2009 This view of the University of Melbourne was taken in the 1960s during the construction of the Medical Building. Many changes to the University landscape can be seen when compared to a similar photo, taken in 1942 (see page 25) and the one on our back cover, which was taken earlier this year. CONTENTS 1 22 COVER THE VALUES OF A MEDICAL EDUCATION REUNIONS FRONT: James Best 1941, 1944, 1949, 1958, 1978 Anatomy students in a ‘body painting’ class 2012 Reunions and Medical School run by senior lecturer Jenny Hayes. Haylee memories Walsh learns about the nerves and vessels 2 of the head and neck by painting them on A PLACE FOR ETHICS 24 fellow student Baotuti Sebolao. Graham Brown, Richard Smallwood, MEDICAL MEMORIES Loane Skene, Lynn Gillam, Jeffrey D Zajac, BACK: James Guest and Jenny Hayes This recent photo shows the Melbourne Paul Stewart, Jim Black, Dave Carmody, Medical School building, the Howard Aaron Wagen 26 Florey and Microbiology and Immunology OBITUARIES buildings and the building site of the 10 Parkville Neuroscience Facility. The old MELBOURNE MEDICAL SCHOOL Dental Hospital (bottom right-hand corner) is 33 currently under demolition and will become Appointments and Departures FROM OUR COLLECTION the site of the Parkville Comprehensive A monument is uncovered, Brownless Cancer Centre. 12 Biomedical Library redevelopment MEDICAL TEACHING AND LEARNING IN THE 21ST CENTURY 35 Jenny Hayes, Geoff McColl, Sarah IN BRIEF Wonseelashote, Chance T Pistoll, Christine Congratulations, Student Prizes and Awards, Mandrawa 2008 Dean’s Honours List, Participants Chiron is published by the Melbourne needed, Books Medical School. Contributions from staff, students and alumni are welcome. Enquiries 17 and correspondence should be sent to the ALUMNI STORIES editor, Liz Brentnall, Advancement and Nick and Hannah Mason, Charles Mullany, Communications Unit, Faculty of Medicine, Richard Pestell Dentistry and Health Sciences, 4th floor, 766 Elizabeth Street, The University of 21 Melbourne, 3010, Australia. MELBOURNE MEDICINE: 150 YEARS T: (+61 3) 8344 5888 E: [email protected] W: www.medicine.unimelb.edu.au/umms/ index.html Designed by Artwords Pty Ltd www.artwords.com.au ISSN 0814-3978 © THE UNIVERSITY OF MELBOURNE 2009

CHIRON 2008 1

THE VALUES OF A MEDICAL EDUCATION

JAMES BEST

‘competency based training’ some seek to The poignant article on Canute Henry impose on universities and their medical Clowes reminds us to value each one of schools. our students and we are very grateful to Another of our erudite alumni, those who choose to contribute for the recently retired vice chancellor of Monash benefit of future students. University, Richard Larkins, addressed I congratulate those who are graduating these issues more broadly in his University this year and hope that you will maintain of Melbourne 2009 Menzies Oration, close links with your medical school. I am entitled Universities: the Foundation of sure we can do more to engage you with Civil and Successful Societies. He warns of your alma mater and hope in particular, the risk of reproducing ‘the errors of the that you will become involved in some of recent past where the things that can be our celebratory activities leading up to and easily measured rather than the things that during the Melbourne Medical School’s really matter become the determinants of 150th anniversary in 2012. both evaluation and behaviour’.* To a significant extent we are In Franz Kafka’s short story, A Country considered one of the world’s great Doctor, he writes: ‘To write prescriptions is medical schools because of our alumni, easy, but to come to an understanding with whose achievements and contributions are people is hard’. Outstanding examples of James Best so prominent and numerous. Exceptional both the capacity for self reflection and an lives and medical careers are recorded in Chiron the centaur was a great healer, understanding of people are provided by this issue, several tragically shortened famous for his knowledge and skill with the medical student elective essays and by by accident and natural disaster. What medicine. Highly revered as a teacher and reports from Nick and Hannah Mason and a remarkable range of individuals have tutor he is described as being intelligent, Charles Mullany. come through medicine over the years and civilised and kind. Among his many famous I worked with Charles as an intern how well their lives embellish the ethos of pupils was the god of medicine, Asclepios, when he was a surgical registrar at St Australian medicine. whose staff with serpent entwined is one Vincent’s Hospital and was surprised Because of our deserved reputation to receive a letter from him earlier this of medicine’s most recognised symbols. we attract outstanding professorial year describing his career change after 22 Appropriately, medical education is the appointees, nationally and internationally, years as a leading cardiac surgeon at the key theme for our 2009 edition of Chiron, but diminishing resources make it Mayo Clinic. Correctional health must with an emphasis on its effect on the lives increasingly difficult to maintain be one of the most challenging areas of of our pupils. excellence. If we are to be highly regarded Geoff McColl’s article draws our focus medical practice and, although he does not internationally we must be competitive onto the attributes or qualities we wish for mention it, Charles was prompted by a at the international level in our ability to in our medical graduates. These include a desire to ‘give back’ to society. His move support academic staff, particularly when capacity for self reflection, the ability to between two such radically different areas they take up chairs with the responsibility deal with complexity and uncertainty, of medical practice was made possible of leading a department. The support of qualities of leadership, and a strong sense by the sound knowledge base in his our alumni is greatly valued and we will of the ethics and responsibilities that medical education. We are committed to seek to provide more specific opportunities must underpin the practice of medicine. maintaining this flexibility in our students to engage your support in this area over Several articles in this issue describe our through outstanding teaching in the the next year. ethics seminars which address issues scientific basis of medicine as well as in its I hope you enjoy reading this edition we now expect our medical students to clinical practice. of Chiron and that it informs you well contemplate and discuss. We have worked closely with our about our medical school. I wish all of you While developing these qualities has medical students’ society this year and I fulfilment and success in the coming year. always been part of both the official and hope to extend the interaction over coming unofficial curricula, the new graduate years. Christine Mandrawa and her fellow Professor James Best is Head of the Melbourne course to begin in 2011 will recognise students have contributed selflessly to Medical School and seek to develop these attributes more many medical school committees and * Richard Larkins’ Menzies Oration can be explicitly. These are not skills to be learnt workshops, including those supporting found online at: http://www.trinity.unimelb. online or from textbooks as part of the development of the new medical course. edu.au/news/2009/assets09/20091027-1

CHIRON 2009 A PLACE FOR ETHICS ON ALL GREAT SUBJECTS MUCH REMAINS TO BE SAID. John Stuart Mill

GRAHAM BROWN AND RICHARD SMALLWOOD AO

The annual medical ethics seminar, held in the Sunderland Lecture Theatre, attracts large audiences from the medical and associated professions.

In 1985 the then Faculty of Medicine at the University of Melbourne ran a seminar genetically modified organisms. The entitled ‘AIDS (Acquired Immune Deficiency Syndrome) and Its Implications for Medical increased accessibility of information Practice’. The seminar, chaired by Professor Graeme Ryan, heard from Professor David through electronic communication and Penington (then Dean of the Faculty and Chairman of the National AIDS Task Force) and data storage has brought problems of Dr Ian Gust (then Director of the Virology Laboratory at Fairfield Hospital). The following privacy and confidentiality. New situations year, another seminar, ‘Ethics at the Growing Edge of Medicine’ was held as part of that have emerged to revive old debates about year’s Dean’s Lecture Series. Convened again by Graeme Ryan, then Dean of the rights of individuals in a liberal society, Faculty, the seminar heard from Professor Emeritus Richard Lovell and Dr Davis McCaughey, and the intrusion into medical research then Governor of Victoria. and practice by government, advertising From these events was launched a series of seminars exploring ethical themes and issues agencies, the pharmaceutical industry, pertinent to the study, practice and research of medicine, which have since formed part of or others who choose to support medical each year’s series of dean’s lectures. As we move towards the 150th anniversary of the research. Melbourne Medical School in 2012, we take this opportunity to ask past and current seminar In 1982, the National Health and contributors and current staff and students to reflect on some of the issues considered in Medical Research Council (NHMRC) these seminars over the years, beginning with the thoughts of two past seminar conveners; set up a working party on ethics in Richard Smallwood and Graham Brown. Before entering into this reflection, however, we might allow the closing comments of medical research, which was chaired by Davis McCaughey’s ethics seminar address in 1986, to presage the discussion: Professor Richard Lovell, and which A good ethical discussion will range over a wide series of considerations. Old wisdom subsequently became the Medical and new demands will cast light one upon another until there emerges that consensus Research Ethics Committee (MREC) of on which formulated conventions depend. It is not necessary for medical scientists to be the NHMRC. Stimulated by the work of dragged screaming through every page of Aristotle or Kant, any more than it is necessary MREC, Professor Lovell, with Professor for lay members of an ethics committee to understand every scientific process involved in Graeme Ryan, the then Dean, decided the experiment. It is necessary, if conventions are to be formulated, that men and women in 1986 to establish an ethics forum in of different backgrounds and skills should be willing to sit down and talk and listen. And the University of Melbourne in which when we have done that, we shall still remember the dictum of John Stuart Mill: ‘On all great contemporary ethical issues, particularly subjects much remains to be said’. (Chiron, 1987, p.10) those that were to appear before the law or other regulatory bodies, could be debated A university environment provides an ideal Over the 23 years that the seminars freely by experts in the field. He saw the place to discuss issues of contemporary have run, the burning ethical issues have advantage of bringing together experts ethics, separated from politics and the evolved, in part due to advances in medical from disciplines of medical research, law, where opinions can be expressed, science and technology. For example, medical practice, the law, and ethics, so debated and reconsidered by an audience the revolution in molecular biology has they could inform, amongst others, the of professionals and informed lay people. enabled genetic testing and creation of lay community, particularly people who

CHIRON 2009 A PLACE FOR ETHICS 3

may be asked to sit on ethics committees the rights of citizens to equitable outcomes Richard Smallwood, AO, Professor of of medical institutions or research bodies. in health care. Medicine at the Austin and Repatriation The ethics seminars have become a point Revisiting the topics covered in Medical Centre (1990-99), convened the Dean’s Lecture Series Ethics Seminars from of great interest for Australians involved these ethics seminars is a reminder that 1993 to 1999 and was Chief Medical in contemporary ethics, and it is timely the conflict between the rights of the Officer for the Commonwealth of Australia to reflect on the topics that have been individual and a utilitarian approach to (1999-2003). He is currently Professor discussed, decisions made, and outcomes the needs of society will always provide Emeritus of Medicine at the University of or advances that were predicted in these dilemmas for those in authority or those Melbourne. symposia. needing to make decisions to achieve the Graham Brown, James Stewart Professor of In the first group of symposia greater good. Medicine and Head of the Department of Professors Ryan and Lovell convened Many themes are recurrent, but Medicine at Royal Melbourne and Western panels composed of experts and new issues will arise as medical science Hospitals (1999-2007), convened the Dean’s Lecture Series Ethics Seminars from 2000 to community members and considered advances and community attitudes and contemporary issues in medical ethics, 2006. He has been Foundation Director of expectations change, so the debates will go the Nossal Institute for Global Health since its examining the first of recurring themes of on. We should all pay tribute to Professors establishment in 2006. privacy in medicine, resource constraints Ryan and Lovell for their foresight in in the practice of medicine, and issues in establishing this landmark calendar event transplantation. of the Dean’s Lecture Series. Professor Smallwood’s era considered the ethics related to ‘end of life’ decisions and caring for severely disabled or DEVELOPMENTS IN GENETIC AND STEM CELL dying children. Two seminars dealt with RESEARCH IN THE LAST 25 YEARS questions that arose with the revolution in genetics, both as a general proposition, and with particular implications for genetic LOANE SKENE testing and the right to know or not to In 1984, the state of Victoria became the develop. The stem cells produced from know the results of individual testing first jurisdiction in the world to legislate on that entity would be almost a perfect that may be of relevance to others. The IVF after a series of careful reports by the ‘match’ for the person whose body cell ‘hypothetical’ format, where an expert Waller Committee canvassing community was used. The cells should not be rejected panel was quizzed by a moderator, was opinion. Many were wary—even openly by the person’s immune system if they first used when issues of consent and critical—of the new technology. Today, were transplanted back to the person in confidentiality in adolescent health were IVF is routine and thousands of babies treatment and the person could avoid a debated. have been born from IVF around the lifetime of the immunosuppressive drugs Professor Brown further developed world. that are needed after transplants of cells the hypothetical format, including on There have been similar fears and derived from donated tissue. However, one occasion using a hypothetical ethics ethical concerns about human stem cell SCNT involves the deliberate creation of committee to discuss issues of ownership research especially where stem cells are a human embryo in order to destroy it, of tissue, the ethics of embryonic stem cell derived from human embryos. In 2002, which many people condemn even more research, and whether Australia needed a federal legislation was enacted to permit than the use of donated embryos for moratorium on this work. One seminar donated human embryos to be used in research. was devoted to the ethics of the interaction research if people undergoing fertility A later advance in stem cell research between medical practitioners, medical treatment no longer needed them. Some avoids the ethical issues of creating or researchers and the pharmaceutical states, like Victoria, allowed donated using human embryos in research. In industry, with particular emphasis on the human embryos to be used in research 2006, Professor Shinya Yamanaka of potential risks of ‘conflict of interest’ in much earlier. However, many people Kyoto University converted adult mouse research and medical practice. A further objected to embryo research, believing cells into induced pluripotent stem (IPS) topic concerned research in cross-cultural that human life starts at conception. cells without creating an embryo and he settings at home and abroad, in particular Embryos that are not needed for fertility and other scientists (including Australian the ownership of data and implications treatment, they say, should be allowed to scientists) have since derived human IPS of outcomes for different cultures. The ‘succumb’—to die naturally. cells from human skin cells for research. questions of ‘designer babies’, ‘advanced Ethical objections to embryo research At present, embryonic stem cells are care directives’, and ‘end of life’ decisions became more intense when scientists believed to have greater flexibility and were also raised again. were able to create embryos by somatic potential than IPS cells but that could In the series now being convened cell nuclear transfer (SCNT, the ‘Dolly change as research progresses. by Professor Zajac, the ethics of organ technique’). Scientists removed the Over the last two years, pluripotent transplantation and the ongoing issue nucleus of a donated human egg, replaced stem cells derived from embryos and from of rationing of health care have been it with the nucleus of a person’s body cell body cells have been differentiated into considered, particularly in the context of (such as a skin cell) and stimulated it to other types of cells that may be needed to

CHIRON 2009 4 A PLACE FOR ETHICS repair particular types of tissue, such as for donating their eggs for research; or reviewed again by a federal committee neural precursor cells, cardiomyocytes and that animal eggs might be used to gestate (yet to be appointed). The law may then be haematopoietic (blood forming) precursor human material to derive human stem further amended in the light of scientific cells; and Professor Doug Melton from cells for research (both currently unlawful developments and changing community Harvard University reported last year in Australia, but lawful in the US and attitudes. that he had been able to ‘short-circuit’ the the UK respectively). Next year, three Loane Skene LLD (Melb), LLM (Mon), Professor process of re-programming an adult cell years after the Lockhart Committee’s of Law, Melbourne Law School, and Adjunct into a differentiated cell of another kind in recommendations were implemented in Professor, Faculty of Medicine, Dentistry and mice through a process he termed ‘lineage amendments to the federal legislation, Health Sciences, University of Melbourne, was reprogramming’. the Australian legislation on human Deputy Chair of the Lockhart Committee on In time, it is hoped that stem cell cloning and stem cell research will be Human Cloning and Embryo Research, 2005. research will lead to treatments for a range of human conditions, such as spinal cord injury, heart disease, diabetes, vision AUTONOMY AND CONSENT: THE PERENNIALS disorders, Parkinson’s and Alzheimer’s OF ETHICS diseases. Critics who question whether such treatments will come—or should LYNN GILLAM be permitted—should remember that the concept of treating patients by Medical ethics covers a great range of transplanting healthy stem cells to topics: from end-of-life decision-making stimulate the repair of diseased tissue has to privacy for adolescents seeking been established for more than 40 years in contraception; from organ transplantation treatment for leukemia (stem cells from to respect for cultural difference; from donated bone marrow). resource allocation to human embryo Successful stem cell treatments with research. But amongst this apparent a patient’s own cells are starting to be diversity there are some relatively reported in people as well as in animals. constant themes. One notable theme In various trials, stem cells are being is informed consent and its underlying injected into patients’ tissue after heart principle of respect for autonomy. and other surgery to aid repair. Stem cells The idea of informed consent is a from a patient’s eye were recently grown relatively new one in the history of artificially and ‘transplanted’ on a contact medical ethics. It is certainly not an idea lens to treat corneal disease in the other that Hippocrates would recognise as Lynn Gillam, photo courtesy Educational Resource eye. In the United States, the first clinical central to medical practice; indeed, he may Centre, Royal Children’s Hospital, Melbourne trial of embryonic stem cell therapy well take exception to it in no uncertain It can be hard for health professionals planned by the pharmaceutical company terms! It is also a radical idea, especially when patients refuse treatment altogether, Geron for acute spinal cord injury has when interpreted as an expression of the or opt for a sub-optional alternative: if they been approved by the Food and Drug fundamental ethical value of personal are to respect autonomy, they must stand Administration and is due to start shortly, autonomy. Autonomy says that people back and refrain from interfering, once though it has been deferred for further have a right to make their own choices they are sure the patient is well-informed safety studies in animals. about their own lives. This may sound and has made a free choice. Perhaps even The realisation that the long-standing perfectly reasonable and innocuous. In the harder, though, are situations where treatment for leukemia is a form of stem health care setting, however, it can have patients want doctors to provide them cell therapy, and the developments in far-reaching consequences. This is because with treatment which doctors consider these new stem cell therapies, is changing the choices some patients make may be would at best be futile, and at worst do the discourse about stem cell research, seen by health professionals as foolish, more harm than good. even when the stem cells are derived short-sighted, ill-considered, risky, and The on-going debate over end-of-life from embryos (as in the proposed Geron even dangerous. And yet, provided the decision-making shows these sorts of trial). If safe and effective treatments patient has sufficient mental capacity considerations playing out in an arena are developed from this research, it will and has been adequately informed, the where the stakes are of the highest be hard to argue against the technology principle of respect for autonomy protects possible magnitude. In the 1970s and 80s, when so many people have serious all these choices. So patients’ choices may the focus was on the right of competent conditions that might be treated with stem put them at avoidable risk, cause them to patients to refuse medical treatment, cells. In recent presentations, I have found recover more slowly, or less fully than even when death would be the outcome. less opposition to stem cell research than they could have, experience unnecessary In Victoria, the issues were very publicly previously, despite canvassing not only pain, suffering and disability—and even aired in relation to John McEwen, a young the use of embryonic stem cells, but also die, when this could have been prevented, man rendered quadriplegic in a water- the possibility that women might be paid at least in the short term. skiing accident. John McEwen did not

