Surgicalthe royaL Australasian CoNewsllege of Surgeons april 2013

Includes Post Op 12 page Lifestyle section

The College of Surgeons of Australia and New Zealand

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D A to Auckland 2013 WelcomeConvenors have an exciting program in store for the 2013 ASC postautumn Lifestyle op

12page lifestyle section

12 page Autumn lifestyle Cycling through

post op appears in Surgical section News loves to ride each c ntents The Tasmanian surgeon who season inside Europe UCK -A L A C

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See you in Auckland 2013 16 Indigenous Health at the ASC The Inaugural Indigenous Health Forum 18 ASC 2013 More on the program 20 Library Report New resources for members 22 International 10 Development regular pages Success in Timor-Leste 6 Relationships & Advocacy 22 13 Dr BB G-loved 25 Flexible Training 14 Poison’d Chalice Dr Pancha on part-time 31 PD Workshops training 39 Curmudgeon’s Corner 44 Book Club 26 Drawing for Surgeons Kellee Slater and a rewarding course 20 32 Successful Scholar

Anand Segar’s Foundation for Surgery scholarship

34 Regional Awards Congratulations on your

achievements

Correspondence to Surgical News should be sent to: [email protected] Letters to the Editor should be sent to: [email protected] Or The Editor, Surgical News, Royal Australasian College of Surgeons, College of Surgeons Gardens. 250-290 Spring Street, East Melbourne, Victoria 3002 T: +61 3 9249 1200 F: +61 9249 1219 W: www.surgeons.org ISSN1443-9603 (Print) ISSN 1443-9565 (Online)

Surgical News Editor: David Hillis / © 2013 Royal Australasian College of Surgeons / All copyright is reserved. The editor reserves the rights to change material submitted / The College privacy policy and disclaimer apply – www.surgeons.org The College and the publisher are not responsible for errors or consequences from reliance on information in this publication. Statements represent on the cover: the views of the author and not necessarily the College. Information is not intended to be advice or relied on in any particular circumstance. See you in Auckland! Advertisements and products advertised are not endorsed by the College. The advertiser takes all responsibility for representations and claims. Pic by Keiran Scott Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053. Courtesy New Zealand Tourism

Surgical News April 2013 / Page 3 The Royal Australasian College of Surgeons A particularly valuable presentation was provided by Professor Phil Carson from Darwin Hospital. He undertakes seeks a general his professional practice in the midst of two large networks of colleagues. SURGEON to work in The first is as a general surgeon where he is linked either by mentoring or tele/video conferencing with many sub-specialty Timor Leste (East Timor) surgeons around Australia who provide direct support for the more difficult or technically challenging clinical situations. As he President’s stated so clearly, the best time via air-ambulance to an operating Perspective theatre in a major hospital in another region is 14 hours. Are you up for the His other network is the very large group of medical challenge? practitioners – non-surgeons – who undertake surgical [ ] procedures throughout the Northern Territory who rely equally on access to Phil and his colleagues to be able to provide the care that is required for the patients they If you are: are treating. It was an incredibly powerful, yet pragmatic • A formally qualified and registered general presentation. surgeon with a FRACS (or similar qualification) Culture eats strategy for breakfast It was not surprising that he was asked, “How would • Keen and experienced to teach junior medical you replicate your model in…” The response highlighted staff he College maintains important partnership those interpersonal and support in the workplace issues. We • Passionate about assisting in the development of arrangements with the RACP and the Canadian all know places where collaboration, communication and a surgical service College of Physicians and Surgeons. In mid-March teamwork would produce vastly improved services and a • Sensitive and adaptable to cultural differences T • Available for deployment in late 2013 for at least we held a number of workshops on issues like CPD and much more rewarding professional practice. revalidation, work-based assessment and clinical decision It was after Phil tried to explain the key interpersonal issues 12 months making in conjunction with an open one day seminar for success that the facilitator echoed the comment made … then we would love to hear from you! on ‘Serving the Community: Training Generalists and famous by Peter Drucker: “Culture eats strategy for breakfast”. ACTIVITIES I had heard the remark before – I think we all have. However, Extending Specialists’. The Faculty of Medicine and Health Sciences of the it does not just relate to management gurus or the Ford Motor This follows on our highly successful seminar last year National University of Timor Leste has started delivering Company where this saying was a clear motto to turn the about ‘The Medical Professional in the 21st Century: an 18-month Post Graduate (PG) Diploma course in five company around. Competent, Fit and Safe’ and again was successful in streams: Surgery (including Orthopaedics), Anaesthesia, bringing key educational and regulatory decision makers It has recently been used in the wake of the Staffordshire Obstetrics, Paediatrics and Internal Medicine. RACS is an from Australia, New Zealand and Canada to discuss the review within the NHS as they come to grips with how a important implementing partner funded by AusAID. An important issues that will be impacting on surgeons in the culture of compassion, caring and consideration (to which all experienced and passionate General Surgeon is required very near future. health-care staff would surely aspire) was replaced by one of to join the Timor Leste Program. Generalism and Specialisation are key strategic issues callous disregard, fear and disinterest. And here it was again – Your role has two main aims; you will mentor and teach for our College and affect all branches of surgery. They can not in the motor car industry or in the NHS, but applying to be considered from different perspectives, the individual hospitals that people in the audience knew so well – too well. junior doctors enrolled in the PG Diploma in Surgery surgeon, the professional organisation and also the views of So how do we change culture? Generalism is one aspect of together with national and other international faculty the community, government and its jurisdictions, and our the “culture” the community expects us to espouse and aspire members; and you will also contribute to the development employers. to, and our response to this challenge is one way in which the of an appropriate and sustainable surgical service together The latter stakeholders in particular are keen to promote But it is not only our recognised specialties where there community will judge us. How do we create models where with the two Timorese general surgeons. generalism and are less than enthused about the increasing is concern with Obstetricians and Gynaecologists as well as generalism is desired, respected? This calls for cultural change. Clinical work forms part of the job, but is always directed trend to super specialisation. During the seminar many Ophthalmologists and Radiologists working in smaller and To change culture we have to change attitudes by challenging towards mentoring and training the junior medical staff scenarios were discussed and both the joys and sorrows of smaller areas of anatomical interest. This has been analysed and modelling alternative attitudes that have credence within and medical trainees. An attractive remuneration package programs highlighted. by health economists as well as health managers. There was the same environment. includes accommodation in Timor Leste’s vibrant capital city It is becoming increasingly evident that unless we an interesting discussion how this drive to sub-specialties For surgeons, we sometimes think that culture is a touchy- continue to recognise the importance of our generalist is now producing a totally uneconomical model of ‘on-call’ feely component that belongs with the HR department. LOCATION training from an individual and professional perspective, arrangements in major and metropolitan health services. However, others will say that “culture” is a key driver that has You will work at Hospital Nacional Guido Valadares then employers and regulators will step in and enact the Not surprisingly some hospitals have now responded in to be set or adjusted periodically, in response to a changing (HNGV), the national hospital in Dili outcome they require. their recruitment processes to a ‘commitment’ to on-call environment, to maintain our position as a respected and The drive to specialisation is occurring across all of the availability in the ‘overall specialty’ that cannot be sub- autonomous professional organisation within our community. Interested? nine specialties in which the College awards a specialty divided or delegated. Our response to the increasing calls by the community Send your CV & Cover Letter to RACS today! – not just general surgery and orthopaedic surgery. In the future, jurisdictions will demand surgeons for “generalist” trained and capable surgeons is one way the The gastrointestinal tract seems to be divided into ever maintain a commitment to the breadth of their specialty. If community will judge whether we can be entrusted with the Contact: decreasing lengths, individual joints now have nominated a surgeon requires ‘back-up’ when they are on-call, then that responsibility for surgical education and standards into the Ms Kate Groves, Senior Program Officer specialists, otolaryngologists now often specialise in is all possible, but they will need to maintain the role of ‘on- future. [email protected] +61 3 9276 7413 one small component such as voice and plastic and call’ surgeon, will need to maintain CPD in generalist skills The Timor Leste Program currently employs six full-time clinicians at and if necessary ‘re-skill’. “I do not do those anymore…” will HNGV and coordinates around 16 specialist team visits across Timor reconstructive surgery have watched the breadth of their Mike Hollands Leste per year. practices skewed to an extreme. no longer be acceptable. President

Page 4 / Surgical News April 2013 Surgical News April 2013 / Page 5 Relationships & Advocacy

Important issues for the College Generalism and Alcohol must be addressed

ne of the privileges of being While surgical practice in rural ism. This is “dangerous territory” for the on an allied issue – GP Proceduralists. It is intended Vice-President is to chair the and regional areas has undeniable College, as many surgeons would support that the two working parties will ultimately deliver OCollege’s Governance and attractions, both in terms of lifestyle and this direction and an almost equal num- a cohesive and coordinated approach to generalist Advocacy Committee (GAC). Several professional challenge, they seem too few ber would oppose it. The challenge for surgical practice which will deliver tangible benefits key initiatives are underway, some being to entice surgeons away from our major GAC is to remain engaged with govern- to patients in rural and regional areas in our two finalised, others in the earlier stages of cities. ment in order to achieve an appropriate countries. development. These initiatives reflect This is bad news for those communities outcome rather than become isolated and Finally, I need to tell you that GAC has become very internal concerns raised by surgeons, but whose very existence can be threatened have a solution imposed. interested in alcohol. Surgeons are ideally placed to take also proactively address issues related by inadequate healthcare provision. It Associate Professor Phillip Carson is a position with respect to alcohol issues within society to community need and government can also result in an unfair burden being a member of GAC and he has accepted – not least because of our reputation for enjoying processes. placed on those surgeons who choose to the challenge of convening a Generalist alcohol or that many of our number produce some very An example of the latter is the well- rise to the challenge of working in less Surgery Working Party that will provide fine wines! We cannot be silenced by being described as publicised need for enhanced rural and supported environments – even wanting advice to GAC. The working party is in the “wowsers”. regional surgical services. After extensive to take a holiday can engender feelings of early stages of its brief, identifying where But as surgeons we have to deal with many of the consultation, and working closely with guilt! the gaps in surgical services are widest adverse effects of alcohol – road trauma carnage, the College’s Rural Surgery Section, the As a profession of surgeons, we need to and devising ways in which the College senseless alcohol fuelled assault, and domestic committee is finalising a position paper identify solutions in the very near future. and surgeons can help fill them. To my violence. Many surgeons have contacted me and on this particularly challenging issue. Otherwise there is the entirely predictable mind, one of the greatest challenges is talked in terms of an epidemic! In our society more There is increasing awareness that risk that what we would view as the how we can restore the prestige of being a than one third of all police time is spent dealing the problem of surgical access outside “draconian” solutions currently being generalist. with alcohol related issues – this has to be telling us metropolitan centres stems not from a contemplated will be imposed. The working party is initially focusing something! shortage of surgeons overall, but from the Another issue being considered by its efforts on those areas where the The College has a well-established tradition of maldistribution of the surgical workforce. GAC is closely related. Government agen- College can have real impact: reviewing taking informed and principled positions on issues The vast majority of us are drawn to cies across both our countries, and in the the training provisions and the role of of public health – alcohol harm mitigation is entirely CLINICAL FELLOW IN PLASTIC AND the cities, where partners are more likely case of Australia at both levels of the specialty training boards within our remit and our voice must be heard on this RECONSTRUCTIVE SURGERY to find work, our children have greater government, have made and assessing the required issue. ROYAL DARWIN HOSPITAL, COMMENCING JANUARY 2014 educational choice and we are close to it clear that the trend scope of practice of Accordingly the Governance and Advocacy major hospitals, universities, the College’s towards subspe- generalists. Committee has decided to develop a College policy conferences and workshops, and a wide cialisation must The working that will guide our advocacy efforts on this issue. network of friends and colleagues. There be offset by party is also We are fully aware that we will come up against the is also an awareness that continuing to a concerted working carefully marshalled forces of the alcohol industry, increase surgical numbers overall will effort to closely with with experienced lobbyists and seemingly limitless not necessarily address the problem of encourage a working advertising budgets. And we will come up against maldistribution. general- party politicians who are more inclined to listen to constituents than surgeons. These obstacles notwithstanding, the committee feels that as clinicians we owe it to the community to An exciting and challenging position exists for a Fellow in Plastic and Reconstructive highlight the extent of the damage being wrought by Surgery at the National Critical Care and Trauma Response Centre,Darwin Australia. This is a unique opportunity to work closely with adult oncology, orthopaedic, otolaryngology and the abuse of alcohol. maxillofacial teams and provides extensive exposure to Indigenous health. The successful applicant will be required to commence in January 2014 and participate in acute In next month’s Surgical News, two committee service on a rotational oncall bases, research and teaching. members, Phil Carson from Darwin and Cathy Royal Darwin Hospital is recognised as the National Critical Care and Trauma Response Centre and has two plastic surgeons, one burn surgeon and one visiting Ferguson from Wellington, will outline why now is the craniofacial surgeon. right time to fight this particular battle, and how we The Royal Darwin Hospital (RDH) is a 345-bed hospital in the Top End of the Northern Territory servicing a population of 140,000. It is the only tertiary For further details propose to win it. referral centre in the Top End and caters for a wide range of clinical please contact: conditions – it is more than 3000 km to the nearest tertiary referral Mr Shiby Ninan centre. It caters for a diverse young population including high Director of Plastic Surgery numbers of Indigenous patients. Royal Darwin Hospital There is a high trauma workload and substantial exposure to Tel: (08) 8922 8888 or email: patients with sepsis and complex medical illness retrieved [email protected] from some of the most remote communities in the world. To my mind, one of the greatest To apply online please Candidates must be eligible for general and/or specialist send your current CV, referee challenges is how we can restore the registration with the Medical Board of Australia together with details and a covering letter to: Michael Grigg “prestige of being a generalist a current Fellowship FRACS (Plastic Surgery) or equivalent. [email protected]. ” Vice President Page 6 / Surgical News April 2013 Surgical News April 2013 / Page 7 Surgical Snips Surgical Snips

New clinic for Hobart A new outpatient clinic of the Royal Hobart Hospital will offer a range of services to patients, including pharmacy, pathology, surgery and specialty clinics. The state-funded facility will become a one-stop shop and make patient care easier and more efficient. Plastic and reconstructive surgeon Fellow Andrew Castley said that families will appreciate the new facility. “There’s more space within the rooms and you’ve got Wii surgery access to everything – I think they’re great,” Mr Castley said. A study from Italy has found that Hobart Mercury, February 27 surgeons who regularly play Nintendo Wii computer games perform better surgery than those who do not. Researchers at the Sapienza University Elective lists rise of Rome observed 42 post-graduates in Elective surgery lists in Victoria are predicted the specialties of general, endoscopy to rise to 55,000 in June, despite the Federal and vascular surgery. Government funding reversal. Spokespeople for They played games such as table tennis both the Australian Medical Association and the Cosmetic risk and Battle at High Altitude to improve Australian Nursing Federation have expressed Patients complaining after botched cosmetic surgery are just hand-eye coordination. Despite concern, AMA President Stephen Parnis saying the “tip of the iceberg” according to a senior research fellow at limited experience in laparoscopic the rise was unprecedented and ANF claiming the University of Melbourne. Doctors support the call for greater surgery, more of the post-graduates the system is “totally underfunded”. awareness, with Fellow Hugh Bartholomeusz saying that procedures performed better than their colleagues Victorian Chairman of the Royal Australasian carried out in risky environments should be outlawed. when tested in the theatre. Scientists College of Surgeons, Robert Stunden said that “It is too often being done by doctors who are not plastic surgeons suggested dedicated training software patient lives were at risk and described the and in non-accredited rooms,” Dr Bartholomeusz said. for surgeons may be helpful. number as “appalling”. Sydney Morning Herald, March 6 Sunday Canberra Times, March 3 The Age, March 20

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Vascular Surgery An outstanding banquet is planned Andrew A. Hill has convened an with a New Zealand flavour. outstanding vascular program with four Book for each of these events either international visitors. The program will on the registration site asc.surgeons. be over three days (Wednesday to Friday). org and click on registration or use the The program will cover many of the key registration form. areas in vascular surgery and highlights will include the Wednesday Masterclass Transport from on TEVAR. Auckland airport to the The International invited speakers, Conference Hotels

