PANACEA 2020

amsa2020

panacea
/ˌpanəˈsiːə/
noun
a solution or remedy for all difficulties or diseases.

The term ‘Panacea’ embodies humanity’s unfaltering idealism, our wishful thinking and our unattainable dreams. It is this idealism which lays the foundation for our ambition and perseverance in the face of unparalleled hardship, and which fuels our resilience after defeat. In a time like the present and indeed throughout history, the concept of a ‘Panacea’ has been a frank deviation from reality – it is nothing more than a fantasy or escape. Nonetheless, for us, ‘Panacea’ is a delight, a source of hope and a symbol of our unending optimism.

This year, the theme of AMSA’s student magazine, Panacea, is “When the dust settles: Reflection and renewal in a COVID-19 world.” We asked medical students from across Australia to submit written pieces or artwork relevant to the theme, for publication in a colourful and engaging digital magazine. Please enjoy the compilation of these wonderful works in Panacea 2020.

When the Dust Settles

Panacea


Photo Credit: Elizabeth Hu

welcome

Dear reader,

Welcome to the 54th Volume of the AMSA Panacea - an annual magazine

Editors

celebrating the diversity of medical student talents across the country.

'Panacea' is defined as 'a solution or remedy for all difficulties' and this year

has certainly presented us with some unique challenges. Fittingly, the 2020

Panacea is themed: 'When the Dust Settles: Reflection and Renewal in a

COVID-19 World'.

Before we let you peruse the artworks, poems, and features of this edition we

would like to thank all the students who submitted to this issue, as well as

the 2020 publications team, and sponsorship officers whom without this

beautiful magazine would not be possible.

So go ahead, turn the page and prepare to be inspired by the phenomenal

talents, resilience, and accompishments of the medical students of 2020.

1


C O

Contents

Truth in a Time of Covid-19: Carpe Diem!

3

A letter to pre-COVID me

4

Student Photography

V

6

I Wonder- To the Ones that Never Got a Chance

7

Generation Z, BLM, and What it Means for Medicine

8

Things to do in Lockdown

10

From COVID to the Coral Sea: An Echo Through Time

12

How has medicine and the world changed and how will it 14

Ichange after the pandemic is over?

Human Connection

16

Medicine at the Movies D18

Student Photography

27

Recovering Medical School

28

Minds of Medicine

30

Ars longa, vita brevis

33

The Lost Magic of Lockdown

36

The Fight Against Gender Based Violence

38

2


Truth in a Time of COVID-19

Carpe Diem!

Carpe diem (Latin)- Seize the day!

Popular phrase drawn from an ode written by the famous 1st century Roman poet, Horace.

You should not ask, it is wrong to know, what end the

gods will have given to me or to you, O Leuconoe, and do not try

Babylonian calculations. How much better it is to endure whatever will be,

whether Jupiter has allotted more winters or the last,

which now weakens the Tyrrhenian Sea against opposing rocks:

be wise. Strain your wines, and because of brief life

cut short long-term hopes. While we are speaking, envious life

will have fled: seize the day, trusting the future as little as possible.

Ode 1.11

by Horace

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Dear pre-COVID-19 Me,

I’m here to warn you: brace yourself.

I know you’re already imagining a clichéd start to your first year

of medical school, complete with exciting hospital visits, mindblowing

lectures taught by renowned professors and, naturally,

exciting adventures involving exploring Sydney with your new

friends. Unfortunately, though you don’t know it just yet, this

isn’t the way your first year will ultimately pan out. Let me tell

you that when people say that sometimes expectations don’t match

up to the reality of things, they really know what they’re talking

about.

Before you know it, COVID-19 will have hit you hard and you’ll be

in lockdown for the foreseeable future, forcing you to put a pin

on all those exploring Sydney adventures. Then by April all your

classes will be transitioned fully online, so you’ll have to give

up those hopes of interacting face-to-face with professors and

visiting hospitals.

Perhaps even more disappointing is the fact that COVID-19 will put

a real dampener on your dream of finally fulfilling the archetype

of a messy and disorganised first-year university student. The

virus will be infectious and easily transmitted meaning that

you’ll probably have to spend hours disinfecting every fruit,

vegetable and juice carton you buy from the supermarket- there’ll

be no room for messiness. Not to mention masks will mean life-ordeath

for you on public transport and you’ll want to keep that

bottle of hand sanitiser that your MedSoc gave you during O-Week

nice and safe. Trust me when I say this: you’ll never take

handwashing lightly after the next few months of your life.

I’m sorry to have to be the one to tell you this but your social

life will also most likely not live up to all the hype. Since most

of your classes will be transitioned online from very early on in

the year, you’ll probably have maybe around a hundred friends,

sorry Facebook friends. Don’t worry though, you’ll soon start

recognising people by their Zoom name and standard blank Zoom

screen; you’ll get used to the feeling of knowing people but not

knowing people at the same time. All jokes aside, just promise me

that you’ll attend all the Zoom parties and Facetime calls you’re

invited to because it will probably be all the social interaction

you will get.

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While this might sound very daunting and a little stressful, I can

assure you that it’s not all going to be bad. Okay, so maybe your

fantasies of a clichéd first year of university might not come to

fruition but change is not always a bad thing. In fact, change

inspires resilience. You’ll find yourself getting stronger over

the coming months and you’ll pick up hobbies and skills that will,

if nothing else, make for cool party tricks in the future. You’ll

be able to spend more time on the things you love like reading and

playing the piano. You’ll find out just how strong your selfdiscipline

is when it comes to exercise (unfortunately, not very

strong) and you’ll definitely improve your cooking skills

infinitely. In fact, you might be able to get by on your second

year of university just by eating all the banana bread that you

will bake this year.

When you’re feeling down because you think you’ve missed out on

key medical student experiences like visiting the hospital and

observing live practicals, know that you will gain plenty of

unique experiences too. For instance, you will find yourself

having the opportunity to meet with simulated patients online and

conduct a tele-health-type consultation. Let me just tell you,

this is a skill that you’ll want to have under your belt

especially since it has gained in popularity tremendously this

year. You should also remember that learning never stops in

medicine and, even if you do miss out on some experiences, you’ll

have five more years of your medical degree and the rest of your

career to learn.

In short, the next year will totally be different to what you

imagine- but different is not always bad. Just think about it:

without difference, you would not have discovered the true joy of

being able to attend lectures all snuggled up in your pajamas.

Your first year might not be what you expected but it will most

certainly be unique!

Good luck,

Anonymous

Present day Me xx

5


Photo Credit: Gabrielle magalski

Surfing at Kirra. Shot on 35mm film

Photo Credit: Frank Lee

6

Photo Credit: Elizabeth Hu

The dynamic and timeless Australian landscapes reflects our resilience through turbulent and challenging periods


I wonder - To the ones that never got a chance

I wonder if, looking through these encounters, I would know:

The vaccination schedules,

The GP appointments,

The growth milestones,

As little steps,

Each carrying you further through that life of yours.

I wonder if, I would know that when time moved,

Just as the way it carried you through that life of yours,

Would put you closer to the inevitable:

The ambulance call,

The head scans,

The things we did that couldn’t stop you from leaving.

Each minute,

Carrying you further away from us.

I wonder if there was anything we could have done differently,

To stop you from leaving us.

Lying here thinking of you,

wondering if time could have frozen,

Transcending you to moments where you were most happy,

Most innocent,

Untouched by the horrors of this world.

I wonder if they knew, it would be the final time they saw you,

And gave you the most loving of hugs,

Most generous of kisses,

And told you that you made a difference in their lives

With the brief time you were here.

Here we are,

Wondering if you know,

That you’ve made a difference in our lives.

And here you lie,

Safely in the midst of our memories,

Never to be forgotten by the ones whose lives you’ve changed.

Wai Chung Tse

7


Generation Z, BLM, and What it

Means for Medicine

2020 has so far been an unprecedented year.

Whether it was the US killing an Iranian

military general and almost sparking WWIII in

January or COVID-19 exposing compromised

healthcare systems, supply lines and social

security we have all witnessed just how easily

everything we take for granted can be

changed. However, what was perhaps even

more remarkable was the explosion of Black

Lives Matter (BLM) protests all over the

world which were unparalleled in their scale

even before considering they were occurring

in the context of a global pandemic. What

stood out about BLM was, unlike COVID-19 or

the US actions against Iran, these disruptions

were not caused by a chance zoonosis or the

decision of a few politicians and military

generals but was led by an extraordinarily

large number of young people. People like

Nupol Kiazolu – only 19 years old – led

protests near Times Square as President of

BLM Greater New York (Ballan, 2020).

Kiazolu belongs to Generation Z, generally

consisting of people born after 1996 who now

make up the younger portion of our medical

student cohorts and the very youngest junior

doctors. Full disclosure: I too am a member of

Generation Z. Our childhood was spent in the

post-9/11 internet age. We saw the impact of

the global financial crisis on our parents and

got our first smartphones in high school.

Floppy discs, cassette players, and MS-DOS are

as foreign to us as horse-drawn carriages

and gramophones. We are comfortable with

coordinating our lives through Facebook,

SnapChat and other social media apps and are

aware of the algorithms and influences that

underpin what we see.

