41.190 --> 00:48:42.059
And then that's it.

00:48:42.510 --> 00:48:49.260
Or you can go in and say that this is an experience that I've never had the chance to, and I really want to see whether I, you might not like it.

00:48:49.260 --> 00:48:50.070
It might not be you.

00:48:50.070 --> 00:48:58.949
You might be, you know, a big city person and hate the idea that, you know, you can't go to the cafe, for example, or there's no cinema, but it's still an experience.

00:48:59.190 --> 00:49:01.739
So you don't know until you've tried it.

00:49:01.860 --> 00:49:02.880
'cause you might love it.

00:49:03.300 --> 00:49:10.469
Yeah, so it's the same with like cooking and I, I, I took the leap obviously, and, and, and opened the restaurant.

00:49:10.469 --> 00:49:14.909
Even though it's still sort of my passion project, not really making any money.

00:49:15.239 --> 00:49:16.409
I'm actually losing a lot.

00:49:16.409 --> 00:49:21.840
But, you know, it's still a passion project and it's a good outlet for my, um, myself.

00:49:22.260 --> 00:49:23.489
'cause we can't just.

00:49:24.914 --> 00:49:34.905
Fully, I don't know, maybe it's different from a surgical point of view because as a surgeon, you know, you are just immersed in it and that's why I, so I thought, oh, I'm, I, I'm not cut out to do that.

00:49:35.835 --> 00:49:37.574
But I think it's a good outlet, everyone.

00:49:38.054 --> 00:49:39.074
And you think you need outlets?

00:49:39.074 --> 00:49:39.644
Everyone does.

00:49:39.675 --> 00:49:39.885
Yeah.

00:49:39.885 --> 00:49:40.994
Everyone needs an outlet.

00:49:40.994 --> 00:49:44.264
You can't just, you know, it's just immerse in one thing.

00:49:44.264 --> 00:49:46.994
You, you need an outlet, a passionate hobby.

00:49:47.445 --> 00:49:50.324
Otherwise you will feel, uh, you just can't go on.

00:49:50.489 --> 00:49:51.494
Yeah, yeah, yeah.

00:49:51.945 --> 00:49:54.344
So, and tell us a bit about the restaurant.

00:49:54.405 --> 00:49:56.534
So, so the restaurant is Katong House.

00:49:56.534 --> 00:49:58.994
It's on 255 Kensington Road.

00:49:59.445 --> 00:50:02.534
Um, and it sells, um, Singaporean food.

00:50:02.925 --> 00:50:06.735
So Katong is the suburb that I grew up in and in Singapore.

00:50:06.735 --> 00:50:11.445
And it's, it's, it's, it has the best food, the lobster, everything.

00:50:11.849 --> 00:50:14.579
Um, yeah, local food from Singapore.

00:50:14.579 --> 00:50:15.869
It's, it's a bit different.

00:50:15.869 --> 00:50:16.920
It's not Chinese.

00:50:16.920 --> 00:50:19.289
It's not really any distinct.

00:50:19.289 --> 00:50:22.679
It's a amulgation, it's a mix.

00:50:22.949 --> 00:50:31.980
It's a mix of, um, of different cultures like Malay Indian and Chinese cooking, um, with our own local influence.

00:50:32.250 --> 00:50:37.289
So things like la bu, na, mac, um, you know, chicken rice.

00:50:37.619 --> 00:50:37.889
Yeah.

00:50:37.889 --> 00:50:39.750
So it's different, the challenge.

00:50:40.184 --> 00:50:42.315
Is the challenge is actually not cooking.

00:50:42.315 --> 00:50:48.344
The challenge is coming up with the process of, of maintaining the standard when I'm not there.

00:50:48.344 --> 00:50:48.405
Yeah.

00:50:49.275 --> 00:50:52.275
And, and, and to actually come up with the process of doing so.

00:50:52.275 --> 00:50:56.039
I make all the sauces, everything in the restaurant is made, um, by us.

