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Aussie Med Ed- Australian Medical Education
Venture into the captivating world of medicine with 'Aussie Med Ed,' your definitive Australian medical podcast. Journey through the diverse medical landscape in an easy-going atmosphere, guided by your host, Dr. Gavin Nimon - an Orthopaedic Surgeon deeply committed to medical education in Adelaide. Our podcast serves as an illuminating beacon for medical students, practitioners, and anyone passionate about understanding health and wellness.
At Aussie Med Ed, we delve into an array of medical conditions, unraveling their mysteries, diagnosis, and treatment options. Our approach is unique, as we bring in experts from the extensive medical community, encouraging engaging dialogues that help demystify complex health issues. We're more than a medical podcast - we're a bridge between you and the world of medicine. Whether you're an aspiring doctor, a seasoned practitioner, or a curious mind, Aussie Med Ed is the perfect platform to expand your medical knowledge horizons.
Dr Gavin Nimon and the team at Aussie Med Ed acknowledge the traditional custodians of the land on which the podcast is produced that of the Kaurna , Ngarrindjeri and Peramangk people.
Aussie Med Ed- Australian Medical Education
The Hidden Rewards of Rural Medicine: One Doctor's Journey
What happens when the nearest specialist is over 700 kilometers away? For Dr. Chong Han Lim, that reality shaped his entire approach to medicine.
Join Dr Gavin Nimon (Orthopaedic Surgeon and Host) as he interviews Dr. Lim ( Han ) about his journey from Singapore to the small coastal town of Tumby Bay in rural South Australia, and he reveals the profound ways that country practice transforms physicians. What began as a six-month placement extended to six years as he discovered the rewards of rural general practice—where clinical independence, creative problem-solving, and deep community connections come together.
The podcast explores the unique challenges of practicing medicine with limited resources and without immediate specialist backup. From managing emergencies with improvised equipment to learning the art of "panicking slowly," rural doctors develop remarkable resilience. As Han explains, these experiences don't represent reckless medicine but rather thoughtful adaptation that prioritizes patient safety while acknowledging geographical constraints.
Perhaps most fascinating is how rural practice blurs the lines between professional and personal life. Unlike urban settings where doctors rarely encounter patients outside the clinic, rural physicians become integral parts of their communities—experiencing everything from "supermarket consults" to forming deep friendships. This integration creates a different kind of doctor-patient relationship, characterized by mutual respect and understanding that spans generations.
Han's eventual transition to dual specialization in pain and palliative medicine demonstrates how rural practice can lay a powerful foundation for diverse career paths. His experiences in Tumby Bay continue to inform his approach to medicine in Adelaide, where he now balances his medical career with running Katong House, a Singaporean restaurant serving dishes from his childhood.
Whether you're considering rural practice or simply curious about different medical career pathways, this conversation offers valuable insights into the rewards of stepping outside your comfort zone. Subscribe to Aussie Med Ed for more candid conversations about the realities of medical practice in Australia.
Aussie Med Ed is sponsored by -HealthShare is a digital health company, that provides solutions for patients, General Practitioners and Specialists across Australia.
Aussie Med Ed is sponsored by Avant Medical Indemnity: They state that they offer holistic support to help the doctor practice safely and believe they have extensive cover that's continually evolving to meet your needs in the ever changing regulatory environment.
