Northern Territory - April 2021
In this first edition for 2021, I’d like to highlight a few of the things your Northern Territory Regional Committee has this year in their workplan, intended to support you.
We are continuing to champion the development of an Internal Medicine Diploma. Its development is now the responsibility of the newly created Rural and Regional Physician Working Group, whose members are currently being confirmed by a Council selection panel from expressions of interest received late last year.
We are also sharing educational resources from South Australia. Flinders Medical Centre in Adelaide has agreed to share its medical grand rounds with all Northern Territory members. Our basic trainees in Darwin will be the first to regularly use these. Contact the SA/NT Office if you would like to view these (live or as a recording).
Also high on the agenda is supporting the Northern Territory Trainees' Committee in their advocacy work within the College. A key area of focus is flexible training options for Northern Territory trainees.
This edition also highlights some of the research work our members are involved in proposing a set of clinical criteria for diagnosis of Human T-cell Leukaemia Virus (HTLV-1) associated pulmonary disease (HAPD) and the impact of climate change on the health workforce in the Northern Territory.
As always, we are here to support you. Is there something on your mind that you would like the College to know about, or act on? Or do you need support from the College, but aren’t sure how to get it? Please reach out to one of the members who represent you on the Northern Territory Regional Committee. They would be glad to hear from you and help you.
The friendly staff team in your SA/NT Office are always here to help, so please don’t hesitate to reach out by email or phone (08 8465 0970).
Katherine Economides
RACP SA/NT Senior Executive Officer
To say that 2020 was a challenging year is an understatement. We continue to monitor the progress of Divisional Clinical Exams that are still in progress for last year’s exam sitters, and the written exam timetable and structure. We are keen to assist trainees in any way we can. It's been particularly difficult for those who have been unable to visit family, take well-deserved rest, or engage with their usual support networks. We are hopeful that 2021 will bring with it more clarity about the path forward for trainees in their personal and professional lives.
After the adversity faced in 2020 have come positive changes, which will be built upon this year. It has been exciting to see stronger links with our interstate colleagues, and a broadening of online learning resources including the Flinders Hospital Medical Series for Adult Medicine Basic Trainee exam-sitters and the expansion of the College Lecture Series. These resources disproportionately benefit smaller and more remote training sites and have been a welcome addition for trainees in the Northern Territory and we are grateful to the College for being proactive in making these resources available.
Social distancing has increased feelings of isolation amongst trainees. To combat this and welcome our newest trainees, we held a meet-and-greet event for trainees on 20 April. It was great to start the year off with a bit of cheer. This was organised by the Northern Territory Trainees’ Committee (NTTC) with assistance from the RACP SA/NT Office.
The Northern Territory Trainees’ Committee (which represents all adult and paediatric trainees in the Northern Territory) is working hard to build a set of study resources. We welcome your recommendations for items you would like to see included. We are also here to answer questions about exams, and here for a talk if you’re having a tough time.
If you would like support from someone independent of the College and workplace, the NT Government Employee Assistance Program provides free psychology services for all government health employees and their families. The RACP support program, Converge is a confidential service available 24 hours, seven days a week. It is free for Fellows and trainees.
Finally, the Northern Trainees' Committee is on the hunt for new members. We meet five times per year, the meetings are lots of fun and we particularly want to make sure we have a wide selection of BTs and ATs from all locations. If you are interested, please contact the new Member Support Officer, Jake Sawyer. The Trainees' Committee is the voice of all Northern Territory trainees on the RACP Northern Territory Regional Committee, and also the College Trainee Committee (Australia and Aotearoa New Zealand version of us). We have a unique training setting and it’s important that’s not only represented but celebrated.
Welcome and we look forward to hearing from you,
Hannah and Kristof
Dr Hannah Bills and Dr Kristof Wing
Northern Territory Trainees’ Committee Co-Chairs
Thank you to everyone who participated in the 2020 consultation on the proposed common learning, teaching and assessment (LTA) programs for Advanced Training (AT). Your feedback was used to refine the programs and ensure they are robust and appropriate. The common LTA programs for Advanced Training have now been finalised.
