Childbirth in a country practice: a sometimes risky business

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Leongatha Hospital is served by a small number of GP Obstetricians (Photo: David McAlpine)

Expectant mothers in many small rural communities lack much-needed access to specialist doctors in the field of pregnancy and childbirth, experts say.

While pregnancy is an exciting time for mothers, it can be terrifying for those experiencing complications, particularly in rural areas distanced from large metropolitan or regional hospitals with specialist expertise and facilities.

In Leongatha, a town of  5000 people 135 kilometres south-east of Melbourne, a small team of five General Practitioners are qualified to provide obstetric care for low to medium risk patients.

High-risk patients must travel to the nearest regional centre to visit specialist obstetricians because Leongatha does not offer regular visiting consultations.

Leongatha mother Helen Pickering is expecting her second child and is concerned with the lack of specialist obstetricians, particularly the perils of travelling to a larger regional hospital if complications arise.

“It’s obviously becoming an issue because there’s no specialist there in the last week of my pregnancy, when things could go wrong,” she said.

The birth of her first child 10 years ago involved a last-minute complication requiring the local doctors to reposition the baby and deliver using “cups”, to avoid a posterior birth.

The alternative, a Caesarean birth, would have required a specialist anaesthetist to travel almost an hour from the Latrobe Valley to assist.

Ms Pickering said the risk of stillbirth and other complications with her second child is heightened because of her age, however the absence of other risk factors means specialist involvement throughout the pregnancy had not been necessary.

Instead, the GP team has recommended more regular appointments and ultrasounds for Ms Pickering, with the option of inducing the birth a week earlier to reduce potential risks.

Leongatha Healthcare GP Obstetrician Dr Elise Ly said a specialist obstetrician would only travel from another area in extreme circumstances.

“The reality of Australia is you can’t have everyone living close to a tertiary centre,” Dr Ly said.

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Local doctors with training in obstetrics care say they provide a valuable service to their rural community (Photo: David McAlpine)

The Leongatha Hospital delivers about 200 babies a year and provides an operating theatre for the one in five births that by Caesarean section.

GP Obstetrician Dr Sewellyn Gale said pathology and radiology services are available but the hospital lacks a special care nursery for critically ill babies and access to extra blood products.

Dr Ly said the GP obstetrician qualification, which trains general practitioners in primary obstetrics care, ensures they are prepared not only for regular births but also for managing complications and emergencies.

“That’s sort of the expected standard, that if you’re going to provide an obstetrics service and if you’re going to provide theatre services, the people that are providing the services need to be trained in some sort of ‘first aid’ for obstetrics emergencies, before being transferred,” Dr Ly said.

Dr Gale said the service could only provide short-term urgent care for more complex obstetrics emergencies, such as pre-term babies, requiring a specialist obstetrician and more advanced facilities.

“It depends on the level of complexity. So the next step after us would be the regional centres at Traralgon and Warragul,” Dr Gale said.

If it is beyond the capabilities of the nearest regional hospitals, patients are transferred to Melbourne, often to Monash Medical Centre.

GP Obstetrician Dr Joel Fanning said they have to take extra precaution when transferring women in emergency care to a regional hospital because of the potential for complications while being relocated, as well as possible delays if an ambulance is not immediately available.

“You have to take into account the potential for her to progress on the road, so it might be safer to deliver the baby here than to have her delivering in the ambulance on the way over to one of those services,” he said.

Dr Fanning said patient satisfaction remains high because the local service provides individualised care, unlike hospitals in metropolitan areas in which patients may become “lost in the system”.

“The personalised element is wonderful. As health professionals, we enjoy that and I think that the patients enjoy it as well because they have continuity of care,” Dr Fanning said.

“Without bagging the tertiary centres, I think that from my point of view and I think from my patients’ point of view, they have a high level of satisfaction because of the personalised care,” he said.

Dr Ly said there is not a one-size-fits-all solution to obstetrics care.

“I don’t think we’re bagging anyone out, I just think there’s pros and cons of big hospital systems and smaller hospital systems, and being aware of them both means that you can address them,” Dr Ly said.

In order to improve rural maternity services, Dr Fanning said more funding should be directed towards GP obstetricians, particularly to cover after hours work.