What was remarkable about the BLM protests was

their urgency. A global pandemic limiting mass

gatherings was not enough to deter young people

from the call to action. Racism and its side effects

like policy brutality are not new foes but despite

being young, Generation Z has seen is how little

progress we have made on racism. However, unlike

many generations before us, Generation Z has the

capacity to spread its message like never before.

Within hours, most of the world could easily

access information about the death of George

Floyd in Minneapolis and within days protests had

to spread to countries as far afield as Australia,

Japan, the UK and Denmark. BLM represents how

Generation Z will not only refuse to accept

inaction in the face of injustice but will also use

tools at their disposal to incite change in a way

that the generations before did not or were not

able to. One of the rallying cries of BLM was to

‘defund the police’ in order to fund social

programs that address issues like mental health

and homelessness. Now, less than 2 months later,

numerous cities across the US have scrapped

planned funding increases and even cut police

budgets.

L

Beyond protesting, Generation Z has leveraged

social media to agitate those unwilling to change.

This was exemplified by the sabotaging of Donald

Trump’s rally in Tulsa, Oklahoma by K-pop fans and

Tik Tok users. They ran a sophisticated campaign

on Tik Tok and Twitter that cleverly worked the

algorithms to publicly reach large audiences

while simultaneously avoiding being found out by

Trump’s campaign. Their message was simple:

reserve free tickets to the Donald Trump rally and

don’t attend. The campaign was expecting in excess

of 1 million people to attend and only 6 000

attended, simultaneously destroying his

credibility but also highlighting the power of

Generation Z to use social media to

surreptitiously subvert those in power (Sakzewski,

2020).

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The medical field is not likely to be exempt from Generation Z, despite coming of age during

these forces. The BLM movement is highlighting uncertain times, are rallying against injustices in

Aboriginal and Torres Strait Islander health ways that appear to be swifter and more effective

inequalities and continued failures of

than past movements. While living through a

government to ‘close the gap’ (Rix & Rotumah, global pandemic undoubtedly presents new

2020). Unconscious biases are rife in the medical challenges to progress, it also amplifies and

professional, even in those whom we trust to

highlights inequalities and injustices. It is hard

teach us. These biases result in poorer pain

to predict what the impacts of Generation Z-led

movements like BLM will have on history but it is

treatment and overall health outcomes in BIPOC.

clear that young people will not accept ‘all talk

Additionally, issues like bullying and harassment

and no action’ from society’s leaders and

in hospitals overwhelmingly impact junior

institutions or having to wait to gain positions

doctors causing untold impacts on the mental

of power to incite change. It is clear that young

health of the future leaders of the profession

people want to see action in addressing the

(Srivastava, 2018). Social media has created an

myriad problems afflicting society and they will

environment where Generation Z are not only hold those in charge accountable for it.

exposed to these issues but can actively incite

change and monitor the progress of those in

charge. The BLM protests have exemplified that

Generation Z do not tolerate an unjust status quo

and are willing to push for radical changes (like

defunding the police) to do what it takes to

address inequalities and poor treatmentṀ

Ashraf Docrat

References

Ballan, R. (2020, June 12). Gen Z Leads The Black Lives Matter Movement, On And Off Social Media. Retrieved from

Forbes: https://www.forbes.com/sites/rebeccabellan/2020/06/12/gen-z-leads-the-black-lives-matter-movementon-and-off-social-media/#d7e7cf319a88

Rix, L., & Rotumah, D. (2020, June 19). Black Lives Matter in health care too. But convincing tomorrow’s health

workers is tough. Retrieved from The Conversation: https://theconversation.com/black-lives-matter-in-healthcare-too-but-convincing-tomorrows-health-workers-is-tough-140631

Sakzewski, E. (2020, June 22). Were TikTok users and K-pop fans really behind the poor turnout at Trump's Tulsa

rally? Retrieved from ABC News: https://www.abc.net.au/news/2020-06-22/did-tiktok-users-kpop-fans-reallytroll-donald-trump-tulsa-rally/12378768

Srivastava, R. (2018, October 30). When doctors are bullied, all of society is harmed. Retrieved from The

Guardian: https://www.theguardian.com/commentisfree/2018/oct/30/when-doctors-are-bullied-all-of-societyis-harmed

9


to do in

Things

lockdown

Artwork Credit: Jessica Teoh

Question marks at the end of statements can lead to beautiful

things! Being curious and questioning the way we do things is

essential. It allows for growth

Photo Credit: Gabrielle magalski

leaning over a cliff on Nusa Penidashot on DSLR Sony A7ii

Do something productive. Use this time to leave something behind, to leave a mark, a reminder of your existence

and presence in 2020. When was the last time you painted something or have you ever tried painting? Have a

little paint and sip session with a canvas, brush, paint, a glass (or two) of your favourite drink on the side and

your favourite tunes blasting in the background. productively de-stressing ! If you can’t be bothered with the

Craft

setup, really even a pen and paper (or if you are more technically inclined an iPad and an Apple pencil) is all you

need to unleash your creativity.

Read a novel... when was the last time you read something that wasn’t news, the textbook, the lecture slides or

study notes? Take some time away from the digital screen: Whether it is watching netflix, scrolling through

social media to check up on the latest med school memes or watching online classes, our eyes are glued to some

sort of screen for the majority of the day. Your eyes are probably feeling the strain and would appreciate a

break from the blue light.

10


Go ahead and write a journal. A paper one is even better as you reflect and consider each word more carefully.

You never know, a couple decades down your journal may contribute significantly to record of the influenza

pandemic history.

Write

With the lack of in person classes, socialising opportunities have equally been diminished. sadly no more inbetween-class

breaks to catch up on the latest goss. Arranging online simultaneous Netflix sessions or gaming

sessions or video call sessions might be a good way to stay connected !

Socialise

Why not use this time to develop your cooking skills? Become the next Masterchef or culinary artist and

impress your friends, family and even yourself. Honestly one of the most useful life skill to develop.

Cook

Being at home all day, it’s easy to spend hours sitting, lying down or lounging. Take some time to get your heart

rate up and prevent your muscles from atrophying. There are so many online workouts and exercise resources

available - it’s just all about finding motivation to get started. Pump some music and some weights. raise those

energy levels. You might be surprised to find your productivity levels to have increased afterwards ! Why

Exercise

endure a workout alone when you can share the burn with your mates? Schedule in that online workout

session with friends!

It’s been a rough, roller coaster of a year. Everyone’s been affected in some way, and things have definitely

changed. Mindfulness is important. Take time to mediate or just pause, reflect and re-evaluate. Looking after

your mental health is just as important as your physical health. Also look out and check in with your friends

and family as well.

Meditate

When was the last time you did a full declutter of your room/house? Embrace your inner Marie Kondo and use

this time to reorganise your space which you are spending majority of your time in. Use this opportunity to add

some creative and unique flair to your space, after all it’s your living, eating, studying and working area.

Changing up the atmosphere can have dramatic impacts on your mood and productivity ! Take my word for it.

Clean

it’s time to catch up on all the films and tv shows that you haven’t been able to watch whilst attending uni in

person. Or even re-watch some good old classics if you’ve been keeping up to date with the latest shows despite

uni, classes and

Netflix

lectures…?

Karen Lee

11


From COVID to the Coral Sea;

An Echo Through Time

n the 18th of April 1942, my grandfather reluctantly left his medical studies and reported for

duty to the Royal Australian Navy. The crisis of World War II would take him away from his

medical studies for three years until the war ended in 1945. Three quarters of a century later

on the 16th of March 2020, I was sent home from medical school due to concern over the

growing COVID-19 crisis. As we mark the 75th anniversary of the end of World War II, I

cannot help but reflect on the similarities between our two stories; two future doctors

forced out of the hospital as the world descends into crisis. Whilst I do not expect to be

away from my studies for three years, with no prospect of imminent return the five months I

have spent away from the hospital already seem like an eternity.

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During my grandfather’s three years in the navy he went from ordinary seaman, to

midshipman and finally to sub-lieutenant. He served most of his time on the HMAS

Shropshire, an 820-man heavy cruiser equipped with 38 gun towers and eight torpedo tubes.

During their service in the pacific, the crew of the Shropshire supported 15 landings and

carried out 56 bombardments. They received battle honours five times between 1941 and 1945. I

cannot imagine how it must have felt to go from studying to save lives, to operating a gun

tower in the midst of an ocean battle. Unlike six of his crew members who died on active

service, my grandfather returned home in 1945 and finished his medical training. He went on

to become one of Australia’s pioneering specialists in drug and alcohol addiction, receiving

an OBE in 1981 for his services to the medical field. Although Dr John Moon died before I was

born, he continues to be a source of inspiration to me as I go through my medical training.

Throughout the COVID-19 crisis people have tweeted and posted about how our

grandparents survived so much worse; about how they lived through wars when all we have

to do is stay at home and endure lockdown. This is supposed to be easy compared to what

they lived through. Yet every day the news tells us that more people have died in the United

Kingdom from COVID-19 than died during the Blitz, while deaths in the United States have

well surpassed the total number of American soldiers killed in the First World War, Korean

War and Vietnam War combined. During a brief return to work in the hospital I saw an

elderly man struggling to breathe with suspected COVID-19 and thought ‘this fight is not

easy.’ In war, deaths are gruesome and vivid; out in the open. In a pandemic, the deaths are

behind closed doors; in empty hospital rooms or hushed intensive care units. No matter how

they come about, they are still deaths. Families still grieve. The world still reels, failing to

comprehend the sheer volume of people suffering and dying. Even those whom Covid has not

personally visited suffer at home, their mental health declining as they are denied access to

their family and friends. Here in Victoria as I write this, we are enduring another hard

lockdown while the rest of the country reopens. All of this considered I think that we

should hesitate to label any of this as easy, because it is not easy. It is hard. Maybe objectively

our grandparents did live through worse; I know that I would rather be enduring lockdown

in my comfortable home than manning a gun in the Pacific Ocean, but their suffering does

not negate our own.