Picture: Chris Sisarich. Courtesy New Zealand Tourism Professor Allan Lumsden (USA) and Buses Professor John Robson (SA), Dr. Patrick Airbus Express is the fastest way to Peters (Belgium) and Dr Timothy Resch travel to the city. (Sweden) will keep delegates fully The service operates 24/7 with informed across a wide range of the latest buses departing every 10 minutes from research and innovations in vascular both the Domestic and International surgery. terminals between 7am and 7pm and Vascular Trainee papers will be every 20 minutes outside of these presented on the Friday afternoon and hours. Stops 3 and 4 are a short walk this will be an excellent way to finish from SKYCITY and the Congress what will be an educational, entertaining hotels. Travelling time is approximately and informative vascular program. The 40-50 minutes depending on traffic Vascular Section dinner will be held on conditions. Tickets are $16NZD one- Wednesday evening and is booked for the way and available online, from airport highly regarded ‘Sails Restaurant’. ticket kiosks or direct from the driver. For more information please visit www. Oncology airbus.co.nz. For the Surgical Oncology dinner on Auckland has a comprehensive May 7 I have arranged for Alissa Bates, bus network and the main city ll the programs are finished, Gluckman will deliver the Syme Oration, Scientific Programs oncology and a special interest in micro- Winemaker at Brennan Wines, to be terminal is at the Britomart Transport section dinners are booked, “The challenge of scientific knowns and At this Congress, 23 section and special vascular reconstruction. present and wines from the Brennan Centre situated 15 minutes’ walk or 5 Asession chairs appointed – all unknowns; perceiving risk and setting interest programs have been convened. Professor Richard Kefford will deliver a vineyard will be served at this dinner. minutes on the Green Inner Link bus is ready for the 82nd Annual Scientific policy”. The convenors are to be congratulated keynote lecture on the systemic treatment This vineyard is owned by Murray service from the SKYCITY Auckland Congress to be held at Sky City Honorary Fellowships will be awarded on an outstanding educational program of melanoma and a combined session Brennan the BJS Visitor and his son, Sean, Convention Centre. Convention Centre in Auckland, winner to Beverley Lindley and A.Brent Eastman. over four days of the meeting. More than with general surgery and rural surgery is the head winemaker. From Britomart you can get of the latest most liveable city in the The Louis Barnett Medal for service 500 abstracts have been submitted and will discuss the difficult cutaneous information about public transport and world competition. It is not too late to get to surgical education will be presented the convenors have selected over 200 for malignancies of the head and neck. HPB/Upper GI take a bus or ferry to most destinations the dates into your diary, and to decide to Professor Mark Edwards and the Sir presentation and 250 for electronic posters. For the HPB/Upper GI dinner on in Auckland. how many of the family members will be Hugh Devine Medal to Mr Campbell The posters can be viewed in the Exhibition Medico-legal Section May 8, Wayne “Buck” Shelford will travelling to Auckland with you. Miles who recently stepped down after Hall – follow the instructions on the screens. Hamish Crawford has brought together give an after dinner presentation on Taxis Registration is easily achieved on the nine years at the helm of the ASC. an interesting medico-legal program Leadership and Team Building. Wayne Taxi ranks are located outside Door 8 at Congress website asc.surgeons.org – Associate Professor Ronald Kaye and Head and Neck Surgery covering such issues as the medico-legal was All Black captain and undefeated in the International Terminal and outside Register now!! Mr Keith Mutimer will receive ESR This program has been convened by aspects of implanted devices and chronic his time in charge. the luggage collection area – Door 4 at Hughes medals, Associate Professor Colin Rajan Patel. He has arranged an extensive regional pain syndrome. The medico- the Domestic Terminal. An indicative Convocation and Russell and Ms Leslie Dunstall the RACS program on head and neck malignancy in legal section program will be conducted Evening functions fare from the airport into the city is Welcome Reception – Medal for Service to the College. Mr combination with the Endocrine Surgery over one day. The day commences with a The Section dinners are on Tuesday between $60NZD – $80NZD (one- Monday 6 May Gordon Low AM and Mrs Rosie Low will program. The international visitor is Masterclass on Implant materials/devices and Wednesday nights and a number way). All taxis will take you to your The official beginning of the meeting is receive the International Medal. Finally, Professor Neal Futran from the University and later the James Pryor Memorial of leading Auckland venues have been destination priced on a meter. the convocation on the Monday afternoon Professor Russell Gruen will be presented of Washington Medical Centre in Seattle. lecture will be given by Professor Ron booked to host these dinners. We look forward to seeing you in when new Fellows will formally join the with the 2013 John Mitchell Crouch Professor Futran’s particular areas of Patterson, Professor of Health Law and Thursday night will be the superb Auckland. college. During the convocation Sir Peter Fellowship. interest are complex head and neck Policy at the University of Auckland. Congress dinner at the Langham Hotel. John Windsor and Andrew G Hill

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D A 2013 The ASC on your mobile device What’s on? Technology at the ASC

his year, for the first time Additionally the ASC is also the ASC will be trialling allowing delegates to post any Tan online Scientific questions they may have during Program to be available via a presentation/session, via an app for Android and IOS Twitter, so that presenters and wireless devices. It is expected CALL FOR ABSTRACTS chairpersons can see in real time that this online Scientific what issues are of central interest Program made available for to the audience.” the 2013 ASC will be a major Mr Thorsland said he resource for delegates for all believed that between 50 to future ASCs. 70 per cent of ASC delegates Delegates at the ASC to be will be using mobile devices at held in Auckland from May 6 – RACS ASC 2013 this year’s ASC and that many 10 will be able to use their tablet attendees were rapidly moving Royal Australasian College of Surgeons nd Trainees at the ASC computers to view the Scientific 82 Annual Scientific Congress away even from carrying Program, select the sessions they SkyCity/Crowne Plaza Convention Centre laptop computers. wish to attend, manage their Auckland, New Zealand “All these developments have n 2013, the Annual Scientific Congress to hear from enthusiastic, inspiring and general interest to Trainees, such as the schedules, get directions and 6 – 10 May 2013 been designed to both simplify will return to New Zealand with highly regarded academic surgeons from master class ‘Applying for and securing view presentations. and enhance the experience for Auckland hosting this year’s event the United States and Australasia. It is an overseas Fellowship’, and those that asc.surgeons.org I The Digital Producer of the presenters and delegates at the between Monday 6 and Friday, May 10. recommended to all Trainees with an the Conveners particularly recommend ASC, Mr Dan Thorsland from ASC, but not to replace social The Conveners have put together an academic interest. Registration is via the for Trainees coming up to their exams, the event management company Sustainable interaction,” Mr Thorsland said. excellent line-up with much to interest ASC website. such as the session on ‘Management of KOJO, said the new electronic Surgery “I think that sitting among Trainees over 25 general and scientific General Surgery Trainees from New advanced skin cancer’. version of the Congress Program your peers and hearing a programs, numerous master classes and Zealand and Australia are invited to We particularly encourage Trainees from Royal Australasian would allow delegates to access College of Surgeons presentation of interest, listening several workshops. attend the GSA Trainees’ Day. The all specialties to attend the Trainee-specific information wirelessly on to the questions posed and The theme of the conference is program aims to provide Trainees with session, ‘Surviving and thriving through Android and Apple devices such answers given is very, very ‘Sustainable Surgery’; plenary sessions an overview of Surgical Oncology and surgical training’. We will hear from as iPads and iPhones. powerful and professionally will examine sustainable technology, will include interactive scenarios, case Fellows and Trainees who have overcome He said the new initiative enriching. training, research and a sustainable role presentations and panel discussions. a range of challenges, such as failing exams would mean that attendees Additionally the ASC is also “All our work behind the for the College. Trainees attending the Registration is via the GSA website, or combining training with parenthood, to could walk around the allowing delegates to post any scenes has been designed to Congress will hear from world-leading generalsurgeons.com.au. thrive in their surgical careers. Their stories Conference Centre, look at a questions they may have during a enhance that experience by surgeons and extraordinary individuals The scientific programs run from and advice will reassure and inspire all of schedule of events, select those making it easier to select the including Sir Peter Gluckman, Chief Tuesday to Friday. Each day starts with us as we face trials and tribulations during they wished to attend and tap presentation/session, via Twitter presentations of interest, easier Science Advisor to the NZ Prime Minister, several master classes, 28 in total. Master surgical training. upon the screen to establish a to get there, easier to retain the and Sir Ray Avery, inventor, social classes allow particular focus to be placed No Trainee will experience all that the calendar, listing rooms, times “In the past, people attending the ASC information and easier to engage entrepreneur and philanthropist. on a well-defined topic, be that an area of ASC has to offer without attending the and session duration. had to run around and check the details with presenters.” Monday, the first day of the conference, technical expertise, academic know-how Younger Fellows and Trainees Dinner, Mr Thorsland, who helped design the of any presentation or session they wished Mr Thorsland stressed, however, that kicks off with a number of workshops or clinical decision-making. Trainees are being held on Tuesday evening. This year Virtual Congress of the ASC in 2007, said to attend which required time and effort a printed version of the program would and concludes with the Convocation strongly encouraged to attend master the dinner is generously supported by that with more than 2000 delegates, 1000 and if there was a late change there was still be available with all information and Welcome Reception. There are classes pertinent to their interests and sponsorship from MDA National and individual audio-visual presentations in little to no ability to advise everyone,” Mr including session times and locations two workshops of particular interest their specialty; registration is required via Baxter. The evening will feature brilliant up to 20 concurrent sessions over five Thorsland said. provided throughout the conference to Trainees: ‘Developing an Academic the ASC website. food, great wine and a truly extraordinary days, the College’s ASC was one of the “The program we have developed, centre. Career’ course (DCAS) and the General The Trainee program also runs live act; tickets are strictly limited, so do most logistically challenging events held however, lets delegates know where they “We have no wish to disenfranchise Surgery Association (GSA) Trainees’ Day. from Tuesday to Friday and, through book early. anywhere in the world. need to be, when they need to be there any Fellow or delegate who does not use DCAS has been collaboratively collaboration with numerous other We look forward to welcoming you to Therefore, he said, the challenge was to and will automatically update them when mobile technology; we just wish to make developed by the Association of Academic sections, aims to highlight some of the Auckland and to New Zealand. make navigation of the event as easy as connected to the internet if there are any it easier for those who do,” he said. Surgeons and the College Section of best of what is on offer for Trainees. We Deborah Wright possible for delegates, presenters and visitors. changes to the program. With Karen Murphy Academic Surgery and is an opportunity highlight master classes and sessions of RACSTA Convenor

Page 12 / Surgical News April 2013 Surgical News April 2013 / Page 13 Surgical Services Professional Standards

Case Note Review Delay To surgery Continuing resulted In colonic perforation and death Professional patient underwent a Acolonoscopy for a presumed colo-vesical fistula, but the scope Development could not transverse a ‘tight rectosigmoid junction’. A couple Making it easier to log your CPD of days later a gastrograffin enema revealed a complete obstruction at the upper ll Fellows will have received a copy of the 2013 sigmoid colon through which no Continuing Professional Development (CPD) gastrograffin passed. AGuide outlining changes to the program. The program is now simpler and streamlined, with better The patient was discharged with Figure 1 an elective operation being defined types of practice, fewer categories and greater booked for more than two opportunities for online recording and verification. weeks later. Prior to this date the New to 2013 is the category ‘Performance Review’ patient presented with an acute which includes a variety of self-directed learning abdomen and at laparotomy options and the option of accruing CPD points through (undertaken by another surgeon), participation in a multi-source feedback review. the transverse colon was found To support these changes, a new CPD diary is now Poison’d Chalice to have perforated secondary to available for Fellows to enter their 2013 activities and an obstructing sigmoid cancer. can be accessed by logging into the College website. “A stage where every man must play a part” A sub-total colectomy and end To access the diary, please log in to the website and (Merchant of Venice, Act 1, Scene 1) ileostomy was undertaken. click on ‘My CPD Program’ (see Image 1). On this Over the next week the patient page you can access both the 2012 CPD diary (until Figure 2 s Director of Surgery, one is doctor too.” Very morbid, I thought. improved in ICU, but then 30 June) and the new 2013 diary. There is also a link slowly persuaded that the part I far preferred the more biblical developed a pleural effusion to the new CPD 2013 Guide which outlines the core one plays can be a mighty one, reference (Luke 4:23) on this occasion that was resistant to catheter changes to the program. A drainage. The first three tubes did that only Kryptonite can really produce of “Physician, heal yourself…” So I On entering the diary you will see your profile not drain the effusion adequately substantial damage, bring one to one’s swallowed more Panadol and battled on. page where you can adjust your practice type (see and during insertion of the fourth knees (so to speak). Can you meet with I eventually succumbed to the Image 2). Click on the CPD tab to see an overview catheter the patient had a the CEO tomorrow... Sure. Director domestic pressure and the heavy of your CPD requirements (based on your practice cardiac arrest and could not be General of the Health Department sighs of my work colleagues who were type) and your progress to date (see Image 3). To view resuscitated. the day after… Not a problem. Chief convinced that I was contaminating individual activities or to add/update your activities Medical Officer… Always available…his their ecosystems… (so they intimated). Comment: click on the My Activities tab. Here you can enter capital city or mine? Maybe I was unwell as I was urgently This patient had a complete individual or recurring activities and add evidence of It is not that my ego was always admitted to hospital for diagnostic obstruction to gastrograffin, which participation (optional) (See Image 4). In 2013 your getting in the way. My children (still tests… the pain in my chest may not will normally get through a pin diary will be automatically updated if you participate living at home) always deflated that and just be strained costochondral joints hole. It seems difficult to defend in a RACS course or if you attend the College ASC. Figure 3 my beloved wife always made sure that from all that coughing. a delay of nearly three weeks to If you have any difficulty adding activities, the ‘Help’ the rubbish bin night was an essential It was the cardiologist who reminded elective surgery. This resulted in tab on your CPD Overview has a user information part of my week. However, Directors of me that the famous Scottish Surgeon the patient having an emergency manual or you can call the Professional Standards Surgery are in demand and as surgeons, John Hunter was known to suffer from operation for a perforated colon office on +61 3 9249 1282 who will be happy to assist. well you know the saying about angina pectoris and frequently stated (CR-POSSUM predicted mortality We would appreciate your feedback regarding the surgeons and opinions… that his life was “in the hands of any >61%) versus an elective operation system and suggested improvements, please contact It started as an innocuous cold – or rascal who chooses to annoy and tease (CR-POSSUM predicted mortality Shirley at [email protected] or on +61 3 9249 that is what I thought it was. Some me”. When he died in 1793, it was just 9%). The patient should have had 1282. If you do not have a username/password or unkind people said it may be man- after an acrimonious board meeting at an urgent operation during the cannot access the website, please contact the IT Help flu and gave me prognostications of his hospital! initial admission. Desk at ([email protected]). Guy Maddern ‘near-death’. I hoped that no-one would Now I waited, having gone from the Chair, ANZASM get what I had – they would surely Director of Surgery, the Master of my succumb. own Universe, to waiting for further This can be found as a blog discussion on One of my Registrars, knowing my tests and procedures… I was a pawn the website, go to : http://www.surgeons. org/my-page/racs-knowledge/blogs/all- penchant for Shakespeare, quoted to their diaries… I wondered who they blogs/anzasm-case-note-reviews/2013/ Graeme Campbell Cymbeline: “by medicine life may may be meeting… anzasm-case-note-review-april-2013/ Chair, Professional Standards be prolonged, yet death will seize the Professor U.R. Kidding Committee Figure 4

Page 14 / Surgical News April 2013 Surgical News April 2013 / Page 15 UCK -A L A Indigenous Health C N "

S D A UCK -A L A C 2013 N

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D A 2013

This to me represents a great opportunity for the College to actively“ work to attract them into surgery so we can develop a meaningful Indigenous surgical workforce in both countries.”

Yet, in Australia there is only one specialist surgeon “This to me represents a great opportunity for the of Aboriginal descent while there are six in New College to actively work to attract them into surgery Zealand; three general surgeons, one plastic surgeon so we can develop a meaningful Indigenous surgical and two orthopaedic surgeons. workforce in both countries. Professor Koea found that the increasing numbers “In recent years, medical schools have developed of Indigenous medical graduates reflected the success the philosophy that the medical community should of medical schools in both countries in actively reflect the general community and given the disparity encouraging, supporting and assisting students in health outcomes in both countries, it seems only throughout their studies. reasonable that we should have a broad commitment “All medical schools have utilised elements of a to developing an Indigenous surgical and medical pipeline approach encompassing contact with students workforce to help address that and improve at secondary school level to encourage aspirational Indigenous health indices.” goals and assisting with suitable subject selection,” Professor Koea said that research now showed he wrote. that mentoring was the key to improving workforce “Bridging courses have been implemented to numbers with graduates being actively encouraged to ensure students leaving school have appropriate skill pursue a surgical career and with that support offered sets before entering degree courses and extensive throughout training. practical help and assistance is available during Indigenous undergraduate study. College support essential “However, by and large, the pipeline has ended at A mentor to three Maori general surgery Trainees, he medical school graduation, but the increasing numbers applauded the College for establishing the Indigenous Health at of Indigenous graduates now represent an opportunity Health Committee and said the College could make to continue the pipeline into postgraduate training, a significant contribution to improving the health faculty appointment and specialist career success.” status of Indigenous peoples in Australia and New the ASC Zealand by teaching and training a new generation of Helping to succeed Indigenous surgeons. Professor Koea said research conducted overseas “Mentoring is crucial because these students not suggested that the keys to increasing the number only have to be the best they can possibly be, they also of Indigenous specialists included mentoring and need to stay culturally competent because when they coaching, identifying suitable candidates, providing finish their training they will be expected to be experts The Auckland ASC will feature the inaugural Indigenous Health Forum a supportive environment and a government in all things Maori and Aboriginal,” Professor and collegial commitment to helping Indigenous Koea said. he steady increase in the number of Maori He said both countries now faced a critical period in candidates succeed. “I think the College has a role to play in both and Aboriginal and Torres Strait Islander the development of an Indigenous medical workforce He said the main issues confronting Indigenous countries in encouraging more of these graduates to Tmedical graduates in both New Zealand and with research indicating that more Indigenous medical students had changed over time. become surgeons and in the process make a significant Australia represents a chance for the College to improve graduates could choose surgery if they were assisted in “Twenty years ago in New Zealand and even contribution to the health of Indigenous people.” indigenous health indices by actively encouraging the careful selection of their clinical focus, offered men- in Australia now, the central problem was getting Professor Koea and Professor Pat Alley from more of those graduates to pursue a career in surgery, toring and support and through a collegial commitment Indigenous kids to stay in school long enough to do North Shore Hospital have organised a 90-minute according to Associate Professor Jonathan Koea. to their success. well enough to get into university courses. symposium on Maori and Aboriginal history and the A member of both the College’s Indigenous Health In research conducted last year, Professor Koea “But now, particularly in New Zealand, we are seeing future of Indigenous medicine and health to be held Committee (IHC) and the Maori Medical Practitioners reported that Australia now has 160 qualified medical more Maori and Pacific Islander students coming from during the forthcoming Annual Scientific Congress in Association, Professor Koea is a general surgeon with practitioners of Aboriginal or Torres Strait Islander more aspirational homes and staying in school which Auckland. Speakers include New Zealander of the Year has led to a spike in the number of medical graduates, Dame Anne Salmond and Sir Mason Durie from New Mr Wil Harrison a special interest in liver, pancreatic and hepatobiliary descent (0.2 per cent of the total medical workforce) talks with Karen disease who works out of the North Shore Hospital while in New Zealand there are 401 qualified Maori some coming through affirmative entry programs and Zealand. Australia will be represented by Mr Ollapallil Murphy about the in Auckland. medical practitioners (2.8 per cent of the workforce). some making it through on their own,” he said. Jacob and Associate Professor Shaun Ewen. Maori experience u

