Latest News

Benjamin Lepke

Hello and welcome, everyone to our first edition of 1 in Focus. This is a podcast series brought to you by 1Medical and it aims to shine the light on some of our favourite doctor’s careers and some of their experiences, potentially some advice and just an idea about some of their interests outside of the wonderful world of medicine. To kick off our series, podcast number one, we welcome Dr. Michelle Withers, a Senior Emergency and Retrieval Specialist based out in Alice Springs. With a wealth of experience in many rural locations around the country and a passion for animals. We couldn't think of anyone better to join us for our first podcast. So welcome, Michelle. How are you? How's your day?

Michelle Withers

Yeah, good thank you just got back from the desert park so it’s always a good day there.

Benjamin Lepke

Very good but we'll come on to that in a little while. So, what I wanted to do is, first of all, I would like to start off by taking the time to thank you for coming on board and taking a bit of time out of your busy day because I know how extremely busy you are. Let's start a little bit by if you could give our listeners an overview of your medical career, and why did you get into medicine in the first place?

Michelle Withers

I'm not quite sure actually, but I guess my background is I grew up in Zimbabwe, and then when I was about a teenager, my family immigrated to England. So, I did my secondary school in the UK, and I've always been a bit interested in how people work so I just kind of naturally drifted into medical school but no one else in my family has ever been a doctor before. So, I was the first that I'm aware of to be a doctor in the family, so I did enjoy training in London at St. George's Hospital Medical School, I think I had excellent training, there were really amazing teachers and mentors and then you have to kind of decide what you want to do with your career and I had done the usual house officer jobs, as they’re called there, like medicine and surgery and then I had scored a job in an emergency at St. Mary's Hospital in Paddington but they used to recruit for the whole twelve months, and they gave me the job for the second six months, so I had six months to fill, and I got an honorary position in Cape Town at the Red Cross Children's Hospital in the trauma unit there for three months, and so that combined with the following job in an emergency at St. Mary's, I thought emergency medicine was interesting and that's what I wanted to do. At that stage, there was no college for emergency medicine in the UK so, you had to either do medicine, surgery, or anaesthesia for your membership, and then you went on and did some extra surgeons got that and then became an unaccredited registrar in emergency medicine at Mary's in Paddington again. I was sort of like kicking around trying to get a training number in the UK and someone said “oh, why don't you go to Australia, they've got good training there for emergency medicine”, I thought oh that’s a good idea, it gave me good references and good experiences. So, I came over to Sydney and got a job at Liverpool hospital in 2003 and loved it and at that stage, the College of Emergency would let you train in emergency even if you weren't a permanent resident.  So, I actually enrolled in the training scheme here and one thing led to another, I just looked up, and suddenly I was a consultant in emergency medicine in Australia, and then in my final year. I got the chance to do a rural rotation to Alice Springs and I already had a couple of friends here, so I'd been out here a couple of times, loved it, and they had a consultant position available when I qualified as a FACEM, so started here as a consultant in 2009 and pretty much been here ever since.

Benjamin Lepke

Excellent, so the pull of the regional and rural locations with potentially drive or derived from your time in Zimbabwe, where you were born and then moving, over to the UK.

Michelle Withers

A little bit. I also think it was about coming here as a registrar and working with a really good team of consultants that were really supportive, good teachers, good mentors, and because it wasn’t, I guess you get to do more in a rural emergency department. You're not as surrounded by specialists and super specialists and senior people to always be in there doing all the difficult things or supervising you sometimes you just have to be the doctor. So, I think that's the appeal is you get to be the doctor when you're in a rural regional place and if you can't do it, there's not always someone to back you up, so you kind of have to be able to make a plan with limited resources, which I enjoy the challenge of that.

Benjamin Lepke

Absolutely and then you're progressing through your career in Alice Springs, you then took on a role of splitting that with doing retrieval work as well.

Michelle Withers

Yeah, so from the beginning, I was involved with the retrieval service here because as part of my training, I did six months with what is now Sydney Hems on the helicopter and so when I arrived here, the retrieval service was in its infancy and the ED doctors used to kind of fly retrieval shifts and then Richard Johnson took that on as the director of the retrieval and was sort of instrumental in was Richard and Steven Gourley was instrumental in sort of pushing the development of a formal retrieval service and so, I always had a bit of a peripheral involvement with that, because my main role was the Director of Emergency Medicine training for the college as a co-director with Hillary Tyler, and then Shane Tan later after that. So, I basically I still remained involved in retrieval but when we got the go-ahead to establish the retrieval coordination centre in about 2017 they were like yeah, you've got three months to set up a Retrieval Coordination Centre, they needed a core group of people who were happy to just put in the hours, and the thinking, and the clinical time to get that set-up so, there were five of us involved in that, getting that up and going with a pretty tight deadline and I was one of five so, I really enjoyed that challenge as well.