CHIRON 2009 A PLACE FOR ETHICS 5 want to continue with the mechanical Parents have an obligation to protect of their parents, and their treating doctors. ventilation that was keeping him alive, and promote their child’s interests. If they The question of whether the wishes of the because he found life as a quadriplegic make decisions about medical treatment young person should be respected is often distressing and meaningless. The reaction that fail to do this, and expose their very vexed, especially where the young from his doctors was first to treat him for child to harm or loss of opportunity to person is refusing treatment which may depression, and when he didn’t change his regain health, then that decision can, and prolong or save their life. mind, then simply to say that ventilation arguably should, be overridden. So in Recognition of the ethical principle could not be stopped, despite his wishes. paediatrics, the central ethical question of respect for autonomy has in many John McEwen’s situation was the catalyst often relates to whether parents’ wishes ways made medical practice much more for a parliamentary inquiry, which resulted would cause enough harm or detriment difficult, but has also, arguably, made it in a law called the Medical Treatment Act, to the child, to require efforts to change more humane. which affirmed the right of competent the parents’ mind, or circumvent them Lynn Gillam is Academic Director and adults to refuse medical treatment even altogether (a legal process which is Clinical Ethicist at the Children’s Bioethics when death would be the outcome, and distressing to all parties involved). Centre, Royal Children’s Hospital and gave clear legal protection to doctors who Things get even more complicated when Murdoch Children’s Research Institute and respected these wishes. children reach adolescence, and begin to Associate Professor in Health Ethics in the Since that time, the idea that continued develop significant capacity to understand School of Population Health’s Centre for medical treatment for people with their situation and make decisions for Health and Society. terminal or incurable conditions might themselves. It can happen that young For more information about the Children’s not always be the best thing, has become people have views about their medical Bioethics Centre see: http://www.rch.org. quite widespread in the community and treatment that are quite contrary to those au/bioethics/index.cfm the health professions. Indeed, the debate has changed significantly to now focus on THE ETHICS OF RATIONING MEDICAL CARE patients who do want continued active treatment, when doctors think it will do no good, and only extend suffering. JEFFREY D ZAJAC Patients may want more chemotherapy, or Implantable cardiac defibrillators can save straightforward process, which is life- ventilation, or CPR, when doctors believe lives. In patients with cardiac arrhythmias, saving if the arrhythmia is ventricular this would not be in their best interests. common in ageing hearts, the onset of fibrillation. Access to these devices So the ethical question is whether doctors ventricular fibrillation is almost inevitably through the public hospital system is have an obligation to respect the patient’s fatal. When treated in hospital with limited because of their expense. Thus, autonomy by doing what the patient has electrical defibrillation, survival rates there are people who would benefit from chosen, even though they believe it will are significant and patients can go on to such devices but in whom they are not do no good, or indeed will cause harm. In live long healthy lives. When ventricular implanted and it is likely some of them some of these situations, the issue of scarce fibrillation occurs outside a hospital will die. resources also comes into play—intensive setting, it is sometimes preceded by serious Rationing of healthcare resources is care beds are limited, and some argue they but non-fatal arrhythmias. Implantable occasionally obvious and transparent as should not be allocated to patients who are cardiac defibrillators can revert potentially in the example above: more frequently it expected to die soon anyway. fatal arrhythmias to normal—a relatively is subtle or hidden. New pharmaceutical Consent and autonomy are also central issues in the medical care of children, but in an even more complicated way. Parents are recognised by our community and its laws as decision-makers for their children in all aspects of their lives, including health care. In health ethics, we therefore sometimes speak of respect for parental autonomy, and focus on making sure that parents are given information about their child’s condition and get a say in decisions about what is done to their child. However, this concept of parental autonomy is a dangerous one, as it suggests that parents can make whatever decision they want about their child’s health care, just as an adult can make any decision she wants about her own health care. But this is not so—neither in ethics nor law. Jeffrey Zajac (centre) with students at the Austin Hospital

CHIRON 2009 6 A PLACE FOR ETHICS agents, almost inevitably more expensive size, resulting in very slight increases THE HISTORICAL than older drugs, offer improvements in average survival, can cost $50,000 to in therapy for cancer, neurological $100,000 for a course. Who decides when DEVELOPMENTS disease and diabetes. Subsidised access, they should be used? IN ABORIGINAL & however, is controlled (rationed?) by the These decisions are often focused on TORRES STRAIT Pharmaceutical Benefits Scheme (PBS). the elderly. How are judgements made? ISLANDER HEALTH In most cases when these drugs are Would the same decision be made for an introduced to the market they are licensed elderly person as for a child or teenager? RESEARCH ETHICS for use but not subsidised by the PBS. Should we be spending more to treat Issues of cost and benefit are assessed younger people? Should the person’s PAUL STEWART during the decisions to list these drugs contribution to society be taken into for general use for those who cannot account? If this were the case, decisions [For researchers to] engage with this afford to pay the unsubsidised prices. would favour older individuals with a history, they may begin to overcome Such limitation of access always generates history of community service. Most Indigenous distrust by demonstrating media controversy. Similarly, admission medical expenditure is spent in the last that they have learned not to repeat to hospital for elective surgery is heavily six to twelve months of a person’s life the more oppressive practices of regulated (rationed?) by waiting times and and, while not futile, the benefits of many the past. Thomas 2004 access to outpatients. therapies when measured against the cost To understand the ‘wrong doings’ as well What ethical basis should be used for can be limited. Examples include dialysis as the ‘right doings’ in Aboriginal and rationing healthcare? On the one hand, in ageing patients; the use of intensive Torres Strait Islander health research it it seems relatively straightforward at care units for people in the terminal stages first. There is limited amount of money is important to acknowledge the history of disease; and major surgery for advanced available for healthcare and thus there and role of research ethics. By engaging tumours. must be restrictions on what can be and consulting with Communities from Considered apart from individual provided. On the other hand, for a doctor the outset, researchers can dilute some patients, it seems clear: this is not the treating a patient, or a relative of a patient of the discouraging phrases associated best way to spend money for health care. seeking medical therapy, the expense of with Aboriginal and Torres Strait However, when the focus shifts to the a particular procedure seems the least Islander research. individual—yourself, your spouse, your important consideration and is frequently The easiest way to understand child or your parent—the approach is not a consideration at all. Our society has the developments in Aboriginal and almost inevitably reversed. Most of us been particularly poor at reconciling these Torres Strait Islander health ethics is want the best available healthcare for two viewpoints. through a timeline that outlines the key our friends, relatives and ourselves: any Politicians, and those charged developments that have taken place on benefit, however slight, is considered with running healthcare within the a national level. Much of this work has worthwhile. The response when a Commonwealth and State Governments been done by Onemda VicHealth Koori physician suggests a particular life-saving rarely admit that healthcare rationing Health Unit, which has had a significant therapy is too expensive and should occurs. There is little community discussion role to play in bringing researchers and therefore not be used is likely to be anger. of how choices are made and who makes communities together. The media is particularly good at forcing them. Rationing can be financial (those Copies of Onemda publications new therapies onto the market and when unable to pay for expensive new therapy about conducting research with individual instances are highlighted by the are more likely to be affected than the Aboriginal Communities, some media, therapy almost always results. This wealthy) or involve other considerations of which are pictured here, can be is especially true in younger patients. such as the availability of organs for downloaded from the Onemda website. transplant. In Australia, one would hope As with many ethical quandaries the financial status of the transplant there is no easy solution. It is clear that Paul Stewart, a Taungurong man from patient would not be an issue. medicine is becoming more expensive and Central Victoria has been Research & Community Development Officer with It is clear that rationing needs to occur. that there is an increase in care towards Onemda since 2002. Paul’s research For example, new drugs are regularly the end of life. Rationing is inevitable focuses on health research methodologies and yet acknowledgement, admission and developed for treating diabetes. Each and ethics in Aboriginal Communities. He discussion about it remain, in most cases, offers some incremental advantage and is has been a principal investigator on the usually added to pre-existing medication. non-existent. No doubt we will continue to following projects: ‘Victorian Aboriginal Many cost between $100 to $200 a month address this among many other perennial Health Ethics Project’, ‘Promoting Ethical and two or three or more of these agents, issues in the Dean’s Lecture Series Ethics Research with Indigenous Communities’, if unsubsidised by the PBS, can result Seminars. and ‘We can like research … in Koori hands’. in considerable expense to the patient. Jeffery Zajac is Professor in the University Cancer drugs are even more expensive Department of Medicine at Austin Health/ Useful websites: and the issue even more controversial. Northern Health and currently convenes the www.onemda.unimelb.edu.au New agents with small effects on tumour Dean’s Lecture Series Ethics Seminars. www.indigenoushealthethics.net.au

CHIRON 2009 A PLACE FOR ETHICS 7

NATIONAL DEVELOPMENTS ONEMDA VICHEALTH KOORI HEALTH UNIT

Research Priorities to Improve Aboriginal Health’ conference was held in Alice Springs. Conference participants formulated 87 recommendations that relate to ethics, benefits, outcomes and Indigenous 1986 participation in research.

National Workshop of Ethics in Aboriginal Health held in Camden, NSW. 1987

Some Advisory Notes on Ethical Matters in Aboriginal Research. The ‘Advisory Notes’ produced the following key principles: consultation, benefit, consent, cultural sensitivity, communication and the 1988 exploitation of Aboriginal Community resources.

By 1990 the National Health and Medical Research Council (NHMRC) established a Working Party to conduct a consultation, and it reported on the 1990 possibilities of developing a set of guidelines specific to Aboriginal health research. The Working Party recommended 12 potential guidelines relating Artwork by Shawana Andrews to Aboriginal and Torres Strait Islander research ethics. These included: consultation, benefit, cultural 1991 issues, communication and consent, exploitation of We don’t like research… But in Koori hands it Community resources, local employment, ownership could make a difference – VicHealth Koori Health and publication of data, ongoing surveillance of Research & Community Development Unit (1999) research, and sanctions. Research: Understanding Ethics – VicHealth Koori Interim Guidelines on Ethical Matters in Aboriginal Health Research & Community Development Unit and Torres Strait Islander Health Research was (2000) produced by the NHMRC. 1999

Indigenous Health and ‘Western Research’ – 2000 Humphery (2000)

The Ethics of Aboriginal Health Research: An Annotated Bibliography – McAullay, Griew & Anderson (2002) 2002 The Development of the National Health and Medical Research Council Guidelines on Ethical Values and Ethics: Guidelines for Ethical Conduct in Matters in Aboriginal and Torres Strait Islander Aboriginal and Torres Strait Islander Health Research Health Research: A Brief Documentary and Oral replaced the 1991 Interim Guidelines. 2003 History – Humphery (2002)

NHMRC conducts a National Training Program for Workshop Report: Aboriginal and Torres Strait Human Research Ethics Committees on the Values Islander People Involved in Ethics – Shibasaki & and Ethics document conducted in 2004. 2004 Stewart (2004)

Keeping Research on Track: A Guide for Aboriginal Ethical Assessment of Indigenous Health Research: and Torres Strait Islander Peoples about Health A Review of the Literature – Dunbar & Scrimgeour Research Ethics was produced by the NHMRC. 2005 (2005)

Victorian Aboriginal Ethics Project Report – Onemda VicHealth Koori Health Unit (2005)

We can like research … in Koori hands – Onemda 2008 VicHealth Koori Health Unit (2008)

Indigenous Health Ethics Network website launch. 2009 www.indigneoushealthethics.net.au (2009)

CHIRON 2009 8 A PLACE FOR ETHICS

QUESTIONS OF ETHICS IN GLOBAL HEALTH Is it ethical to perform studies if the major risks will be borne by people in developing countries but the major GRAHAM BROWN AND JIM BLACK benefits will accrue to people in affluent societies? Can anyone really make an ‘informed decision’ to participate in the trial of a new drug if the trial is their only hope of getting treatment of any kind? When does appropriate compensation for participants become undue inducement to participate when communities are extremely poor or vulnerable in other ways? What do researchers owe to other community members who are equally in need of treatment but happen not to be enrolled in the study, such as family members or neighbours of HIV-positive participants in a study? How do you obtain informed consent in communities that have little or no concept of ‘research’ or ‘consent’? Graham Brown (centre) with staff of the Nossal Institute for Global Health A good general principle for clinical research in developing countries is that Global Health is a relatively new discipline Declaration of Human Rights 1948, their there should be ‘no research without that now appears in the curricula of interpretation for an individual or for a service, and no service without research’. many medical schools, subject lists, community may be different in different It is important to consider the benefits and publications of politicians and aid circumstances. In particular, the focus that may be gained by participating in agencies. Whereas international health of western societies on individual rights research, to ensure that they are not refers to implications for health between and patient autonomy may be inadequate inducements to participate, and that nations, and tropical medicine focuses on to account for ethical responsibilities existing health services are strengthened biomedical aspects of disease, global health to contribute to well-being or capacity to ensure adequate treatment and care is generally concerned with multiple building in the communities in which for the community where research is issues in many countries, particularly the these people live, and may be at odds with being conducted. Debate continues as to poorest countries of the world. A recent a society in which communal decision whether subjects in trials should receive definition suggests that global health is: making is normal practice. Community ‘gold standard international treatment’ an area for study, research and practice input is important in determining that may not be present, or sustainable that places a priority on improving whether particular clinical practices or in the country, or whether individuals health and achieving equity in health clinical research should be undertaken, but should receive the optimal standard of for all people worldwide. Global health it is hard for an outsider to decide whether care outlined in national guidelines. If we emphasizes transnational health issues, community consent is in fact present, insist on a high international standard determinants and solutions; involves or whether vested interests of powerful we risk impeding valuable research that many disciplines within and beyond personalities are being met, and whether the health sciences and promotes might benefit local people, but if we interdisciplinary collaboration; and individual consent is also being obtained. allow ‘the best which would otherwise be is a synthesis of population-based Special questions arise when available’ we risk exploiting impoverished prevention with individual-level clinical considering what research should be done communities. It is important to consider care. (Koplan et al 2009). in resource-poor settings, remembering the need for ongoing care at the conclusion The working definition described that only ten per cent of the world’s of any research study, for example in above is a useful way of differentiating research resources are spent on health treatment or vaccine trials. Lifelong access global health from other disciplines, problems that account for 90 per cent of to the study drug should be made available and immediately highlights equity and the global burden of disease. What should if it is effective, even if the drug would inclusive multi-disciplinary approaches be the role of an Australian university not otherwise become easily available that need to be considered in relation to dedicated to being a ‘great public locally, and lifelong health care should be the ethics of global health. university’ in such a global context? What provided if subjects are injured through Although ethics principles formally should our research priorities be? How their participation in a trial. adopted by many countries are likely to be can we best tackle injustice? What are our There are many important ethical the same, based on landmark documents local and international capacity-building issues for students and staff who choose such as the 1964 Declaration of Helsinki roles? What knowledge do we exchange to work in developing countries where and the United Nations Universal and with whom? standards of medical care are inferior to