Like the war, this crisis will eventually end. Like my grandfather, I will eventually return to

my medical studies and hopefully become at least a fraction of the doctor that he was. Until

then, it is okay for this to be hard. Until then, we need to continue to support each other as

much as we can and together, we will come out the other side.

Serena Moon

13


How has medicine and the world changed

and how will it change after the pandemic is over?

Farah Joy Hawila

I write this piece whilst in the throes of a throbbing headache. Going on 19

consecutive years of academia, such a situation is no news to write home about.

However, never have my run-of-the-mill ‘uh-oh I’m getting sick’ head pains been

aggravated by patrolling helicopters with their bright spotlights and

dreadfully loud racket pouring through my bedroom window.

Moreover, every twinge of pain is accompanied by a spike in anxiety. Suddenly,

microscopic germs manifest to form a chilling vision before my eyes, exploiting

innocuous exchanges with my family and friends to make a home of those I love

the most. Meanwhile, life is expected to continue as per the ‘new normal’ with

the unrelenting march towards academic and work deadlines. Such is the

condition of over 5 million Australians who have endured the uneasy wait for

basically forever (actually 2-3 days) for the results of a COVID-19 swab. With

restrictions easing and flu-season fast approaching, that number will only

multiply over the months ahead. Years may even pass before Australians can hear

a random sneeze without flinching.

On the subject of scars on our collective psyches, as a Lebanese-Australian

born in the oh-so-great US of A, disillusionment is a central feature of my

political outlook. Reaffirming this notion, the manner in which different world

leaders navigated this pandemic has revealed a sea of unfortunate truths that

had previously lain dormant under the surface of peace-time governing.

In my first years of medical school, medicine was a safe-haven from the shades

of grey that coloured my life and the world at large – one follows best

practice as judged by the established literature base. There was a heavy

responsibility that weighed upon each of us to ensure all we advise is

begetting benefit and avoiding harm, especially when the most commonplace of

drugs can be perfectly safe for some and fatal for others. So goes the humble

motto when asked almost anything by almost anyone at hospital: ‘I’m just a

medical student,’ and part of the answer to most every examination question:

‘Seek senior help and reference to the relevant evidence-based guidelines.’

Recognition of one’s limits in defiance of their ego and henceforth knowing how

to seek suitable assistance in a timely manner is key as a medical student.

Arguably, this principle is even more pertinent after graduation regardless of

how much knowledge and experience one amasses.

Similarly, if any group of individuals were to comprehend the burden of making

judicious decisions when lives hang in the balance, it ought to be world

leaders. As such, I could never help but be somewhat mistrustful of those in

office without a single white hair or wrinkle to be found. So, being forced to

stand by and watch powerlessly as the medicine I once revered for its

scientific purity is muddied and misrepresented in the name of egotism and

national interest by individuals in indisputably sociopathic ways feels like a

strange and unusual punishment.

For the nations who have now been forced to implement the necessary strategies

after actively ignoring the relevant specialist advice – we will remember.

14

For those who dare to gloat about superlative testing and treating when the

former is an actual farce and the latter consists of criminally negligent,

unilateral presidential advice featuring the injection of caustic materials –

humanity would be stupid to forget.


For the powerful few who shot down the ‘canary(ies) in the mine’ thus

endangering hundreds of millions of innocents across the globe – No worldly

punishment could even come close, although regrettably I don’t envisage one

coming at all.

Moving forward past the coronavirus, I would be naïve to suggest that the

world’s ‘war-time’ leaders will have changed in the slightest. For many, what

is right and what is politically convenient overlap occasionally, but are often

separate concepts. For instance, it just so happens that a dictatorial state

with mass surveillance and established channels for government messaging turned

out to be exceedingly effective in limiting infection control and saving lives.

Even so, whatever good is accrued is quickly followed by exploitative

misconduct as many such countries have taken advantage of the present temporary

situation as an opportunity to instate permanent infringements on personal

privacy. To make matters worse, this then muddies the waters for any members of

the international community to attempt to implement measured, short-term

digital surveillance as a useful tool without the baggage of its typical overreaching

dictatorial packaging. Political conundrums such as these will surely

continue to feature in our post-COVID-19 world, but for my wellbeing’s sake, I

selfishly hope they leave medicine out of it.

After the first wave of the coronavirus, what worries me more than the

politicians is the state of desperation of the people they govern. Staggering

proportions of Australians, Americans and Lebanese alike have been afflicted

with economic struggles in a way they could never have otherwise predicted.

Unsurprisingly, no-one had factored in ‘pandemic’ into their estimations of job

security. So, we find ourselves in a position where newly heightened emotions

of anxiety and hopelessness have fanned the flames of mistrust in conventional

medicine and ‘big pharma.’ People have been forced to choose between the

potential, invisible threat of a respiratory infection and the immediate,

tangible threat of losing their homes or their children starving. If I weren’t

a doctor, I may have been seduced by the black-and-white nature of this

argument. I mean: it’s not even cancer, the C-word which we avoid even saying

due to the heft the mere word carries – so how bad can it be?

Analogous to the issue of vaccine hesitancy, the degree of difficulty is

compounded by the fact that the more well-controlled the disease spread is, the

more one can mistakenly argue it wasn’t a concern in the first place.

Subsequently, if restrictions aren’t followed, and eventual vaccination isn’t

widely taken up, I fear there is no foreseeing a world after the coronavirus;

not for a long time anyway. The issue of an intangible and distant enemy is far

more benign than a malignant enemy which has ravaged through every suburb,

workplace and household. With the second wave spreading through Melbourne and

creeping up on Sydney, restrictions notwithstanding, I fear it will not be long

before ‘coronavirus’ becomes the newly dreaded C-word. As such, I hope for the

opportunity for the masses who dismiss COVID-19’s true potential for harm to

never have that harm reach them or their loved ones. I deeply hope they are

educated by theory and statistics so they may prevent the lesson becoming

imprinted through personal tragedy.

With all this happening on an international, societal, professional and

personal level, it is incredibly difficult to think of the future in terms of

life post-COVID-19. To be honest, even thinking about next week in any certain

terms personally triggers an impulse towards prayer rather than prediction. So,

I pray for relief for our world on fire and that we come out of the flames on

the other end as a global community (citizens and governments alike) taking a

page out of medical ethics textbooks by collectively working a little harder

towards upholding justice, beneficence and non-malevolence.

15


Human

Yashaswini

Connection

Makkoth

16


COVID-19

A virus with a face, marred by the scars of devastation,

It shackles us as we try to reach out to each other,

1.5 metres, loneliness quantified,

We are fighting a battle everyday,

Armed not with swords, but sanitisers and masks,

The new and frightening reality,

It’s as if we’re stuck at the door of socialisation,

Straining our necks passed the stern face of social distancing,

Searching for our friends, but barred from joining them,

The value of human connection was learnt in quarantine,

Even the most introverted felt the weight of isolation,

Being alone was not easy,

But we adapted,

Zoom, Netflix Party, what have you,

Connections flourished from the thorn of COVID-19,

Technology bridged the 1.5 metre gap,

Now the wait begins for The Great Escape, a vaccine,

When shall it come, when shall we be free?

17


at the

Medicine

Movies

Dr Peter McLaren

Most of us, I guess, are a bit cynical about movies on medical topics; the patient in a coma who

still looks immaculate, the implausible plot lines, too many machines in the room for a

conscious patient, not enough machines in the room for an unconscious patient, the faintly

ridiculous dialogue; you get the picture?

But there are some movies, documentaries and docudramas that get the medical concepts

and moral issues across better than any textbook.

On that basis, I decided to look at movies that I feel should be essential viewing for anyone in

medical school. I have reduced them to the top 10 but have found it difficult to place them in

any particular order, so I present them from old to most recent. I have taken into account

their medical authenticity, the relevance of the topics they tackle, the quality of the

writing, directing and acting, and awards given. I have also striven for variety. I apologize if

some are old but greatness doesn’t come along that often!

The Doctor (1991)

The story of an arrogant surgeon who becomes a patient and gets a taste of his own medicine? It could

have been that simple but thanks to good writing, a strong caste and the talents of William Hurt, it

transcends this scenario and shows an insightful view into the hospital environment.

The plot and dialogue are credible and the acting and directing, subtle. Hurt plays Jack McKee, a

successful surgeon who develops throat cancer. The experience that follows causes him to review his

approach to life, his family and the practice of medicine. Janet Maslin from the NY Times made a

perceptive assessment, writing: "...a charming, cocksure doctor who specializes not only in difficult

surgical procedures but also in careful, deceptively breezy intimidation." Sometimes it takes an

outsider to identify a behaviour we often brush off as simply male bravado.

The director was Randa Haines who had previously teamed up with

Hurt on ‘Children of a Lesser God’, another fine movie. The script

was written by Robert Caswell and based on a book by Ed Rosenbaum,

'A Taste of My Own Medicine'. It was only a modest box office

success with few awards. Still, IMDB gave it 6.9/10 and Rotten

Tomatoes 85%.

