IR in OZ

Created - 12.09.2010

I travelled from the cold January weather in the West Midlands to land in Melbourne just in time to experience its hottest day on record when the temperature soared to 47°c. Not everything here is in such stark contrast to the UK but the “get the work done and reported asap” attitude in the hospital and the “no worries” approach out of work makes it seem a long way from Kansas (and Birmingham).

I am doing an interventional radiology fellowship at the Austin Hospital which supplies healthcare services to north east of Melbourne as well as providing state wide services for liver transplantation. It is a medium sized public hospital with 400 in-patient beds. The radiology department has 2 angio rooms within a brand new interventional suite. The main room, which houses a biplane Siemens Artis zee unit, is so big that even the anaesthetists think it is roomy. The other room has a Philips C-arm fluoroscopy unit. On the day the suite opened there were 35 sets of lead all hung neatly, colour coded by size. What a beautiful sight. And I was allowed to do the first case!!

The work is varied and ranges from liver intervention including TACE and RFA, vascular and urological procedures, fistula work and the inevitable venous access procedures. The vascular surgeons here lead the EVAR service but the procedures are done in the radiology department and a radiologist is usually involved. The angio suites are well supported by nursing staff and there is a well staffed recovery area in the department where all patients arrive, are prepared for the procedure and return to recover before either discharge home or back to the ward. A full time radiology liaison nurse organises the lists and takes requests from the clinicians, hugely minimising interruptions during the working day.

The majority of the biliary work including PTCs, biliary dilatations and TIPSS are done under general anaesthesia and it is relatively easy to organise anaesthetic cover even at short notice for emergency cases. Early morning meetings start most days at 7:30 or 8:00 so 11 or 12 hour days are not uncommon. I have 7 sessions a week doing intervention. One day a week I go to the out-patient hospital down the road where 4 or 5 radiologists sit at reporting stations all day and report all the plain films and CTs done there. It is very efficient and it is expected that all the studies are reported and preferably verified before we leave at the end of the day. 

I applied for this position at the Austin after discussion with the previous 2 interventional fellows who were both from Oxford, where I started my radiology training. In fact, there have been 4 fellows from Oxford here in the last 4 years, 3 of whom are still here (!!). The department is very friendly, all staff are on first name terms from the director of radiology to the portering staff. The atmosphere is very supportive with all of the consultants happy to be approached for advice. The fellows participate in the general on-call rota which consists of an evening shift until midnight or an overnight on-call shift. There is a consultant led interventional on-call which I will try and become involved with later in year. A CT scanner is being installed in the emergency department in the next couple of months when 12 hour night shifts are to be introduced. This will involve a week of nights followed by a week off, good for exploring Australia but it will mean less time in the angio suite. 

It takes a while working in a new health system to see its flaws. Generally the public health provision here seems quite good although waiting times for routine surgery including non-urgent vascular intervention is long. Clopidogrel is not indicated here for PVD here so a patient in a public hospital will not receive it after lower limb angioplasty or stenting unless they pay for it themselves (highly unlikely) so the benefit of some our more peripheral interventions becomes questionable. I am sure there are many other quirks in the system which I will come across in the next year.

I came over with my husband and 3 young children. We were lucky to have taken over a fully furnished house from a leaving fellow which greatly eased our first few weeks here. We found places for our 2 older girls at a local school and they have settled into the system really well. The schooling seems much more relaxed with far less focus on exams at their age. My husband is having 6 months off before starting a fellowship here in August and the fact that he has been at home with the children has made it possible for me throw myself fully into the work here without worrying about getting home on time!! There was a lot of paperwork necessary to obtain a work visa and medical registration. My advice to anyone coming out here is to start the process of application early as there are many forms that require time to process and this can become very stressful as the time to travel rapidly approaches. We ended up getting our visas only 3 days before my job and my children’s school was due to start. Not ideal.

The devastating Victoria bushfires impacted hugely on the local area and community and effects of it will be felt for months and years to come. Through contacts in the department, I had the opportunity to spend a day at the state coroner’s office with a forensic radiologist. Here in Victoria, all patients whose deaths are referred to the coroner undergo a full body CT scan whether or not they proceed to post mortem. The task of trying to identify the bush fire victim was mammoth and although it sounds rather macabre, it was fascinating to see what kinds of identifying features could be gleaned from what in many cases was a charred bag of remains. Obvious implants such as joint prostheses, pacemakers and dental work could help in identification (although as the dental surgery in one area was burned down, many dental records were lost) as well as estimating the age of the victim by assessing degenerative disease in the spine or other joints present or seeing evidence of previous surgery. A huge number of allied professionals worked for many long and hard days to try and complete this undertaking.

The lifestyle is great. I cycle to work every day and have only been rained on a few times (!). The fellows are encouraged to explore the city, Victoria and beyond. There are impromptu “wine club” meetings after work on Fridays and departmental trips to the pub. There was a welcome dinner for the new fellows and almost the whole department turned out for a meal. There are departmental bike rides and there are whisperings of a tennis day too. Almost every suburb has a large pool complex, tennis courts and sports grounds, enough to spur anyone into action. I pass many people on their early morning walks on my way in to work. The annual IRSA (Interventional Radiology Society of Australasia) meeting is in the idyllic setting of the Whitsunday Islands in July. There is a big emphasis on family centred activities with boat trips out to the Great Barrier reef and days at the beach scheduled into the meeting (as well as international speakers, of course) and many from the Austin are going. If anyone is tempted to come out I will see you there!

If I were to pick out the weaknesses of this post, I would say that as the Austin is not a trauma centre there is little experience in trauma related intervention but hopefully by the time I finish here my skills will be transferable to the acute trauma setting. There is not a big chance to get involved with EVAR but there is plenty of other vascular intervention including CO2 angiography which I had not previously performed. 

What advice would I give to someone thinking about coming abroad for a fellowship? Speak to the current fellows and find out about the strengths and weaknesses of the post and have a clear idea of what you want to gain from a fellowship post. I am so far really enjoying my time here. I wanted to come to a well run, happy department where I would be able to increase my experience in a wide range of interventional procedures and so far, that is exactly what I have found. And it’s in Australia!!!

Susan Jaffe Austin Hospital, Melbourne