RACS Complaints Process Updated It's a Great Life out There! Volume 21

Volume 21 | Issue 02 Surgical News

Volume 21 | Issue 02 | Issue 21 Volume surgeons.org

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RACS leadership President’s perspective 4 RACS complaints process updated 6

Spotlight on Embracing diversity International Women’s Day at RACS 10 It’s a great life out there! 14 Cover image: Byron Morning 20x30 cm. The two of us 18 Watercolour on Fabirano paper. Australia’s first female paediatric Artist: Professor Mohamed Khadra, Urological surgeon 20 Surgeon, NSW, Australia. Professor Wood talks about her work 22 “COVID 19 has given us all a chance to see our country through different lens. Instead of Bali and Fiji, our holidays have been in Australia. Articles of interest This was an early morning in the Byron Bay Full steam ahead for the RACS ASC 8 hinterland near Bangalow. The yellows of the dawn sky combined with the layer upon layer College Name Change Working Group 24 of the foreground inspired me to think of the Use of name Aotearoa in New Zealand 25 possibilities ahead and the joy of the new day and the sun’s promise of warmth.” Meet our new surgical advisors 27

Five years of JDocs 34 Professor Khadra’s art will be part of a virtual Australia and New Zealand 54 gallery that will be displayed during the Royal Australasian College of Surgeons Annual Operating at the cutting edge 40 Scientific Congress 2021. The Congress has the New draft road safety strategy 46 theme of ‘Celebrating the art of surgery in a time of disruption’. It combines the science of The American College of Surgeons 46 medicine with the creative elements required Who should use the title ‘surgeon’? 47 to become a great surgeon. The theme also celebrates the important contribution to the Good reading 52 arts by surgeons, who continue to excel not only with a scalpel but also in music, painting, design, sculpture, writing and other creative Scholarship Historical pursuits. Microsurgery in Australian hospitals 33 Surgeons of Vanity Fair: Oscar Clayton 42 Correspondence and letters to the editor for Surgical News should be sent to: [email protected] Game changer in prostate cancer 37 Archibald Watson’s surgical diary 50 Editor: Abderazzaq Noor T: +61 3 9249 1200 | F: +61 3 9249 1219 Contributing writers: Sharon Lapkin, Saleha Singh, Rachel Corkery Global Health www.surgeons.org Voices from the Pacific 12 ISSN 1443-9603 (Print)/ISSN 1443-9565 (Online). Hearing care for all 30 © Copyright 2021, Royal Australasian College of Surgeons. All rights reserved. All copyright is Global Health at the RACS ASC 38 reserved. The editor reserves the right to change material submitted. The College privacy policy and A trilogy of world pandemics 42 disclaimer apply – www.surgeons.org. The College and the publisher are not responsible for errors or consequences for reliance on information in this publication. Statements represent the views of the author and not necessarily the College. Information is Research not intended to be advice or relied on in any particular circumstance. Advertisements and products POSTVenTT 29 advertised are not endorsed by the College. The Case note review 48 advertiser takes all responsibility for representations and claims. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ACN 081 735 891, ABN 44081 735 891 of 129 Bourverie St, Carlton Vic 3053 4 RACS leadership

President’s perspective

Due to the lockdowns across Victoria, the notice, was no small feat and I would like The previously approved plans agreed on February meeting of Council was held to thank the many people, especially staff before the onset of COVID-19 have been predominantly outside Melbourne for in Melbourne and Adelaide, who ensured put on hold and our position needs to the first time in the history of the Royal that the meeting ran smoothly. be reassessed. Many of our Melbourne Australasian College of Surgeons (RACS). At the meeting, elections were held for staff have begun returning to work, but Our brand new South Australian office office-bearing positions. Congratulations we expect the working environment to was the meeting point for the majority to Dr Sally Langley who will be the next look significantly different to 18 months of the Councillors, with small hubs in RACS President, and to Dr Lawrie Malisano ago. As such, Council has decided to our offices in Wellington, Melbourne and who will take on the role of vice president. re-evaluate the whole project and we Sydney, where others assembled to join Sally and Lawrie will commence their expect that any new proposals will differ the meeting. leadership roles during the RACS Annual significantly from what was originally While we have held many face-to-face Scientific Congress (ASC) in May. envisaged. meetings over the years and have also During the meeting, the RACS Business The meeting also saw the renaming of become accustomed to virtual meetings, Plan for 2021 was approved. This includes various boards and committees, and the hybrid approach used for this Council information on the planned upgrades to the establishment of a new Health meeting was another first. Arranging the the Spring Street offices in Melbourne. Policy and Advocacy Committee (HPAC). logistics of this, particularly at such short The New Zealand National Board will Surgical News | Volume 21 | Issue 02 5 now be known as the Aotearoa New I hope this type of visibility will inspire Zealand National Committee (AoNZNC), the next generation of female surgeons and the Professional Development and and help us achieve the goals we aspire Standards Board has been renamed to towards. the Professional Standards and Advocacy I would also like to announce that the Committee. The name changes reflect a President’s Meeting Room in Melbourne decision in recent years to move away is to be renamed the Anne Kolbe Room, from using the term ‘board’ to describe in honour of our first female president. our various governing bodies, with the More changes are being discussed to exception of the Board of Council. recognise our diverse Fellowship. The role of HPAC will be to identify I would like to draw your attention to our and advise on advocacy initiatives and updated complaints process. As many priorities. It will ultimately work with the of you know, our position as a member offices of the president and vice president organisation does not provide us with the in managing health policy and political powers that a hospital or medical centre advocacy. The committee will meet that employs surgeons has, or that a regularly, and it is expected that there will regulator such as the Medical Council of also be a significant amount of out-of- New Zealand (MCNZ) or the Australian session work. This will allow the College Health Practitioner Regulation Agency to generate content quickly and respond (Ahpra) holds. to the often very short turnaround times Images of government consultations. With this in mind, we have taken steps to Above: revise our approach. We learned from the Associate Professor Phillip Carson, Associate Professor Julie Mundy and Dr Tony Sparnon. Another flagship area of our Business Plan way we used to address complaints. We is the Rural Health Equity Strategic Action have developed a process that supports Over page: Dr Sparnon with Councillors. Plan. For those who are unaware, the professionalism in surgery and makes Strategic Action Plan embeds actions for Front: Mr Adrian Anthony, Dr Sarah Coll, Associate sure that all complaints and concerns Professor Julie Mundy. rural health equity in all RACS activities are handled by the agency best placed to Second row: Dr Pecky De Silva (Observer), Professor and across all specialties and is available manage them. Deborah Bailey, Dr Tony Sparnon, Professor Henry on our website. Woo. I would like to finish by thanking you all Thank you to Dr Bridget Clancy and the Third row: Professor Christopher Pyke, Dr John for the support that you have extended Quinn (Executive Director for Surgical Affairs Rural Surgery Section Committee, who to me over the past two years. This Australia), Dr Lawrence Malisano, Associate were instrumental in developing this was especially appreciated during the Professor Phillip Carson, Professor David Fletcher, key RACS strategic action plan. Council Professor Owen Ung, Dr Christine Lai. extraordinarily difficult circumstances Back corner: Dr Gregory Witherow. has now approved a Rural Health Equity we faced in 2020 and 2021. Steering Committee for managing the principles outlined in the action I have had the great honour of working plan and prioritising the actions for with some exceptional people during my implementation. time on Council. There are far too many to name, but I would like to make particular Since the Council meeting, we celebrated mention of the two vice presidents that International Women’s Day in March and served during my term, Mr Richard Perry RACS offices held various events across and Associate Professor Julie Mundy, Australia and New Zealand. As you know, as well as Associate Professor Phill the College has made a number of specific Carson, Censor-in-Chief, who, like Julie commitments to promote greater gender and myself, will be finishing his time on diversity and we are working towards Council during the RACS ASC in May. these as part of our Building Respect and Improving Patient Safety initiative. Finally, I wish Sally and Lawrie all the This work is incredibly important and best in leading our College forward. I will remain an ongoing priority for the have known them both for many years, College, particularly in the context of the and they are incredibly passionate about national and global conversations that surgical standards and education. They are occurring regarding gender equity, will make exceptional leaders of our discrimination, bullying and sexual College, and I am excited to see what harassment. RACS will achieve under their guidance. I am looking forward to seeing many of Dr Tony Sparnon I was pleased to see a number of our President highly talented female surgeons profiled you at the RACS ASC. through our online social media campaign during International Women’s Day. 6 RACS leadership

RACS complaints process updated

Supportive, confidential, respectful, Medical Council of New Zealand (MCNZ) approach. We learned from the way we and non-judgmental – these are the or the Australian Health Practitioner used to address complaints and have words that best describe our new and Regulation Agency (Ahpra) holds. developed a process that supports enhanced 2021 complaints process. We simply do not have the legal powers, professionalism in surgery and ensures As an organisation that furthers the nor the resources, to effectively and all complaints and concerns are handled interests of our members by supporting efficiently investigate complaints, other by the agency best placed to manage their ongoing development and than involving our own employees. We them. maintenance of expertise, the College do not control the workplace of the Our new complaints framework is in a unique position when it comes complainant, respondent, or witnesses, balances our: to dealing with enquiries regarding and cannot conduct a sound, defensible, • duty of care to our Trainees, Specialist incidents and reports of poor conduct prompt fact-finding investigation. Our International Medical Graduates and inappropriate behaviour. We want attempts to do so in the past have (SIMGs) and surgeons to provide a safe to make sure that your concerns and created legal challenges and have environment complaints are heard and addressed. resulted in the complainants being • responsibility to provide a Our position as a member organisation confused and dissatisfied with the procedurally fair and timely process does not provide us with the powers process and outcome. This inevitably led that a hospital that employs surgeons to some losing trust in the College. • professional commitment to build a has, or that a regulator such as the We have taken steps to revise our culture of respect Surgical News | Volume 21 | Issue 02 7

• legal and ethical responsibilities as a respect your wishes and will progress that supports resolution and improves College your report as long as we know who the workforce culture and respect. While we must still work within the you are. Please be assured that we take I encourage you to access the RACS limitations that surround the way we each matter that comes to us seriously Support program. It is a free confidential can manage enquiries, reports and and treat each one with the utmost service available to RACS Fellows, formal complaints, our new approach confidentiality and sensitivity. Trainees and SIMGs, and your immediate centres around offering our Fellows, What do we do to address a report? family. Visit our website to find out more: Trainees and SIMGs support and We are committed to building a culture surgeons.org/about-racs/surgeons- guidance throughout our process. This of respect in surgery and improving wellbeing/racs-support-program applies to all types of reports we receive, patient safety through identifying and whether they are out of our scope addressing unacceptable behaviour. or better handled by an employer, a Unacceptable behaviour not only Find out more about our revised regulatory agency or a health complaints adversely affects co-workers, but complaints approach and let us know commission. also our patients. In instances where how we can support you: surgeons.org/ In 2020, we asked an external expert unacceptable behaviour is identified about-racs/feedback-and-complaints. and a report is submitted to the College to review our updated complaints We recently published a short or information provided to us, we approach. Areas specifically reviewed animated video to explain our new encourage a profession-led conversation were visibility, accessibility, approach, which is also available on our to resolve the matter. responsiveness, restorative approach, website. independence, confidentiality, This approach is led by our surgical accountability, monitoring with a advisors, Dr Sarah Rennie and Professor centralised, anonymous data collection Spencer Beasley in New Zealand, and with an analysis process, protection in Australia, our Executive Director for for those who make the complaint, and Surgical Affairs, Dr John Quinn. We have prevention of victimisation. You can read found this approach, which is collegial the full report and recommendations on and non-judgmental, encourages self- our website. reflection and behavioural change. While the findings were supportive of Let me emphasise that this approach the changes we have made, several is not all-encompassing and will not be refinements and recommendations were appropriate for all types of complaints suggested and are being addressed. or concerns. We assess each report You can read the full report and based on information we receive and recommendations on our website at will progress each matter accordingly. surgeons.org/about-racs/feedback-and- We also work in tandem with healthcare complaints. services and employers of surgeons to support professionalism by How do we act when we receive a report? Our new approach, which we have been collaborating for change. trialling with success since late 2019, As I mentioned above, sometimes the aims to build a culture of respect and best approach is for us to refer the trust between you and the College. Our matter to the agency that will be able to process is informal and non-judgmental. act and carry out an investigation; with When you contact us, we discuss your us helping you navigate these external options together and help you decide complaints processes and staying in what to do next. We might refer you to touch with you from start to finish. another agency that has the necessary It is in all our interests to ensure our power to look into your concern or Fellows, Trainees and SIMGs are provided formal complaint. We will continue to with a safe and respectful training keep in contact with you and provide and working environment. The core support and guidance as you undergo of our work is to provide caring, safe, that agency’s process. and comprehensive surgical care for The details and outcome are always kept our patients, and the way we work confidential. Even if you decide not to and communicate with each other is make a formal complaint, we urge you to a substantial part of that. We cannot provide satisfactory patient care if we raise any concerns you have with us, so Dr Tony Sparnon feel unsafe or disrespected at work. we can look into the matter and help you President resolve it. It is important that all disrespectful behaviours are reported and not just If you prefer not to be identified, we will accepted, and that we have a system Full steam ahead for the RACS ASC

Good news (with fingers crossed) – we a standout finish to the Council Plenary on are now able to increase the number Thursday. We have also confirmed Dr Nick of in-person registrations for the Royal Coatsworth, former Deputy Chief Medical Australasian College of Surgeons Annual Officer for the Australian Government, who Scientific Congress (RACS ASC 2021) to will speak on the topic ‘Communicating 1000, and the allocation for each specialty public health messages to a general for physical attendance has doubled. We audience. What works and what doesn’t?’. hope the vaccine rollouts will increase Another standout will be the keynote our security in being able to deliver this address, ‘Audacious goals 2.0: the global component of the RACS ASC and will enable initiative for children’s surgery’, by Dr more of you to visit Melbourne in May. Diana Farmer, section visitor for RACS Several section dinners are being planned Global Health. As one of the co-founders of and may be able to proceed; the section this growing collaboration, she will speak conveners are working with venues to look to the vision of safe, affordable and timely at what is possible for our social functions. surgical care for all children. Dr Farmer Details for these dinners will be made will also be presenting to the Paediatric available on the RACS ASC 2021 website Surgery program, and I look forward to once confirmed. hearing her contributions. On 4 March 2020, we had a meeting with The College Conference and Events and the president and both vice presidents Communications teams have been working of the Royal College of Surgeons of like trojans to prepare what is effectively Edinburgh (RCSEd). While there is great two conferences, and my heartfelt thanks disappointment that their Fellowship go to them. The final program is in the last cannot attend in person, all three were stages of preparation and will be made very excited about the hubs concept and available online in April. Registration is seized on the idea to create hubs in their open and all Fellows are encouraged to centres in Edinburgh and Birmingham. register early for a spot to attend the There was lively discussion around the RACS ASC physically at the Melbourne available scientific programs for them to Convention and Exhibition Centre. Don’t select, with content of general interest miss out on being part of a fantastic from the plenary, global health and congress. surgical director’s sections, as well as a mixture of specialty section content to We would also like to thank our sponsors create a stimulating virtual conference. and exhibitors for their continued support of the Congress, in particular our Platinum Our Edinburgh colleagues were also very Partners Ethicon and Medtronic, and our excited about the possibility of using Silver Partner Device Technologies. digital platforms to increase the level of collaboration between the two Colleges in Dr Liz McLeod the future. RACS ASC Coordinator The President of RCSEd, Professor Mike Griffin, will give the President’s lecture, ‘It’s good to talk: talking to patients with cancer’. Having now met Professor Griffin and heard him speak, I’m sure this will be Surgical News | Volume 21 | Issue 02 9

Spotlight on Embracing diversity

International Women’s Day at RACS 10 Surgeons across our countries 14 The two of us 18 Diversity in all Remembering Australia’s first female paediatric surgeon 20 its dimensions strengthens the surgical profession.

Diversity and inclusion are part of the wider work we are undertaking in the College to build a culture of respect in surgery.

There is considerable advantage to having the Fellowship of our College reflect the diversity of the community that we are privileged to serve.

Read on to learn about the breadth of our surgeons working rurally and regionally across our two countries, Australia’s first female paediatric surgeon, and how the College celebrated International Women’s Day.

At the College we believe that celebrating our many parts makes us a greater whole.

10 Embracing diversity feature International Women’s Day at RACS

International Women's Day was In South Australia, Fellows and Trainees In Queensland, the local membership commemorated on Monday 8 March, with gathered at the new RACS office in Kent met at Customs House in Brisbane for various RACS events hosted around the Town, Adelaide to celebrate the day. The a lunchtime gathering on Saturday 13 country. ceremony was attended by the RACS March. Women in Surgery Chair, Dr Christine Lai, As part of our International Women's Day A similar function was held in Western who took part in a panel interview with program, the ‘President’s Meeting Room’ Australia, where guests gathered at ABC journalist Wendy Harmer the day at the College will now be called the ‘Anne Goodwood Restaurant at Optus Stadium before, and former Queensland Premier Kolbe Room’ in honour of our first female on Saturday 20 March. President, who was President of RACS Anna Bligh. Listen to their conversation 2003-2005. here.

