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Aboriginal Health Special
by: Paul Grinzi - Assistant Editor
 Hi, and welcome to this special edition of the GPRA e-newsletter.
This fortnight we are focusing on Aboriginal Health and we have a few different registrar perspectives from around Australia, including an article published on the national ABC science website. Enjoy!
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Outer metro experience
by: Jen Lonergan - GPRA Board member
Great opportunities for GP Registrars in Aboriginal Health!
Working in an Aboriginal Controlled Community Organisation (ACCHO) is a fantastic learning opportunity for General Practice Registrars. There are over 80 Aboriginal Community Controlled Health Services operating in Australia in vastly different regions: from Inner City to Outback. Not all of these will be equipped or accredited to take GP Registrars but check with your Regional Training Provider about opportunities available in your region.
I worked 6 months at the Aboriginal Medical Service, Redfern as an Advanced GP registrar. Despite the city location, around 40% of my patients were from rural regions. The Aboriginal population is very mobile and any major distinctions made between city vs. rural dwelling Aboriginal people is simply not true. Read more
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Urban Perspective
Registrar's experience
by: Rumi Liyanagamage - Westwest RLO
When I undertook my advance term at Daruk Aboriginal Medical Service as a fulltime GP registrar little did I realise what a unique experience it was going to be. Migrating from a South Asian country, which was a British colony once, I shared similar historical experiences with the Aboriginal people. I thought I was very open- minded and culture sensitive. I soon fitted into my role as a coordinator of the health care team serving the Aboriginal community in Western Sydney.
People would walk in and wait for hours to see “their doctor” as there was no appointment system. The children ran around in the waiting room and corridors. I desperately tried to listen to the mum about the child’s illness while guarding my computer from the other children. On many occasions when I asked a mum to bring the child back for review they did not return. I later discovered they had attended a funeral of a distant relative in the country. Death was a recurring theme and it troubled me to hear so many of them died young from illness and accidents. Read more
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A rural view
Dr Patrick Kinsella takes time out from his demands as a GP, supervisor, and medical educator to work part-time in Aboriginal Health at Lake Tyers, Victoria
When the opportunity arose to work in an Aboriginal Community, I put my hand up. I knew many people in the local Indigenous Community and had enjoyed the relationships that I’d built up over the years and also I felt I should do my bit to try and help.
Some 5 years down the track I can report that I’m still learning. Having a good health worker to work beside is really important. They so often steer you onto the right track when you’re barking up the wrong tree. Sometimes I feel what I do is no more than applying band-aids, but the community seems to value my involvement. I’ve learned to think not just of the individual in the consulting room but also to always keep the Community in mind. I’ve learned that humour is really important for Aboriginal people, maybe their history has taught them the old adage ‘If you don’t laugh you’d cry’. I’ve seen too many funerals of Community members but have been impressed by the numbers that turn up to mourn. There are regular frustrations when people don't do what they’re meant to but I’ve learnt that there are often other agenda’s beside mine.
You can work in Aboriginal health part time as I do and as long as you’re flexible in your approach and willing to learn, you’ll get a lot out of the experience, as I have. Try it you might just enjoy it.
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Training opportunities
by: Luke Wilson - Bogong RLO
Aboriginal health is a bit of a buzzword at the moment, and the unfortunate reality is that indigenous people in our society have a terrible burden of disease – particularly diabetes. There are fantastic opportunities for people to gain exposure to indigenous health through the training program, and I would heartily recommend that anyone the slightest bit interested put there hands up.
Some regional training providers have particular posts in Aboriginal Health, but that is not the only way that you can do it. Part of your subsequent time can be done as a locum, and this can potentially be done outside of your region (in an area like the NT or the Kimberley where there is a distinct lack of doctors – and lots of aboriginal ill-health).
Seeing the delivery of health care to indigenous people first hand is really the only way to fully comprehend the enormity of the problem facing this country in indigenous health. It is not uncommon for an 18month old to have an inch thick hospital file, and be admitted with pneumonia, otitis media, gastroenteritis and failure to thrive all as concurrent problems.
It really is quite scary to see the distinct divide between mainstream and aboriginal health problems, and an honour to be involved in attempting to make a difference.
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Australian GP Registrar Gets Published!
D r Ed Poliness, a subsequent GP registrar, recently had an article published on the ABC's website about his experiences working with the Aboriginal community in Katherine.
To read this great article, click the link below.
Well done Ed!
http://www.abc.net.au/health/regions/features/territory/default.htm
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Ask Prof
- Professor Murtagh answers your clinical questions ...
 In our new section we invite you to email Professor John Murtagh with curly questions. These can be about any aspect of General Practice. You will be able to draw on Prof's many years of experience as a practising and academic GP. Let's see what Prof would do in your tricky situation...
Q1) "When prescribing topical steroids what is the heirarchy or progression of weakest to strongest?"
A) There is a heirachy of steroids and the table can be found in my textbook-all editions. In the third edition it is Table 108.9 page 1140.
Q2. "How do you assess menopause in women who are taking the oral contraceptive pill? I saw a lady who is 50 and on the OCP-she wants to stop the pill but doesn't want to risk pregnancy."
A) The way to assess this is to get the woman to stop the OCP for 4 weeks and have tests especially FSH. In that time alternative contraception is obviously needed. If the tests indicated that she is menopausal the rule is that she is still capable of getting pregnant for around 1 to 2 years so precautions are advised including the option of continuing the OCP . Not an easy one but they must be informed of the risks for the sake of all concerned.
Q3) "What do you advise men about using their propecia when wife is trying to fall pregnant ??? It is working well for their hair loss.."
A) Provided the man is functional that is libido and erectile function is ok he should continue with the option of checking with a sperm count-it is a balancing act!
Email questions to: askprof@gpra.com.au
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Find out more about your GPRA
 Membership of your GPRA is open to all currently enrolled GP Registrars and those who have graduated from the GP training program within the past 2 years.
Each Region should have a Registrar Liaison Officer (RLO). Your RLO is a currently enrolled GP Registrar and is there to support you and offer assistance in your training. Your RLOs are genuinely interested in helping in your training and advocating for you on any problem that you may encounter. Many times the problem you are experiencing, or the information you are seeking, has affected a Registrar before somewhere across Australia - with our national network of RLOs we can answer most questions or offer possible solutions to training problems.
To join online or find out more about the GPRA, visit our website at www.gpra.com.au
We look forward to receiving your application and helping you in your training!
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We value your input
The Australian GP Registrar is produced by registrars for registrars. We welcome any comments or suggestions for future editions. You are welcome to submit articles or photographs. Please forward contributions in Word or Jpeg format to the editor: editor@gpra.com.au or post (photos will be scanned and returned to you) to The Editor, GPRA, GPO Box 78 Canberra ACT 2601.
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AusDoc Competition
Australian Doctor is giving registrars the chance to win one of three instant libraries, each containing 9 texts recommended by clinical book reviewer Dr Deidre O’Dea. Each pack is worth $1050. For more information and terms and conditions, check out your Australian Doctor. Competition closes 18 June 2004.
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