CHIRON 2009 A PLACE FOR ETHICS 9 those we receive in Australia. An ethical PHARMA PHACTS One way Pharma Phacts does this is dilemma is presented for the clinician with to encourage students to recognise that access to personal therapy, for example it is normal to be affected by advertising, if an injury is sustained with a needle DAVE CARMODY AND AARON WAGEN as students often see this suggestion as an affront to their intelligence or contaminated with HIV infected blood, The ‘modern’ medical curriculum professionalism. In addition, Pharma Phacts whereas such intervention is not available endeavours to produce ethical graduates tries to educate students about the evidence for fellow colleagues or students. The almost as much as it does knowledgeable which suggests that even seemingly personal dilemmas in such encounters and capable ones. Medical courses therefore innocuous items such as the ubiquitous are set against a background of working broach topics such as confidentiality, patient drug pen do have an effect on attitudes to in extremely poor environments, with autonomy, and life and death directly. certain medications or products and can under-resourced healthcare systems Pharma Phacts is a student initiative therefore affect clinical judgment. Pharma where students can gain an understanding established to fill a perceived hole in Phacts also campaigns for universities to of their responsibility to use the lessons medical education, and to varying extent, to make a difference in reducing health include this issue in medical courses to in the medical profession as a whole. better prepare students for interactions inequities through good care, and through Medications have been effective in carefully scrutinised ethical medical with the industry. On the Pharma Phacts decreasing morbidity and mortality for website, students can also elect to sign a research for the benefit of those in need. millions of people and, despite the push pledge to avoid accepting gifts from pharma Global health also highlights the to preventive medicine and lifestyle companies and to always seek out unbiased inequity of medical services, and the loss interventions, are still the staple of sources of prescribing information. of workforce from developing countries to much medical practice. Unfortunately, With over 600 members so far on the well-endowed countries, popularly referred pharmaceuticals today are often mistakenly social networking site Facebook, Pharma to as the ‘brain drain’. Richer countries equated with a mere supply of pens, pads, Phacts seems to have struck a chord with preparing workforce plans should bear in and other clinical tools. Medical students many medical students across Australia. mind their ethical obligations to ensure that of today are entering a largely ambivalent This is extremely positive, and shows that their plans do not exacerbate the situation professional landscape with regards to there certainly is a movement amongst in countries where the need for a trained pharmaceutical sponsorship, with the medical students to challenge some of medical workforce is far greater, and the very real danger that the next generation the accepted practices in the medical numbers of trained workers are already of doctors will be ill-equipped to interact community and make the appropriate relatively insufficient to meet local needs. positively with pharmaceutical companies steps to take their ethical practice of There are various ways of doing and make objective prescribing choices. medicine into their own hands. our best to attempt to avoid unethical In an attempt to raise awareness about If you are interested in Pharma Phacts behaviour and colonial approaches to the issue of pharmaceutical advertising or would like to join the group, please visit working in poor countries. When reflecting and its potential effects on students, a our website or simply search ‘Pharma on a given health-related decision from an group of medical students from each of Phacts’ on Facebook. The website features ethical perspective, we need to understand the 19 Australian medical schools have information about the group, details of the the advantages and limitations of, on the formed a group called Pharma Phacts. evidence on the issue of pharmaceutical one hand, utilitarianism (manifesting as Inspired by the efforts of similar student advertising and discussion boards, where ‘the greatest good for the greatest number’ run organisations overseas and by the visitors are encouraged to voice their own or via health economics as ‘getting the work of groups of doctors such as Healthy opinions on this important issue. most value for money’ even if that means Skepticism here in Australia, Pharma Dave Carmody and Aaron Wagen are some people miss out on basic services) Phacts campaigns to encourage students entering their final year of Medicine/Arts and, on the other hand, deontology to consider the effects that advertising at Melbourne. (most often seen as ‘doing what is can have on them and what they can do to The Pharma Phacts website can be found at: right’). Working with partners, ensuring remain as objective as possible. www.healthyskepticism.org/pharmaphacts/ community participation in research and practice, putting the centre of gravity of activities in the developing countries, and adhering to national guidelines and ethical review at home and abroad should assist in achieving ethical standards that stand the test of time for all involved.

Graham V Brown and Jim F Black, Nossal Institute for Global Health

Reference Koplan JP et al (2009). Towards a common definition of global health. Lancet 373:1993- Medical students and Pharma Phacts members Aaron Wagen, Dave Carmody and Elise Williams. 1995 Photo Jason South, The Age.

CHIRON 2009 10

MELBOURNE MEDICAL SCHOOL APPOINTMENTS AND DEPARTURES

ophthalmology (Moorfields Eye Hospital) research. The first specialist surgeon to Professor Ian Everall recently took up and a PhD (University College) in London. be appointed to a chair of surgery at this his new appointment as Cato Chair of Two Glaucoma Fellowships took him, university, many of Wayne’s 17 years as Psychiatry, based at Melbourne Health. firstly, to Westmead Hospital, Sydney, then chair of the department corresponded with After medical training at Leicester to the University of California, San Diego. his directorship of the Bernard O’Brien University School of Medicine, Ian trained His 2003 Pfizer Award for Excellence in Institute of Microsurgery. in psychiatry at the Bethlem Royal and Glaucoma Research was ranked first in the Maudsley hospitals in South London. The USA for this award. Succeeding Wayne Morrison to the Hugh focus of much of his research has been Tackling glaucoma, the leading cause Devine Chair of Surgery is Melbourne investigating the cellular and molecular of irreversible blindness world-wide, is a medical graduate (1984), Professor Peter neuropathology of disorders relevant pressing cause. In ageing populations like Choon who is internationally recognised to psychiatry. He has investigated the Australia, the incidence of glaucoma is set to for his expertise and research in surgical neuropathological changes associated with double in the next 20 years costing billions oncology, in particular bone and soft tissue schizophrenia, major depression and bipolar in health services, support payments and cancer. disorder and identified that HIV infection lost productivity, to say nothing of the While undertaking his advanced surgical of the brain resulted in neuronal death. human cost to patients and their families. training, some years ago, at St Vincent’s Recent appointments include In response to this urgent need for Hospital, Peter also began a three-year running an HIV liaison psychiatry more research, Jonathan assembled an basic science MD under the supervision service at the Maudsley Hospital and a outstanding team in the newly-established of Professor TJ (Jack) Martin. A succession position as Professor of Experimental basic science glaucoma laboratory in the of international fellowships, focusing Neuropathology and Psychiatry at King’s Department of Ophthalmology and at on musculoskeletal oncology, followed, College, London. Ian now comes to us from CERA. The department and centre jointly including appointments at the University employ some 100 researchers and are the University of California, San Deigo Hospital in Lund, Sweden and at Mayo considered the leading ophthalmology (UCSD) where he has been Professor Clinic, Rochester, USA. research group in Australia today. of Psychiatry since 2004. In work with Since Peter’s return to Melbourne Jonathan continues to teach and was colleagues at the HIV Neurobehavioural and St Vincent’s in 1996, he has held a recognised with the Excellence in Teaching Research Centre, UCSD, Ian correlated the number of key clinical leadership roles in award from the RANZCO last year. pathological changes with neurocognitive addition to his role as Professor/Director of Orthopaedics and as chair of the RACS impairment. More recent work has board of orthopaedic surgery. seen him investigating avenues for The Hugh Devine Chair of Surgery is neuroprotection and assessing how well named for Sir Hugh Berchmans Devine various antiretroviral agents suppress (1878-1959), in recognition of important viral replication in the human brain. contributions he made to the University, Ian’s clinical focus is in liaison St Vincent’s Hospital and the discipline psychiatry for individuals with ongoing of surgery. These included a period as medical disorders, including HIV, and the dean of the clinical school and founding assessment and treatment of affective roles in the development of the Royal disorders. Australasian College of Surgeons (RACS), St Vincent’s Institute of Medical Research In 2006, Professor Jonathan Crowston was Jonathan Crowston and the Anti-Cancer Council of Victoria. appointed to the only specialty glaucoma chair in Australia when he became Professor Wayne Morrison, AO stepped Coming from a position as Professor of Professor of Glaucoma in our Department down this year from the Hugh Devine Gynaecology at the University of Western of Ophthalmology. Jonathan has now Chair of Surgery at St Vincent’s Hospital. Australia, Martha Hickey has been taken up appointments as the Ringland Wayne’s pioneering work in reconstructive appointed to a new chair of gynaecology Anderson Chair of Ophthalmology and microsurgery and prodigious record of based at the Royal Women’s Hospital. Managing Director of the Centre for Eye publications in the fields of plastic surgery, Martha entered the study of medicine Research Australia (CERA). microsurgery, the ischaemia-repurfusion from psychology, training in the United With science (immunology) and medical phenomenon, angiogenesis and tissue Kingdom and in Australia. With a Doctor of degrees from the Royal Free Hospital engineering have been very important Medicine from Bristol University, she was Medical School in London, Jonathan for the department, as has his record of awarded the RCOG/RANZCOG Young also undertook his specialist training in continuous NHMRC funding for his Investigator of the Year Award in 2002.

CHIRON 2009 MELBOURNE MEDICAL SCHOOL 11

During 2006-7, Martha was Visiting To this day, many clinicians ask for At the end of June this year, Professor Professor ObGyn at Yale University. Her George’s opinion on their challenging George Jerums stepped down from his interest in the endometrium and uterine patients. position as Director of Endocrinology at bleeding problems has led to several Finally, George is an outstanding Austin Health although he continues in his research grants in this area in addition teacher. He has always kept to the ‘open clinical and academic roles. Two of his to research on young women and breast door policy’, literally keeping his door seven current graduate students highlight cancer. open at all times, being available to his achievements and celebrate his remarkable career as follows: answer questions. Over the years he has Honorary professorial associate at the taught many medical students, residents, George Jerums and his family arrived in Department of Medicine, Austin and registrars, colleagues, nursing staff and Australia from Latvia in 1944. In 1962 Northern Health since 2007, Geoffrey the public. His energy and enthusiasm George completed his medical training at Donnan commenced as Director of the are contagious and he inspires the passion the University of Melbourne, and he was Florey Neurosciences Institutes at the for learning and striving for excellences, beginning of this year. awarded an MD in 1970 for investigating this being reflected in the success of his mechanisms of hypertension under Geoffrey’s major interests in neuroimaging former students. Many of his former the supervision of Professor Austin and clinical trials have involved him in students now head their own research Doyle. After post-graduate work in founding roles with the National Stroke groups and have leading roles in medicine. Cleveland, Ohio and Hammersmith and Research Institute, the Australian Stroke Some of his previous mentees include St Bartholomew’s Hospital in London, Trials Network and Neurosciences Trials Mark Cooper and Terri Allen (Baker IDI), George returned to the Austin Hospital in Australia and leadership roles with Leon Bach (Monash University), Richard 1976 as senior endocrinologist. the Stroke Society of Australasia, the Gilbert (University of Toronto), Ashim Australian Association of Neurologists His inaugural directorship of Sinha (James Cook University), and Albert and the World Stroke Organization. He is endocrinology at Austin Health in 1991 Frauman, Richard MacIsaac and Richard author of over 400 papers in peer reviewed has seen the department flourish to O’Brien (University of Melbourne). journals, over 60 book chapters, and has become one of the largest in Australia. Importantly, George has also created a edited four books. Every week, approximately 350 patients friendly, productive working environment International acknowledgement of attend the Endocrine Centre and over 30 for all his staff and students, showing the Geoffrey’s leadership in the field of medical staff, from professors and specialist importance of mutual respect to work neurology has led to numerous visiting consultants to endocrine trainees, work in together despite differences. There is a lecturer and professorial appointments the department. In addition, George has sense of integrity and honour working across the world and the bestowal of assembled a dedicated team of research alongside Professor George Jerums and we important awards such as: the American nurses, specialist diabetes nurse educators are very fortunate to have the opportunity Stroke Association William Feinberg and dieticians. to work with him. award for excellence in clinical stroke He has also played a significant Elif Ekinci (MBBS, FRACP) & Scott Baker research; the MJ Eadie Award for Career role in the development of research in (MBBS, BMed Sci, FRACP) Achievement in Neuroscience Research at diabetes in Australia. George’s rigorously the Australian and New Zealand conducted research in the field of diabetes Association of Neurologists; and the complications, in particular diabetic Bethlehem Griffiths Research Foundation nephropathy, is reflected in his over 260 medal for outstanding contribution to papers published in leading endocrinology international stroke research. In 2007 he and diabetes journals and in competitive delivered the Priscilla Kincaid Smith funding received during his 47-year Oration for the Royal Australasian career. The Australian Diabetes Society College of Physicians. 2002 Kellion Award went to George for his achievements in teaching, scientific and clinical research in the field of diabetes and diabetes-related kidney disease. George’s skills as a clinician exceed even his administrative and academic prowess. He ensures that every effort is made to provide the best clinical care for each patient, bringing care and compassion George Jerums to each consultation. In particular, he really strives to understand his patients and respects their choices. His clinical acumen is excellent and there have been many instances when he has made the correct Geoffrey Donnan diagnosis in difficult clinical settings.

CHIRON 2009 MEDICAL TEACHING AND LEARNING IN THE 21ST CENTURY ANATOMY CLASSES – PAINTING AND LAYERING

JENNY HAYES

Anatomy students Zhi Liang Tan & Frith Foottit explore the difference between dermatomes and cutaneous peripheral nerve distribution by painting on Erika Tomlinson’s arms.

Was I participating in the halcyon days I have planned an anatomy curriculum systems and we have a policy to procure of anatomy when I took my seat in that will move through anatomical regions any radiographs available. I want to use the Sunderland Lecture theatre for an in a way that roughly aligns with the the wealth of learning opportunities that anatomy lecture in the late 1970s? A total systems-based curriculum. The weekly each cadaver has to offer. Over the last of 600 contact hours with single topic lectures will each revise basic principles two years Duncan Macgregor (who sat in lectures, small group tutorials in the Padua and basic regional anatomy but will that same anatomy lecture theatre as I in rooms on level five and weekly dissection mostly emphasise clinically important the 70s) from the Pathology Department, with six students per cadaver seems an anatomy and clinical applications. has provided wonderful impromptu embarrassment of riches compared with Dedicated radiological anatomy lectures pathology tutorials during dissection today’s total of 124 contact hours. Yet my will be placed at the end of each study unit. as students uncover diseased tissue. It’s cohort also raised the ire of elder statesmen: Some practical classes will be in the a fabulous lesson for the students to ‘Don’t you know any anatomy?’ form of workshops with student groups approach dissection as a mini post-mortem Anatomy in the current problem rotating through osteology, radiology examination and compare their findings based learning (PBL) curriculum is and wet-specimen stations guided by with those listed on the de-identified taught via 58 lectures and 66 hours of a worksheet that promotes individual death certificates available to them. The practical classes delivered to a mixed study. Over the last two years I have arrival of scales in the dissection room cohort of undergraduates and graduates. piloted body painting to encourage the has allowed better appreciation of normal In accordance with PBL philosophy the study of surface anatomy and this has variation as individual viscera are weighed curriculum is ‘hidden’ but lectures and proved hugely popular and successful. and the results tabulated. If, in the future, practical classes are closely aligned with Any initial reluctance to participate on we have the radiographs available for the body system being studied and the the students’ part has been replaced by similar impromptu radiology tutorials as weekly PBL tutorials. unabashed enthusiasm as they come to the imaged tissue is uncovered, we will By contrast the new generation MD appreciate the advantage of a ‘draw or be- take the educational experience to another will have a clearly defined anatomy drawn-on’ philosophy! So body painting level again. curriculum and, although the contact will continue as an interactive station in As students of the current program hours will remain roughly the same, practical classes. have progressed through the clinical all students will already have studied We are privileged at Melbourne years and graduated, it is rewarding to be anatomy to a pre-requisite level. University to have the only body donor contacted by a number who want to return And so, how to ‘dream large’ with 124 program in Victoria. The willed bodies and teach in the program. Instead of only contact hours? are nearly always co-morbid in several the traditional surgical trainees, I currently

CHIRON 2008 MEDICAL TEACHING AND LEARNING 13 have a flexible list of demonstrators drawn from final year medical students, interns and surgical trainees and am happy to cater for irregular availability in return for the wonderful collegial atmosphere generated in the practical classes. Peer teaching or co-operative learning has been used in classrooms for many centuries and my experience is very much that those who teach learn, and that the more layers available in the expertise, the more energy and enthusiasm in the teaching and learning process. In the new MD we will have a mix of anatomical experience in the student cohort as well, as some will have just the basic pre- requisite knowledge whilst others with Drawing on the abdominal viscera has really helped the current cohort understand what they are an anatomy major will be able to assume palpating for in clinical examination of the abdomen. Pictured around Anton Musiienko are (L-R) Zhi Liang Tan, Sarah Grigg, Haylee Walsh, Jenny Hayes and Heath Tibballs informal responsibility for teaching their less experienced peers around the cadaver. My dream is an even greater sharing of expertise in the dissection sessions. We all share the provenance of the medical anatomy program. It is a wonderful opportunity to create a vibrant interface between consultants, trainees and students in the fields of surgery, radiology and pathology (and beyond?) I look forward to hearing from anyone who shares an interest and enthusiasm for the process.

Jenny Hayes graduated MBBS from Melbourne in 1982 and is now a senior lecturer in the Department of Anatomy. Alumni interested in participating in Jenny’s anatomy classes please contact her on: [email protected] Haylee Walsh paints the nerves and vessels of the head and neck on fellow student Baotuti Sebolao.