New South Wales International Women’s Day

On Friday 12 March I was honoured to chair a discussion on ‘Gender Parity in the Public Hospital Medical Workforce’. This event was co-hosted by the Royal Australasian College of Surgeons (RACS) New South Wales and the Honourable Bronwyn Taylor, New South Wales Minister for Mental Health, Regional Health and Women. The purpose of the day was to focus on gender barriers in surgery, especially in the public hospital system. This was scheduled as part of New South Wales Women’s Week, a week dedicated to celebrating achievements of women in the state. During my time as a RACS New South Wales Committee member and now as Chair of the Committee, I have heard many Elizabeth Koff, Secretary, New South Wales Health, and the Hon. Bronwyn Taylor, MLC, New South female Fellows who have engaged with Wales Minister for Mental Health, Regional Youth and Women. RACS New South Wales report frustration applying for advertised public positions (SET) applicants, as well as a significant with current workplace practices. and being told that the preferred gender pay gap, which can be greater than This was reflected in the discussions candidate is a male 50 per cent in some specialties (based on throughout the day, with many barriers to • Female Fellows working unpaid in non- RACS 2014 census data). women’s success identified. clinical roles or being appointed but RACS has a diversity and inclusion policy These included: without operating privileges. and has been very proactive in increasing • Difficulties accessing parental leave These issues compound the problems of representation of women to boards and (both maternity and paternity) the lack of visibility of women in surgery, committees. Currently, 35 per cent of RACS committee and board members are • Female Fellows being discouraged from which leads to barriers to attracting women Surgical Education and Training women, even though only 14 per cent Surgical News | Volume 21 | Issue 02 11

of Fellows are female. Despite this, the proportion of female SET applicants has not increased beyond 30 per cent. Many who attended the March 12 event felt a major contributor to this disparity is the lack of diversity in surgical departments in public hospitals. As more female Fellows complete training, if these gender barriers are not addressed, the problems will apply to a larger proportion of the workforce. There is significant research that shows that diverse healthcare teams have better patient health outcomes, are more adoptive of innovation and change, and demonstrate better financial outcomes. RACS New South Wales believes that all Trainees completing the training program have demonstrated adequate capability to be registered as a practitioner in a Associate Professor Payal Mukherjee with RACS Councillors Professor Raymond Sacks, Dr Jennifer Chambers relevant specialty. Furthermore, data OAM and Miss Annette Holian. reveals that outcomes achieved by Panellists for the discussion included: members, Councillors, society and New South Wales International Women’s Day female surgeons are not inferior; rather, Minister Bronwyn Taylor; New South section representatives (especially these surgeons may be equal or superior Wales Secretary of Health, Ms Elizabeth those who travelled interstate), to their male peers. Koff; CEO of Sydney Local Health District, representatives from other colleges and The theme of this year’s International Dr Teresa Anderson AM; Head of Discipline the Australian Medical Association, as Women’s Day, #choosetochallenge, was of Surgery, University of Sydney and co- well as government representatives. so appropriate. We should all choose to chair of the Institute of Academic Surgery I would particularly like to acknowledge challenge the barriers and discriminatory at the Royal Prince Alfred Hospital, those at the New South Wales Ministry of behaviour in surgical departments, and Professor Paul Bannon; RACS Councillor Health, who have championed this issue question why they are so prevalent and Australian Society of Otolaryngology and expressed an ongoing commitment and systemic. Unless these barriers are Head and Neck Surgery (ASOHNS) Vice to address the barriers female surgeons changed, not only will there not be parity President, Professor Raymond Sacks. face. in the workforce, there will also be a Thank you to everyone who attended It was great to see the widespread continued absence of female surgical this event, including RACS committee support from all genders across several leaders in our health system. institutions, and the open forum, which allowed these vital discussions to take place. While we still have a long way to go, it is events like these that play a key role in setting the standards we should all abide by and uniting us in using these standards to deliver the best patient outcomes in health.

Associate Professor Payal Mukherjee FRACS

Left: Dr Pecky De Silva, Deputy Chair of RACS Women in Surgery and Chair of Younger Fellows committees, with the Hon. Bronwyn Taylor. Voices from the Pacific: International Women’s Day event

On Monday 8 March 2021, in honour of They hosted a panel that included She hopes that her experiences made it International Women’s Day, medical Dr Fane Lord, an ear, nose and throat easier for future generations of female professionals from around the world (ENT) surgeon from Fiji, Dr Esther surgeons, of whom there are now seven, gathered for the ‘Voices from the Apuahe, a neurosurgeon from Papua and was especially proud that four of Pacific’ forum, a webinar focused on New Guinea (PNG), Nerrie Raddie a these women are now undertaking the challenges, opportunities and perioperative nurse from the Solomon subspecialty training. experiences of women working and Islands, and Dr Sepi Lopati, an ENT Dr Sepi Lopati is currently in Melbourne training as surgeons, anaesthetists and surgeon from Tonga. studying her Master of Surgery – perioperative nurses across the Asia- The event began with an address from Research degree on the prevalence of Pacific region. Dr Ifereimi Waqainabete, Minister for ear disease in primary school students The event was presented by Miss Health and Medical Services in Fiji, who is in Tonga. As a mother to two young Annette Holian, Chair of the Royal himself a general surgeon. children while training, she found it Australasian College of Surgeons Dr Esther Apuahe, the first female difficult to find the appropriate training (RACS) Global Health Committee, and surgeon in PNG and a mother of three, to suit her life. She found the lack of Dr Rachna Ram, a general surgeon talked about her challenges in being outside connections hard as she couldn’t from Fiji who specialises in Plastic accepted by her male colleagues and travel for training and wanted help and Reconstructive Surgery, currently patients, especially in the provinces. finding a pathway. Dr Lopati explained undertaking her PhD in Melbourne. that women entering the surgical field Surgical News | Volume 21 | Issue 02 13

Dr Fane Lord, a surgeon in Suva, Fiji, Miss Holian invited all participants and reflected on 16 years practising as a viewers to join the new RACS Global clinician with 13 years in the field of Health Section, designed to foster surgery. Dr Lord had always wanted to connection and communication with be a surgeon and applied for training like-minded people. She suggested it every year, but when she was finally can be a forum for discussions such as accepted she had a six-month-old the ones they were having, whether baby. Luckily, she was offered a place someone is interested in learning more again three years later and continued about training pathways or a particular studying, specialising in ENT. disease, or looking for resources and In 2017, she was a recipient of the support. “I see it as a great constellation Rowan Nicks Pacific Islands Scholarship of surgical shining stars connected and as a result completed a placement across PNG and the Pacific,” she said. at Royal Adelaide Hospital. “I didn’t All participants agreed there had been realise the depth or breadth of ENT improvements over the years but there until I went to the Royal Adelaide,” she were still more changes to be made. said. “I felt out of my depth and was As Ms Raddie said, “With challenge willing to learn as much as I could.” She comes change. May we all choose to “You must love what you continued mentorships on her return to challenge.” choose. If you have the Suva and believes that “now the onus is RACS Global Health is committed to on me to impart whatever knowledge supporting and advocating for Pacific heart for the job and a good I’ve received – there’s a real shortage of support system, you’re able Island women clinicians through the female mentors.” Dr Lord also stressed Pacific Islands Program, an Australian to cope and be up for the the importance of family support. “You aid initiative implemented by the Royal challenge.” can’t do this alone,” she said. Australasian College of Surgeons on behalf —Dr Esther Apuahe Dr Pecky De Silva, a vascular surgeon of the Australian Government. and the Deputy Chair of RACS Women in Surgery and Chair of Younger Fellows is a recent phenomenon in Tonga, and committees, echoed the importance stressed the challenges faced by women of female role models. “When you’re a wanting to upskill. smaller proportion, our duty is to carry Ms Nerrie Raddie, a perioperative that torch, to make our junior colleagues nurse in Honiara, Solomon Islands, feel empowered and allow them to has firsthand experience in educating follow in our footsteps,” she said. Dr De and facilitating training. When she Silva explained the four main themes began perioperative nursing in 2006, of the strategic plan of the Women she found it very different from her in Surgery Committee: leadership, work on the wards, yet there were no role modelling, flexible training and practice guidelines in place. Ms Raddie advocacy. learned from senior nurses and became In the lively discussion that followed, all passionate about the field. Ms Raddie participants stressed the importance of joined the Pacific Islands Operating Room loving the work. “I love being a surgeon,” Nurses Association and is now interim said Dr De Silva. “I think it’s a great secretary. career. I’m so happy where I am and I In 2015, practice guidelines were hope I show that to all my junior doctors developed for 14 Pacific Island countries, and medical students.” and in 2016, Ms Raddie attended Dr Apuahe agreed. “You must love what the Pacific Perioperative Standards you choose,” she said. “If you have the Implementation workshop in Fiji. From heart for the job and a good support there, she “teamed up with colleagues system, you’re able to cope and be up for to do presentations at international the challenge.” Over page, clockwise from top left: conferences, co-authored articles The group discussed the challenges Dr Rachna Ram, Dr Fane Lord, Dr Esther Apuahe, Dr for ACORN [the Australian College of Sepi Lopati, Miss Annette Holian, Dr Pecky De Silva of balancing a family at any stage of Perioperative Nurses] journal, became your career and developments that involved in mentoring activities both could make life easier for families, such in-country and in Fiji.” She is excited as dedicated rooms for mothers and to empower perioperative nursing children, childcare services, flexible practices and provide opportunities for training and parental leave. women to excel in their profession. 14 Embracing diversity feature It’s a great life out there!

Surgeons share their experiences working in rural and regional areas of Australia and New Zealand

Mr Sabu Thomas, General Surgery, Associate Professor Matthias Wichmann, Every Australasian surgeon should be Kalgoorlie, Western Australia General Surgery, Mount Gambier, South exposed to rural surgery for at least Australia six months of their training. I would be I have always had wonderful and very surprised if we do not see more young collegiate general and subspecialty When we came to Australia from Munich surgeons developing an interest in colleagues in the regional areas where I we had to work in an ‘area of need’. this fascinating specialty. Life in rural worked. In rural practice you have a close We chose Mount Gambier because it communities is very rewarding and relationship with colleagues, including was halfway between Melbourne and welcoming. My advice would be, try it surgeons, anaesthetists, staff in clinics Adelaide, had good schools for our and keep an open mind about a non- and theatre. children, and the hospital was closely metropolitan career. It’s a great life out here! Urban surgeons and specialty boards need connected with two universities. to value rural surgery and rural surgeons. Working in a rural environment always Dr Roxanne Wu, Vascular Surgery, Cairns, Don’t devalue their work – indirectly, keeps you on the tips of your toes. Even Queensland or directly. Support rural surgeons by after 15 years of working in rural surgery, visiting them, and credential them to visit Living and working in a regional area and work in needed subspecialty areas in has given me a balanced life and a big tertiary centres once in a while. richly rewarding career. I have brought Rural surgeons need to be encouraged subspecialty skills in Vascular Surgery to to do procedures that can be safely done a region that did not know they needed a in regional hospitals, rather than always vascular surgeon. When I came to Cairns sending patients to larger hospitals. it became evident there was a huge need Sending patients away does not build for dialysis and its attendant vascular regional surgical capacity, nor attract a problems; a need for a vascular surgeon capable workforce to regional areas. to attend to the diabetic foot problems If you are a surgeon in a regional area, and of course the usual peripheral keep learning new procedures relevant vascular disease and trauma. to your practice. Travel nationally or It takes me 15 minutes to drive to the internationally, if possible, and keep hospital, except for the days I do a rural using your learning and skills to assist outreach clinic which is usually an hour’s in different parts of the world. Think of drive away. Running a practice in a surgery in terms of a vocation and calling. regional centre is easy. I have never had to look for work, it comes to find me. Most of the general practitioners know you you need to come up with new ideas or personally and it is easy to get to know find a friend to talk to about how best to them. There is absolutely no shortage of approach a certain condition. In Mount work, rent is reasonable, and getting good Gambier I have always been lucky to have colleagues to work with and to rely on. This has made my life as a rural surgeon much easier and much less stressful. Rural surgery is probably the only specialty where a surgeon can do an endoscopy and a hernia repair followed by a gallbladder and a bowel resection – all on patients they have met before surgery, will meet again after surgery and will most likely bump into at a friend’s place not long after that. We get to care for our cancer patients throughout their cancer journey and I would not want it any other way. Surgical News | Volume 21 | Issue 02 15

employees who stay for years is not a hospital you will be asked to step up and problem. lead hospital committees, help establish One of the best things is the ability to clinical services or assist with managing work in a community: patients and their the trainees or rosters. families stay close and now that I have I have been able to establish my practice been practising here for over 30 years, relatively quickly and use all of the skills I have had the privilege of operating from my training immediately. I also had on multiple generations of the same the opportunity to establish a breast families. I have one of the best followed reconstruction service from the ground up cohort of EVAR (EndoVascular up and design the model of care in line Aneurysm Repair) patients in the with best practice, instead of having to fit country. It is really special to follow up into an existing structure or way of doing patients for decades and be able to really things, which has been very exciting. know what one’s outcomes are for the Don’t be afraid to ask for the working procedures that you do. conditions and flexibility you need to make the move to rural. Consider how you will maintain your collegiate networks training to work amongst regional and Dr Shehnarz Salindera, General Surgery, and support structures once you make rural communities where our people are. Woolgoolga, New South Wales the move. As Māori there is a very strong internal drive to do this. Specialty boards can help by developing I grew up in a rural area and studied more rural training positions at all My training career thus far has seen me medicine with the goal of one day stages in the training pipeline, including working in four regional hospitals and practicing in my hometown. As I Fellowship posts. Having the opportunity one tertiary hospital. Next year, for my progressed through training, I requested to train rurally at any point in your final two years in training, I will be placed rural rotations where I was able to meet pathway will help more Trainees explore in a tertiary hospital, which is probably wonderful mentors, such as Dr Sally the wonderful opportunities available in a necessity. However, on completion of Butchers in Lismore and Dr AJ Collins in rural settings. training, my whānau and I would very Bega, who encouraged me and supported much love to move to a region with high me through training. They showed me Dr Lincoln Nicholls, Orthopaedic Surgery, Māori need. Te Tai Tokerau, Rotorua, that you can be a generalist and Whangārei, New Zealand Waikato, Te Tairawhiti, Manawatu, and practice subspecialty surgery in a rural Whanganui are all regions we have iwi setting. I’m currently a Māori SET 3 Orthopaedic (tribal) connections to and regions where Trainee working at Whangārei Hospital our people would like us to be. We look in New Zealand’s most Northern District forward to opportunities that may arise Health Board. from such communities. My wife is a Maori pharmacist and A Māori whakatauki (proverb) explains the health research fellow and together we importance of training and remaining or are proud and dedicated Maori health returning home to their people. ‘Tangata i practitioners from small town Aotearoa akona ki te kāinga, tūngia ki te marae, tau New Zealand. We believe we are charged ana. A person trained at home will stand with the responsibility to work extremely on the marae with dignity.’ hard and strive to improve outcomes Mr Philip Gan, General Surgery, for Maori as well as all patients under Warrnambool, Victoria our care. This is a responsibility we are honoured to uphold. We believe that our clinical skills, soft skills, life experiences, When I set up a practice in Warrnambool our cultural expertise and command of 19 years ago I wanted to maintain a broad Te Reo and Tikanga Maori can help achieve skill-set and varied practice, but also to Working in a rural setting has ensured this. have a greater relative freedom to follow I maintain my skills in General Surgery my areas of interest, to avoid the battle of Being from small towns in New Zealand, and further developed my leadership Melbourne traffic, and to be close to the we feel we have a responsibility to return and management skills. In a smaller ocean, which I have always loved.  to the regions after completing our 16 Embracing diversity feature

My first ‘bosses’ as an accredited registrar port, mini-laparoscopic and even hybrid I was honoured to convene the 2015 were Mr Rodney Mitchell and Mr John trans-vaginal NOTES techniques across a Provincial Surgeons of Australia Annual Daniels in Bendigo, who inspired me to very broad range of operations. My series Scientific Conference (PSA ASC) in Lismore, high levels of surgical care in a regional of laparoscopic colorectal resections which provided a great opportunity to setting. I could see that skills and was the first to be presented from any showcase to junior doctors, registrars, standards are something you develop and Australian regional centre (RACS Annual and young Fellows some of the benefits of bring with you, wherever you practise. Scientific Congress, Hong Kong 2008), living and working in a non-metropolitan Importantly, my wife, who is a general and have evolved to intra-corporeal surgical environment. practitioner, spent many of her formative anastomoses. These patients go home as years growing up on the Gold Coast and early as day one or two post op without was very comfortable moving to another opioids. My cholecystectomies are coastal region. We did investigate the typically day procedures, also generally local schools and were satisfied that without requiring discharge opioid we could provide our two children with analgesia. a great education without resorting to I became involved in medical device boarding schools. innovation and have three patents to my When I started, there were only three name, covering two medical devices, one general surgeons in Warrnambool, of which (the LiVac Retractor) is already with far fewer sub-specialties available in market. I felt very supported during locally. I was therefore doing superficial the journey of taking this from concept parotidectomies, thyroidectomies, to registered medical device, particularly fundoplications, Dupuytren’s in conducting a First in Human Clinical contractures, digital nerve and extensor Trial to International Standard ISO 14155 tendon repairs, finger fractures, all (2011). This was the first and only time manner of flaps and grafts, breast that St John of God Australia and South surgery, as well as a broad range of West Healthcare Warrnambool had colorectal surgery on top of the usual approved a First in Human medical device I think it is important for everyone to gamut of cholecystectomies and hernia trial. recognise that maintaining generalism repairs. I don’t know that I could have developed within any specialty training program is As subspecialists started to set-up in and maintained the same breadth of important. It allows us to provide a level Warrnambool, I progressively divested practice that I enjoy now in an urban of care to the same high standards for all those areas of my practise, which allowed setting. Being in a rural setting has not Australians, regardless of where they live. me to further focus on my particular prevented me from advancing my surgical We need to support Trainees who have passion of minimally invasive surgery. I interests and skills. an interest in working in rural areas, have incorporated single and reduced- and the establishment of more rural Dr Sally Butchers, General Surgery, training hubs is one way to achieve this Lismore, New South Wales goal. We can also continue to promote rural Fellowship positions. An example Rural surgery has given me the of this is the collaboration between opportunity to maintain an interesting the many specialties in setting up the and broad general surgical practice. I Post-Fellowship Education and Training have not had to subspecialise, and I enjoy (PFET) program in Rural Surgery, the wide variety of work that I am able commencing in 2022. This program will to do. I also feel that the opportunity allow Fellows to have additional training to be involved in the local community in two subspecialty areas in metropolitan has provided me with a good work-life centres, and establish vital peer support balance. networks that they can call upon when I live on a property that is 15 minutes from they start working in their rural positions. work with no traffic, and I do feel that the lack of commute has played an important part of being able to get the balance right! Surgical News | Volume 21 | Issue 02 17

