BMB Edition

BMB Edition
Issue 1 • March 2015
INTERNATIONAL SURGICAL
ELECTIVE REPORTS
NEPAL- JASMINE DAVIS
LONDON- ELLIOT DOLAN-EVANS
Plus
ASLS
REPORT
MIA ZHANG REPORTS
2015 EXECUTIVE
ANNOUNCED
NEW PRESIDENT
MICHAEL SCHACHTEL

FEATURES
03 2015 Events Calender
04 President’s Address
Michael Schachtel
05 2015 Executive
06 ASLS Report
Mia Zhang
08 A Brief History of Neurosurgery
Tien Chen
10 Anatomical Arts Series
Evon Jude
12 The Complex Art of Coping
Jack Matulich
13 Review: When the Air Hits Your Brain
Mia Zhang
14 Nepal Surgical Elective
Jasmine Davis
17 STAIRS Report
Mia Zhang
STAFF
Editor In Chief
Mia Zhang
Managing Editor
Tien Chen
Associate Editor
Tyron March
Associate Editor
Evon Jude
Graphic Artist
Jack Matulich

February
2015 CALENDER
Pathways into Surgery
MRI Basics (Radiology)
MS Swimathon
Event
The Professional Surgeon
The Anatomical Surgeon
The Community Surgeon
Portfolio
March
April
May
June
July
August
Orthopaedic Anatomy Session
Surgical Educational Seminar
Basic Suturing Workshop
Mentoring Mixer
Gastointestinal Anatomy Session
Mid-Face Trauma Seminar & Workshop
Pathways to O&G Seminar
CT Basics (Radiology)
Journal Club - Anaesthetics
O&G Anatomy Session
Head & Neck Anatomy Session
Mentoring Morning Tea
Oral Surgery Clinical Cases Seminar
Feedback-directed Anatomy Session
Advanced Skills Workshop
Undergraduate Mentoring Mixer
Ultrasound Basics (Radiology)
Professional Member’s Dinner
Pathways to Anaesthetics
Intubation Workshop
Feedback-directed Anatomy Session
Social Night
Transplant Symposium
Surgical Skills Competition
Journal Club - Academia
Plain Radiograph Interpretation
The Anatomical Surgeon
The Academic Surgeon
The Skilled Surgeon
The Engaged Surgeon
The Anatomical Surgeon
The Oral & Maxillofacial Surgeon
The Obstetrician & Gynaecologist
The Anatomical Surgeon
The Academic Surgeon
The Anatomical Surgeon
The Anatomical Surgeon
The Engaged Surgeon
The Oral & Maxillofacial Surgeon
The Anatomical Surgeon
The Skilled Surgeon
The Engaged Surgeon
The Anatomical Surgeon
The Professional Surgeon
The Anaesthetist
The Anaesthetist
The Anatomical Surgeon
The Community Surgeon
The Community Surgeon
The Skilled Surgeon
The Academic Surgeon
The Anatomical Surgeon
September
O&Gs High Tea for Hamlin
The Obstetrician & Gynaecologist
Journal Club - O&G
The Academic Surgeon
Anaesthetics & Critical Care Seminar
The Anaesthetist
Intraoral Suturing Workshop
The Oral & Maxillofacial Surgeon
Annual General Meeting -
Become a member today!
Become a Surgia Life Member for just $20, payable
by cash or credit card (PayPal). Don’t forget
to grab your MEMBERSHIP CARD for 50¢ off coffee
at Doctors Orders Canteen, access to membership
rewards and swipe registration at events!
For more information check out our website –
www.surgia.org – or add Griffith University’s Tiny
Surgeon (GUTS) or her friend Brisbane Universities’
Tiny Surgeon (BUTS) on Facebook to stay up to
date with events on the Gold Coast and Brisbane!
Also, like our official facebook page:
Surgical Interest Association
• 3