Page 16 / Surgical News April 2013 Surgical News April 2013 / Page 17 Indigenous Health Surgeon Health

diabetes. It should probably be avoided in patients with chronic renal failure. Other natural remedies for the menopause include soy isoflavones, black cohosh and red clover. These have been well tolerated in clinical trials, but without convincing evidence of being efficacious. Other agents that The Maori experience have been used to alleviate hot flashes include belladonna/ergotamine tartrate/ phenobarbital combination, dong quai, r Wil Harrison is an interventional medicine, is very competitive, evening primrose oil, ginseng, and cardiologist at Middlemore Hospital in demanding long work hours, vitamin E. Unfortunately the evidence is UCK Auckland and has been the Deputy Chair and many of us have to make -A L not strong for their effectiveness though A C D N

of the Maori Medical Practitioners Association – sacrifices to lifestyle and family in order to they are safe. Most trials have been S D

known as Te ORA – since 2011. During his tenure develop a career in these disciplines. A Wild Yam is it a scam? conducted in patients with breast cancer, he has worked closely with the College Indigenous There are also only a handful of Maori SMO’s 2013 Wild yam versus today’s treatments understandably as normal women might Health Committee (IHC) to develop a clinically and in these positions to be role models or mentors to simply settle for HRT, depending on their culturally competent Maori medical workforce to both provide support to aspiring surgeons and physicians. assessment of their risk of breast cancer improve the care of Maori patients and to highlight Day to day hospital work can also be devoid of things or venous thrombosis. the specific issues confronting the Maori population Maori making it easy for some to feel like a ‘cog in the There have been trials that have in the public health arena. He talks to Surgical News. machine’ rather than a unique Maori doctor. considerable number of my merely some form of naturopathic scam? supported the use of serotonin reuptake patients sleep poorly, feel Yes she could even have sung: inhibitors, but then one would want to What is the link between Te ORA and the College? Why is it important to have more Maori A chronically tired and every night look very closely at all the other potential We collaborate with other like-minded organisations surgeons and specialists? experience the torture of lying in bed “I’m flashing, just flashing effects of messing around with one’s such as the College through the IHC to promote Maori specialists can be prominent advocates awake, tossing and turning, their mind And the glow is not my jewels, serotonin or other neurostransmitter and expand a Maori medical workforce. As such (clinically and politically) for their discipline in unable to rest. Recently I was consulted I didn’t know The Change could be so cruel.” pathways. I wouldn’t be comfortable we strongly support initiatives that could produce relation to Maori health. We can also offer cultural by a menopausal female, Dr H Flashing, tinkering with those. more Maori surgeons and we also strongly support insights into ways that systems and treatments who was suffering the full force of ‘The Wild yam contains diosgenin, dioscin, I stared at Dr H Flashing over the rims international efforts to increase the number of can be improved while taking cultural needs into Change’ despite being a normally calm phytosterols, and other phytoestrogens. It of my spectacles. I felt myself start to Indigenous medical and surgical graduates. Our consideration. Having a Maori specialist delivering individual. She was frustrated, forgetful can be given orally or as a cream. It was flush; suddenly I was awfully hot, and I graduates often go on to become prominent advocates care to a Maori patient is also a unique thing. Many and flushed, at her wits’ end, desperate used for pain relief including menstrual was stopped gasping in my tracks, mid- for Maori and Indigenous health which we believe Maori patients are scared, apprehensive and isolated for a good night’s sleep; and from her cramps by the Aztecs and Mayans, and sentence. What was I saying? Where were is crucial. when attending specialist services, particularly account her family were ducking for later termed ‘colic root’ as a result of its we? Then I remembered! I momentarily when there are serious and complicated medical cover trying to avoid her irritability and use, particularly in the 18th and 19th composed myself, advised that the day How many Maori surgeons are there now in NZ? issues involved. I think most Maori specialists will unpredictability. Had she been a singer or centuries, for gastrointestinal upset. of the yam was probably 1000 years ago We are proud to have six Maori surgical colleagues. go the extra mile for their Maori patients, not by a poet, she might well have paraphrased It was only recently that it earned an and that its true role in 2013 is now as a delivering different treatment, but by communicating her problem with lyrics from Jeanie undeserved reputation for treatment of substrate in laboratories manufacturing How many Maori are going through clearly, involving the extended family, informing and Linders’ ‘Menopause the Musical’: menopausal symptoms largely because steroids. The world did not end on medical school now? empowering. it was used in the 1950s and 60s to 21st December 2012, the Mayans built There were 233 Maori medical students in 2012 across “I’m just so tired of not sleeping, synthesise progesterone from diosogenin, amazing temples, but they didn’t get the two medical schools in New Zealand, a fantastic What are the main health issues confronting At first I was afraid I was petrified, a plant based oestrogen or phyto- everything right. number of which we are very proud. the Maori population? Staring at the ceiling with eyes open wide, oestrogen present in the yam root. It Progesterone might help, but although In adult medicine there are a number of important Night sweats, Night sweats… can also be used to synthesise cortisone, it can be synthesised in a lab from yam What is Te ORA doing to encourage more Maori health issues. These include cardiovascular Spending time just soaking, and pregnenolone. However, it does not root, unfortunately for yam enthusiasts it doctors and students into surgery? disease, heart disease, cancer, smoking-related Good God you must be joking, actually contain progesterone despite its cannot be converted by the human body. Te ORA currently runs a senior medical student/ diseases, Type 2 diabetes and its complications, If only I could rehydrate use in synthesis. There is no Day of the Yam on the junior doctor mentoring scheme called Te Whatu with obesity and obstructive sleep apnoae. Palliative care Night sweats, Night sweats…” A placebo controlled trial of wild yam horizon. It may not do you much harm, the aim of fostering support and interest in pursuing is also a culturally important area that has often not cream for the control of menopausal but evidence is lacking that it will obtund specialist careers. Our annual meeting, or Hui-a-Tau, been given a lot of attention. What she came to ask me is what symptoms found it was free of side- the menopause. I think Dr Flashing agreed also has a popular careers session where students can could I give her that would spare her effects, but offered no more improvement with me. There is only one problem with meet surgeons and other specialists to discuss and How many Maori surgeons would Te ORA like the symptoms, the unpleasantness, than placebo. Another study testing its this conclusion. Some patients claim their explore career development. to see in the near future? but without resorting to hormone toxicity and safety in animals showed symptoms are so much better taking As many as possible! It would be great to have replacement therapy (HRT), which she that although the pure extract could wild yam that for those of you suffering What are the particular problems or barriers that representation among a diverse range of surgical was averse to because of a family history be an irritant, diluted extract was safe, the same it might be worth a try. Phyto- confront Maori pursuing a surgical career? specialties. Personally, I would love to see a Maori of breast cancer and a DVT after a flight certainly in rats and rabbits, but also oestrogens have many other potential Hospital practice can appear intimidating to Maori cardiothoracic surgeon. when she was 30. But what she actually as administered in creams for humans. benefits, but that is another story though students and junior doctors. Surgery, like internal With Karen Murphy asked was whether she should try wild Wild yam would be of uncertain safety one that is certainly not a scam! yam, or is wild yam as many suggest in pregnancy, children or patients with Dr BB G-Loved

Page 18 / Surgical News April 2013 Surgical News April 2013 / Page 19 Library Report Letter to the Editor

All surgical specialties are served by the Clinical summer

Key product. Current issues of The Lancet will Image 1 Image 1: image of eclipse between 10 and 6 o’clock be available to Fellows and Trainees for the first Image 2: eclipse Lifestyle between 9 and 5 o’clock Image 3: The full New Library resources image of the sun and time. New resources and editions will continue the solar flare. It is almost the same as the eclipse illustration in Wikipedia of For all specialties to be added to Clinical Key over the year. This is Image 2 Eddington’s 1919 image from Africa which was claimed to confirm Einstein’s Elsevier’s premium product and they want it to be theory of General Relativity. As Stephen Hawking tells us, gravity is the mainspring of the as compelling as possible. universe in the equation of space and time. It can bend light waves and it was concluded that this bending of Image 3 light waves apparently confirmed the theory. I just happened to be a century behind these master minds withsummer Comprehensive access my own observational In 2013, Library users will be able to access the findings. Borodin’s work ‘On the Steppes of Central Asia’ – the

Lifestyle English title for this symphonic poem of the 1880s – Peter conveys the impression of someone constantly on the move, mentally and physically, from the Asia I have to make a declaration (not in the style of entire Clinical Key product, across all areas of Pacific and beyond. Oscar Wilde, who when asked by New York customs He gave me a copy of his latest book called ‘Sentinel in the 1890s: “had he anything to declare?” replied, Chickens – what birds tell us about our health and the “Nothing but my genius”). world’. It recounts the importance of ou My declaration here is that I paid for this camera tracing them from Patten’s original 1920s and as I had to say before my recent presentations medicine and surgery. This will allow users to on embryology of the chick, through to MacFarlene-r avian friends, overseas (in Paris in October and London in Surgical Silhouettes Burnett’s egg inoculation technique, to the textbook importance December 2012), all my Powerpoint presentations were of sentinel chickens left in the countryside to mon done with the aid of this Casio. There is no conflict of the likes of arboviruses and mosquito inoculations interest. The Eclipse - An alternative focus on excisional defects and the Avian flu (H2N2 virus). become familiar with the way the product has itor However, I must mention a little historical pearl It is a bedtime storybook, full of pearls of wisdom about the digital camera story – Kodak of America and scientific facts from the helix on – pre and post developed this technology in 1977. The Chairman n the morning of the recent solar eclipse of Government House in the area now occupied –by reflecting the wonderful world of experience of of the board at the time made the comment at that (14 November 2012) – I had an interesting Melbourne Zoo at Royal Park. Developers scentedsomeone who bestrides the scientific world stage meeting that “nothing would replace film”. How wrong like a colossus, yet never losing the ‘common touch’, been designed and allow users to access all areas of experience in Parkville, without having to potential profit and bought up land in the vicinity. he was. Kodak now is holding onto financial survival O reflecting, I think, his unpretentious by its fingernails, trying to avoid bankruptcy – and fly to Cairns to see this celestial event. As a result the government changed its mind andhas theproduced his success. yet it was one of the original stocks on the Dow 100 It should not be forgotten that on any workday location, placing the site in the vicinity of the BotanicalAt 7.30 on that November morning, personality Laura Dean, which in the 1900’s. Mark said it shows what happens when morning, there are many personalities whom I meet, Gardens along St Kilda Road. lecturer in the Department of Pharmacy Studies saw the board and scientists fail to communicate. Do not interest without limitation. At the end of the year, me fumbling with an X-ray film to create a filter f forget all NASA photographs are digital. walking up and down Royal Parade from the various I learnt this interesting detail years ago fromthe damagingthe solar rays (which can cause blindness),a departments of the University of Melbourne, the then chairman of ICI in London, who had relationsin order to visualise the eclipse. Barbera Howlett from Worth a good story the Department of Botany (University of Melbourne)or Walter & Eliza Hall Institute and even the Monash in Australia. He used to visit them regularly, as well Let me finish off with a piece of science from Aldous suggested I might make a career change. University School of Pharmacy. as my wife and myself. Needless to say, he had been Huxley, who said that in any scientific environment, the Library will have meaningful usage statistics in The image was unsatisfactory as one could see the the fact we do not know its presence does not preclude This contingent of academia (who can offer an an oncological patient of mine (and Ian Wilson’s)skeletal details at on the single X-ray film. She suggested I its existence. opinion about anything or everything) – are the the Marsden in the 1970s and he was gratefuluse double for his X-rays to filter the light, and this proved to be the solution to the problem (one should always ac Most of my astronomical contacts said that the people I meet regularly. Yes, we exchange pleasantries. surgical outcome. eclipse could not possibly be visible so far south. I am the advice of a lady). This resulted in a photographic not even an amateur astronomer – I was just lucky. order to inform decisions on this offering for 2014. They are part of the passing parade of this Another frequent passerby is my colleague,series in Peter a time-dated sequence of the eclipse. cept Osler’s statement about obser magnificent boulevard. Doherty, whom I see regularly. On this occasionImage 1 showshe the shadow of the moon creating an all, that all scientific advancement originates from elliptical defect between the clock-face positions of Why was it called Royal Parade? The name was had just returned from his umpteenth trip to the halls incidental findings. vation encompasses it and 7 o’clock. Image 2 is 15 minutes later showing this u 15 given in the 1870s in anticipation of the future location of academia, lecturing all over the world.ellipse As had with moved through to the 10-6 o’clock position This principle was reinforced recently again when I read in The Age the obituary of Nobel Laureate and then another quarter of an hour later between 9-5 11 Mme Levi-Montalcini (aged 103). She showed that o’clock. On the hour (Image 3), I took the final shot when tumour cells from mice were transplanted to a when the eclipse had finished. This pin-head disc of MUNCHAUSENchicken embryo, this induced rapid tumour growth; white intensity on the X-ray plate was the point of SYNDROMEa simple observational finding for which she received photographic focus and I did not realise its significance. the Nobel prize for the Nerve Growth Factor in 1986 in Additional new specialty journals On viewing it through the viewfinder and conjunction with Professor Cohen and his Epidermal magnifying the image with the camera by a factor of K Growth Factor. It’s interesting in my own clinical 12, I was amazed by what I saw. Mark Hinds,Y a research sphere that the Keystone Flaps are all designed within biophysicist from the Walter & Eliza just happenedM to neurodermatomal precincts. come along and I shared this observational findingC with In addition to the wealth of Clinical Key resources, Finally, let me state philosophically that an eclipse him. His scientific response was quite simple – “I think is a metaphor for a wipe-out. I sometimes find it hard you may have photographed the craters and solar flares to be a little self-effacing in these stories, but the ideas from the sun’s surface.” – from a distance of 150,000km. Plate: spring to mind and they become theFactitious genesis of a story. As disorders What a few Yet, I was not using a heavy-duty Bronica, Hemingway repeatedly said: “Any story based on truth is Hasselblad, Canon or Nikon camera (the Rolls-Royces the Library has recently added the following new a good story and worth Musingsprinting”. about Munchausen Syndrome, are there three types? of the international photographic brigade). I was using my 12 MP Casio Exilim camera, the size of a cigarette packet. I have it in my pocket constantly whenever I use it for clinical or social shots. It produces image 16 titles, based on requests from Library users – “000”s have quality suitable for textbook publication or lecture presentations. I regard it as my “Colt 45”, ready to hand.

-2009

Opus XXIV later that evening discharged herself. This clin- Clinical Teacher OPXIII Felix Behan done to my Felix Behan Victorian Fellow ical history stimulated me to recount the story Victorian Fellow of some of my other Munchausen experiences over the last three and a half decades, and three As we know musing is gazing meditatively and refl cases in particular spring to mind – I wonder ectively in a literary context. This led HPB n a recent theatre list I had an inter- if this is the statistical average (one every ten me to ponder the Munchausen syndrome. esting clinical exper Whether by proxy or direct involvement Date: 27-SEP years and I would welcome other comments). thinking! Omy age. In the Anaestheticience evenroom ata in the public or the private sectors, this The second case makes an interesting patient was awaiting surgery. My registrar was psychiatric disorder is classifi not there with me to present the details on his narrative, in the 1980’s. In those days the medi- cal administrator allowed us to transfer insur- tious sequence of c line of management. He had mentioned before- ed as a facti- Journal of Hepatology ance patients to the private domain. Over a two feigned or self-infl linical epi hand that this lady had presented for removal this eponym arose: icted-. Richard It Asheris interestingsodes in -1951 fancied, how was of something off her leg. month period a general surgeon and I operated on this young man a number of times. He had the fi rst to describe such self-harm, recall- When I addressed the patient in this ing Baron Munchausen in an article in the context, my question was “now what am I sustained abdominal injuries in a motor vehi- cle accident, a perfectly credible story until I Lancet. He mentioned how the Baron had a Journal of Surgical Oncology removing today?” She said “I have a scar on the list of fantastic stories, beyond belief, refl later questioned t n the January/February 2013 edition of Surgical News,leg at a skin graft sitemy and I was told you could ing daring exploits, quite unbelievable. In his possibly fi abdominal wall scarshe – anothermultitudi wa x it”. Previous attempts at serial scar nous mature obituary in the British Medical Journal, it was revision had been unsucce ect- rning sign. mentioned how Asher respectfully dedicated I have successfully closed similar defects in ssful. People “As one of my mentors and laterthis syndrome colleagues to the Baron said Microsurgery melanoma patients with the usual keystone knew astronomical accuracy was rightly called into question.technique. I oftenyears ago “Plastic surgeons are sometimes described Like any experienced surgeon, I exposed as psychiatrists with knives” – but not always.” the whole lower limb to examine it and found, Neurourology and Urodynamics to my horror, she had a donor site dressing on Page: 40 her upper thigh. On further questioning, it Three days before discharge he asked a dictate these notes with Margaret (dare I be called a dictator?)young nurseand for $15 so that his clothes could transpired, this had been there for six months. I then glanced at her notes on the anaesthetic be dry-cleaned. I asked the young lady some The Baron served in the Russian mili- bench. There were fi months later whether she had ever received her tary forces against the Ottoman Empire and Shoulder and Elbow I inches thick – “a warning ve volumes, sign”. Ateach this about stage fi the money. She was never paid. acquired a reputation for witty and exagger- alarm bells were ringing and I asked her “why Some years later, I was doing Monday if detail is necessary I resort to the Internet for cursory verification ve of ated tales and became the subject of numerous have you been in hospital so often?” suspect- morning rounds when I encountered the texts published in 1862 by Gustav Doré, from ing some major c same individual, recently admitted again balloon fl rotic syndrome. linicalShe gave catastrophe a history likeof repeatneph- with abdominal trauma. Needless to say he ights, to taming wolves to shooting fl ocks of ducks and being mauled by bears (en. overdose needing ICU admission. It transpired signed himself out within the hour when I linical Key is a comprehensive wikipedia.org). information for the purposes of grammatical, historicalshe was seen in ouror unit six monthsscientific earlier and confronted him. However the idea occurred to me that it was found that she has been putting oven A further story relates to a nursing aide this recollection had a similar ring to cleaner on the skin graft donor site. who burnt her fi trar in the Emergency nger on Departmenta steriliser. The referred regis- particular person who also wrote about I took her into theatre and manually debri- fi ctional and fanciful adventures. He anotherwas far integrated product which includes ded the wound under general anaesthesia and her to me for grafting (which failed), which Library redesign accuracy. more readable and he became the second most dressed it with the usual donor site techniques, was repeated and failed a second time before Pub: CMC TOTS translated author of all time, (second only to reinforced with soft topical non-removable doing a cross fi nger fl Agatha Christie). Having written Journey to dressings, and signed it “not to be removed fi nger years later resulted ap. in Thea ray resultant amputation stiff the Centre of the Earth in 1864, then 20,000 without my permission”. I heard that she had of the middle fi hundreds of journals, e-books, The Library web site is being redesigned to provide On this particular occasion, following my usual rule, the referenceI discovered when nger, she bycame another back specialist,to me for asa Leagues Under the Sea in 1869, and Around the SURGICAL NEWS P40 / Vol:1 medico legal report seeking compensation for World in 80 days in 1873 – none other than the great Jules Gabriel Verne (1828-1905) 0 No:8 September 2009 this work related injury. C He lived along the Loire Valley. At the a better grouping of resources and multiple access school of St Donation College, one of his image libraries, practice guidelines, clinical I obtained of the distance from the Sun to the Earth – did I misread tutors in drawing and mathematics was possi- trials and operative surgery videos from points to Clinical Key. The Library pages will be it? – came out at 150,000km. The reference I quoted was missing three Elsevier. Clinical Key offers fast reliable organised in a way that is as intuitive and user “000”s. The actual average distance is 150,000,000km from the Sun to response to clinical information queries, friendly as possible. We have been looking forward the Earth (Ref: Wikipedia, Earth’s Orbit). similar to the Up-to-Date product, and is to offering these improvements to our Fellows This led me to ask the significance of three “000”s in scientific based on broader knowledge database than and Trainees for a long time, and are now proud language and I could feel another story coming along. We are fully any other similar product currently available. to present a new Library interface along with a aware that in Babylonian cuneiform script (orthopaedic surgeons Library staff members have been reviewing fantastic collection of new resources. note) it was an important part of historical communication. Clinical Key for the past three months and we The 0 symbol in mathematics was introduced in part from the are confident that it represents an outstanding Indian subcontinent in the 7th-8th century, where they separated the scope of relevant information resources for symbol and the numeral zero by the 9th century, then adopted by Fellows and Trainees. Clinical Key offers a range of products for Trainees, Muslim scholars. Neurosurgery Trainees will appreciate the many of which are available for the first time. These The Indian scholar Pingala and his colleagues earlier in the 2nd include the following core curriculum texts: Cathy Ferguson availability of Youmans Neurological Surgery Chair, Fellowship century BC had used the Sanskrit word sanya to refer to zero or (latest edition, 4 volume set) included with a – Grey’s Anatomy for Students Services Committee the void. Decimal-based reckoning followed shortly thereafter. This comprehensive package of e-books, journals and – Netter’s Atlas of Human Anatomy led me to explore the history of the zero in mathematics, all as a operative videos. – The Developing Human by Keith L. Moore } consequence of my initial error. As so often happens, the word zero The Plastic Surgery package includes 20 e-books, 4 – Epidemiology by Leon Gordis comes from the French le zéro and the first English use is noted in Your feedback on any aspect of journals and 13 operative surgery videos. – Thompson & Thompson Genetics in Medicine 1598 (OED). Clinical Key and the Library redesign Operative surgery videos have often been requested – Wheater’s Functional Histology: A Text and Colour Atlas In conclusion one of my surgical registrars, Andrew Sanderson, by users of the Library, and this was highlighted in last – McMinn’s Clinical Atlas of Human Anatomy is welcome. If you have any questions offered me a witticism “attributed” to Lincoln (pertinent to the year’s customer satisfaction survey. Clinical Key offers – Medical Microbiology by Murray, Rosenthal and Pfaller or would like assistance please don’t current Lincoln –Spielberg production): “do not believe all the quotes high quality videos ranging from basic to complex – Rang & Dale’s Pharmacology hesitate to contact the Library at on the internet” - Lincoln 1852. surgery, across all specialties, with a higher number – Cellular and Molecular Immunology [email protected] or by Felix Behan available in the larger specialties. – Principles of Medical Biochemistry by Meisenberg and Simmons phone +61 3 9249 1271. Victorian Fellow