Dr Mark Romero, General Surgery, other is non-existent. I feel this generates Port Macquarie, New South Wales a very collegiate work environment and I have always felt very supported. Working in a regional area means you The advice I would give to aspiring rural have to be flexible in order to provide surgeons is to voice your desires as soon care to the community. Although all as you know them. If you are in a rural the general surgeons here have a term and you could see yourself working subspecialty interest, we all also overlap there, let the local surgeons know. They in a lot of ways. This means we can often will often keep you in mind and let you cover for each other and also that when know if a job is coming up, whether in more specialised care is required, we can that institution or somewhere else. I find refer to or consult each other. Your area of the lifestyle fantastic and I thoroughly practice is broader than in big centres but recommend it. not so broad that you become a ‘jack of all trades’. It’s certainly a nice balance. We Dr Kesley Pedler, Urology, Port Macquarie, are expected to deal with all emergency New South Wales general surgery when on call, which can range from simple abscesses to trauma I grew up in Sydney and did not consider I also recommend establishing good laparotomies. Elective operating lists are regional practice until I was seconded relationships with colleagues in your varied and it’s not too uncommon to start on rural rotations as a surgical registrar. close major centres who will be able to the day with, for example, an ingrown I particularly enjoyed working in Port give you advice for complex cases and toenail and finish with an ultra-low Macquarie. I liked the beautiful region accept referrals for patients who cannot anterior resection. and the staff who worked at the hospital. be managed locally. I came back to Port Macquarie two years later as a Urology Trainee and was inspired by the consultants, who had established a subspecialised unit offering almost all the same procedures available in a large city hospital, including major oncology operations. My goal is to offer patients who live in a regional and rural Australia the same quality health care as is received by patients who live in the city. It can be challenging accessing new technology, such as robotic surgery, but I am fortunate to have a very supportive colleague in Sydney who mentored me for robotic cases, first in Sydney and now locally. The most surprising thing about rural If you are interested in working in surgery is the sense of community. You a regional area I would strongly will fix a hernia on a patient one day and recommend working in the area a few months later you will see them at beforehand if possible, either as a Bunnings, or they will turn out to be your Trainee or a locum. There is more than child’s soccer coach. New patients will tell just location to consider when setting up you how you operated on their neighbour practice and this will allow you to get to or that their friend recommended you. know the other surgeons and staff who Word of mouth is incredibly powerful and, work in the area. I am fortunate to work given that there are only a few of us, the with three other urologists so I have need to advertise or ‘compete’ with each supportive colleagues locally. 18 Embracing diversity feature The two of us

Meet twin surgeons Associate Professor Sanjay Warrier and Dr Satish Warrier

Associate Professor Sanjay Warrier and Dr Satish Warrier are twins – identical twins – with many shared interests including surgery, family, sports and music. Associate Professor Sanjay is a breast oncology and oncoplastic surgeon. He is a current Council member for Breast Surgeons of Australia and New Zealand (BreastSurgANZ) and the immediate past president (May 2019-May 2020). Dr Satish Warrier is a colorectal and general surgeon at Peter MacCallum Cancer Centre, Alfred Health, and Epworth Healthcare. Born in Albury and growing up in Nambucca Heads, New South Wales, Sanjay and Satish enjoyed an idyllic country life. As twins, who were mistaken for each other in primary school, they were content with each other’s company, Associate Professor Sanjay Warrier and Dr Satish Warrier spending hours together studying, playing friend and spending every day together for a year. Sanjay remembers their Dublin sports and spending time with their until you’re outside of university. It’s been days with fondness. Along with excelling family. a norm for us – someone being there all in their studies, both brothers were “We are very close,” Sanjay said. “It’s an the time.” strong in the sporting field, playing cricket interesting phenomenon to be growing Growing up in a family where their mother and tennis at inter-varsity levels. up with another person who is your best was a local general practitioner and their Their paths split after they completed father a surgeon, gravitating towards a medical school. Satish completed his medical career from a young age was a internship in Hobart to be with his future given. “Dad said to us, ‘Service is a part of wife and later relocated to Melbourne. our goal. Do your best, do your duty, and Initially he was interested in Plastic help others,’ and it became ingrained in us Surgery and as a pathway studied General and a driving force for us to do medicine,” Surgery. Around that time laparoscopy Satish said. or keyhole bowel surgery was emerging, But at 17, Sanjay and Satish travelled and he found the procedure technically to India for six months and lived in an very interesting. “Since this surgery was ashram. They were the youngest at the minimally invasive, I was attracted to ashram where they lived a simple life: it and the more I found out about the they woke up early, prayed, sang bhajans surgery the more I veered towards that (devotional songs), and learnt to play the pathway,” Satish said. tabla (Indian drums). In 2009, Satish got his Fellowship and On their return they enrolled in the in 2010 he spent a year at Epworth University of New South Wales medical Cleveland as part of the Epworth’s school, completed an elective in Cleveland fellowship program. That Bangalore (India) – where they did a experience was an eye-opener, with modelling stint – and travelled to Dublin world experts teaching him not only Associate Professor Sanjay Warrier surgical skills but also how to balance Surgical News | Volume 21 | Issue 02 19

clinical life with academic and home life. That set the standard as he pursued his The two of us professional career. Meanwhile, Sanjay undertook general surgical training at the Prince of Wales Hospital Network, where he had a broad exposure to oncology surgery. His post- Meet twin surgeons Associate Professor Sanjay Warrier and Dr Satish Warrier Fellowship training was an extensive three and a half years in breast surgery. As part of this, Sanjay spent a year and a half at the Prince of Wales Hospital and Royal Hospital for Women within the Breast Surgical Oncology Unit. He was based at the Oncoplastic Breast Unit at Royal Prince Alfred Hospital for two years, consolidating surgical techniques in both an oncological and reconstructive setting. Although the twins work in two different

branches of surgery, both are involved Dr Satish Warrier in cancer treatments and have been whether alternate treatments are a good Outside of work, Sanjay spends his time pioneers in their respective fields. As a idea. Both appreciate having a broader with his doctor wife and son. “My son colorectal and general surgeon, Satish perspective outside their own fields, as is a kind and gentle person. He enjoys does minimally invasive work and the principles of surgery remain the same. playing basketball and we go for runs evaluates newer technologies, including While cancer is a daunting experience together. Taking care of our bodies is very advanced applications of robotics, which for most of their patients, treating them important and I instil that in our son,” he he has helped introduce in Australia. with compassion and achieving positive said. He also does a lot of advanced cancer outcomes has been rewarding . treatments, which have good outcomes Satish has an equally supportive family. with complex cancer patients. He says When asked what they think of each His wife, who has just completed her this is extraordinarily rewarding. other, Sanjay said, “Satish has been paediatric training, specialising in ICU, has blessed with natural talents, whether been his biggest support. Of his children, Sanjay has had his share of using in studies or sports. While I’ve had to Satish says, “My daughter talks about innovative technology. He is currently study harder and longer, Satish would being a doctor but at the moment enjoys using ICG (indocyanine green – a fusion finish his three-hour exam in 45 minutes, her tennis and may represent Australia tool for assessing blood flow after breast maximum an hour, whereas I would wait one day. My son is extremely bright, he reconstruction), which reduces skin until the final three hours revising my may become a businessman and start his death at the time of reconstruction, and papers. Same with sports, be it tennis, own tech firm. But it’s early days yet.” has led the country in this area. Sanjay cricket or golf. He just has sheer natural and his team are currently trialling radar In the end, both believe their children talent.” technology in the form of a probe, a small should follow their dreams. They will be antenna placed in the breast. Meanwhile, Satish says that “Sanjay is happy as long as their children turn out to unafraid to meet new challenges and be good human beings and contribute to Outside of surgery, both brothers are extremely hard working and goal-focused. the good of the society and community, dedicated to teaching. Sanjay is an He plays competitive tennis and is quite as they were taught to do. Associate Professor at the University good at music, playing the piano, guitar of Sydney with the Royal Prince Alfred and tabla – all of which are self-taught.” Academic Institute. He is the lead researcher at the institute and hopes to Both also share a passion for travel – develop and create a culture of academia which they still do together whenever in the Breast Department. Satish is the they get the opportunity – and their Chair of the Training Board for General young families. Family has been a key Surgery in Victoria and has a keen interest component for them since they were in teaching the next generation of young and now provides a foundation for surgeons. a successful career and life. Despite their busy schedules, Satish and “Along with our parents, our older Sanjay talk to each other every day. They brother – an ophthalmologist in Brisbane discuss sport, still a big part of their lives, and a naturally gifted person – has been and keep abreast of each other’s work a great influence in our lives,” Sanjay said. and discuss commonalities – the way “This has translated into how we treat they evaluate a patient, radiology and our families.” 20 Embracing diversity feature

Pioneer, inventor, educator: Australia’s first female paediatric surgeon

Helen Rae Noblett was a pioneering and Edward Durham Smith AO and others. She Jim O’Neill at Columbus Children’s hospital innovative paediatric surgeon. Born in was awarded her FRACS in 1964, becoming from 1967-1968 and made a strong Terowie, South Australia, but brought up in the first female paediatric surgeon in impression. Her colleagues noted that she Queensland, Helen made an impression at Australia. was ‘delightful, collaborative, charming, her school as a sporty, bright and hard- During Helen’s time in Melbourne, she very scholarly,’ ‘we learned an enormous working scholar who won prizes and a pursued research in gastrointestinal amount from her’ and that ‘she was the scholarship to medical school in Brisbane. diseases in parallel with her clinical work, real thing’. Other Americans mention her She qualified in 1957 and proceeded working with Ruth Bishop’s team (which enthusiasm, skill and kindness. to training in General Surgery and then later went on to first describe Rotavirus in Back in Melbourne, Helen was part of the Paediatric Surgery in Brisbane Children’s 1973). It was during this research that she thoracic surgery unit headed by Russell Hospital under the late Des McGuckin in invented a device for sampling ganglion Howard, which also included Nate Myers 1962. She was McGuckin’s first Trainee. cells in rats, which she later developed and Max Kent. Helen developed her In 1963, Helen moved to the Royal into the instrument for use in babies and own method for managing babies with Children’s Hospital, Melbourne and children. It bears her name to this day. oesophageal atresia post-operatively: continued her training as a registrar In the United States, Helen worked as a at the time of repair she fashioned a under Frank Douglas Stephens AO, research fellow with Bill Clatworthy and gastrostomy with a trans-pyloric feeding tube to enable immediate enteral feeding without the complications of gastro- oesophageal reflux. She continued to use this technique throughout her career. For cases with a long gap she used the reversed gastric tube, though later she was open to discussion of alternatives. In 1969, Helen published two landmark papers. The first was a method for the non- operative treatment of meconium ileus by Gastrografin enema. Until that time, most babies were treated surgically. The second described the rectal suction biopsy device of her own invention used in the diagnosis of Hirschsprung disease. Both of these are in regular use worldwide today and associated with the name of Noblett. In 1976, Helen left Melbourne to become the first paediatric surgeon at the Bristol Royal Hospital for Children in the United Kingdom. Bristol was one of the last major centres in the UK to recognise the need for paediatric surgery and there was opposition to the role in the entrenched views of some senior surgeons and paediatricians. However, Helen was a very strong and resilient character and within a short time she had demonstrated that her outcomes were as good as those at any centre in the country. The next battle was to appoint a colleague but it was not until 1982 that David Frank was appointed to share the large workload and develop paediatric urology in Bristol. It is difficult to understand how one person managed the workload generated by a Surgical News | Volume 21 | Issue 02 21

population of four million people for six There was a steely side to Helen which Pioneer, inventor, educator: years, but she did, and to an extremely was apparent whenever anything high standard. threatened to interfere with patient care. Helen was a scholarly and cerebral Trainees described her variously as ‘tough Australia’s first female paediatric surgeon surgeon. From 1976, she published but fair’, and ‘a hard taskmaster’ who ‘did 22 papers on a variety of topics and not take any nonsense’, but all emphasise was always innovative and up to date. how supportive she was to those she She served as examiner for the newly assessed as sensible, competent, and introduced Fellowship of the Royal hard-working. She was uncompromising College of Surgeons (Paediatrics). and a shrewd judge of Trainees. If a She had little taste for managerial or Trainee did not come up to her high administrative duties and concentrated standards, she made sure they went into on her patients, who were the driving a different branch of medicine. force behind her extraordinary energy and Away from work, Helen was cultured stamina. Her patients and their families and sociable, warm and humorous. She Helen Noblett deserves to be remembered appreciated how fortunate they were to could discuss art, literature and music, as a great character and a paediatric be under her care and spoke of her with with Mozart a particular favourite. Her surgeon of the highest calibre. Her legacies affection and respect. annual Christmas parties were eagerly are her innovations in her field, the many departments around the world which she Helen had exceptional technical expertise anticipated; the food and drink were inspired, the large number of children who and clinical judgement. She cherished the lavish, and we gathered round the piano owe their lives to her exceptional abilities, concept of a strong team and glowed in (with Helen playing) to sing carols. Her and the large and thriving department of the company of her favourite colleagues relaxation often centred round her canal Paediatric Surgery in Bristol today. and Trainees. She took her responsibility narrow-boat, ‘Katkin’, and she had many as a trainer very seriously and many amusing anecdotes concerning boating Mr Richard Spicer FRCS mishaps to tell in the theatre coffee room distinguished surgeons from a variety Adjunct Professor Deborah Bailey FRACS of countries regard her as the formative between operations. figure in their careers.

tHe alFreD IntensIve HosPItal Course In General surGery SAVE THE DATE 29 - 30 october 2021

Pullman Melbourne on the Park

www.alfredgeneralsurgerymeeting.com In 1985, Professor Fiona Wood was jolted by a realisation that defined her medical A career of career for the next 35 years. A young child was brought into the research, hospital where she was working in the south of England. He’d had a cup of hot coffee spilled down the front of his chest. innovation The burns healed, but he was badly scarred and in need of plastic surgery. “It hit me straight between the eyes that and surgery this boy would never move properly again and the scars would be with him for life,” Almost 20 years after the she said. “I became increasingly focused Bali bombings, Professor on how to make sure that the quality Fiona Wood talks about of outcome must be worth the pain of her life’s work. survival.” This led to a decision that her surgical career would be a combination of research, innovation and surgery. Has she achieved this goal? “It’s been a long journey,” she said, “and it’s still a work in progress.” Director of the Burns Service of Western Australia since 1991, consultant plastic surgeon at Fiona Stanley Hospital and Perth Children’s Hospital, and Winthrop Professor at the School of Surgery at the University of Western Australia’s Faculty of Medicine, Professor Wood packs a lot into her days. But this isn’t surprising, considering that she once said, “There’s absolutely no mileage at all in getting up in the morning to be average.” “For whatever reason, I’ve been driven and motivation is contagious but illusive. I feel I’m very fortunate. I found something I’m passionate about, and to work with an amazing multidisciplinary clinical and research team is exciting, exhilarating, exhausting and, at times, overwhelming,” she said. “I absolutely get all that, but for me it’s a privilege.” The Bali bombings In October 2002, Professor Wood faced one of the most challenging incidents in her surgical career. One, it turns out, that Fiona Wood Wood Fiona resulted in her being made a Member of the Order of Australia, being awarded the Australian Medical Association’s Contribution to Medicine Award, and being recognised as an Australian Living Treasure. She was also awarded the 2003 and 2004 West Australian of the Year, and was Australian of the Year in 2005. The Bali bombings left 202 people dead and hundreds injured. Twenty-eight of the seriously injured were airlifted Surgical News | Volume 21 | Issue 02 23 from Denpasar to Royal Perth Hospital she does some form of exercise because seven key investigators on the project, under the care of Professor Wood. She “by looking after yourself, you have the is integral to the team’s goal of ‘in situ coordinated four operating theatres that capacity to look after others.” tissue-guided regeneration to regenerate ran concurrently for five days, as well as A broader education skin’. The current method for deep burns 19 surgeons and 60 nurses, and was able Professor Wood is an advocate for is to put a scaffold on, wait a few weeks to provide surgery and post-operative students studying dual degrees, such for it to repair the deeper elements of care to 28 badly burned bomb victims. as science and commerce. “It enables the skin, and then repair the superficial Looking back, Professor Wood said you to look at a single problem through area with skin grafts or skin cell spray. she was grateful that her team had multiple lenses and provides a diversity What the team hopes to do is spray on the participated in significant disaster of solutions that are more likely to have a dermis, as well as the epidermal cells. planning exercises as a result of the 2000 positive outcome,” she explained. “We’re trying to print the whole of the Sydney Olympics. The plans were then “We live in a complex world with skin – not just the skin cells, but the expanded in collaboration with and with extraordinary technology and knowledge. chemistry of the skin framework. So the support of Woodside Petroleum, Translating information to knowledge instead of putting the scaffold at the the Royal Flying Doctor Service and the to experience facilitates innovative base of the wound, we want to spray the Department of Health. The resulting solutions,” Professor Wood said. “We scaffold onto the wound with the cells,” recommendations were signed off by the need to push forward and collaborate and she explained. In a single process they’ll Health Minister’s Advisory Council two link with people who have a broader view, be able to tailor the repair to exactly how months prior to the bombings. “We had or a different view to us.” much is missing. a level of understanding about how to “It’s a collaboration that’s built on work respond and the philosophy ‘We do best The Fiona Wood Foundation already in play and it allows us to do what we do every day, but we have to Since 1995, when Professor Wood began better,” Professor Wood said. “We’ve work out how to escalate to maintain the spraying skin cells onto burns patients, started the preliminary work, but have a quality of care as the number of patients she has been working towards scarless long way to go.” increase’,” she said. healing. Understanding the triggers to regeneration as opposed to scar repair is Future plans The Bali bombing patients received a an ongoing journey, but one she works on “We get to know our patients really well,” standard of care that Professor Wood continuously. Professor Wood said. Some have gone on and scientist Marie Stoner had developed to do remarkable things, and she takes over the previous decade. “We started Along with Stoner, she established the an active interest in their endeavours. using cell-based therapies in 1993, and McComb Foundation in 1999. It was Unsurprisingly, when asked about her by 1995 we were spraying skin cells onto named in honour of Dr Harold McComb, dream for the future she explains what the wounds. By 2000, we were using a and renamed the Fiona Wood Foundation she’d like for her patients. point-of-care device, and by 2002 we had in 2012. The Fiona Wood Foundation is invented, developed and built a medical the primary support organisation for the “My dream is that we can print in the device for the point-of-care harvesting of Burns Service of Western Australia, and is basic elements within a wound that not cells. The autologous cells were used on affiliated to and collaborates with a range only have the raw materials to facilitate the prepared wounds in isolation and with of prominent institutes and organisations. regeneration of the tissue, but with traditional skin grafting techniques.” It includes a research hub dedicated to analgesic properties and anti-microbial all facets of burn care along the patient properties, so that we can sort out the Caring for your team and yourself journey, including cell-based therapies to pain and infection issues and link that On teamwork, Professor Wood said that rehabilitation. The Fiona Wood Foundation with a visualisation program so that the time invested in training a team is relies on philanthropic support from we use the power of the brain to drive a important because “when push comes a generous community to facilitate neurologically intact repair. Then l wake to shove, the reliance on each other is research, education and innovation. up because that’s my dream. I often say extraordinary”. The team expands as well, to the guys – ‘One day we’ll all be able to she said, and “because we have such a Collaborating to develop 3D skin think ourselves whole.’ ” cohesive team, the hand of friendship In June 2020, the Medical Research goes out to all those in our buddy systems Future Fund awarded a grant to a team to collaborate”. of researchers to develop a treatment for acute and chronic skin wounds. Led by Beyond teamwork, it’s essential to look Associate Professor Pritinder Kaur, they Over page: after your own health, as well as your advance the work on 3D printing of skin by Main: Professor Fiona Wood education, and it’s those things that can the Burn Injury Research Unit of UWA and Inset: A recent book on Professor Fiona Wood be uninteresting that are important, such Inventure to the next phase – developing for 10 to 13-year-olds from Wild Dingo Press as adequate rest, eating well and sensibly, a clinical prototype, a 3D bio-printing ISBN 9781925893281 and staying fit, Professor Wood said. “I platform using stem cells to improve the was in the ocean this morning in the dark treatment and healing of wounds and because if I don’t go in the dark, at this scars. time of year, then I’ll miss that start to the day with exercise,” she said. Every day The burn surgery research expertise of Professor Wood and Dr Mark Fear, two of 24 New Zealand College Name Change Working Group