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. But what does a career in rural GP really look like? Where can it take you? 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. Joining us today is Dr. Chong Han Lim, known as Han to his friends. He began as a rural GP in Tumby Bay in South Australia, and is now a dual trained pain and palliative medicine physician. 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. In this episode, we'll explore Han's journey, the challenges of rural medicine, and the lessons he's learned along the way. Welcome to Aussie Med Ed. 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. I'm Gavin Nimon, an Orthopaedic surgeon based in Adelaide, and I'm broadcasting from Kaurna Land. I'd like to remind you that this podcast is available on all podcast players, as also available is a video version on YouTube. 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. 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. 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. It's just general advice and may vary depending upon the region in which you're practicing or being treated. The information may not be appropriate for your situation or health condition. And you should always seek the advice from your health professionals in the area in which you live. 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. But it's my pleasure now to induce Dr. Chong Han Lim. Han to Aussie Med Ed. Originally from Singapore, he obtained his medical degree from Adelaide University Medical School. Initially working as a rural GP in Tumby Bay in South Australia before becoming a dual qualified pain and palliative medicine Physician. Outside of medicine. He is also the chef and owner of Kantong House a Singaporean restaurant in Adelaide. Han, thank you very much for coming on Aussie med Ed. It's great to have you here. Thank you for the invitation. It's brilliant to have you along. 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. Yep. So, well, my journey is a bit convoluted. It's, it is a bit strange, not your typical journey. So, came from Singapore originally and went through well Adelaide University Medical School. Graduated in 2009, started an internship in 2010 at the Lyell McEwin Hospital. 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. Um, because I have too much interest in life. 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. Um, and that was when I was really interested in palliative care and thought really seriously about doing palliative care. Now, to get into palliative care, there's two streams. 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. So fellows from other colleges can also attend the advanced training in palliative care. 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. It's a bit different from now. So it's, it was quite daunting and I thought that if I just wanted to do palliative care in future, I could just. You know, going do, do it through the GP pathway. So I signed up to do a, um, the GP fellowship without actually really knowing if I would enjoy it. I thought it would be interesting to just to find out a bit more. So I wanted to go somewhere really rural, 'cause I was from Singapore. Adelaide at that point in time was most, was a rural country town to me. 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. So I went to Tumby Bay with um, um, for an interview and Karen Speed was the manager at. 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. Dennis Eaton, Dr. Graham Fleming, and Dr. Judith Degner in combination, they have over a hundred years of medical experience from, you know, for you to learn from. So I thought, oh, that's good. So I basically signed up for six month stint just to see how it is, whether I really enjoy it and stuff, and. Ended up finishing my entire training in rural medicine over there and, um, staying on for six years. So that was how I got into rural medicine, and again, practicing as a rural GP in Tumby Bay. Yeah, that's amazing. Just to put it into perspective, how far away is Tumby Bay from Adelaide? Um, it's about 700 and 750 kilometers away. So it's a decent distance. It is, it's a decent distance like driving. And for those listening from overseas, they really, Adelaide is the next major hospital scenario Really? From the tertiary hospital. Yeah, yeah, yeah, yeah. There's Who would you refer to? Is there any backups from Tumby Bay? So Port Lincoln would be our, uh, secondary referral center. Yeah. Um, from the Tumby Bay Hospital. And there is, well, it start by a general physician, Dr. Rufus McLeay and a general surgeon, Dr. Quentin Ralph. And, um, basically they do, like us, being rural practitioners, they do everything right. And it's, it's quite interesting. And how far away was Port Lincoln? Tumby Bay? It's about 50 kilometers. Half an hour away. Yeah. Yeah. On the highway. Yeah. So it's not exactly near. Um, but to, to the country people, that's quite near. And the population of Tumby Bay. So our coverage is about 2000, um, thousand 500 to 2000 people around the region. Yeah. 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. Yeah, yeah. In the town. Excellent. Yeah. Right. So in that area of 2,500 people, what sort of, uh, distance would that be covering? That'd be a few. A fair few Ks, I would imagine. Yeah. Well. It's, it's, it depends on how far you want to drive, like, so, yeah. So it really is quite rural. It is. And what lessons did you learn from being, being a rural gp? I, well I learned to actually be, I think in a way, a better doctor. Um, not so much based on technology, based on back to basic clinical skills. Do you remember the first. Week I was there. Um, Dr. Eaton brought, you know, an arrhythmia, um, an ECG with an arrhythmia for me to have a look. And he's like, what would you do? And, you know, I just came from the city. I would say, all right, we need a cardiologist. We need this, we need that. We need CCU, we need monitoring, continuous. 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. So yeah, it, um, and, and, and he just said, went panic slowly. My son, panick slowly. And, and then, you know, that was how I was taught. So I was their very first registrar in a hundred years. They never had registrars before. 