Page 2420 / Surgical News April 2013 Surgical News April 2013 / Page 21 International Development

Colin Brown looking into a child’s ear Success in Timor Leste Programs improve the health of the Timorese population with the College's help

ive ENT surgical visits to Timor Julie holding a baby with aphrasia Leste in 2012 under the Australia FTimor Leste Program of Assistance for Secondary Services (ATLASS II) and the Rotary Club of Balwyn Ear Care Project saw more than 94 patients in Dili and Baucau receive vital surgery to restore hearing, treat chronic infections and remove obstructions. More than 900 patients presented for examinations, demonstrating the concrete need for visiting ENT surgical teams. ATLASS II is funded by AusAID in partnership with the Government of Timor-Leste as part of its support to improving the health of communities in Timor-Leste. Teams of long-serving volunteers as well as a couple of first-timers made up the volunteers who participated in the ENT surgical visits in 2012. Sydney surgeon Mr John Curotta delivered “After his visit it was clear that there “This patient had been seen in a two visits to Dili in April and October; was a considerable backlog of surgical regional health clinic and sent down to NZ based surgeon Mr Colin Brown ENT patients in Baucau and I was asked us in Baucau, but even then it took the visited Baucau in May for the first time; to help,” Mr Dobson said. family almost two days to arrive.” Mr Michael Dobson, a surgeon from “This meant that our visit was very well Mr Dobson said he first went to Timor Melbourne, made his fifth trip in July organised because all the patients had Leste in 2002 and had made a number to treat the children of Baucau; and already been triaged and determined to of trips in the years following until health Mr Malcolm Baxter, a surgeon also need surgery and all had been contacted authorities decided they had sufficient ENT from Melbourne, also delivered a visit directly to attend the clinic or hospital resources from the Cuban-trained specialists. to Baucau in early December. Each of which made for the efficient use of the However, he said that in 2010 visits the trips resulted in a large number of time available. resumed when it became apparent that the patients being screened and treated. “In addition to performing the theatre need for ENT surgery remained significant, Working alongside anaesthetist Dr cases, a number of clinics were also held particularly in areas outside Dili. Mark Adams and theatre nurse Mrs Katie and from that a young child with a fistula Indeed, according to a recent report Nordhausen over the seven days, Mr and active infection received a timely which screened children aged five to 14 at Dobson performed 14 operations to treat mastoidectomy. two primary schools in Baucau, up to 18.3 perforated ear drums, Suppurative Otitis “This patient presented on the per cent suffered some form of hearing loss. Media and cholesteatomas as well as Wednesday and received surgery on the The authors of the report, Ms Tess performing a life-saving mastoidectomy. Thursday to treat the fistula because such Bright, Audiologist, and Ms Julie Souness, Mr Dobson said the trip in July cases are urgent given that some patients Primary Ear Care Nurse based in Baucau, followed an earlier visit to Baucau in May can develop meningitis and die. said this translated to 2262 children within by surgeon Mr Colin Brown who had “Complications associated with ear disease the tested age group who potentially screened over 300 patients and undertook still cause deaths in Timor Leste, particularly needed medical/ENT management in the 26 surgeries. for people in the more remote areas. Baucau sub-district alone. u

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In their report, written in June 2012, they also suggested that Michael Dobson the number could even be an under-estimate because children using portable with significant hearing loss may have already been taken out of suction machine inset: Colin Brown post op school and also because the screening was done in the dry season looking into a with ear infection rates likely to rise during the wet season. baby's ear “There is no local ENT surgeon in Baucau, but the need for such surgery keeps growing, particularly because the population of Timor Leste is so young,” Mr Dobson said. “That is what makes these visits feel so valuable and the 12page visit in July was particularly successful in terms of how it was organised and also the fact that selected patients had their ears lifestyle treated prior to our arrival so they were suitable for surgery. section “One of the real delights of this trip was to see the high skill levels of the locally-trained primary ear care nurse and the work undertaken by Julie Souness, in particular, was outstanding. “Her ability to speak Tetun meant that she could clearly communicate with patients, overcome cultural issues related to patient consent and get people where they needed to be to receive treatment. “We all understand that if the young people of Timor Leste receive timely treatment for hearing loss they stand a much better chance of going on to lead fulfilling, productive lives which is good for the entire country.”

Overcoming difficulties patient booked for surgery Mr John Curotta, who along with his team, during the Dili ENT visit was delivered two week-long visits to Dili in April given an arm band with name, age and October had somewhat more to contend and planned surgery written upon with. In a report on the trip in April, he said that it which was not to be removed until no screening had been done prior to the team’s arrival discharge. and that a TV ad which aired in the days before the visit had “This was adhered to very well, but not universally,” described the trip as Ear, Nose, Throat and Eyes. he wrote in his report. As a result, he said that along with the 400 patients seen “Also each patient was photographed with their planned over the first two days, 92 eye patients also presented who surgery on a placard in front of them, a virtual mug shot, and had to be referred to the regular eye clinic at the National stored on the anaesthetist’s laptop. Eye Centre in Dili. Mr Curotta’s team comprised Dr Jane “Language barriers were a significant impediment at all McDonald, anaesthetist, and Mrs Danielle Doughty, theatre stages of the visit and these two means of identification were nurse. Over the course of the April visit, they performed seven very helpful to ensure safe surgery.” myringoplasties, five mastoidectomies, three microsuction Mr Curotta said that he strongly recommended the and ear inspections, one removal of a foreign body, one provision of a dedicated interpreter for the duration of each marsupialisation of branchial cyst, one adenoidectomy and future mission, particularly to work in theatre to guide treatments for ear canal skin lesion and thyroglossal cyst. communication between visiting team members and local “The overwhelming number of patients presenting meant hospital staff. that the team worked from arrival to departure without a He said such an interpreter needed both good English break,” Mr Curotta wrote in his report. and Tetun skills as well as some familiarity with Portuguese, “Even so prioritisation was necessary for surgery with Spanish or Bahasa. Cycling through patients with bilateral ear perforations given the highest “Some final year medical students attended a few of the opera- priority followed by those with cholesteatoma.” tions we conducted which was most welcome,” he said. Mr Curotta said that in line with recommendations from “However, these were Cuban-trained junior doctors who post op previous visits to Baucau regarding identification of patient spoke fluent Spanish, some Tetun and some Portuguese, so appears and site of surgery – particularly in an environment where even our ability to train and up-skill local staff is hampered in Surgical people struggled with communication difficulties – every without sufficient translation services.” News The Tasmanian surgeon who loves to ride each season Page 24 / Surgical News April 2013 Europe autumn Lifestyle 3

With Karen Murphy Karen With “Riding like this is intellectually also riders do, rough it like some other don’t “I “This type means also of tourism cycling cycling for his enthusiasm great Despite working years two past he has spent the Yet he said. do miss it,” “I recover to a long time quite has taken “It riding, keep like to and I’d this year 72 “I’m “You also have no idea how far you’re likely you’re far how no idea have also “You challenging because you have to find your find to have challenging you because very easy and it’s using maps your way own book can’t so you day on any given get to to just have you in advance; accommodation a B&B upon a village with come you hope lightwhen the is in. closing and cooked shower I like a comfortable bed, been ridingdinner I’ve when I’m and so far to close came very and only lucky once outdoors. sleep to having an enormous variety meet of people to I get of different cyclists fellow to locals the from and climbers and bushwalkers to nationalities, of pilgrims band occasional the like I even met when riding Loire trip.” on the in France go unable has been to Mr Edwards holidays, after a back years three past the touring for him cancel to forcing injury surgery, required Iceland. trip to cycling a planned strength his regain core gym at the to hard Europe on another to back go to and hopes this year. later adventure cycling but the injury the from surgery, and the to strength from going vineyard has been me busy. keeps and that strength I really which but I think mountain rides, – at least back on my hard be too may love, now.” for to get lost and you have to be able to deal be able to to have lost and you get to with that.

“That was a great ride, but I think my ride, “That a great was 1800 cover to days 19 “That ride took Mr Edwards his interests, outside to add To the sunny on 1989 hisPlanting first vines in the while he said that he enjoyed As such, rides “The of these most stimulating aspect don’t you that given you, with take you “All so much stuff with surround ourselves “We Mr Edwards followed that original that scenic followed Mr Edwards ride with a cycle from Cardiff from Holyhead to a cycle ride with from a ferry crossing, following and then, returning before in Ireland Rosslare to Galway riding and through Wales in Fishguard to a journey made Swansea, to Pembrokeshire weeks. two over I did one which last with the has been favourite started we where son and brother-in-law my Rhone, the and followed France, in Orange, Massif Central climbed followed the and then the origin to its from Loire River down the he said. at Saint Nazaire,” Ocean Atlantic fun.” great and it was kilometres vineyard of a highly-regarded owner is the also in Tasmania. of his historicslopes property the overlooking Vineyard Craigow Mr Edwards’ River, Coal Wine Australian Halliday’s in listed James was Winery in 2011. Star Companion as a Five whileopportunity wines biking local taste to of tourism prime the attraction in Europe, to strip life to back chance the was cycling essentials. its very little,” survive with to chance me is the to he said. a few card, is a credit down, be weighed to want kit. repair and a bike some toiletries clothes, in in live modern life to and it is very refreshing almost unbelievable really a minimal it’s way; to survive and need you don’t find out what to survive well. “In 2000 I coached an Australian rowing crew in crew rowing Australian an 2000 I coached “In from and I met a coach 59 I was “That year I after doing training, considerable in 2001, “So which achievement personal “That a great was the World Championships held in Zagreb, Croatia, Croatia, Championships held in Zagreb, World the from know a lot of people to I got and while there he said. a lot of different countries,” celebrated his me that father who told Austria Alps and turning Swiss 60 riding by the across I didn’t because idea a great was I thought that while myself push but to I did want race, to want andimmersing in a different landscape myself culture. Alps and Italian Swiss Austrian, through the cycled Italy and then into down Austria in Landeck from Lugano. to a journey do such to eight and I decided days took with alone and sometimes sometimes every year, and friends.” children my It’s never too late to take up a new hobby

fter spending his youth rowing and playing spendingfter rowing his youth rugby and his as a rowing prime years Mr surgeon general Tasmanian coach, On your bike Since taking up the activity some years ago, Mr ago, taking some years Since activity up the his from at the public appointment retired Now A Edwards has cycled through the mountains through the of has cycled Edwards of Ireland, coast spectacular the around Europe, Passau in Germany from Danube valley the down in River Garonne and along the Vienna to on the Midi Sete Canal Du the and onto France, Mediterranean. but still with Hobart after 40 years, Hospital Royal St Calvary, out of the working practice a private Mr Edwards Hospitals, and Hobart Private John’s to up as a way tourismsaid he took cycling his birthday. 60th celebrate Barry Edwards decided to devote his middle years devote Barry to decided Edwards most through some of the cycling recreational to beautiful on earth. places

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2013 A C S THE CITY Hauraki the between lies Auckland the low Ocean, Gulf Pacific of the Harbour Manukau the Hunua Ranges, on and lies Ranges Waitakere and the at one field which volcanic an extinct volcanoes. active 50 produced time of cones, form the take these Today, islands and depressions lagoons, lakes, spectacular providing some cones with city and of the panoramic views while individual the Yet coastline. the extinct, considered are volcanoes lava large with dormant field is merely running tube volcanoes the caves from more to Home sea. the towards down Zealand’s of New cent per 32 than largest has the Auckland population, of any city in population Polynesian while ethnic world groups from the their made also globe have the across a vibrant making and for home here, city. cosmopolitan GALLERY ART AUCKLAND first permanent “the as 1888 inHeralded Art Gallery Dominion,” in the Art Auckland Gallery known – also largest the – remains Tamaki o Toi as a art with in Zealand institution New works. 15,000 numbering collection over The holdings major Gallery of features modern and contemporary art historic, Maori and by and outstanding works with artistsEuropean Island along Pacific and print sculpture collections painting, 1376. to dating back some works with A Surgeon’s Guide to Guide A Surgeon’s uckland, New Zealand’s largest city with a city with largest Zealand’s New uckland, is million people, 1.3 than of more population sobriquets, other two locally by known also In the Maori language it is known as Tamaki- as it is known Maori language In the of “City as the known it is popularly also Today, Surgeon an Otolaryngology Mr Richard Douglas, ASC the for Executive Conference member of the A on the hard worked have “The surgeons local of our city and enjoy proud are “Aucklanders in worked have surgeons Zealander New “Many way best on the tips Mr Douglas’ are The following Make the most of the ASC with some inside knowledge the most of the Make A one that exotically conjures its ancient beauty ancient and its conjures exotically one that modern charms. more its to refers that another suitors” a hundred with maiden “the – Makau-Rau this North Island coveted many tribes that the – for isthmus a narrow around on and lies that region River. Tamaki Inlet and the Mangere between dot that of yachts hundreds the to a reference Sails”, have claiming now to Auckland with harbour, the any other than capita per and launches yachts more city world. in the North Shore Auckland, out of the who works in raised was and educated and Gillies Hospitals, beautiful of the proud and is clearly city of Auckland his birth. Mr surgeons Douglas said local be held in May, to and looked meeting the be hosting to pleased were and guests. delegates welcoming to forward is scientifically believe program we which conference a number of invited also have while we strong, he said. non-surgical speakers,” interesting visitors. welcoming who will be friends good there and made Australia the find they hope and we conference the coming to as city as pleasing ASC program stimulating and the do.” locals we environs. gorgeous and its Auckland enjoy to Auckland

autumn Lifestyle 4 autumn Lifestyle 7 AUCKLAND WAR MEMORIAL MUSEUM WAR AUCKLAND is Museum housed the just a short taxiLocated city ride centre, the from on a hill harbour. the overlooking perched style building, in a neoclassical story the Memorial tells Museum War the millions to Home of objects, wartime and its history. people its Pacific, in the place its Zealand, of New tourist man-made most popular attractions “This Zealand’s is one of New and artefacts Island of Maori and Pacific unsurpassed its collection for Mr said. Douglas natural history,” Zealand’s of New displays KAREKARE AND PIHA BEACHES KAREKARE drive only an hour’s situated are Piha beaches and Karekare ‘ThePiano’, film of the viewers to Familiar surf sand black of dramatic beaches, a unique experience and offer and spectacular Auckland out of While beaches the swimming and secluded holes. waterfalls cascading rushing streams, walks, rainforest surrounding the provides region months, cooler in particularly the still retain a sense of glorious isolation, Mr Douglas art coastal galleries and village markets. parks, cafes, picnic spots, walks, and forest woodlands surf wild sand and are They and black have beaches. Coast West favourite two my “These are said: go to place a great are and they around people other will be very few there In May beautiful. exceptionally lunch.” a casual for stop is a good The Cafe Piha city. out of the get to need a walk when you for TIRITIRI MATANGI ISLAND TIRITIRI MATANGI ferry an hour’s nature reserve A Auckland, ride downtown from Tiritiri Matangi has been Island to farm working from converted of courtesy wildlife sanctuary, of Conservation. Department the of almost all stripped its Once consequent the bush with native volunteers loss of biodiversity, years ten than more for worked former its island return to the to more planting natural abundance, eliminating trees, 250,000 than and non-indigenous predators threatened land with the restocking birds and reptiles. and endangered can birds you native of the “Many mainland on the rare are there see predators,” of introduced because see can “You Mr Douglas said. fantails, kokako, saddlebacks, penguins and while and takahe Auckland trip round from the it is an day, most of the takes experience.” unforgettable WAIHEKE ISLAND WAIHEKE Auckland from minutes 35 Just Island, ferryWaiheke by is Hauraki in the situated Gulf. more boasting a coastline With and coves, beaches 100 than island an adventure isthe both home of and the playground premier region’s some of the Mr vineyards and restaurants. has“The Island Douglas said: a number of beautiful beaches progressively become which as pristine and remote more That western west. head you island has a also end of the and number restaurants of great vineyards including of my two Restaurant Cable Bay favourites, MudbrickWinery and the and superb A Restaurant. Vineyard Crisci, Poderi Italian restaurant, if long lunch famous its offers in no hurry are you return to to Auckland.” BRITOMART AND THE VIADUCT PRECINCT BRITOMART foreshore the to opening up access last decade, in the redeveloped extensively has been waterfront Auckland The into developed been have areas adjacent two As part of this, port. working of the activities the by restricted once in sea the the from Reclaimed Precinct. and transportationViaduct shopping hubs: Britomart restaurant, the and Britomart decline into Point fell city, growing the for port facilities buildas part to improved of a scheme 1870s hub a glamorous has become this most historic precinct Now demolition. escape to lucky and was 1970s in the a magnificent Office, Chief the Post a visit to Mr Douglas recommended and cafes. bars boutiques, of designer designers Zealand New best of the and said several rail a commuter terminal, into in Fort Laneold building as a converted now Roxy’s listed He Cooper. Trelise and World including Sylvester, Kate area in shops the have now was also Italian-styleproduce, spot of fine an diningfarm restaurant Ortolana, serving own while new-comer its site the and was city“This centre the from walk is a ten-minute Precinct: Viaduct said of the He a visit. worth established more Auckland’s and some of there many new restaurants are There Cup defence. America’s of the worth like Soul a visit.” and Euro while is definitely Maritimealso Museum the favourites