“It should be highly valued by the people deciding how much medical staff are remunerated,” Dr Fanning said.

 

David McAlpine is studying a Science and Arts double degree at Monash University and is a freelance science and health journalist. He tweets as @dreamingscience

This article was first published by Mojo News, Monash Journalism’s online magazine www.mojonews.com.au

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Monash PhD student designing ‘smart’ drugs using nanoparticles

Written by David McAlpine for Monash University’s Faculty of Engineering.

Imagine a tablet that could reduce the side effects of cancer treatment by releasing a dose of medication at a particular organ or tissue.

Shahrouz Taranejoo, a PhD student in chemical engineering at Monash University, is making this a reality by designing systems that help to target drugs or genes to specific areas and control their release.

His ‘smart polymeric system’ uses several layers of nanoparticles to coat a drug particle, with the sacrificial coatings degrading at different locations as they pass through the digestive system.

Read more on monash.edu

Pottering Around

The tranquility of my garden

There has been much hype in recent years regarding Horticultural Therapy, that pottering around in the garden improves one’s mental wellbeing.

Last year, mental health awareness organisation Beyond Blue shone the spotlight on this humble public health strategy, partnering with nurseries nationwide to promote pottering around in the garden as a way of fostering healthier minds and bodies.

This is not a new concept. It was believed over a century ago that garden and farm surroundings assisted with the health of patients suffering from mental illness in the often oppressive and traumatising asylums.

Scientific studies have demonstrated that horticultural therapy in healthcare settings improves mood state, thus reducing stress and aiding both physical and mental health. One study, for instance, cites subsequent benefits to cardiac health. Other research suggests that ‘wander gardens’, typically designed to assist in the care of sufferers of dementia, also provide the essential first steps in gaining independence when recovering from stroke, improving attention and reducing stress. Furthermore, it has shown to contribute to patients feeling less self-conscious of their post-stroke neurological deficits and thus assisting with their normal rehabilitation program.

This type of environment has the potential to both escape the reality of their illness and exist in peace, at least for a short while, away from the odour of disinfectant, noisy corridors and exhausting physiotherapy sessions. Place definitely has the potential to alter the perception of our reality.

My elderly Great Uncle has been very ill of late but when he is well enough to walk, his first mission is to stand on his back step and check on his backyard full of vegetables. Part of his ‘unofficial’ physical and mental recovery has been tending and nurturing the dutifully sown fruits and vegetables which have not only provided him with great pride but also supplied most of the grateful neighbourhood! It has certainly been a relief from and tastier than hospital food or Meals on Wheels!

On the other side of the world, horticultural therapy has been utilised for many years in the context of the estimated 20% of British military veterans facing invisible wounds of conflict. Before closing in late 2015 due to financial difficulties, the ‘Gardening Leave’ program tended to troubled veterans in their journey with mental wounds and their transition to civilian life, with sessions individually designed to maximise physical, psychological and social strength. The gardens reconnected them back to the reality of civilian life, home and nature and away from the horrors of war.

Further to horticultural therapy being utilised in the hospital setting and for those with physical and mental disabilities, pottering around in one’s backyard garden or simply being at peace on a park bench in the spectacular Royal Melbourne Botanical Gardens is also beneficial for all of us.

During a trip to Sydney this time last year, I disappeared from the city noises by stepping through the gates of my accommodation and into a peaceful and serene garden, bustling with bird life and the evening breeze. Little would one know from the inside that behind the walls and sheltering trees was one of city’s corporate hubs; it felt as though I was at home amongst my own garden.

I am a keen green thumb myself and enjoy escaping from computer screens to immerse myself in the outdoors, whether planting tens of trees or simply pottering around raking and pruning. It is also a family affair; Nanna (my great-grandmother) loved her cottage garden, my Nan planted three acres of bush forty years ago and my Mum has created a two acre oasis from a bare block apart from a few established Eucalypts.

My woodworking is a similar pastime in its objective and application. The wholesome material of timber, the uniqueness of each section of grain, the cleansing nature of its aroma and the sawdust on one’s hands is akin to gardening; one nurturing the plants when alive and the other crafting its products into practical and beautiful forms. The creativity that can be expressed is as beneficial for the mind as it is for the physical activity, just as in gardening. If one is physically able to even perform the simplest of tasks, it allows the mind relief from ‘everyday’ life to connect with nature and its materials, whether in coping with disability or illness or recovering from a tiring week of work.