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. I then realized that, yeah, you can call for help, but really in reality, the nearest tertiary hospital is over 700 kilometers. 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. The nearest MRI scan at that point in time was in Whyalla. About 350 kilometers away. Yeah. Yeah. So, so it's not near Right. Right. So really, uh, you would've learned resilience from being in that sort scenario, having worked now in the, , city practice., 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. The, , programs. Okay, so I guess the main difference would be you are actually part of a community. So you see the patient, you interact with the patient both professionally, socially. You go to the pub, you see them at the pub. Um, there's always what I call, um, um, supermarket, um, consults. Like you go to the supermarket and you're like, oh, Dr. Lim. Um, you know, the results. How's that going? 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. 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. 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. It's much more difficult to get there, even though it's much bigger, but there's more bureaucracy to get through. So in a certain way, it's, it provides better, um, holistic, um, services in whatever limitations we have. 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? Yeah, yeah. But it's just limited in resources. Right. And , were there a difference in presentations too that you might see in the country? Yeah, plenty. So over here you see like your chronic diseases management. You see, um, like your sick clinic, uh, acute presentation. 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. Um, we have had many instances that that has happened and we are quite lucky in Tumby Bay. We, um, most country towns have problems retaining doctors. 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. Providing continuity. And we also have like newer doctors like us who stay around. So, um, after me, the, uh, doctors, Dr. George, um, Sara Georg is a registrar after me and Dr. Emmy Hennell, who is actually, her story is quite special. We might touch a bit on her because she was a graduate from here, did internship and became a teacher's wife. For the next 20 years. Right. And then finally went back into medicine after her, her children went, um, into school. Her youngest, she had, she had eight kids. Really? And yeah. Yeah, yeah. 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. So then obviously they all stayed on. So there were quite a few of us, five of us actually. Yeah. And when something major happened. Um, it's very collegial, so we all help each other and in that way we have the support. So in a way, Tumby Bay was very lucky. We were very lucky that there was enough doctors and, and we were very supportive of each other. Um, whereas sometimes I find in urban practice it can be more isolating. Like you would think that in country practice it's isolating. But in our situation, we were lucky if, let's say you are a single gp, for example, 24 7 right On call. Yeah. And so that could be certainly very difficult. But I guess we were lucky in a way, in Tumby Bay. 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. Mm-hmm. I presume it's like that every day of the week in, in working in a country practice. Is it? Uh, yeah, it is. So again, because of our unique situation. Our, um, we had wind downs, so almost every day. Um, we had what we call wind down with the doctors, the nurses of the practice, and the receptionist. It's a good way to debrief about the day if there's any problems or any difficult challenging patient. Um, you know, you sought advice from everyone, and it's not just a person, one new single person. 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. So it's, it's, it's rewarding in that situation. And then after that. Um, you know, the pub. 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. Whereas over there, most of the time you call up and say, oh, you want to go dinner tonight? Oh, sure. Yeah. And, and there's not much choice. 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. And, and in a way it's a simpler life. It's actually, um, I actually appreciate that quite a lot. Excellent. So obviously as a, as a, you put down as one of your hobbies, as of being a foodie. Yes. And you're, you are now a chef of your own restaurant. Does, but working in a country town actually help you develop your cooking skills and your, your abilities that way. I was that saying that you had before that? Well, um, I actually, I converted, so I, I have a property over in Tumby Bay and I converted a shed. Into a dining hall. Right. Okay. For, 'cause I love cooking and I love having friends over. 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. I think we do that quite, um, frequently, and it helps with, in a way, it did help my cooking skills a lot. And, and apart from that, most of the, our nurses, , our practice manager after that, Michelle, uh, she's a great cook. So, you know, you learn tips, she comes across and then she helps out. And, um, and yeah, so it, it's, it did help me, um. 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. Um, because yeah, there isn't much ex exposure to Asian food in Tumby Bay. In fact, there is no. Well, no Asian restaurant in Tumby Bay. I think that's my house. So yeah, it did help hone my, my, my, my, my skills in cooking and my passion in cooking. 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. Brilliant. Obviously COVID sort of taught us all that there's more to life than just working and. Whilst, you know, us as doctors, we all like to work and like the reward of helping patients. It sounds like Tumby Bay in a rural life, it actually brings out in a lifestyle., Would you agree with that? Yeah, absolutely. 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. Um, however, at the same time people want you to be involved in. In, in the community too. 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. I don't fish, but I get seasick, so I have to politely decline. But you know, people will be asking you say, oh, come along, we'll bring you out, we'll bring you exploring. And um, and, and, and there's all these activities that people try to make you feel welcome. Um. Uh, at the same time you make your own friends. 