The SUMS Little Book of Calm

This year Publications and Health and Wellbeing are hoping to produce the first SUMS Health and Wellbeing Guide.

If you would like to contribute to a guide for med students that covers issues like dealing with stress, talking about mental health, coping strategies, exercise and eating well- please email us at publications@sydneymedsoc.org.au

We look forward to hearing from you,

 

The Publications Team

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Contents

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Photo Source: Benjamin Walters

Letters

Welcome to Volume 67

Meet the Co-Directors of Program

Features

Innominate chats with Mike Natter

Artwork

Skull by Amelia Welch

Photography

Ben Walters in New Zealand

Poetry

Whispers by Ceren Guler

Book Review

Joel Selby reviews Do No Harm- By Henry Marsh

Essays and Opinion

Victoria Cook and Josephine de Costa – Problems with women in med begin in medical school 

Joel Selby – There is no such thing as Fair-trade Cocaine

Amelia Welch – And Bid the Sickness Cease by Amelia Welch

Study Stuff

Konrad Shultz – The Pragmatist’s Guide to Studying in Stage One

The Pragmatist’s Guide to Studying in Stage One

 

Konrad Shultz shares some well-buffed pearls of wisdom about thriving in the SMP. First years listen closely! 

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Image Source: http://www.freepik.com/free-photos-vectors/business”

 

Disclaimer: There isn’t only one way to study. Different people learn in different ways. I recommend trying out a few things and seeing what sticks. That said, here is what I found worked last year.

Take Home Points

• Try to make time to study and don’t neglect your health.

• Figure out your priorities and goals.

• Annotated lecture slides are high yield but not complete resources.

• Anki for days.

• Use hand-me-down notes and anki decks but make your own additions.

• Use other resources but don’t make these the majority of your study.

• Try to do some practice questions before RSAs.

Balance and Goals:

It’s important to set realistic goals for yourself. It’s going to be very different to anything you have ever experienced before, I know people keep telling you this but it is true. Your cohort is filled with bright, hardworking people and getting an “average” mark simply suggests you are a bright, hardworking person. You should aim to pass RSA 1 comfortably and then improve on that in the future.

From what I’ve seen, struggling or succeeding in medicine isn’t a reflection of intelligence.  Generally, those who struggle,  have other things in their life that make putting the necessary time into studying difficult. Similarly, people who do well often have very good study habits and are in a position where they are able to spend a large portion of their time studying. It is good to remember that you aren’t all working from the same starting point.

I think it’s important to figure out your priorities and stick to them and to try and structure your life to reflect your priorities. For me my first priority is my mental and physical health and medicine comes second to that, followed by pretty much everything else. As a consequence of this, I won’t cut down on sleep or stop exercising regularly in the weeks prior to an exam but I might cut down on going out with friends or other hobbies.

Ultimately USYD Medicine is pass/fail in the first two years so your marks matter far less than being happy and healthy, provided you pass.

How I study

I don’t normally attend lectures. I’ve found I get far more study done and am less likely to burn out if I watch lecture recordings sped-up at home or in the library. That said some people like lectures, do what works for you. Lecturers will certainly appreciate seeing a lecture theatre full of your bright and shining faces at 8 or 9 AM.

Lecture slides aren’t complete resources but they will highlight what the lecturer thinks is important. I’ve found it useful to annotate lecture slides as you are listening to lectures and use these as a major resources. That said, annotated lecture slides aren’t a complete resources and it’s important to use a variety of resources.

Anki is an absolutely brilliant program and extremely valuable. Use anki every day. If you aren’t using flashcards of some sort or other you are probably doing something wrong. I found I saved a massive amount of time by using anki decks and notes made by more senior students and annotating and making my own additional cards. That said, some people find making notes and flashcards themselves helps them engage better with the material.

Finally, try to do some practice questions prior to the RSAs.

Textbooks and Learning Resources

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Image Source: http://www.freepik.com/free-vector/schoolboy-studying-in-his-laptop_824356.htm’

The recommended textbooks from the School of Medicine can be extremely large and boring so here are my thoughts on some of the more user friendly resources out there.