The Aotearoa New Zealand National Over time, the term ‘Australasia’ has Zealand’, for example, the Australian and Committee recently requested that RACS become less prevalent. Its meaning is New Zealand College of Anaesthetists. Council consider updating the College not clearly defined, and some definitions There have been a number of occasions name to better reflect the binational include Melanesia and wider Oceania. The when the issue of changing the College nature of the College, and where its word ‘Australasia’ is not well understood, name has been raised, in particular by the members come from – Australia and particularly by those outside New Zealand New Zealand Fellowship. A referendum of New Zealand. Councillor Andrew Hill has and Australia, but even amongst our own all Fellows on the College name was held assembled a working group to discuss Fellows and Trainees. It is often mistakenly in 2007, with 57 per cent of respondents options, which will then be put to Council written or spoken as ‘Australian’, even in voting to change the College name to for consideration and potentially a vote our own College documents. A web search the ‘Royal Australian and New Zealand by the Fellowship in the future. The brings up an Australian Government College of Surgeons’. This fell short of group represents a wide cross-section of Department of Health document with the 75 per cent required at the time to the College from both nations, including the heading ‘Royal Australian College change the Articles of Association (no senior surgeons, Councillors from both of Surgeons’; references to several longer applicable; since replaced by the countries, a Younger Fellow, a Trainee, surgeons with an ‘Australian Fellowship Constitution). In contemporary process, and both New Zealand and Australian of the College of Surgeons’; and to the the Australian Corporations Act requires Indigenous representatives. ‘Royal Australian College of Surgeons a special resolution passed by members, training program’. Meanwhile, surgeons The College of Surgeons of Australasia with the support of at least 75 per cent of and surgical organisations from other was founded in 1927, and the Exordium votes cast, to change a company name. countries often interpret Australasia to specifically refers to ‘Australasia, include Asia. The Aotearoa New Zealand National which includes New Zealand’. In 1930, Committee believes it is time to revisit King George V granted permission This means that the strength and unity this matter and to propose to all Fellows for the prefix ‘Royal’ to be used, and of the binational nature of our College is a change in name. the name was changed to the Royal not always recognised. New Zealanders Dr Nicola Hill FRACS Australasian College of Surgeons in have always been active participants in Dr Rachelle Love FRACS 1931. At this time, the ‘Journal of the our College’s activities from formation. College Name Change Working Group College of Surgeons of Australasia, which While there is generally open internal includes New Zealand’, changed its recognition of this and of the College’s name to the Australian and New Zealand binational status, externally this is Journal of Surgery, suggesting the term often not apparent. A number of other ‘Australasia’ was not clear to all even medical colleges and surgical specialist then. associations use ‘Australia and New Surgical News | Volume 21 | Issue 02 25 Use of name Aotearoa in New Zealand

The Aotearoa New Zealand National A senior colleague tells us that while she RACS, or to have our FRACS, and wonder Committee has requested that the working was in her 20s, Aotearoa was the first what any new combination of letters group incorporate ‘Aotearoa’ into any Te Reo Māori word she learned to spell. might sound and look like. We worry that proposed new name for the College. Aotearoa is now ubiquitous. It appears others won’t be able to say the name or The name Aotearoa can be traced back on official government documents, in maybe that we ourselves won’t really get 700 years to our great navigating ancestor, business names, popular songs, sporting our tongues around it. We have no issues Kupe. After a long voyage, Kupe observed events and many other places. The words with ordering a pinot or a cappuccino. As a cloud bank and surmised that it must ‘Aotearoa’ and ‘New Zealand’ are paired with surgical skills, repetition will likely be gathered above a land mass. It is not on the cover of the New Zealand passport sort that out. We note that, within our clear whether he was applying this term to and banknotes. Although some struggle lifetimes, Yugoslavia is now six separate Great Barrier Island or Te Ika-a-Māui (the to pronounce the name fluently, almost countries, Rhodesia is now Zimbabwe, and North Island) and whether it included Te all recognise it as an alternative name for Holland is now the Netherlands. There is Waipounamu (the South Island). New Zealand. no doubt that there were (and perhaps still In a Māori world, names are significant. are) challenges for these countries, but the In the signing of our foundation document, rest of the world seemed to manage, and Te Tiriti o Waitangi, the name Aotearoa There is mana (honour, status and authority in this context) and obligations respect, the name change without great was not used. The term Niu Tireni was. difficulty. This is likely to be a transliteration of that come from the naming process. The New Zealand. The origin of the name obligations of our joint cultures coming In wrestling with our identity, resisting New Zealand is less familiar to most of together in nationhood were recognised change is a default setting. We have a us. Abel Tasman, the Dutch explorer, first in Te Tiriti O Waitangi. Te Tiriti is a broad unique opportunity to determine how we named it Staten Land, thinking it was part statement of principles on which the wish to be identified as surgeons and as of the vast southern land mass. It was British and Māori made a political compact inhabitants of New Zealand. The proposal subsequently renamed Nieuw Zeeland by to found a nation state and build a new to change our name to include Aotearoa an unknown Dutch cartographer after a government in New Zealand. There is a doesn’t mean that we remove a part of our province in Holland. It’s not clear whether growing acceptance that embracing the history, it incorporates another story. The this cartographer ever set foot on this land, name Aotearoa is a tangible honouring of first story. The story of tangata whenua, but it certainly seems that our country that obligation. the Treaty partners. Moving forward in took its official name from a group who However, there is an attachment to partnership means telling that story and were just passing through. names. For example, our forebears fought it also means being an active part of that story. After being on the periphery for many for this country, New Zealand, and stood years, the name Aotearoa has organically under the same flag that we acknowledge Dr Nicola Hill FRACS Dr Rachelle Love FRACS worked its way into common parlance. today. Many of us feel proud to be part of College Name Change Working Group End-Of-Financial-Year Benefits for RACS Fellows

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e: [email protected] | ph: 1300 853 352. Surgical News | Volume 21 | Issue 02 27

End-Of-Financial-Year Introducing our New Zealand surgical Benefits for RACS advisors

Introducing Dr Sarah Rennie and to contact us, raise concerns, ideas to colleagues and getting to know a whole lot Fellows Professor Spencer Beasley, the Royal improve the College, ways we can advocate more. Australasian College of Surgeons (RACS) for our diverse population in Aotearoa New “Although we remain Fellows of the New Zealand’s two new surgical advisors. Zealand and work towards health equity. College, we are now College staff and as Dr Rennie and Professor Beasley replace “Some surgeons feel removed from such our relationship with other Fellows is Mr Richard Lander, former New Zealand our College and uncertain about its altered. So is our role on the various boards Executive Director of Surgical Affairs. The relevance to them. Many have had bruising and committees. We are there to support new part-time positions are designed to experiences as Trainees,” continued Fellows of our College and provide advice make the workload more manageable for Dr Rennie. “However, being involved with as required.” active Fellows and enable a wide range of the professional development wing of Professor Beasley has carried out many experience to be brought to the roles. the College over the last seven years has roles both within his specialty society As Surgical Advisors, Dr Rennie and enabled me to appreciate how passionate and at the College for the last 30 years, Professor Beasley support Fellows, some Fellows and staff are about ensuring including being a RACS Councillor, Coming into EOFY season, Trainees and Specialist International quality continuing surgical education Chairman of the Court of Examiners and Medical Graduates (SIMGs) on the pathway across a wide spectrum of the College Deputy Censor-in-Chief. “During my long your College benefits program to Fellowship who are experiencing competencies.” association with our College I have come to includes exclusive offers to help difficulties, advocate for them through Professor Beasley, a paediatric surgeon, deeply respect what it does for surgeons a range of forums, and provide advice says since taking up their new roles late and for surgical training,” he said. “It has you save. Visit your benefits to RACS Aotearoa New Zealand National last year, he and Dr Rennie “have been been highly effective in representing our Committee. very quickly acquiring an understanding of specialties at multiple levels, and the website to find all your offers. “Ultimately our role is to embody the some aspects of College function, things of quality of its specialty training programs RACS values: service, integrity, respect, which we had little knowledge previously. has been a major reason that surgery is of compassion and collaboration,” says Dr It has opened up new insights into how our such a high standard in both countries. But Rennie, a general surgeon. “I hope that College works. The most enjoyable part so challenges remain, as do opportunities to we can provide a safe space for people far has been re-establishing connections improve what we do.” www.surgeons.org/memberbenfits and relationships with friends and

College Financial & Insurance Offers

Purchase new technology or upgrades with Travel in style with everything for your next access to commercial prices on laptops, trip. Including car rentals, travel insurance and phones, coffee makers and heating & cooling hotels across Australia & New Zealand. devices. Dr Sarah Rennie and Professor Spencer Beasley. e: [email protected] | ph: 1300 853 352. Developing a Career and skills Hot topic speaker: Michael Vallely - Ohio, USA in Academic Surgery (DCAS) course Keynote speaker: Peter Choong - Victoria Monday 10 May 2021, 7:15am – 4:30pm Who should attend? Melbourne Convention and Exhibition Centre, Melbourne Surgical Trainees, research Fellows, early career academics and any surgeon who has ever considered involvement with publication or presentation of any academic work. 6:15 am Registrations and light breakfast If you have been to a DCAS course before, 7:15am - Welcome and Introduction - Tony Sparnon, Colin Martin and Jonathan Karpelowsky the program is designed to provide previous 7:30am attendees with something new and of interest each year. 7:30am - Session 1: A Career in Academic Surgery 9:30am 2019 comments: Why every surgeon can and should be an academic surgeon - Marc Gladman Finding your research question - Carrie Lubitz “A transformational day” Finding the time – clinical work vs research, an ongoing conundrum - Christobel Saunders “Wonderful course, as a first-time delegate this was Burnout and wellbeing, a constant challenge - Brenessa Lindeman very inspirational. All of the speakers were highly knowledgeable” Academic engagement and navigation in a new virtual world - Eugene Kim Panel discussion “Really informative sessions... As a prevocational doctor 9:30am - 10:00am Morning Tea I felt that the course was perfectly targeted to me” 10:00am - Session 2: Inclusion and Diversity in Surgical Academia “A truly inspirational course” 11:00am Inclusion and diversity in surgical academia - How can we improve? - Lesly Dossett Association for Academic Surgery and BLM an Australian Indigenous perspective - Where to in surgery? - Kelvin Kong International Invited Speakers: BLM a U.S perspective - Where to in surgery? - Colin Martin Zara Cooper - Massachusetts, USA Lesly Dossett - Michigan, USA 11:00am - Hot topic in Academic Surgery: First in Human Trials - Michael Vallely Amir Ghaferi - Michigan, USA 11:30am Eugene Kim - California, USA 11:30am Session 3: Tools for Academic Output Brenessa Lindeman - Birmingham, USA -12:20pm Carrie Lubitz - Massachusetts, USA Preparing a conference abstract and presenting at a scientific meeting - Amir Ghaferi Colin Martin - Alabama, USA Writing and submitting a manuscript - Zara Cooper Australasian Faculty includes: 12:20pm - Keynote Presentation: Disruption and Innovation in Academic Surgery - Peter Choong 1:00pm Sarah Aitken - New South Wales Marc Gladman - South Australia 1:00pm - 2:00pm Lunch David Gyorki - Victoria Richard Hanney - New South Wales 2:00pm - Session 4: Concurrent Academic Workshops Julie Howle - New South Wales 3:10pm Jonathan Karpelowsky - New South Wales Concurrent Workshop 1: Finding My Niche / Fit / Tools of the Trade Kelvin Kong - New South Wales Basic science translational research – bedside to bench to bedside - Michelle Locke Michelle Locke - New Zealand Clinical research and randomised control trials - Michael Solomon Payal Mukherjee - New South Wales Christopher Reid - Victoria Being part of international collaborative studies - developing and engagement in international William Ridley - New South Wales RCT - David Gyorki Christobel Saunders - Western Australia Beyond medicine - Interdisciplinary collaboration - Payal Mukherjee Michael Solomon - New South Wales Panel discussion Tony Sparnon - South Australia Sean Stevens - Victoria Concurrent Workshop 2: Trainee Led Collaborative Trials ACTA (Australian Clinical Trials Alliance) and the clinical trials landscape in Australia - Christopher Reid Notes: Engaging surgical trainees in collaborative research - Sean Stevens New RACS Fellows presenting for convocation in Starting early – Engaging medical students and their surgical societies in collaborative 2021 will be required to marshal at 4:15pm for the research - William Ridley Convocation Ceremony. Mentoring a trainee network – How I do it - Sarah Aitken Panel discussion CPD Points will be awarded for attendance at the course with point allocation to be advised at a later 3:10pm- Closing Remarks date. 3:30pm General Surgery Trainees who attend the RACS 3:30pm - 4:30pm Networking Function Developing a Career and skills in Academic Surgery course during their SET Training may, upon proof of DCAS Course Participation: Proudly sponsored by: attendance submitted to [email protected], count this course Physical registration: $250.00 per person incl. GST (includes towards one of the four compulsory GSA Trainees’ virtual platform access) Days. Information correct at time of printing, Virtual registration: $100.00 per person incl. GST (provides Presented by: subject to change without notice. access to sessions prior to lunch only) Association for Academic Surgery in partnership with the RACS Section of Academic Surgery. Further Information: Register online: Conferences and Events Management Royal Australasian College of Surgeons www.tinyurl.com/DCAS2021 T: +61 3 9249 1117 There are ﬁfteen complimentary spaces available for E: [email protected] interested medical students. Medical students who would like to register their interest, please visit www.tinyurl.com/DCAS2021 for further information. Surgical News | Volume 21 | Issue 02 29 Embracing diversity through POSTVenTT

Surgical trainee participation in multi- model, CTANZ reached out to SET Trainees Richards, builds on a large multi-centre, centred trials has been shown to who, together with junior doctors and randomised controlled trial, PREVENTT, contribute significantly to advances in medical student societies, have created and aims to increase our understanding clinical practice, which in turn improves the critical mass that ensures patient of variability in adherence to anaemia patient management and outcomes. recruitment numbers were met in a series management guidelines. It also aims to The Royal Australasian College of Surgeons, of ongoing global COVIDSurg studies: assess the impact on patient outcomes through the Clinical Trials Network several thousand patients were recruited and readmission to hospital of anaemia Australia and New Zealand (CTANZ), is by many hundreds of researchers. The management in clinical care following preparing a future surgical workforce of collaborative framework within CTANZ major surgery. scientifically literate trainees who will has now facilitated more ‘homegrown’ It is evident that a sustainable workforce develop the necessary leadership, training, multi-centred studies that will harness the can only be created and maintained by organisational and analytical skills vital energy and enthusiasm exhibited by junior welcoming a diverse group of collaborators to successfully helping with large-scale doctors and medical students. that includes junior doctors and medical clinical trials and studies, and also to The rewarding experience provided by students into the CTANZ program. understanding clinical research and how involvement in large-scale audits has data can impact surgical care. whetted the appetite of this younger Professor David Watson Over the last 12 months, CTANZ-associated cohort of surgeons-in-training to assume FRACS studies have confirmed that trainee greater organisational responsibility in collaboratives can deliver unique and conducting future multi-centred studies. informative practice-changing research. In Impeccable timing has played a part in the SUNRRiSE International Collaborative presenting this group of juniors with an opportunity to lead and launch a new Clinical Trial, trainees successfully Professor Toby Richards recruited 300 patients at eight centres in 2021 study in post-operative variability in FRACS Australia and New Zealand. anaemia treatment and transfusion, called POSTVenTT. Building on this highly successful Clinical Trials Network (CTN)-UK collaborative The POSTVenTT study, led by Professor Toby

New Zealand POSTVenTT members Top row, l-r: Dr Cameron Wells, Mr Chris Varghese, Ms Sarah Rennie. Middle row, l-r: Dr Matthew McGuinness, Dr Deborah Wright, Mr Liam Ferguson. Bottom row: Mr William Xu. 30 Global health