The common LTA programs will establish a baseline for learning, teaching and assessment across all AT programs. As each specialty undertakes their program-specific curricula reviews, they will build on the common LTA programs to meet the needs of their specialty.
This year, in collaboration with Curriculum Advisory Group, we will continue to support the first six specialty groups to undertake the development process:
- Cardiology (Adult Medicine)
- Cardiology (Paediatrics & Child Health)
- Gastroenterology
- Geriatric Medicine
- Nephrology
- General Rehabilitation Medicine.
Find out more
It’s not long until RACP Congress commences, and for those wanting to attend, whether virtually or face-to-face in Adelaide on Saturday, 1 May or at one of our other cities, time is running out to secure your ticket. Online access to the RACP Congress 2021 sessions will be available only to those who register so do not miss the opportunity to hear from expert voices across a range of topics.
If you are purchasing a face-to-face ticket, you can also live stream the entire RACP Congress 2021 program wherever you may be so register now to ensure you can access the opening sessions in Brisbane.
For those attending in Adelaide, help us congratulate the SA and NT 2020 Trainee Research Award Recipients at their presentation.
When you register for RACP Congress 2021, you will also have access to sessions such as:
- Remote retinal scanning: Transforming early detection outcomes
- Genetic discovery and translation in neuromuscular diseases
- Our digital health future, today
- Advancing Women in Healthcare
- Artificial intelligence: Ready or not here it comes
- Building a solution space for Indigenous health at the RACP: Transformations, challenges and opportunities
Find out more
I am an Infectious Diseases and General Physician at the Alice Springs Hospital (ASH). I am the clinical lead in Antimicrobial Stewardship (AMS) and I have piloted the AMS program at the hospital. I am also a member of the RACP Northern Territory Regional Committee.
My key areas of interest are antimicrobial resistance and Human T-cell Leukaemia Virus-1 (HTLV-1) infection, which are two important issues affecting us as a community in Central Australia.
I have initiated several quality improvement projects to improve antimicrobial prescribing with the ultimate aim of slowing down or halting resistance development in pathogens. I have also engaged with primary health organisations in research and education on topics relevant to AMS.
As for HTLV-1, I think a robust public health response is urgently required to stop the spread of this ancient virus that is plaguing our communities. I also advocate for other important issues affecting community health such as climate change and disadvantaged social determinants of health.
Dr Fabian Chiong
Before I came to work in Central Australia, I'd hardly heard of, or knew anything about Human T-cell Leukaemia Virus, despite being an infectious diseases doctor. While working in Central Australia, I developed significant interest in this intriguing virus in addition to my usual passion, antimicrobial stewardship, in the rural and remote setting.
Human T-cell Leukaemia Virus Type 1 (HTLV-1) is an enveloped, single stranded ribonucleic acid, human delta retrovirus. It was first identified in 1980, a few years prior to the discovery of Human Immunodeficiency Virus (HIV). Interestingly, HIV was previously named HTLV-3 before the exposure of its unique characteristics. Despite the earlier discovery of HTLV-1, it was completely outshined by HIV in the past four decades. HIV caused a global pandemic in the 1980s and an enormous amount of resources were thrown at it to bring it under control.
To date, the repertoire of antiretroviral medications for HIV is expansive and yet there is not a single antiretroviral medication that is effective against HTLV-1. Worldwide, at least five to 10 million people are infected with HTLV-1, predominantly in areas of high endemicity in southern Japan, the Caribbean basin, parts of South America and inter-tropical Africa.