General Resources

  • First Aid for the USMLE. The bible for US students, still worth getting and spending lots of time with even if, like me, you have no intention of sitting the USMLE.
  • Brosencephalon anki deck. Consists of First Aid for the USMLE and Pathoma content in anki form. Quite a good deck to supplement your learning for each block but is quite in depth so only bother if you are looking for deeper coverage of content.
  • Dr Najeeb Medical Lectures. A very large collection of lectures on a variety of topics. Typically his lectures are pretty long-winded (I think there are 5 lectures on the cavernous sinus and another 4 on Trigeminal Neuralgia) but his explanations are generally pretty easy to understand.
  • USMLE Rx New Videos. I thought these were quite good and very concise.
  • Talley and O’Connor, Clinical Examination. This is considered to be a bible for physician training.

Anatomy

  • Rohen, Yokochi, & Lütjen-Drecoll,  Color Atlas of Anatomy: A Photographic Study of the Human Body. An absolutely beautiful book. It is invaluable for preparing for practicals and spot tests.
  • Acland’s Anatomy. A great video series by one of the pioneers of plastic and reconstructive microsurgery, I like to watch it when I’m too worn out to do any other study.
  • University of Michigan School of Medicine Anatomy Practice Questions.  A useful series of practice questions to check you know your stuff (see link below).

Histology and Pathology

  • Pathoma An extremely good resource, covers most relevant pathology and pathophysiology very quickly.
  • Goljan Audio Lectures. I found these quite good. I especially recommend downloading them onto your phone and then listening to them while in transit

Physiology

  • Costanzo, Physiology. I absolutely love this book, very concise, well explained, not too much nor too little information. I didn’t feel the need to look at any other general physiology textbooks.

Block by Block

Block 1 (Too late sorry guys!)

  • Gladwin, Clinical Microbiology Made Ridiculously Easy. Essentially a complete microbiology textbook but was written with the intention of being easy to read and remember.
  • SketchyMicro One of the best resources out there if you are a visual learner.
  • Abbas &  Lichtman, Basic Immunology: Functions and Disorders of the Immune System. This book is straight forward, well written, with about the right level of knowledge. If you’ve studied immunology before you (or if you are a massive nerd) might want to look at the parent book.

Block 2

If anyone finds a rheumatology resource that makes the subject vaguely accessible please tell me.

Block 3

  • West, Respiratory Physiology: The Essentials and Pulmonary Pathophysiology: The Essentials. These are brilliant concise textbooks that will make block 3 a piece of cake. Get them and then read them.
  • West, Lectures in Pulmonary Physiology and Pathophysiology: They can be found on YouTub and are a good introduction for people who like watching lectures (or who are interested in orthopaedics and find reading challenging). They cover a lot of the same content as the textbooks.

Block 4

  • Hoffbrand, Essential Haematology. The parent book was a bit too large for me and this was about right.

Block 5

  • Hampton, ECG Made Easy and 150 ECG Problems. There are plenty of good ECG books and it doesn’t matter which one you get.
  • Lily, Pathophysiology of Heart Disease. Considered by many to be the cardio bible.

Useful Websites

Other useful university sites:

Useful YouTube channels include:

And Bid the Sickness Cease by Amelia Welch

And bid the sickness cease
~ Pears’ Soap, “The White Man’s Burden” (1899).

The saying goes ‘those who do not learn history are doomed to repeat it’ – Amelia Welch reflects on two particularly shameful chapters in the history of medicine. 

The practice of medicine, by nature and necessity, lays claim to our bodies, professing to know us intimately while seeking to cure ills and aches. In the right hands, we can consider it a noble endeavour. However, history is littered with stories of how medicine was used as both justification for, and a tool of control. Its diverse victims include the mentally ill, women, colonial subjects, Jewish populations and slaves. Some of these stories we know. Some I’ll share with you now.

Manila, 1906

Let us begin in Manila, November 1906, when an American surgeon visiting Bilibid Prison asked twenty-four prisoners to form a line. A month later, thirteen of them were dead.