PRESIDENT’S
ADDRESS
Welcome everyone to 2015! I am thrilled to be leading Surgia
this year in what should be a very exciting year for the association!
To provide some background, Surgia is a not-for-profit incorporated
organisation dedicated to promoting the profession
of surgery and enhancing the surgical knowledge and skills
of students, young doctors and medical professionals in the
South-East Queensland region. Ultimately we aim to enhance
future surgical care and access in the community by creating
and inspiring the surgical leaders of tomorrow
Surgia remains one of the fastest growing medical/surgical
societies in Australia, and our reputation has spread to medical
schools throughout Australia and internationally. We currently
have over 580 members, with over 100 professional members
and alumni. In 2014 alone, we held over 30 events hosting
up to 400 students from multiple universities, featuring both
nationally and internationally renowned speakers and surgeons.
We target ALL students, not just those interested in being surgeons!
In only its third year of existence, we have been the winner of
4 awards from the Griffith University Guild for our activities
as an outstanding cultural society, including winners of the
2012 Griffith Innovation Challenge. Surgia is now also widely
recognised as a key member of the International Association of
Student Surgical Societies (IASSS).
In 2015, we are aiming to again improve on our strong foundations
that have been formed over the last two years. We have
a range of exciting new initiatives launching this year, such
as our Surgical Educational Seminars, Radiology Workshops,
Professional Members Dinner, and an expanded Skills portfolio.
We are also very excited to be launching our Newsletter series,
the first being this BMB Edition, that will keep you up to date
with all of Surgia’s happenings. Also stay tuned to our website,
Facebook, and Instagram pages to keep up to date with all of
our events throughout the year.
I wish everyone the best of luck for 2015, and happy reading!
Michael Schachtel
President

2015
SURGIA EXECUTIVE
PRESIDENT
VICE PRESIDENT (ACADEMIA)
VICE PRESIDENT (SKILLS)
SECRETARY
TREASURER
MICHAEL SCHACHTEL
MIA ZHANG
NATHAN JEFFERY
ELIZABETH HAMILTON
KRISTEN WADWELL
DIRECTOR OF COMMUNICATIONS
DAVID MALETSKY
DIRECTOR OF MARKETING
TYRON MARCH
DIRECTOR OF ACADEMIA
PHILIP CHUNG
DIRECTOR OF ANATOMY
ADRIAN MAHER
DIRECTOR OF RADIOLOGY
CATHERINE VO
DIRECTOR OF SKILLS
ERICK CHAN
DIRECTOR OF PROFESSIONALISM
AHMED MAHMOUD
DIRECTOR OF COMMUNITY
STEPHANIE JONES
DIRECTOR OF ENGAGEMENT
JUPINDERPREET KAUR
DIRECTOR OF MENTORING
CATHERINE TANZER
DIRECTOR OF ANAESTHETICS
LYNSEY COCHRANE
DIRECTOR OF ORAL & MAXILLOFACIAL SURGERY ANDREW TRAN
DIRECTOR OF OBSTETRICS & GYNAECOLOGY YONG SHI ZHANG
DIRECTOR OF PUBLICATIONS
TIEN CHEN
CHAIR OF BRISBANE COMMITTEE
DANNIEL BADRI
• 5

ASLS REPORT
MIA ZHANG
This year, the Queensland surgical societies
have joined together to host the ally diverse and exciting two-day pro-
The Symposium ran across an exception-
premier event in medical student leadership,
the Australasian Surgical Leadership of the most widely respected surgeons
gram, featuring presentations from some
Symposium (ASLS). This event was run and academics in the modern world, who
by SurgIN (Surgical Interest Network, a have been leaders of their field in a variety
of ways; whether this is performing
representative body of 26 surgical associations
throughout Australia and New foreign aid work, designing new surgical
Zealand), held on the 23rd to the 24th tools, or reforming the health system, the
of August at Griffith University Medical ASLS were extremely fortunate to welcome
these pioneers to inspire the next
School on the Gold Coast. This flagship
event was a monument in the medical generation of healthcare leaders.
student calendar, with 200 delegates and
speakers from everywhere between Perth Uncle Graham opened the ASLS by paying
respect to the land and a warm
and Auckland, with a special speakers
from as far as Ethiopia!
welcome to everyone. This was followed
by an inspirational presentation
Dr Deborah Bailey on her journey through
medicine and leadership. Michael Gorton
(RACS Solicitor and medical legal expert))
and Michael Moore (Former Health Minister,
and current CEO of Public Health Association
of Australia) followed suit after lunch, providing
a legal insight into the law and ethics of
surgical practice and important public health
issues. Dr Dimitrios Nikolarakos (Director of
Maxillofacial surgery at Gold Coast University
Hospital) presented a jaw-dropping seminar
on 3D printing for reconstruction purposes in
surgery. To finish off the Saturday academic
events, Dr Humsha Naidoo (Principal Health
Officer for Qld Health) gave an enlightening
presentation about her senior management
roles in large tertiary teaching hospitals and
training new generations of surgical pioneers.
To top off the wonderful day, ASLS held a
Social Evening, which gave the opportunity
to relax and unwind. Surgeons and delegates
mingled together to the pleasant tones of jazz
and enjoyed canapés in front of the harbour at
Marina Mirage.