00:50:56.940 --> 00:51:03.690
So I make the base and then everything is commercially sealed and vacuum packed and, and then stored.

00:51:04.050 --> 00:51:08.730
And, and the staff will then, um, make the dish according to my instructions.

00:51:08.730 --> 00:51:16.860
So everything is scientifically measured out to the, to the volume of fluid, how long you put it in the cooker, and so the taste is actually maintained.

00:51:17.340 --> 00:51:18.750
Um, so that was a challenge.

00:51:18.780 --> 00:51:26.041
Cooking wasn't a challenge, but the challenge was to come up with a, with a process that, um, that could maintain the quality of it.

00:51:26.744 --> 00:51:27.795
Brilliant when I'm not there.

00:51:28.005 --> 00:51:28.364
Brilliant.

00:51:28.485 --> 00:51:28.994
Yeah.

00:51:29.085 --> 00:51:30.675
So that took a couple of years.

00:51:33.135 --> 00:51:34.574
Well, I look forward to trying it out.

00:51:34.579 --> 00:51:37.605
I, I haven't been there myself yet, but it's one of those things on my bucket list.

00:51:37.605 --> 00:51:40.364
Know you're more, most welcome to come and try it.

00:51:40.635 --> 00:51:41.715
I'll cook for you personally.

00:51:41.715 --> 00:51:42.855
That sounds brilliant.

00:51:44.085 --> 00:51:46.434
Well, Han, it's been fantastic having you on Aussie Med Ed.

00:51:46.454 --> 00:51:49.815
Is there anything else you'd like to add to that for the listener at all?

00:51:51.344 --> 00:51:53.025
The other thing that I would like to mention is.

00:51:53.445 --> 00:52:12.644
The, the country people, the rural people actually respect their doctors a lot, and I suddenly have patients who would like to discuss their, their condition before they, they take the, the, the City specialist, that's what they call it, the city specialist, like their, their views.

00:52:12.974 --> 00:52:23.565
Um, and, and I mean, I've only been there for six years, but like people like, you know, Dennis Eaton and Graham Fleming who have been there for 40 years, they know the generation, they know the problem.

00:52:23.565 --> 00:52:26.324
They, they, there's this continuity of care that.

00:52:26.715 --> 00:52:33.704
It's sometimes non-existent in, in, in, in city centers because they know the same family for like 40 years.

00:52:34.065 --> 00:52:52.875
And, and I still remember I had, I had, uh, it was quite funny because I had this patient that I followed through, um, antenatal care and then gave birth in Port Lincoln, came back and then I look after the baby and I just mention off the cuff, I told Graham like, I can't imagine I, I know this baby since she was a fetus.

00:52:53.565 --> 00:52:58.065
And Graham just said, well, I know fetuses who had their own fetuses.

00:53:00.525 --> 00:53:03.585
So, so that continuity of care is so important.

00:53:03.585 --> 00:53:07.155
Like they know the family history and, and everything is just.

00:53:07.485 --> 00:53:10.454
In, in there, in, in their knowledge bank.

00:53:10.454 --> 00:53:21.764
So, so they, they really, um, think, you know, highly of their Doctors and, and like I said, they, Graham, Graham, Fleming and Dennis Eaton can, in their eyes, can do no wrong.

00:53:22.514 --> 00:53:30.315
Um, and yeah, and, and you just have to deal with everything that comes through the door, even though, um, you are at least expecting it.

00:53:30.375 --> 00:53:33.795
There, there was a, um, um.

00:53:34.409 --> 00:53:38.550
I, I, I still remember my, my, one of my friend was actually a builder.

00:53:39.494 --> 00:53:43.724
Um, from Tumby and he's now relocated to, to, to Adelaide.

00:53:43.815 --> 00:53:54.195
Um, Simon Hebel, he, he, he once came back and had dinner with my friends who were like, you know, cardiologists and other specialists and all of the blue.

00:53:54.195 --> 00:53:55.094
He just pop a question.

00:53:55.094 --> 00:53:57.554
He was like, why are none of you rural gps?