The place of a tranquil garden connects us back to nature and to what is truly ‘real’. It allows us to escape our busy, stressful, appointment-orientated lives and focus the beauty of natural surroundings and of what we can create with soil and plants.

As musician Joe Cocker sung, the best things in life are the simple things.

Back to the garden for me, then.

 

Science: From Imagination to Reality

David McAlpine explores how Science is more imagination and ambition than simply numbers and elements.

Albert Einstein, famous thought-experimenter

There are two types of people; those who happily watch television and enjoy it for what it is and those who constantly point out the inaccuracies of this and that. I should probably disclose that I belong in the latter group; no detail is spared from my assault on a filmmaker’s follies.

The physics of science fiction movies is one such example that is the subject of heated debates on internet forums. This introduces a third group into the mix; those who are inspired by such farfetched concepts and seek to make them reality. On the novelty end of the spectrum, the hover board featured in the 1980’s film, ‘Back to the Future’, is still influencing popular culture three decades later. On an insanely more complicated level, time travel has captured the collective imagination of humanity for generations, despite arguably being the most farfetched science fiction concept. Yet, on the other hand, the scientific theory of Special Relativity, devised by Albert Einstein, predicts that it could be possible to travel forward in time. In response to this, my Physics teacher has even remarked, “My time machine design would work if I had the power of three nuclear power stations.” Farfetched, indeed.

If science fiction inspires new thinking and pre-empts changes to the way we live, where is the distinction between fact and fiction? The answer is the essence of how the study of Science works.

At its core, Science is an imaginative and ambitious activity that dreams of the next frontier, the next transition of an idea into a reality. A successful scientist must not only have the academic ability to understand how the body fights disease or how a supernova occurs but also have the imagination to pursue new theories. Hypothesising in essence is imagining a scenario, from a slight tweak of an established theory to an entirely new, potentially revolutionary concept. If individuals such as Einstein, Galileo and Newton had not employed their imagination when pondering how the Universe functions, our understanding would have hardly progressed. Hence, it is no coincidence that when a scientist is explaining a concept, it often begins with “If you can imagine…”

Testing this idea is also a creative endeavour; to design an experiment that accurately determines if an idea is realistic, is a challenge of sometimes epic proportions, whether this be determining if a particular drug is actually more effective than another or if the Higgs Boson particle exists. Spoiler alert; it does. Innovation in experimental equipment has often been stimulated by creative and ‘outside the square’ thought. Australian chemist Alan Walsh, for instance, was struck by a flash of inspiration whilst pottering around in his garden on a Sunday, leading to the development of a technology called AAS, now one of the most widely utilised instrumental analysis techniques in Science worldwide. This part of Science is just as creative as it is about logic and convention.

Analysing the data is when the logic, mathematics and statistics really come into their own; however, the interpretation in order to support or disprove the hypothesis involves thinking outside the square and being prepared to challenge longstanding beliefs. As Italian physician and educator Maria Montessori argued, “We especially need imagination in science. It is not all mathematics, nor all logic, but it is somewhat beauty and poetry.” Of course, the process does not end here. A scientist repeats experiments, changes variables and devises new methods of modelling data, all of which involve creative thought and abstract thinking.

Einstein, famous for his thought-experiments, pondered that “To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.” In considering this, one realises that imagination is the intersection between art and science. It is no wonder that many notable scientists are also artistically inclined. One of the most brilliant creative beings ever to exist, Leonardo da Vinci, is recognised more for his artwork but he was a brilliant scientist and engineer, several hundred years ahead of others in his designs. More contemporary figures also come to mind, such as American regenerative medicine researcher and scientific leader Professor Nadia Rosenthal, who is also an accomplished artist. There are other parallels between Science and Art. Just as novelists face writer’s block or publish a book which is a dismal failure commercially, failure is a part of Science as much as discovery and success.  The well-known adage of the development of the light bulb by Thomas Edison exemplifies this. He famously asserted, “I have not failed. I’ve just found 10,000 ways that won’t work.”