Our motto:
Innovation through
leadership!”
The second day of the symposium heralded
the some spectacular keynote speakers
and the start of workshops. Sunday
featured presentations from Professor
Barry Hicks (who’s contributed over 40
years of humanitarian surgical work Africa
and Asia), Dr Andrew Laming, (MP and
Opthamologist who has worked in rural
Australia and undertaken various leadership
roles in his career), Professor Dietmar
Hutmacher (modern science icon, pioneer
and innovator of 3D printing and tissue
engineering) and Dr Keith Boon Kua
(amongst the first urologist in Australia to
utilises the Da Vinci Robot System in surgery).
They presented on their inspirational
surgical experiences, from the depths
of Ethiopia to the streets of Logan to the
growing area of surgical technology.
Workshops commenced after lunch and
with 9 surgeons, 3 parliamentarians, and
3 humanitarians facilitating these workshops,
they were a huge success! It gave
an opportunity for delegates to share
ideas, engage in dialogue, gain knowledge
and skills as well as address issues
in our modern-day world of surgery and
health-care.
The highly engaging workshops included:
1. Dr Toughlove: triaging and implementing
the ISBAR, augmenting student’s ability
to deal with multiple life-threatening
situations in a busy ED. Targeting clinical
reasoning under time pressure and how
to get a surgeon out of bed in the middle
of the night.
2. Great ASLS Debate: All great leaders
should know how to provide incisive
commentary on the tough medical issues
doctors face today. Teaching students how
to speak to the Speaker in parliamentary
style debates session, with feedback from
those well versed in the political agenda,
Michael Johnson, Dr Alex Douglas, Dr
Andrew Laming and Rowan Holzberger.
3. Dr Desert Island: A discussion on surgical
aid in developing countries with Dr
Rebecca Szabo and also Professor Barry
Hicks, who in particular flew in from
Ethiopia for the ASLS to present his aweinspiring
adventures to enthusiastic groups.
These experts on low resource settings
talked our students through the process of
planning theatre on a budget.
The ASLS was the most prominent health
leadership event of the year – providing
a unique opportunity to hear and experience
the most diverse range of presentations
and workshops seen in the Southern
Hemisphere! Bringing all of the leaders
of the future surgical workforce together
in one place to collectively increase skill,
network and gain unique insights on the
challenges and developing areas within the
medical profession with its constantly challenging
clinical environment, budgetary
constraints, increased litigation, and rapidly
developing technology. The ASLS met these
challenges head-on, and aimed to ensure
medical students in the region are fully
prepared to be pioneers in the profession.
• 7

Underpinning the
reason behind
these early forms of
neurosurgery was
an appreciation
of a relationship
between the brain
and behaviour. ”

A BRIEF HISTORY OF
NEUROSURGERY
TIEN CHEN
In the current day and age, surgery on the brain and nervous
system is perhaps mostly associated with complex and intricate
microsurgery conducted in state-of-the-art facilities
and with expensive, specialised surgical instruments. This
is starkly contrasted against the crude use of tools at various
points in history made from sharpened volcanic rock known
as obsidian, or copper or bronze, amongst other materials.
Interestingly, historical evidence suggests that many different
cultures and societies from around the world have tried to gain
access to the brain via the cranium through cutting, scraping,
chiselling and drilling.
However, before only relatively recently in history, such surgeries
would have been performed with little or no anaesthesia,
in unsanitary conditions with unsterilised surgical instruments
and with no means of visualisation apart from the naked eye.
Some of the earliest attempts at brain surgery pre-date written
records, and therefore must be interpreted through the evidence
of deliberate trauma conducted onto the skull itself. Despite
the brutality of the methods used, it seems that many survived
the surgery due to the signs of recovery and healing found on
remains. Some individuals however, were less fortunate.
round holes which range in diameter from a few centimetres
to almost half the cranium. By the time of Hippocrates (460
– 370BC), ancient Greek physicians were using bow and drill
instruments known as terebras to form either a small hole or
multiple small holes around a central section of bone so as to
remove that central segment of skull. Ancient Islamic texts also
describe a similar technique used by Arab surgeons during the
12th century. Of particular interest is the discovery of ornately
decorated Incan tumi blades, which were likely used to produce
linear cuts into the skull during 15th century. It seems that
these openings were made using sharp stones such as flint or
obsidian. By the Medieval period, mechanised trepanning instruments
were being used, which continued to be improved upon
over time.
With regards to reasons why such practices were undertaken,
it has been suggested that not only were they conducted for
medical purposes such as the treatment of mental illness and
epilepsy, but they were also undertaken for spiritual and magical
reasons. Costandi has suggested that underpinning the reason
behind these early forms of neurosurgery was an appreciation
of a relationship between the brain and behaviour.
Perhaps the earliest evidence of trepanning, the process of producing
openings in the cranium through surgery, were discovered
at a burial site dated from the Neolithic Age approximately
7,000 years ago in Ensisheim, France. Trepanning, however, has
not been limited to Europe. Other civilisations which may have
practiced trepanation include the ancient Greeks, Romans, Incas,
Aztecs, Egyptians, Chinese and Indians amongst others.
According to neuroscience writer Mo Costandi, the remains
found at ancient European sites include skulls that have small
Dr G Michael Lemole describes the era of modern neurosurgery
as having commenced with the concept of localisation
around the late 19th century and its application with regards to
identifying ‘tumours, abscesses and [removing] them’. Notable
pioneers in the field of neurosurgery include Harvey Cushing,
whose name is synonymous with Cushing’s syndrome and who
developed electrocautery and surgical silver clips, and William
Macewan, who applied the contributions to neuroanatomy made
by Broca and Ferrier as well as the notion of antisepsis by Lister
to localising and removing pathologies of the brain.
• 9
References
Costandi, M 2007, An Illustrated History of Trepanation, Neurophilosophy, viewed 20 November 2014, http://neurophilosophy.wordpress.
com/2007/06/13/an-illustrated-history-of-trepanation/
Dr Ralph Mobbs, The History of Neurosurgery, Neuro Spine Clinic, viewed 19 November 2014, http://www.neurospineclinic.com.au/historyneurosurgery.html
Greenblatt, SH, Dagi, TF, Epstein, MH 1997, A History of Neurosurgery: In Its Scientific and Professional Contexts, The American Association
of Neurological Surgeons, Park Ridge, IL.
Lemole, GM 2014, The Evolution of Modern Neurosurgery: A History of Trial and Error, Success and Failure, online video, March 28, viewed
19 November 2014, https://www.youtube.com/watch?v=FpfcomlXYhE