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With Karen Murphy Karen With “To see our beers in a bottle shop or on or shop in our a bottle see beers “To “There is something extremely is“There something extremely “Even before I began brewing more more brewing I began before “Even the make to urge the resisted I have “So months, 15 than in more a little Now, So far Mr Brown and Mr Schultz, and Mr Schultz, Mr Brown So far rewarding in seeing your beer on tap and in beer seeingrewarding your you something that enjoy people watching wear and I doubt will ever that made, have he said. off,” lista wine is very personally satisfying and if ever day the it away give probably I’d granted.” for that I took that came Western Australia. Western Close to home while he said that at one stage Mr Brown his moving home- seriously considered premises commercial to operation based working he enjoyed as a brewery-pub, such his three home and involving to close endeavour. inchildren the my back cut already I had seriously, a lifestyle hours simply from working whole like my I felt point of view because time little with work around life revolved he said. family,” the for is something there because bigger business about back nice it in having really the to still close I’m not only because yard, it automatically but because family, the and when capacity a production imposes to have it and don’t reach we that, reach we pressures.” outside to react quality brews and Mr Schultz’s Mr Brown on shops, of bottle at scores available are tap at a number of boutique pubs and at Melbourne and can across restaurants in Taphouse Local at the be found also in Doctor Freo and at the Sydney constant cleaning. constant Children’s Royal at the works who now styles 65 around brewed have Hospital, on now releases special ten with of beer The mainstays of production, way. the styles mainstream more the are however, American Pale as Englishsuch Ale, Pale Belgian Blond Ale, American Brown Ale, and Weizen Bohemian Pilsner, Ale, Dunkelweizen. monitoring fermentation, labelling and monitoring fermentation, the up with bottling keeping or Mr Brown, a former VicBrew VicBrew a former Mr Brown, the Heart Brewery, Called Black “This all grew out search of a basic this in I got involved when I first “Yet turned be a positive that out“But to came of brewing knowledge my “All is all about like surgery, “Brewing, equipment, the with working love “I as a brewer enter you “The world social interests said his brewing Mr Brown Champion and brewing judge, said he judge, Champion and brewing in 2011 production commercial began perfusionistin partnership with Brad Royal at the whom he met Schultz Melbourne Hospital. of beer litres 500 enterprise produces now each week. strange a bit seems which beer better for buy almost anything can when you in the he said. in now,” live we world interconnected I the styles of beer find simply couldn’t them make to how learn to so I had liked, scratch. from Brad committed and I remain now because historical characteristics the respecting to meaning make, we styles of beers of the all natural no chemicals are they with that or additives. experimentation and early reading from gained background science while my and that invaluable through medicine was I that of brewing aspect is the probably not there’s because find most enjoyable, once involved amount of science a huge clinical practice. entered you’ve detail and minimisation to attention of there same time at the yet contamination, is something very relaxing about working procedures machinerywith complex and human body. the involve don’t that and the toys my tinkering with while if knowing that of it, microbiology just can we work, try doesn’t something we start again. and anxieties stresses the for is a tonic also a different are they of medicine because going and easy laidback of people, breed not everything that an attitude has to with instant.” be done on the which week per day 12-hour up one took men when both most often chosen was while commitments of work free were most days shed inhe spent time the Now, that personal endeavour and private and private endeavour personal that Now, kit brewing from his and from days university kit brewing childhood father’s memories of his physicist Mr Brown experiments, brewing basement Royal the from away time spent his free stores Melbourne scouring Hospital hardware of the in suppliers search and component tubes and pumping equipment machinery, brew. perfect the create to needed a commercially- into has grown passion in a based boutique brewery successful sterile commercially-equipped, pristine, of his back at the shed 45-square-metre Brighton home. fter spendingfter UK in in time the the Melbourne cardiothoracic 1990s, returned Brown Mr surgeon Robin The perfect brew The perfect So few such brews were imported and were brews such So few of home- on hisDrawing experience Fellow Robin Brown relaxes with a beer, or two, in his spare time or two, in his spare with a beer, relaxes Fellow Robin Brown home to Australia not only with increased increased not only with Australia home to English for but and a taste surgical skills, European style beers. he soon that however, then, here stocked indulge if this that to realised he was to not only have he would taste acquired components the but source it himself, make for and build necessary equipment the production. 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autumn Lifestyle 8 autumn Lifestyle 11 u With a handicap of nine, he said that he said that of nine, a handicap With pro a golf from a lesson getting was “I pick to going then thought he was “I and that problem the was said that “He one take to I decided that, “After months I became after a few “However, Mr Jay, who describes himself who describes as Mr Jay, “transitioning towards retirement”, has retirement”, towards “transitioning public appointment week per a one-day McEwin and Lyell Adelaide Royal at the practice and a part-time private Hospitals his enjoy him to give time to designed club while golf also of the as captain role ASOHNS. within work to continuing golf playing enjoyed while always he had with as a lad out going on course since who went brother, and older his father champion, amateur a state become on to weekday only a regular he had made 1980s. in the play to commitment what I was who watched day one particular should handicap my me that doing and told he said. half been of what it was,” have he asked but instead game apart, my think about to when I me what I tended it that I explained course. the on to come thinking about usuallywas about work, all calm and hoping was patients, my the into back be called to not wanting hospital. work leave to I had improve, to if I wanted while is because relaxing, golf gate at the concentration. great requires it also was which play to afternoon off week per was I actually a very difficultthingto do. surprised draw to discipline at the it took no consultations, a line no more and say today. work more it because time of that very possessive against relief work be a great to proved a very and it actually became stress important week.” working part of my Seeing the sustainable angle on golf Seeing the sustainable angle hen Mr Michael Jay, the the hen Mr Jay, Michael President immediate past Society for Australian of the Then, being a golf course in the capital capital in being course the a golf Then, Captain of as the however, Now, regarded widely club, the that means It the enhanced has greatly “The wetland back put as much water aim to “We in on as a boy the I played “The scrapes A day on the A day Otolaryngology Head and Neck Surgery and Neck Head Otolaryngology clubstook golfup athis first (ASOHNS), course the local ripe of five, the old age greenery little had ofAdelaide in North boast. to which driest in driest continent, the state of the “scrape” the to manage first had players that sink to a putt, attempting before dirtis a thick required which covering shot. each scraping before Mr Jay GolfClub, Adelaide Royal the created of a wetland workings the oversees boundaries harvest to club’s the within runoff surrounding from stormwater by when cleaned suburbs which, an into back is injected beds, reed underground aquifer. can Australia, inas ranking best the with but do greens, luscious its not only keep of aquifer water. net user so as a zero that course of the of an area appearance in saltygrew only scrubbyvegetation the to a benefit soil while provides it also of turbid flow community the reducing by said. Mr Jay ocean,” the into stormwater winter aquifer over the into wetlands from summer is which out over take as we the for and great course the for great community. upon tough reflection, pretty seem 1950s in particular, but many country courses, water that now that to revert to have may commodity.” a precious such has become W green

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We aim to put as much water back from wetlands into the aquifer over winter as we

Lifestyle “ take out over summer which is great for the course and great for the community. ” Time for family Dr Pancha took up the chance to spend more time with his family

he College could play a lead role in identifying surgical Tunits around the country that could best adapt to a part-time training position, according to final year Trainee Dr Gowrinanthanan Panchacharavel. Dr Pancha, as he is known, spent 2011 in a job-share Trainee position with Dr Penelope De Lacavalerie at Liverpool Hospital’s Head and Neck Unit. He said he applied for the part-time position so he could spend more time Michael Jay on the Golf Course with his family following the birth of his second son in September 2010 and was also planning to spend the year Now playing twice a week on average, Mr Jay said Since its inception, the competition has now undertaking a part-time Masters Degree. he loved the history, traditions and etiquette of golf been expanded to include members of other “When my first child was born I didn’t as well as the social interaction it provides. medical colleges, pitting surgeons against initially get to spend much time with him Fellowship training in colorectal surgery, pivotal role in this aspect of training by “One of the things I most love about golf is that it psychiatrists, physicians and anaesthetists with at all and I didn’t want that to happen a Dr Pancha is the first male Trainee in identifying which hospitals and units are is so inclusive,” he said. more than 60 golfers participating most years for second time,” Dr Pancha said. NSW to undertake part-time training. appropriate for part-time positions and “The handicap system allows people of all the coveted Wilson-Walsh Cup. “I also had plans to study during that “Because I was the first, I got a lot of which are not.” standards to compete against each other while That cup is again up for the winning in year which didn’t work out because people asking me about the job-sharing Dr Pancha said he believed more you are also always competing against yourself, November. of both the difficulty in designing a arrangement along with suggestions that I suitable surgical units for part-time constantly trying to improve your handicap. As Captain of the Royal Adelaide Golf Club, study regime that would fit in with the was slack and didn’t want to work as hard training could be colorectal, trauma, acute “It is also totally absorbing and exhilarating Mr Jay has hosted events against the Royal alternating weekly roster we worked and as others,” he said. surgical or breast and endocrine units whereby you can have a totally wretched game, Sydney and Royal Melbourne Golf Clubs and last also because of the unit’s heavy workload. “But I did a pretty good job there, I whereas Upper GI, cardiothoracic and but be overjoyed with one shot in an otherwise year travelled to England with his wife, Penelope “I did most of the on-call rosters, filled had a good reputation and I gained a lot Head and Neck may not, because of the horrible match. Steele, a doctor and keen bird watcher, to play at in for other registrars who took leave for of skills by spending one year in a Head workload and complexity of procedures “It’s also great exercise and at our course, players the Royal West Norfolk Golf Club. their exams and during the second half of and Neck unit rather than the usual six undertaken in public hospitals. can walk up to about 10 kilometres a game.” As a representative of the Royal Adelaide Golf the year the unit was understaffed which months on rotation. “That year of part-time training was chal- Mr Jay said he found it a great thrill to be elected Club, he has also been invited to play many increased the workload all around. “However, this type of stereotyping lenging in terms of meeting everyone’s ex- captain of the Royal Adelaide Golf Club last year, courses around Australia and the UK and is “I didn’t get to do all the things I planned means that the two Trainees sharing the pectations, including my own, but I gained a overseeing the maintenance of a course which has planning a trip to Canada later this year to to do and there’s no doubt that your position have to work very well and very lot of operating experience,” he said. been ranked in the top 100 worldwide and a club play at the centennial celebrations of the Royal income takes a hit, but I did get to spend closely with each other to ensure the “I think you gain skills rather than lose steeped in tradition. Colwood Golf Club, a private club located in more time with my wife and children so I position works for patients, meets the out in terms of training in a part-time He said the links course located at Seaton had Victoria, British Columbia. am glad I had that part-time year.” expectations of senior supervisors and position because you are spending more hosted nine Australian Open Championships and “It is wonderful to be invited to play on some advances our training. time working within a specialty and sixteen Australian Amateur Championships as well of these courses which are among the most A new approach “Yet it does work and could become while I think there is still some degree as the 2008 Eisenhower Cup, the largest amateur beautiful and challenging in the world and when Dr Pancha was born in Sri Lanka and more common if there was a greater of negativity towards part-time training, golf competition held anywhere in the world. we do go abroad, given that my wife has less graduated from the University of Papua understanding of where such positions I think many of the problems could be One of the lesser known – but no less keenly interest in golf, we try to combine both of our New Guinea before going to the US for could best be accommodated. overcome if the right units in the right contested - competitions held there, however, is the interests so that after I finish playing we go bird further medical training. Arriving in “For instance, I think Liverpool hospitals were selected in the first place. RACS Golf Day. watching,” he said. Australia in 2001 to take up a short-term Hospital may be one of the busiest – if “And while I did not commence my Held annually, the event began in 1981 as a com- “Yet I still haven’t played at St Andrews in position in Alice Springs, he decided to not the busiest – hospitals in Australia Masters Degree as I had hoped to, I did petition between surgeons and physicians after physi- Scotland, the birthplace of the sport. stay after the Twin Towers terrorist attacks and therefore the workload may make a enjoy spending time with the new baby cian Dr Leigh Wilson and the late surgeon Mr John “I’ve left that as something to look forward to and pursue surgical training in Australia. part-time training position more difficult and sharing more of the family load with Walsh donated a trophy which stands on display in when my responsibilities have lessened a bit.” Now planning to sit his final exams to manage. my wife.” 12 the College of Surgeons Building in Adelaide. With Karen Murphy later this year before embarking on post- “I think the College could play a With Karen Murphy

Surgical News April 2013 / Page 25 Professional Development

s someone who is often looks for conferences The Aand meetings that end of that Drawing for Surgeons are a little to the left of centre, day culminated a surgeon friend of mine in a trip to London’s su- mentioned a course called perb National Portrait Gallery A lesson in art for an Australian surgeon in London “Drawing for Surgeons”. Held where we were taken on a guided in London at the Royal College tour by our instructors and given of Surgeons twice a year, this a crash course in art appreciation. Dr Kellee Slater MBBS (Hons) FRACS, became a Fellow of the Royal Australian wonderful two day program This was followed by a friendly College of Surgeons, General Surgery (FRACS) in 2002, then obtained her teaches surgeons the basics of and informal dinner. certificate in Transplantation Surgery in 2006. She is a Hepatobiliary and General art with a view to trying their The following morning I Surgeon and specialised Liver Transplant Surgeon at Princess Alexandra Hospital, hand at anatomical drawing. awoke, keen to embark on Greenslopes Private Hospital and Mater Private Hospital. She is also a Senior With my leanings much another session of drawing and Lecturer at the University of Queensland, School of Medicine. more toward the sciences, I’ve to see if I could build on my always considered myself to newly acquired artistic skills. be artistically inept. Given The second day was spent in the that my operative drawings impressive Wellcome Museum. could best be described as This newly refurbished room stick figures, I wondered if contained an array of dissected this was the course that might pathology specimens from every enable me to improve my visual part of the body. communication skills. I paid The choice was ours as to what the very reasonable registration we would like to sketch. I spent fee and winged my way to that day turning dissections of London. livers and pancreas into works of The course is held at the art. By the afternoon, Rowan and historic College at Lincoln’s Inn other objects in the room. We learned Steve had us painting with water Fields, somewhat of a tourist attraction all about the ‘negative space’, light and shade colours and with their support I had at by itself. Sixteen colleagues from all walks and the principles of ‘blind drawing’. It least touched on the basics of something of surgical life and from all over Europe was with great trepidation that we all that I always thought was very difficult. were there to keep me company. put pencil to paper. One of the surgeons On returning home, I have continued Sitting on the table in front of each of in the room put into words how we to hone my drawing skills in my operative us was a sketch book emblazoned with were all feeling. ‘Is it OK that I am really notes and now, if you can’t find me “Drawing for Surgeons”. This was filled nervous’? he said. ‘I don’t usually like to after a case, you just have to check the with sheets of thick, blank pages, ready for fail at anything and I know I’m going to anaesthetic room where I’ll have my us to draw our masterpieces. Alongside be really bad at this’. We all concurred watercolours out, putting pictures on it was a beautiful artist’s roll, brimming with nervous laughter, clearly feeling way paper to describe the operation I have just with pencils, erasers and watercolour outside our comfort zones. performed. paints. We were excited to find out that But, despite our concerns about At just under £400 including lunches these were ours to keep. They had been producing something that even Picasso and artists materials, this course is great especially chosen so we could carry them may not recognise, Rowan and Steve value for money and I couldn’t think of a around and were to be our tool kit to use, praised and encouraged our efforts. more pleasant way to spend a couple of any time we were moved to make a sketch By the end of that first day we were all days and advance my surgical education. in the course of our daily work. turning out some reasonably decent Kellee Slater, Qld Fellow The Drawing for Surgeon’s course is drawings. a labour of love for the delightful Dr After we finished sketching each other, If you would like the Rowan Pritchard-Jones, a plastic surgeon we were given some spectacular plaster with a keen interest in surgical drawing. models made especially for the course, Professional Development Frustrated by his inability to do this well, depicting real life surgeon’s hands holding Department to explore ways in he had enlisted the help of art teacher surgical instruments in various poses. which we could bring Drawing friend Steve Downey and together they The detail was so fine, there was even real for Surgeons to you, express formulated this highly instructive class. suture in the needle holders. It was our your interest via an email to They threw us into it straight away by task to draw them with lead pencil and [email protected] asking us to draw each others faces and then move onto shading with colours.