Unbeknownst to them at the time, the American surgeon, Dr Richard Strong, was testing a potential cholera vaccine. Administered to each prisoner in turn, the vaccine was later found to contain traces of the plague, a sample of which had gone missing from Strong’s office.  None of the test subjects knew about, nor had the opportunity to consent, to the procedure. Strong, head of the Philippine Biological Laboratory, was not punished for his negligence. In fact, there were no notable outcomes from an incident in which 13 men were unintentionally put to their death.

This anecdote is merely a small fragment from America’s foray into the Philippines. A strategic outpost in the Spanish-American war, the United States assumed control of the colony in 1898, and retained power in some form until 1946. However, it was not solely military might that allowed the United States to maintain control over the colony, but rather a particular brand of ‘benevolence’ popular with colonialists at the time, which sought to save or improve the lives of the natives. Their mission was justified by mainstream-media theory, and medicine itself was used as a tool to maintain widespread and invasive regulation and control of Filipino life.

The amalgamation of germ theory and tropical medicine was crucial to justify the American intervention. Tropical medicine divided the globe into temperate and torrid zones, and germ theory was used to describe how overcrowding, uncleanliness, and the lack of sanitation and drainage, combined with tropical heat, caused putrefaction and disease. It was believed that hot climates robbed the ‘native’ of the will to improve these conditions, leading to a vicious circle in which decomposing materials amassed, promoting the spread of parasitic insects, which then infected the native, further reducing their vitality and efficiency. The only way out of this vicious circle is for a third party to intervene, master the environment, and save the natives from their hopeless circumstance. And in 1898, the Americans were more than willing to assume the guise of benevolent tutor, enabling and legitimising their subjugation of a foreign people.

Colonial health programs in the Philippines and elsewhere made habit of assuming a rigid and intimate control of indigenous bodies, homes and societies. Prevention of disease warranted constant inspection and mass vaccination, forced, if necessary. These campaigns were conducted with military rigor – vaccinators often relied on soldiers for protection and enforcement – and served to feed the triumphant celebrations of the wonders and wisdom of western medicine. By 1914, American authorities had performed almost 18 million vaccinations.  By 1929-1930, smallpox ceased to be endemic in the Philippines.

Methods of public health regulation were diverse, involving the imposition of quarantines and forced isolations, burning and disinfecting homes and clothes, changes to diet. American authorities established a health bureaucracy, a registration of marriages, death and births, and a licensing system for physicians, pharmacists and dentists. They policed the sale of food and drink. Filipinos were relocated to sanitary barrios, and the number of habitants in dwellings were monitored. The military, American health officials, and appointed local sanitation inspectors were instructed to examine Filipinos at random, and to disinfect, fumigate and medicate at will.

The role of these medical interventions in maintaining and encompassing complete control over the colony and its subjects cannot be understated. Although justified by germ theory and a benevolent desire to control the spread of infectious diseases, the sanitary codes, vaccinations, regulations and bureaucracy amounted to a network of surveillance, maintained by the watchful eye of municipal officers and sanitary police. Physicians were required to report any suspected case of disease, and subject the individual to mandatory isolation. These efforts not only ensured the establishment of a healthy native workforce and protection for American bureaucrats and military, but it ensured the transformation of the Filipino people into surveyed colonial subjects, securing the United States’ foothold in the Pacific.

Puerto Rico, that same year

The United States assumed control of Puerto Rico from the Spanish in the same year as the Philippines, and for similar reasons. Although historically an isolationist power, in the late 19th century the United States began to push for greater influence abroad. Establishing a powerful navy and attaining strategic overseas outposts was crucial to this endeavour. The acquisition of Puerto Rico promised a commanding naval position between two continents and vast potential for commercial gain.

The methods of maintaining control over the island and populace were similar to other colonial interventions, balancing military might with the appearance of beneficence. It was an expensive endeavour, made worse by the 1918 Great Depression and several natural disasters to hit the island. However, the United States was determined to extract as much economic gain as possible, which eventually lead to the passage of Law 116 in 1937.

Justified by the need for a productive workforce, concerns about overpopulation and squalid conditions and influenced by eugenic theory, Law 116 made tubal ligation legal and free for all Puerto Rican women. No alternative methods of birth control were offered.