ANATOMICAL
ARTS SERIES
DR EUGENE PETCU PAINTED A PASSIONATE PICTURE
OF FORM AND COMPOSITION IN RELATION TO ANATOMICAL ART,
USING HIS WEALTH OF EXPERIENCE FROM TEACHING
GRIFFITH UNIVERSITY’S SUMMER SEMESTER
ANATOMICAL ART SUBJECT.
EVON JUDE
Dr
Petcu’s lessons were served with an accompaniment
of tea, coffee and biscuits for all the
students unwinding from their busy schedules.
SURGIA members explored their inner Da Vinci through strokes
of lead on cartridge paper. Beginning with a historical journey
of anatomical art, Dr Petcu gave formal introductions for the
individuals from our past that had been prominent in both the
enhancement of art and the exploration of anatomy. A medical
student clearly expressed the impression that this course aimed
to make, “the history of medicine and art are very much intertwined,”
he said.
The appreciation of the classes ranged from “valuable” to the
study of anatomy, to “therapeutic,” as a break from fighting the
good fight against exams and assessments.
Having access to the Anatomy museum on Level 10 was
the highlight of the course for many of those involved. They
sketched their afternoons away as medical students, perfectionists
from the tip of their toes to the pencil in their fingertips,
manifesting as artists for just a few relaxing moments.
From this experience it became evident that anatomical art is
essentially beauty in its truest form. For true beauty comes from
within and it shows that which whom we truly are, muscle and
tendon wrapped carefully around bone.

• 11
Appreciation of the
classes ranged from
‘valuable’ to the
study of anatomy, to
‘therapeutic,’”

THE COMPLEX ART
OF COPING
JACK MATULICH
I’M
not going to blow any minds when I say that
being a doctor is a stressful job. As if it’s not
enough to have lives in ones hands today’s doctor
must keep up exacting standards of training,
deal with (unfortunately) vulturous middle management and work
hours beyond most people’s comprehension. Sacrificing so much
for a career takes some serious coping strategies which come in all
shapes and sizes.
Whilst the Medical Journal of Australia shows exercise, balanced diet
and time management help doctors cope, there is an inherent ‘missing
piece’ in the coping process; connection to others.
Bound by the legalities and regulations of patient confidentiality,
NDAs and hospital policy doctors suffer from restriction on the ways
they can communicate their stressors among friends, family and colleagues.
Perhaps as a way of bypassing these restrictions in order to
cope with the stressors of contemporary medicine many anonymous
Facebook pages have been created by doctors using humour, satire
and criticism to cope with stress.
Pages such as Disgruntled A&E SHO, The Anaesthetic Registrar and
The Salaried GP have attracted incredible amounts of attention and
interaction with fans contributing to, criticising and applauding the
blogging of these doctors. Though coping is good and obviously
makes for better doctors and thus better outcomes the elephant in
the room remains; where do we draw the line?
Yes, Facebook is moderated and kept within community guidelines.
But does Facebook hire medico-legal lawyers to ensure the legality
and morality of these pages? I’m going to take a stab in the dark and
say no. But can’t we trust doctors to moderate their own content?
Well to the most part these pages protect the identity of patients,
employers and colleagues which reasonably indemnifies them from
red-tape. However there is a consistent influx of criticism on the way
the page managers portray the healthcare system, their employers
and patients in the public forum.
If members of the public and indeed healthcare workers are unhappy
with the posts on these pages surely there is an indiscretion between
what should be posted and what is. Hospitals, trusts and employers
have little control over the social networking of their employees
and what little control they have can be shrugged away with careful
anonymity by doctors. So how do we manage this issue?
Perhaps the identification of what aspects of coping doctors seek in
social networking in contrast to what is provided by healthcare services
needs to occur. Then, maybe we can aim to supplement those
deficits by developing ways to facilitate individual coping styles.
In a world so dominated by structure and legalities it can be difficult
to remember that doctors are still mere humans on the inside and
we desperately need to invest in keeping those humans happy and
healthy to allow the doctor on the outside to do their best.

