Northern Territory - May 2022
The last few months have been busy for the RACP Northern Territory Regional Committee as it comes to the end of its term. I would like to take the opportunity to thank outgoing Committee members: Dr Fabian Chiong, Dr Clif van der Oest, Dr Swasti Chaturvedi and Dr Simon Quilty for their time and advocacy through the Committee.
During this term the Committee has had a strong focus on advocacy in a number of topics, including energy security in remote communities, recent IT failings in the College exam delivery, NT government changes to youth justice legislation and raising the age of criminal responsibility. I would also direct you to read the recent joint speciality College open letter to government calling on action on the health impacts of climate change that has been published in the lead up to the federal elections.
I am pleased to hear the Regional and Rural Physician Working Group has been meeting regularly to discuss multiple issues that are highly relevant to the Northern Territory. Accreditation of training positions in rural settings is essential to support recruitment of trainees and ultimately to retain Fellows in the NT. On this note I would encourage you to consider thinking of a project that could be funded to support the training and retention of specialists in the NT through Commonwealth FATES funding which can be applied for through the RACP. For more information please email RACPNT@racp.edu.au.
As we enter the next federal election, I am sure you are considering issues that are important to you. Perhaps you could also consider what issues the Committee could advocate for on your behalf. Further to that, if you are interested in contributing to working more closely with the College through the Regional Committee, Trainees’ Committee or another body, please email the NT RACP support team to express your interest.
Dr Richard Budd MBChB MRCP (UK) (Resp Med) FRACP FRCP Edin.
Chair, NT Regional Committee
Trainees in Focus - Dr Dorothy Sze
“Medicine in the Northern Territory is like no other”
On my first day as a basic physician trainee at Royal Darwin Hospital I remember having to manage a patient with a rare medication adverse event, and then another patient with a neurological syndrome that I had never heard of. And it only got better from there. Every day, I am directly involved in a whole spectrum of acute and chronic conditions, many of which I only previously encountered in textbooks. Our Indigenous patients present unique cultural and social intricacies to practicing medicine; an experience that cannot be acquired anywhere else in Australia.
Through ward work, ED admitting shifts and outpatient/outreach clinics, I am always encouraged to be more independent in my clinical decision-making. It is a safe environment for me to develop my skills and interests, while still being supported by seniors who are either present or just a phone call away. This has given me more confidence as I continue my physician training over the next few years.
You will notice that while everyone working in NT has a different reason to be here, people are generally open and chilled. They often bring with them a wealth of clinical and life experiences too. I have learnt a great deal about fishing, sewing and international food from my colleagues. And after a fulfilling day at work, there is just something magical about watching the sun go down over the Timor Sea.
I love photography and the endless NT landscape has been a dream. With its open roads, overflowing waterfalls and the most interesting wildlife, NT never fails to amaze me. I would often make time outside of work to explore new places, and sometimes it doesn’t even have to be too far from home. It is a reminder that outside of study and career, there is a whole wide world out there waiting for you to discover.
The Northern Territory is rural, but it is a very underrated part of this country. For anyone willing to take a leap of faith, I promise it’ll be an experience you will never forget. You will probably also never forget that 15-syllable name of the bacteria your patient grew in his blood culture.
“A Trainee Physician in the Northern Territory” – Dr David Carroll
When faced with challenge, we all look to those people we admire or the things that comfort us and bring us hope. I am an Irish basic physician trainee who started out in an academic resident position in Belfast and have worked in Darwin for four years.
The recent death of Dr Paul Farmer has returned me to the comfort of his writing and the hope of his beliefs. His writings have influenced me since I was a medical student. More recently they have taken particular significance when confronted with the pathologies of power present in the Top End, whether that’s the ongoing impact of racism and colonisation, or the constant shadow of homelessness and poverty.
Dr Farmer demonstrated the impacts that health systems can have when their services put the needs of marginalised people at the centre of what they do, and the impact that trainees can have when demanding change.
A trainee physician in Darwin not only has the challenge of complex caregiving of the sick, but also the never-ending struggle to improve health care delivery for the marginalized patients that live here. After four years, I remain angry at the enormity of the barriers that impede the path towards good health.