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. And so, um, and that helped too because I can imagine if you are. 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. 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. 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. Yeah. Yeah. That, that, that is actually very true. That's very, um, how the country people think they, they actually help each other out a lot. 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. Blackout throughout the state, and we were without power in Tumby Bay for a couple of days. You know, things didn't work. Um, mobile, there was no reception. We couldn't charge. We had a generator in hospital. So when there was an emergency, what would, what, what would happen? We, we, we then had, you know, a contingency plan with everyone in town. So then we. 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. Um, and there was no lights, so most garages wouldn't work, so then we might have to go in a police car. Um, uh, but the, the, the problem was the, the hospital generator runs on diesel. 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. 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. And I found that really touching. Um, I'm not sure, I'm sure if something like that happened in Adelaide, there will be people who would do that. 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. And, and the pub was providing like, um, um, free meals because I think because the. 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. And they were just, it created a community of help within the community. And, and I don't remember anyone asking for it. They just opened up. It's amazing. It is, it is. I think the country spirit is really alive in the country. Um, which unfortunately sometimes I don't see that much in. Urban areas. Yeah. But in, in the country town, it's, it's just that. That's brilliant. Yeah. What happens in an emergency, you, you're looking after a patient and you really are struggling. Know you've done all the. The right thing. 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. Yeah. What actually happens in that scenario for acute appendicitis is simple. We just call Quentin Ralph and tell him that we're sending a patient down, and then we, we, we, we manage that locally. And so that's simple. But for things like a mi um, a heart attack, you know, or, or something a bit more. 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. 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. For example, one patient had a, a, a, you know, metastatic cancer cauda equina syndrome. And I called out requesting, um, to transfer. 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. 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? Um, yeah. Have you done an MRI scan. How, why can you be, I'm like. Well, I stuck my finger in and, and, and, and they can be quite, um, obstructive at times and in. 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. Um, yeah, it's a bit unreasonable to ask about MRI scan when your nearest MRI machine is 350 kilometers away. 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. Yeah, yeah. But other challenges like getting crash blood. So the blood bank is in Port Lincoln Hospital that is 50 kilometers away. 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. His hemoglobin was like eighties and, and he was hypotensive. Um, and then I had to get blood, so called Dr. Fleming. He rushed down to grab crash blood and race up, and he was on the highway and he was going quite fast. 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. And that's again showing how, you know, it's not. If you need crash blood over here in the tertiary hospital, you write a request form and the orderly would send it here. Yeah. But over there we had to get in police escort, a police escort, and it was half an hour away. 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. So it's, it has its challenges. With, I think with technology has improved because you're able to get help. And now with the, so back then we didn't have the. 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. Is that something that's happened since COVID started or just before COVID that they, COVID really kicked it off right. On that basis. What is the access to specialists like in the, in that area? Is it, uh. Do they come up and visit? They do. So they do come out and visit. Um, but obviously it's not very, um, not as often as we would like. And because when they do come and visit, they cover wide area and not just in Tumby they other towns. So they usually stay in Port Lincoln who is bigger and get the patient's referral from all over the region. But like I said, we were, we were lucky with the general surgeon and the general physicians. 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. 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. Removal or lumps and bumps and other things. Yeah. Did you have any experience with that when, when you were there hand? Oh, plenty. 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. 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. They have eye injury from, from not wearing proper safety glasses. Yeah. And, and so you just have to blow out the, the rust from the cornea. So basically you anaethetise the eye putting in a local anesthetic. Really? Yeah. 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. So, um, that's just one of the minor procedures we do. Um, which I don't think a lot of urban GPS would actually do. 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. 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. 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. Oh, really? Yeah, yeah, yeah. Because we don't actually have the, the whole setup. But it is not something that, it's difficult. It just needs a bit of creativity as long as it's not causing harm to the patient and it's safe. 