BOOK REVIEW: WHEN THE AIR HITS YOUR BRAIN:
TALES OF NEUROSURGERY, FRANK T. VERTOSICK JR.
L
ike many others around me, reading for leisure
took a nose-dive after medical school
started. However, after resolving to read
more and having this book recommended to
me by a neurosurgeon, I got my hands on a copy and
couldn’t put it down.
The book offers a poignant and humorous insight to
the rigorous medical training we’ll soon be embarking
on ourselves. It journeys through the decades Dr.
Frank Vertosick spent struggling through his medical
training, from eager intern to top neurosurgeon.
The lessons he has learnt aren’t solely restricted to
neurosurgical training and his “rules” can be applied
to registrar training in general. For example: “if the
patient isn’t dead you can always make them worse,” a
contemporary spin on the Hippocratic motto: primum
non nocere. Other rules included, “the only minor
operation is one that someone else is doing” and the
motto:
MIA ZHANG
You ain’t never the same when
the air hits your brain,” a worrying
proposition that the brain was
not meant to be trifled with.”
The title of the book derives from the number one
rule: “You ain’t never the same when the air hits your
brain,” a worrying proposition that the brain was not
meant to be trifled with.
Dr. Frank Vertosick brings the book to life through intimate
portraits of patients and unsparing yet gripping
chronicles in brain surgery. From the young cerebral
trauma patient who died quickly in the emergency
room to the child with an incurable tumour and the
young man rendered tetraplegic by a spinal epidural
haematoma. Each case provides important challenges
to the author both as a doctor and as a human being.
Every medical student, doctor or patient would have
something to gain for reading this book for the
invaluable insight it offers into the world of neurosurgery
through fascinating anecdotes seamlessly
delivered with humour and wit.
About the author:
Frank Vertosick, Jr., M.D., is associate chief
of neurosurgery and associate director of
the Center for Neuro-oncology at Western
Pennsylvania Hospital in Pittsburgh.
• 13

NEPAL
SURGICAL ELECTIVE
Reflecting on travelling a path less troden.
ADVANCED
PRESENTATIONS
AND AND AND CLINICAL
SIGNS YOU ONLY READ
ABOUT IN TEXTBOOKS
JASMINE DAVIS
I
arrive for the morning
ward round after a bumpy
and crowded bus ride
from my guesthouse in
Boudhananth to Nepal Medical College
Teaching Hospital. Boudhananth was
the perfect antidote to the craziness of
Kathmandu, with the central Buddhist
Stupa surrounded by many restaurants
and lots of cheap and simple accommodation
options attached to the monasteries
in the area.
The ‘bus’ was an experience in itself, with
the vehicle being more like a mini-van,
for which it seems there is no maximum
passenger limit.
Looking around the surgical ward, I see
that I am the first of the medical team to
arrive. Even the doctors are on ‘Nepali
time’, so I use this as an opportunity to
look at the patient charts to prepare
myself for an hour of mild confusion. The
morning ward round is done almost completely
in Nepali, yet each of the charts
is written in English so I pre-empt my
lack of understanding of the language
by familiarising myself with the patients
to maximise my learning for the day. In
retrospect, learning some basic Nepali
prior to arriving would have been very
useful and improved my experience, but
I encountered few problems despite my
lack of understanding.
The surgical interns arrived and greeted
me fondly, as we had rapidly formed
a friendship over lunch at their homes
and Bollywood movies. Each team has
5 interns who are responsibly for most
jobs that a nurse or wardie would do in
Australia, from dressings and wound care
to patient transfers to and from theatre.
After all the patients had been seen we
headed to theatre, which at first glance
seems like absolute chaos in comparison
to any theatre I have seen at home. The
first thing I found completely foreign was
being asked to switch my closed in shoes
for bare feet or sandals, which felt bizarre