Hearing care for all: World Hearing Week in Samoa

On 3 March 2021, the Royal Australasian College of Surgeons (RACS) Global Health department celebrated World Hearing Day, established by the World Health Organization (WHO) to raise awareness of how to prevent deafness and hearing loss and promote ear and hearing care across the world. The RACS Global Health Samoa Hearing Program supports the Samoan Government’s strategy on disability and inclusion and the broader Australian Aid-funded Samoan Disability Partnership Program. This program aims to support the Samoan Government’s implementation of disability-inclusive policies, plans and programs that assist in decreasing barriers for people with Surgical News | Volume 21 | Issue 02 31 disabilities to access services. screening clinics, talks on ear and Interpreters, who work closely with the hearing health, and promotion of ear Pacific Island countries have among hearing impaired community. and hearing health training for health the highest rates of ear disease and workers in Samoa. The activities took hearing loss in the world.1 In Samoa, place across a full week, with official approximately 40,000 children will Hearing loss: presentations by the Minister for Health reach school age in the next decade and, and outreach visits to rural areas such as facts and figures based on current service estimates, Savai’i and Vaovai. • 400 million people, including 34 fewer than 20 per cent of these children million children, are estimated to will receive a routine hearing test. Fewer RACS Global Health, with the support be living with hearing loss globally, than five per cent of those with a hearing of the Department of Foreign Affairs and approximately 80 per cent of impairment will receive any hearing and Trade (DFAT) Humanitarian people with hearing loss are living in intervention or support. The impacts of Corridor, has been able to deliver 32 developing countries. unaddressed hearing loss or impairment boxes of equipment to Samoa. This on the inclusion and productive potential included a large shipment of hearing • Major causes of hearing loss include of Samoa’s population are profound. Yet aids and batteries, audiometers and congenital or early-onset childhood screening and hearing interventions, tympanometers, as well as training hearing loss, chronic middle ear such as hearing aids, are a relatively materials and instruments to facilitate infections, noise-induced hearing loss cost-effective intervention to implement the delivery of the WHO Primary Ear and age-related hearing loss. at scale. and Hearing Care Training Program. The • Children with hearing loss and timely arrival of this equipment aided RACS Global Health is responding to deafness in developing countries RACS’ local partners to advocate for this critical issue under the direction often experience greater barriers in and raise awareness of ear and hearing of Dr Sione Pifeleti, with the Tupua access to education, impacting their health throughout World Hearing Day Tamasese Meaole (TTM) Hospital ear ability to participate when navigating celebrations. nose and throat (ENT) team. The Samoa future employment and social Hearing Program supports the further Government partners include the contexts. development of a cohesive national Ministry of Health and the Ministry • WHO estimates that unaddressed hearing service across Samoa to help of Women, Community and Social hearing loss costs the global economy bridge the gap between mainstream Development. Local civil society partners US$980 billion annually due to health and disability services. Recent activities include SENSE, a special education sector costs (excluding the cost of include the delivery of a mobile organisation supporting the inclusion of hearing devices), costs of educational hearing trailer, and success in securing those with hearing loss and impairment, support, loss of productivity and accreditation through the Samoan to participate in education and the societal costs. Qualifying Authority for the WHO community, while providing other vital Primary Ear Health training course. This support to hearing impaired individuals REFERENCES course will be offered to healthcare and their families. RACS Global Health 1. Kaspar A, Pifeleti S, Driscoll C. The role of health promotion professionals and community service also works with local Disabled People’s in the development of ear and hearing health services in the Pacific Islands: A literature review. SAGE Open Med. 2021 Feb 10; providers later in the year. Organisations, Nuanua O Le Alofa (NOLA), 9:2050312121993287. doi: 10.1177/2050312121993287. PMID: 33623701; PMCID: PMC7878995. the umbrella organisation for disability 2. Samoa Bureau of Statistics, Ministry of Women, Community and For World Hearing Day, Global Health Social Development, Pacific Community and UNICEF Pacific, 2018 advocacy in Samoa, and SASLI, the Samoa Disability Report: An analysis of 2016 Census of Population supported events such as free hearing and Housing. UNICEF, Suva, 2018. Samoa Association of Sign Language

Over page: Top: Dr Sione Pifeleti examines a patient. Bottom: The SENSE team at World Hearing Day events providing information and advice on hearing devices and educational support. Left: Australian High Commissioner Sara Moriarty presenting Dr Sione with a certificate for completing the RACS Global Health Child Safeguarding training. All photo credits: Ministry of Women, Social and Community Development. REGISTER NOW https://tinyurl.com/P4PMelbourne21

PREPARATION FOR PRACTICE MELBOURNE WORKSHOP 21-22 AUGUST 2021

BUILDING BLOCKS FOR STARTING CPD FOR FELLOWS OUT IN PRIVATE PRACTICE This educational activity has This two day workshop will provide surgeons, final year been approved in the RACS CPD Program. Fellows who participate trainees and practice managers with information and can claim one point per hour in practical skills to set up and manage private practice. Maintenance of Knowledge and Skills. LEARN ABOUT: - Issues involved in setting up private practice. VENUE - Practical strategies and tools for practice operations. RACS - Melbourne 250-290 Spring Street - How to develop a practice framework and improve Melbourne East, 3002 practice performance Contact: - Managing practice staff, staff contracts and Victorian State Office employment relations P:9249 1254 E: [email protected] https://www.surgeons.org/about-racs/racs-offices/victoria Surgical News | Volume 21 | Issue 02 33 Bringing progressive microsurgery to Australian hospitals

techniques that aren’t yet widely used system by getting involved in the resident in Australia but, more importantly, he training program. He gave talks on burns discovered how to be highly efficient in management and ran pre-exam slide microsurgery. Now, he shares these skills sessions. with his surgical units at home, where Since returning to Australia, Dr Soliman patients can benefit from a broader range has begun two consultant microsurgery of reconstructive options. positions in Sydney tertiary referral Dr Soliman also learned new techniques centres. He’s implementing the in free flap planning with 3D printing. knowledge he learned abroad and hopes This is invaluable in head and neck to bring more efficiency to free flap reconstruction and facial trauma, as planning and execution. He also plans to surgeons can plan their reconstruction set up a free flap database for research before surgery. This takes the stress out and teaching purposes, and would like of the procedure and reduces operating to teach his microsurgical techniques to time. registrars. He also noted that using the same well- Dr Soliman feels very grateful to have trained team, set up and equipment for worked alongside world-class surgeons all flap cases reduces variability and through his fellowship. He hopes more helps with efficiency. surgeons will seek out a scholarship to go Dr Bishoy Soliman Dr Soliman saw how useful Enhanced abroad and return with enhanced skills, so New Zealand and Australian surgeons Dr Bish Soliman, a Sydney-based plastic Recovery After Surgery (ERAS) protocols can share knowledge and strengthen and reconstructive surgeon, used the can be. These multimodal perioperative the future of surgery in our corner of the Morgan Travelling Fellowship to advance care pathways are designed to solve world. his knowledge of microsurgery in Canada. problems that may delay recovery and, ultimately, discharge (for example, Dr Soliman chose the Morgan Travelling pre-op nutritional support, post-op Fellowship because it fitted his needs early mobility, pain management and professionally and, from a personal bowel function). ERAS protocols lead to standpoint, his young family wanted to improved outcomes and greater patient explore Canada. He came back with new satisfaction. surgical skills and refined techniques to share with colleagues and Trainees, so Dr Soliman spent his second six months they can benefit from advanced, efficient in Kelowna, British Colombia, where microsurgical practices. he enhanced his skills in aesthetic reconstructive surgery. Participating in He spent the first six months of his 250 cases, he learned new techniques fellowship involved in state-of-the- in the art of breast shaping and pre- art microsurgery at the University of operative planning for aesthetic and Manitoba in Winnipeg. He participated reconstructive breast surgery. in more than 150 cases of microsurgical reconstruction, mostly of the breast, Dr Soliman also realised the true value head and neck, and lower limb. of teamwork and the importance of good communication. Grateful for his During his time in Manitoba, Dr Soliman experiences, Dr Soliman gave back to the learned advanced surgical and flap 34 JDocs JDocs: five years of preparing aspiring surgeons and proceduralists

was launched in February 2016. It is work in orthopaedics and that changed supported by a range of learning and everything. The fast-paced atmosphere, assessment resources and is available to technical aspects, and the teamwork in any junior doctor registered in Australia the theatre made me want to take it up,” and New Zealand. Dr Page said. The development of JDocs has been While working as an unaccredited guided by the following aims: cardiothoracic registrar in Townsville, • identify the skills, knowledge and North Queensland, a colleague suggested behaviours expected of junior doctors she contact a surgeon in Melbourne to and aspiring procedural specialists discuss future opportunities. He provided so they can be a safe and competent instrumental career advice, including clinician during the early postgraduate recommending JDocs. years Subscription to the JDocs ePortfolio (at • provide a range of work-based a cost of AU$350 in 2021) enables the assessment strategies and tools to progressive assembly of evidence of identify the clinical situations in which achievements, work-based assessments a junior doctor can demonstrate the and experiences, which can help support JDocs program participant Dr Sarah Page achieved learning outcomes and application to proceduralist specialty Surgery is often characterised as a professional standards training. rewarding and challenging career, and • provide junior doctors with tools and In addition, JDocs subscribers also have the challenges start before training even resources to support the development access to a range of resources including: begins. of their professional profile by • Generic Surgical Science Examination Junior doctors need to have a great documenting evidence of work-based resources and a multiple-choice knowledge of the body, its systems assessment, achievements and question bank and what can harm it. They also require experiences through the ePortfolio • select RACS library resources an excellent knowledge of anatomy, The JDocs Framework is aligned to the physiology and pathology. They also • eLearning resources (currently 23 RACS Core Competencies, with learning need strong interpersonal, professional, outcomes or activities grouped into Dr Jennifer Chambers, RACS Chair of the cultural awareness and safety skills Prevocational & Skills Education Committee Key Clinical Tasks (KCTs). The KCTs that allow them to listen, lead, learn, represent the daily professional activities communicate effectively, make undertaken by a junior doctor, where the appropriate decisions, empathise and level of performance can be observed and understand. But how can junior doctors feedback provided. The KCT documents and aspiring surgeons navigate their way include options for a supervisor or mentor through all of this? to provide feedback. The Royal Australasian College of Cardiovascular Surgery Trainee Surgeons (RACS) established the JDocs Dr Sarah Page completed a Bachelor of Framework because it recognised a need Science degree, majoring in anatomy to provide educational resources and and pathology – subjects she found guidance to junior doctors seeking to so interesting that she applied for a explore a proceduralist career, so they postgraduate degree in medicine. Her can make informed career decisions prior passion was haematology “but in my to committing to a specialist pathway. first clinical year I did some hands-on The JDocs Framework and ePortfolio Surgical News | Volume 21 | Issue 02 35

online modules and resources including the Aboriginal and Torres Strait Islander Cultural Safety: Course 1 and 2) • Morbidity Audit Logbook Tool (MALT) for junior doctors JDocs does not guarantee selection into any procedural specialty training program. However, by engaging with the JDocs Framework and ePortfolio, junior doctors can ensure their skills, knowledge and behaviours are at the level expected for entry to procedural specialist training. Dr Page said the JDocs framework and ASPIRING TO A SURGICAL ePortfolio have been beneficial, especially OR PROCEDURAL CAREER? the MALT logbook, which contains a record of all the procedures and assisting she had done during her unaccredited JDocs by RACS: years. This was helpful for Surgical Education and Training (SET) selection Guidance and and job interviews, and when starting a new job – giving surgeons an idea of support for her experience. The JDocs framework junior doctors proved useful when preparing for the SET interviews and the ePortfolio, RACS modules and resources came in handy. Contact “I liked having a logbook, so I can monitor [email protected] my own progress and performance, and patient outcomes. I’ve discovered the clinical tasks section, which will be helpful for the communication stations in the clinical exam. I would encourage junior doctors to use JDocs to track their progress and assist with their SET applications.” Dr Page’s experiences with JDocs have been shared by current junior doctors who have found JDocs very helpful in covering many educational and clinical aspects of medicine and surgery. Along with being technical, JDocs elaborates nearly 60 per cent in 2020. support junior doctor development on on the importance of communication Dr Jennifer Chambers, Chair of the their KCTs. and decision-making – managing critical Prevocational and Skills Education There are also many free resources patients and assessing the risks. Dr Committee and JDocs champion, is available on the JDocs website that Natasha Bertschi said that “there are meeting with the Specialty Training can be accessed by medical students many resources for planning exams and Boards (STBs) to increase awareness of considering a career in surgery. having the information in one place helps JDocs in preparing SET applicants for the keep track of your progress. You learn selection process. She is also seeking what is required of you and keep to a plan, feedback on STB-specific requirements For further information on JDocs see and the wide range of resources cover all that can enhance the Framework. This surgeons.org/jdocs or contact jdocs@ the RACS competencies.” year the Morbidity Audit and Logbook surgeons.org with any questions. Throughout 2020, RACS increased Tool (MALT) Committee membership engagement with the JDocs subscriber includes a current JDocs subscriber to cohort through the newly established provide insight on the experiences of this JDocs eNews. The newsletter provides fundamental user group. JDocs subscribers with useful Through the RACS portfolio, all RACS information on relevant RACS activities members have access to JDocs View. This and has seen subscription renewals allows supervisors or mentors to explore increase from 46 per cent in 2019 to the ePortfolio resources and access and 36 STANZ

Western Australian election ends in landslide

The McGowan Government has been emphatically re-elected in Western Australia.

In the recent election in Western Australia, • Western Australian Audit of Surgical the government to account will become the Labor party won 53 of the state’s 59 Mortality increasingly important. legislative assembly seats. The National • Use of the title surgeon Over the next four years, the Western Party now holds four seats, leaving the Australian Committee will endeavor Liberal Party holding only two seats. The statement provided background information on each of these issues and to work with the Government and the Before the 13 March poll, the Royal then posed a series of questions. opposition to ensure that issues of public Australasian College of Surgeons (RACS) health, particularly those relating to the Western Australia Committee sent an There have been many examples where delivery of surgical services, remain a election statement to the major parties. RACS has been able to secure firm priority. The statement identified six key focus commitments from political parties before To view RACS’ Western Australian election areas relevant to surgery: an election. In response to this election statement, the Labor Party reaffirmed its statement, as well as the Labor Party • Data sharing legislation commitment to update the state’s data response, please visit our website. • Elective surgery waiting lists sharing legislation. • Ongoing COVID-19 response With a depleted opposition lacking in • Public and private hospital re- resources, the role of the College and admission rates other like-minded organisations in holding

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wa ∙ smith co ey 08 9388 2833 Surgical News | Volume 21 | Issue 02 37

Potential game changer in the management of high-risk prostate cancer

given upfront before prostate cancer potentially be game-changing in the surgery, through the LuTectomy trial. She management of high-risk prostate wants to see how this impacts disease cancer. PSMA technology has changed the recurrence and long-term survival. landscape in the management of prostate Excitingly, her team can interrogate cancer, with significant implications tissue in the lab and understand the in diagnosis, staging and theranostics. impact of Lutetium PSMA on the tumour This use of theranostics in high-risk microenvironment, including changes in localised prostate cancer is pushing the tumour immune context and cell types. boundaries even further. Dr Eapen hopes to identify tissue and Dr Eapen says the Paul Mackay Bolton serum biomarkers that may be associated Scholarship has been instrumental in with clinical outcomes and the factors backing this important work in prostate that lead to the progression of low-risk to cancer. advanced disease. “Research is exciting if you can imagine After her urology training, Dr Eapen the implications of your findings and embarked on fellowships in the US and how they can impact on the day-to-day Canada where she spent four years management of patients,” she said. This training in uro-oncology and robotics, potential ‘bench to bedside’ transition as well as functional urology. She was is what inspires Dr Eapen and makes Dr Renu Eapen exposed to a great deal of prostate cancer her efforts worthwhile. She encourages research in highly academic centres, young surgeons not to accept clinical Dr Renu Eapen, a Melbourne-based such as the University of California in San limitations and to always think about urologist, has used the Royal Australasian Francisco, which sparked her interest in how the situation can be made better for College of Surgeons (RACS) Paul Mackay the management of low-risk and high- the patient. “This inspires ideas and the Bolton Scholarship to explore treatment risk disease. RACS scholarships are instrumental at options for men diagnosed with prostate making those ideas a reality.” cancer. After returning to Melbourne, through her work at the Peter MacCallum Cancer Dr Eapen’s research has the potential Centre and Austin Health, Dr Eapen found to change the management of high- herself working with teams who were on risk prostate cancer. It focuses on the the cutting edge of incredible research. clinical and immune landscape response The collaboration of urologists, nuclear to Lutetium PSMA therapy in advanced medicine physicians, and medical and disease. radiation oncologists in developing High-risk localised prostate cancer is world-class trials led her to enrol in a PhD usually treated by radical prostatectomy with the University of Melbourne. or radiotherapy. A significant number of The Paul Mackay Bolton Scholarship is these patients will progress to have local supporting her prostate cancer research recurrence or metastatic disease. Clinical based on the LuTectomy trial and her trials of neoadjuvant therapies including PhD. Dr Eapen and her team will recruit chemotherapy have not shown survival 20 patients for the trial. Seven have been advantages. recruited so far. Dr Eapen is looking at the clinical effects The outcomes of the trial could of the novel treatment Lutetium PSMA 38 Global health

Global Health at the RACS ASC

The past year has been especially innovative registration option for Our session will also include a discussion challenging for the Royal Australasian international surgeons and other health around the preparation of a regional College of Surgeons (RACS) Global Health, professionals to participate virtually in strategy on National Surgical, Obstetric our partners and the communities we the RACS ASC via offshore hubs. These and Anaesthesia Plans (NSOAPs) delivered work with. As our programs rely largely on hubs will allow overseas participants by Dr Liz McLeod, a presentation on RACS freedom of movement and international to dial in from surgical centres free of Global Health Volunteering by former travel, many of our efforts in delivering charge from many of RACS Global Health’s RACS President and Visiting Medical Team safe, accessible and affordable surgical partner countries across the Indo-Pacific leader Mr John Batten, and a conversation care to some of the most vulnerable and region. This will allow us to broaden the about the changing face of international isolated communities in our region are contributions and discussion amongst development with Philippa Nicholson either on hiatus or have undergone a participants, and share more widely the and the CEO of Interplast, Mr Cameron significant operational transformation. lessons and networking opportunities this Glover. Participants at this session will Our participation in the 2021 RACS Annual important event provides. also be able to engage more closely with Scientific Congress (ASC) is no different. For this year’s event, RACS Global Health the RACS Global Health panel during a The ASC, to be held from the 10-14 May is proud to have confirmed a stellar cast 30-minute question and answer session 2021, is a unique opportunity for RACS of speakers to present on a variety of with the speakers at the conclusion of the Global Health to connect and engage with topics critical to our work. On the first presentations. our peers in Australia and New Zealand, day of the RACS ASC, Monday 10 May, Throughout the week, participants as well as internationally. However, RACS Global Health will share a welcome will also have the opportunity to join a given the obvious impacts of COVID-19 and introduction of the upcoming Global range of Global Health presentations on on international travel, many of our Health Section, presented by RACS Chair topics including regional health security, overseas-based partners, who would of Global Health, Miss Annette Holian, sustainability in health services and the usually travel to Australia to participate, an overview of Global Health Programs prize session for Global Health abstracts. will be unable to attend in person this by Head of Global Health Philippa For more information on the RACS Global year. Nicholson, and impacts of the East Timor Health sessions please contact Global To overcome this unfortunate situation, Eye Program by RACS Global Health’s Health Engagement Coordinator Mr James RACS Global Heath has created an International Advisor, ophthalmologist Dr O’Keefe, at [email protected]. Manoj Sharma.