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. Yeah. Yeah. So it's something that you just have to learn. And I was very lucky that, that, um, I had good experience, um, GPS to teach me that. What about orthopedics? Did you get any, uh, fractures or trees? No. This is a story you enjoy. So this is, um, an even older. Generation. So, um, so Graham and Dennis told me this story when they were registrar, so that was a good 40 over years ago. There was a rural general practitioner, a rural doctor that, um, 'cause that was before the age of x-ray. So if a patient comes with a, with a fracture, he would get the matron to drop ether. Like, you know, that's how old it is, eater to put the patient under and then he would. Scrub in. Open up, look at the fracture.'cause there was no x-ray. 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. It's not like that now. No, no, no, no. But that story is stuck like, you know how. How resilient country g and that's how rural gp, rural medicine evolved. Um, but, but in our situation, like if we have a fracture and stuff, we, we had to do our own x-ray. Yeah. 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. 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. But now we have the modern, um, reusable plates and everything's quite automated. 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. Um, yeah, just like plastics and all that stuff. Um, depending on whether it's an urgent thing or whether if it's stabilized, then we can. Um, wait for transport or they can even go on a commercial flight, for example, if it's all neurovascularly intact. Um, but if it's an emergency and stuff, then they get retrieved over. Your backslab skills would've come in handy though. Oh, you think of everything like back slab you. You think of ways to make the back slab from cardboard from whatever you can find. Um, yeah. Excellent. Is there anything else you'd like to add to that for the listener at all? 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. I, I don't, I didn't perceive it that way. So that's, you don't, no, I, I took my hat off to you. It's brilliant. So I think we should talk a bit about rural training. Yeah. So like, it is a bit distinct, um, from urban GP training. So usually it's, it's, um, additional training. So we have two colleges in Australia. One is the Royal College of, um, Royal Australian, Australian College of. Um, general practitioner, and then one is ACCRM, which is the Australian College of Rural and Remote Medicine. So the time is quite different from being a rural generalist. So that's the term now that we use in the past as rural gp, but now the term is rural generalist. So. A, a general practice, um, or a GP P training is three years. 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. 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. To be able to do that. So in a lot of areas, so you do have to do additional training, um, to be a rural generalist. 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. And they could then do things like simple appendicitis and know appendectomy and stuff like that. 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. 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. So, so in Australia, that's, that's, that's what you need, um, um, to be a Rural generalist, right? Yeah. For those overseas, uh, listening, it's, it's, it's, um, who want to have an experience. Maybe you could come in and, you know, have an experience in the country yourself. Go and experience that. Yeah. Um, provide that. You could get your, at least come and observe anyone. Yeah, exactly. Did a visitation. Yeah. Yeah, yeah, yeah. Yeah. Obviously you, you went there with the idea of mo moving towards palliative medicine as well. Yes. Did you get any experience with the palliative medicine in, in the rural setting? Yeah. Um, so we were lucky we had a visiting, um, um, palliative care specialist, so Dr. Roger Hunt, um, who sort of dragged me into palliative care training and he's my mentor in palliative care. 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. Um. And because of the procedural skills we had as CHI General practitioners, um, we did nerve blocks over there. 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.'cause the patient wasn't mobilizing anyway, and, and rather than just a single block, we will connect that to a continuous pump. Um. And, and that's what we did. So we basically blocked it with, again, an IV cannula and just left it in as the end of life care. Um, and, and that managed pain in that way. So again, creativity with what we have in the country. And a lot of times patients actually prefer not to, um. Not to be transferred, obviously, because there are families over there. Support system is over there. 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. 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. So it's really a quite a nice setup from a palliative care point of view. Um, but the whole Tumby Bay Hospital is amazing. Every single room faces the, the sea. Oh, really? Oh, that sounds great. Great view. Great view, great view. Yeah. I, I teach the medical students that palliative medicine. Yeah. I think Orthopaedics have got a reputation of being. Tough buggers around the place,, because we, we fix broken bones. But really, I think palliative is really, you, you're very strong to be able to do that. And the Orthopaedic, we are soft and I think it's brilliant that you've got that. We interviewed , professor Greg Crawford about it. Yeah. He talked about the importance of a rural palliative medicine approach as well. Yeah. Yeah. He was from Kangaroo Island. Yes. Yes. So, so he said that really helped as well. So yeah, I think it's a,, great approach to it. Right? It's, it's actually, um, so Professor Crawford, um, was the one that actually. 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. Yeah. Because if that's what you have, that's what you have. You can't have anything more than that. So that's just what you have and you what you have to think about. But as long as it's not causing harm to the patient. That's fine. We can always try. Brilliant. So it sounds like you've maintained a connection with Tumby Bay. You've still got a property there, have you? Yeah, yeah, yeah., But you had to move to Adelaide for training as a palliative physician. I did. 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.'cause you know. That was part of what I was thinking. Uh, I was always interested in palliative care, but then I thought being a rural gp that was, I was quite happy with that. But yeah, somehow fate intervened and I came back and started training, um, in 2018. Right. Yeah. 