Rural Health West
Hunting for boab nuts, vaccinating cattle and installing fence posts are not activities you would typically expect to see on the curriculum of a medical degree, however they form an important part of the University of Notre Dame’s Kimberley Remote Area Health Placement Program.
For ten days each year, second-year medical students from the University live and work alongside west Kimberley people in family-owned and community organisations, such as cattle stations, schools, radio stations, local shires and small business. Through this work, they gain an appreciation of the lives of people living in remote communities.
Founded in 2006 by Professor Donna Mak, the program gives students an opportunity to engage with and learn from local people to inform the care they provide once they start to practise.
“This program starts to teach the students the art of medicine. They are learning the science side of medicine through their classroom studies, but the science part – prescribing, diagnosing – doesn’t vary much between city and country patients,” Professor Mak said.
“The art of medicine is understanding that person in context; how they live, their relationships, their access to care. That’s what this program aims to capture.”
Student Vince Figliomeni completed his placement at Wangki Yupurnanupurru Aboriginal radio station in Fitzroy Crossing.
“You pick up bits and pieces from textbooks and lectures, but being on the ground and talking to people gives you different perspectives. Putting that personal experience and insight together will be invaluable when we start to practise,” Vince said.
“I asked one lady what can white fella doctors do to improve trust among the Aboriginal community. She told me ‘you being here – coming here and taking an interest – that’s a good start’.”
Fellow student Juan Stephen worked at Mowanjum Art and Culture Centre in Derby.
“A lesson for me was the complex family structure in Aboriginal communities.
“Understanding cultural practices such as avoidance; it can be hard to wrap your head around, but as a future doctor this is something that’s critical to know,” Juan said.
“You begin to appreciate why it may be difficult for a patient to have a complete family medical history and can explore other ways to fill in the gaps.”
Professor Mak said ongoing evaluation of the program since its inception has demonstrated the influence it is having on clinical practice and career choices.
“Our research has shown that these programs help the students to make informed decisions about their future careers and that the students are more responsive to the needs of rural patients accessing urban services when they begin practising.
“They also report that they have greater appreciation of the circumstances and resilience of rural people, and that their immersion experiences helped them to establish future professional networks.”
One former student shared this account when approached for their feedback on the program.
“Less than two months into my employment as a doctor in a tertiary hospital in Perth, I had an Aboriginal patient in my care whose treatment goal had been changed to ‘palliative intent only’.
“The lady was uncommunicative due to her condition, but we discussed her care options with her partner. It was agreed by all that the most sensitive and culturally appropriate place for her palliative care would in her own country with her own people.
“I may not have appreciated this aspect of care provision without the Kimberley placement.”
Professor Mak said another advantage of Notre Dame’s approach is that it enables a broader spectrum of students to be influenced than other similar programs.
“Programs like [UWA’s] Rural Clinical School are incredibly important in preparing students for future medical practise, but not all students will have the opportunity to be involved,” Professor Mak said.
“This program is compulsory for all of our students; we’re not just exposing the ones who are already interested in rural medicine or the ones from rural backgrounds.
“We know that not every doctor will work out bush – and nor should they – but regardless of where they work, they need to be able to relate to people from the country and to deliver the best care for that person. This program gives every student a chance to develop that ability.”
A video of the program is available on the Rural Health West YouTube channel at https://youtu.be/4MD4SMFS9qs