Australian and New Zealand Post Fellowship Training Program in Colon and Rectal Surgery 2022

Applications are invited for the Post https://cssanz.org/index.php/training/ Please email your application to: Fellowship Colorectal Training Program, application-for-training-program Mr Stephen Bell conducted by the Australia and New A Notaras Fellowship will be awarded in Zealand Training Board in Colon and Chair, Australia and New Zealand 2022. A Medtronic Research Scholarship Training Board in Colon & Rectal Surgery Rectal Surgery (ANZTBCRS). The for a full-time researcher will be ANZTBCRS is a Conjoint Committee available. Email [email protected] representing the Colon & Rectal Surgery Phone +61 3 9853 8013 Section, RACS, and the Colorectal Applications for the 2022 Program will Surgical Society of Australia and New be accepted from 1 April 2021 to 1 May Zealand (CSSANZ). The program is 2021. administered through the CSSANZ office. Applications: All applicants must use the For details about the Training Program ANZTBCRS Application Form 2022 (see and the application process, please see website link above). Applications accepted 1 April 2021-1 May 2021 Surgical News | Volume 21 | Issue 02 39 Education activities

The Professional Development Program aims to support surgeons in aspects of their professional life, encouraging professional growth and workplace performance. Life-long learning through professional development can improve our capabilities and help us to realise our full potential as surgeons as well as individuals.

Face-to-face courses

Course Date Region Clinical Decision Making Wednesday 14 July 2021 Brisbane, Queensland Foundation Skills for Surgical Educators Saturday 5 June 2021 Auckland, New Zealand Saturday 19 June 2021 Adelaide, South Australia Thursday 15 July 2021 Melbourne, Victoria Non-Technical Skills for Surgeons (NOTSS) Friday 30 July 2021 Auckland, New Zealand Operating with Respect Saturday 22 May 2021 Sydney, New South Wales Saturday 19 June 2021 Melbourne , Victoria Thursday 1 July 2021 Adelaide, South Australia Thursday 8 July 2021 Christchurch, New Zealand Friday 16 July 2021 Canberra, Australian Capital Territory Operating with Respect (Trainees) Friday 18 June 2021 Melbourne, Victoria Process Communication Model: Seminar 1 Friday 25-Sunday 27 June 2021 Auckland, New Zealand Promoting Advanced Surgical Education Friday 30-Saturday 31 July 2021 Sydney, New South Wales Writing Medico Legal Reports Wednesday 21 July 2021 Sydney, New South Wales

Online courses

Course Date Conflict and You Wednesday 26 May 2021 Thursday 29 July 2021 Leading out of Drama Tuesday 15-Thursday 24 June 2021

For more information email [email protected] or visit our website surgeons.org/education/professional-development

Seeking examiners

The Clinical Committee is seeking (four points per examination) and have examiners for our upcoming June 2021 an opportunity to meet and build rapport Clinical Examination. with colleagues. The Clinical Examination will take place Please note you may be required to on Saturday 26-Sunday 27 June 2021 complete Clinical Examiner training if you at the Royal Children’s Hospital in have not examined before. The training Melbourne, Victoria. will require 1-2 hours of your time and The Royal Australasian College of will be held a week or two before the Surgeons Clinical Examiners are exam. Further information will be sent in involved in the assessment of Surgical the coming weeks. Education and Training (SET) Trainees, If you have any questions, please contact gain valuable Continuing Professional [email protected] Development (CPD) points 40 Society spotlight Operating on the cutting edge

Virtual planning and 3D modelling technology is helping surgeons at Chris O’Brien Lifehouse perform intricate operations with tremendous results.

When 46-year-old mother-of-two Tara Flannery first noticed a lesion on her upper gum, she never could have imagined the road that lay ahead. “I received a call saying I needed to meet with the surgical team at the Lifehouse Centre because my lesion was something more sinister – cancer,” she said. After months of uncertainty and multiple biopsies, Tara was diagnosed with a squamous cell cancer. It was already surrounding her teeth and her medical team recommended the complete removal of her upper jaw. Surgically, it was far from the easiest option but it would give her the best chance of a cure. On its own, the removal of Tara’s cancer would leave significant cosmetic deformities and make it difficult, if Professor Jonathan Clark AM Associate Professor Carsten Palme not impossible, for her to chew and surgery. This groundbreaking approach was aware of the meticulous planning swallow. But the surgical team at Chris enables them to plan the surgery going on behind the scenes, but admits O’Brien Lifehouse utilised the collective digitally, and use 3D printed models she was apprehensive given the invasive expertise of head and neck ablative and and guides with custom-made titanium nature of the surgery. As a primary reconstructive surgeons, maxillofacial plates to hold the transplanted bone in school teacher, she envisioned having surgeons, and prosthodontists from place. to stand with a disfigured face in front Westmead Oral Restorative Sciences of a class of 30 children.The ‘what ifs’ to map out the removal and complete “We can plan where cuts should be took a toll on her mental health, but reconstruction of Tara’s jaw. made, what part of the body we are going to borrow bone from, what precise Tara said going to work became a coping Associate Professor Carsten Palme, part of the fibula to take, where the mechanism. Director of Head and Neck Surgery at dental implants and bridge should be “I wanted to model resilience for the Lifehouse, was one of Tara’s surgeons. He positioned, and where teeth will be in the kids,” she said. “There was a little girl at said that while medical teams are good future,” Associate Professor Palme said. school who also had jaw cancer. We said at getting cancers out, historically they we were ‘jaw buddies’ and would high have not measured up when it comes to Professor Jonathan Clark AM, Director five every time we passed. I thought, if rehabilitation. of Head and Neck Research, said past procedures of this kind have relied this little girl can come to school, then I “Dental rehabilitation is crucial to solely on the surgeon’s experience can too.” restoring a patient’s appearance and judgement about where the bone Six weeks before Tara’s surgery, and function and allowing them to should be located. Now virtual modelling surgeons placed implants and a new gum successfully integrate back into work leads to a much higher success rate. “It lining in Tara’s fibula. Dental implants and society,” Associate Professor Palme means the patient can walk in and out are placed in the patient’s leg bone and said. of hospital looking almost the same,” he then a denture is fitted to the implants Lifehouse surgeons have expertise in said. when the cancer is removed, so that the virtual surgical planning, allowing them In the months before her surgery Tara patient leaves hospital with a full set of to comprehensively map out a patient’s teeth. Surgical News | Volume 21 | Issue 02 41

cancers. “We are seeing the numbers increase by about five per cent every year, especially in young non-smoking women,” he said. “I recently saw a 15-year-old kid who had bone cancer of the upper jaw. He will be one of the beneficiaries of this work.” The Lifehouse team, backed by a $4 million multi-institutional grant, is currently attempting to grow bone and cartilage in laboratories, in the hope they can be used in future reconstructive operations. They expect the project will take years but are excited by what lies ahead.

Above: Tara Flannery, before her cancer diagnosis (left) and after her successful reconstructive surgery (right).

Before going into theatre on the day to subside. But she is now in remission of her second surgery, Tara recalls and, other than a scar on her leg from being astounded at the number of the transplant, there are no visible signs surgeons and nurses lined up ready for of the invasive surgery she has endured. the marathon procedure. “The surgery “My daughters tell me my nose is a little took 12 hours but proved a success,” bit wider, but when I’m meeting new Tara said. “I will be eternally grateful people they have no idea,” she said. for medical science and the skill of my According to Associate Professor Palme, surgeons.” tongue and lower jaw cancers have Tara’s recovery has been a long process, historically occurred in male smokers and the pain associated with the bone and drinkers, but now a lot more young Below: Associate Professor Carsten Palme removed from her fibula took two years people are presenting with mouth Images from the planning stages of the operation. 42 The surgeons of Vanity Fair

Oscar Clayton: surgeon and socialite (1816-1892)

Knight Bachelor. C.B. C.M.G. LSA FRCS M.D.(Erlangen)

institution’, he said in a later address. In In 1868, Clayton was appointed as Extra 1842, Clayton had been elected a Fellow Surgeon-in-Ordinary to the Prince of of the Royal Medical and Chirurgical Wales, later King Edward VII, and as Society of London, and the following Surgeon-in-Ordinary to his brother, Prince year read a paper before that Society, an Alfred, Duke of Edinburgh. account of several cases of a hysterical In November 1871 ‘Bertie’, the Prince of affection of the vocal apparatus. This was Wales, became gravely ill: at the time to be his only recorded publication. he was at Sandringham, where he was In 1841 and 1842, a considerable number seen by Dr John Lowe MD FLS, a physician of the institute children were afflicted and naturalist medical attendant to the with, as he told the Society, ‘a short Royal Family at Sandringham. Dr Lowe almost hacking constant cough altered diagnosed typhoid and sent for Clayton, to shrill screaming expiration followed who agreed with Lowe’s opinion. by a quick catching inspiratory effort.’ There was grave concern that the Prince Following the failure of treatment with of Wales would succumb to typhoid, just expectorants and sedatives and with as his father had, on the 10th anniversary ‘the uproar in the building becoming of his father’s death. The Archbishop of alarming to the neighbourhood’, Clayton Canterbury issued a form of prayer to assembled the children and informed invoke his recovery and a slightly altered them, ‘I must apply a red-hot iron to the version was used in Catholic churches and throats of all who were not quite well on synagogues. the following morning.’ The bellringers were summoned to St Oscar Clayton was featured in Vanity Fair Any failures were to be treated by a Paul’s Cathedral to prepare to toll out on 12 September 1874 and caricatured spatula covered with a silk handkerchief the Prince’s death: miraculously, over by Carlo Pellegrini ‘Ape’ with the caption, and heated in boiling water. Treatment a weekend he began to improve and ‘Fashionable Surgery’. The National was successful with no remissions! thereafter made slow and continuous Portrait Gallery, London holds the original Vanity Fair observed, ‘He was early made progress towards recovery. Pellegrini watercolour and the published Surgeon to the London Police and lithograph created from it. acquired such experience that he Vanity Fair noted, ‘the son of a surgeon, has now grown to be the favourite Oscar Clayton was from his youth up medical authority consulted by young destined to be a Doctor. By dint of hard men of fashion.’ labour made himself master of all that On 10 February 1840, the cousins was known and of even more than was Queen Victoria and Prince Albert were practised in his profession’. married in London: they had no less Clayton qualified via University College than nine children, five daughters London and the Middlesex Hospital and and four sons. Their eldest son, first practised from his father’s address Albert Edward, known as ‘Bertie’ to until in 1853 he was elected a Fellow of his family, was Prince of Wales, and the Royal College of Surgeons. He spent heir to the throne. his later years in practice at Number 5 Tragically, Albert, the Prince Harley Street: Clayton was essentially a Consort, died at Windsor Castle fashionable general practitioner. on 14 December 1861, following From 1841, Clayton was ‘surgeon’ to chronic and debilitating medical the St Pancras Charity School for Female episodes, and finally typhoid fever. Children, aged between nine and 14, At this time there were 120,000 where children were ‘treated with the cases of typhoid each year in strictness so difficult to accomplish, England, and of these, one in six except within the walls of a public died. Surgical News | Volume 21 | Issue 02 43

wrote, ‘Oscar Clayton, who is nominally doctor, but really “pimp” to the Prince of Wales’. James Tissot’s portrait, HRH The Prince of Wales in the Vanity Fair of 8 November 1873, confirms a complete recovery: Vanity Fair commented, ‘this day he completes his 32nd year, and it is to be hoped that he will see many more before he comes to his inheritance’. Likenesses of Clayton are rare: in 1890 his portrait was painted by Frederick Goodall and is now in the Hunterian Art Gallery in Glasgow. The art journal The Academy described it as the first important of Harley Street sparkled with good portrait of Sir Oscar Clayton, continuing, company but were of the old fashion; a ‘the eminent medical practitioner and separate choice wine being served with homme du monde is represented sitting, every course, of which there were, also, With his recovery came the granting of and leaning, after his wont, somewhat far too many’. honours. Oscar Clayton in due course heavily upon his walking stick; and collected the CB (Companion of the while certainly observing all the time Towards the end of his life Clayton was Order of the Bath), CMG (Companion of with nothing less than his accustomed noted to remark, ‘I should have been the Order of St Michael and St George) shrewdness whatever persons may be in far more successful if I had sometimes and a knighthood. It was usually said his company’. been able to write cheques instead of that Clayton had diagnosed the Prince prescriptions for my patients… worry In 1880, the magazine Time: A Monthly with typhoid, whereas Dr Lowe, who kills most people, and, want of money is Miscellany published a sketch of a society had actually made the diagnosis, and often the root of bodily evil’. doctor entitled ‘Mr Osric Claypole’, which attended the Prince most assiduously, began with, ‘gold rimmed spectacles; Plarr’s Lives of the Fellows of the Royal received nothing! Lewis Harcourt, who hair carefully distributed by the brush… A College of Surgeons of England concluded was knighted at Windsor with Clayton, rosy, healthy face… When Osric Claypole Clayton’s entry thus: ‘The successful dines out, which he does on every night career of Sir Oscar may have aroused that he does not entertain at home, some jealous comment amongst his he shuffles off the last remnant of the contemporaries, but he was a staunch doctoral coil and is the heartiest and friend, a good colleague, and a supporter merriest of companions’. of the medical profession’. Some weeks later another review noted, Sir Oscar Clayton died aged 76 on 27 ‘surely Mr Osric Claypole, with his Louis January 1892 and his will was proved at Seize furniture, his Sėvres, and his upwards of £150,000, a very substantial ‘younger Court’ was Mr Oscar Clayton of fortune. No reference to partnerships, Harley Street?’ marriage or descendants is recorded. Royal patronage was showered upon him. Mr Peter F Burke Vanity Fair stated, ‘He is a favourite with FRCS FRACS DHMSA all, he gives dinners where all may meet, he is always afoot, and when he retires, both he and his greys will be missed from London’. In 1885 the Midland Medical Miscellany recorded, ‘The career of Sir Oscar Clayton Images is an interesting one. He shone suddenly Over page: Top left: Mr Oscar Clayton. Fashionable Surgery as a star in the medical firmament. To do ‘Ape’ 1874. him justice, he is one of the first medical Bottom right: Prince Alfred and Prince Albert, men of the day, in spite of his exquisitely September 1867. varnished boots and his aspiration to the This page: juvenility that is not his’. Top left: Harley Street, London. Typical Georgian facade. The former actress, Lady Bancroft, wrote Bottom left: His Royal Highness The Prince of Wales, in her memoirs published in 1909, that Vanity Fair, 8 November 1873. Oscar Clayton was well-known as a Top right: Oscar Clayton. Portrait by Frederick Court Surgeon; ‘his dinners at the corner Goodall, 1890. 44 Fellow contribution Pearls of wisdom from my surgical mentors

Part I OPUS LXVIII

The term ‘pearls of wisdom’ dates back to of this investigative tool in the diagnosis Original French Biblical times. In the Old Testament Book and management of tumours and version of the of Job it says, ‘No mention shall be made malignancies. dermatome of corals or pearls but the price of wisdom pattern defined on a leather doll of is above rubies’. The pearls of wisdom I the 1930s. have gained from my surgical mentors is the basis of this article. These range in variety like the colours of the rainbow and, at the completion of our careers, Churchill’s words ring true: ‘We make a living by what we get, but we make a life by what we give’. Recently in my consulting make a diagnosis, just open up and have rooms I repeated Newton’s a look”. experience. He originally The late Bob Shannon, trained by Michael observed morning light’s DeBakey in Texas, introduced me to reflection off a mirror Transverse section of the mid-thigh showing the vascular surgery for repairing large and painting the colours of the relationship of muscles and other vital structures. small vessels while using the DeBakey rainbow. I saw the same The late Sam Mellick was the next rung forceps. Their gentle apposition in pincer effect in my consulting suite in this ladder. He was a vascular surgeon activity was non-traumatic (suitable for bathroom. from Brisbane and achieved eminence coronary vessels), whereas the toothed Newton’s scientific eminence ranged from in the Royal Australasian College of variety of Adson and Gillies forceps could gravitational constants to telescopic Surgeons (RACS) hierarchy, holding cause adventitial or paratenon damage in investigations of the universe, but he positions from censor-in-chief to senior any reconstruction. always acknowledged his forebears vice president. When visiting him at I joined Benny Rank at the Victorian in this scientific journey. There is a Ascot we would lunch on seafood and Plastic Surgery Unit (VPSU) in 1970 to French saying, debout sur les épaules champagne while sitting on his veranda, commence my transition in Plastic and de géants – ‘standing on the shoulders his favourite distraction. His embracing Reconstructive Surgery. This was the of giants’ – and this mentoring article lecture style imparted wisdom based on beginning of my journey into surgical is an acknowledgement of some of my experience, something we all have tried refinement in the fields of head and neck, predecessors’ contributions. to emulate. What a mentor he was. His hand and general reconstructive surgery. style was in stark contrast to another The late Max Hickey was my original London was the next phase in my eminent lecturer on the Oxford set – W mentor in the basic science of Anatomy maturation process. I worked at three H Auden, the composer of the poem for at the University of Queensland. His major teaching hospitals doing head and Rodin’s Thinker. He once lectured in that philosophical and academic style stood neck surgery and established hand units post-prandial phase after lunch when he him in good stead and, thanks to my at each. I am grateful to the late David said it was like lecturing sleepwalkers. father, who was on the senate, his Conroy for suggesting I go to London to academic appointment was approved by Another figure in this mentoring saga is do the College course and stay at Nuffield the University Senate in the late 1950s, the late Brian Courtis, who topped the for six weeks – I ended up staying three contrary to the wishes of the Professorial 1944 English Primary Fellowship exam, years. Over lunch at the PANCH (Preston Board. winning the Hallett Prize. He was tutored and Northcote Community Hospital) in Max had us focus on transverse by Raymond Last of Last’s Anatomy fame. the Doctors dining hall David suggested I anatomical sections, the bane of our We all used this famous textbook for do the English Fellowship, including the lives. Little did we know in the late 1970s our Primary FRACS but some of us had to College course to become acquainted when CT investigations were established re-read it. Brian’s philosophical advice for with surgery on the London scene. our background was atuned to the use me in surgery was simply, “if you cannot Surgical News | Volume 21 | Issue 02 45