An endemic focus is also present in Central Australia, where infection with the Australo-Melanesian HTLV-1 subtype C (HTLV-1c) is highly prevalent. In Australia, HTLV-1 was first described in the Kimberley region, Western Australia. Remarkably higher prevalence of HTLV 1 reported in remote communities in Central Australia (15 to 72 per cent) and Western Australia (up to 16.4 per cent), with lower prevalence in Top End Northern Territory (0.6 to 2.2 per cent) and Far North Queensland (1.3 per cent), and zero cases detected in two studies from Victoria. Blood donor screening data showed a very low national prevalence of 0.0035 per cent. In Central Australia, the prevalence is highest in the communities situated in the southern and western regions of Central Australia. The Indigenous people are disproportionally affected compared to the non-Indigenous people.
Once a person is infected with HTLV-1, like HIV, it causes lifelong infection. The routes of transmission of HTLV-1 are similar to HIV. HTLV-1 is transmitted by cell contact with infected lymphocytes, exposure to which may occur by ingesting breast milk, through condomless sexual intercourse, blood transfusions, organ transplantation and intravenous drug use. However, unlike untreated HIV infection, which inevitably caused Acquired Immunodeficiency Syndrome (AIDS) after a period of infection, HTLV-1 infection only results in serious health consequences in a minority of those infected.
HTLV-1 is thought to be the most oncogenic virus known and is the causative agent of a rapidly progressive haematological malignancy, adult T-cell leukaemia/lymphoma (ATL). Two inflammatory diseases, HTLV-1 associated myelopathy (HAM) and HTLV-1 associated uveitis (HAU), are also acknowledged to be caused by HTLV-1 infection. HTLV-1 has long been considered to have a particular tropism for the lung, a condition that has been variously termed HTLV-1 associated broncho-pneumonopathy (HAB), HTLV-1 associated bronchioloalveolar disorder (HABA) and HTLV-1 associated pulmonary disease (HAPD).
Dr Lloyd Einsiedel, an infectious diseases physician at Alice Springs Hospital, conducted an extensive body of research on HTLV-1 infections in Central Australia over the past decade. In the past two years, I had the honour of joining Dr Einsiedel in exploring more about the virus via my clinical work as an infectious diseases and general physician in Alice Springs. In Central Australia, we encountered a disproportionately greater number of HAPD cases comparing with other HTLV-1 associated complications (such as HAM and ATL) in our clinical practice.
The prevalence of bronchiectasis in Central Australia is among the highest reported in the world, and a large proportion of the patients with bronchiectasis are infected with HTLV-1, and with a high HTLV-1 proviral load. Recently, we have published a review article on HAPD in BMC Retrovirology Human T-cell leukaemia virus type 1 associated pulmonary disease: clinical and pathological features of an under-recognised complication of HTLV-1 infection. The key objectives of this paper were to provide a narrative review of all relevant literatures related to HAPD and propose a set of clinical criteria for HAPD diagnosis. Having a clinical definition for HAPD is essential to design clinical trials to develop therapeutic options for patients with HAPD.
In conclusion, HTLV-1 has been plaguing Central Australia for centuries. A robust public health intervention is urgently needed to curb the spread of HTLV-1 in Central Australia and more resources should be invested to assist with the improvement of our understanding of this virus.
References can be provided upon request to the author via emailing the RACP SA/NT Regional Office
Dr. Fabian Chiong, Infectious Diseases and General Physician, Alice Springs Hospital
Pictured: Professor Toshiki Watanabe (third from the left) from the University of Tokyo, who is also the President of the International Retrovirology Association and his team visiting Alice Springs, November 2018. Dr Lloyd Einsiedel (third from the right) and Dr Fabian Chiong (first from the right).
Northern Territory Basic Training Orientations
We have held Basic Training Orientations in both Darwin and in Alice Springs. Basic Trainees received a RACP wellbeing pack to welcome them to the College and provided some valuable resources. We wish them a successful start to their training journey.
For some, it was their first introduction to the College, as well as their first opportunity to meet other Basic Trainees and potential future Basic Trainees from Royal Darwin, Palmerston Regional and Alice Springs Hospitals.
