Working as a rural General Practitioner in Broome

Working as a rural General Practitioner in Broome

Apr 29, 2020 0
General medicine,onthepods,rural and remote medicine

Allison Hempenstall speaks with Rebekah Ledingham about working as a rural General Practitioner in Broome, Western Australia.

Summary Writer:  Theoni Haralabopoulos

Script Writer:  Allison Hempenstall

Editor:  Allison Hempenstall

Interviewer:  Allison Hempenstall

Interviewee:  Rebekah Ledingham

About Dr Allison Hempenstall

Dr Allison Hempenstall is an ACRRM Registrar currently working on Thursday Island. Her interests include public health, tropical medicine and medical education.

About Dr Rebekah Ledingham

Dr Rebekah Ledingham is a Rural Generalist and medical educator in Broome, Western Australia. She is passionate about Aboriginal health and committed to Closing the Gap and supporting an increasing number of Aboriginal and Torres Strait Islander people in the health workforce. She is also a keen advocate for well-being of medical students and doctors in training and would like to see a more nurturing, flexible system in which to grow our future workforce.

She founded the online group Medical Mums and Mums To Be, now a support network for more than 9,000 doctors,  after struggling with the prospect of being a junior doctor and a mum simultaneously but remains eternally thankful that she ignored the (ridiculous) advice not to have babies as they are growing into fabulous humans who help it all make sense.

A career in rural and remote medicine

Dr Allison Hempenstall interviews Dr Rebekah Ledingham, a rural generalist at Broome Hospital in Western Australia and a senior lecturer at the University of Western Australia. April 2020

Introduction

In this podcast, we hear from rural generalist Dr Rebekah Ledingham and her perspective on life as a clinician in Broome. This podcast gives an overview of Dr Ledingham’s career path, her role as a rural doctor during the COVID-19 pandemic, and the challenges rural medicine is now facing within the current landscape.