Pictured around Anton Musiienko are (L-R): Zhi Liang Tan, Sarah Grigg, Baotuti Sebolao, Jenny Hayes, Haylee Walsh and Venkataganesen Ponnalagu

CHIRON 2009 14 MEDICAL TEACHING AND LEARNING

GRADUATE It is intended that on each day of the first week of the course the students will Self ATTRIBUTES FOR examine their learning goals in the context OUR NEW COURSE of self, knowledge, the patient and systems Society Knowledge of health care, the medical profession and GEOFF MCCOLL society. This will set the agenda for their learning which will be reinforced in each In February 2011 a group of 330 students Student phase of the course. By the end of the will begin the new MD program at the Systems of course the successful achievement of University of Melbourne. They will be in Patient Health care the graduate attributes will be ensured the vanguard of a new medical program in each student through a combination developed from the ground up to meet Medical of assessment and self reflection. In this the needs of the students and their future profession way we believe that the graduates of the roles in the health care environment. At Melbourne MD will demonstrate a new the very centre of this program will be benchmark in medical education. 67 graduate attributes which define the project (European Union), Association characteristics of those who will graduate of American Medical Colleges (USA), Geoff McColl is Director of the Medical from this new course. CanMEDS (Canada), Cambridge Education Unit and Professor of Medical Education and Training. The Melbourne MD graduate attributes University, University of Sydney and are the result of a rigorous process of Stanford University. We ended up with 67 development, alignment and refinement. statements mapped into the six domains. MELBOURNE MD We began with the premise that desirable This aligned map was then taken to a GRADUATE ATTRIBUTES attributes for graduates of our new faculty workshop for further refinement. EXAMPLES program would depend on the perspective The final product is a ‘living document’ of the individuals viewing those attributes. which will continue to be reviewed and Self: an understanding of the principles In other words, what a student or patient or refined during the development and of reflective practice, the ability to doctor or community member might think implementation of the Melbourne MD. apply them, and recognition of their about the ideal characteristics of a doctor So why are the Melbourne MD importance in health care. may well be different (although they may graduate attributes different to those of Knowledge: an understanding of the overlap). To account for this notion of other medical schools? First, they were aetiology, pathology, symptoms and perspective we chose to employ a technique derived using a broad group of informants signs, natural history and prognosis of called concept-mapping to develop our and applying a rigorous methodology. important physical and mental illnesses graduate attributes. In this process seven Second, as a result of the breadth of in all stages of life. small groups (8-10 people) were asked to the informants, the graduate attribute define the ideal characteristics of a medical statements set a new educational agenda Patients: the ability to communicate graduate from our University in 2025. The for our medical school. Traditional graduate with patients from diverse backgrounds groups included current medical students, attribute statements for medical programs including the ability to listen to, respond patients, bio-scientists, doctors, allied health focus on knowledge and the patient. The to, inform and understand the patient’s professionals, public health professionals/ Melbourne MD graduate attributes will perspective. health administrators and faculty members. bring the educational program to focus on Medical Profession: an understanding Concept mapping is a technique that additional areas including self, the medical of organisational governance, the ability allows a group to collate and map their profession, systems of health care and to be an active participant in professional responses to a particular question. At the society. Third, the graduate attributes will be organisations, and an appreciation of end of the sessions over 400 statements used to scaffold the curriculum, so students the benefits of this participation. were assigned to concept maps. These were will be aware of building their knowledge, then examined by a reference group which skills and attitudes in all six domains Systems of Healthcare: an found considerable overlap between the over the course. Finally, the Melbourne understanding of the roles, maps and some differences, related mainly MD graduate attributes will be used to responsibilities and expertise of all to emphasis. The reference group found develop evaluation tools to test that we health professionals, and how they that the majority of statements could be have achieved our aims. This will include work in teams to deliver health care. placed into six domains—self, knowledge, matching assessment to the attributes but Society: an understanding of the health the patient, the medical profession, society also looking at the performance of our of Indigenous Australians including and systems of health care. graduates in the longer term in a proposed their history, cultural development The six domain map and its graduate longitudinal study. and the impact of colonisation and the attributes were then benchmarked against To emphasise the importance of this ongoing health disparities of indigenous key local and international graduate framework of attributes the Melbourne peoples in this country and globally. attribute frameworks including those MD will begin with a week in which the from the Australian Medical Council, educational goals of the program will be More on the Web: www.meu.medicine. General Medical Council (UK), Tuning laid out in the context of the six domains. unimelb.edu.au/md/

CHIRON 2009 MEDICAL TEACHING AND LEARNING 15

ON THE BORDER OF each patient and try to make a diagnosis quickly removes the child’s clothing and or to work out the best treatment, in the cools him down with wet towels. Within TWO WORLDS absence of nearly all investigations besides minutes he has inserted a drip and has urine dipstick and blood films for malaria. given him diazepam and IV artesunate SARAH WONGSEELASHOTE Even the need for a plain chest x-ray must as presumptive treatment for cerebral be rigorously discussed and agreed to by malaria. He reassures the child’s mother Dr Cynthia Maung, a Karen refugee, fled the senior medic, as sending the patient and father in Karen. across the Burmese/Thai border in 1989 to Mae Sot hospital consumes precious I look on in awe of his swift thinking after the military had seized power in funds needed for medications and food for and skill. I imagine him waiting in the her homeland the previous year. In the the other patients. It is clear that no test camp for a foreign nation to accept him border town of Mae Sot she established should be ordered which will not affect and feel like crying. We are the same the Mae Tao Clinic to help treat the the patient’s management. Very often, age, both medical students of sorts, but thousands of ethnic Burmese fleeing into the reason that the test will not affect we live lives so vastly different that it Thailand. Many were students being the patient’s management is not because is virtually impossible to comprehend. persecuted for their involvement in pro- the patient’s condition is untreatable, but My time at the clinic showed me how democracy activities. Dr Cynthia believed because neither the patient nor the clinic difficult it is to practice medicine ina the situation would soon resolve and would have enough money to pay for the resource-poor environment. It made me that they would be able to return home treatment. but, sadly, the internal conflict continues. realise that everything comes at a cost In the children’s inpatient department The Mae Tao Clinic comprises several to somebody and, in practical terms, to I work with another trainee medic, Aung small buildings and treats some 400 think carefully about the patient’s clinical patients every day. Its team of medics are Myint Pin (or Ha-Aung) who is 24. The picture before turning to investigations. It themselves refugees and receive training, ward round is done kneeling down on was also the most humbling experience I food and shelter at the clinic. the floor beside the children, where they have ever had: to be around young people There are no signs to mark the lie on rugs or blankets. Those along the working with so much skill, dedication entrance. We are told to look for the blue window side have malnutrition. The two and courage, in the face of tremendous telephone box and the blue gate. The Thai in the far corner writhe constantly, eyes hardship. I learnt about the ways in which government tolerates the clinic but does shut, brains damaged from tuberculous Burma’s internal conflict has affected the not officially recognise it, as nearly all of meningitis. Ha-Aung is gentle and softly- health of her people, both directly and the staff and the patients are considered spoken. He helps me to examine the indirectly, through the abysmal poverty it illegal immigrants who would be deported children and adjusts their treatment. He has brought. It made me almost painfully immediately if the clinic was raided by came to the clinic when he was 21. I ask aware of the plethora of opportunities I Thai police. Some patients have travelled him if he will stay here much longer. He have and gave me a greater awareness of for days to reach it, often by foot through says, if democracy comes to Burma, he the people of this region, whose struggles jungles strewn with landmines. In the would like to go home and see his family. are largely hidden from view. adult inpatient department a 22-year- If it doesn’t, maybe in a year’s time he Sarah Wongseelashote is a final year medical will enter a refugee camp to wait, for old trainee medic, Kyawni-Soe, takes student. This is an edited version of her me on ward rounds each morning. The an indeterminate period of time, to be winning Peter G Jones Elective Essay. Other ward is crowded with rows of wooden resettled in a third country. Suddenly a winning essays this year were by Alyson Kelly benches with no mattresses. We stop by child in the comer starts seizing. Ha-Aung and Chance T Pistoll.

Kyawni-Soe (on left) and two friends. The boy in the corner has malaria for the twelfth time, due to having to sleep in the jungle each time soldiers come to ransack his village.

CHIRON 2009 16 MEDICAL TEACHING AND LEARNING

AN INFLEXIBLE MIND

CHANCE T PISTOLL

‘Medicine is nothing if not multi-tudinous… defined in the broadest sense, as organized health practices and decisive therapeutic choices…it is fundamentally human in experience amid the vast diversity of cultural worlds.’ – Arthur Kleinman, Medical Anthropologist Sometimes you set out on a project with such determination you forget to look sideways. I had always been interested in public health and when time came for the medical elective, Cuba, I thought, would be the obvious choice. I dreamed about academic discussions regarding healthcare delivery in a socialist and financially embattled context. I devoured Cuba’s history and envisaged drawing together Peeling paint on Cuban buildings macro-level models into a discrete review of public health theory. I was determined. a plastic bag, the mother recited her with the television belied the severity of The people I met in Cuba challenged my directions aloud: his illness. Carmelo was on the waiting list perseverance: they taught me to look ‘So, I should apply it two times.’ for a kidney transplant, citing ‘irreversible sideways, and when I did, I began to see ‘Yes, that is correct’ came the reply. end stage disease’. He lay in bed connected another variable at work in the Cuban My mind roamed. What was this to a haemodialysis unit, the odd air bubble health system, one I did not come across foreign substance the doctor had disrupting the constant flow of red. Sitting in my reading. prescribed? Silently, I performed a review in the chair next to him was a young of the management of dehydration in woman. She was slouched lazily, eating THE SETTING infants. No green solution surfaced. Was a canteen ham and cheese sandwich. I Hospital Pediátrico Centro La Habana this some groundbreaking treatment the introduced myself to Carmelo and asked Stray dogs lazing in the long grass Cubans had kept secret from the west? how he was doing. The lingering smell of cigarette smoke After the mother and baby left, Dr Ramon ‘Fine’ came the reply, without averting wafting from open doors asked: his gaze. Pre-revolutionary blue paint flaking ‘Any questions?’ Turning my attention to the woman, from porous concrete walls ‘Yes. What was the medicine in the ‘You must be Carmelo’s mother?’ Professor Ramon was director of the bottle, Dr Ramon?’ An outburst of laughter: diarrhoeal ward and quite possibly the He let out a hearty chuckle and turned ‘I’m the registrar! I’m on my lunch shortest fully grown man I had ever seen. to me. break! Carmelo’s mother couldn’t make He toiled tirelessly, lumbering around ‘That medicine was paint! She is it for dialysis today. We are hanging out.’ the ward directing interns, weighing repainting her living room and can’t afford The giggling continued. ‘Is there anything newborns in archaic looking contraptions, to finish the job.’ you want to know about Carmelo?’ and meticulously washing his hands at the ‘I had some left over from my house.’ In my final week, Gabriela, a Cuban solitary basin with the solitary bar of soap. He continued casually. student, approached me to ask a favour. His brow, contorted by a heavy burden, At that moment, I became acutely Her cousin had moved to Australia a reflected the never ceasing demands of his aware of something. But, why this few months ago, and had developed an patients. One day I watched him discharge interaction affected me specifically, I illness prior to leaving. He spontaneously a patient: he instructed the infant’s young cannot put into words. married an Australian tourist and had to mother how to prepare oral rehydration I met a young patient during my time depart the country quite suddenly, before formula and supplied her with a few at the nephrology service. Carmelo, a the results of his investigations were packets of the stuff and a kitchen kettle. 16-year-old boy had presented two weeks available. Because neither the hospital Then, before she left, he rose from his prior with fasciculations and headaches. nor his family could afford to contact chair, turned and disappeared into the After a battery of investigations, it was him, Gabriela asked if I would carry the closet opposite his desk. Several rustling declared his kidneys had begun failing— results of his investigations and a course moments later, Dr Ramon emerged the aetiology unknown. I remember of treatment to him in Australia. Her clutching an old bottle full of a viscous observing the boy from the end of the bed. cousin would contact me in Melbourne green concoction. As he poured it into His muscular physique and preoccupation after I had arrived. I thought this to be

CHIRON 2009 MEDICAL TEACHING AND LEARNING 17 a highly unorthodox request but after West, although it was a whole new world delivery. Instead I learned that a health making enquiries with my indemnity for him. I broached the topic of his illness. system is more than just governmental organisation and customs I accepted her He told me how he had been suffering decisions and the availability of resources. appeal and packed my bags for my return for the last three months. He had not It is made up of individuals and the to Melbourne. seen a doctor in Australia due to finances. relationships they forge. In this sense On a grey afternoon in late February, After a lengthy discussion, he left with Arthur Kleinman was right: there is the doorbell rang. I answered and saw a instructions on applying for Medicare, something fundamentally human about young Cuban man. details of bulk billing, how emergency the experience of medicine. Gabriela’s ‘Hi’ he said sheepishly, ‘my name is departments work and how to contact a trust has shown me this, and in a small Juan. My cousin is Gabriela, I think you general practitioner. I told him, if he ever way I feel I have become a part of the met her in Cuba.’ needed anything he has my number. With Cuban health system. As I handed him the letter and that he walked away and I haven’t heard * All names have been changed. prescription, we began to talk. He told me from him since. Chance Pistoll is a final year medical student. how he left Cuba, about his new wife and In Cuba, I anticipated learning about This is an edited version of his winning Peter G life in Melbourne. He was enjoying the the politics and economics of healthcare Jones Elective Essay.

UNIVERSITY OF MELBOURNE MEDICAL STUDENTS SOCIETY: CONTRIBUTING NOW FOR OUR FUTURE MEMBERS

CHRISTINE MANDRAWA

You’re clearly doing something right when UMMSS believes that the new students say: ‘I wish I was doing the new medical course will incorporate current medical course’ ... and that’s exactly what best evidence-based teaching practices, be those students who have been involved intellectually stimulating and challenging in the MD curriculum development and continue to produce the excellent, workshops are saying! caring and competent doctors for which the This is an exciting time for the Melbourne Medical School is renowned. University of Melbourne Medical The new medical course will not only be Students’ Society (UMMSS) and the focused on teaching knowledge but also Melbourne Medical School. With the on equipping its graduates with skills in incoming Melbourne Model currently communication, research, professional and being implemented and a revamp of many personal development and leadership. courses at the University of Melbourne, Being heard by Faculty has meant the medical course is also turning over a that more students are willing to voice new leaf to become a masters level entry their opinions on the current course Christine Mandrawa MD course. and new ideas for change. So, whilst not by UMMSS, as we face an increasing To the advantage of our future all interested students can be involved number of medical student enrolments in students (and therefore future members directly in forums such as the workshops, Victoria and therefore an increasing need of UMMSS), our student society has a opinions and feedback are regularly for clinical teachers. unique and strong relationship with the procured through a pool of students within The student contribution to the medical school. As a result, we have been the UMMSS education subcommittee. involved in curriculum development Through this subcommittee, we are development of the new course has for the new course since its conception able to provide greater representation ensured student advocacy needs are met through a variety of forums, including the of the student cohort and stimulate from the very beginning. UMMSS would curriculum development workshops run greater interest in medical education. like to thank the Melbourne Medical by Geoff McColl. This subcommittee has been involved School and the Medical Education Unit As students, we have been looked upon in providing feedback on the current for the opportunity to be involved in to provide valuable feedback regarding the course with selected student ideas lately the course development process during ‘on-the-ground’ experience of medical implemented with the view to carrying this exciting time. We look forward to schooling, to give realistic views about these through into the new course. continuing to work together to make the how educational programs are received Our members are also involved in new Melbourne graduate MD course an and suggest innovative ideas around how pilot programs such as peer-to-peer outstanding medical degree. medical teaching could be better delivered. teaching which encourages students to Our involvement has been well received get involved in informal teaching of their Christine Mandrawa is 2009 President of the and greatly valued. peers. This is recognised as a positive step UMMSS

CHIRON 2009 ALUMNI STORIES

Nick and Hannah at the Apam Hospital in rural Ghana. This photo was taken by Nick’s father, John Mason, when he visited them in Ghana during their time there.

OUR YEAR IN GHANA

NICK AND HANNAH MASON

From October 2008 to August 2009 we we encountered. Ideally, chronic disease teaching patients to monitor and manage worked as medical officers in rural Ghana. like diabetes is managed with good patient their own conditions. Most families’ main Apam Hospital is a district hospital in understanding, lifestyle changes, dietary concerns are financial and a prolonged a town of 20,000 serving a population adjustment, allied health co-operation admission, not to mention costly diabetic of about 200,000. It has approximately and medical optimisation. So, how to equipment such as glucometers and 150 inpatient beds and sees about 300 achieve this in a five minute consultation glucose testing strips (if available), cause outpatients a day. At the time we visited, with a poorly trained nursing assistant huge financial stress on a family, even there were two other doctors and two translating for an elderly Twi-speaking with health insurance. medical assistants providing the medical Ghanaian? How do you explain to this In this case the boy’s family were care with good pharmacy, x-ray and lab person that their condition, unlike malaria subsistence farmers in a village about facilities on site. About 75 percent of the or pneumonia, will not be cured by taking an hour’s drive from Apam. The boy’s population subscribes to the national tablets for a week, and needs long term father, who is illiterate and cannot speak health insurance scheme, which provides treatment and follow up? What sort of English, was taught to record blood basic in- and out-patient care for about doctor gives medicines that probably sugars, administer subcutaneous insulin A$15 annually per person. won’t make you feel better in the next few at appropriate times and doses, and to Overwhelmingly, the main health days? recognise and manage dangerously low issue in the district is malaria. Mainly due Another challenging case involved blood sugars. The family benefited from to HIV/AIDS, TB is again increasing as a newly diagnosed type 1 diabetic boy. supplies including a reliable insulin a public health problem. In Ghana, HIV It was very difficult to treat this boy supply, glucometer and test strips donated prevalence is about three percent—quite and educate him and his family in a from an Australian organisation Insulin low compared with the rest of Africa. busy, understaffed and under-resourced for Life. Despite this, the family’s level of Also common are nutritional disorders, hospital. Nursing staff (who would also understanding of his illness, the resources gastrointestinal and respiratory infections. translate for us) often had very limited available, and the boy’s blood sugar levels What surprised us, however, was the training and understanding of conditions are still far from optimal. It appears impact of chronic disease throughout such as diabetes themselves. Initially, few that the co-ordinated, time- and labour- the population: hypertension and type health staff understood that there were intensive approach needed to properly 2 diabetes formed a large proportion of different types of insulin, and many nurses address chronic disease is still some way outpatient reviews. believed that insulin was administered off for the people of rural Ghana. Dealing with chronic diseases, intramuscularly. In a paternalistic medical Nick and Hannah graduated MBBS from especially diabetes, highlighted some of culture like in Apam, many health Melbourne University in 2005, Hannah, as the cross-cultural and language barriers practitioners are unused to ideas such as Hannah Magree