The Darwin event was held at Flinders University on 16 February. Participants heard from our guest speakers Dr Emma Spencer, a Director of Physician Education at Royal Darwin Hospital, Dr Bronwyn Carson from Doctors Health NT, Lana Rohde, the outgoing RACP SA/NT Member Support Officer and our MC for the evening was Dr Hannah Bills, Paediatrics Co-Chair of the Northern Territory Trainees’ Committee.
Dr Emma Spencer explained the Northern Territory Basic Physician training requirements and how to be accepted into the Darwin program. She also encouraged potential trainees to reach out for help or advice when they need it. Dr Bronwyn Carson expressed how important it is for doctors to look after their own health and wellness, and to look out for each other.
Following a presentation from Lana Rohde on the College requirements of the Basic Training program, Dr Hannah Bills and Dr Divya Sreedaran provided members with information on approaches to training, hospital-based learning and their experience of what to do and not to do.
The Alice Springs event was held at the R.E.D Centre on 22 March. Participants heard from Dr Simon Quilty, the Director of Physician Education from Alice Springs Hospital about the training program in Alice Springs.
Dr Kirsty Neal, the outgoing NT Trainees’ Committee Co-Chair for Adult Medicine spoke about approaches to studying for the Divisional Written Exam and her experiences as a trainee. Lana Rohde (outgoing Member Support Officer) also spoke about the College requirements of the Basic Training program.
Before and after the event attendees met and chatted with staff from their RACP SA/NT Regional Office in Adelaide; Jake Sawyer (incoming Member Support Officer) and Katherine Economides (Senior Executive Officer).
Hi, I’m Lana Rohde, your local RACP Member Support Officer. I will be leaving in April for maternity leave and will be replaced by Jake Sawyer until my return in April 2022. I recently had the pleasure of virtually presenting to many new Basic Trainees at face-to-face orientation events in Darwin and Alice Springs, while the event was supported in-person by Katherine Economides, the SA/NT Senior Executive Officer, and for the Alice Springs event, also by Jake Sawyer.
Some other events for trainees to look forward to include:
- Basic Training Exam Preparation Panel: Details to be announced soon
- Basic Training Lecture Series: Details to be announced soon
Supervisor Professional Development Program (SPDP) is a training program for final year Advanced Trainees and Fellows who supervise trainees in RACP-accredited positions. With the extended deadline, RACP supervisors now have until the end of 2022 to complete all three SPDP workshop to become RACP approved Supervisors.
Supervisors must complete:
- one SPDP workshop by the end of 2021 (an extension of 12 months)
- all remaining workshops by the end of 2022.
You will be a RACP-approved supervisor (previously 'accredited supervisor') when you've completed all three workshops, which you can complete in any order. SPDP is considered a 'Category Two: Reviewing Performance' activity in the 2021 MyCPD Framework. MyCPD participants will earn three CPD credits per hour. Further information and how to enrol in SPDP workshops can be found on the SPDP workshop registration webpage. If you can’t find a workshop to suit your availability, please reach out to your SA/NT Regional Office, and we’ll attempt to assist.
From January to March, 15 virtual SPDP workshops were made available to SA supervisors. This wouldn’t have been possible without our facilitators who give so generously of their time. I would like to extend a big thank you to facilitators, Professor Martin Veysey, Dr Michael Noel, Dr Peter Gale, Dr Carole Khaw, Dr Danielle Ni Chroinin, Dr David Holden and Dr Suganya Vignakaran who have supported these events with enthusiasm. SPDP workshops are offered regularly. If you would like to be notified when we have new workshop scheduled, please let us know.
As your College contact, please contact us with any questions you have. You can continue to reach Jake on the same details, Phone: (08) 8465 0971 or email.
We look forward to (virtually) seeing you at upcoming events.