Page 26 / Surgical News April 2013 Surgical News April 2013 / Page 27 Medico Legal

Advanced Series My TiMor hearT Changing lives, saving lives Introduction to Local Flaps Auckland Venue: Advanced Clinical Skills Centre 4-5 June 2013 98 Mountain Road, Epsom, Auckland My TiMor hearT IMG Assessment Process upheld Changing lives, saving lives Important College processes have been upheld in court Convened by: The College has Mike Klaassen produced a book, recent decision of the Supreme that “years spent simply in a service Australia, are defensible. It also confirms with invited faculty called My Timor Heart, Court of Western Australia position do not automatically equate to that, so long as medical colleges properly Earle Brown and Mark Gittos to celebrate our Ahas upheld the International the number of years that may have been follow the procedures established for achievements in Timor Medical Graduate (IMG) Assessment spent in the Surgical Training Program”. IMG Assessment, then successful legal This 2 day course is designed for Plastic Surgical Leste. My Timor Heart process of the Royal Australasian College The Court noted that this basic reason for challenge is unlikely. Trainees and others who wish to upgrade their of Surgeons (Elobadi v. RACS [2013] non-comparability had not changed, and recognises the surgical skills. WASC 29). As part of the College’s usual the IMG had not completed a Training Implicit for medical colleges, arising from extraordinary efforts of One of the first principles that a plastic surgery trainee learns is to repair “like tissues assessment processes, the IMG was Program. this case, are the need for: with like tissues”. This principle offers a significant challenge to the novice Plastic the medical volunteers in assessed as “not comparable” on the The IMG had previously appealed > clear criteria to determine Surgeon, nowhere better illustrated than Local Flap repair. Timor Leste, and the basis that he did not meet the assessment College decisions twice. On the last comparability, substantial life-changing impact criteria to even qualify as “partially appeal, the decision of the College comparability or non-comparability; The aims of the course are: Registration: their work has on people comparable”. Appeals Committee clearly stated that > clear processes by which the • Understanding the basics of local flap Registration fee, $1633.00 GST living in a country that The IMG had made several more work of a similar type (non- IMG Assessment process will be surgery. inclusive. continues to struggle applications for assessment, and the consultant) would not provide the basis undertaken; • Understanding skin biomechanics to help Registration closes 6 May 2013. decision of the Court was in relation for comparability, and that the IMG > transparent and documented processes plan skin defect repair. with the legacy of to the most recent IMG Assessment. needed to apply to the College Training in each individual case; • Understand the different categories of local A course manual and full catering years of civil war and flaps and how they are designed are provided. violence. Using striking On previous assessments, the IMG was Program to complete formal training > documented discussions, meetings geometrically. photographs and the similarly assessed as “not comparable”. requirements. and even incidental contact with the • Learning how to apply local flap surgery in For further information contact: The IMG had also sought to appeal The IMG produced a number of IMG, referees or others involved in the words of the volunteers, the appropriate clinical, pathological and Administrator ACSC the decision of the College through the referees attesting to his competence, but process. anatomical setting. the book tells the story Phone: +64 9 923 9304 College’s independent Appeal processes the Court did not accept that there was • The philosophy of reconstruction: create the of the many hundreds Email: [email protected] and, on previous occasions, was not sufficient evidence to establish that the Important in this decision was the defect then choose the most appropriate who have contributed method of repair. successful. IMG had a number of years experience ability of the College to substantiate its to creating a healthier Because the recent IMG Assessment effectively operating as an independent processes, including with documents and Please register online at: future for Timor Leste. was on the same basis, with no further surgeon at the equivalent of consultant notes of telephone conversations and https://ecommerce.auckland.ac.nz/shop/acsc/courses/p-115.htm My Timor Heart is edited new information, no appeal was allowed level. other meetings, to demonstrate that it had by Ellen Whinnett, the in relation to the most recent decision. In its conclusion, the Court accepted transparently followed its own processes. Walkley-award winning It was argued by the IMG that his that the College had appropriately Accordingly, well documented processes Local flaps 2013_01.indd 1 12/02/2013 8:06:44 a.m. journalist and Head experience in Australia, for a number of followed its procedures for IMG of all aspects of IMG Assessment will Medical of News at the Herald years, in senior roles, now entitled him to Assessment. The College had applied greatly assist medical colleges to defend For Lease Sun. All profits from the a higher level of recognition under IMG its criteria appropriately, and there was challenges in the future. Consultation Assessment. A central consideration in insufficient additional evidence to suggest The College representatives, who gave sale of the book will AMA HOUSE, ST Rooms for Rent the IMG Assessment was whether the that an alternative conclusion should have evidence in the case before the Supreme go directly to the Timor LEONARDS, SYDNEY Consulting Rooms, Sessions IMG had undertaken formal training to been reached. Court, were considered credible, and gave Leste Program and the equivalent of an Australian trained The Court noted that the IMG “has comprehensive evidence from memory 3 x Specialist consulting Located in Darlinghurst moments from the fund essential surgical surgeon. never completed a comparable Specialist and in documentation as to the manner rooms available St Vincent’s Hospital campus, the Garvan services and training In previous assessments, and appeal, Training Program to the College in which the IMG process had been Modern spacious medical Research Institute and directly opposite opportunities. the conclusion was reached that the IMG Programs. He will never be regarded as undertaken in this particular case. the Victor Chang Cardiac Centre had worked in Australia in registrar roles “partially comparable” until he does. The suites with a large patient on Liverpool Street are modern and Russell Kennedy, Solicitors, acted for the for a reasonable period of time. However, policy has not been rigidly applied, but waiting room beautifully appointed consulting rooms. College in this case before the Supreme Contact Emily Salt he had not performed at consultant level, properly applied”. Ample parking adjacent to Rooms are competitively priced - Court of Western Australia. at +61 3 9249 1230 or and his log books did not indicate that The decision is therefore a helpful rooms includes reception service whilst car parking space is available. [email protected] he had operated at the level expected of a decision confirming that the medical Contact (02) 9438 2271 or if you would like to fully trained Australian consultant, on an colleges IMG processes are legally Contact Toni on 0433 019 524 or 0411 430 509 (ah) purchase the book. unsupervised basis. supportable, and the criteria used, as email [email protected] In a previous appeal decision, before authorised by the Australian Medical Michael Gorton, the College Appeals Committee, it noted Council and the Medical Board of College Solicitor

Page 28 / Surgical News April 2013 Surgical News April 2013 / Page 29 Professional Development

In Memoriam Our condolences to the family, friends and colleagues of the NSW 15 July, Sydney following Fellows whose Writing Medicolegal Reports, death has been notified 2013 9 August, Sydney over the past month: Workshop success Non-Technical Skills for Surgeons (NOTSS) The Acute Neurotrauma workshop has Workshops & Activities Vincent Ooi, Professional development supports life-long learning. College activities NZ South Australian Fellow become a popular and successful event are tailored to the needs of surgeons and enable you to acquire 6 May, Auckland – ASC Keeping Trainees on Track (KToT) rom 2007 until last year the with some neurosurgical units, in the David Warnock, new skills and knowledge while providing an opportunity for reflection 6 May, Auckland - ASC New Zealand Fellow College has offered nine Acute emergency situation. about how to apply them in today’s dynamic world. Supervisors and Trainers for SET FNeurotrauma workshops in All participants thought their (SAT SET) Graham Hill, total. Three of these were offered in concerns had been addressed and that 6 May, Auckland - ASC New Zealand Fellow Adelaide, two each in Melbourne and they were more confident in dealing Non-Technical Skills for Surgeons Keeping Trainees on AMA Impairment Guidelines 5th (NOTSS) Brisbane and one each in Perth and with emergencies in the future. One Marius Fahrer, Townsville. They provided training in participant wrote: “Certainly, feel like Track (KToT) Edition: Difficult Cases Victorian Fellow 6 May, Auckland – ASC; 18 29 May, Brisbane QLD performing burr-holes, craniectomy l could perform this procedure given 29 May, Brisbane Wilton Carter, and craniotomy for head trauma guidance over the phone from the June, Adelaide The American Medical Association (AMA) Impairment AMA Impairment Guidelines 5th Victorian Fellow emergencies and provided a foundation neurosurgery specialist.” This 3 hour workshop focuses on how Guidelines inform medico-legal practitioners as to the level of Edition: Difficult Cases for improved head injury management. I am very grateful for the support to manage trainees by setting clear goals, impairment suffered by patients and assist with their decision 18 June, Brisbane James Lewis Jardine, The workshops were primarily I have received from my colleagues giving effective feedback and discussing as to the suitability of a patient’s return to work. While the Supervisors and Trainers for SET (SAT SET) New Zealand Fellow for rural surgeons, but also other around Australia in facilitating these expected levels of performance. You can guidelines are extensive, they sometimes do not account for unusual or difficult cases that arise from time to time. This 31 July, Brisbane health care professionals, such as workshops and take this opportunity also find out more about encouraging 3 hour evening seminar compliments the accredited AMA Keeping Trainees on Track (KToT) William Chin, retrieval emergency physicians, found to thank Teresa Withers, Eric self-directed learning at the start of term Victorian Fellow meeting. Guideline training courses. Please note: Fellows will still the course very valuable. Over 150 Guazzo, Larry Marshman, Glenn need to attend AMA training to be accredited to use AMA SA Anthony Bookallil, participants gained the skills to deal McCulloch, Marguerite Harding, guidelines. 18 June, Adelaide with neurotrauma cases in the rural Stephen Santoreneos, Amal Abou- Supervisors and Trainers Keeping Trainees on Track (KToT) New South Wales Fellow setting. Hamden and Ellison Stephenson for for SET (SAT SET) Writing Medicolegal Reports 29 - 31 August, Adelaide 6 May, Auckland – ASC; 18 Surgical Teachers Course Wilton Carter, Due to the urgency of the case or their great contribution. They have 15 July, Sydney Victorian Fellow difficulties with patient transport, there also commented on how they have June, Brisbane VIC are occasions when rural surgeons enjoyed imparting skills to their rural This 3 hour evening workshop helps you to gain greater This course assists supervisors and trainers insight into the issues relating to providing expert opinion 16 April, Melbourne need to perform emergency procedures colleagues. to effectively fulfil the responsibilities of and translates the understanding into the preparation of high Supervisors and Trainers for SET We would like to notify readers to relieve raised intracranial pressure This project has been funded by their very important roles. You can learn (SAT SET) that it is not the practice of quality reports. It also explores the lawyer/expert relationship to use workplace assessment tools such as 19 April, Melbourne Surgical News to publish obituar- to save the patient’s life or reduce the Department of Health and Ageing and the role of an advocate. You can learn how to produce Non-Technical Skills for Surgeons ies. When provided they are neurological morbidity. under the Rural Health Continuing the Mini Clinical Examination (Mini CEX) objective, well-structured and comprehensive reports that (NOTSS) published along with the names These skills are taught using Education Sub-program (RHCE) and Directly Observed Procedural Skills communicate effectively to the reader. This ability is one of the of deceased Fellows under In (DOPS) that have been introduced as part 19 July, Melbourne relatively inexpensive equipment, Stream One which is managed most important roles of an expert adviser. Finance for Surgeons Memoriam on the College web- such as the Hudson Brace, which can by the Committee of Presidents of SET. This workshop is also available as site www.surgeons.org go to the an eLearning activity by logging into the 2 - 4 August, Melbourne easily be available in smaller hospitals. of Medical Colleges. The Royal Fellows page and RACS website. Finance for Surgeons Process Communication Model click on In Memoriam. Participants learned to correctly Australasian College of Surgeons is 19 July, Melbourne 24 - 25 August,Melbourne } Preparation for Practice evaluate whether treatment on-the-spot solely responsible for the content of, Informing the College Non-Technical Skills for This whole day course establishes a basic understanding was needed and how to proceed after and views expressed in any material of how to assess a company’s performance using a range of If you wish to notify the College Surgeons (NOTSS) contact with a neurosurgeon. Adequate associated with this Project. analytical methods and financial and non-financial indicators. Contact the of the death of a Fellow, please time was spent operating on cadavers New funding is crucial to be able 6 May, Auckland – ASC; 9 It reviews the three key parts of a financial statement; balance Professional contact the Manager in your until participants were comfortable to offer further practical workshops. August, Sydney sheet, income (profit and loss) and cash flow. Participants Development Regional Office. They are with performing the procedures. Following the success of the workshops This workshop focuses on the non- learn how these statements are used to monitor financial Pleasingly, all the workshops a series of online modules have been technical skills which underpin safer performance. Department on ACT: [email protected] received excellent feedback from the developed, and in this I am very operative surgery. It explores a behaviour +61 3 9249 1106, NSW: [email protected] participants and there have been grateful to Professor Peter Reilly who rating system developed by the Royal Process Communication by email NZ: [email protected] waiting lists for workshop attendance. has taken the lead in developing this College of Surgeons of Edinburgh which Model PDactivities@ can help you improve performance in the QLD: [email protected] Some of the major concerns the complementary resource. 2 - 4 August, Melbourne surgeons.org or visit participants had about dealing with operating theatre in relation to situational www.surgeons.org SA: [email protected] awareness, communication, decision PCM is one tool that you can use to detect early signs of neurotrauma before the workshops - select Fellows TAS: [email protected] making and leadership/teamwork. Each miscommunication and turn ineffective communication were; unavailability of staff to of these categories is broken down into into effective communication. This workshop can also help then click on VIC: [email protected] perform or assist in rural hospitals, behavioural markers that can be used to to detect stress in yourself and others, as well as providing Professional WA: Angela.D’[email protected] no confidence in performing the assess your own performance as well as you with a means to reconnect with individuals you may be Development. NT: [email protected] procedures, and communication issues Marianne Vonau your colleagues. struggling to understand and reach.

Page 30 / Surgical News April 2013 Surgical News April 2013 / Page 31 Successful Scholar profile Highlights 2011: Commonwealth Scholarship; Royal Australasian College of Surgeons Foundation for Surgery Research Scholarship; ith the financial support of “My research aim is to determine if “Another reason I wanted to come Award from the New Zealand the College, NZ Orthopaedics leptin and adiponectin, produced by here was to work under my supervisors, Orthopaedic Association WTrainee Dr Anand Segar is fat, are involved in the pathogenesis of both of whom are internationally Wishbone Trust now investigating the pathophysiology low back pain and intervertebral disc regarded for their work in this field. As a 2007: Douglas Robb Prize for the of intervertebral disc degeneration and degeneration.” surgical Trainee conducting basic science best academic performance its link with obesity as part of a PhD at Dr Segar said that his work during research, I think it is very important to throughout the clinical phase Oxford University. 2012 had shown that both leptin and be supervised by both a clinician and (MBChB degree); J D K North Dr Segar, from Auckland, was adiponectin reduce cellular function in scientist.” Prize in Clinical Medicine for the awarded both a Foundation for Surgery the intervertebral disc, down-regulate Dr Segar said he felt proud to be able to best performance in the clinical Scholarship for 2012 by the College and matrix production and up-regulate return to New Zealand upon completion assessment; Flavell Exchange a Commonwealth Scholarship by the degradative enzymes. of his PhD with the skills in, and Scholarship to undertake an British Government to fund his place at knowledge of, mesenchymal cell biology elective at Barts and The London Oxford, the latter prize awarded to only Focusing research to advance research work conducted Hospital in London three New Zealanders each year. During this year and next, he said he in Australasia into the development 2006: Year 5 Annual Award for He is conducting his research at the would refine his research to attempt of cell-based therapies for treating best academic performance Nuffield Department of Orthopaedics, to identify the cellular signalling musculoskeletal conditions. Rheumatology and Musculoskeletal processes which mediate the response “There is a small research community Sciences (NDORMS), situated on the site of and has already received ethics with this focus in New Zealand the Nuffield Orthopaedic Centre, the largest committee approval to conduct a cross- and Australia, but both obesity and dedicated orthopaedics hospital in the UK. sectional clinical study to investigate degenerative musculoskeletal conditions Under the supervision of Dr Jill Urban, the relationship of the adipokines in are becoming an ever increasing problem. an internationally regarded expert in symptomatic patients. On my return, I hope to combine science cartilage and intervertebral disc biology, Dr Segar said he hoped that his work with my future surgical practice to and Professor Jeremy Fairbank, head of would advance global research efforts into promote translational musculoskeletal spine research, Dr Segar is investigating the development of cell-based biological research to improve patient outcomes.” the role of adipose tissue in the disc therapies to treat disc degeneration. degeneration process. Dr Segar graduated from the University Essential support “An article published in the Lancet last of Auckland in 2007 and was selected Dr Segar’s Foundation for Surgery year highlighted the burden of low back onto the New Zealand Orthopaedic Scholarship provided a $45,000 stipend pain, ranking it as the foremost cause of Association (NZOA) and RACS SET and the Commonwealth Scholarship worldwide disability, ahead of ischemic orthopaedic program in 2010, completing provided a small living allowance and heart disease and diabetes. However, our his first year of training in Wellington covered the international student fees at understanding of the disease process before heading to Oxford. Oxford University. His laboratory costs leading to disability is unclear.” Dr Segar He said it took 18 months of contact have been funded by the Wishbone Trust said. and negotiation to win his place at the of New Zealand. “Obesity is a significant contributing prestigious university, a success he could “It was a great honour to receive the factor to low back pain and disc not have achieved without the support Commonwealth Scholarship, but still I degeneration; however, the mechanism of the New Zealand Orthopaedic would not be here without the support underlying the link between the two is Association (NZOA) and the College. and funding from New Zealand and unclear. “My interest in surgical research was the College while the NZOA was very “It is very exciting because we all once initially fostered and supported by Professor supportive of me taking a break from my thought fat was quiescent. However, John Windsor and I am very grateful to him clinical training to undertake this research this view has shifted recently and we for helping me get here,” he said. work,” he said. now know fat directly contributes to “I wanted an international experience “Oxford is an amazing place and even the chronic low-grade inflammation to my research and was lucky enough to after living here for a year, I am still taken of obesity via specific cytokines called be working for a surgeon, Mr Richard aback. adipokines. Nicol, who had contacts at Oxford. “I am based at Christ Church, an Relieving “Of these, two important adipokines “Now I feel incredibly lucky to be Oxford college founded in 1546. are leptin and adiponectin, both of working at NDORMS, which is a world- “Christchurch, New Zealand, was which can be pro-inflammatory in class centre of excellence. founded by a graduate of this college and cartilage. Researchers have now drawn “It is an integrated department housing it is amazing for me to see all these links a link between intra-articular fat, researchers from many backgrounds with New Zealand. back pain which produces local adipokines, and including clinical orthopaedics, “I also enjoy the fact that you osteoarthritis. immunology, genetics, rheumatology, cannot immerse yourself in any more This scholar is working towards a “In osteoarthritics, the degenerating oncology, engineering and statistics. All orthopaedics than you can in Oxford – pain free future for patients bone and cartilage even produces these of this provides great opportunities for particularly when your work is associated adipokines, further feeding back on the discussion across different research areas with the Nuffield Orthopaedic Centre.” degradative process. and ideas for translation of the research. With Karen Murphy