So why include it as a must-see for medical students? Well,

firstly for the presence of William Hurt, another of the

outstanding actors of our time. It will also introduce students to

the music of Jimmy Buffett. As an anaesthetist, I can't deny there

might have been a little schadenfreude involved, though, in

reality, it could have focussed on any specialty. But the main

reason is that watching this film could replace all of the medical

school activities exploring empathy in medical practice (of

course, with the compulsory group discussion afterwards, as I

wouldn't want to put anyone out of work!).

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One Flew Over the Cuckoo's Nest (1975)

Most would agree that this is a great movie;

after all, it received 5 Academy Awards! Best

actor (Jack Nicholson), best actress (Louise

Fletcher), best movie, best screenplay (Laurence

Hauben/Bo Goldman) and best director (Milos

Forman). Only two other movies have achieved

that: “It Happened One Night” and “Silence of

the Lambs”. However, is it a great medical

movie?

Most psychiatrists would disagree. This was the

era of the anti-psychiatry movement. There were

other spokesmen for the movement; Foucault,

Laing, Szasz, but a movie is intrinsically more

persuasive. Much damage was done, not only to

the profession but to patients who were

persuaded to stop their treatment. The movie was

based on the book by Ken Kesey, a figure in the

60's counter-culture who had worked as a janitor

at a Veterans Hospital in California. The

characters were perhaps not typical psychiatric

inpatients. However, psychiatry was not entirely

blameless at the time; the concept of the

'therapeutic community' had been misused, ECT

and psychosurgery were hardly evidence-based and

over the centuries, treatments have been used on

occasion to solve social problems.

Getting back to the movie; it follows Randle

McMurphy (Nicholson) who, looking for the easy

path, opts to serve his prison sentence in a

mental hospital. He is unaware of two factors;

the head ward nurse, Nurse Ratched (Louise

Fletcher) likes to run the ward her way and the

length of his sentence is based on him showing

improvement in his behaviour while in the

hospital. Some viewed it as an allegory of the

social conflict at the time between conservative

and alternate cultures.

It was a showcase for the prodigious talent of Jack Nicholson. This was coming off his scene-stealing

performance in Easy Rider in '69', Five Easy Pieces in ‘70 and Chinatown in ‘74. The true strength of the

movie is that he does not overshadow the rest of the cast and the directing skills of Forman. This was

Forman's US debut following his success with the Czech movie, 'The Firemen's Ball'. Michael Douglas was the

producer together with Saul Zaentz. He had been gifted the rights from his father, Kirk, who had played the

lead in a short-running Broadway adaptation.

As an aside, it is good to see Danny de Vito before he lost his hair and Christopher Lloyd before he grew his

and built a de Lorean time machine!

Why should medical students see this movie? Hopefully it may help them recognise when power politics intrude

on the rights of the individual and it may make them less likely to stereotype or dehumanise those with

mental illness.

But lastly, just to appreciate art and how powerful it can be at disseminating ideas; whether you agree with

them or not.

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The Elephant Man (1980)

David Lynch, the director, chose to film this in black and white which was a great choice but does make it

look older than its years. Despite his initial surrealist film effort, Eraserhead, he manages mostly to

keep his renown 'weirdness' under control. The cinematography was by Freddie Francis and enhanced the

period look of the sets. The writers were Lynch, Christopher De Vore and Eric Bergren. Production was by

Jonathan Sanger and Mel Brooks who declined to be credited so as to avoid the expectation of a comedy.

It is based on the true story of Joseph Merrick, born with a still unknown congenital disorder which caused

progressive disfigurement. One of the few options for him in Victorian times was to appear in a travelling

circus, until a curious surgeon, Frederick Treves (Anthony Hopkins), shows an interest, initially in his

disorder and later in him as a person. It is to be noted that Hopkins’ Hollywood career did not really take

off till “Silence of the Lambs” 11 years later, in 1991.

To this day, in some societies, disfigurement is still taken as a sign of evil, either committed in this

life, or perhaps, a previous one. This attitude still persisted in Victorian England. Although, writers,

journalists and politicians had their role to play, it was the medicalisation of these disorders and the

personalisation of those who suffer from them that was pivotal in changing community attitudes.

Despite layers of make-up, the amount of expression that John Hurt conveys in his role is astounding.

Apparently the make-up took 7-8 hours to apply and 2 hours to gently remove! Christopher Tucker, the makeup

artist, used original casts taken from Merrick's body for greater veracity. With him on screen are a

young Anthony Hopkins, Anne Bancroft, John Gielgud and Freddy Jones, all supplying thoughtful performances.

Despite being nominated for 8 Academy Awards, it received none, losing out largely to Robert de Niro in

Raging Bull. So upset were some by the result that it caused the Academy to list a future award for film

make-up and hairstyling. It did score well at the BAFTAs though and also at the box office. IMDb gives it

8.2/10 and Rotten Tomatoes a 90% rating.

The reasons I feel that it should be seen by all medical students?

It will certainly make them hesitant about complaining of their lot in life. It may hopefully make them

look beyond the superficial when dealing with patients. They can be proud of the role that the medical

community had in changing community attitudes and it may spur them to uphold this tradition. In these more

enlightened times, it will caution them to the xenophobic trait still embedded in the human psyche.

But my lasting impression, and I theirs, is that it is one of the ultimate film portrayals of human

dignity.

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This Irish movie is based on the autobiography of Christy Brown, who grew up with cerebral palsy in

a poor but supportive Irish family. He was initially thought to be of subnormal intellect, however,

at the age of nine, he wrote his first word using his left foot. He was then taught by a succession

of therapists, coalesced into one character in the movie. He later went on to become a successful

artist and author. The screenplay was a joint effort by Shane Connaughton and the director, Jim

Sheridan.

The film was nominated for 5 academy awards and won best actor ((Daniel Day-Lewis) and best

supporting actress (Brenda Fricker). ('Driving Miss Daisy' carried off the best film in 1990.) They

also achieved the same distinction at the BAFTAs. IMDb gives it 7.9/10 and Rotten Tomatoes a

whopping 97%.

The role played by Daniel Day-Lewis is an epic performance, even judged by those with the disorder.

Not only does he nail the cerebral palsy, his portrayal of Christy Brown's complexity is even more

impressive as he was known to be cantankerous and a heavy drinker. In one scene he portrays him, as

described by one reviewer, as "cussed, frustrated, indulged, immature".

Day-Lewis was motivated to take on the role, as he doubted it could be done. In a sense, he was

right, as he was only able to control his right foot adequately and the filming of those scenes

required a mirror. He often remained in character while off camera, which apparently upset his

agent on one visit to the set!

As well as Barbara Fricker, who was suitably awarded for her role as Christy's mother, the rest of

the supporting cast was excellent. In his acceptance speech at the Academy Awards, Day-Lewis made a

special mention of Hugh O'Conor, who played the younger Christy, as well as paying credit to the

tenacity and talent of Christy Brown himself.

Daniel Day-Lewis's performance alone is

enough to make it a 'must see' for

medical students. It is ultimately a

feel-good movie; it does demonstrate

triumph over adversity. It demonstrates

the advantages of community services; it

champions diversity and it demonstrates

the value of the disabled in communities.

But I also like the way it doesn't sugar

coat disability. The disabled aren’t

homogeneous; they don't always act like

saints; and nor should they be expected

to.

My Left Foot

(1989)

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Awakenings (1990)

Wow! What a movie! What an ending! What a story and what

good performances! Often criticised for its sentimentality,

I personally find it restrained in its presentation of what

is an incredibly sad situation. Directed by Penny Marshall.

Screenplay by Steven Zaillian.

It is based on a book of the same name by the neurologist,

Oliver Sacks. It was released in 1973 and based on his

experience treating patients institutionalised due to

encephalitis lethargica. The movie received three academy

award nominations but unfortunately no awards. (Best picture

that year - 1991 - went to Dances with Wolves.)

Still, it manages a Rotten Tomatoes score of 88%, an IMDb

score of 7.8/10 and a Metacritic score of 74.

Oliver Sacks, the author, oversaw some aspects of the

production and said he was mostly pleased. Robin Williams’

serious role as the neurologist is solid and nuanced but it

is Robert de Niro's immersion in his role as a patient with

a Parkinsonian-like illness that is an acting tour de force.

Sacks commented that even after filming ceased, he could

still detect these mannerisms when conversing with de Niro.

Many top actors, those who do not merely play versions of

themselves in each performance, often seem to reach the

pinnacle of their acting when playing those with

disabilities. viz. Dustin Hoffman in 'Rain Man', Daniel Day-

Lewis in 'My Left Foot' and Sean Penn in 'I am Sam'. Care

must be taken not to overact and make it cartoonish but I

think de Niro nails it.As a medical history of institutions,

diseases and how we treated them, it scores; as a depiction

of a disease process it scores and as at treatise on how we

should not only treat our patients but care for them as

well, it is wins a spot on my top ten movies for medical

students.