Lana Rohde and Jake Sawyer,
Outgoing and incoming SA/NT Member Support Officers
Dr Sunday Pam, a paediatrician based at Rockhampton Hospital, received a call from Rockhampton Zoo for the treatment of an unlikely patient. Below is Dr Pam’s account of treating the chimpanzee patient, Gandali.
I received a call on 1 December 2020 – it was the head of an allied health department, with an explanation that their request was ‘weird’. I was silent. “Are you still there? Pop your seat belt on” he said. “I have been asked by the Zoo Manager to get you to see a 10-month-old infant chimpanzee following possible severe injuries from a fall.” I could not laugh, cry, or even speak. My silence betrayed me. He continued, “Human doctors generally see them instead of veterinarians because they are closer to humans.” Reference was made to a local human subspecialist who sees the adult chimps. In this case, the local vets had been consulted and declined.
My mind went to ‘what about registration regulations?’ I was reassured that this was not an issue for the above reasons. I was asked for my number to give to the lovely zoo manager, a few minutes later she called. I was again reassured and now I was getting interested, but cautiously. I was invited to name my fee and to decide how I would be paid. I quickly declined and told her that it would be my contribution to the local zoo.
Having heard the story and the behaviour of the animal, I suspected an intracranial bleed and recommended a quick CT. This would need to be under general anaesthetic. The vets, doctor and nurse were willing to give the general anaesthetic but not take decisions on the health of Gandali.
At 7 pm, my recipe-style cooking was interrupted to head to the radiology outfit in town for the celebrity CT. On arrival, I had difficulty touching the animal due to fear of zoonoses. The pictures will show me standing far away from Gandali. My physical examination with gloved hands, was similar to what I would do for a child with the same history. It was based on symmetry to rule out lateralising signs. There were none, however, there were bruises on the head, ear, and arm on the same side. This reinforced my suspicion and confirmed my request for the CT.
The CT was preceded by celebrity pictures with the sick animal. Finally, Gandali was under general anaesthetic and the CT completed without further ado. The CT showed as normal, later confirmed by the radiologist. Again, my reading of the image was purely on principles of symmetry and appearance in the human child. I cleared my chimpanzee patient of severe intracranial bleed. Gandali returned to the zoo that night.
By the next morning, I had become a celebrity Chimp Paediatrician, that I had never trained for, with only the very basic principles of medicine delivered by me.
Dr Sunday Pam FRACP
Image one (pictured at beginning of article): Dr Sunday Pam and Primate Keeper Blair Chamma and Gandli, Image two: Chimp Gandali in MRI, Image three: Chimp MRI, Image four: Chimp Gandali sedated.
The north of Australia has experienced unprecedented heat events in the past decade. Over the foreseeable future, these events are predicted to get more frequent and more extreme. The impact this new heat will have on health and wellbeing for people living in tropical locations around the world is predicted to be severe. It is often considered that these individual adverse health impacts will occur because of the direct impact of heat on human biology, however, the impact of climate change in these environmentally and socially vulnerable regions is much more complex than that.
For those of us who live and work in the Northern Territory, it is common to hear colleagues lamenting the concerns they have over the impact of climate change in a region that already suffers extreme heat. Most of us in the Northern Territory know colleagues who have left, and more speak of leaving, because they cannot envisage living in a future Northern Territory that is even hotter than it is now.
We have recently conducted a survey of all doctors in the Northern Territory, based upon a standardised workforce retention survey and modified to include the impact of climate change, to determine what this is having on workforce retention. The overwhelming majority believed that climate was a real threat (96 per cent), with 85 per cent concerned that these new extremes of heat were already either harming or risking harm to their patients. Of most concern was that 34 per cent were either considering or in the process of moving away from the Northern Territory to cooler locations because of their concerns about the impact that global warming would have on the Northern Territory.
The impacts that climate change is having on health come not just from the direct effect of heat, but also on complex human migration. Places like the Northern Territory are probably already experiencing destabilisation of workforce that is hard to measure, and even harder to measure in terms of real human health outcomes. Urgent policy attention needs to focus on health workforce and climate change.