in comparison to the OHS rules that I
am familiar with. Yet despite the lacking
of facilities, the way the overhead lights
often flicker and the scarcity of substandard
equipment - the surgical procedures
are familiar and performed exactly as they
would be in any Australian hospital.
The registrars and consultants were always
keen to chat and find out how I was finding
Nepal and what I thought of the way
procedures were done and patients were
managed. Bedside teaching was often
in Nepali (unless they remembered that
I was there) and it was surprising how
much I could understand with all scientific
and medical terminology being in
English. Unfortunately there wasn’t a lot
of opportunity to scrub into procedures,
however I did assist with minor operations
in outpatients, and was able to examine
patients and see advanced presentations
and clinical signs you only read about in
textbooks.
The main difference I found between surgery
in Nepal and Australia is that the cost
of each procedure was at the forefront
of the doctors’ minds, knowing that each
patient is required to pay for all disposables
used. Patients are sent with a list
of required equipment to the pharmacy
and bring back a plastic bag containing
everything from their cannula and fluids
to sutures and sample pots.
When it comes to cases common things
happen commonly, even in Nepal, and as
such I observed many appendicectomies,
cholecystectomies and incision and drainages.
In contrast to Australia, we also saw
many cases of intestinal perforations, in
relatively young people, with the aetiology
attributed to abdominal tuberculosis.
The hierarchical nature of medicine is
ever present, even in Nepal. Without
being able to understand the detail, I saw
the interns scramble when the registrar
scolded them. I sat in on a case conference
where a registrar presented a patient
case (in English, with all questions and
feedback in Nepali) and saw him flounder
under the pressure of being asked
questions by the consultants. There were
hoards of medical students milling around
wide-eyed and keen to learn, but for the
most part they were ignored, much like
in Australia.
While my academic experience with
regards to general surgery felt slightly
• 15

edundant after my 3rd year rotation, the cultural
and language differences created a unique
experience and gave me insight into life in
Nepal that I would never have had as a tourist.
The challenges that doctors face in an environment
with limited finances and resources gave
me extra appreciation of all that we have access
to at home and reminded me of just how lucky
we are to live and work in a country where we
have all of what we need available. I also felt
that I gained a new perspective on doctorpatient
interactions by paying extra attention to
body language when I couldn’t understand the
detail of conversations.
Outside of theatre and ward duties there were
opportunities to attend formal and informal
teaching sessions, both at the bedside and in
seminar rooms throughout the hospital. Final
exams were running for the medical students
so I was able to observe the process from a different
perspective – it seems that exam stress is
a global phenomenon!
After my placement was over I was thankfully
able to spend 2 weeks travelling around
Nepal and experiencing all that the vibrant
and chaotic country had to offer. I saw sights
around Kathmandu itself, relaxed in Pokhara
and trekked in the Himalaya, which was one
of the most amazing experiences of my life.
Though I was officially ‘on holiday’, I was grateful
that I had read a little on altitude sickness as
I heard the terrifying ‘is anyone a doctor’ while
we were at Annapurna Base Camp and went to
assist another trekker in need.
My time at Nepal Medical College Teaching
Hospital was an incredible experience and
though the academic yield was limited, the cultural
aspect surpassed all expectations and I will
carry the impacts of the people I met with my
for the rest of my career. If you are looking for a
placement where you get to ‘play doctor’ and be
very hands on this may not be for you, but if you
are looking for a different culture, experiencing
a hospital in the developing world and meeting
incredibly kind and welcoming people – I highly
recommend choosing Nepal Medical College
Teaching Hospital as an elective.
I self organised this elective by emailing
Nepal Medical College directly at
wprincipal@nmcth.edu
Costs included:
$300 USD for tuition fees paid to Nepal
Medical College
$85 USD for a tourist visa to Nepal (which
can be extended depending on your length
of stay)
$140 USD for hospital accommodation for
4 weeks
Additional costs: flights and vaccinations

