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Meeting the needs of rural communities: from student to specialist

23rd August 2019

For most Babinda is known for little more than being Australia’s wettest town.

But for Dr Manik Kumaranayake the far north Queensland town has proved a challenging, stimulating and satisfying part of her intern year.

“No two days are the same, they’re very unpredictable. I have GP clinic and rostered patients for day procedures and I’ll also be helping out with emergencies. Some people will drop in for a script and I’ll end up admitting them and sending them to Cairns,” Dr Kumaranayake said.

“I’m learning so much all the time. Every experience and opportunity has been a learning point for me. Not knowing what’s coming certainly keeps me on my toes.”

No stranger to rural medicine, Dr Kumaranayake undertook rural placements throughout her years as a medical student at James Cook University. She believes JCU’s focus on rural and remote medicine has served her well going into her intern year.

“You do a lot of things yourself as an intern. Having an understanding of what rural patients go through, and how their health and treatment affects their livelihoods makes a difference,” Dr Kumaranayake said.

“I fit in well. I understand the town and what we can do here. I understand the medical services we have and what we can offer.”

While she’s yet to decide on her specialty, Dr Kumaranayake believes it will involve working in a rural or regional location.

“I like that nice mix you get with that along with the chance to get to know your patients. Even though we’re just an hour away from Cairns there's a huge difference between the experience here and what you get in bigger regional or metropolitan areas.”

Like many rural towns around Australia, Babinda had suffered from the lack of a permanent medical workforce, relying heavily on locum doctors.

But all that’s been changing. While Dr Kumaranayake is the first JCU graduate to intern with the Babinda Multi-Purpose Health Service, she joins a growing list of JCU medical students, registrars and general practitioners to work in the town in recent years.

Dr Renee Cremen graduated from JCU in 2008 and joined the Rural Generalist pathway. After completing her junior years in Cairns she moved to Babinda to take up a 12-month placement and never left.

In 2016 she was appointed Medical Superintendent for the Babinda Multi-Purpose Health Service and Yarrabah Emergency Services.

“During my time at JCU, I developed a passion for rural and remote medicine. I also really liked the tropical medicine up here and decided to further my career in rural generalism,” Dr Cremen said.

“I was meant to be here for 12 months. But I could see that if I left, Babinda would have the same problem of relying on locums again. That would mean people would lose that continuity of care. So I changed my advanced skill to population health and eight and a half years later I’m still here.”

During her time in Babinda, Dr Cremen has seen the number of JCU medical students coming to the town grow substantially, with 14 now taking up placements with the service each year.

She said the rural and remote training JCU students receive places them in a unique position to contribute.

“They’re ready to step through the doors of a rural facility like Babinda, which is a multipurpose health service, and become one of the team. The confidence they have and the ability to apply their skills and knowledge is very evident.”

Dr Cremen believes working in rural areas benefits the students, junior doctors, registrars, and ultimately for her, the Babinda community. She’s keen to encourage more doctors to pursue medical careers outside metropolitan areas.

“Australia has the right number of doctors, but there is a great discrepancy when it comes to where they're practicing, there is maldistribution and as such rural towns like Babinda, Yarrabah, Innisfail, Atherton, Mareeba, Tully and Mossman need more,” Dr Cremen said.

GP Ayesha Sheikh chose to pursue her career where she was most needed. She completed her General Practice training through the JCU program with placements around the far north region. She now practices two days a week in Babinda.

Dr Sheikh believes the skills and experiences acquired during her rural training have made her a better doctor.

“You do get more experience. You might not have access to imaging or the transport available to get patients to other specialists, so you rely on your clinical knowledge. I’ve developed a lot as a doctor working in resource-restricted areas. It takes you back to basics and it does make you a better clinician.”

Dr Sheikh would also recommend rural general practice for those looking to build their career.

“There’s an endless breadth to what you can do. You are not limited to one specialty, and if you want further training you can do that. There are so many opportunities, you can stay interested and develop your career as a GP throughout your whole life.”

It’s a sentiment echoed by Dr Kumaranayake.

“I'm quite passionate about rural health. It’s the people in the community. You get to know your patients and it’s a hands-on experience. You see interesting cases and increase your skills as you are often the only doctor there. You get some complex cases, it’s a great mix.

“I find it fulfilling that I can do something for people, that I can be someone in their lives who they can count on. I love it, I really do.”

It’s that passion for rural and remote medicine, instilled throughout their training, which will ensure people in towns such as Babinda have the doctors they deserve, doctors they can truly call their own.

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