By Dr. Simon Quilty, Specialist General and Acute Care Physician, Alice Springs Hospital
Please click on the above images to see them in full size. We would like to acknowledge Pandora Hope and the Bureau of Meteorology for providing these images mapping the extreme summers of 2018/2019 and 2019/2020.
Applications for the 2022 funding round will open on Monday, 3 May 2021. Upwards of 50 awards up to a total value of $2.5M are available across the different categories:
Applications for the following other award categories will open Tuesday, 1 June 2021:
Most awards are open to Fellows and trainees across Australia and New Zealand. Please refer to the RACP Foundation website for information on specific eligibility requirements for each award.
AChPM Award for Outstanding Contribution to the Discipline of Palliative Medicine
Nominate a Fellow for their outstanding contribution to Palliative Medicine. The award includes a cash prize of $500 and a certificate formally presented at the ANZSPM Conference in September 2021. Please see the website for further details. Nominations close 30 June 2021.
AChSHM Jan Edwards Prize
The Jan Edwards Prize is awarded for the best research-based abstract oral presentation by a registered AChSHM trainee. The prize includes $500 and a certificate. For further details and to apply please visit the website. Applications close 31 May 2021.
Hood Sweeney: Lock in income protection insurance before terms tighten in 2021
The benefit structure for income protection insurance policies is slated to be tightened further by mid-2021 as insurers seek to stem the billions of dollars the industry loses each year. Hood Sweeney has written an interesting article to help you learn more about the impact of the changes.
Find out more
Online course: Physician wellbeing in challenging times
Physicians often fail to put on their own oxygen masks when dealing with the challenges and stresses that come with practising during a pandemic. This online course explores in-depth how to better support your own wellbeing, as well as the wellbeing of your staff and colleagues through compassionate leadership. The course covers concepts, strategies, and tools to help you mitigate the impact, set healthy boundaries, prevent burnout, and build support networks during a crisis.
Enrol now
Fellows and trainees of all specialties are invited to enrol in this new Qstream course, which has a mid-May start. The course is designed to provide practical strategies to help you enhance your teaching skills and effectively balance teaching with a busy workload.
You'll access in-depth case studies with questions that are sent directly to your inbox at spaced intervals over a three-week period. Each question takes just ten minutes to complete, and participants are encouraged to discuss the case studies and share opinions with others through secure, online discussion forums.
The course is designed to enhance your knowledge in adult learning, provide practical strategies to incorporate effective teaching skills into day-to-day settings, and encourage self-reflection and peer discussion.
Enrol now
We’re hosting more online events than ever before, so have introduced a condensed monthly events digest. The first one was sent to you on 7 April, but you can also read it online.
This monthly communication will be sent to you on the first Wednesday of each month, to provide you with an opportunity to virtually attend events from all over Australia and Aotearoa New Zealand. We hope this makes your life that little bit easier and we look forward to seeing you at our next event.
Read the April events digest
This is the third and final part of the series on gendered medicine. We step back and look at the way that health care and research are funded. It’s been said that the health needs of women are undervalued by our existing fee-for-service model, down to individual item numbers in the Medicare Benefits Schedule. There’s also evidence that diseases predominantly experienced by female patients receive less research investment. Is this blatant sexism or a symptom of structural imbalance, and what do we do about it?
Guest
Dr Zoe Wainer BMBS, PhD, MPH (Director of Clinical Governance, BUPA)
Listen now
Expressions of Interest are still open for Fellows in the Adult Medicine and Paediatric & Child Health Divisions to join our team of accreditors. As an accreditor, you play a vital role in ensuring the delivery of high-quality workplace training. Your contribution to accreditation can also count towards your annual CPD credits.
Please submit an Expression of Interest (EOI) form by Wednesday, 30 June to accreditation@racp.edu.au.
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.