Page 32 / Surgical News April 2013 Surgical News April 2013 / Page 33 Graham Coupland Lecture 2012

Was Graham Coupland ahead of his time? me, are that he was a most complete isn’t in writing. To be excellent, either as but I fear that it is this aspect of patient surgeon. I am particularly indebted a citizen or a surgeon, one must function care that we are at risk of losing, agape This is the first half of a lecture presented at the NSW Regional to the eulogy that Tom Reeve wrote. well above the minimum standard, the in the wonderland of technology like Committee End of Year Dinner, 14 December 2012 Graham’s knowledge and technical skills written code. kids in a sweet shop, and at the same were enormous, supported by excellent This is not to say that I believe the time, constrained by a fiscally driven judgement. He was a kind, gentle person, College’s standards, as codified in the bureaucracy. communicated well, highly professional Code of Conduct and the Competence If this part of patient care is so am honoured and flattered to be asked in his dealings with patients and and Performance Guide, are too low. important we need to know something to give the 2012 Graham Coupland colleagues, an outstanding team player It is more that they are standards that about it. In the past this non-technical ILecture because I believe there are and a leader such that his nursing staff are in some degree measurable, such aspect of healing was either innate within many surgeons in NSW, and certainly were utterly devoted to him. as is outlined in the Competence and the individual or learned by osmosis and in the rest of Australasia, who are more Those who passed through his hands Performance Guide. example from a mentor who possessed it. qualified and more eloquent than I. as junior members tell us that he was a But we all know that a huge part of a Now we have considerable literature to However, I shall try to hold your interest wonderful teacher. The recollections of human’s life is concerned with that which help us understand it, much of it coming at this time of day when somnolence is his son, given to us only a few years ago is not measurable, including their response from work done with cancer patients,1,3 the rule. in this address, show that if there was any to contact with a medical practitioner, and, but more widely applicable because it Born in Manilla in 1934, he (Graham area of life in which he did not excel it more specifically, a surgeon. It is this that I deals with one of the core aspects of Coupland) graduated from Sydney was as a family man. Like so many of us, want to address tonight. everybody’s life, that of suffering. University in 1959, obtaining his he seems to have struggled with work/life Suffering is a universal human Fellowship in 1964 and an MS in 1975. He balance and health advocacy as far as his The fixer experience. It is hard to define. Coulehan2 was primarily a general surgeon, but also own health was concerned, but this was As surgeons, we fix things. Operating described it as “the experience of As surgeons, we fix trained in paediatric surgery at the Alder long before those terms were coined. is what makes us different from non- distress or disharmony caused by the things. Operating Hey Hospital in Liverpool, an aspect of Those of you who are still awake may procedural specialists. We should take loss, or threatened loss, of what we most “ his practice that continued for the rest of realise that I have just gone through the pride in doing it well, and doing it well cherish”, but I think we all have some is what makes his life. nine College competencies. Graham should give us pleasure. What we can understanding of what the word means. us different from My personal contact with Graham was would never have heard of them. Indeed, do is expanding at an amazing rate: Suffering separates the sufferer from the non-procedural through his involvement in paediatric even if he had, I doubt if he would have when you think of what we can do now society and their personal supports such specialists. surgery. In the 1970s he used to come spent much time worrying about them, compared with only 50 years ago when I as family and friends. It destroys daily quite often to the Thursday lunchtime as individuals who excel rarely waste time was a student, one cannot but be amazed, routines, belief systems and core values ” surgical meetings at the Kids Hospital, trying to measure how good they are. and there is little sign that the rate of such as the meaning and purpose of life. then at Camperdown. Doug Cohen and This is not to say that we shouldn’t change is slowing. Hugh Martin, Arch Middleton were the senior members write down what we expect of surgeons. The downside of this is that we are NSW Fellow of the group with Martin Glasson as the We should have some explicit standards. bedazzled by the technical wonders at our young gun. Graham was there not so But writing down a lowest common command. In the past we couldn’t “fix” References much as an expert as his practice did not denominator does not mean that some many things, but, perhaps surprisingly 1. Kearsley J: Therapeutic use of self involve the sort of complex cases that individuals, such as Graham, will not and certainly paradoxically, this didn’t & the relief of suffering. Reprinted in were usually discussed at this meeting exceed the codified standard. mean that medical practitioners were held Surgical News, Vol 12 Number 1, 2011 (although his opinion was always This is so of human behaviour in in low esteem. Indeed, just the opposite. 2. Coulehan J. Compassionate Solidarity. valued), but he was there to maintain his general: laws are a lowest common In all cultures throughout history, healers Perspect Biol Med. 2009; 52:585-603 knowledge. denominator that the society will accept have been held in high esteem. 3. Wilson KG, Chochinov HM, I think it speaks a lot about the man of its members, but most honourable I think the clue to this apparent McPherson CJ, LeMay K, Allard P, Chary that even with his high level of expertise people would have a code of behaviour contradiction lies in the last phrase of that S, et al. Suffering with advanced cancer. in the main area of his practice, he took well above that, a code we could well known saying “...to comfort always”. J Clin Oncol. 2007; 25:1691-1697 the trouble to ensure that all areas of his call ethics or simply being a decent, It is this that makes an individual surgeon professional life were at a high level of honourable human being. For example, a healer, not simply a technician. This lecture is to be expertise. you and I would hope that our word was I believe it is this aspect of patient continued in the next issue My recollections, and those that others binding when we give it even though care that made many of the greats of who knew him better have shared with legally we can abandon an agreement that our profession, like Graham, stand out, of Surgical News.

Page 34 / Surgical News April 2013 Surgical News April 2013 / Page 35 Regional Awards

Congratulations on your achievements

Presented at the NSW End of Year Dinner, held on 14 December 2012 Through the University of Western Sydney, Department of Mechatronics in the faculty of engineering, Patrick was involved Bryan Wheaton Yeo in the development of a touch sensor to develop data in-vivo for 25 April 1938 – 5 May 2012 Kerin Fielding and also a Cordon Bleu Chef, having been successful in Le in-vitro haptic feedback use. ryan graduated from Sydney University in 1961. erin Fielding has been an essential part of the Certificat de Patisserie de Base de l’Ecole Le Cordon Bleu, Patrick’s interest in training surgeons is legendary and most He completed internship at Royal North Shore surgical service in Wagga Wagga since 1992, having Paris 2012 particularly assessing the use of virtual reality and other BHospital in that year. In 1962 he accepted his first Kgraduated from Sydney University in 1982 and Kerin’s parents were both schoolteachers who answered an simulation tools, and he was Medical Director and Chairman appointment at Prince Henry, Prince of Wales Hospitals. been awarded FRACS in 1991. She is a highly accomplished advertisement to teach in Canada when Kerin was 7-years- of the Board of Directors at MedicVision which has developed These hospitals were to become his clinical home for his Orthopaedic and Trauma Surgeon. old. Kerin was educated in Ontario gaining her School effective simulators which are used in Australia and internationally. professional life. Tonight we want to recognise and celebrate her Certificate at Laura Secord Secondary School, St Catherines. Patrick initiated the Medical Simulation Group within the Royal Like so many at that time, he went to England in 1968 to contribution to our College’s activities in NSW and, in At this stage her father returned to Wollongong University Australasian College of Surgeons and has played a significant role complete his surgical training. He held positions at Essex particular, her very significant contribution to Surgical as the Professor of Education and Kerin attended Dapto in SIMTEC and ASERNIP-S assessments. Hospital, Colchester; Guy’s Hospital, London and St. Marks Education. High School for her HSC. She describes the culture shock In this field Patrick was a Visiting Professor to Stanford University where he worked with Lloyd-Davies. So what are some of Kerin’s particular achievements? she experienced. There was a totally different approach to in 2009 in their centre of Immersive and Simulative Learning. He returned to Prince Henry Hospital in 1970 as Senior She was a member of NSW Australian Orthopaedic education with only 47 students in years 11 and 12 in a High Outside the operating theatre Patrick instigated a Registrar and was appointed to the consultant staff the Association Board of Studies for registrar training and term School which was one of the largest in the state. Told by the communication video (“technically brilliant”) which was following year. He was awarded Fellowships of the College supervisor for accredited and unaccredited registrar Trainees school counsellor she should do nursing made her doubly completed with others including Prof Richard West, with the video of Surgeons England in 1967 and the Royal Australasian 2001 -2005 determined to do Medicine and then become a Surgeon. She winning international acclaim in the training of advanced surgical College of Surgeons in 1971. She was a member of AOA NSW state executive became the first pupil to ever enter a Medical Faculty from Trainees in communication skills. Bryan’s clinical interest was Upper Gastrointestinal committee 2003-2009 Dapto High School and there is in the Headmasters office a Patrick was always a leader – the Year Representative at the Surgery with particular interest in surgical diseases of She is currently a Course Director and Instructor trainer small wall plaque commemorating her achievement. Sydney University Medical Society for three consecutive years, the pancreas. He loved all things surgical. He was a for the Early Management of Severe Trauma programme, Kerin, thank you for all you have given to our College and 1973-1975, New South Wales Trainee Representative on the consummate clinician who provided a great deal of support Royal Australasian College of Surgeons. to Surgical Education in NSW. Royal Australasian College of Surgeons, 1980-1981, President of to his colleagues both clinically and emotionally. It was She is Associate Professor, University of Notre Dame Citation provided by Robert Rae the Concord Hospital Residents Association from 1980-1982 always good to see Bryan and share his enthusiasm for life. Australia, School of Medicine Sydney and clinical discipline before a series of positions at Nepean Hospital and the previous A true persevering advocate; there was nothing he would lead for Speciality Surgery, Wagga Wagga Sub-school. Patrick Cregan Wentworth Area Health Services, including the Clinical Director not do to help a patient in need, no matter how menial. However, perhaps her most significant contribution here is no more deserving recipient of the Michael of Surgery from 2000-2004. He had an unfettered fervour for teaching. Teaching has been and continues to be to various institutions that Donnellan Award for 2012 than Patrick Cregan. He Patrick served on the New South Wales State Committee of was his greatest professional passion. He had style that have succeeded the former NSW Post Graduate Medical Thas demonstrated over the years his commitment to the RACS from 1987-1996 including Chairman of the Continuing was humble, but engaging where his enthusiasm for what Foundation. She was a member of the NSW Medical surgery and most particularly surgical leadership. Patrick Medical Education Committee, Chairman of the Standards he did and how he did it was infectious to all who were Education and Training Council MTEC 2003 – 2007 and has, as all real surgical leaders do, extended his influence Committee and was the Secretary from 1993-1996. privileged to be part of it. Chair of the procedural stream (Basic Surgical Training outside of conventional surgical fields and thus enhanced His leadership and innovative skills were recognised when He was the professional yard stick against whom many Project) 2005 – 2007. the role of surgeons in guiding our Health Care System in he was appointed the Inaugural Chair of the New South Wales of us measured our own performance. MTEC evolved into the Clinical Education and Training Australia. Surgical Services Task Force and proceeded to revolutionise the He would have been brimming with pride the day he Institute in 2007 and Kerin became Chair NSW Surgical Following his surgical training at Concord Repatriation process of elective surgical services in New South Wales Hospitals. died. He was in transit to attend the convocation of his son, Training Council which continues under the new Health General Hospital he heeded the advice to “go west young This will be one of his major legacies. David, at the Annual Scientific Congress in Kuala Lumpur. Education and Training Institute formed in 2011. man” rather than heading overseas to obtain his B.A. (Being Although considered by some to be Nepean-centric, Patrick has He probably died the way he wished; fully in harness and In this position her responsibilities cover all of NSW Abroad). His clinical work has remained based at Nepean been a major player in the development of clinical services and in good health. through several surgical skill networks covering all hospitals from 1983 until the present and he has been the catalyst teaching at Nepean Hospital, moving it from a semi-rural district His legacy will be the hands that he has trained and the in NSW that provide prevocational training in Surgery for for the expansion of surgical and subsequently many other hospital when he first accepted an appointment there to a major hearts and minds he has touched of hundreds of surgeons Resident Medical Officers. She has been responsible for clinical services at Nepean Hospital and he is now the teaching hospital of Sydney as it is now recognised. and thousands of medical students. His influence will be the implementation of training programs either developed Chairman of the Board of the Nepean Blue Mountains Patrick has been recognised for his academic pursuits with limitless and timeless. on site in hospitals; e.g. skills laboratories or instructional Local Health Network. Professorial titles at both the University of Sydney and the He was a loving father to Paul, David, Belinda and Anna lectures, seminars or workshops or state wide programmes As a surgeon he was an early and enthusiastic uptaker of University of Western Sydney. and devoted husband to Paula. such as surgical science courses preparing for the College laparoscopy and is now a leader in advanced laparoscopic Patrick Cregan is a true surgical leader and we all congratulate We have lost a teacher, coach, mentor, friend and Surgical Science Exam or courses to develop non clinical surgery. He has been involved in the development of him on his most recent recognition – that of the Michael colleague. The art of surgery has been enriched by his skills. surgical robotics and tele-surgery; Patrick has assessed and Donnellan Award, an award that I am sure will give Patrick much contribution. Kerin is a wife, married to Dr Joe McGirr, a mother of implemented a Virtual Critical Care Unit Programme at a pleasure in receiving. Citation provided by Phil Trusket four children, an enthusiast of all things French, being fluent remote hospital. Citation provided by Brian McCaughan

Page 36 / Surgical News April 2013 Surgical News April 2013 / Page 37 Book review Curmudgeon’s Corner Royal Australasian College of Surgeons 2014 Rowan Nicks Australian & New Zealand Exchange Fellowship

The Rowan Nicks Australian and New Zealand Exchange Fellowship is intended to promote Lion Hearts international surgical interchange at the An accomplished addition to the list levels of practice and research, raise and Winner maintain the profile of surgery in Australia of 2011 and New Zealand and increase interaction Bialystok was in Czarist Russia; business between Australian and New Zealand surgical later it was German, then Polish, excellence communities. then Russian, then German and finally Polish again after award The Fellowship provides funding to assist a New 1945. Lonek grew up and lived Zealander to work in an Australian unit, or an Rooms With Style Australian to work in a New Zealand unit, judged through all this turmoil. by the College to be of national excellence for a However, Harry has not offers 3 core period of up to one year. simply told the story of a man services exclusively who lived through extraordinary for Surgeons Applicants must have gained Fellowship of times, although that story clearly the RACS within the previous ten years on the comes through. We learn of his >Medical Fitouts closing date for applications. father’s childhood and being a >Practice Selection Criteria lawyer before the war, surviving Management The Committee will the war in Southern Russia, Consulting – consider the potential of the applicant to emigrating to Australia in 1947, become a surgical leader and ability to setting up a successful small No phone home? >Recruitment provide a particular service that may be business here, and living to 95. deficient in their chosen surgical discipline. But this story which Harry Mobile, but not easy – assess the applicants in the areas of surgical weaves is also brilliantly told by Call today ability, ethical integrity, scholarship and enry R. (Harry) relating the stories of more than here is one thing that that is a really cheap phone. to find out how leadership. Lew is a quiet, 20 other people with whom his really annoys me and As I left the shop I asked we can tailor our The Fellowship is not available for the purpose Hunassuming senior father interacted at different Tthat is marketing, and what happens after 24 services to suit of extending a candidate’s current position in ophthalmologist, with a wry stages of his life. This wonderful in particular the marketing months and that is where Australia or New Zealand. smile and a mischievous sense device brings in a host of of mobile phones. I recently it gets complicated. You can your practice. Value: Up to $75,000 pro-rata, depending on the of humour. One would not intimate details and texture bought an iPhone 5. Yes, we change to another carrier funding situation of the candidate and provided guess that behind this lies about life in Poland before and curmudgeons are tech-savvy! (or “port” your number as 1300 073 239 sufficient funds are available, plus one return an author of considerable after the war and the struggles I was aware that they were they say) or take out a new [email protected] economy airfare between Australia and New skill. His previous, highly and triumphs of survivors of about $800 in the US and I plan with Telstra. You can www.roomswithstyle.com.au Zealand. successful books have included those terrible times. thought that I could simply be sure that new plan will Tenure: 3 - 12 months an historical novel and two The result is a fascinating call in to my local Telstra be more expensive. What biographies of little known and informative book, well shop and buy one. However, happens to your MRO? early Australian modernist written, extensively researched that lovely sales assistant said That will cease, but the MRO bonus artists whose work he has and a great read. As Sir Michael they were not selling them. This will also cease and so your new Further Information assiduously collected. Holroyd, one of Britain’s leading seemed to be a disaster for a phone plan, if you do nothing, is $60 per Application and instructions will be available from the College website from These books were followed biographers has said about it, shop to not sell phones as I would month. Now that means that they Surgical News December 2012: www.surgeons.org by a brilliant, collaboratively “…the story embraces us all. It have thought that was their core have sold you a really cheap phone, welcomes Closing date: 5pm Monday 6 May, 2013. translated first-hand account of deserves a wide readership”. business. but sold you a contract for on-going Applicants will be notified of the outcome a Holocaust survivor originally Hugh R Taylor, They will allow you to enter a charges that are artificially inflated. letters from by 30 October 2013. written in Yiddish, ‘The Stories Victorian Fellow two year contract with one of their Most people will simply continue Our Parents Found Too Painful iPhones for $67 per month which the contract by default after the 24 readers. Please contact: To Tell’, which subsequently was Professor Hugh R Taylor AC, includes a fee of $17 per month months. Please write to The Editor, Secretariat, Rowan Nicks Committee made the subject of an ABC Melbourne Laureate Professor, for “MRO” or mobile repayment So there you go, Mr Telstra wins Surgical News, Royal Australasian College of Surgeons telemovie. Harold Mitchell Chair of option. Now I assume that is the the day – but you can always go to Royal Australasian 250 - 290 Spring Street, In his new book, ‘Lion Hearts’, Indigenous Eye Health, cost of the phone. $17 for 24 months see Mr Optus who no doubt will East Melbourne VIC 3002 College of Surgeons, he has outdone himself. The Melbourne School of Population is $408 so that is a cheap iPhone. have a special deal if you “port” to Email: international.scholarships@ 250-290 Spring St, E book is fascinating. It basically and Global Health, However, the generous people at them, which no doubt will have an surgeons.org ast Melbourne. Vic 3002 tells the life story of his father, University of Melbourne, 207 Telstra also give you a $10 per “MRO” or a “BBRO” charge. In case Phone: + 61 3 9249 1211 or [email protected] Fax: + 61 3 9276 7431 Lonek (or Leo), who was born Bouverie Street, Carlton, 3053. month MRO bonus discount so you don’t know, BBRO is technical in Bialystok in 1907. At that time www.iehu.unimelb.edu.au over 24 months you pay $168 – now language for blasted big rip off.