00:53:57.824 --> 00:54:05.054
Like, like, and, and, and, and what he said really surprised me because I never understood, or I never thought to see things that way.

00:54:05.054 --> 00:54:08.594
He actually said that, look, if something happened to me, Han had to.

00:54:08.724 --> 00:54:12.474
You know, they got stuff from my eyes, or he had to take care of this hammer on my head.

00:54:12.835 --> 00:54:18.775
Um, and, and, and, and, um, like, you know, he have to do everything from a heart attack to this and that.

00:54:18.835 --> 00:54:30.295
Uh, and none of you able to do any of that, or, and I was taken aback because in my, you know, in our training, you know, especially, it's like, oh, you know, you must be really smart.

00:54:30.295 --> 00:54:31.525
Lots of intensive, but.

00:54:31.875 --> 00:54:44.505
But actually then I realized to the rural people, um, you know, the country people, they, they really respect their doctors because, you know, they are part of the community, like you said, so they're the ones up on the pedestal.

00:54:44.594 --> 00:54:47.025
Yeah, yeah, yeah, yeah, yeah, yeah.

00:54:47.025 --> 00:54:52.934
And, and it's, it's really quite and interesting experience and I never expected Simon to say that.

00:54:53.114 --> 00:54:53.385
Yeah.

00:54:53.909 --> 00:54:56.809
But that was one of the thing that really threw me off.

00:54:58.105 --> 00:54:58.965
But that's brilliant.

00:54:58.965 --> 00:54:59.039
That's brilliant.

00:54:59.130 --> 00:54:59.250
Yeah.

00:54:59.639 --> 00:55:09.869
I say I've only been there for six years, but country doctors like, you know, Graham and Dennis and, and Quentin, Ralph, who's a surgeon, and you know, Dr.

00:55:09.869 --> 00:55:10.460
McLeay.

00:55:11.309 --> 00:55:12.659
They are the real heroes.

00:55:12.750 --> 00:55:16.380
They have been around forever, and they are the real heroes in the country, not me.

00:55:18.000 --> 00:55:18.659
That's brilliant.

00:55:18.780 --> 00:55:19.619
That's absolutely brilliant.

00:55:19.619 --> 00:55:19.679
Yeah.

00:55:20.250 --> 00:55:23.730
Well, Han, it's been fantastic having you on Aussie Med Ed and hearing all about this.

00:55:23.789 --> 00:55:24.150
Thank you.

00:55:24.150 --> 00:55:25.889
It's been really, really enlightening.

00:55:26.039 --> 00:55:27.630
I really take my hat off to you and, uh.

00:55:28.054 --> 00:55:33.965
Hopefully catch up with some sleep on the weekend at some stage, but love that.

00:55:34.025 --> 00:55:35.099
You can sleep when you're dead.

00:55:37.324 --> 00:55:38.375
Well, thank you very much.

00:55:38.465 --> 00:55:39.005
No, thanks.

00:55:39.010 --> 00:55:39.519
Thanks, Gavin.

00:55:39.545 --> 00:55:40.204
Thanks for having me.

00:55:40.594 --> 00:55:42.045
Thank you very much for coming on Aussie Med Ed.

00:55:42.264 --> 00:55:42.565
Thank you.

00:55:42.684 --> 00:55:43.534
Thank you for having me.

00:55:44.074 --> 00:55:47.344
I'd like to remind you that all the information presented today's one opinion.

00:55:47.914 --> 00:55:49.179
There are numerous ways of treating all.

00:55:50.594 --> 00:55:54.764
This is general advice and may vary depending upon the region in which you're practicing or being treated.

00:55:55.275 --> 00:55:58.215
The information may not be appropriate for your situation or health condition.

00:55:58.724 --> 00:56:01.364
You should always seek the advice from your health professionals in the area in which you.

00:56:03.315 --> 00:56:07.215
Thanks again for listening to the podcast and please subscribe to the podcast for the next episode.

00:56:07.724 --> 00:56:09.255
Until then, please stay safe.