Contagion (2011)

This was the first medical movie that grabbed my

intention. 'Contagion' follows the evolution of a

pandemic. It embraces the science so well that it feels

like a docudrama. It starts with a star-laden cast that

give pretty authentic if not exactly riveting

performances. (Matt Damon, Gwyneth Paltrow, Jude Law, Kate

Winslet, Marion Cotillard, Laurence Fishburne, Bryan

Cranston) It moves at a good pace but avoids over

dramatisation.. It obviously had good medical input from

experts in infectious disease. Director - Steven

Soderbergh. Writer - Scott Z Burns.

However, it only received a few nominations and two

awards. David and Margaret gave it 4.5 and 4/5, IMDb

6.6/10, Rotten Tomatoes 84%. Interestingly, the LA Times

reviewer invited three infectious disease experts to

critique it. They did think that it massaged the science a

little for greater dramatic effect but they said that the

movie 'mostly got it right'. One did comment that it

should be seen by all medical students!

Why do I like it? I like the fact that it looks at the

personal and sociological elements of a pandemic. It

doesn't talk down to you, perhaps a reason it wasn't more

appreciated by the general audience. It also mentions our

own Nobel prize winner in medicine, Barry Marshall!

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But to cap it off, with the ubiquity of modern jet travel

and the fact that some cultures still live in close

proximity to animals, pandemics will continue to be a

concern for future doctors and the world they live in.

SARS, Ebola and now, Covid-19 are reminders of this. In

the words of George Satayana: “Those who cannot remember

the past are condemned to repeat it.”


And the Band Played On (1993)

We just had to have a movie about the AIDS

epidemic, the greatest medical crisis since

the ‘Spanish ‘flu’. You could not have

invented the plot; an epidemic starts among

derided minority groups (gays and I.V. drug

users), then spills over into other sections

of society while it is also ravaging the

developing world. This all happens to the

background of emerging gay activism.

‘And the Band Played On’ was made as a

television docudrama and plays out like a

thriller. Researchers, doctors, bureaucrats,

politicians, AIDS victims; and many don't

come out smelling like roses.

Directed by Roger Spottiswoode. Teleplay by

Arnold Schulman. It is based on the 1987

bestselling non-fiction book by Randy

Shilts, a reporter on the San Francisco

Chronicle at the time of the epidemic. Randy

was diagnosed with HIV shortly after

completing the book and succumbed to the

complications of AIDS in 1994. It was a

monstrous book, packed with research that

attempted to encompass the many strands of

the unfolding of the epidemic in the U.S.

The fact that most of the activism and

research was in the U.S. is an explanation

and solace for its North American centrism.

Making the book into a movie was always going to be a tall order. It has been criticised for its

irregular pace and occasional disjointed plot, not helped by the sudden appearance of famous actors in

supporting roles. To critics of its chaotic approach to the epidemic, I feel comes the old refrain; 'You

had to be there!'. The main role goes to Matthew Modine, playing an epidemiologist, Don Francis. A good

performance but the writers gave him little in the way of character development. The familiar faces

include: Ian McKeller, Alan Alda, Lilly Tomlin, Phil Collins, Steve Martin, Angelica Huston and Richard

Gere who all apparently only collected actors’ union rates. Gere was supposedly the first to join the

project, an act which encouraged some of the others. Still, it garnered 3 Emmys. Rotten Tomatoes gave it

100% and an 88% audience rating. IMDb gave it 7.8/10.

The AIDS epidemic not only stretched health services in research, epidemiology, infection control,

manpower and finances; it also stressed the system morally and ethically and strengthened it in the long

term. It has messages for the medical profession, not only in the management of pandemics but also in the

profession's involvement with minority groups.

The power of this telemovie about the AIDS epidemic, I feel, is summed up by an anonymous on-line

reviewer who said: '......- it isn't a quick-fix wallow or a time-filler....it is a serious, frustrating,

angry movie with no easy answers. And that is as it should be.'

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Wit (2001)

This American, made for television, movie was based on the book and Pulitzer Prize winning play by

Margaret Edson. The director, Mike Nicholls and the star, Emma Thompson tweaked the dialogue but

largely it remains true to the play. This includes the theatrical technique called ‘breaking the

fourth wall’, where the actor addresses the audience directly.

It is a cancer movie; you know we had to have one; and I feel that this is the best. It has no

clichés, it isn’t maudlin nor are there any miracles. It involves the eight months of aggressive

treatment of advanced ovarian cancer in a 50 y.o. professor of English literature. Vivian (Emma

Thompson) has no partner, no children, no religious affiliation and few friends. Her life revolved

around her study of the poetry of John Donne. This is a recurring theme throughout the movie.

Although the lack of social support is not typical of life or the cancer movie genre, the focus on

one’s career is a situation that other professionals can empathise with and it does allow a more

intimate relationship with the audience.

Emma Thompson is perfect in the role,

perhaps aided by her university

degree in English literature. She is

ably assisted by Christopher Lloyd,

Jonathon M Woodward and Audra

McDonald all providing authentic

hospital characters.

Awards included two Emmys for best

movie for television and best

directing of a movie for television.

Rotten Tomatoes give it 83%.

So, why is this movie a must-see for

medical students? Firstly, to note

the communication skills and agenda

of the medical staff. Secondly, to

see what some of our therapies put

patients through. Thirdly, to see

that the subjects enrolled in

research projects are real people.

Fourthly, to join the main character

in realising that all the learning in

the world can never make up for a

lack of kindness.

In searching online, I noted that

there was an article in the BMJ

outlining the use of excerpts from

Wit as an entree to the discussion of

communication in medical practice.

Though I do applaud that initiative,

my stance would be to make them watch

the entire movie; to place the

conversations in context and make

them appreciate the beauty and power

of great art!

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anks 37th in the world on health outcomes!

Sicko (2007)

It is, with deliberation, I include this documentary by Michael Moore in my ten top movies. It has

flaws but tells an important story with power and humour.

Moore takes on the U.S. health industry, in a laid-back style for him, letting his interviewees get

their messages across. They are just average people with their many stories that chip away at the

image of the American health system. He looks at the health care systems in other countries and

then makes his point by using the plight of those with health problems who helped in the aftermath

of 9/11 to make a comparison with Cuba. The ultimate message is that this is not a country where

one would like to be sick and poor. As Moore points out in the documentary, the U.S. has 4 health

care lobbyists for each congressman and the largest per capita spending on health care, but only

It did get an Academy Award nomination. The Rotten Tomatoes score is 93%, Metacritic 74/100 and

IMDb 8/10. Moore shows less bombast and refrains from his usually aggressive interview technique,

that's true, but parts of it are sloppy, superficial and overly dramatic. There is little in the

way of investigative reporting and few topics are nuanced.

So, why would I want all medical students to see this?

Our public health system has problems; limited resources, inefficiencies, waiting lists, waiting

lists to get on waiting lists, health departments with large media departments, multiple levels of

bureaucracy, bureaucrats who are more interested in preserving their jobs and way of life than

caring for the sick, etc. But, behind every national health care system there are essential values

that define us as citizens and humans. This documentary shows the impact of not having a

functioning system for supporting society’s most vulnerable members.

I feel that it is a little like Winston Churchill's comment on democracy: a public health system is

the worst form of health care; apart from all the other forms of health care that we have tried.

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Vera Drake (2004)

Vera is a well-meaning, in the parlance

of the day, ‘kindly’, working-class

woman in London in the 1950’s who likes

to help others. Amongst her helpful

duties, she performs abortions on young

woman who have ‘got themselves in

trouble’. She accepts no payment but her

friend, Lily, who organises the service,

does charge and in turn, makes sure Vera

is looked after with occasional gifts of

black market goods. Like in real life,

the plot then goes on to show that bad

things can happen.

Vera is played by Imelda Staunton in an

exquisite performance. In fact, it is

the audience’s belief in Vera that helps

paper over inconsistencies in the plot.

The rest of the British cast are all

authentic characters from that era. Mike

Leigh was both writer and director and

used his trademark approach of immersing

the cast in the milieu of the times and

circumstances. The dialogue is

convincing and the sets embody the

nostalgia of the 50’s without

trespassing on the twee.

The movie won a Golden Lion at Venice,

was denied screening at Cannes for some

reason, lifted three BAFTAs (including

best leading actress) and was nominated

for three Academy Awards. Metacritic

give it 83/100, Rotten Tomatoes 92% and

IMDb 7.7/10.

If all, or any illegal abortionists, were as well-meaning as Vera they would not have been held in

as much disrepute. The reality was that it was highly dangerous both for the woman and the

abortionist and often carried out with poor preparation, poor counselling, poor knowledge, poor

technique and poor equipment. Some criticism was directed at the lethality of the actual technique

that Vera uses; however, until abortion was legalised in the late 60’s, it was estimated that there

were approximately 250,000 illegal abortions performed each year in the U.K. Those comments were

perhaps based on only seeing the tip of the iceberg: those that went wrong.

Well, if it is not a fair and accurate portrayal of backyard abortionists, why should it be seen by

medical students?

Well, for starters, it raises the topic.

Secondly, it authentically depicts situations that they might be exposed to in their medical

career. Pregnancy will still continue to have a possible negative effect on a woman’s future.

Abortion has persisted through the ages and even in these enlightened times will continue to be an

option. It does illustrate the contrasting options for rich and poor.

We only need to go back to the life and campaigning of Dr Bertram Wainer in Melbourne to conjure up

the rather similar situation that existed here in Australia. Seeing this movie may deter some of

those who would be tempted to revisit the past and make it a criminal offence.