After thinking of how Science works, we now return to the issue of science fiction becoming reality. If these writers appear to be ‘out of this world’, totally unrealistic in their dreams of the future, then how different are the scientists endeavouring to discover an elusive particle that lives for a tiny fraction of a second? Their aspirations of demonstrating that this particle exists in reality are apparently as wacky as those ideas developed by writers. Who would believe that space is curvy, that there are four dimensions, that light is a particle and a wave at the same time? All of these examples of apparent fiction being tested and supported as fact show that the difference between fact and fiction is the scientific method, the ambitious verification of an idea into reality.

Furthermore, perhaps the only difference is that novelists possess artistic license in order to ignore reality, whereas scientists must account for it? In the realistic world of Science, the elephant in the room cannot be ignored, rather metaphorically examined and its blood tested, its presence investigated and debated. After all, if Science was not forward thinking and challenging, we would still believe that the world is flat or that the sun orbits around us!

Both science and science fiction are part of the human condition, our desire to reach out into the unknown; a challenging journey. Whilst most literature is a reflection and critique of society past and present, science fiction provides inspiration for the future and cautions against immoral change. Science without dreaming is not science; it is just a recitation of old information. It is an evolving, fluid and dynamic adventure narrative, as theories are devised, supported, modified and eventually replaced with a new model or school of thought.

Sure, we may not have those hover boards from ‘Back to the Future’ yet, but be reassured that an ambitious and creative scientist somewhere is developing one. Like the lightbulb, it may just take 10,000 prototypes to be a success.

The Legacy of the Nonconformists

Maya Angelou, American author, performer and civil rights activist, famously asserted, “If you are always trying to be normal, you will never know how amazing you can be.”

Leonardo da Vinci/ Source: Flickr

Leonardo da Vinci/ Source: Flickr

Throughout history, countless examples exist of those who have defied normality and have discovered “how amazing” they can be. Renaissance artist and scientist Leonardo da Vinci, for instance, one of the most inventive and creative beings ever to exist, was not only considered eccentric but lived a lifestyle with other artists that was very much unconventional.

Around the same period, Galileo Galilei, often touted as ‘the father of modern science’, was persecuted by the Roman Inquisition and the Catholic Church for not conforming to the ‘normal’ view of the Earth being the orbital centre of all celestial bodies. Using scientific evidence, he supported his and other claims and although their model was rebuked at the time, after his death it gained support and the scientific world established it as fact. Without the courage and sacrifice of Galileo and others not aspiring to the ‘normal’ view of the world, the story of science in the past 500 years would have been significantly different.

In 1880’s Poland, another scientist, a young Marie Curie, was not permitted to attend higher education and instead sought out the clandestine ‘Flying University’ to pursue her passion. She completed her education with a doctorate and began years of industrious research, first independently and later with her husband, Pierre, and other scientists. In 1903, the couple was invited to the prestigious Royal Institution in London to discuss their work; Pierre delivered a speech to the distinguished audience but Marie was not permitted to speak because she was a woman.

Marie Curie/Source: Wikipedia

Marie Curie/Source: Wikipedia

It was also in that year that she was initially unrecognised for her contribution towards research into radiation along with her husband and another male scientist, with the nomination committee for the Nobel Prize for Physics listing the two men on the commendation and not Marie. It was only after the complaint from an advocate of women scientists that she was congratulated for her extraordinary services. She became famous for being the first woman to receive a Nobel Prize and, later, the first person to be awarded two. This created a legacy for other women to strive to push the boundaries of what is considered possible, in science but also in other fields.

The women’s suffrage movement, as it became known in its infancy in the late 19th Century, initially focused on changing societal attitudes in an attempt to secure the right of voting for women. The second and third waves of feminism, beginning in the 1960’s, were more inclusive of other aspects such as equal pay, greater involvement in the workplace and generally challenging accepted stereotypes and what is ‘normal’ for a woman.

Without the spirited efforts of these pioneering women, the majority of whom were ‘normal’ citizens, the significant political change that reformed the lives of women worldwide would not have occurred. Feminism allowed women the freedom of choice to participate to a greater extent in society and democracy, for each of them to discover “how amazing you can be”, as Angelou remarks.