William Cheselden by Jonathan Richardson the Royal College of Surgeons, London adjacent to Nuffield College. elder. This English Fellowship course had This research led to the establishment On the evening following the Queen’s some light moments and I recall an of the ‘angiotome’, a term describing bestowal of his Knighthood at Buckingham incident with one of the other surgical the neuro dermatomal background Palace in October 1973, he invited me to personalities on my first bus trip to St of island flaps with a fascial base and return to Melbourne – yes, the wine must Thomas’. He greeted me with a handshake random perforator blood supply. Simply, have been talking! and was obviously from the Oxbridge if there is a nerve supply, there must be His stern teaching style reflected his fraternity. My maroon and navy club tie a blood supply. Historically, the focus of wartime aptitude but in all surgical caught his eye. “Kings College, Cambridge, vascular investigation of the perferator procedures he always had the patient’s I presume?” he said. I could not resist architecture has not highlighted any interests at heart. Even on ward rounds we giving my reply, “No, I’m sorry, Fosseys of aspects of somatic, autonomic and learnt this one simple principle from him: Footscray in Melbourne”. lymphatic input. Let us not forget, “What is best for the patient?” nature gave us all these modalities. The The accommodation at Nuffield, next to development of the keystone has been Benny subsequently offered some the Royal College of Surgeons (RCS) in my tool to documenting these essential critiques about some of my reconstructive Lincoln’s Inn Fields, became my surgical clinical contributions all based on clinical procedures of doing island flaps in lower focus. In the corridor linking Nuffield observations with an embryological basis. limb repairs, a little contrary to his own to the College, this portrait of William dogmas. But the keystone island flap Cheselden I passed many times. He was Now back to dermatomes. Sir Henry worked successfully, reflecting the Helen also Isaac Newton’s physician. Head, a neurologist at Trinity College, Keller dictum of heresy and orthodoxy, Cambridge, established the pattern of the which I have quoted in the past: “the My English Fellowship exam with Felix dermatomes in 1929. Russell Brain from Eastcott, who did the first carotid heresy of one age becomes the orthodoxy Queen Square, London, said of Henry Head, of the next”. endarterectomy at Middlesex Hospital “Some men find teaching difficult: others in London, was no more than a social are born exponents”. Incidentally, Don Marshall totally interchange. We spent the whole supported my island flap reconstruction time discussing Maurice Ewing from Benny and I became mutual friends. ideas and used my cases with the Middlesex and his transition to He was not one for familiarity but we acknowledgement at one of the plenary the Antipodes as the inaugural James respected each other’s personalities. sessions of the RACS meetings in the 90s. Stewart Chair of Surgery at the University Every time he came to London over those three years, I was his aide-de-champ. Finally, I must mention the late Bill of Melbourne. Manchester from New Zealand, my next mentor. We met at the fifth international Plastic Surgical Congress in Melbourne in 1971 before meeting again at the Madrid Congress in 1972, where I gave my first ‘Angiotome Concept’ presentation. Afterwards, he said, “Felix, traditionally I don’t know where you are coming from, but keep it up.” What a mentoring gesture during my phase of exploring new avenues of reconstruction! End of part I

Tompsett’s image of stillborn child of the vascular patterns of the head and neck in the Huntarian Museum at the RCS. Associate Professor Felix Behan At Nuffield I became deputy warden before becoming a Research Fellow at the RCS, Sir Henry Head, neurologist at Trinity College assisting DH Tomsett with his vascular Cambridge, established the pattern of the anatomy resin studies. dermatomes in 1929. 46 Road safety

RACS welcomes new draft road safety strategy

Every year, around 1200 people are killed message and is integrated into all of the accountability in the new strategy. on Australia’s roads, and almost 40,000 are other areas. While RACS welcomes the draft strategy, seriously injured. That is the equivalent of In response, the Royal Australasian College it is important to reiterate that the hard the population of a medium-sized country of Surgeons (RACS) commended the work has yet to begin. Australia failed to town, seriously injured. This does not even extensive consultation that has occurred meet the conservative targets identified in take into consideration the countless other in developing the draft strategy. The the National Road Safety Strategy 2011- lives shattered in the process. College is satisfied that the vast majority 2020. We cannot allow this to happen As we enter a new decade, we must draw a of our recommendations, made in prior again. line and recalibrate. consultations, have been considered and It is therefore imperative that the In February, the Australian Government implemented. Government remains committed to released its draft National Road Safety Our response is available on the RACS delivering the objectives of the new Strategy 2021-2030. The draft strategy website by searching for ‘2020-2031 Road strategy throughout its tenure. This outlined a series of targets to reduce Safety Strategy’ and highlights a number includes updating the strategy when deaths and serious injuries on our roads, of initiatives that the College is supportive necessary and dedicating the appropriate setting us on the path to achieve Vision of. One of these is the central role that the resources to allow this to happen. Zero (zero deaths and serious injuries) by Government’s Office of Road Safety will RACS recognises that it is incumbent upon 2050. play in the strategy. us all to work towards these objectives, The draft strategy has three key themes: The establishment of this office was a and we remain committed, throughout the Safe Roads, Safe Vehicles and Safe Road key recommendation of the 2018 Inquiry duration of the strategy, to advocating for Use. into the effectiveness of the previous and supporting sensible policies that aim Safe speeds, which was considered as a road safety strategy, and it will play to eliminate death and serious injury on fourth theme in the previous strategy, an important role in providing national our roads. has been highlighted as an overarching oversight of and ensuring ongoing

The American College of Surgeons in Australia and New Zealand

Calling all RACS Fellows and Trainees: the associate members and Trainees can “It also gives you access to a wealth of Australia New Zealand (ANZ) Chapter of apply to be guests. educational resources to support life- the American College of Surgeons (ACS) Professor Andrew Hill, a general surgeon long learning.” invites you to apply to become a member based in Auckland, is the current The ANZ Chapter meets once a year at the and enjoy the benefits. President of the ANZ Chapter Council. Annual Scientific Congress (ASC) and it The ACS ANZ Chapter promotes the “The benefits of being a member of the funds and runs a number of scholarship objectives of ACS, including elevating Chapter include meeting and networking programs. These include the Hugh the standards of surgery, establishing a with other members of the ACS across Johnston ANZ Chapter ACS Travelling standard of competency and character for Australia and New Zealand,” he said. Fellowship and the John Buckingham practitioners of surgery and educating the “However, the main benefits come Travelling Scholarship, which provide for public and profession regarding training from being FACS, which requires an a young Fellow and Trainee to travel to in surgery. interview process and involves having the United States and attend the Annual The Chapter facilitates communication your surgical education and training, Clinical Congress of the ACS. among its members and works towards qualifications, competence and ethical RACS has provided administrative building new and stronger links between conduct rigorously evaluated and being support to the ANZ Chapter of the the ACS and RACS, to enable a united effort found consistent with the high standards ACS for many years. This support is in improving the care of surgical patients. established and demanded by the College. currently provided by the Fellowship Founded 36 years ago, the ANZ Chapter “FACS also gives you heavily discounted Services Department and the Finance welcomes all RACS Fellows and Trainees. registration, including an online option, Department. Those holding FRACS for more than three to the annual ACS clinical congress, the For more information visit: surgeons. years can immediately apply to become largest surgery conference in the world, org/en/Resources/interest-groups- members. Those holding FRACS for less attracting members and presenters sections/anz-chapter-of-the-american- than three years can apply to become from all over the world,” he continued. college-of-surgeons. Surgical News | Volume 21 | Issue 02 47 Who should use the title ‘surgeon’ in Australia?

As many members know, while the use of undertake ‘consultation on which medical their qualifications via Australian Medical the title ‘specialist surgeon’ is restricted practitioners should be able to use the College accredited courses including a in Australia, the use of ‘surgeon’ itself is title “surgeon”’. With this process in mind, surgical component, would also be able not protected or restricted. Last year, the RACS decided to reconsider the issue, and to use ‘surgeon’ in their title. This would Australian Health Practitioner Regulation in February endorsed a new position on only be in combination with the words Agency (Ahpra) wrote to the Royal who should be able to use ‘surgeon’ in ‘GP’ or ‘general practitioner’, allowing the Australasian College of Surgeons (RACS) their title in Australia. titles ‘GP surgeon’ or ‘general practitioner expressing the following view. It must be recognised that Australian surgeon’. Enforcement of use of the title ‘surgeon’ is governments do not seek to protect This position is one that cannot be complex as the term ‘surgeon’, with other medical titles in order to protect the construed as RACS restricting the title descriptors, is used commonly to describe interests or prestige of practitioners; they to RACS Fellows. Its focus on surgical medical practitioners who, as part of do so with the aim of ensuring Australians training means the position is primarily their usual practice, perform surgical have access to a safe and competent about patient safety. Allowing GPs with procedures of varying invasiveness. This registered health workforce. relevant training in underserved areas to reflects the common definition of surgery, The RACS position is that those who use the term acknowledges the need to as well as the fact that the basic medical are not specialist surgeons should be ensure equitable access. qualification is generally a ‘bachelor or restricted from using ‘surgeon’ in their With this new position confirmed, doctor of medicine and surgery’. titles, except if they are a member RACS will be engaging with Australian This means there is little to prevent any of a medical profession which has a governments as their focus widens medical practitioner from referring to significant surgical training component beyond COVID-19. themselves as a ‘cosmetic surgeon’, or in its curricula. (Such professions other similar titles. Meanwhile, using include specialist medical practitioners ‘surgeon’ in combination with other in obstetrics and gynaecology and words that imply a person is registered ophthalmology.) According to the RACS in a particular surgical field of specialty position, these medical practitioners practice (i.e. one of the nine RACS would be able to use ‘surgeon’ in specialties), is prohibited when the combination with relevant ‘qualifier’ person using the term is not registered in or ‘descriptor’ words that accurately that specialty. describe their scope of practice. This However, there is some movement on would allow titles such as ‘ophthalmic this issue happening at a government surgeon’. level. Not long before their focus turned General practitioners in areas of need, The detail of RACS’ position can be found to the COVID-19 pandemic, Australian where other medical specialists are less on the RACS website at surgeons.org/ health ministers announced they would accessible, and when they have attained about-racs/position-papers.

Academic gown donation RACS would like to thank Mrs Sue Armstrong for the generous donation of Mr W. L. H. Armstrong’s academic gown to the College, and Mr Kenneth MacGowan FRACS for the generous donation of his academic gown to the College. RACS preserves academic gowns for use by Convocating Fellows and at graduation ceremonies at the College. If you no longer have use for your gown, RACS would be grateful to add to our reserve. We can acknowledge your donation and place your name on the gown if you approve. To donate your gown, please contact the Conference and Events Department +61 3 9249 1248. Alternatively you could mail the gown to Ms Ally Chen c/o Conferences and Events Department, Royal Australasian College of Surgeons, 250-290 Spring St, EAST MELBOURNE, VIC 3002. 48 Research Case note review

Introduction of the audit of surgical mortality in Tasmania

Tasmania has Australia’s oldest (median Regional Hospital and Mersey Community age 42) and most regionally dispersed Hospital), Tasmania quickly arrived at a population. A relatively high proportion position where every surgeon in public of its population of around 534,000 (as of practice in the state was enrolled in the June 2019) lives in areas of disadvantage, audit. From the outset, all public hospitals as compared with other states. More referred all eligible deaths fitting the audit than 33 per cent of Tasmanians are living criteria to TASM. within geographic areas in the lowest Tasmanian private hospitals were also quintiles of disadvantage, as classified engaged from 2004. Calvary Health Care by the Australian Bureau of Statistics’ operates two hospitals in Hobart, Calvary socio-economic indexes for areas. Lenah Valley and St John’s Hospital, and Along with age and socio-economic two in Launceston, St Luke’s Hospital disadvantage, reduced education rates, and St Vincent’s Hospital. In addition, reduced employment rates and other Healthscope operates the Hobart Private environmental factors combine with the Hospital, and Healthcare Australia Pty Ltd result that Tasmanians have the highest operates the North West Private Hospital burden of chronic disease, the highest in Burnie. prevalence of risk factors (e.g. smoking meets twice a year, with the membership prevalence and high blood pressure) and Tasmania became the first state in consisting of RACS members, a member of generally the poorest health outcomes of Australia to include all anaesthetists the Australian and New Zealand College any state in Australia. in the audit, starting from 2004. This of Anaesthetists, a member from the initiative has since been picked up Tasmanian DoH, and a member from the Tasmania was the second jurisdiction in by other jurisdictions, including New Royal Australian and New Zealand College Australia to introduce an audit of surgical Zealand. of Obstetricians and Gynaecologists. mortality in 2004. This was based on the The Chair, Mr Rob Bohmer, specialises in Over the past 16 years, 2300 deaths have successful introduction of the Western upper gastrointestinal and hepatobiliary been reported to TASM. These have all Australian Audit of Surgical Mortality surgery across both the public and private been recorded and reviewed, giving TASM (WAASM), which commenced on 1 sectors. June 2001 as a pilot project under the a rich dataset of surgical mortality. In conjunction with the Tasmanian DoH, management of the University of Western Recruitment of both surgeon and TASM presents individual hospital reports Australia (based on the then Scottish anaesthetist first-line assessors has been to each public and private hospital in Surgical Mortality Audit). very strong since the inception of TASM, Tasmania every year. The state TASM however an issue in a small jurisdiction Mr Rob Bohmer and I were appointed by report is tabled with the Tasmanian such as Tasmania, is the ability to appoint the Tasmanian Audit of Surgical Mortality Minister for Health and the Secretary of second-line assessors. TASM welcomes (TASM) Management Committee as Health at the end of each calendar year. the inaugural chairman and program and encourages recruitment of second- manager, respectively. Together we line assessors. There are ongoing professional development activities either run by TASM have now completed 16 annual reports. Not only does this activity provide or undertaken in conjunction with RACS While working under the aegis of the continuing professional development and the Tasmanian DoH Clinical Quality, RACS TASM Management Committee my (CPD) points to the assessor, but it Regulation and Accreditation unit. These salary has been paid by the Tasmanian provides deeper learning into the patient sessions have been well supported Department of Health (DoH) under a journey and identification of where there and provide opportunities for ongoing contracted arrangement. As a result, I may have been system or process errors. discussion about quality improvement actively participate in the Clinical Quality, The feedback provided to the treating in areas such as unexpected death, Regulation and Accreditation unit within surgeon and anaesthetist helps inform improving patient outcomes, patient DoH, Tasmania. and educate them about valuable lessons safety and culture. Due to Tasmania’s relatively small number learned and helps facilitate change for of public hospitals (Royal Hobart Hospital, best practice. Ms Lisa Lynch (with Mr Rob Bohmer FRACS) Launceston General Hospital, North West The RACS TASM Management Committee “We are not a team because we work together. We are a team because we trust, respect and care for each other,” Vala Afshar

Build better relationships at work Speak in total confidence to a Converge International consultant. Australia 1300 our eap (1300 687 327) New Zealand 0800 666 367 International +613 8620 5300 or visit convergeinternational.com.au 50 From the archives A glance at Archibald Watson’s surgical diary London, January 1882-April 1884

7 December 1883, Watson noted, ‘Lister came to the hospital a Baronet today’. There are numerous references to Lister throughout the diary. On the 18 January 1884, for example, John Hulke operated on a boy for phimosis and Watson noted that Hulke ‘likes Lister’s dressing forceps only with longer blades’. Similarly, in notes made in August 1884 about multiple cystic epithelioma, Watson mentions that ‘Wood likes Lister’s method of elevation thereby emptying the veins by gravitation and the capillaries and arteries by reflex action’. Other references include Lister’s plates and Lister’s verband. It is apparent that many of the surgeons that Watson observed embraced Lister’s innovations and his theories of antisepsis. Lister’s innovations included a method of repairing kneecaps with a metal wire, the use of catgut sutures and rubber drains. Watson described these methods in an Images from Watson’s surgical diary. Patella operation- Lister page 169-170. operation on 23 November 1883. Fracture of patella four years ago – atrophy Born in Tarcutta, New South Wales in meticulously records operations of quadriceps 21/2 inches less round lower 1849, Archibald Watson had a chequered performed by some of the most notable third of thigh than other one – instead of early life and in 1872 he was aboard the surgeons of the period. Prominent dissecting out the fibrous band connecting notorious brig Carl when she was involved among them are Joseph Lister, Jonathon the two fragts [sic] which was about 1 inch 1 in ‘blackbirding’ activities in the Pacific. Hutchinson, Christopher Heath, John long he forcibly flexed knee and tore away In 1873, Watson travelled to Europe and Whitaker Hulke, John Wood, James half of lower fragment – to complicate studied medicine at the Georg-August Cantlie, Henry Morris, William Savory and matters the upper fragment was found to Universität Göttingen (MD 1878) and Waren Tay. consist of two pieces an outer layer and the Université de Paris (MD 1880). By Lister is a pervasive influence in Watson’s an inner smaller (whether this was caused 1880, he was in London working as an diary. His role as a pioneer of antiseptic by his bending the knee or whether it was assistant demonstrator in anatomy at surgery is undisputed and by 1867, he part of the original fracture I could not the Charing Cross Hospital Medical School was using carbolic acid as an antiseptic hear) – the small piece was sutured on to and studying surgery under Joseph Lister. in the operating theatres, as well as for the big piece with catgut and then the pared He was already a member of the Royal dressings and sterilising instruments. lower fragment to the lower piece of the upper fragment with silver wire – a button College of Surgeons (RCS) and was working In 1877, Lister left Edinburgh to replace hole was made in front of the tendon of the towards his Fellowship, which he obtained Sir William Fergusson at the King’s College biceps and a drainage tube introduced – in 1884. Hospital in London. While Watson records quadriceps tendon had to be partly divided Watson’s densely written 384-page diary, only about 15 of Lister’s operations, he and the tendinous expansion freely divided filled with illustrations and addenda, clearly thought highly of him. On Surgical News | Volume 21 | Issue 02 51

Left: Hydatids 1, Lister page 84. Below: Hydatids 2, Lister page 85. in order to get upper fragment down leg – adhesion has taken place open it – on Watson’s first surgical diary is significant put on Gooches splint with lots of cotton cutting down however found peritoneum because it provides insights into late 19th wool adjacent ahead to sack of what turned out century surgery, and to the great surgical The procedures observed in the diary were to be a suppurating hydatid cyst – stinking names of the period. decomposing pus – a lot of wallnut[sic] diverse and ranged across every specialty. Elizabeth Milford, RACS Archivist On the 26 June 1883, Watson watched sized cysts flopped out and a larger another of Lister’s operations on a woman gelatinous membrane – cavity was washed with hydatid cysts. out with ? [sic] solution (I think Condy’s fluid) and 2 thick drains put in thus to REFERENCES Last sept severe colique hepatique – faeces 1. See Carter, J, Painting the Islands Vermillion, Melbourne University prevent them from slipping with cavity Press, 1995 and https://adb.anu.edu.au/biography/watson-archi- colorless [sic] – bile in urine – will incise bald-8997 abdominal wall and sew gall bladder to The whole covered by Listers verband [sic] edge of wound and in three days when of eucalyptus gauze 52 Good reading

Good reads

Heroes of a Moment: The Heroes of a Moment details the most productive period in the history of surgery. History of Body Cavity Surgery Anaesthesia and antisepsis made it possible to explore the contents of the abdomen, chest and skull. However, even in the early part of the 20th century, these main cavities of the body were only invaded by the most adventurous surgeons. John Hall Once the mechanics of operating had advanced, science and technology became the drivers for change. These changes were reflected in the equipment used by surgeons, the architecture of hospitals, and the nature of being a surgeon. The expansion in manufacturing that occurred after World War II fuelled a new era of open body cavity surgery. Another big advance occurred in the 1990s when the rapid uptake of laparoscopic cholecystectomy generated the ‘escape velocity’ needed to progress minimal access surgery. At the end of the 19th century, surgeons used cutlery; by the 21st century, they were looking at digital images and flirting with robots.