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Photo Credit: Gabrielle magalski

unknown woman on Gili Trawangan

Photo Credit: Karen Lee

27


Recovering

Medical School

My medical school, like many, was forced by

COVID-19 to send students home to study

online. During lockdown, I kept coming across

articles about other people’s experiences of

lockdown, raving about how it gave them

space- space they hadn’t had for a long time or

even realised they needed- to reflect on the

way they were leading their lives, and maybe

consider ways they could better align

their daily practices with their values.

This got me thinking - maybe this forced

reflection period could be useful for med

schools too. Maybe there needs to be more

reflection going on about what needs to

change.

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I don’t know about your medical school, but

mine often raises this concept of ‘student

wellbeing.’ We receive regular reminders that

we need to be ‘looking after ourselves’ and

should contact faculty if we need help. Over

the years however, I have been increasingly

frustrated by the fact that, despite us

learning in our course that prevention is the

best cure, this hasn’t extended to med school’s

approach to student wellbeing. Sure, they

offer counsellor access when you’ve fallen

apart, but they seem to pay less attention to

preventing the falling apart process from

happening in the first place. Medicine has

never been known as the easiest course to get

through, but I’ve found myself wondering so

many times over the past years how a course

designed by some of the brightest minds in the

world is struggling to educate the next

generation of doctors without damaging

them with stress and anxiety, and

encouraging in them a fear of exposing any

imperfection or vulnerability.

I feel very lucky to get to be taught by some of

the most talented and knowledgeable

physicians and medical professionals in the

country. My admiration for these teachers is

slightly dimmed however, every time I have to

hear the phrase, in response to student

inability to answer a question that has been

posed, ‘You should know this.’ In my more

tempestuous moods, I can’t help but wonder

about the inherent ridiculousness of the

statement. Do our teachers think we enjoy

not knowing the answer? Do they think a

bunch of neurotic perfectionists (guilty as

charged!) need more shame heaped on them?

Do they think they need to have their

impossibly high standards for themselves

raised even more impossibly high? Now of

course the majority of educators are

wonderful humans who, if asked, would no

doubt answer negative to all the above. But I

also think the majority have been educated in

med schools in times when shame and

perfectionism was rampant and encouraged,

and public humiliation used as a weapon to

force med students to study harder. I guess

some habits and ways of thinking die hard.

Another thing that seems to occur regularly

in the lectures and tutorials I attend in

hospital and at university is teacher-led

laughing at wrong answers. I cringe

internally and feel so bad every time I see a

student give an answer, and watch the

lecturer imply that the answer is so wrong, it

is funny, thereby implying the student is a joke

for suggesting it. Ridicule doesn’t have to be

performed by the malicious; sometimes it comes

from a simple inability to remember back to a

time when questions that seem obvious to you

now were anything but. The same lecturers I

see laughing at ‘silly’ answers that have been

offered by well-meaning students are also

ones that complain that students in their

classes don’t seem to want to speak up and

answer questions they pose to the class. Hmm,

I wonder why that could be…

But do we want students to be trained to see

not knowing the answer as a weakness that

must be hidden at all costs? Is it not possible

that such an attitude may lead to issues down

the line in a clinical setting with doctors

feeling unable to admit to their colleagues

that they feel unsure about how to manage a

patient? Medical schools emphasise that

patient safety and wellbeing should be the

priority; maybe for this to be ensured, doctors

need to be comfortable from the time they are

still med students with not knowing the

answer, and be able to be out and proud about

this. Right now, as we think about how to fix

things so that we exit the COVID-19 era better

than we entered it, let’s spare a thought for

how we can help medical schools to recover

from the culture of shame that has gripped

them for far too long.

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Minds of Medicine

An interview by Karen Lee

Intervewee Ishwarya Nair

Artwork Credit: Janhavi Suryawanshi

This artwork represents the importance of

mindfulness and positive mental health within in

medical students, especially in a COVID-19 world

covid has impacted each one of us in many diverse ways and medical students have, no doubt,

been uniquely impacted by the adverse circumstances. This interview provides a look into the

impact of COVID to a medical student in their clinical years.

I thank Ishwarya for taking her time to respond to these questions and providing an insight

into her covid experience

Tell me a little bit about yourself.

Hi there! I’m a fourth-year medical student at Griffith University. Outside of medicine, I enjoy

rock climbing, cycling, running, baking (and eating my own baked goods), cooking and

spending time with loved ones.

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How were you impacted during the COVID-19 period as a medical student?

When the COVID-19 outbreak first started spreading to other countries in January, I was

completing my elective in London. Looking back, it feels like a different time. People weren’t

wearing masks 24/7, hand sanitiser hadn’t become as valuable as oil and giving hugs didn’t

earn you dirty looks. I also remember how the doctors that I worked with were very

confident that the outbreak wouldn’t hit London as hard as it did (oh how wrong they

were…). I was fortunate enough to do lots of travelling and have a wonderful learning

experience before I returned to Australia. Incidentally, a week after I visited the Louvre in

Paris, France, and returned to Australia, it was closed because the outbreak had spread to

Europe. That was pretty crazy.

Fast forward, as COVID-19 cases started growing in Australia, I was doing my GP placement. I

slowly saw how pharmaceutical reps stopped coming to the GP practice with free food

(something that I very much looked forward to), how the practice had to be dynamic with

taking on patients, the receptionist having to conduct screening questionnaire when they

made an appointment, to almost all face-to-face consults turning into telephone consults.

This meant that physical examinations, one of the key diagnostic tools of medicine, were no

longer being done! You only had a history to rely on when deciding further management for

the patient. I also saw first-hand how patients were exposed to fake news circulating

around on social media or hearsay. As such, I had to remain up-to-date with the latest

information and guidelines regarding COVID-19 in order to give them the most accurate

information.

Following this, I started my anatomy rotation on the Gold Coast which involved me going to

the lab to prepare different dissections, as well as teaching anatomy to the second years

online. Unfortunately, because of Griffith’s COVID-19 restrictions, after week 2, the other

students and I were no longer allowed to enter the lab to work on dissections for the rest

of our rotation. As such, we were only able to fulfill the teaching component of the

rotation. While I was disappointed that I was unable to fulfill this component, one that I was

very much looking to, I was content with the fact that I was still able to continue with

rotations instead of stopping them altogether.

Were there any major learning curves? What was the greatest challenge and how did you

overcome it?

One of the major learning curves I experienced was doing telephone consults and taking a

very thorough history without seeing the patient during my GP placement. I managed this by

going back to the basic frameworks of history-taking such as SOCRATES PP to ensure that I

covered all relevant aspects.

Another challenge was trying to model a real-life anatomy lab with cadavers into an online

lab using pictures and videos. Fortunately, this experience has made me a bit of a tech whiz

using shapes and tacky animations!

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How has this experience changed you or your perspective?

This experience has shown me just how integral technology is to our life now and the

importance of being flexible and adaptive to changes that are well beyond our control.

Is there a particular moment that stands out to you or that you were most surprised by and

why?

The past 8 months and counting will be something I will never forget!

What is something positive about your experience?

Reduced time in rotations meant that I took on new hobbies like cycling and practised way

too much of others, like baking. It also meant that I made an effort to connect with friends

via video call. I think in some ways, it has also strengthened my cohort to find innovative

ways to ensure that our learning has not been affected by shortened rotations by sharing

notes etc. I believe that we will make an interesting and resilient bunch of interns next year

(if we graduate!)

Is there anything you are proud of?

I am very proud of the way that GUMS has been advocating for all cohorts of our medical

school to ensure that our learning remains as undisrupted as possible. I am also very proud

of how Queensland has managed the COVID-19 situation so that we haven’t experienced much

of a second wave.

How did you feel about it all?

Mixed feelings of frustration and shock at how a microscopic organism has brought to the

world to a stand-still preventing travel and limiting social interaction. However, I am also

very grateful to be safe and healthy and to have mostly had the opportunity to continue

with all my rotations according to plan. I am also very fortunate to live in a state which

isn’t quite as badly hit by the pandemic and to have a close group of family and friends to

support me through these unprecedented times!

Where to from here?

Hopefully graduation!

Would you care to share a word of wisdom to fellow med students?

Make sure that you don’t leave all major socials to final year! You never know when a global

pandemic might hit!

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Ars longa, vita brevis

In clinical medicine ‘ars longa, vita brevis’, medical

professionals must always be prepared for the unexpected. This

reflective piece will describe a highly unexpected Advanced Life

Support experience I had as a 3rd year medical student whilst

aboard a train carriage. It also includes my introspection and

insights gained following the medical emergency, while

contemplating the significance of the words uttered by ancient

Greek physician Hippocrates, which especially resonate now in the

midst of the COVID-19 pandemic.

I would like to extend my thanks to Dr Stephen Teo and Dr Karina

Hochholzer for your advice and feedback. Your support and

encouragement has been invaluable.

Dhruvi Lathigara

Most medical students don’t expect their first Advanced Life Support (ALS) experience to occur in the middle of a

train carriage. I certainly didn’t.

It was almost 6pm; the train was emerging from the underground tunnel, beginning to decelerate before pulling

into the platform. I had just risen from my seat and turned to face the train doors, anticipating my arrival home

after having spent the day at my first clinical placement as a 3rd year medical student in the Emergency Department.

All of a sudden, there was a thud, punctuated by raised voices and cries of alarm from the surrounding passengers.