Students thoroughly enjoyed listening and
interacting with 11 guest surgeons cover
a wide variety of topics”
STAIRS REPORT
MIA ZHANG
On the 2nd and 3rd of October 2014, the Surgical Training in Acute ety of topics. These topics included acute abdomen and gastroenterology
emergencies, paediatrics, vascular surgery, orthopaedics,
Illness and Injury Recognition for Students (STAIRS) conference
was held at Griffith University in the G40 Auditorium. This is the ENT emergencies, trauma, colorectal surgery, and neurosurgery.
second year the event has been run. Organised by Surgia and This year acute care medicine was also included in recognition
Griffith University, with special help from Dr Charles Nankivell, that physicians and surgeons often work closely together.
Dr John North, Dr Claire Harrison, and Dr Marije Dalebout, the General feedback gathered from the students was amazing. They
event was attended by over 170 students – including all third year thought that the presentations greatly increased their knowledge
Griffith students and other clinical year students from Griffith, and that they were aimed appropriately for their level of understanding
and for what applies to students. Students also thought
Bond and UQ.
As its name indicates, the theme of this conference was acute and the conference was improved on from last year, and was great
emergency surgical management. It is designed to help ensure preparation heading into end of year exams!
that attendees as junior doctors are able to recognise and initially Surgia would like to thank everyone involved in making this conference
possible. We hope to see such a great response again, and
manage acute surgical cases. Students thoroughly enjoyed listening
and interacting with 11 guest surgeons covering a wide vari-
aim for bigger and better things for STAIRS 2015!
• 17

ELECTIVE
REPORT
National Hospital of Neurology and
Neurosurgery (London)
ELLIOT DOLAN-EVANS
Immediately following fourth year exams, I was fortunate enough
to be heading straight to the United Kingdom (for the first time!)
for an elective in a neurosurgical rotation at the National Hospital
of Neurology and Neurosurgery (NHNN). I travelled to the UK via
a conference pit-stop in Cape Town, South Africa, which was probably
one of the greatest experiences of my life – but more on that
another time!
This report will detail some of my experiences at the NHNN, and
also cast a critical eye on overseas placements, such as mine, so that
younger years can be properly informed when choosing these often
very expensive journeys.
Firstly, my journey to the UK started at the end of 2012, easily 18
months prior to the actual journey. The NHNN, associated with the
University College of London (UCL), is a prestigious institution for
neurosurgery and neurology; anyone who aspires to be anything in
these fields, I’ve since been told, must visit the NHNN. As such, it is
highly difficult to get a placement at such an institution. I had to
plan this elective over 18 months in advanced, and in doing so only
missed the cut-off by a fortnight! It’s a very good idea to think about
your 4th year elective at the end of your second year – or now if you
are past that point! Very unfortunately, due to the raft of administrative
changes that have crept into fourth year at Griffith University,
students now don’t have any certainty as to when their elective
rotations will be scheduled in the year, until only a few months prior.
This is evidently an inadequate situation for those who want to visit
highly-esteemed institutions for their electives. It is worth getting
in touch with the School early to force them to lock you into a date
of your choosing if you are planning an elective at a ‘centre of excellence’
– although I’ve heard guarantees of accommodating students
who get electives at these centres in the misshaped calendar that
is now fourth year, experience dictates that such guarantees do not
always come through.
Regardless, it is worth investigating your elective placement early.
If you are like me and signed up to every medical indemnity insurer
on the first day of medical school, you will be able to access the
MDA National Elective Database. This is a highly useful source of
information for electives – gives you information on who you should
contact, where, and also includes student reviews on the elective.
You will need your MDA National member number, which you can
acquire by giving them a call.
I can’t stress enough to younger years that you have to have very
clear goals when choosing your elective. An elective such as mine,
which I will reveal more detail about shortly, that is at a highly
prestigious institution can mean that your involvement
is minimal. Whilst if you were to travel to a hospital
in a developing country, you will inevitably get to use
more of your skills and be a useful member of a team.
However, the flip-side is that you have an opportunity to get a
highly valued reference letter at a top institution… but, be warned,
they make you work for it. Finally, if you want to be a bit of a tourist,
make sure you don’t get locked into an elective that won’t let you
do this (i.e. mine weren’t too happy at any days taken off).
Before I go into more detail about my placement, I want those reading
this to keep in mind the context of my general disillusionment
at the medical field and lack of desire to pursue a surgical career. I’ll
let that sink in, as it has been a shock to some – but to those who
know me very well, this is not news. So I will be uncompromising
in my critique of the placement, and assess it fairly objectively on
its merits.
The NHNN is an exceptionally old institution, and some of the most
significant advances in neurological and neurosurgical sciences
have occurred there. Entering into my placement there certainly
inspired a lot of awe in the portraits of pioneers that were variably
shown about the premises. The NHNN is a building in the famous
‘Queens Square’ in central London, where it is joined by other
research facilities. Research is a highly important life of practice at
Queen’s Square, and I imagine it could be a good opportunity for an
individual interested in the more analytical aspects of medical science
to engage with, if they had the opportunity (the NHNN almost