So You Want To Be a Doctor? This book is an Australian first. It is designed to help young people who are thinking about applying to study medicine and become doctors to become as fully informed as possible in regard to what is required to be successful in their application, and more Kerry J Breen importantly what is really involved in a career in medicine. The book describes the attributes that the Australian community desires in its doctors, the prerequisites for entry into medical school, the nature of the educational programs offered by Australia’s nineteen medical schools and the expectations placed upon medical students. It includes advice about study methods, financial support and balancing study with part-time work and a social life. Surgical News | Volume 21 | Issue 02 53 In memoriam RACS publishes abridged obituaries in Surgical News. We reproduce the opening paragraphs of the obituary. Full versions can be found on the RACS website.

William David (Bill) Proudman AO MBBS The use of a live donor was highly Our condolences to the family, FRCS FRACS controversial at the time and Bill played friends and colleagues of the a leading role in gaining the approval of General surgeon following Fellows whose deaths the Ethics Committee to perform the have been recently notified. 20 January 1928-16 February 2021 procedure. Born in Adelaide in 1928, Bill was In the early 1960s, the surgical transplant foremost among surgeons in South William David Proudman (SA) team spent many sessions in the Animal Australia and a highly valued mentor to House at TQEH developing and honing Keith McDowell Ewen (NZ) many students and surgeons throughout their skills in renal transplant surgery. Helen Rae Noblett (NZ) his career. He was truly a general surgeon, Immunosuppressive medication was in its able to operate in many areas that are infancy and Bill was closely involved in the now separated into sub-specialties. He planning and establishment of protocols contributed greatly to his profession, the for every aspect of the renal transplant Royal Australasian College of Surgeons process. He continued to play a leadership and the community. role in obtaining renal transplants from After attending Glenelg Primary School many live and deceased donors over many and St Peter’s College, Bill graduated from years. medicine at the University of Adelaide in Bill was a highly skilled surgeon and one 1951. Shortly afterwards, he travelled of the key innovators in the development to the United Kingdom where, after of parathyroid surgery in Adelaide in the several years, he became a Fellow of the 1970s. He authored scientific papers Royal College of Surgeons of England. He on thyroid and parathyroid surgery. returned to Adelaide in 1958 where he He performed the first insertion of an became a Fellow of the Royal Australasian Austin-Moore prosthesis in a patient College of Surgeons after further training. with a fractured hip at TQEH, illustrating When The Queen Elizabeth Hospital his ability to operate in a broad range of (TQEH) opened in 1959, he was areas. appointed the first senior registrar in the Bill remained in South Australia, providing Department of Surgery. He subsequently a lifetime of surgical service and joined the ranks of the honorary education to aspiring young surgeons. His consultant staff, where he became one extraordinary knowledge, clinical skills of the specialists who provided clinical and judgement were highly sought after Informing RACS services and graduate and undergraduate and valued by generations of students If you wish to notify the College of teaching on a voluntary basis. This and colleagues. ‘Proudman’s Rules of the death of a Fellow, please contact practice continued for another ten years Surgery’ are still quoted. the relevant office: until the excessive demands on clinicians were recognised and payment was In addition to surgical matters, he had ACT: [email protected] introduced. an outstanding knowledge of the basic NSW: [email protected] surgical sciences (histopathology, In 1965, together with Dr Peter Knight, anatomy and physiology) and rare medical NZ: [email protected] Bill performed the first successful live conditions, which he eagerly debated QLD: [email protected] donor renal transplant procedure in with his colleagues in their own fields Australia. It was performed at TQEH with SA: [email protected] of expertise. Such was his passion for Bill removing the kidney from the donor. knowledge and education. TAS: [email protected] The actual procedure proved hazardous This obituary was provided by Mr Tim VIC: [email protected] with the discovery of a vascular anomaly, but ultimately resulted in the delivery of a Proudman FRACS WA: [email protected] viable donor kidney. NT: [email protected] 54

Thank you for your extraordinary support to the Foundation for Surgery from January to March.

Every donation makes an incredible difference to help ensure children, families and communities can access safe and quality surgical care when they need it most.

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Ms Karlene & Ms Waratah Bell Ms Joanna Jensen Mr Henry Lumley Mr Mark Hehir Mr Konfir Kabo Mr Peter Lumley

Silver Mr Adrian Anthony Dr Stephanie Demkiw Dr Sanjay Kalgutkar Mr Murray Melville Mr Ronald Baker Anonymous donor Mr Srisongham (Sam) Mr Gregory Mitchell Anonymous donor Mr Philip Gan Khamhing Mr Rudolph Ngai Mr Wei Chang Mr Roger Hargraves Dr Johannis Kilian Mr Martin Rees Dr David Choy Anonymous donor Mr John MacCormick Mr John Taylor

Bronze Dr Renata Abraszko Dr John Beer Dr Alessandra Canal Anonymous donor Dr John Estens Mr Anthony Goodman Dr Brandon Adams Mr Peter Bentivoglio Dr Rachel Care Dr Ruth Collins Mr Ian Farey Dr Jenny Gough Mr Nicholas Agar Mr Samuel Benveniste Mr Ian Carlisle Dr Scott Coman Mr Michael Farrell Mr Peter Grant Mr Sejad Ahmadzada Mr Michael Berce Mr Bernard Carney Mr Andrew Comley Dr William Farrington Dr Jennifer Green Mr Paul Ah-Tye Mr Barend Beukes Mr Vidyasagar Casikar Mr Anthony Connell Dr Linda Ferris Mr Timothy Gregg Dr Sarah Joy Aitken Mr Adam Bialostocki Dr Anne Cass Dr Lauren Cooper Assoc Prof Kerin Fielding Assoc Prof Roger Grigg Mr Fady Aldakkan Assoc Prof Nigel Biggs Mr Anthony Cecire Dr Daron Cope Dr Kirsten Finucane Dr Bina Gurung Dr Hamish Alexander Dr Theo Birch Mr Sean Chan Mr David Cottier Mr Garrett Fitzgerald Mr Dennis Gyomber Mr Ahmed Alkadhi Dr Benjamin Black Mr Simon Chan Dr Mark Courtney Mr William Fitzgerald Mr Simon Hadlow Dr Christopher Allan Dr Melissa Bochner Mr Stanley Chang Assoc Prof Brendon Mr Richard Flint Mr George Halliday Dr Charlotte Allen Mr Laszlo Borbely Dr Avril Chang Coventry Mr Esmond Fogarty Dr David Hamilton Mr Patrick Alley Mr Roderick Borrowdale Dr Jared Chang Dr Jacinta Cover Mr Mark Forbes Dr Michael Harden Mr Robert Allison Mr John Boulas Mr Lean Peng Cheah Mr Scott Crawford Dr Amanda Foster Mr Gerard Hardisty Dr Mustafa Alttahir Dr Bernard Bourke Mr Siew Cheah Mr Simon Crowley Mr Russell Fowler Mr Christopher Harman Anonymous donor Mr Thomas Bowles Mr Stanley Chen Dr Jack Crozier Ms Jane Fox Dr Christopher Mr Mostafa Ammar Dr Luke Bradshaw Mr James Cheng Mr Ian Curley Assoc Prof Ian Francis Harrington Mr Salvatore Arena Ms Vanessa Bramfitt Dr Deepak Cheriachan Ms Carla D’Amico Prof Peter Friedland Dr Damien Harris Anonymous donor Miss Ingra Bringmann Mr Michael Chin Dr Paromita Das Gupta Mr Nicholas Frost Mr Robert Harris Dr Muhammad Ashraf Dr Andrew Broadhurst Mr Jin Cho Mr James Davidson Dr Colin Furnival Mr Henley Harrison Dr John Ashworth Dr James Brown Mr Wai-Ting Choi Mr Neelika Dayananda Mr John Gan Dr Gordon Hay Dr Alisha Azmir Mr Graeme Brown Ms Yvonne Chow Dr Nadine De Alwis Dr Marek Garbowski Mr Ian Hayes Dr Mohammed Baba Mr Joseph Brownlee Mr Chun-Hung Chow Dr Stefaan De Clercq Dr Rebecca Garland Mr Brian Haymet Mr Mohammed Ballal Dr Thomas Bucher Mr John Churchill Prof Richard De Steiger Dr Rohan Gett Dr Bulang He Dr Therese Ballal Mr Andrew Bui Mr Anthony Ciccocioppo Mr Polbert Diaz Dr Alexandria Gibson Dr Marc Heinau Prof Zsolt Balogh Mr William Bye Mr William Clark Dr Ian Dickinson Dr Katherine Gibson Prof Alexander Heriot Dr Michael Barakate Dr Ross Calopedos Mr Matthew Claydon Ms Raji Divekar Mr William Gilkison Prof Peter Hewett Mr Peter Barrie Mr Donald Cameron Dr Mark Clayer Mr Zeev Duieb Prof David Gillatt Dr Nicola Hill Miss Ginny Barro Mr David Caminer Dr Juliet Clayton Dr Kiren Dulku Prof Peter Gilling Prof Yik Ho Dr Borjana Barth Dr Sandra Campbell Dr Emma Clout Mr Malcolm Dunshea Ms Tamara Glyn Dr Richard Hocking Dr Ahmed Bassiouni Prof Ian Campbell Mr Harvey Coates Dr Abdul-Kader Ebrahim Prof Glen Gole Mr Gregory Hogan Anonymous donor Prof Abraham Campero Dr Neil Cochrane Dr Jodie Ellis-Clark Mr Keith Gomes Mr Christopher Mr Max Esser Holdaway Surgical News | Volume 21 | Issue 02 55

Anonymous donor Mr Thomas Kuruvilla Mr Peter Milne Mr Ian Penny Mr Hamish Shilton Dr Susan Velovski Assoc Prof Jonathan Dr Vytauras Kuzinkovas Mr Dragomir Anonymous donor Dr Saesol Shin Mr Subramaniam Vigna- Hong Dr Christine Lai Mladenovic Mr Murray Pfeifer Prof Stanley Sidhu Rajah Mr Robin Hooper Mr Min Lai Assoc Prof Irwin Mohan Dr Francesco Piscioneri Anonymous donor Prof Shyan Vijayasekaran Mr Kym Horsell Anonymous donor Mr Peter Moloney Dr Santosh Poonnoose Mr Stewart Skinner Mr Vijith Vijayasekaran Mr Nezor Houli Anonymous donor Dr Luke Mooney Ms Marge Pope Dr Timothy Sladden Mr Justin Vivian Mr Robert Howells Dr Sonja Latzel Mr Andrew Moot Dr Robert Pozzi Dr Ian Smith Dr Sindy Vrancic Mr Gregory Hoy Mr Pui Lau Anonymous donor Ms Kimberley Prince Prof Bernard Smithers Dr Jen-Chen Huang Dr Joanna Morgan Mr Christopher Dr Hui Lau Mr Timothy Proudman Mr Broughton Snell Wainwright Mr David Huber Mr Matthew Lawrence Assoc Prof Matthew Mr Vikram Puttaswamy Dr Rabi Solaiman Morgan Dr Faye Walker Mr Andrew Hunn Mr Gabriel Lee Mr Robert Rae Mr Richard Somerville Dr Mark Morgan Dr Malcolm Wallace Mr Martin Hunn Mr Tristan Leech Prof Gunesh Rajan Dr Naveen Somia Assoc Prof Gary Morgan Mr John Walsh Mr Ishfaq Hussaini Dr Christopher Lehane Mr Angamuthu Rajoo Dr Steven Sowter Mr Krinalkumar Mori Dr Yong Gang (Gary) Mr Grahame Inglis Mr Haig Lennox Mr Anand Mr Juggrich Srisurakrai Wang Dr Mathew Morreau Assoc Prof John Ireland Dr Alexander Lim Ramakrishnan Mr David Stabler Dr Satish Warrier Anonymous donor Dr Ajay Iyengar Mr Jonathan Livesey Dr Pankaj Rao Mr David Stary Assoc Prof Bernard Dr Juanita Muller Mr Mark Izzard Mr Julian Lofts Assoc Prof Prem Rashid Mr George Stening Whitfield Mr Donald Murphy Dr Mark Jackson Mr Simione Lolohea Dr Luke Rayner Mr Daryl Stephens Mr Mark Whitty Dr Spencer Murray Dr Ollapallil Jacob Dr Aldenb Lorenzo Dr Matthew Read Assoc Prof Graham Mr Sumitra Dr Abraham Jacob Mr Ananthaswamy Emeritus Prof Thomas Stewart Wickramasinghe Assoc Prof Bruce Love Nagesh Dr Anthony Jacobson Reeve Dr Elmarie Steyn Dr Shehan Ms Rosaleen Love Anonymous donor Wickramasinghe Dr Manish Jain Mr Mark Renehan Dr Shelley Stokes Dr Bernard Luczak Mr Charles New Mr Gerard Wilkinson Dr Carolyn Jameson Dr William Renton- Assoc Prof Douglas Mr William Lynch Mr Thang Nguyen Power Mr Randolph Williams Mr Paul Jansz Stupart Mr Bernard Lynch Dr David Nielsen Dr Faizur Reza Dr Kasmira Wilson Mr Janek Januszkiewicz Mr Charles Su Dr Mark Lynn Mr Markus Nikitins Dr Samuel Rice Dr Ailsa Wilson Mr Jason Jenkins Dr Peter Summersell Dr Frank Machart Mr Arjuna Nirmalananda Dr Amanda Richards Dr Christopher Wilson Mr Robert Jensen Dr Daniel Swan Mr Alastair MacKendrick Dr Gregory John Nolan Dr Sophie Ricketts Dr Rebecca Won Mr Rondhir Jithoo Mr Alistair Swanton Mr Michael Mackey Dr Benjamin Norris Dr Hayder Ridha Dr Jason Wong Mr Reuben Johnson Mr Konstantinos Mr John Malouf Dr Hannah North Mr Dale Rimmington Syrrakos Mr Kwok-Kee Wong Mr Michael Johnson Prof Peter Malycha Mr Gregory Nutting Mrs Elizabeth Ritchie Prof Noel Tait Mr Justin Wong Dr Simon Johnson Mr Keith Markwick Mr John O’Brien Mr Simon Robinson Mr Alwin Tan Mr Daniel Wong Dr Vindya Johnston Mr Richard Martin Dr Justine O’Hara Dr Stephen Rodrigues Dr Richard Tapper Mr Enoch Wong Mr Jacobus Jordaan Mr David Mason Mr Michael O’Keefe Dr Sebastian Rodrigues Dr Tapukitea Dr Dale Wood Mr Mark Joseph Mr Rhett Mason Prof Stephen O’Leary Mr Lalit & Mrs Minakshi Taumoepeau Mr Robert Wood Dr Larry Kalish Mr Phillip Mathews Mr Olubukola Rohit Dr Kourosh Tavakoli Dr Martin Wood Dr Yasiru Karunaratne Dr Chere McCamley Oloruntoba Mr Norm Russo Mr Gregory Taylor Ms Alison Wray Mr Bhadrakant (Bhadu) Mr Eamonn McCloskey Mr Barry O’Loughlin Dr Alex Rutherford Mr Michael Thomson Kavar Dr Yaying Xu Mr John McDonald Dr Shane O’Neill Dr Naveen Salutagi Dr Chantel Thornton Mr Ross Kennedy Dr Ruwei Xu Mr Christopher Dr Lovelace Osei-Tutu Mr Paul Samson Dr Benjamin Thurston Dr Nam Kyu Yang Mr Andrew Kennedy- McDonald Smith Assoc Prof Howard Mr Mark Sanders Mr Craig Timms Mr Philip Yeung Dr Frances McHugh Outerbridge Mr Jesse Kenton-Smith Mr Alan Saunder Dr Sophie Tissot Dr Jessica Michelle Yin Mr Ian ‘Cas’ McInnes Mr Stephen Packer Dr Naeem Khan Dr Alys Saylor Dr Albert Tiu Ms Nadya York Dr John McKee Dr Junius Mr Janus Schaumkel Anonymous donor Mr Omar Khorshid Packiyanathan Dr Osamu Yoshino Mr John McMahon Mr David Scott Dr Linh Trinh Mr Elie Khoury Prof Richard Page Anonymous donor Dr Timothy McMeniman Dr Matthew Scott- Mr Adrian Trivett Assoc Prof Sebastian Mr Trevelyan Palmer Mr Michael Zacharia King Dr Gabrielle McMullin Young Prof Richard Turner Prof Benedict Panizza Miss Jie Zhao Dr Hagop Kiyork Mr Allan Meares Dr Mathew Sebastian Mr Brent Uren Dr Jason Papacostas Dr Mark Zonta Mr Stephen Kleid Dr David Melsom Prof Shomik Sengupta Mr Ralph Van Dalen Dr Jean-Louis Papineau Mr Doug Knight Dr Graham Meredith Dr Ekrem Serefli Mr John Van Dalen Dr Patrick Michalka Dr Suchitra Dr Yanni Sergides Dr Milos Kolarik Paramaesvaran Dr Melinda Van Dr Sameer Mihrshahi Dr Gaurang Shah Oosterum Mr George Koniuszko Dr Hye-Sung Park Mr David Miller Dr Anil Sharma Mr Andrew Vane Dr Olga Korduke Mr Bruce Peat Assoc Prof Brian Miller Dr Philip Sharp Mr Vincent Varjavandi Dr George Koufogiannis Mr Richard Pemberton Dr Geoffrey Miller Dr Peter Sharr Dr Ashish Vaska Mr Govind Krishna Dr Sze-Lin Peng

All fundraising administration costs for the Foundation for Surgery are provided for by the College so that 100% of your donation can achieve its maximum benefit to the community. To find out more, please join us at www.surgeons.org/foundation Dr Ravi Mahajani Plastic surgeon, NT

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