Living in Darwin, I have had opportunities to improve systems and add to my training by working in roles beyond direct care of the patient in front of me. I worked in partnership with other trainees on policy implementation on communication in healthcare, as well as having current roles in safety and quality committees in the hospital and the NT Department of Health. This is supplemented in my spare time by leading Doctor in Training advocacy, and being an active member of the local Human Research Ethics Committee. This work as a trainee allows me to link direct clinical care to pragmatic actions in solidarity with the sick.
Whether you work in the NT or further afield, our primary allegiance as trainees is to patients. I hope we, as trainees, can work to reimagine the practice of medicine and work toward treating the systems that surround patients, and not just the diseases they have, by dismantling the pathologies of power that surround us.
The Antimicrobial Resistance Crisis in Central Australia – Dr Fabian Chiong
Antimicrobial resistance (AMR) is declared by the World Health Organisation (WHO) as one of the top 10 global health threats to humanity. There are two main drivers of AMR – excessive volume of antimicrobials use, both in human and farming animal, and poor sanitation which enables the spread of pathogens carrying antimicrobial resistance genes.
Misuse or overuse of antimicrobials is traditionally thought to be the main culprit that drives the development and maintenance of AMR. In addition, the lack of access to clean water, sanitation and adequate infection control measures also plays a significant role in promoting the spread of pathogens and their resistance genes.
Central Australia is a part of remote Australia with a large land mass where it is sparsely populated. Aboriginal and Torres Strait Islanders (respectfully referred to as Aboriginal from here on) make up a significant portion of the population in central Australia, representing approximately 25 per cent of urban Alice Springs and almost 100 per cent of the surrounding remote communities. Aboriginal Australians in central Australia are one of the nation’s most socioeconomically disadvantaged populations with remarkably high infection burden compared to their non-Aboriginal counterparts. The high incidence of blood stream infection, sexually transmitted infection, trachoma, pulmonary infection, skin and soft tissue infection leads to a significant amount of antimicrobial use, which in turn speeds up the emergence of AMR. Overcrowded housing, suboptimal health hardware and poor sanitation are the likely factors which propagate the spread of resistant pathogens. The combination of high antimicrobial utilisation and poor social determinants of health are two perfect ingredients for an AMR calamity.
In 2020, the AMR problem in central Australia is at crisis point where about 52 per cent of the community acquired Staphylococcal aureus is methicillin resistant, which is possibly one of the highest rates in the world. In comparison, the rates of methicillin-resistant S. aureus (MRSA) in other parts of Australia are approximately 15 to 20 per cent. This is a steep climb over the past 16 year, as the proportion of MRSA was only 20 per cent in 2005 in Central Australia. It is suggested that blood stream infections caused by MRSA lead to higher mortality, poorer clinical outcomes, prolonged hospital stays, and more complications compared to those caused by MSSA.
Antimicrobial treatment options are also limited and less effective with MRSA infection compared to MSSA infection. For non-severe MRSA skin and soft tissue infection treatment, the first line oral antimicrobial treatment is clindamycin or sulfamethoxazole and trimethoprim; however, the clindamycin resistant rate in both MSSA and MRSA is approximately 40 per cent according to the local antibiogram, making clindamycin an unreliable empirical option. Treatment failure due to AMR means S. aureus skin infections take longer to improve and are more likely to spread to other people. In more serious cases, S. aureus skin infection could cause invasive disseminated infection in the blood, bones or lungs.
The other major pathogen that is evolving to become more resistant in central Australia is Escherichia coli. Approximately 20 per cent of all E. coli isolates in central Australia produce extended spectrum beta lactamase (ESBL), rendering common empirical antimicrobials for urinary tract infections, such as amoxicillin and clavulanic acid, cefalexin, cefazolin and ceftriaxone, ineffective. According to the local antibiogram, only 8 per cent of the total E. coli isolates were ESBL producing in 2012, and in less than 10 years’ time, the rates have more than doubled. About half of the E. coli isolates in central Australia are resistant to trimethoprim and 20 per cent being resistant to ciprofloxacin. Gram negative bacteria such as E.coli are capable of transferring their resistance genes via plasmids to other E. coli or gram negative bacteria and propagate the expansion of their resistance empire. For severe ESBL E. coli infection, such as blood stream infection, the most effective treatment is with the carbapenem class of antibiotic. Corresponding to the rise of ESBL producing E. coli, the usage of carbapenem is steadily increasing, which leads to our next major concern down the track – the inevitable emergence of carbapenemase-producing enterobacterales.