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. So then I did a stint in pain medicine for six months as a, um, elective, and then decided to go ahead. Uh, and do the full training and, and yeah. Did both training at the same time. That's brilliant. As well as being a chef. Yeah. As well as maintaining a connection with Tumby Bay. Yeah. So, so you've got kept busy. You kept busy. You've got three, three homes, I take it you've got Adelaide, Tumby Bay, and I presume Singapore is still a connection. Singapore. Yeah. 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. I presume from, you know, Singapore is six times smaller than Kangaroo Island. There you go. Yeah. And so, so your friends at home in, in Singapore too,, would, , find it interesting. Your, your next closest tertiary center was 700 kilometers from Tumby. Yeah. Yeah. 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. Um, and the, and the, and the. 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. Right, right. How do you feel about palliative medicine and pain pain work now? Does it say it's a different side of life? I would assume those two areas are also close community. And looking after not just the patient, but the relatives of, of people going through palliative care and those requiring pain relief as well. It's probably as similar in some ways as a local community in Tumby Bay, in, in that way, isn't it? Um, from, from my observation. Um, I think in the country, even though they're limited, like I said, the community spirit is strong. So in a way. 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. 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. It's, it's, it is very involved. If you think about end of life care at home, it's actually very involved. 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. Um, and then you need a lot of family support. 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. 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. Um, whereas that in urban areas, I find it's sometimes lacking. So even though the population is bigger, but the isolation might be greater. Very interesting. Yeah. That's my observation. It's sad, isn't it? It is. It is. 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. Um. 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. Palliative care team is quite limited, so that has its own challenges. 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. 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. And that to them it's, is, it is calming, you know, it's, it is kind of support. So, so in a way, I think in the country, in a smaller community, um, that might be sometimes easier, right? Yeah. Yeah. It's strange. I know. But yeah, that's my observation. Right. So it's, so in some ways it's more challenging in Adelaide than it It is, yeah. It is, it is. Um, and also I think the country people are more resilient. 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. Whereas there's a certain expectation. That you know, oh, this is not good enough. You know, we need this. We should be able to assess that because it's convenient. It has always been convenient for them to assess services and the expectation is different. So I think expectation or the difference in expectation actually makes a difference. Right. And obviously the resilience in it too. Yeah. Yeah. Where do you think palliative medicine's going both in the country and in in Adelaide? So, so in, in the country, um, the palliative care services are run mostly by, um, nurses. Um, so with the support from palliative care consultants or palliative care specialists, um, in the three services, NAHLN, CAHLN, SAHLN. So that's the local health network we have in Adelaide, and they provide specialist input if needed. Um, but by and large it's mostly run by the nurses. Now there are, there are very limited, um, nurses that, that, that do that. And the distances that they have to cover are quite great. So to see a patient, they might drive one, 200 kilometers just to see a patient. Geez. Yeah. So that kind of, um, help or that kind of service is obviously. Um, daunting and difficult to maintain in the long run. So, um, shout out to all the palliative care nurses and nurses of the country and all the rural doctors. They, they are actually quite amazing 'cause of the areas that they have to cover. Um, I, I think in future, once we, if we are able to get more like telehealth and with technology. Um, that would be good. Currently you need the nurses to go there because some of the older patients might not be able to have handle technology. Um, and also internet connection, reliability and stuff. But hopefully in future, because nowadays people are more, um, used to technology and if they can manage their own technology. The nurses don't have to drive 200 kilometers just to set up the system for them. Yeah. And that might be useful too. And maybe with like drones, um, delivery of, of, of equipments and all that stuff. Maybe one day the delivery of medication from the local pharmacy can be run by unmanned drones. I don't know. Maybe I'm thinking a bit too far, but, you know, I think technology is the way to, to overcome all these problems. And even monitoring, like, like you have your app now. You can monitor your heart rate, you can have a basic ECG done from your iWatch and stuff like that. 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. Um, yeah, so I think technology to overcome all these challenges we have to, um. Wait for technology to advance. 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. You do. I think it makes you a better doctor and a better person, um, because you are able to relate to. To the actual situation over there, because we are all doctors by default. You do have a passion to help out. No one says, oh, you know, I, I hate helping people, but I want to be a doctor. I don't think that happens. 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. So I think for a young, um, medical student or a young doctor, um, that would be quite useful because. Remember, you are there and you are able to make a difference, make an impact. And at the same time, you're able to hone your own skills, especially when you know, when you're just starting out. And with the right, um, supervision. 