Benjamin Lepke

Excellent. It's a very good service as well, a lot of people want to go and work in Alice Springs in the retrieval. What is it about retrieval that you enjoy? splitting your time between ED and retrieval? You know, some ED physicians do it some don't? What is it that you know excites about the retrieval?

Michelle Withers

I think the reason people enjoy retrieval is it gets you out of the hospital, and you have more direct one-to-one responsibility for your patient and you're working with either flight nurses or paramedics and, flight crews so, it's a bit more personal setup than ED, which can be very big and a bigger team. It's a bit more like anaesthetics, you have your core team, and you're going out and you've got one or two patients that you're responsible for and again it's that curveball of like, it's not a nice, controlled environment, much as people probably don't think that ED is controlled, at least there's a lot of backup and equipment and you can call for help when you need to. Whereas one of my colleagues when I was training, coined the phrase about retrieval, “it's where nobody can hear you scream” so if you are stuck somewhere, and your equipment fails, or you know you don't have the resources you need, you have to be able to, come up with a plan to do the best you can for that patient in that situation. So, I think that's the challenge of retrieval I think, probably that's what appeals to a lot of people.

Benjamin Lepke

Absolutely, any memorable retrievals that you can think of?

Michelle Withers

No, there are too many to mention, and I probably couldn't discuss them in detail without breaching patient confidentiality, but the memorable ones are always the ones where you had a big challenge, and you somehow managed to get the patient home alive.

Benjamin Lepke

Yeah, absolutely which is the aim, with that there are a lot of junior doctors in the world that are coming through their critical care training, ED, anaesthetics, ICU that have the view to get into retrieval down the line. What advice would you give to any of your doctors that are starting out in their training, to really bolster their chances of getting into retrieval service down the line? Is there anything you would look for in what people have done, when you were picking staff?

Michelle Withers

Well, it's interesting, because I think what we look for out here would possibly be slightly different than what the city hems-based retrieval services would look for.

Benjamin Lepke

We'll talk about Alice, what would you look for? Because there is a lot of people, I know that want to go out?

Michelle Withers

Yeah, I mean I think common sense and also an ability to be flexible and adaptable when you're operating in non-ideal circumstances. I think in terms, of terms to do in your training, good critical care skills obviously, you need to be able to manage airways, you need to be able to manage sick patients that require support for circulation, sepsis, etc. but also, a breadth of experience if you're going to do rural retrieval, you need to be able to deliver a baby and manage postpartum complications and deal with psychiatric emergencies and you know, have a really general experience. A general practice term or ACRRM training would be useful and then critical care training would be useful, pretty much anaesthetics, ICU, emergency, and rural general practice would be the core terms and if you can get obstetrics, psychiatry and paediatrics would also be useful, don't forget a third of our patients are children and I think these days, a lot of the big hospitals in the city are adults-only departments so, people are quite scared of looking after children. So, if you are coming to Central Australia to do retrieval you’ve got to be comfortable with the cradle to grave age group and you’ve got to be comfortable, not only with the high-end critical care staff but with the complicated chronic disease picture and with all of the subspecialties, you can't have something where you're like, I don't know anything about that so, get a good broad general experience and make sure your critical care skills and your decision making, and your common sense, have had lots of practice.

Benjamin Lepke

Yeah, absolutely. It's certainly not something for the faint-hearted. I’ve definitely seen an increase in the interest from the more junior ED doctors that I'm talking to people want in a bit of a challenge and want to get out there and get into the retrieval service so, this information that you just said it’s great for them to take in heave so, thank you for giving us an overview on you on the medicine side of things. I just want to slightly step away from that now, you mentioned at the beginning, you just come back from the desert park in Alice Springs. Could you give us an overview of what is that for our listeners that don't know? And what's your involvement in the desert park?