CHIRON 2009 ALUMNI STORIES 19

FROM THE MAYO CLINIC TO BEHIND BARS: A SURGEON’S ODYSSEY

CHARLES MULLANY

The last 18 months have been some of the most challenging and rewarding of my medical career. After a professional lifetime in surgery, including 22 years as a consultant and professor in cardiothoracic surgery at the Mayo Clinic, Rochester Minnesota, it was time for a new direction. My nights are now spent treating society’s marginalised and forgotten—the inmates of the Maricopa County Jail, which serves the greater Phoenix area in Arizona. The jail houses 10,000 inmates and books over 300 inmates each day. At any one time, more than two million individuals in the United States are behind bars (one percent of the adult population) and an even greater number are either on parole or probation. Jail populations of the major cities are staggering: the Los Angeles County jail houses 20,000 The 4th Avenue Maricopa Jail receives over 300 inmates a day. inmates, New York City 14,000 and Cook County (Chicago) 10,000. Most prisoners are minorities (39% Black, 16% Hispanic) and 13% are female, many of whom are pregnant and will deliver while incarcerated. The per capita incarceration rate in the USA is the highest in the world (six times that of Australia) and comes at enormous social and economic costs. Over the last 20 years, spending on corrections has increased 127%, while at the same time spending on higher education has increased only 21%. Since many inmates come from a background of poverty, dysfunctional homes, poor education, sub-standard housing and inadequate or often no health care, their medical problems tend to be extensive and severe. In addition, the ‘enlightened’ closure of state run mental hospitals in the 1960s has led to criminalisation of the mentally ill. It is Charles Mullany in his Arizona desert garden. estimated that 15-20% of incarcerated individuals have serious psychiatric Being physician to the jail’s intake assessed for risk of self harm or suicide. disorders, with the consequence that area is equivalent to working in a busy Suicide is a major cause of death in both prisons and jails have become the major inner city casualty. On arrival, all inmates prisons and jails and every effort is made de-facto facilities caring for the mentally undergo a medical assessment, including to identify and manage those at risk. All ill. The Maricopa County Jail has a recording vital signs (pulse, BP, respiratory inmates with a psychiatric history are 240 bed psychiatric ward and employs rate, oxygen saturation, and, where assessed by a mental health worker and eight psychiatrists, making it the largest appropriate, blood glucose and pregnancy suicidal individuals are placed in safe cells psychiatric facility in the State of Arizona. testing). They are questioned regarding with constant observation. Alcohol abuse Psychotropic medication accounts for 40% serious medical problems, prescription and intoxication, as well as addiction to of all pharmaceutical expenses for the jail. medications and psychiatric disorders and heroin and other opiates, is widespread and

CHIRON 2009 20 ALUMNI STORIES a serious cause of morbidity within the Having been a surgeon all my life, I physical examination and diagnosis were jail. Monitoring these individuals, as well approached my new ‘career’ with both the highlights of my medical education and as preventing and treating of withdrawal trepidation and excitement. Touring the have stood the test of time. My mentors jail at the time of my interview convinced symptoms, is a major function of the were master clinicians. Furthermore, me that this was something that I had to intake area. Uncontrolled hypertension my experience as a surgeon has brought do. Nothing in my entire professional life (BP> 220/120), diabetes (blood glucoses had prepared me for what I saw behind invaluable skills to the jail intake area. are often >33.3 meq/l), asthma, epilepsy, bars. Here I saw a minority marginalised Clinical actions need to be decisive and chest pain, lacerations, fractures and population that desperately needed basic rapid, particularly with the large volume abscesses are seen many times a day and care, yet I felt totally inadequate to deal of inmates passing through the area. are routinely treated. Serious infectious with these problems: it was 39 years since Minor trauma can be handled easily. I feel disease is also widespread. HIV infection I had been a resident. Moreover, I would renewed, as if I had returned to my roots among inmates (1.0-2.0%) is estimated be working within the confines of a jail. in the casualty department of St Vincent’s to be four to five times that of the My fears could not have been more Hospital, Fitzroy! Finally, I could not have general population while Hepatitis C unfounded. To my surprise, the transition has been easy, stimulating and rewarding. is estimated to be present in 17-41%, done this without the overwhelming love Reflecting on why this should be so, I believe depending on geographical location. In and support of my wife, Anne, and our that the outstanding medical education 1997 it was estimated that one quarter of seven children. Thanks to you all. I received at Melbourne University and all individuals infected with HIV in the St Vincent’s Hospital prepared me well. Charles Mullany graduated MBBS in 1969 USA and one third of those with Hepatitis The emphasis on mastering the basics and MS in 1982. His email address for C passed through a correctional facility of anatomy, physiology and pathology alumni interested in contacting him is: during the year. and the clinical skills of history taking, [email protected]

A SHARED JOURNEY

RICHARD PESTELL

Early experiences often play a formative on new discoveries in the area of cell discoveries are being made as a collective role in the development of a person’s cycle/control and the interface of the cell intelligence—will be a real legacy of the career. For Richard Pestell, son of an cycle with hormone signalling. current generation of cancer biologists. academic surgeon, the deaths from cancer With a string of awards to his name This article was compiled from information of a number of friends and family, the first already, Richard’s overriding sense of his in Richard Pestell’s article ‘Remembering when Richard was six years old, kindled career so far, is of a journey he is sharing Team Science is for the Patients’, published in him a desire to make a difference by with friends, mentors and colleagues— in Cancer Biology and Therapy, 5:4, April working in cancer research. people who share many understandings: 2006. Ed. Richard’s Western Australian of the value of developing enabling Discover more from the Delaware Valley childhood was enriched by immersion in technologies; the barriers to translational Institute for Clinical and Translational Research science and scholarship through family research; growing health care delivery website: www.dvicts.org/aboutus/ and friends: science magazines around the inequity; the inertia of scientific dogma; house, a father who discussed his work apparently stunning serendipity in with his son, and early involvement in discoveries; the perversity of the scientific the life of a university. His path in cancer review process; the importance of targeted research, begun in childhood, has taken therapies; the value of team science; the him through a medical degree at the changing perception that the diagnosis of University of Western Australia, a PhD cancer is now a journey ‘not a destination’; (Howard Florey Institute) and MD at a growing interest in quality of life values; Melbourne University and a wide range of and the value of truly transformational clinical and academic appointments. discovery in driving real cures for cancer. For the past four years now, Richard Richard’s hopes that his own research has been Director of the Kimmel Cancer translates readily into therapeutics Centre in Philadelphia, PA, and Director for cancer patients are matched by his of the Delaware Valley Institute for hopes that initiatives in his and other Clinical and Translational Research (a five laboratories and the growing international state, four university clinical and research collaboration in cancer research—a institute). His research focuses primarily renaissance in which fundamental Richard Pestell

CHIRON 2009 MELBOURNE MEDICINE: 150 YEARS

Anatomy Class, 1916

In 2012 the Melbourne School of Commemorating 150 years of student days: photographs, video or film Medicine will be 150 years old. As a way Medicine at Melbourne will focus on the footage, documents and stories. Medical of marking and celebrating this milestone past, present and future experiences of graduates interested in contributing to we are commissioning a history of the medical students as they become doctors or becoming involved in this project school to be researched and written by and we are interested in collecting the are invited to contact Liz Brentnall at: Drs Janet McCalman and James Bradley of memories and memorabilia of medical [email protected]. the Centre for Health and Society in the School of Population Health. Our history encompasses the full history of modern medicine: the story of medicine at Melbourne is also the story of the rise of biomedicine over the past 150 years, beginning with the role of the clinic in medical training, anaesthesia, the impact of the laboratory, anatomy and concluding with the evidence-based, research-driven medicine of the 21st century. A literary, well-synthesised history is planned, which focuses on the making of doctors—on the medicine they were taught and the manner in which they learned it—contextualised by discussion of the nature, potential and limits of modern medicine and its practice in Australia. The planned history will look in detail at the cohorts of students and settings for their learning—clinical schools, laboratories, class rooms, home births The third year medical students hockey team in 1976, the day they played the second year team - and and casualty departments—and maintain lost! Pictured are (L-R), in the back row: Julie Knight, Lorraine Baker, Helen Banting, Judy McNaughton, an underlying narrative of how scientific Kate Davey, Mary Parkin, and in the front row: Barb Goss, Marguerite Skeehan and Jo McCubbin. Team members missing from the photo were Louella Crawford and Heather Cleland. Lorraine Baker remembers and clinical discovery has changed the umpires for that day were Joe McKendrick and Tom Kay and says: ‘We women were rather tired of understandings and practice. watching inter-year football and had demanded a girls’ contest’.

CHIRON 2009 22

REUNIONS

MBBS 1941 The MBBS graduates of 1941 on 18 September 2009, celebrating 68 years since their graduation. Pictured L-R are: (standing) Brian Costello, Peter Bird, James Guest and Frank De Crespigny; (seated) Clarice Hetherington, Alexe Gale, Mary Wheeler. Ida Seward was present at the luncheon but not for the photograph.

James Guest

MBBS 1944 Six of the surviving MBBS graduates of 1944 met for lunch at the Kew Golf Club on Wednesday 18 March 2009. Those attending were, as pictured: Back, L-R—Howell Hosking, Charles Wilson, Peter Blaubaum; Front, L-R—John Floyd, June Howqua, Andrew Newell.

Mary Abrahams (Hoy), Bell Matthews (Broderick), Nancy Cowling (McNeill), Percy Cowan and John Williams were unable to attend and sent their apologies.

Andrew Newell & Howell Hosking

An interesting feature of reminiscences was the lasting effect of those who worked as groups during anatomy dissection in second and third years, perhaps reflecting the impact of this very unusual and demanding activity on people just reaching maturity. Certainly the long medical course and shared experiences have led to ongoing, close associations. Conversation inevitably reflected changes in medicine and practice since we graduated, and concern that the enjoyment of practising medicine might be at risk. On the other hand, advances in medicine during the second half of the twentieth century were clearly to our advantage—artificial hips and knees, cataract replacements and coronary stents as well as developments in surgery, anaesthesia and therapeutics. MBBS 1949 The recent deaths of ten members were noted The 1949 medical graduates celebrated their An informal occasion, apologies and greetings with sadness, and there was widespread sixtieth year since graduation with a luncheon from those absent, followed lunch. Most of those agreement that we should meet annually from at Graduate House on Tuesday 20 October. attending looked pretty fit despite the years now on! We were particularly pleased to welcome Rae and, although many reported minor problems Williams (Lee) from Perth, John Pawsey from with arthritis, hearing and vision, there was Noel Cass (for the conveners) Queensland and John Brine from Canberra, widespread agreement that the alternative to author of several books (the latest on medical advanced age, even with some disability, is a aspects of Shakespeare’s plays) who joined us for poor option. the first time.

CHIRON 2009 REUNIONS 23

MBBS 1958 It was particularly pleasing to have two the futility of herding not only cats, but seagulls! international and seven interstate graduates After 50 years since graduating MBBS at Mr Robert Marshall gave an enjoyable talk attend. After toasting ourselves as the Class of Melbourne University in 1959, 57 of the original about success and about many of his memories 1958, MC Barrie Morley proposed a toast to 109 who graduated gathered on 8 November of surgical practice over the 60 years since absent friends—two of whom have died since 2008 at the RACV Club to renew friendships he graduated. Some of the stories were quite our last gathering, and those who were unable and compare notes. The venue was highly disturbing and he exhorted us to do all possible to attend. A page of messages from 18 of those suitable, and the camaraderie, if measured to continue improvements in medical practice and who sent apologies was displayed. by the conversation noise level, was excellent. medical ethics to enrich our noble profession. Several comments have been made, saying Assembling the graduates for the traditional Ralph Lewis what a great experience it has been to catch up photograph appeared to interfere with the social with colleagues again and exchange details of aspect of the evening, and the process resembled activities since last seen.

MBBS 1978 One hundred & fifty four people attended the 30 year reunion of MBBS 1978 on 22 November 2008 in the Jim Stynes room at the MCG. The venue was magnificent, looking over the floodlit oval. Prior to dinner we had the opportunity to spend time in the wonderful National Sports Museum. The highlight of the evening was a rendition of the Neuro-anatomical Aria, led by Elsdon Storey (photo).

Robert Brack

2012 REUNIONS AND students’ experiences have changed over a return to Melbourne and organising MEDICAL STUDENT the time and in identifying and tracing the a celebration in coordination with the common threads which run through all Medical School’s anniversary activities. If MEMORIES those years. your group is planning a reunion for 2012, As Noel Cass has noted, in his report of the Accordingly, we would like to tap into please let us know. 1949 graduates’ sixty years reunion (facing our medical graduates’ memories of their CONTACT DETAILS: page), the long medical course and shared student days in any way we can. If you experience—such as anatomy dissection are organising a reunion between now and Liz Brentnall classes and first clinical encounters 2012 and are interested in gathering and Advancement and Communications with birth and death—on people just recording memories from your student Faculty of Medicine, Dentistry and Health reaching maturity, led to ongoing, close days, please contact us. Sciences associations. With the Melbourne Medical MBBS graduate cohorts with 4th floor, 766 Elizabeth Street School about to turn 150 in a few years, we anniversaries in 2012 may also be The University of Melbourne are interested in determining how medical interested in combining their reunion with Email: [email protected]

CHIRON 2009 24

MEDICAL MEMORIES

The approach of our 150th anniversary the first year of the Vice-Chancellorship at Mildura High, then as a boarder at has prompted the Melbourne Medical of Raymond Priestly—the first salaried Geelong Grammar, was quickly eclipsed School to reflect on our students’ changing Vice-Chancellor of the University. James’ by the liberating experience of college life. experience of becoming doctors over the memories of one effect this change to Enjoying the opportunities to fraternise past one-and-a-half centuries. With this in University administration had, are that with women and become involved with mind we have begun a program designed ‘Priestly pushed the student point of sports and societies he threw himself into to document and record the memories of view’ and insisted on the construction college life. Involved in many activities, past students. The first of our ‘Medical of the student union building. This had in particular rowing and the dialectic and Memories’ interviews involves two a great impact upon the day-to-day lives theatrical societies, James reflects that, alumni, James Guest AO, CBE and Jenny of students, providing a central place for although he participated perhaps too Hayes in conversation. them to gather and socialise. Prior to that, much, he doesn’t regret it at all. Jenny graduated MBBS from students had to bring sandwiches from Other compelling memories of James’ Melbourne in 1982 and her memories of home or find food at a nearby shop, unless student days involve the teaching of student anatomy classes include lectures they were lucky enough to be able to Frederic Wood Jones and membership of from James Guest. She is currently a senior return to a college residence for lunch. the McCoy Society under Wood Jones’ lecturer in the Anatomy Department and Some of James’ fondest memories of his leadership. Wood Jones, easily the most writes about her experience of teaching student days are of life at Trinity College. inspirational teacher of the course in anatomy in this issue of Chiron (p.12). During his first year at University he lived his day, led groups of students and staff During the interview James talks about off campus but ‘worked hard’ and gained (including, on at least one occasion, his experience as a student of science, then a scholarship to Trinity. He remembers the Vice-Chancellor) on annual field medicine, during the 1930s and ‘40s. His that his time at Trinity ‘altered [his] whole expeditions. The McCoy Society motto: first year at University coincided with life’. His life’s experience of schooling ‘For field investigation and research’ describes the opportunity offered by the society for students from a wide range of science-based disciplines to participate in hands-on research in the field. Working and living side-by-side with experts and students from a range of related disciplines was an obviously inspirational experience for a young man, as was the eclectic, wide- ranging approach to education taken by the somewhat rakish-looking, intellectual and practical adventurer, Wood Jones. The interview was filmed and edited excerpts will be finished in early 2010 and posted on the Melbourne Medical School website.

‘The camp established’. This photograph from a McCoy Society expedition is reproduced courtesy of the For more on the Web: http://www.mdhs. University of Melbourne Archives. unimelb.edu.au/knowledge_transfer/ podcasts/medical_memories

This aerial photograph (facing page), from the Melbourne University Archives, was taken by the Royal Australian Air Force in (1942). Other photos from the series show the RAAF barracks on nearby Royal Park, where James Guest remembers them being stationed during the war. The photograph clearly shows the layout of the University soon after James’ graduation. The bottom left hand corner, the site of the current medical building, microbiology and immunology, the Howard Florey and the Neurosciences building site, is still a playing field and the row of professors’ houses are still standing. The Vice-Chancellor’s residence, built during James Guest’s student days is next to them. The newly built Student Union Building is in place at the centre of the campus but the Baillieu and James Guest talks with Jenny Hayes about his memories of Medicine at Melbourne University. Brownless libraries are still yet to be imagined.