The result of the feminist battle is that young women today unequivocally have the brightest futures ever to be bestowed upon them. Their futures are not reliant upon any one else but themselves and their destinies lie in their own hands; the endless choices available are unprecedented. The modern saying of ‘breaking the glass ceiling’ is achievable more than ever.

The lives of Maya Angelou, Marie Curie, Leonardo da Vinci and the pioneers of the feminist movement and countless other courageous examples throughout history demonstrate how an attitude of defying ‘what is normal’ leads to prosperity and success.

This legacy of nonconformity should inspire us today as we confront the issues of the twenty-first century, both in our everyday lives and in wider society.

We owe it to them that we continue their fight.

Natural Instincts

From ‘Man’s Best Friend’ to our affinity for meerkats, it is interesting to observe the human species interacting with other animals. Some we feed, some we feed off, others we are afraid of being eaten by.

Recently, an aviary was installed at my school, which as an aficionado of birds is simultaneously exciting and repulsive; I love watching the creatures but it pains me that they are not free to fly.

The small budgerigars and ground-dwelling quails do not appear to mind; however, the pair of female Eastern Rosellas constantly look to the sky and, seemingly frustrated, attempt to destroy the wall and their perches to give themselves something to occupy their time with between masticating seed. These birds may have arisen from pet shop stock but their natural instincts are very much intact.

As the coup is partially open to above with chicken netting, the Rosellas poke their beaks through and hang off the wire. Several times per day, a wild male of the same species can be observed perched on the other side of this barrier to the outside world and regurgitating food to the two captive females, a heartwarming yet heartbreaking sight to behold.

Many students have taken an interest in the birds, some even observing and making comment on their behaviours and plumage, the spectacularly ostentatious colours of some and the art of distinguishing between male and female quails.

Outside the enclosure, there is an abundance of birds in their natural states. Native Magpies, Crows, a pair of nesting Masked Lapwings and Rosellas and introduced species such as Blackbirds and Common Mynas abound the campus, yet little interest is taken in them. The only exception is the hatred by some of the swooping ‘Plovers’, or Masked Lapwings as they are officially known, as they rightfully protect their clutch from predators.

As a lover of the avian kind, it has saddened me that other students do not appreciate the external life but are interested in those that are caged for human pleasure.

Why is it that, as humans, we only take an interest in nature if it is caged up specifically for our pleasure, or euthanised, stuffed and exhibited on the wall?

This is far from a new phenomenon. An example that springs to mind is the quests by English explorers centuries ago to kill and transport back home exotic specimens for taxidermy and display. Of course, much of this was for genuine scientific purposes, to catalogue the fauna of the ‘New World’; however, despite this, a large proportion was destined to hang on the walls of wealthy family homes rather than in a museum for study.

Most zoos nowadays base their work around public awareness and the preservation of endangered animals but it is relatively not long ago that as a child my Nan rode Queenie the elephant around Melbourne Zoo. After 40 years of this, the animal fatally trampled her keeper after a lifetime of torment and beating to train her into a particular behaviour.

Furthermore, questionable handling techniques are still being employed even today. Only last year, a handler was near-fatally attacked at Australia Zoo by a tiger, after he deliberately ‘excited’ the animal by changing his appearance to encourage the beast to ‘play rougher than usual’, as was disclosed in the Workplace Health and Safety report. This was designed to produce a more entertaining show for the audience.

It makes me wonder what fuels our interest in other species; is it a love for and appreciation of the animals in their own right, or a disillusioned human quest to exert dominance?

Whatever the answer, the reality is that our relationship with animals has been as fraught with exploitation as much as mutual benefit.

Welcome to ‘Dreaming Science’!

It’s finally here – the Dreaming Science blog.

What is behind the name, you may be thinking? Well, it was originally derived from the fact that my dreams often involve contemplating the Universe, discussing Biology concepts with myself and undertaking Physics problems.

Furthermore, I suppose that it refers to my aspirations of entering Medicine and Science as a career; I have been dreaming of Science in this regard since I was little.

Please enjoy, ponder and dream the wonderful journey that Science is for yourself, whether you are a veteran of the field, a keen citizen scientist or neither. WARNING: May also contain non-Science content!

Yours in Science,

David

PS: I am also on Twitter – @dreamingscience