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. Yeah. 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. 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. So I've, you went the next step, I dunno where you get all the time to do all this, but it's amazing. But you've gone the next step in actually now running your own restaurant and a chef for it as well. Well, um, one of my motto in life is you can sleep when you're dead. But yeah, but I mean, it's all an experience. 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. It depends on what you see life. So there's always two views. So you can go to the country and think, you know, I have no choice as part of the curriculum. I just have to. Do it for three months or do it for three weeks, you know, as part of my rural week. And then that's it. 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. It might not be you. 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. So you don't know until you've tried it.'cause you might love it. Yeah, so it's the same with like cooking and I, I, I took the leap obviously, and, and, and opened the restaurant. Even though it's still sort of my passion project, not really making any money. I'm actually losing a lot. But, you know, it's still a passion project and it's a good outlet for my, um, myself.'cause we can't just. 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. But I think it's a good outlet, everyone. And you think you need outlets? Everyone does. Yeah. Everyone needs an outlet. You can't just, you know, it's just immerse in one thing. You, you need an outlet, a passionate hobby. Otherwise you will feel, uh, you just can't go on. Yeah, yeah, yeah. So, and tell us a bit about the restaurant. So, so the restaurant is Katong House. It's on 255 Kensington Road. Um, and it sells, um, Singaporean food. So Katong is the suburb that I grew up in and in Singapore. And it's, it's, it's, it has the best food, the lobster, everything. Um, yeah, local food from Singapore. It's, it's a bit different. It's not Chinese. It's not really any distinct. It's a amulgation, it's a mix. It's a mix of, um, of different cultures like Malay Indian and Chinese cooking, um, with our own local influence. So things like la bu, na, mac, um, you know, chicken rice. Yeah. So it's different, the challenge. Is the challenge is actually not cooking. The challenge is coming up with the process of, of maintaining the standard when I'm not there. Yeah. And, and, and to actually come up with the process of doing so. I make all the sauces, everything in the restaurant is made, um, by us. So I make the base and then everything is commercially sealed and vacuum packed and, and then stored. And, and the staff will then, um, make the dish according to my instructions. 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. Um, so that was a challenge. 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. Brilliant when I'm not there. Brilliant. Yeah. So that took a couple of years. Well, I look forward to trying it out. I, I haven't been there myself yet, but it's one of those things on my bucket list. Know you're more, most welcome to come and try it. I'll cook for you personally. That sounds brilliant. Well, Han, it's been fantastic having you on Aussie Med Ed. Is there anything else you'd like to add to that for the listener at all? The other thing that I would like to mention is. 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. 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. They, they, there's this continuity of care that. It's sometimes non-existent in, in, in, in city centers because they know the same family for like 40 years. 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. And Graham just said, well, I know fetuses who had their own fetuses. So, so that continuity of care is so important. Like they know the family history and, and everything is just. In, in there, in, in their knowledge bank. 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. 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. There, there was a, um, um. I, I, I still remember my, my, one of my friend was actually a builder. Um, from Tumby and he's now relocated to, to, to Adelaide. 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. He just pop a question. He was like, why are none of you rural gps? 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. He actually said that, look, if something happened to me, Han had to. You know, they got stuff from my eyes, or he had to take care of this hammer on my head. Um, and, and, and, and, um, like, you know, he have to do everything from a heart attack to this and that. 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. Lots of intensive, but. 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. Yeah, yeah, yeah, yeah, yeah, yeah. And, and it's, it's really quite and interesting experience and I never expected Simon to say that. Yeah. But that was one of the thing that really threw me off. But that's brilliant. That's brilliant. Yeah. 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. McLeay. They are the real heroes. They have been around forever, and they are the real heroes in the country, not me. That's brilliant. That's absolutely brilliant. Yeah. Well, Han, it's been fantastic having you on Aussie Med Ed and hearing all about this. Thank you. It's been really, really enlightening. I really take my hat off to you and, uh. Hopefully catch up with some sleep on the weekend at some stage, but love that. You can sleep when you're dead. Well, thank you very much. No, thanks. Thanks, Gavin. Thanks for having me. Thank you very much for coming on Aussie Med Ed. Thank you. Thank you for having me. I'd like to remind you that all the information presented today's one opinion. There are numerous ways of treating all. This is general advice and may vary depending upon the region in which you're practicing or being treated. The information may not be appropriate for your situation or health condition. You should always seek the advice from your health professionals in the area in which you. Thanks again for listening to the podcast and please subscribe to the podcast for the next episode. Until then, please stay safe.