explicitly did not offer this to elective students).
The initial impression of the NHNN was one of
disappointment for me, unfortunately. The administration
there for elective students is run fairly
poorly, and being a student who arrived without
others (quite rare there) and completely new to
the area and system, I had no idea what I had to
do there. The lack of orientation as it pertained
to day-to-day responsibilities was frustrating and
trying – it actually resulted in me completely
misinterpreting what the placement was to consist
of, and spent my entire first week attending
various clinics, as this was the only information
given to me.
I should not neglect to tell you some more
logistical information as it comes to my mind –
accommodation and money. I arranged my accommodation
at fairly short notice (within 3 months),
but I was highly impressed with the location
and people I was sharing with. I was located in
Greenwich, which is about a 45 minute journey on
public transport to the NHNN, and it
I CAN’T STRESS ENOUGH
TO YOUNGER YEARS THAT
YOU HAVE TO HAVE VERY
CLEAR GOALS WHEN
CHOOSING YOUR ELECTIVE.
is a beautifully historical area. I stayed in a share house with
other housemates, and I very much enjoyed spending time with
them – unfortunately I was limited due to placement and extracurricular
requirements that were weighing me down all the
way from Australia. I paid 200 pounds per week in rent there,
which is one of the cheapest I could find in the greater London
area that was within reasonable distance (that’s about $400
Aus.). I could get a batch of grocery shopping that would last me
for about 10 days for around 30 pounds, the cheapest take-away
I found was great meals for 5 pounds, but expect to be paying
10 pounds at least. Public transport was also a significant cost
– I’d pay at least 7-8 pounds each day on a return trip to the
NHNN (~$16).
Money was a huge issue for me! I must say that I incorrectly
budgeted for my four weeks in England, and the week in South
Africa beforehand (South Africa is exceptionally cheap, would
highly recommend you visit!). I borrowed $4,000 from the
OS-HELP scheme that is a government initiative where you can
borrow money that goes on your HECS for an elective, for up to
$6,000. Stupidly, I did not borrow the full amount (on retrospect,
I think it was my overriding fear of debt that did it), but I did also
get $500 from another source that I believed was something
along the lines of the ‘Vice Chancellors Fund’.
Back to the NHNN – Just for time’s sake, I’m not going to go
through every little detail of my experience there, but give you
broad ideas of how it was, after I eventually met up with my
team in week 2. Positively, I was stationed there with students
from the UK, Macedonia, and New Zealand, who were all fantastic
– one of the most positive aspects was to learn about the
cultures of a diverse group. Ward rounds started at about 7AM
each morning, and we’d finish around 4PMish, standard clinical
hours as in Australia. However, after a very short period, it
became immediately obvious that this was entirely an ‘observational’
placement. For those of you who don’t know, this means
that there is no handling of patients, minimal interaction in
ward rounds, no scrubbing in to theatre, and no contact in clinic.
You are effectively watching doctors work for 4 weeks. Very
unfortunately, the breed of individuals that graced the halls at
the NHNN were left wanting of some basic manners and human
characteristics; most of the supervisors at the NHNN were brash,
callous, and exceptionally arrogant, to such an extent that you
couldn’t have a conversation with them that wasn’t directly
related to themselves for over a sentence. I illustrate this point,
which can be called unprofessional, in order to inform younger
students of what to expect in attending these ‘centres of excellence’
– this is not a golden rule, and I may have just been
unlucky at the NHNN.
To be quite honest with the reader, I find it difficult to allay anything
else of any kind of importance of my elective experience
at the NHNN to you here. Thinking back upon it, there was a lot
of silent watching of clinics and operating theatres, neither of
which were that engaging. I yearn again for the tight bond that
I shared with the students there who also felt my pain! Briefly,
as it will be of interest to those who would look for a reference
letter – be prepared to be worked exceptionally hard. One of my
student colleagues at the NHNN who was desperately hoping
for one, was there six days a week, from 7AM to 10PM, slaving
his guts out over administrative tasks and ‘monkey work’ that
the senior supervisors did not want to do – and he only barely
received a positive letter.
What I would conclude with here was to ensure that you know
what your goals are when you go on your elective, as much as
you can without the benefit of foresight. Get a placement that
aligns with your long-term career goals, or alternatively, be very
comfortable in going to an elective where you can really engage
with the local culture and history and have a real life experience
(I would have much preferred this). This four weeks can be
very influential in your professional and personal development,
so take some time to think about it, and make sure you plan
appropriately!
Please don’t ever hesitate to get in touch with me if you need
any advice or guidance on choosing electives or sorting through
the painful administrative/logistical nightmares it entails, I’ll be
delighted to assist.
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