“Going rural”

Whether you’ve had your heart set on studying medicine in a rural setting for years or you’ve never quite considered it for you, it won’t hurt to find out more about it! We’ve asked Sachi Senarath for his thoughts, based on his experience so far. Sachi is a current 3rd year medical student doing a placement in Sale for this year.

Before the start of this year, what sort of experience did you have in rural health?

Prior to third year my experience in Australian rural health was very minimal. The only instance when I was exposed to it was when I went on a 2-week rural placement in 2nd year to Mildura. That experience was very enlightening and gave me a good exposure to certain aspects of rural healthcare, but I was set on doing a rural placement even before that.

From my childhood growing up in Sri Lanka, and undertaking some volunteering trips throughout my time at university to India and Nepal, I have experienced rural health on in developing countries. This was my primary motivation for wanting to learn more about rural health in an Australian setting, to compare the similarities and understand the differences in issues of rural health between developing and developed nations.

Why did you choose to be placed in a rural health centre?

Several reasons predicated my decision to opt for a rural placement.

Further to the aforementioned reasons, I also chose to be placed at a rural site because it provides more opportunity to be involved than at metropolitan sites. Ward rounds often consist of smaller teams and less students, so we can play a bigger role in the team and do things like write patient notes on ward rounds, do pre-surgical assessments, assist consultants with appointments in their consulting rooms and a whole host of other things that may seem very minor, but also very important and valuable to experience. There is also minimal stress with getting procedures ticked off on our logbooks.  As there are fewer students, there is ample opportunities for everyone to get involved, which helps alleviate the year-long chronic stress of wanting to experience everything throughout the year and having to compete with other students to do so. At rural sites, passing up an opportunity is quite minor because it will almost always come up again, whether it be taking bloods, giving injections, going into theatre to see surgeries, working with the anaesthetists and much more.

sachi in sale
“These smaller group settings [provide] more opportunity for me to ask questions, speak up and place myself in situations outside of my comfort zone.”
Another positive aspect of a rural placement is the individualised teaching, or at least that’s what it feels like. At Sale, there are only 10 of us, so you form a very close bond with the people around you and the clinical staff. Even didactic lectures turn into close-knit tutorials, and I prefer that sort of learning because it is more engaging and less intimidating than bigger crowds. As a person who is somewhat reserved by nature, these smaller group settings is something that I value because it provides more opportunity for me to ask questions, speak up and place myself in situations outside of my comfort zone.

I also wanted to challenge myself. Medicine should not consume our life. I wanted 3rd year to be one where I allow myself to live away from the comforts of home and family and get used to fending for myself by living away from home for the first time. As much as for the experience of placement itself, I chose to go rural because it is very different to what I have experienced in my life so far and I wanted to gain more experience and grow as a person in the process. Another thing to keep in mind is that as future doctors, we should allow ourselves to be exposed to all that healthcare has to offer in our country. An important part of this is understand how healthcare functions in its various settings, and I thought that rural healthcare is a very important aspect that I ought to experience so that I know how best to make a difference when I am capable of doing so.

Has it met your expectations or have there been any surprises? What is the craziest thing you’ve seen or done in Sale so far?

So far, my rural placement has been really good. I don’t think I can say there has been any surprises because I didn’t have any expectations at all going into the placement so everything was new. It was quite overwhelming at the start when everything including the people you meet, the hospital you learn at, even the very aspect of this being our very first clinical year, and even the house you live in and the bed you sleep in being so different to what you are used to. So all of that does take you by surprise I suppose, but not in a negative way.

As an extension of that, the definition of “crazy” also tends to change depending on what time of the year it is. If it’s the start of the year, then every day is crazy because all that we see is new to us. Walking into theatre wearing scrubs was a thrill, and that soon wears off and something else takes its place, like actually getting to scrub-in for a surgery and assist the surgeon. There are the various MET calls from the ED that offer another rush, or getting to put a cannula into a patient before they go into the operating room. I got to scrub-in for a mastectomy when the surgeon needed some extra hands to hold things and took the opportunity to do some live teaching as he was operating. Then there was another time when a patient was not breathing once they were put under anaesthesia and the anaesthetic team struggled for what seemed like ages trying to get the patient stable.

I think the biggest thing has been how quickly I have managed to settle in and absorb all of these things.

Doing a rectal exam on a patient would have sounded preposterous to the Sachi of 2nd year, but now I have come to accept it to be just another part of an examination, in the same way I have come to grips with how loops of small intestine look on a patient whose abdomen has been opened up with a mid-line incision.

How does it feel being away from home and family?