The person sitting a mere two seats away from me had collapsed.

Various thoughts and emotions raced through my head in a split second. I thought of syncope, a transient and

abrupt loss of consciousness and began considering possible differentials. His face had gained a purple hue,

signalling cyanosis. He wasn’t breathing normally, instead making abnormal gasping sounds, alerting me to

something much more urgent and dire. This jolted me to recall my ALS training session, which had coincidentally

taken place that morning. Could those sounds actually be classified as agonal breathing? Was it a cardiac arrest?

I knew then that I had to act immediately. I just didn’t expect to be the most competent or qualified individual at the

forefront of a situation as tenuous as this. Nor did I imagine that my first exposure to a medical emergency would be

in the middle of a train carriage, without a MET call team or any hospital adjuncts. But there was no room for

hesitation. It was no longer about me, a 3rd year medical student in the first week of my emergency rotation; the

sole focus was on this man caught in a precarious situation between life and death. Appropriate action needed to

taken immediately, especially considering the survival rates for cardiac arrests.1, 2 I found myself saying ‘I’m a

medical student, I can take a look, give me some space’ and nearing the man.

33


Danger, the first element of Basic Life Support guided by the acronym DRSABCD had been accounted for and I

launched into the next, checking for responsiveness. I asked in rapid succession ‘Hello, can you hear me? What is

your name? Squeeze my hand if you can hear me.’ Nothing. No response. I did the trapezius squeeze. Nothing. No

response. Both the radial and carotid pulses were imperceptible, further supporting my suspicion of a cardiac

arrest. The train doors had been open for a couple of seconds now. I raced to the edge, exclaiming ‘Stop the train!

Medical Emergency! Suspected cardiac arrest!’ After I had sufficiently gained a transport officer’s attention, I

rushed back and checked the airway, there didn’t seem to be anything obstructing and I remembered being advised

against doing a blind search with my fingers. Two transport officers had just entered the carriage and I asked them

to call 000, the emergency number.

By this point, I knew the man required urgent cardiopulmonary resuscitation (CPR). With the help of passengers I

lowered him to the train floor. Unfortunately I had no access to any basic airway adjuncts to maintain the airway

such as with a Guedel’s, so obstruction by the tongue was a concern. There also wasn’t a bag valve mask to provide

ventilation, so the main focus had to be rescue breaths. This highlighted the significance of having access to

hospital adjuncts during a medical emergency and the requirement for adaptability in their absence. I commenced

CPR, interlocking my hands and placing the heel of them at the centre of his chest, aiming to depress one third of the

depth. Fortunately, the transport officer was carrying a plastic barrier as part of his uniform, and administered

the two rescue breaths after 30 compressions. This allowed hypoxia, one of the reversible causes of cardiac arrest,

to be somewhat accounted for. I began the next set of 30, intending on continuing for up to two minutes when the

transport officer stated that he was trained and could effectively perform CPR. This transition enabled me to go to

the head and maintain the airway through the three way head tilt, chin lift, jaw thrust manoeuvre. I had just

completed my two-week anaesthetics rotation, which enabled me to adjust the manoeuvres and prioritise the jaw

thrust due to the man’s size and girth. While performing these manoeuvres, I considered other reversible causes of

cardiac arrest, ruling out hypothermia and hypovolaemia caused by trauma. The other reversible causes were

difficult to assess due to the setting and lack of an adequate history or context. I was also aware that in the

background, there was a police officer on his day off who had started prudently clearing the train carriages.

As we approached two minutes, I asked the other transport officer who was on the call to bring me a defibrillator. I

attached the pads and followed the prompts of the AED, which was slightly different from the device I was familiar

with in hospital. Unfortunately, the defibrillation attempt was not successful and it must have not been a

shockable rhythm. However, I had no definite way of assessing the actual rhythm due the lack of an ECG. This led me

to prioritise chest compressions, getting the transport officers to alternate. We alternated another time.

Then the paramedics arrived, there were three of them. I remained at the head maintaining the airway, explaining

the situation and the steps taken thus far while they set up their equipment. One of the paramedics inserted a Guedel

airway and began bag mask ventilation. Another paramedic attached ECG leads, replacing the defibrillation pads

while the third took over CPR. Now I could clearly identify that the man was in Ventricular Fibrillation, a

shockable rhythm. They applied COACHED – compressions continue, oxygen away, all others away, charging, hands

off, evaluate rhythm and then delivered the charge. Just after the first COACHED two other paramedics had

arrived. They performed COACHED again, then about four or five times subsequently with adrenaline delivered

through the inserted cannula.

The paramedics continued their efforts for approximately 20 minutes, with no return of spontaneous circulation.

Eventually, the paramedics all agreed to unfortunately make the call, ceasing operations, removing all adjuncts,

ventricular fibrillation eventually diminishing to asystole.

34


Being thrust into such a stark situation exposed me to the harsh reality of medical emergencies. Before the acute

balance between life and death had been a concept that I had only explored through the humanities or vicariously

through others. Never had I been so close to the edge, directly exposed to the precariousness of human existence.

The immediacy of the situation reminded me of the existentialist play Waiting for Godot by Samuel Becket that I had

studied in high school ‘light gleams an instant, then it’s night once more.’3 Our shared fate, encapsulated over 2000

years ago by the Roman poet Horace ‘pulvis et umbra sumus’4 – we are but dust and shadow, remains valid now and

forevermore. I realised that this would be my reality as a medical professional, facing this precipice between life and

death, performing treatment and management interventions and inevitably seeing the patient progress down

either incline.

The experience emphasised the importance of prioritising patient care, using all your skills and knowledge to secure

the best clinical outcome possible. This is especially relevant when clinically appropriate action can be taken in an

emergency situation, unlike Beckett’s play, which was imbued with a sense of passivity and irresolution from the

first line ‘nothing to be done.’3 It has also emphasised the importance of providing medical students with

interactive and hands on ALS training similar to the session I had attended just that morning, enabling students to

take necessary action. This also extends to members of the public, highlighting the necessity of basic life support

knowledge to improve outcomes for similar medical emergencies1. Further, the current COVID-19 pandemic has

demonstrated the importance of widespread health literacy and education in interrupting the chain of

transmission.

Overall, being placed in a position where I had to take initiative has made me more observant and attentive during

my clinical placements. It has augmented my desire to learn and to take a more active role, so that when the next

critical moment arises, I can once again take part to help secure the best possible outcome for the patient. The words

uttered by ancient Greek physician Hippocrates still resonate ‘Ars longa, vita brevis, occasio praeceps, experimentum

periculosum, iudicium difficile’ – ‘life is short, the art long, opportunity fleeting, experiment dangerous, judgment

difficult’5, emphasizing the urgency of acute medical emergencies and the importance of being prepared for the

unexpected. This has been exemplified by the unprecedented nature of the COVID-19 pandemic, which has

necessitated rapid action on a clinical and public health front, underlining the significance of contingency

planning.

Acknowledgements:

Thank you Dr Stephen Teo and Dr Karina Hochholzer for your advice and feedback. Your support and

encouragement has been invaluable.

References

Brady WJ, Mattu A, Slovis CM, Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest, N Engl J

Med, 2019, 381:2242-51.doi: 10.1056/NEJMra1802529

Myat A, Song KJ, Rea T, Out of hospital cardiac arrest: current concepts, Lancet, 2018, 391(10124): 970-979.doi:

10.1016/S0140-6736 (18) 30472-0

Beckett SB, Waiting for Godot, London, Faber and Faber, 1956

Horace, The Odes of Horace, Book IV, Ode vii, 13BC

Hippocrates, The Aphorisms of Hippocrates, 400BCE

35


Photo Credit: Gabrielle magalski

The Lost Magic of

On a ferry in the Salish Sea Shot on DLSR Sony A7ii

By Vijendran Jayaveerasingam

Lockdown

On a sweltering summer day in Newcastle, I was trudging through a

park alone. Why you ask? Well in an addition to my growing list of

car mishaps I had punctured my tyre on the highway, and was in the

middle of the painful wait while I waited for my ride to be ready.

“Hey how are you going?” I turned around expecting to see a chance

run in with a friend but instead found a total stranger- a tall

gentleman, dark hair and a welcoming smile. Hold your horses, this

is not another romantic short story! We did however have a great

chat as I eventually made it back to the vicinity of Kmart Auto.

His name was…something Irish…Ciarran? No that’s the Bachelor in

Paradise…character. Instead of his name, what stayed with me was

his story- with no set home yet in Australia he was bouncing

around trying to help people. At that point in time he was

volunteering in a shelter for the homeless and couch-surfing, or

so he claimed, but what’s the value in questioning? At the end of

our chat, I shook…Ciarran’s…hand, we wished each other good luck

for the future and went our separate ways forever.

36


What was the point of that tale? I met a random guy, can’t

remember his name, and am not even completely sure his wonderfully

selfless story was entirely true. But that interaction- the

spontaneous moment which brightened up my otherwise dull day, is a

pleasure which I took for granted that is hard to come by

nowadays. A conversation with a stranger now is tinged with the

suspicion and worry that they may be infected, and as we progress

through this, will have to be done through masks- removing the

possibility of the welcoming smile that sets the ball rolling.

I’m not questioning the lockdown measures in any sense at all.