CHIRON 2009

26

OBITUARIES RECORDED WITH REGRET, THE PASSING OF:

Jack Acheson (MBBS 1956) Alan Gilchrist (MBBS 1944) Hazel Y Noble, AM (MBBS 1949) Clement W Ahern (MBBS 1943) John M Grant (MBBS 1948) Ian M North (MBBS 1964, GDip Ophth 1970) Patricia M Bale-Hirst, AM (MBBS 1955) Harry Green (MBBS 1956) Francis J O’Rourke (MBBS 1955) Nicholas R Bare (MBBS 1964) Philip H Griffin (MBBS 1966) Robert J Pierce (MBBS 1970, MD1980) Harley K Baxter (MBBS 1969) Maxwell L Hankin (MBBS 1958) Murray C Piercy (MBBS 1945, GDip Michael S Benson (MBBS 1941) Keith E Harrison (MBBS 1941) Anaes 1983) Stanley C Berger (MBBS 1954) Cleve Hodge (MBBS 1956) Patricia M Preston (MBBS 1942) Marcus K Benjamin (MBBS 1955) Henry Horne (MBBS 1958) Jack Ptasznik (MBBS 1972) Alexander L Bennett (MBBS 1951) June L Howqua (MBBS 1944, MD 1947) Ronald P Quirk (MBBS 1959) Noel M Bennett (MBBS 1954) Kenneth G Howsam (MBBS 1943, Noel M Ramsey, OAM KSJ (MBBS 1947) Stanley C Berger (MBBS 1954) GDip Ophth 1948) William Refshauge, AC, KT cr CBE (MBBS Benjamin W Bergman (MBBS 1963) Ronald W Hoyling (MBBS 1941) 1938) Nishal K Bhullar (MBBS/BMedSc 2006) Shirley M Huntsman (MBBS 1950) Charles R Richardson (MBBS 1962) John T Breen (MBBS 1953) Helen G Irinyi (MBBS 1964) Hendrik D Ritman (BAgSc 1958, MBBS 1965) Kenneth F Brennan (MBBS 1940) Lindsay F Irwin (MBBS 1940) Douglas M Ritchie (MBBS 1954) Margaret F Bridge (MBBS 1971) Paul E Jeffery (MBBS 1945, DipO&G 1952) Hendrick D Ritman (BAgSc 1958, MBBS Leon R Bryan (MBBS 1952) Richard A Joske, AM (MBBS 1948, MD 1952) 1965) Frank H Buchanan (MBBS 1951, Pamela D Roberts (MBBS 1965) GradDip Psych Med 1968) Donald F King (MBBS 1947, MD 1953) Neville J Rothfield (MBBS 1946) Barry L Butler (MBBS 1946) Julie C Knight (MBBS 1979) Shaw Rudzki (MBBS 1961) Roger Bullen (MBBS 1953) Walter H Koschade (MBBS 1954) Leonard B Satchell (MBBS 1942) Barbara G Burbury (MBBS 1938) Ivan W Laurich (MBBS 1963) Ron Saunders (MBBS 1951) Heather Carmichael (MBBS 1972) Bill Lawrence (MBBS 1953) Simon A Schnall (MBBS 1976) Anne J Caro (MBBS 1954) John H Leyden (MBBS 1951) Daniel Shortall (MBBS 1990) Norman J Chamberlain (MBBS 1942) Charles R Lucas (MBBS 1956) James L Sinclair (MBBS 1942) David M Conroy (MBBS 1957) Helen Mackenzie MBE (MBBS 1938) Keys Smith, OBE (MBBS 1940, BA 1983) Russell G Cole (MBBS 1944) Gerald A Manley (MBBS 1947) Colin A Speck (MBBS 1948) John L Connell, AO (MBBS 1947, MS 1951) Dennis W Maginn (MBBS 1946, MD 1952, BSc 1963, GDipPsych 1963) John C Spensley (MBBS 1962) Desmond A Cooper (MBBS 1949) F Ian R Martin, AM (MBBS 1953, MD1957) Henry Stonnington (MBBS 1950) Donald P Cordner (MBBS 1945) Douglas N McCulloch (MBBS 1953) Harold F Story (MBBS 1947) Leo J Cussen (MBBS 1954) Douglas McCutcheon (MBBS 1950, Brian Thomas (MBBS 1965) Robert E Davies (MBBS 1953) MD 1959) Robert V Thompson (MBBS 1994) Eric C Dax, AO (MD 1984) Brian D McKie (MBBS 1962) Chris Towie (MBBS 1982) Bryan Egan (MBBS 1949, BA 1974, Ian G McPherson (MBBS 1966) MA 1982) Gordon W Trinca, AO, OBE (MBBS 1945) Ian L McVey (MBBS 1949) Bill Etheridge (BDSc 1940, MBBS 1945) Chester A Troy (MBBS 1955) Samuel D Mecoles (MBBS 1940) Austen S Ferguson, AM (MBBS 1943) Clifford E Warmbrunn (MBBS 1959) Peter F Meehan (MBBS 1968) Dermot C Foster OAM (MBBS 1945) William F Wilson (MBBS 1966) Camille Michener (MBBS 2003) Andrew Fraser (MBBS 1939) Peter F Williams, AO (MBBS 1946) Helen M Moran (MBBS 1969) Bryan H Gandevia, AM (MBBS 1948, Susie Woodward (MBBS 1970, MD 1953) Alan B Ng (MBBS 1958) GDipEpidemiol 1996)

CHIRON 2009 OBITUARIES 27

ERIC CUNNINGHAM DAX AO therapy and; particularly, art therapy— of Psychiatric Research from where 1908—2008 indeed, he has been called ‘the father of art he coordinated research still used by therapy’. Tasmanian services. Here, too, he led the Chair of the Victorian Mental Hygiene expansion of voluntary services to the Authority until 1969, Eric described his mentally ill or disabled. In 1978 (aged 70!) work in many publications—the Victorian he started his first private practice which work in Asylum to Community where he continued upon returning to Victoria he wrote that when he came to Victoria, in 1984. ‘mental hospitals were in a deplorable From 1984 until his final retirement state of neglect and disrepair’. Staff in 2002 Eric worked two days a week ‘frustrated and disillusioned’ and patients cataloguing and writing commentaries leading ‘an asylum-like existence, often for the artworks he had gathered since unoccupied, locked up, sleeping on straw 1947. These works were donated to the Eric Cunningham Dax is pictured here with his mattresses and badly clothed’. The book’s University in 1985-6 and now form son-in-law Hugh R Taylor (Harold Mitchell Chair of preface observed: ‘With imagination and the basis of an expanding collection Indigenous Eye Health). dynamic energy Dr Dax and his colleagues of over 12,000 works fashioned by stimulated the staff by giving them new people experiencing mental illness or Eric Cunningham Dax died in his purpose, initiative and opportunity.’ psychological trauma: one of the largest hundredth year. Recruited from Britain Dilapidated buildings and bedlam-like such collections in the world. Named for by the Victorian Government in 1951, wards were repaired and refurbished, new him by the University, the ‘Cunningham ‘Dr Dax’ became a household name which hospitals were acquired or constructed, Dax Collection’ is based in Parkville and still resonates with many. As Chair of new research and methods of treatment runs a regular program of exhibitions. Victoria’s Mental Hygiene Authority he undertaken. (It should not be forgotten In 2012, the collection is due to move to presided over an all-encompassing reform that therapies for the mentally ill at that of facilities. His many contributions the University’s Parkville Neuroscience time were limited.) centred on reforming care facilities and Facility where it will present the ‘human He separated the intellectually seeking social acceptance for mental illness: face’ of basic scientific research on brain innovations which form a continuing disabled from those who were ill, function. The collection constitutes a legacy of scholarship and understanding developed occupational therapy services, remarkable and under-recognised legacy of mental health. professionalised psychiatric nursing and to the nation which, as a centrepiece of the Born in Eastwood, Nottinghamshire expanded other professionally associated future Cunningham Dax Centre, will offer in 1908, Eric attended Perse School, groups, developed in-prison psychiatric education about mental illness with the Cambridge, excelling academically and in services and instituted day hospitals. He aims of promoting mental health through sport, and achieved a London University introduced the first telephone crisis line in the use of art. Matriculation First Class. Having checked Australia. Communicating this innovative Eric remained in good health until the results of the entry examination he work to the public helped abolish much of shortly before his death. Well-respected wired home that he had failed: he hadn’t the prevailing stigma of ‘madness’. for professional achievements, he was looked at the distinctions list! Eric was able to make these changes also held in deep affection by many. In 1933 he graduated in medicine because he fostered extraordinarily He is survived by his four children, his with honours—scholarship prevailed good relationships with the press, with daughter-in-law, and son-in-law, his nine throughout his professional life—and soon politicians, and later with business, grandchildren, their partners and ten great after met, courted and married a nurse, particularly through the Lions Clubs of grandchildren. Victoria. Although he spent much effort Kathleen Aimee (Katie) Thompson. Their Elizabeth M Dax, AM marriage lasted 62½ years until her death improving mental hospitals, he believed in 1998. Several house jobs in psychiatry in progressively moving care of mentally BRYAN EGAN led to his appointment as Deputy ill people into the community and 1922—2008 Superintendent at Netherne Hospital, involving community in that movement. Surrey in 1939—only twelve years after At one point there were 1500 volunteers Bryan Egan graduated in medicine from he had left school—and promotion by1942 supporting mental health services in Melbourne University in 1949. Much of to Medical Superintendent. When he left Victoria. The State’s services became an his time as a medical student was spent at Netherene to immigrate to Australia, the international show-piece and his family St Vincent’s Hospital, as a clinical student hospital was what would now be called entertained visitors from all over the and as a long-term patient following a ‘a best-practice organisation’ for the care world. His reputation led to several World bout of pulmonary tuberculosis. He spent of the mentally ill. His pioneering work Health Organization consultancies and a much of his career at Box Hill Hospital included editing a handbook for psychiatric prominent role in the Royal Australia and where he was Medical Superintendent nursing; introducing different types of care New Zealand College of Psychiatrists. (1958-73) before returning to St Vincent’s for different mental illnesses; introducing In 1969 Eric took the position of as Assistant, then Deputy, then Medical general anaesthetics for electroconvulsive Tasmanian Coordinator Community Superintendent of the Hospital. His therapy; advancing psychosurgery; music Health establishing a new Department early retirement in 1981 enabled him to

CHIRON 2009 28 OBITUARIES pursue his interest in historical studies for passed on his love of learning, his ability the medical staff, were threatened with which he obtained a PhD from Monash to see both sides of an argument and his dismissal, Ron was a tower of strength, University. love and respect for nature. with a clear view of the principles at stake In 1988 Bryan was commissioned It must have been a remarkable and a firm resolve to avoid compromise. to write a history of St Vincent’s to experience as the school turned out a His integrity and the huge respect in which commemorate the Hospital’s centenary Rhodes Scholar and several academics he was held by his peers, were significant and his book Ways of a hospital: St including George Seddon, Geoff Tunbridge, factors in the resignation of most of Vincent’s Melbourne 1890s—1990s Jim Pittard and Ron: all outstanding the medical staff and the threatened established his unparalleled knowledge teachers and mentors, imbued with a resignation of the scientific team—forcing of the hospital. Retaining an active and love for nature and the environment, all the State Government to intervene and passionate interest in preserving and committed to public service. replace the medical superintendent and the documenting the history of St Vincent’s Ron was a resident at Trinity College board. Not long after, Ron was appointed Hospital until his death, Bryan was a while he studied medicine. His great to the inaugural board of the new hospital driving force in the hospital’s Archives and passion was cricket and, an accomplished research centre, now the Burnet Institute, Museum Committee. He was generous left handed batsman, he represented and played a key role in its success. with his knowledge and modest about his both the University and, later, Richmond In the 1980s, as AIDS appeared in own accomplishments. Cricket Club with distinction. the community, Fairfield managed most LB from material kindly supplied by St Vincent’s After graduating Ron spent a brief Victorian patients with the disease. Before Hospital period at Horsham Base Hospital before he much was known about the disease there was recruited by John Forbes to Fairfield was a great deal of anxiety, but Ron’s CHARLES RONALD LUCAS Hospital for Communicable Diseases calm, sensible, pragmatic, non-judgmental 1932—2009 in 1964, where he remained until his approach and honesty endeared him to his retirement in the early 1990s. Ron was an patients and earned him great respect in outstanding physician: calm, thoughtful HIV affected communities. He facilitated and thorough. Inspired by John Forbes’ the establishment of dedicated HIV clinics view that medicine could only advance and acted as a guide and role model for an if it were illuminated by insights from entire generation of infectious diseases clinical research, Ron worked closely physicians and physician scientists. with the hospital’s laboratory team— Ron’s founding membership of the the sympathetic administration and Australian Society for Infectious Diseases close relationship between clinical and was a significant contribution to the field laboratory staff were an ideal research of infectious diseases. He also taught environment. While primarily a clinician, medical students from both Monash and Ron saw his role to challenge existing Melbourne for approximately 30 years. paradigms, create hypotheses and help Graduates will recall their three weeks others sort out the answers. With the of infectious diseases teaching at Fairfield advent of diagnostic tests for hepatitis B Hospital (and also the scones with lashings and later hepatitis A, he worked closely of jam and cream provided for morning with the virology team, laying the tea around the fireplace). building blocks for our current knowledge After Ron’s first marriage ended in For a person legendary for his long of the natural history of those diseases as divorce he married Jo Cornish. They silences and frugal use of words, Ron he did later with hepatitis C. built a wonderful mud brick home on Lucas answered to an unusually long list During the 1970s, fulminant hepatitis a hill overlooking the Yarra River at of names. Know as ‘Ronny’ to his school B infection was a relatively common Eltham which became a haven for the friends and ‘Ron’ to his medical colleagues, cause for admission to Fairfield Hospital. many friends they entertained with Ron’s he was know as ‘Lagubes’ (lugubrious) at Ron pioneered a number of techniques well stocked wine cellar and Jo’s superb University, ‘Rowdy’ to his cricket mates in Australia for patients with no other cooking. Following his retirement, Ron and, perhaps most appropriately to the clinical options, and was thrilled when helped Sandy Milne roll out a regional members of the Melbourne University a vaccine was developed and the disease hepatitis B immunisation program in Cricket Club team, which he toured largely disappeared. He played a critical New Zealand, before settling down to his England with aged 60, as ‘Gunsynd’… the role in the development of the hepatitis other passions: woodwork and gardening. galloping grey. A vaccine as the physician who cared for His finely turned tables, chairs, boxes Ron attended Ballarat Grammar the large family from whom HM175, and trays, made from jarrah fence posts School when it was led by the legendary the strain which became the basis of the recovered from Fairfield Hospital’s educator and playwright GF ‘Jack’ Dart. world’s first licensed vaccine, was isolated. grounds, and his special twig chairs were With only 200 students in the school and During the notorious dispute at highly sought after, as was his company. very small matriculation classes, Dart took Fairfield Hospital in the 1970s, when Ron As Ron began to develop signs of the a particular interest in senior students and and Ian Gust, unofficial spokesmen for debilitating neurological disease which

CHIRON 2009 OBITUARIES 29 was to claim his life, he was forced to give Laboratory—an alcove-sized room in the by Membership of the Order of Australia. up most of the pleasures which sustained Department of Medicine—he established More recently, Skip’s passion found him and became increasingly immobile bioassays for gonadotrophins and one of yet another outlet—medical history. and confined to his favourite chair where the few bioassays for the Long Acting His book The History of Diabetes in in the loving presence of Jo and his Thyroid Stimulator, later known as Australia, commissioned to celebrate daughter Kate and his sons Eric, Michael thyroid stimulating immunoglobulins. the 25th anniversary of the Australian and David, he received a stream of visitors, Immunoassays for insulin and growth Diabetes Society, was a scholarly treatise with calm dignity to the end. Ron was a hormone were soon followed by several and fascinating to read. He focused on the physician’s physician—the person you others. Important papers were published characters involved—including the first would want caring for you if you were ill. in international journals, including patients to receive insulin—the researchers Ian Gust, Suzanne Crowe & Edwina Wright seminal work done with Alan Stocks and the early practitioners. As always he on the association of resistance to the was interested in the quirky, including the action of insulin and the complications of first attempt at pancreas transplantation FIR (SKIP) MARTIN, AM diabetes. This interest in insulin resistance by an imaginative maverick in Tasmania 1929—2008 and its adverse associations predated the in 1911. Skip was an active member of description of syndrome X or metabolic the Australian and New Zealand Society syndrome by a couple of decades. Another of the History of Medicine after retiring seminal work related to the different from active hospital practice. expression of diabetes in Papua New Devoted to his family, Skip Martin Guinea with an early description of J-type is survived by his wife Megan, their five diabetes. children and an increasing number of Skip’s perpetual curiosity and genuine grandchildren. Every person who knew desire to find answers to the clinical Skip has been enriched by the experience. problems he saw in his patients inspired We give thanks for his life and mourn his my interest in research. He had a powerful passing. influence on the direction of my career, as Richard Larkins, AO on many others who now occupy leadership positions in hospitals and universities IAN LUMSDEN MCVEY throughout the country and the world. Shortly after I started with Skip, I learnt 1927—2008 Skip Martin was an extraordinary and he was the author of, to that point, 112 Born in Brisbane, Ian’s early years were wonderful man. scientific papers. As I struggled to publish in Queensland before the family moved Extraordinary because he was one of my first two or three, the magnitude of to Melbourne where he finished his a kind: totally unconventional in manner this achievement for someone with a huge schooling at Wesley College. and style. At first impression he was clinical load quickly became apparent. Ian studied medicine at Melbourne disorganised and awkward; at second What I remember most about Skip University, graduating in 1949 and going impression he was a person of razor sharp Martin is his interest in the lives of his on to resident, registrar and associate intellect, perpetual curiosity, enthusiasm patients and the respect he held for them. surgeon positions at the Alfred Hospital, for everything he did with a passionate Fascinated by their range of interests, while also working as demonstrator in the interest in his fellow human beings. their backgrounds and the way they Anatomy Department. He won the Sir Wonderful because of his generosity handled their illnesses, he had a particular Gordon Taylor Prize for Excellence in the of spirit and the inspirational effect he had affinity for migrants, especially from the Primary Fellowship Examination in 1953. on those around him. Mediterranean region, and the prevalence Travelling to England to further his Born in 1929, Skip was in the of diabetes in different ethnic and national studies, Ian worked at St Bartholomew’s University of Melbourne cohort who groups. His affection for his patients was Hospital (with Sir James Patterson Ross), studied at Mildura after the Second reciprocated: an exemplar of the best obtaining his FRCS in 1955 and finishing World War. He undertook research at kind of doctor, he cared for his patients in his training as registrar at the West Case Western Reserve University in every sense. The travails of the long-term Middlesex Hospital. Cleveland, on the exchange program sufferer of diabetes and its complications He returned to Melbourne and the started after the occupation of the Royal require just this sensitivity. Alfred Hospital where he was duly Melbourne Hospital by the US 4th Army Skip occupied many leadership appointed senior inpatient surgeon and from Cleveland, and returned to succeed positions at the Royal Melbourne Hospital proved himself a skilful, often conservative Pincus Taft as physician-in-charge of and in the Australian Diabetes Society. and thoughtful surgeon. His main area endocrinology in 1964, a position he His selfless contributions to medicine of clinical interest was in diseases of occupied for 25 years. and to medical research, the training of the breast and he strived long for the Although his appointment was part- a generation of endocrinologists and his development of a multidisciplinary breast time, Skip established an active research leadership and support of the Australian clinic. His lectures to students and nurses program. In the grandly-named Endocrine Diabetes Society were recognised in 1995 were always clear and, given his command