Initially, it takes some getting used to, but I don’t think it has been overwhelming. I am able to be back home once every fortnight or so because the drive back home is only about 2 hours. Rural doesn’t mean that you have to live under a rock, all the basic amenities you have back home will also be accessible wherever you are placed. I call my parents most nights and stay in touch with friends online just as I would do back home. Once you have settled into the new house and set up your room the way you want it to, it feels like a second home and you get used to the life very quickly.

The clock tower
The clock tower in Sale

Is transport ever a hassle?

In my experience in Sale so far, transport is never a hassle. For us rural students who get student housing very close to the hospital, it’s a short 5-10 minute walk to the hospital in the morning. And if we are too lazy to even walk that distance or are running 5 minutes late, there is always plenty of free all-day hospital parking so you can cut down the short walk into a 30 second drive.

For us at Sale, we also get some placements at Bairnsdale hospital for a few weeks at a time. We are also given student housing close to the hospital for this. But it does still require us to drive from Sale to Bairnsdale each week so having a car is pretty much essential to be placed at a rural site. We get reimbursed for the petrol, and there is no additional cost for the extra accommodation.

How are you finding the community?

The Sale community is a friendly bunch of people living within a nice and tranquil neighbourhood. It’s like a toned-down, slower-paced version of a typical metropolitan suburb. The hospital staff are largely locals too, and the students, interns and registrars are also on rotations so they too are provided with local housing. Over time, a natural bond forms between groups and people as the students become closer to one another through shared experiences, and these groups extend to include 4th years, 5th years, interns and registrars. So in addition to feeling part of the local Sale community, you also begin to feel that you are not alone because there are plenty of people living away from home just like you.

Port of Sale

What have you noticed that is different between rural and metro hospitals? Or what have you noticed that is similar?

I’ve probably answered this question in my previous responses. But I’ll try to add some more points of note. Rural hospitals are smaller in size and staff and patient number. It also means that students like us get access pretty much anywhere and are able to see most things that happen. The staff come to recognise us quite quickly and those who are more helpful might even seek us out for certain procedures or teaching opportunities. There’s a quickly-established sense of familiarity which probably stems from all these factors, and I feel it’s not something that is as achievable in a metropolitan hospital.

In terms of similarities, the healthcare of patients functions much the same way, as it should. The rural hospitals live up to same strict standards of healthcare as their metropolitan counterparts, with the added considerations of potential transfers of patients to bigger hospitals. The aspect of holistic healthcare also takes a more prominent seat in a rural setting when you have to consider the distances patients have travelled to get treated. I have come across one patient who lives alone in a farm that is 2.5 hours away from the hospital, and 2 hours away from her normal GP. These aren’t situations that may be seen in a metropolitan setting.

sachi in sale 2
“The staff come to recognise us quite quickly… there’s a quickly-established sense of familiarity.”

What advice would you give to a medical student who is considering going rural?

I think a rural placement is a great opportunity. It allows you to broaden your horizons on how different rural healthcare is compared to what many metropolitan based students might be used to. Even if practicing rurally is not a future goal – I am still undecided on what exactly I want to do – a rural placement will give you a broader understanding of not just medicine, but also provide the opportunity for self-improvement, with having to live away from home but also learning to forge new friendships and learn in a new environment that will become very familiar over the course of a year. I am a person that prefers variability to constancy, so being able to live away from home, but come home for the weekend, or have a placement at another hospital like Bairnsdale, are all things that makes the year more variable, and I really enjoy that. And on an yearly scale, you can plan to do a rural placement in 3rd year, and an urban placement in 4th year, and gain experience from both sides of this rural vs. urban debate.

Understand that each side has their ups and downs.

Rural sites have a lot of good things, but there are some disadvantages. The primary one is of course being away from the comforts of home, and having to fend for yourself. Also, the teaching varies across various sites, and some tutors are better than others. Overall however, metropolitan teaching is said to be better, in terms of exam-related content. That is not to say that rural students fail, not at all, it just means in certain cases we have to put it more effort and rely on textbooks to learn certain concepts. Also, many of the conditions seen at rural hospitals may not be as extreme as patients treated in metropolitan hospitals. Rural hospitals are not as equipped to treat patients who are very critical or to perform certain procedures, so such patients are often transferred to bigger centres. This provides our metropolitan colleagues the opportunity to witness such things, leaving those of us rurally with more basic cases. In reality however, I think exposure to more basic cases is more helpful at a medical student level, where basics are what’s really needed to consolidate our learning.

My final advice – deciding between a rural or metro placement shouldn’t be a source of stress. Know that no matter where you are placed and despite any lows, you will still grow as a person and also in your medical knowledge. Medicine is a marathon of building on top of what you already know, a non-step journey of learning. If you keep that in mind and adapt to learn and make the most of your experiences, you will be more than fine.


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