Page 38 / Surgical News April 2013 Surgical News April 2013 / Page 39 Yes, I would like to donate to our Foundation for Surgery

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Your skill. I would like my donation to help support: Your legacy. General Foundation Programs International Development Programs Thank you Scholarship for and Fell oyourwship Programs donations Indigenous Health Programs I have a potential contribution to the Cultural Gifts Program Your I do not give permission for acknowledgement of my gift in any College publication Please send your donation to: FouAustraliandation. AUSTRALIA & OTHER COUNTRIES NEW ZEALAND Foundation for Surgery Foundation for Surgery Dr Renata Abraszko Mr250 Ronald - 290 Sprin Brodyg Street POMr Box 745Gerard1 Coren Fearnside AM Dr Christopher Allan AssocEast Melbo Profurne Brian , VIC 300 Brophy2 Newtown,Prof Ross 6242 WCrawfordellington Mr Alan Ferguson Mr David Allison MsAustralia Belinda Brown NewMr Zealand Andrew Crocker Mr Gary Fermanis Dr David Anderson Mr Maurice Brygel Mr Alan Crosthwaite Prof David Fletcher Dr Vikija Andersons Mr Geoffrey Buckham Dr Richard Curran Prof John Fletcher Dr Bee Ang Dr Kim Bulwinkel AO Mr Geoffrey Curtin Mr Stephen Floreani Mr Frank Anning Mr Peter Burke Dr Jonathan Curtis Mr Michael Fogarty Mr Adrian Anthony Mr Anthony Burneikis Dr Sami Dayoub Mr James Galbraith OBE Mr Stephen Archer Prof Brian Buxton AM Mr Alan De Costa Assoc Prof Alan Gale Dr Michelle Atkinson Mr Peter Byrne AM Prof Richard De Steiger Mr John Garvan Assoc Prof Rupert Atkinson Dr Bruce Caldwell Mr Samson Dean Mr Robert Gates Mr Ting Au Prof Abraham Campero Prof Stephen Deane Dr Trevor Gervais Mr Christopher Bambach Mr Robert Carey Prof Leigh Walter Delbridge Dr Katherine Gibson Mr Jonathan Bare Assoc Prof Hugh Carmalt Mr Terence Devine Mr Michael Gillespie Mr Frederick Bartholomeusz Mr Lawrence Carroll OAM Mr Richard Dickinson Dr Anthony Glover OAM, RFD Assoc Prof Phillip Carson Mr Simon Donahoe Mr Jerome Goldberg Dr Renata Bazina Mrs Ann Carter Dr Eric Donaldson Prof Glen Gole Mr Antony Beeley Dr Anne Cass Mr Michael Donovan Mr Ian Gollow Dr Margaret Beevors Mr Kevin Chambers Mr John Douglas Mr Andrew Gong Mr Stephen Bell Mr David Chan Mr Armin Drnda Dr Carlos Gonzalvo Mr Ross Benger Assoc Prof Richard Chard Mr Douglas Druitt Mr Paul Goodman Dr Paul Bennett Mr Wai-Ting Choi Dr Francois Du Toit Mr John Gooey Mr Ratnakar Bhattacharyya Dr Kelvin Choo Dr Ertugrul Durmush Mr Ralph Gourlay Mr Michael Bickford Mr Chun-Hung Chow Mr Marshall Eastman Prof Herbert Graham Mr Stephen Blamey Dr Christina Choy Mr James Elder Mr John Grant AO,OBE Mr David Blomberg Mr John Christie Mr James Emmett Mr Peter Grant Assoc Prof Desmond Bokor Mr Anthony Ciccocioppo Mr Albert Erasmus Mr Peter Gray Mr Anthony Bookallil Mr William Clark Mr Max Esser Mr Angus Gray Dr Hilary Boucaut Mr Graeme Clarke Mr Anthony Ethell Mr Peter Gray Mr Ross Boulton Dr Heather Cleland Mr Adrian Farinelli Mr Emmanuel Gregory Dr Bernard Bourke Mr David Close RFD Dr Ian Farmer Dr Michael Gross Dr Peter Bovey Assoc Prof Andrew Cochrane Mr Eric Farmer Mr Peter Grossberg Mr Conrad Brandt Dr Philip Colman Mr Alan Farnsworth AM Dr Mark Haber Dr Borislav Brankov Dr Catherine Cord-Udy Assoc Prof Michael Dr Ashutosh Hardikar

Surgical News April 2013 / Page 41 Foundation for Surgery

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Name: Address: Telephone: Mr Brent Uren Mr Peter Wilson Dr Catherine Mary Ferguson McMillan Email: Speciality: Mr Wade Harper Mr Ghulam Khan The Estate of Dr John Egan Mr Philip Scarlett Prof John Harris AM Kimberley Foundation Moulton Dr David Schache Mr Peter Van Duren Dr Gregory Witherow Dr Gordon Ramsay Craig Dr Alex Douglas Rutherford Enclosed is my cheque or bank draft (payable to Foundation for SurgeryMr) for Robert$ Harris. Assoc Prof Francis Kimble Mr Charles Murphy Assoc Prof Margaret Mr Peter Van Gelderen Mr Benjamin Witte Howie Mr Ian David Stewart Mr John Harris Mr Michael King Mr Leslie Nathanson Schnitzler Prof Richard Vaughan AM Dr Hugh Wolfenden Mr Ravindranath Rao Ullal Mr Julian Blair White Please debit my credit card account for $ . Prof John Preston Harris AM, Mr Stephen Kleid Mr Gary Nattrass Dr Joseph Schoeman Mr Subramaniam Vigna- Mr Robert Wong Mr Ross Henry Roberts Mr Gary Leon Stone Mastercard Visa AMEX Diners Club NZ BankcardMr Stewart Hart Mr Neill Kling Mr Hanh Nguyen Dr Heinrich Schwalb Rajah Mr Alexander Wood Mr Hugh Shackleton Cooke Mr Nicholas David Mowbray Mr Robert Hartemink Mr James Kong Mr Gary Nielsen Dr Christopher Scott Dr Laurencia Villalba Mr Christopher Worthley Mr Roy Andrew Craig Finnis Credit Card No: Dr Megan Hassall Expiry / Mr George Kourtesis Mr Markus Nikitins Mr Davendra Segara Dr Marian Vrtik Dr Yi Xie Mr Duncan Scott Stevenson Mr Peter Jaan Raudkivi Mr Michael Haybittel Mr Melvyn Kuan Mr Arjuna Nirmalananda Dr Lali Sekhon Dr Forest Waddell Mr Allen Yeo Mr Vipul Upadhyay Mr Jeffrey Mark Robinson Your passion. Card Holder’s Name - block letters Card Holder’s SignatureMr Lawrence Hayden Date Prof Markus Kuster Dr Brian Noll Mr Shibu Sen Gupta Mr William Walker OAM Mr David Young Mr Michael Koi Young Mr Gavin Neil Wilton Your skill. I would like my donation to help support: Mr Erik Heineman Dr Hui Lau Prof John Edgar Norman AO Dr Robert Sharp Dr Faye Walker Dr Keith Zabell Mr Christopher Michael ONZM, Dr Andrew Zacest Your legacy. General Foundation Programs InternationalDr Dev Jonathanelopment Prog Hemlirams Mr Pui Lau Dr John North Mr Peter Sharwood OAM, RFD Dr William Walter Holdaway ED, Scholarship and Fellowship Programs Indigenous HealthMr Craig Programs Hendry Mr Po Lee Prof Paul O’Brien Mr David Simons Prof Allan Wenli Wang Mr Avdo Zahirovic Miss Philippa Mary Mercer I have a potential contribution to the Cultural Gifts ProgProfram Alan Hewson AM Mr Paul Leong Mr John O’Brien Mr Sanjay Singh Mr Jonathon Wardill OAM Mr Hans Robert Stegehuis Your I do not give permission for acknowledgement of my giftMr in anyHenry College Hicks publication Dr Alfred Lewis Mr Richard O’Connor Mr Adam Skidmore Mr Michael Warner New Zealand Mr Adrian John Nicholas Please send your donation to: Mr Peng Ho Mr George Lewkovitz Mr David Oliver Mr Denis Smart Mr Darren Waters Mr John McDonald Folwell Total: Foundation. AUSTRALIA & OTHER COUNTRIES NEW ZEALAND Prof Yik Ho Dr Donald San Liew Mr Keith Ong Prof Julian Smith Dr Matthew Wilkinson Mr David Charles Raymond Mr Andrew Alexander Hill Foundation for Surgery Foundation for Surgery Mr John Hogg OAM Prof David Little Mr Orso Osti Prof Paul Smith Mr Simon Williams Adams Dr William Mitchell 250 - 290 Spring Street PO Box 7451 $68,000 East Melbourne , VIC 3002 Newtown, 6242 Wellington Mr Michael Holt Mr Kwok Liu Mr Geoffrey Painter Mr George Somjen Australia New Zealand Mr Stephen Honeybul Mr Jonathan Livesey Dr Hugh Paterson Mr Khee Soo Mr Henry Hook Dr David Love Mr Anthony Patiniotis Mr John Spillane Assoc Prof Nigel Hope Dr Matthew Lyons Assoc Prof Elizabeth Prof Michael Stacey Mr Bernard Horan Mr Jacobus Malan Penington Mr George Stening Mr Kym Horsell Mr Gregory Malham Mr John Percy Dr Andrew Stevenson Yes, I would like to donate Mr Charles Horvath Dr Aylwyn Mannell Mr Anthony Perks Mr David Stoney to our Foundation for Surgery Mr Desmond Hughes Mr George Marcells Dr Grant Phillips Dr Mark Strahan Mr Andrew Hunn Dr Andrew Martin Ms Meron Pitcher Assoc Prof Jonathan Stretch All donations are tax deductible Prof John Hutson AO Mr Richard Masters Mr Kenneth P’ng Dr Kate Stringer Dr Wisam Ihsheish Mr Niall McConchie Mr Peter Pohlner Dr Neil Strugnell Name: Mr David Innes Mr Hunter McEwen Dr Timothy Porter Mr Kenneth Stuchbery Address: Telephone: Mr Peter Isbister Dr Michael McGlynn OAM Mr James Powell Mr Unis Suliman

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Page 42 / Surgical News April 2013 Surgical News April 2013 / Page 43 advertisement All Books now Welcome to the Surgeons’ Bookclub 25% discount

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Page 44 / Surgical News April 2013 Surgical News April 2013 / Page 45 Developing a Career in Academic Surgery Monday 6 May 2013, 7.00am – 4.00pm Royal Australasian College SKYCITY CONVENTION CENTRE AUCKLAND, NEW ZEALAND of Surgeons 2014 Rowan Nicks Pacific Provisional Program 7:00am Registration and Breakfast Islands Scholarship & 2014 7:15am Welcome ...... Michael Hollands (RACS President) Introduction ...... Andrew. . . Hill. (Auckland) Rowan Nicks International SESSIoN 1: GENERAl PRINCIPlES Chairs: Mark Smithers (Brisbane) and Julie Ann Sosa (Durham, USA) Scholarship 7:30am What is a career in academic surgery? ...... John . . Windsor . (Auckland) 7:50am Research - How to get research started - ideas, grants, ethics and collaboration ...... Russell Gruen (Melbourne) 8:15am Academic surgery - the essentials - teaching, leadership and administration ...... Timothy. Pawlik (Baltimore, USA) 8:40am Discussion The Royal Australasian College of Surgeons Applicants for the International Scholarship must 9:00am MoRNING TEA invites suitable applicants for the 2014 Rowan be a citizen of one of the nominated countries SESSIoN 2: ToolS oF ThE TRADE Chairs: Eric Kimchi (hershey, USA) and Richard hanney (Sydney) Nicks Scholarships. These are the most listed on the College website from December 2012. 9:15am hoT ToPIC IN ACADEMIC SURGERy - Stem Cells ...... Julie. . . Ann Sosa (Durham, USA) prestigious of the College’s International Awards 9:35am Bedside to bench to bedside ...... Lillian . .Kao . (Houston, USA) Applicants for the Pacific Islands Scholarship and are directed at surgeons who are destined to 9:55am Basic science ...... Carlton. . . .Barnett (Denver, USA) must be a citizen of the Cook Islands, Fiji, 10:15am Randomised clinical trials ...... Andrew Hill (Auckland) become leaders in their home countries. Kiribati, Federated States of Micronesia, 10:35am Comparative effectiveness research ...... Justin. . . Dimick (Ann Arbor, USA) 10:55am Surgical education/simulation ...... Jeffrey Hamdorf (Perth) The Scholarships provide opportunities Marshall Islands, Nauru, Papua New Guinea, 11:15am Discussion for surgeons to develop their management, Samoa, Solomon Islands, Tonga, Tuvalu or 11:30am lUNCh leadership, teaching and clinical skills through Vanuatu; 12:30pm KEyNoTE PRESENTATIoN - An Antipodean academic odyssey - between the siren call and the rocks Charles McGhee (Auckland) clinical attachments in selected hospitals in SESSIoN 3: CoNCURRENT ACADEMIC WoRKShoPS: Selection Criteria Australia, New Zealand or South-East Asia. – The Committee will consider the potential Workshop 1: Interactive Workshop on Workshop 2: Career Development Workshop 3: Presenting your Work Issues in Research Chairs: Russell Gruen (Melbourne) and Chairs: lillian Kao (houston, USA) Applicants for the Rowan Nicks International and of the applicant to become a surgical leader Chairs: Mark Smithers (Brisbane) David Watson (Adelaide) and Arthur Richardson (Sydney) Pacific Islands Scholarships must: in the country of origin, and/or to supply a and Julie howle (Sydney) I want to be an academic surgeon . 1:00pm Writing an abstract – commit to return to their home country on much-needed service in a particular surgical 1:00pm Getting the most out of a team What can I do as a: Eric Kimchi (Hershey, USA) 1:00pm Medical Student 1:15pm Writing a paper completion of their Scholarship; discipline. Justin Dimick (Ann Arbor, USA) 1:20pm Multiple Faculty Deborah Wright (Auckland) Rebecca Sippel (Madison, USA) – meet the English Language Requirement for – The Committee must be convinced that the Justin Dimick (Ann Arbor, USA) 1:15pm Intern 1:45pm Presenting a talk medical registration in Australia or New Zealand applicant is of high calibre in surgical ability, Marc Gladman (Sydney) Carlton Barnett (Denver, USA) Michael Edye (Sydney) 1:30pm SET Trainee 2:00pm Producing a poster (equivalent to an IELTS score of 7.0 in every ethical integrity and qualities of leadership. Jeffrey Hamdorf (Perth) Gregory O’Grady (Sydney) Eric Kimchi (Hershey, USA) category); – Selection will primarily be based on merit, with Timothy Pawlik (Baltimore, USA) 1:45pm Fellow 2:15pm Discussion Win Meyer-Rochow (Hamilton) – hold a Master of Medicine in Surgery, or his/ applicants providing an essential service in remote Julie Ann Sosa (Durham, USA) 2:00pm Consultant her country’s post-graduate qualification areas, without opportunities for institutional Susan Neuhaus (Adelaide) in surgery. However, consideration will be support or educational facilities, being given 2:20pm Discussion given to applicants who have completed local earnest consideration. 2:40pm AFTERNooN TEA general post-graduate surgical training, where Value: Up to $36,000 pro-rata, plus one return SESSIoN 4: A CAREER IN ACADEMIC SURGERy appropriate to the needs of their home country. economy airfare from home country Chairs: Andrew hill (Auckland) and Timothy Pawlik (Baltimore, USA) – be under 45 years of age at the closing date for 3:00pm Choosing and being a mentor ...... Mark. . Smithers. (Brisbane) Tenure: 3 - 12 months applications. 3:20pm Work-life balance ...... Julie. . Howle . . (Sydney) 3:40pm On the shoulders of giants - The legacy of the Otago University Department of Surgery . . . . . Andre. van Rij (Dunedin)

Registrants receive a complimentary copy of Success in Academic Surgery (Part 1) edited by Herbert Chen and Lillian Kao.

Further Information Proudly sponsored by: Application forms and instructions are available from the College website: www.surgeons.org Presented by: Closing date: 5pm Monday 6 May, 2013. Association for Academic Surgery in partnership with the Royal Australasian College of Surgeons, Applicants will be notified of the outcome of their application by 30 October 2013. RACS Section of Academic Surgery Section of Academic Surgery

Please contact: Secretariat, Rowan Nicks Committee Cost: $265.00NZD (inc NZ GST). Royal Australasian College of Surgeons , 250 - 290 Spring Street, East Melbourne VIC 3002 Register on the ASC registration form or online at asc.surgeons.org Further Information: E: [email protected] T: +61 3 9249 1273 E: [email protected] P: + 61 3 9249 1211 F : + 61 3 9276 7431 Program correct at time of printing (March 2013), however the Organising Committee reserve the right to change without notice.

Page 46 / Surgical News April 2013 Surgical News April 2013 / Page 47 ADVANCED ALLERGY PROTECTION & SENSITIVITY

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