CHIRON 2009 30 OBITUARIES of language and caring approach, always and the beaches—especially her beloved Camille, your legacy will live on in our popular. He was examiner in surgery at Cottesloe—and completed her internship hearts and our work. We thank you. Melbourne and also, more latterly, at at Freemantle Hospital. After initially Alex Markwell and Ruth Blackham Monash. considering a career as a rural GP, In 1983 Ian was nominated to Camille fell in love with, and trained in, This is an edited version of the obituary which was published first in AusMed directorship of the Road Trauma Service, obstetrics and gynaecology: she received a position he held until 1996. The service the RANZCOG Award for Outstanding benefited from his ability to organise Achievement for the DRANZCOG exam ROB PIERCE and obtain a desired result. As the in 2005. 1947—2009 revolutionary helipad structure of the Continuing her training in Western trauma centre and its organisation and Australia, Camille spent time at many reception of casualties became a reality, hospitals including Joondalup, Osborne the Alfred Hospital became the prime Park, Princess Margaret, Albany and King centre for management of road trauma Edward Memorial hospitals. She became in Victoria. His work on the consultative involved in junior doctor advocacy from council on emergency and critical care her first meeting as an intern and was was pivotal in the development of trauma an active member of many professional services in Victoria and the Road Trauma groups, committees and forums. Centre at the Alfred Hospital remains a Despite her heavy workload and monument to him. professional commitments, Camille still His career was studded with committee found time to volunteer for LifeLine as a work: for the hospital, the AMA, the counsellor, the Red Cross Family Support Medical Practitioners Board, the Medical Program and to Banda Aceh following the Defence Association of Victoria, the 2004 Tsunami. Medical Benefits Schedule Advisory In 2007, Camille became Chair of Robert John Pierce died tragically on 7 Committee, the Anti-Cancer Council of the AMA (WA) Doctors in Training February 2009 whilst defending his home Victoria, the Victoria Medical Insurance Committee and WA representative to at St Andrews, Victoria against the Black Agency and the Professional Indemnity the AMA Council of Doctors in Training. Saturday firestorm. Rob graduated in Insurance Company of Australia. A master A passionate advocate for junior doctors, medicine from Melbourne University in of organisation with an ability to think on her dedication, energy and resilience were 1970 and completed his house officer years his feet, he could often influence a meeting respected by all who worked with her. at St Vincent’s Hospital. Inspired to enter and had a strong and clear vision for the She was particularly interested in junior the field of respiratory medicine by the late profession. doctor training and doctors’ health and her Doug Gauld at the Repatriation General A most generous host, Ian and his enormous contribution to work in these Hospital, Heidelberg, he completed his wife, Norma, developed a property raising areas must be applauded. She remained an training at the Royal Brompton Hospital. Murray Grey cattle on the Mornington active member on the committee after the An excellent clinician and teacher, Peninsula, selling it at the turn of the completion of her term as chair, and was Rob’s inquiring and incisive mind and century to build a residence at Mornington always happy to help. capacity for hard work led to research where Norma still resides. Vivacious, bubbly, generous and publications in the fields of pulmonary Cas McInnes. An abridged version of the modest, Camille always had a smile on physiology, asthma, chronic obstructive obituary originally published in the Alfred her face, especially if the conversation pulmonary disease, lung cancer, and Hospital Residents and Graduates Association involved anything to do with her favourite more recently, sleep and upper airway Newsletter. footy team, Collingwood. She loved sports mechanics. and the outdoors, especially running, Rob used the amalgamation of the CAMILLE MICHENER swimming and surfing. Even when away Austin and Heidelberg Repatriation 1979—2009 at AMA meetings, she would ensure she respiratory units as an opportunity It is with great sadness that we farewell went for a run and was a wonderful role to establish the Victorian Respiratory a dear friend and colleague, Camille model for us all. Support Service which now supports Michener. Camille adored her friends and family the needs of patients requiring chronic Born on 4 February 1979 and raised (parents Helen and Norm and sister, ventilation throughout Victoria. He in country Victoria, Camille graduated Sarah) and worked hard to stay in touch was well known and highly respected in medicine from the University of with those in the east and west. throughout national and international Melbourne in 2003. She had deferred her Her tragic accident on 24 July this sleep and respiratory communities, training for a year during her course in year devastated all who knew her and forging strong collaborations and order to travel and work as a volunteer at the wider medical community. She was enduring friendships with colleagues in the 2000 Sydney Olympics. farewelled at a beautiful memorial service many different parts of the world. After finishing medical school on Cottesloe Beach by her family, friends He founded the Institute for Breathing Camille moved to Perth for the lifestyle and colleagues. and Sleep to promote research, education

CHIRON 2009 OBITUARIES 31 and public advocacy in respiratory and Born on 6 March 1925 at Caulfield, Noel Noel played an important role in sleep medicine and was integral to the was the adored only child of Merle and Roy improving the standards of general development of the Australian Sleep Trials Ramsey. His ‘onlyness’ was quintessential practice though the RACGP and with Network. to his character: an independent thinker, the FMP. In 1979, when required to sit Rob was loved by his patients, many self contained and often single minded in the inaugural exam for the Diploma in of whom became friends. His abiding his ambitions, he also actively sought to Obstetrics and Gynaecology, to continue interest in respiratory and sleep health engage with others, and his great capacity practising obstetrics, he topped the course. in Indigenous Australians was deepened for friendship saw him always at the centre As his clinical work wound back he during a sabbatical spent travelling of a wide social circle. took on teaching roles: as senior clinical and working in northern Australia He attended school at Auburn South where he saw many unmet needs in the Primary, then his father’s alma mater, lecturer for the Monash University understanding and treatment of common Scotch College. A good cricketer, he held and as clinical tutor and lecturer in the respiratory and sleep health problems in his own at footy, but excelled at school Department of Community Medicine at remote Aboriginal communities. work and matriculated aged 15 before Melbourne University where he also sat Rob loved living, walking and camping going up to ‘the shop’ as Melbourne’s only on Faculty. His interest here led to his in the bush. He enjoyed music, art and university was then known, to graduate election to the Committee of Convocation sailing in his yacht Terra Nova out of MBBS in 1947. (1994—2007). Williamstown. He regularly served as After a residency at Prince Henry’s, In the last two decades of his career his medical officer on tall ships such as the Noel’s interest in paediatrics took him services as an expert witness were sought James Craig and Alma Doepel. to the Royal Children’s Hospital. His by the major medical defence solicitors An extremely humble person, Rob’s marriage and children to Diana Harrison, and by the Commonwealth Government door was unfailingly open to patients, the young theatre sister he met over an as a member of the Professional Services students, colleagues and friends. His operating table, led to a reassessment of Review Tribunal. sphere of influence was wide and stories his ambition and kindled a new passion Noel’s active professional and attesting to his laid-back but hands-on in primary care and family medicine, recreational life did not keep him from his attitude to work and life abound. Always which became the hallmarks of his general down-to-earth, he had a laconic sense of practice. family. His children each shared one or humour and a lifelong desire to minimise In 1951 he and Stan Kay purchased other of his passions: golf, skiing, surfing, red tape and get the task done. a general practice in Box Hill where cricket, fishing or tennis. They revelled in He inspired research students, Noel remained for 52 years, providing his attention, enjoying family camping scientists and registrars, many of whom exceptional family medical care, often and fishing holidays and was proud to are now in senior positions—all of whom for five generations in one family, and see them through university. His greatest would be proud to have considered him delivering over 4000 babies. trial came in 1993 when his youngest their friend. Rob leaves his wife Jan, their From the early 1960s Noel and John child, Rosie, died from cancer at the age children Chris, Lucy, Nick and Tristan, and Gates, a Cessna pilot, would spend a week his grandchildren. Taken from us all so of 36. He cared for her with the patience, or two each year flying all over Australia suddenly—he is sadly missed. tolerance and understanding that were and later New Guinea—Noel navigating the hallmarks of his practice, in the face Abridged from the obituary by Christine and John flying. Each trip became more of the overwhelming grief he must have McDonald and Peter Holmes published in daring, until, in 1978, they flew with their felt as her illness dissembled her immense ‘Medicine, Dentistry and Health Sciences’ wives to London and back in a single engine earlier this year. creative and academic talents. Cessna 210. The trip took four months Noel and Diana travelled extensively as the intrepid foursome flew from one NOEL MCHUGH RAMSEY OAM refuel stop to the next across South-East visiting isolated places in a wide variety 1925—2009 Asia, through Burma, Afghanistan and of vessels and vehicles and often in the the Middle East, and on to Europe. After company of close friends. In 2003, after a short stop in London they returned to the fabulous celebrations of Diana’s 70th the confines of the plane’s cabin to do it all and their golden wedding anniversary, he again flying home. was again faced with loss when Diana died. Noel’s medical career extended far past His own health had not been without its his general practice. He provided honorary problems but, as with his own struggle service at the Royal Children’s and Prince with cancer since 2004, he bore them with Henry’s hospitals and, his move to Box amazing stoicism, retaining his gentle Hill coinciding with the emergence of the humour, charm and unflagging interest in Box Hill Hospital, had a long involvement others until his final days. He is survived with the hospital which included a range by his children Andrew, Malcolm and Jill of clinical and leadership roles. He also and five grandchildren. served a number of hospital and health services throughout Melbourne’s east. Andrew and Jill Ramsey

CHIRON 2009 32 OBITUARIES

as saying: ‘The trouble with living is that road trauma, they were an influential CHRIS TOWIE you only get one body to live in, one life to group—and among this group Gordon 1955—2009 live, when a million wouldn’t be enough.’ stood out as an incessant and successful Chris Towie, a 1982 MBBS graduate of Chris Towie was obviously an campaigner. He chaired the Royal the Melbourne Medical School, died in extraordinary person: someone who saw Australasian College of Surgeons (RACS) the devastating fires which swept through what was wrong in the world and sought road trauma committee 1971-93 and NSW much of Victoria on Saturday 7 February to change it by changing himself. Perhaps surgeon Jim McGrath noted that he was: this year. Barely three weeks later, the the best legacy he could leave would be, ‘the dominant force in the College road Broadmeadows Town Hall filled to as Chris’ brother, Rod, suggested at the trauma work. His tremendous enthusiasm capacity with Chris’ friends, patients and memorial, to take his example and live as and drive inspired all of us.’ family who came together to remember a he did. In December 1970 Victoria passed remarkable man. The many tributes from Liz Brentnall from a DVD recording of the compulsory seat belt legislation—a world friends and family during the memorial memorial service for Chris Towie first. Much more was to follow: stricter service paint a picture of someone whose seat belt legislation, helmets for cyclists, legacy was perhaps already well-written GORDON WALGRAVE TRINCA AO, OBE blood alcohol tests, speed limits, improved long before he died. 1921—2009 vehicle design, safety equipment, road Born in Alberta, Canada, Chris improvement and vitally, education. migrated with his family to Australia Statistics quickly showed the enormity of when he was eleven. Long-time friends the achievement. Overall road fatalities for of Chris remembered him as the kind Australia from 1960 to 1994 declined by of child who loved maths quizzes and 49 percent. There was a similar diminution reading the encyclopaedia and took delight of serious injuries from road crashes. in confounding his teachers by learning to His international reputation for read upside down. work in road trauma led to Gordon’s Many words were used to describe establishment of the Global Traffic Safety Chris as a person: eccentric and very Trust in 1985: a group of eight people in clever; wildly unconventional and the field from different parts of the world. fiercely intelligent; physically powerful; Informally known as ‘Trinca’s Thinkas’, controversial; unshakable, unmistakable the group looked at the traffic injury issue and irreplaceable. Other stories of Chris globally, estimating that fifteen million told about his drug and alcohol-free, vegetarian lifestyle, his twice-daily people world-wide were injured annually meditation and a legendary kindness to in traffic accidents, and published a book, Reducing Traffic Injury - A Global animals which saw his Broadmeadows Gordon Trinca, son of notable pioneer general practice—a converted bank Challenge, which received the prestigious Melbourne surgeon and pathologist Alfred 1988 international Volvo Traffic Safety building—often full of rescued animals. John Trinca, was educated at Melbourne Prize. With such character traits it comes Grammar School and the University of From 1939 Gordon was also active in as no surprise to learn Chris deliberately Melbourne. He went from general practice the Lord Somers Camp and Power House. chose to work in areas of disadvantage at Clifton Hill to a surgical career holding He held many posts and was involved because that was where he felt he could various posts before becoming head of a in a wide range of activities with this make the most difference. A strong surgical unit at the Preston and Northcote organisation and its clubs for the welfare campaigner for social justice, Chris Community Hospital. of young people. would challenge orthodoxy and injustice In the 1960s, aware of the increasing The contribution of Gordon Trinca wherever he found them and often took volume of casualties from road accidents on the role of advocate for his patients. and concerned at how cases were handled to combating road trauma cannot be His intuitive ability to assist with as they came into the hospital, Gordon overemphasised. The Gordon Trinca healing and make people feel comfortable started collecting statistics. Under his Medal of the RACS honours him as was matched by his generosity, often direction surgeons were soon no longer does the annual Gordon Trinca Lecture paying for patients’ prescriptions himself ‘on call’ at home, but at the hospital ready of the Australasian Trauma Society. A when he knew they couldn’t afford to. to make the all-important first assessment keen sportsman and poet, he was happily Chris sought refuge in the bush— of an accident case. Gordon himself set married to Elizabeth (Beth) Robertson, retreating like a monk to draw strength the example by spending long hours at who died in 2004. He is survived by two from the pure, peaceful environment— the hospital during peak crash times. sons and a daughter, three grandchildren and spent the last few weeks of his life Later research showed conclusively how and one great grandchild. there considering new challenges and important early treatment was for the From Alan Gregory, author of Blood Belts horizons. recovery of trauma victims. Booze and Bikes, a history of the response of Towards the end of the memorial While surgeons were only one group the Royal Australasian College of Surgeons to service Chris’s brother, Rod, quoted him to fight for road safety measures to reduce the epidemic of road trauma

CHIRON 2009 33

FROM OUR COLLECTION A MONUMENT IS UNCOVERED

RITA HARDIMAN

In late 2005 a plaque was discovered in contemporaries who moved up into the the triradiate medical building during a medical profession: he had one more exam refurbishment. It was made in the early to pass, held in March 1911. 1900s to commemorate and express The only written clues to his gratitude to a student of the University. participation in the medical course were The plaque reads: two hand-written entries in anatomy examination results books of 1906 and IN MEMORY 1908, the latter signed by Richard Berry, OF According to the death certificate, CANUTE HENRY CLOWES professor of anatomy at the time. Canute Henry Clowes died in his home of a peri-tonsilar abscess, after a brief illness, A STUDENT OF THIS UNIVERSITY A PRODUCTIVE LIFE CUT SHORT 1903-1910 at the age of 32 years. An obituary in the Canute Clowes was a widower at the HE DIED ON 27TH NOVEMBER 1910 local district newspaper stated that he died time of his death. Details on his death IMMEDIATELY AFTER COMPLETING of septic pneumonia, contracted from a certificate reveal that he had been married. HIS MEDICAL COURSE. poor patient he treated in Melbourne. His wife’s name was Minnie. The death THIS TABLET HAS BEEN ERECTED BY According to the obituary, CH Clowes certificate also tragically revealed that HIS FELLOW STUDENTS Minnie had died in 1903, seven years was attended to in his final days by his IN REMEMBRANCE OF HIS before Canute. Canute and Minnie were close friend from medical school, Dr MANLINESS OF CHARACTER AND married in April 1902, and Minnie died Colquohoun. KINDNESS OF HEART AND TO of ‘heart failure’ after a haemorrhage in a COMMEMORATE THE SERVICES YOURS FAITHFULLY, W BALDWIN fallopian tube. So Minnie had presumably THAT HE RENDERED TO STUDENT been pregnant with what would have been SPENCER LIFE IN THE UNIVERSITY. the Clowes’ first child when she died. The Baldwin Spencer, at the time Secretary of the Sports Union, wrote in a letter To say that this plaque kindled pregnancy was ectopic and the result was to Canute Clowes’ father that Mr CH some interest in the mystery that was the death of Canute’s new wife. At this Canute Henry Clowes would be an point it is significant to note that in modern Clowes death ‘is a loss to the University understatement. The plaque testifies to times, most probably neither Minnie’s nor as a whole’. a student who made a large contribution Canute’s medical conditions would have Spencer later sent another handwritten to the University and its students. It was been fatal. One wonders whether Minnie’s letter together with some photographs of compelling: a mystery engraved in brass, tragic death was the driving force behind the ‘memorial tablet’ that had been erected waiting to be solved after many years. Canute’s choice of medicine as a career. in Canute’s honour by students of the Who was Canute Clowes? What did he do that was so appreciated by his fellow students—enough for them to take it upon themselves to erect a plaque in his honour? For the following months, various members of staff and students passed through the curator’s office of the Harry Brookes Allen Museum of Anatomy and Pathology and offered theories as to what might have happened to Canute Clowes and what had been so special about him. No degree exists to acknowledge Canute Henry Clowes’ graduation from the medical course. His passing occurred soon after the final exams for the year in 1910 and even sooner after his return home to Tylden in central Victoria. He died at home on 27 December (not November as stated on the plaque). As such, his name is not recorded with his Canute Henry Clowes’ family gravestone

CHIRON 2009 34 FROM OUR COLLECTION

BROWNLESS BIOMEDICAL LIBRARY REDEVELOPMENT

In June this year the Brownless space for research higher degree and Biomedical Library was closed to allow honours students; the Faculty Graduate construction work to begin on a significant Centre (Faculty delivered enrichment redevelopment of the library building. The and administrative support services for library, which has served medical students students) and a café. The construction and other health and science students work is on schedule to be finished in since the 1960s, is being substantially December with staff and services available redesigned to offer an expanded range of to students from February 2010. services including: access to books, journals These photographs were taken as and online resources; improved self- library materials were removed to other service facilities; improved information technology and study environments sites for the duration of the renovations. for students; displays from the Medical More on the web: www.lib.unimelb.edu.au/ History Museum; dedicated quiet study collections/medicine/ The plaque found during refurbishments. University. This is the tablet discovered in 2005. Baldwin Spencer wrote in a second letter to Canute’s father that he trusted the plaque would be ‘of some gratification’ to the Clowes family because in this way ‘his memory will be perpetuated amongst future generations of students’. The University community will only be enriched by this story—by the fact that good deeds and a community spirit are both remembered and appreciated by your peers, and then by those in the future when they learn the story.