Obviously to curb a global pandemic, we need to limit our

interactions. But it would be remiss of me , I feel, to not

discuss the social impacts of this disease, and that does not

diminish the importance of the health impact- the hundreds of

thousands dead worldwide- in doing so.

My worry is whether the fear of interaction becomes the ‘new

normal’, even when the virus is finally under control. Will a

seven year old who spent their formative years in primary school

watching their parents turn their head away from people on the

street, be in a position to strike up a conversation at a bus stop

in twenty years? Ultimately society will progress as normal. The

next generation will still be productive whatever happens, as many

businesses can be fully contactless both in payment and

interaction if needed. But where is the magic in that?

I have no idea what happened to my Irish friend. Neither do I have

any idea what happened to the troubled man who I struck up a

conversation walking back to Parramatta Station after he had been

kicked out of Centrelink for swearing at the staff. He was

frustrated- he was trying his best with a poorly dealt hand and

unfortunately sometimes the natural response is anger. We chatted

about what’s wrong with society, and like the Irishman, I never

saw him again. Did he end up getting a job? Is he happily settled

and raising a happy family now? Or did the pent up anger lead him

to commit a crime? I will never know, and in that there is the

magic. Not knowing the ending doesn’t diminish a treasured moment.

So for now, my eyes are turned towards the American Pharma giants

like Pfizer, praying that their brazen confidence that a vaccine

will be ready by early 2021 is true. Because for me one of the

core pleasures of humanity is the chance meeting with a stranger

never to be seen again- let that never not be part of a ‘new

normal’.

37


The

fight

Against Gender Based Violence

For most of us, the idea of eliminating worldwide violence against women is well and truly in the ‘too hard’ basket.

But not for feminist icon Dr Emma Fulu.

Interviewee : Emma Fulu

By Kate Maddams

Dr Fulu is a global leader of research into violence against women as well as the founder and CEO of The Equality

Institute, a Melbourne-based agency focusing on ending violence worldwide.

Good morning Emma, thank you for chatting to me today. I wanted to start by getting some insight into how

and why you started The Equality Institute.

I’m a researcher by background, and have been researching in the field for almost 20 years now. I initially was

doing a degree in International Development Studies at university where I became interested in the gender

dimensions of international development. My family is actually from the Maldives, so when I finished my

honours degree I went to the Maldives to work at the Ministry of Gender. One of the first things they asked me

to do was look into the issue of violence against women. They had anecdotal evidence that the problem existed

but didn’t really know the scale of the problem so they asked if I could try to do some research.

I ended up working with the World Health Organisation (WHO) to do the study – the first national prevalence

study in the Maldives .

From then on I kept working in the space. I’d found my passion. I worked with the United Nations (UN) and then

moved to South Africa to lead another global program on violence prevention. In the midst of that I had 3 kids.

So I was doing a crazy job, travelling a lot, and the truth is I burnt out. I knew I was still passionate about the

work but was struggling to do the career. So I moved back to Australia to be closer to my family and to re-asses,

and that’s when I started the Equality Institute.

I started it with the idea that I wanted to combine research with policy and create a space where there was

nurturing and I could balance my career with my family. It started small but it has grown now to be a global

agency. We’ve worked in more than 20 countries, we have an office in Timor-Leste and I’ve since set up a charity

in New York.

That sounds very exciting. Could you tell me a little bit more about what you do at The Equality Institute?

38


We’re a global feminist agency and our priority is advancing gender equality and ending violence against

women. We do that through 3 core areas – research, creative communication and policy and advocacy work.

So for example, we do a lot of research to try to understand violence against women and also to evaluate

programs and policies to see what’s working in different settings. We then work with a lot of global

organisations like the UN and Word Bank to help set the policy agenda, and then we also do work on social

media to ignite the conversation around feminism and gender equality and how to end violence.

It sounds like extremely rewarding work yet at the same time the content of the work is also deeply upsetting.

How do you manage the nature of the work?

That’s a good question. The focus of our work is predominantly on primary prevention, so trying to address the

root causes and we take a very positive, strength based, empowerment approach. So even though the content of

the work is very heavy, because we are working to create positive change, that keeps the work positive and

engaging and it feels like you’re doing something meaningful. For me, I feel like I’d be more depressed if I wasn’t

doing anything towards the issue. It’s a deep passion for me and for members of my team so I think as hard as it is

some days, we all feel better for actually trying to do something to end violence against women.

I think we also see change happening, so while from a distance it can look like this issue is overwhelming, that’s

not true, we are actually seeing rates of violence decrease in some countries, we are seeing programs that are

actually having an impact on the ground and we are seeing women and girls all over the world leading that

change which is really inspiring. So most of the time I feel inspired more than I feel upset, but we do have to take

care of yourself as well because it is hard work.

You know when I started in this field about 20 years ago, no one was talking about violence against women and

now it’s on the global agenda. There’s the sustainable development goals which all countries have to report

on. In my career I have seen massive change, and that’s motivating.

There’s been some concerning reports of increased violence in the home during COVID-19 lockdowns around

the world. Can you expand upon this?

Sure. There definitely is, and while we still don’t have all of the data, what we do know is that in Australia

we’re seeing increased rates of reporting around violence against women. We also know that during the

lockdown, unfortunately home isn’t always the safest place for some women and children. It also makes it

harder for these people to seek support. We’re also seeing diversity in the types of violence that women are

experiencing, for example technology facilitated abuse and more controlling behaviour.

The pandemic is also impacting gender equality through risk of catching the virus. In the vast majority of

countries, a higher percentage of front-line workers (health workers for example) are women, putting these

women at a higher risk of being infected with COVID-19.

On top of this there have been interruptions of supply chains for medical products. For example women’s access

to contraception is being impacted because the world’s largest IUD factory has shut down. Shipping

interruptions are also worsening the issue. So there’s a huge number of flow on effects that we’re just starting

to get a better sense of, but we really need to collect more data to get a better understanding of the situation.

39


At this point, we really need to focus on violence against women, and we also need women to be leading to this

response because they know the issues that they are facing. It’s a really challenging time for many, many people.

Do you think the Government is responding to this appropriately?

I think there is definitely more that could be being done. Importantly, ensuring that response services are well

funded, but also looking at other ways to protect women in vulnerable circumstances.

I think there’s the opportunity for using this time to create long term changes. It’s a complicated issue but we

have some lessons from a humanitarian context, that when things fall apart, as challenging as the situation is,

it also offers opportunities.

In Australia we currently have the chance to think about long term systemic and structural changes, and to

improve gender equality through this process. That could be things like restructuring childcare and thinking

about existing child caring responsibilities as well as norms around men and women’s work. It’s a time when all

of these norms are being disrupted and I would like to see more of that long-term change and investment in

transformation rather than just responding to the crisis. I think we need to be thinking more holistically

about what’s possible to create in the post-COVID world.

As junior doctors and future doctors, is there anything in relation to gender-based violence that you think

we should be aware of?

Violence against women is now defined very clearly as a global public health issue. The evidence is clear that it

has an impact on women’s physical, mental and reproductive health. We also know that in Australia it’s the

greatest heath risk factor for women in their reproductive years - greater than smoking, alcohol and obesity.

What we know is that women who experience violence are engaging with doctors and health professionals

more often. So doctors are inevitably going to be seeing women who have experienced violence. Globally 1/3

women will experience sexual or physical abuse. So you will be seeing those women. The issue is that they don’t

always present as experiencing violence through injuries - they may be presenting with a variety of other

health consequences and concerns.

There’s a lot of work being done globally to help health workers identify and be able to provide the right

treatment for people who are experiencing violence. So I would say it’s being aware.

Alongside this awareness though, there really needs to be a whole health system response. It has one of the

highest health burdens of any health issue facing people in this country.

The WHO has some great guidelines on this for healthcare professionals. And it does really require training.

It’s not just about asking the basic questions, it’s also about noticing the subtle signs and symptoms that might

indicate experiences of violence. It’s also about being able to ask in sensitive and safe ways and then knowing

ways to support women. I think it’s an area that should definitely be introduced into medical training.

As medical students who are passionate about feminism and gender equality, do you have any suggestions for

how young people can advocate in these areas?

40


Dr EmmaFulu

A few ways! There’s a public health approach. A lot of the work globally being done in the field of violence

against women is being completed by public health experts who are medically trained. So there’s always the

opportunity to combine being a doctor with a public health focus and then potentially have an influence on

policies and health promotion in that regard.

But I also think it doesn’t necessarily have to be through the health space, it can be through talking about

these issues in your families and communities or finding local organisations working on gender issues. I

recommend trying to identify the space that you’re most passionate about, finding like-minded people and going

from there. We (The Equality Institute) will also be starting to develop more resources and support for people

to engage with these issues.

What’s your vision for The Equality Institute?

Within our organisation, we envision a world where diversity is celebrated, all people are respected and

resources are shared. We recognise that we are one player in a big ecosystem and we’re trying to contribute in

areas that we feel like we can.

Personally, I tend to be a big dreamer. I’ve always been interested in pushing things further. I have a vision of

supporting people to be themselves, because I really feel that everyone benefits from gender equality - it’s really

about people having the freedom to live the lives they want to live. I personally feel like feminism is for everyone

and feminist leadership can help transform the world. So I guess my big vision is expanding the reach of that

type of work and broadening the people who feel engaged in this issue. For us at The Equality Institute, that

manifests in lots of different forms and I’m really open to seeing where that takes us as an organisation.

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