  • I was a nurse before I studied medicine. During my time in Alice Springs in my Grad year, I went out to a remote community in Papunya, which made me want to do more of remote medicine.
  • In medical school I liked everything, every rotation and specialty, with a few exceptions (particularly surgery), which prompted me to want to do rural generalism.
  • I like being part of a community, so the rural/remote aspect is quite important to me in terms of life outside of work.
  • I had children during my junior doctor years, which interrupted my training in the sense that I worked temporarily part time.
  • My intern year was completed in rural South Australia, then I came back to Perth.
  • In my residency I did a few PGPPP (Prevocational General Practice Placements Program) rotations which no longer unfortunately exist, but I found the community-based aspects very useful, for example palliative care. I did quite a lot of ED, both adult and paediatric ED, and general practice rotations in my prevocational years.
  • I did 6 months of Paediatrics and 6 months of Obstetrics and Gynaecology, because they were my particular interests.
  • I would encourage junior doctors to try everything, it is the prime time, as you are being paid for what you do.
  • It is also important to get exposure to internal medicine and gain skills within the acute setting.
  • When you’re going into remote primary care, it is definitely an adventure you create for yourself, because you can gain a broad exposure, but also choose particular areas that interest you and build a team with others who have different special interests to you.
  • This is a unique time because we are in the midst of a viral pandemic, and there have been many changes.
  • What I like about my job here is the variety; no day is the same as another day.
  • When you are working rural/remote, it is more likely that you will take on many roles, the clinician being the overarching role, but you also get involved in policy and advocacy, as well as planning (particularly now amidst the Covid-19 pandemic).
  • At this time as rural workers we are all in it together, and we are working alongside specialist colleagues as one team. I work closely with the obstetrician, physician, psychiatrist, etc. to look after patients.
  • You can be involved in the baby check, then be involved in palliative care for a patient all in one day; the ‘cradle to grave’.
  • What particularly applies to rural generalism is that you can move across sectors as your skills are needed everywhere.
  • Over the time in Broome I have done private general practice, Aboriginal medical service work, District Medical Officer work in a hospital, as well as teaching.
  • I move between these sectors dependent on where I am most needed. This year I have stepped back from an academic position and become more clinical.
  • I am doing administrative/management planning during the pandemic, and Telehealth will be a big part of the future for all of us.
  • The great challenges are distance and geography, and the timely transfer of sick patients.
  • A disease has the potential to spread through a small community quite ferociously. However, the upside is that rural/remote communities in particular have the chance to prevent. Some remote communities in the Kimberley have closed to travel. Yesterday the Kimberley was closed, so we are not allowing anyone to come in before quarantining.
  • While there are significant challenges, we also have a natural protection in terms of geography, which can be used to our advantage.
  • The other challenge is that the comorbidities of patients that can impart greater vulnerability to Covid-19 are very prevalent in the community.
  • In a small and tight-knit community, you often know well and care for the people that you are treating not as just your patient, but also, for example, as the parent of the children you teach; there are multiple connections you form with patients. This makes everything quite meaningful, but also a challenge when you are journeying alongside a patient experiencing a tough time.
  • Distance and communications are often a challenge when you are remote. It can be difficult to convey a patient story to colleagues in tertiary centres due to contextual differences, and this has helped me to hone my communication skills.
  • There is a lot of pre-existing unnecessary travel that occurs for patients who live in a rural setting, so some of the changes may be for the better. For example, for a patient deciding about having an operation in a tertiary centre, their first consult should be Telehealth because they are still able to make this decision without the travel.
  • This is especially pertinent for some places in the Kimberley that are three days travel away from Perth.
  • This may prove to the medical fraternity what is possible, and may help to breakdown the distance barrier.
  • The statistics in areas like cancer treatment and survival for patients in remote areas are dismal, and a large contributing factor involves the decision about whether or not to go for treatment that is far away from family. This is very sad for patients who have to make decisions such as these.
  • I’m currently writing a fictional book, a long-term goal of mine. The protagonist is a thirteen-year-old girl, and her mother gets breast cancer. Based in Broome, she has to travel every two weeks for chemotherapy. I have known patients with similar experiences, and I have understood on an intellectual level how difficult this is. Writing about this character, a single parent, and imagining the struggles, has led me to gain a different level of understanding.
  • Broome has just three flights a day, and for some communities, it is an entire day to get there. I’m hoping that a degree of the distance barriers will be lessened after the pandemic by Telehealth.
  • Being remote I have ‘found my tribe’ amongst colleagues who were similarly ‘misfits’ in the traditional medical world; I haven’t always felt like I belonged amongst doctors.
  • I love camping in nature, attending the beach, and we have the most beautiful scenery where we are.
  • I am involved in community events, such as the Sindhu festival, which celebrates the multicultural history of Broome. I am also part of the adult choir for local community performances, which has demonstrated to me the importance of involvement in the arts sector as a doctor.
  • There are many different communities in Broome, which has been a place of high transit for many years. We have always welcomed visitors. For example, the pearling industry has imparted a Japanese and Indonesian influence to the history of Broome. The cultural feel is similar to that of New Zealand, where I was born, which is an island nation.
  • Broome can be likened to a meeting place of many different people, a place of joint cultures. For example, there are people of many different Asian backgrounds.
  • ‘A Taste of Broome’ is a cultural event, featuring a musical picture show of Broome’s history. This demonstrates the unique background of Broome that is hard to describe in words. An appreciation can be fulfilled by a visit in person!
  • Tertiary hospitals are becoming more sub-specialised, so a rural setting can allow a ‘generalist specialist’ experience. For example, experience in general medicine or general surgery can be an uncommon opportunity in tertiary centres.
  • As a rural practitioner, you look after the patient as a whole. It is a fantastic opportunity to experience this in your junior years.
  • I was 39 weeks pregnant at my graduation. I spent a significant amount of time as a medical student worrying and wondering when the right time to do this was and the effect on my progression through training. I was fixated on the details.
  • What we all have learnt during these recent times with the Covid-19 pandemic is that plans can be abolished unexpectedly.
  • The most important thing is to enjoy the ride/journey you are on now, and to ‘go where the wind blows you’.
  • As soon as you finish your intern year and you have general registration, you’re a doctor and you should enjoy the adventure.
  • No decision is completely irreversible. We are lucky in Australia, we don’t have to choose exactly what we want to do straight out of medical school. Try to get as much experience as you can.
  • Even taking time off and travelling can give you a rounded life, and it will all come together in the end.

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Tags: #ACRRM,#career in medicine,#career paths,#doctors health and wellbeing,#General Practice,#general practitioner,#GP,#medical careers,#rural and remote medicine,#rural doctors,#rural generalist,#rural health,#tipsfornewdocs,#work-life balance

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