THE KYNETON CONNECTION The Clowes family is still present in Kyneton and surrounds today. Indeed, there is even a Clowes Street in Kyneton. Through a member of the Medical History Society of Victoria I was invited to speak at the annual weekend conference in 2008, held in Kyneton. There I met the Clowes family’s GP, and other locals who knew or knew of the family. All were pleased to know of the existence and ‘resurrection’ of the commemorative plaque. Soon after, I was sent photographs of the Clowes grave. This brought the story of Canute Henry Clowes to an end, at least in my mind. I found I had unearthed all the information I could from what was, in the beginning, the suggestion of a great life engraved in brass. Today, the plaque is awaiting restoration and a suitable location to be displayed with this story.

Rita Hardiman is curator of the Harry Brookes Allen Museum of Anatomy and Pathology Moving the journals collection The rare books collection

CHIRON 2009 35

Liz Hartland (Coordinator, Infection Brian A McNamee (MBBS 1979)—AO for IN BRIEF and Immunity Research Domain, service to business and commerce through Microbiology and Immunology)—2010 innovative leadership in the expansion Australian Society for Microbiology and growth of the Australian bioscience CONGRATULATIONS Frank Fenner Award. industry, and to the community. TO ALUMNI, FRIENDS, David J Hill—AO for service to public Alan B P Ng (MBBS 1958)—OAM STAFF AND STUDENTS health, particularly through leadership (Posthumous) for service to medicine, roles in the promotion of cancer awareness particularly in the field of pathology. Thomas F Acheson (BSc 1954, MBBS and prevention programs. Stephen O’Leary (William Gibson Chair 1957)—OAM for service to medicine as a James Hillis, Brendan Jones and of Otolaryngology, RVEEH)—Royal general practitioner, through administrative Ewan Chan (medical students)—2009 Australasian College of Surgeons’ John roles with aged-care organisations, and to Dreamlarge Knowledge Transfer Student Mitchell Crouch Fellowship. the community. Project Grant for their part in their Anna Proietto (WEHI)—high com- Associate Professor John W Agar (Staff)— development of ‘Teach the Teacher: Sexual mendation in the 2009 Premier’s Awards OAM for service to renal medicine, and to Health Activities Booklet’. The booklet in Medical Research for her research into the community of Geelong. has been produced through collaboration the development and functions of dendritic James D Best (MBBS 1972, MD 1989, Head, between medical and education students cells and their role in regulating the School of Medicine)—reappointment as at the University of Melbourne and immune system to prevent autoimmune Chair, NHMRC Research Committee. the Australian Medical Association of disease. Samuel Berkovic (Medicine, Austin/ Victorian Doctors in Training and is aimed David J Scrimgeour (MBBS 1974, BMedSc Northern Hospitals, Epilepsy Research part of a project aimed at helping future 1974)—AM for service to medicine Centre)—2009 Bethlehem Griffiths teachers feel comfortable when dealing through the development and delivery Research Foundation Medal. with sexual issues in the classroom. For of services and programs in remote John A Carnie (MMed 1989)—PSM for more information see: http://www.mdhs. Indigenous communities, and to public outstanding public service in leading the unimelb.edu.au/knowledge_transfer/ health research. advancement and protection of the health podcasts/teach_the_teacher Micheil F Sweet (MBBS 1958)—OAM and well-being of all Victorians. Michael R Jones, PSM (MBBS 1963)— for service to medicine as a general Lawrence A Carroll (MBBS 1963)— AM for service to medicine in the areas of practitioner, and to the community of the OAM for service to medicine in the field health services management, accreditation Derwent Valley. of ophthalmology, particularly through and patient care, particularly with the Melissa Wake (Paediatrics, RCH & the provision of surgery and training in Australian Council on Healthcare Standards Murdoch Children’s Research Institute) developing countries. and the World Health Organisation. —2009 Federal Health Minister’s Award Jennifer Conn, Margo Collins, Agnes Michael R Kidd (MBBS 1983)—AM for for Excellence in Health and Medical Dodds and Ruth Sutherland (Medical service to medicine and education in the Research. Education Unit)— Australian Learning areas of general practice and primary health and Teaching Council Citation for care and through a range of professional STUDENT PRIZES Outstanding Contributions to Student organisations. Learning and Award for Programs that Geoffrey L Klug (MBBS 1959)—OAM for AND AWARDS Enhance Learning for Innovation in service to medicine, particularly in the field Curricula, Learning and Teaching for their of paediatric neurosurgery, as a clinician 2008 UNDERGRADUATE MEDICAL program ‘Beyond Serendipity: Structuring and mentor to professional organisations, STUDENT PRIZES AND AWARDS early Clinical Skills Learning for Medical and to the community. GA Syme Exhibition—Tsui Nam Trier Students’. Liyen Loh (PhD candidate, Microbiology Lau Alan K Eade (GDipEpid&Biostat 2004)— and Immunology)—high commendation Australian Medical Association Prize— ASM for outstanding contribution to the in the 2009 Premier’s Awards in Hannah Skrzypek development and provision of ambulance Medical Research for her work towards Clara Myers Prize in Surgical services in Victoria. understanding how HIV-infected people Paediatrics—Xueling Tan Elizabeth A Farrell (Obstetrics and respond to the virus and how this plays a David Danks Essay Prize for Human Gynaecology)—AM for service to medicine role in successful vaccine design. Genetics—Emily Margret Geraghty in the field of women’s health, particularly Kylie Mason (WEHI)—Premier’s Award Dr Kate Campbell Prize—Ankit Garg obstetrics and gynaecology through for Public Health and Medical Research Dwight’s Prize in Integrated Clinical research, clinical practice, education and in recognition of her ground-breaking Studies—George Heriot administrative roles, and as a contributor work in the treatment of blood cancers ESJ King Prize—Julia Lai Kwon to a range of professional organisations. and discoveries about the life-span of blood Edgar and Mabel Coles Prize—Kate Sandra Hacker AO (MBBS 1969, clotting cells. Hodgson GradDipPsych 1974)—appointment as William D McKellar (MBBS 1962)—OAM Edgar Rouse Prize—Hannah Skrzypek Chair, NHMRC Australian Health Ethics for service to medicine as a paediatrician, Fulton Prize—Lucy Ralston Committee. and to the community of Barwon. Geoffrey Royal Prize in Clinical

CHIRON 2009 36 IN BRIEF

Surgery—Jasana Aleksova Handbook Award—Paxton Loke Bone density testing, muscle strength Geriatric Medicine (Aged Care) Prize— Sir Albert Coates Prize—Asma Sohail and function testing is conducted every six Lucy Ralston Smith and Nephew Prize—Lucy Ralston months. GlaxoSmithKline Semester 5 Prize—Julia The Ilana Rischin Award for Outstanding If you have patients interested in Lai Kwon Achievement by an International Student participating in the study (Melbourne Harold Attwood Prize in Pathology— in Medicine (2007)—Shuli Cheng only), contact program coordinator Dr George Heriot Therapeutic Guidelines Award—Ajay Christine Bailey on: 8345 7164. Hedley F Summons Prize (for Iyengar Otolaryngology)—Halina Lisnichuk Thomas and Elizabeth Ross Scholarship— FITNESS FOR THE AGEING Herbert Bower Memorial Prize—Danielle Nicole Tham BRAIN STUDY II Clucas Vernon Collins Prize in Paediatrics— This study has been designed to test Herman Lawrence Prize in Clinical Stephanie Chen whether physical activity can improve Dermatology—Bonnie Swan Victorian Metropolitan Alliance Prize in the memory and wellbeing of sufferers Howard E Williams Prize—Scott Schemer General Practice—Joe Rotellai. of Alzheimer’s Disease (AD). The main Ian Johnston Prize in Reproductive hypothesis is that participants with mild Medicine/Biology—Scott Schemer 2008 DEAN’S to moderate AD who participate in 24 James Stewart Bequest—Julia Lai Swon, HONOURS LIST weeks of physical activity will experience Vivien Li & John William Guinane significantly less memory loss by the end Jamieson Prize—Sidharth Vermuri Semester 12 of the program than participants who Francene Christie Woodse Bond, Sook John Adey Prize in Psychiatry—Jonathan undertook usual exercise activity. Chuei Cheong, Kathryn Nicole Cugley, Epstein The study, led by Professor Nicola Katherine Dorothy Cummins, Jonathan John Cade Memorial Medal in Clinical Lautenschlager, Chair of Old Age Epstein, Lawrence Evatt Gray, Khai Lin Psychiatry—Scott Schemer & Lucy Psychiatry and Director of St Vincent’s Huang, Hieu Minh Lam, Heath Andrew Ralston Aged Psychiatry Service, is being Liddell, Katherine Moors, Lucy Victoria Katharine Woodruff Memorial Prize – coordinated across the University of Anastas Ralston, Erin Frances Sharwood, Palliative Medicine—Rehana Ratnatunga Melbourne, the National Ageing Research Scott Andrew Shemer, Candice Simpson, Keith Levi Prize—Sidharth Vermuri Institute, the University of Western Hannah Judith Michel Skrzypek, Victoria Max Kohane Prize—Lucy Ralston Australia and the University of Queensland Mary Snowball, Xueling Tan, Jessie Huey Neil Johnston Prize—Nathan Wong with the support of Alzheimer’s Australia Teng, Sidharth Vemuri. Peter G Jones Elective Essay Prize and is funded by the NHMRC. (UMMS Elective Essay Prize)—Jennifer The study needs both participants Jamison, Cameron McPherson, Jonathan PARTICIPANTS NEEDED living at home with mild to moderate AD, Epstein & Daniel Mason FOR UNIVERSITY OF and their carers, from metropolitan areas Prize in Clinical Gynaecology—Jyoti MELBOURNE TRIALS in Melbourne, Brisbane and Perth. The Blencowe program prescribes a range of physical RACGP Victoria Faculty Prize—Jessica OSTEO-CISE: STRONG BONES activity for up to 150 minutes per week. Participants will have personalised Day FOR LIFE training programs and be assessed on their RANZCOG Women’s Health Award— This study, being run by the Department activity using a pedometer, their ability to Rehana Ratnatunga of Medicine at Western Hospital walk distances, how quickly they can get Rehabilitation Medicine Prize—Danielle combines health education, behavioural out a chair, and their ability to grip objects. Clucas modification strategies and high velocity Commenting on the study Nicola RL Simpson Memorial Fund—Christine power training with the aim of improving Mandrawa, Sudha Palit, Chance Pistoll, bone strength and reducing the incidence Lautenschlager says, ‘the evidence is Joshua Crace & Sarah Good of falls and fractures in older Australians. mounting that regular exercise is good for Robert Gartly Healy Prize in Medicine— The study group are looking for more brain function, even in older age. Whilst Sidharth Vemuri than 80 participants to participate in the promising progress has been made in Robert Gartly Healy Prize in Obstetrics— second stage of the study. drug development research, there is an Francene Bond Participants will need to attend a gym urgent need to progress research on non- Robert Gartly Healy Prize in Surgery— for twelve months training three times pharmacological treatment for AD and George Heriot, Sidharth Vemuri, Francene a week, under supervision of a qualified one of the most promising strategies is Bond exercise trainer once a week. In addition physical activity.’ Robert Yee Prize in Medicine—Sarah to the exercise program, development of People from Melbourne, Brisbane or Good personal strategies to improve lifestyle Perth who are interested in participating Royal Australian and New Zealand behaviours is included. Participants will should contact Dr Elizabeth Cyarto on College of Ophthalmologists’ Prize— also need to attend quarterly educational 03 8387 2332. Michael Jamieson seminars to improve their knowledge and More information is available on: Royal Children’s Hospital Paediatric awareness of bone health. www.mednwh.unimelb.edu.au

CHIRON 2009 IN BRIEF 37

BOOKS of other cultures was needed to bring doing similar imaginative and productive real change in the world; not imposing work in this field through the World A Century of Influence our beliefs on them. Following the war, a Health Organisation. The Australian Student Christian commitment to international peace was Perhaps, as Renate’s title suggests, the Movement 1896-1996 seen as more appropriate than traditional biggest contribution of SCM has been in by Renate Howe, UNSW Press, 2009, evangelising missions. Amongst other the way it has influenced the development paperback, pp480, rrp $69.95 things, the Student Christian Movement and attitudes of generations of young This is an account of a remarkable history (SCM) urged action to abandon the White people as their careers evolved. The list of begun during a meeting at Ormond Australia policy. Many within it urged notables touched by it included the first College in June 1896, led by John R Mott, dropping commitment to formal religious president of the United Nations, a notable the first General Secretary of the World doctrine and examining growing interest prime minister, a deputy prime minister, Student Christian Federation (WSCF). in social reform, including the politics many high achieving state ministers, the Renate Howe has done a remarkable job— of such movements as founding of this heads of many government departments, not only sifting through mountains of University’s Labour Club. The Evangelical professors and vice-chancellors and documents, but also undertaking lengthy Union split off, distressed at the move away leaders in many professions. A Century of and telling verbal histories from many from traditional religious endeavours. Influence is worthy of celebration! The years following the Second World key players. David Penington The book gives a fascinating insight War were, in many ways, the blossoming into changing Christian views and attitudes of the SCM. Still struggling with many Psychiatric Ethics over the century, as adopted and adapted issues, still led by students, it was Fourth edition by successive generations of young people supported by older members who did their by Sidney Bloch and Stephen Green, embarking on careers in universities. Not best to hold it together at difficult times. Oxford University Press, 2009, only did the movement contribute to Traditional beliefs were being questioned paperback, rrp$59.95 shaping the lives of individuals, it had a and tested and membership longer Ethical issues are pivotal to the practice powerful international influence in many depended on formal Christian tenets. ways. The remarkable contribution of of psychiatry. Anyone involved in The Australian Student Christian Herb Feith, from the Melbourne SCM, psychiatric practice and mental healthcare Union, as initially titled, mixed young working in the public service of the new has to be aware of the range of ethical men and women and frequently provided Sukarno Indonesia after graduating from issues relevant to their profession. An the only outlet for the growing number Melbourne in political science, was followed increased professional commitment to of young women on campuses around by Operation 20 Plus, in 1954, when a accountability, in parallel with a growing Australia to participate in situations significant number of members, including ‘consumer’ movement has paved the way where ideas could be explored and they medical graduates, committed to work for a creative engagement with the ethical could hold office as much as men. in Indonesia. Ken Inglis, a former SCM movement. In the late 1800s, its work was seen leader, became founding Vice-Chancellor The bestselling Psychiatric Ethics has as ‘the evangelisation of the world in this of the University of Papua new Guinea. carved out a niche for itself as the major generation’ and many young graduates My medical contemporary, Ian Maddocks, comprehensive text and core reference did commit their lives to missionary founded the Papua Medical College, in the field, covering a range of complex work in hospitals, schools and parishes and later the Faculty of Medicine of the ethical dilemmas which face clinicians and in India, Africa and China. Before the university. Vern Bailey made a remarkable researchers in their everyday practice. This First World War, however, awareness contribution to improved nutrition and new edition takes a fresh look at recent was growing that better understanding health in Indonesia then spent many years, trends and developments at the interface between ethics and psychiatric practice. Coming ten years after the third edition, the editors have observed several emerging aspects of psychiatric practice and as a result, five new chapters have been added, including cutting edge and controversial topics—such as neuroethics, trauma/PTSD, and the relationship between psychiatry and the pharmaceutical industry. All other chapters have been fully revised and updated. The book will continue to be essential reading for psychiatrists, psychologists, other mental health professionals, and

WSCF Conference, Agape, Italy, 1952. ASCM delegates (L-R) in back row: Harry Wardlaw (1st), bioethicists, as well as of interest to policy David Penington (2nd), ‘Bill’ Strugnell (4th) and Frances Paton (5th). ASCM Centennial History Collection. makers, managers and lawyers.

CHIRON 2009 2009