Michelle Withers

Yeah, okay, so the Alice Springs Desert Park is essentially a combination of a zoo and botanical garden, I guess would be the best way to describe it. There is a similar one up in the top end called Territory Wildlife Park and I think that both of them are great, of course, but I think the Alice Springs Desert Park is better. What they want to do is showcase the ecosystems and the wildlife and, also a bit about the cultures of the local area. The desert park is divided into different sort of areas according to habitat, I guess you'd say so, there's like sand country, there’s are woodlands, there’s desert rivers, it's set up that way that you can kind of walk through it and experience the different ecosystems that you might encounter if you out bush here and then they've got the native plants and native animals and birds that you would be likely to see in those environments and then talks are given about not only the animals and birds and sort of flora and fauna but also here are some good talks about the local cultures and the sort of tools and weapons and foods that people would traditionally eat in our area so that's the front end of it. That's what you see when you come as a visitor and then obviously, at the back end of it, there's a whole lot of zookeepers and horticulturalists and botanists and people keeping it going at the back end and they have volunteers that help them to keep it going. So, there's a lot of volunteers that contribute at the back end from the ladies that come in and chop up the vegetables and prepare the food for the animals, to people like me who come in one day a week when I'm available and I assist the mammal’s keepers, with looking after the animals in their nocturnal house and also there's an area called holding, which is not open to the public, but it's where some of the breeding programs and other animals are housed. So, it's not just what you see at the front, there are also breeding programs for endangered animals so, for mammals, there's a breeding program for the mala, which is the Rufous Hare Wallaby, which is I think is either extinct in the wild or critically endangered at the very least, and also the Red-Tailed Phascogales, which is a little about sort of the size of a sugar glider, I guess, or maybe a bit smaller. But there's sort of a carnivorous marsupial that's nocturnal that not a lot of people know about, and they're also endangered so they've got a breeding program for those two at the moment. They've had other things come and go depending on, what the resources are at the time so yeah, I got involved in that through friends of a friend, and very much enjoy it. It's a completely nice one-eighty from working with humans in the emergency department.

Benjamin Lepke

Yeah, I can imagine. It sounds great what they're doing is it is the plan to reintroduce those animals back into the wild, or are they keeping them?

Michelle Withers

So Australian Wildlife Life Conservancy is kind of the group that is doing more of the reintroduction things. So, they've got a property up in New Haven up near Yuendumu that used to be a station and it's now got a predator-proof fence and they are slowly reintroducing some species there. There was a recent podcast on the ABC conversations podcast actually I think last week interviewing one of the researchers who's looking at ways that these native animals might be taught to become more wary of predators such as cats and stuff like that. So, there's a lot of research going on about that, but the desert park’s involvement is essentially to breed populations of these animals that would then potentially be available to either go to other breeding programs for genetic diversity or to be reintroduced to the wild, in hopes they can thrive in these predator-proof enclosures.

Benjamin Lepke

Very good. Sounds very exciting. I'm definitely going to be making it my mission to get out to Alice, when we're all allowed to come to see you and come and visit the park, absolutely. Is this a plan to replace Medicine at any point?

Michelle Withers

No, look, I've spent, you know, 20. What is it? 23 years? As a doctor? No, yeah, more than that a long time anyway and I don't think I'll give it away as a career, I'm just interested in the intersection between humans and animals and the environment with regards to health, and I'm actually studying with the University of Edinburgh, the online master's in one health, which is exactly that. So, I guess, the volunteer work at the Desert Park kind of intersects nicely with that interest, and at some point, for my master's, I'll have to do a dissertation. So, I’ll need to do some research, so I'm also kind of exploring what might be, you know, not only something that I can do for my research to get tick the boxes of fulfilling the master’s but I'm actually quite curious to do some research that might be useful or relevant to Central Australia so I guess that's what I'm exploring at the moment is what might be a good project and what might be potential outcomes there so.

Benjamin Lepke

Brilliant, it’s excellent what you’re doing, I’m envious I would love to do something of the same may be in later life, I suppose.

Michelle Withers

We will see what I've managed to achieve, but at the moment is just kind of exploring and making contacts and reading up and learning more so yeah.

Benjamin Lepke

Superb, okay, well, look, Michelle, I will leave it there, I feel that we've got to know you really quite well and you've given us a really great insight into, your experience, your career where you come from what you're doing at the moment. Thank you ever so much for your work with 1Medical, I appreciate it and very much enjoy working with you and I look forward to working with you into the distant future.

Michelle Withers

Thanks, Ben. I think 1Medical’s provided a really good personal service in the locum sort of scheme of things and being able to locum at the moment, it may not be what I want to do forever, but at the moment, it gives me the flexibility to do what I want to do and still pay the bills and also to explore, different departments around the Northern Territory and other parts of Australia to sort of see what it's like to work in different places because I think you can get quite stale if you work in the same place for your whole career. It's always good to see how other people do so, it gives you that chance to tippy-toe in the water and see how it's done elsewhere.

Benjamin Lepke

Yeah, great. You highlighted some of the major benefits of doing locum work. So yes, it's great it's great to have you onboard and help you see those different places. So, I will leave you to your Friday afternoon and weekend ahead. Enjoy yourself and I will I'll speak to you soon. Thank you ever so much, Michelle. Cheers.

Michelle Withers

Bye

Benjamin Lepke

Bye