The advent of AMR among pathogens is imperilling the role of life-saving antibiotics plays in modern medicine. Infections with resistant pathogens may be untreatable one day if the issue of AMR continues to propagate. Addressing AMR in remote Aboriginal communities in central Australia must be part of the ongoing effort of ‘closing the gap’ in health outcomes between Aboriginal and non-Aboriginal central Australians. The Central Australian antimicrobial stewardship (AMS) program was established at the Alice Springs Hospital (ASH) in 2017. The program has been continually expanding since its inauguration. We currently conduct twice weekly AMS ward round and weekly intensive care unit and nephrology multidisciplinary meetings where we focus on reviewing the appropriateness of broad spectrum antibiotic usage as well as the accuracy of antibiotic allergy labelling. In addition, we provide regular education sessions to hospital staff and monitor the quality of antibiotic prescribing. The AMS program has also reached out to primary health care organisations for collaborative education and research activities. We are pleased to mention that the AMS program at ASH was a key highlight in the recent hospital accreditation.
In conclusion, a comprehensive and collaborative AMS program between primary health care and hospitals in central Australia is needed to slow the pace of AMR trends in central Australia. The AMS program will also need to collaborate with other relevant sectors to address the social determinants of health that are driving AMR.
*References available on request
RACP Online Community (ROC) and Mentor Match
Welcome to the RACP Online Community (ROC)!
You will have seen correspondence from the College around the launch of our online community; the ROC. The ROC which provides RACP members with the opportunity to discuss topical industry news, to catch up with colleagues, and to keep abreast of College news and events. It can also be used to post questions, share comments, and start debates and discussions with members in Western Australia, as well as with other members from across Australia and Aotearoa New Zealand.
We would encourage you to log into the ROC and take part in our online community.
Log into the ROC
Mentor Match at the ROC
Mentor Match is open to all members who would like to share their knowledge, expertise and advice with junior colleagues. You are invited to register as a mentor, and to watch this short video to see how easy it is to participate.
We will soon be inviting members to apply to be mentees. Please keep a look out for further information, and contact us if you have any questions.
Supervisor Professional Development Program Workshops
Supervisor Professional Development Program (SPDP) workshops provide supervisors with an opportunity to share their expertise with other supervisors and enhance and strengthen their supervisor skills.
Register for a virtual, face-to-face, or online Supervisor Professional Development Program (SPDP) workshop.
RACP Online Learning
The RACP offers an extensive collection of online learning resources designed to support members with their professional development and lifelong learning needs. Resources cover a range of clinical and professional topics, including:
And more! Don’t forget to claim CPD credits for time spent on RACP Online Learning.
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Health and Wellbeing
How are you?
Studies show that doctors are more hesitant to access support services than the average person due to a fear of appearing weak or incompetent.
Did you know the College has a wealth of free resources to support member wellbeing?
Visit this webpage to see a host of options for your own support or for you to support a colleague. There are several services that offer 24/7 confidential phone support (some, such as Doctors Health SA, have other doctors providing this support), strategies for self-care, eLearning resources and podcasts.
There are also several member stories. RACP members have shared with us their personal mental health journeys in hopes of reducing the stigma.
Help is available in many different ways, please visit this webpage to see the range of supports available to you. You are never alone.
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What are the opening hours of the SA/NT Regional Office?
Monday to Friday, 9am to 5pm. This is unchanged as staff work from home due to COVID-19 measures.
Where is the SA/NT Regional Office located?
The SA/NT Regional Office is currently closed to members and staff are currently working from home. However, the address is: Suite 7, Level 2, 257 Melbourne Street, North Adelaide SA 5006
What is the contact number for the SA/NT Regional Office?
You can reach our office on 08 8465 0970 or Member Services on 1300 697 227.
Where can I park at the SA/NT Regional Office?
Two-hour street parking is available in Melbourne Street and all-day parking opposite the Old Lion Hotel (fees apply). A reminder that the office is currently closed.
How do I book a meeting?
Although the office is currently closed due to COVID-19, we can assist you with booking virtual meetings. Please email us or call 08 8465 0970.