Misinformation about the permanence of tubal ligation was rife. Many women believed it was reversible. This belief, along with employer discrimination incentivised women to undergo the procedure.

It was common practice in hospitals to sterilise women post-partum. This policy, funded by the United States government, effectively institutionalised a program of population control on the island of Puerto Rico- by 1965, one-third of Puerto Rican women aged 20-49 were sterilised.

Imperial medicine

Through medical intervention and military might, the imperial grasp was both rigid and intimate, holding power over the colonial subject’s environment, home, freedom and fertility.

Although heralded as missions of benevolence, the overriding purpose was undoubtedly to serve the imperial powers’ own military and economic interests.

The United States may have eradicated smallpox in the Philippines, but the legacy of medicine as a military tool hangs over modern foreign policy. We need only look to the recent targeting of polio vaccinators by the Taliban in Pakistan, the purposeful bombing of the Médecins Sans Frontières compound in Kunduz, the kidnapping of doctors in Burkina Faso and elsewhere.

This distrust of medical profession exists because of the immense power and intimate reach medicine has into people’s lives. However, these are also the very things which endow it with its capacity for good.

As we venture out into this world as medical professionals, we must be aware of the legacies past, and the legacies we are helping to create.

The views and opinions expressed in this article are those of the author and do not necessarily represent those of SUMS. 



There Is No Such Thing as Fair-trade Cocaine

Joel Selby recently travelled to South America where he witnessed first-hand the thriving cocaine-trade. He reflects on the trail of damage left by pleasure seeking ‘gringos’. 

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Photo source: http://www.wsj.com/ad/cocainenomics

“Yeah I knew Tommy, Rusty, if you’ve read the book, I knew all of them”

In a piazza outside San Pedro prison in La Paz, Bolivia, an ex-inmate regales tourists with stories from his time spent inside one of the world’s most notorious prisons, and the subject of the book Marching Powder by Australian Rusty Young.

‘Crazy Dave’, as he is known, looks like a caricature of a gangster from GTA San Andreas, complete with bandana, singlet, sleeves of tats, but with a broad Long-Island accent. Once he reveals that he was sentenced to 14 years for trying to smuggle cocaine into Bolivia, which seems like a bad idea at the best of times, a nagging bit of doubt starts to form about the authenticity of Crazy Dave’s stories, and his motives on this so-called ‘prison tour’.

“How much is coke at home? Brits tell me 200 pounds. Aussies tell me 300, 350 dollars. This stuff, this will cost you 20 dollars, straight from the prison.“

San Pedro must be the most ironic prison in the world; the inmates relocate with their families, the children go to school across the road, the rich come and go as they please, and the whole system pulls together so that the inmates, many of whom who were put away for drug offences, spend their sentence making cocaine.

“I see most of y’all have the wristband for Wild Rover Hostel – I know the Aussie bar guy there he’s cool. I know all the staff there, they’re cool. Make sure you hit us up before New Year’s tonight.”

At this point Crazy Dave hands over to ‘Magic Mike’, a compadre he met on the inside.

Mike looks a little like the dad from Matilda, sporting a silky red tie, slicked back hair, and an over-sized three-piece suit. Mike tells us a few stories, explaining that he grew up in LA, joined a gang of Mexicans for which the entry condition was that he kill somebody, and ended up extradited back to Bolivia to serve his sentence. He hands out a piece of paper with his phone number on it. I am less than thrilled about accepting it.

“Make sure you call before 6pm.”

Back at the hostel, it looks as though Crazy Dave is right. Despite the signs in the bathrooms with catchy phrases such as ‘We are all equal before the law’ and ‘the following substances are prohibited’, it seems as if you are handed a bag of white stuff on arrival. As we arrive home our Aussie and Kiwi roommates are racking up at three in the afternoon, and later when a group of Aussie blokes fresh from Death Road arrive, their first question is ‘How’s the rack here?’


There are lots of ways to travel, and there are lots of ways to spend your money.

Of course, there is also legal dimension to trying something illicit that you wouldn’t normally do at home. But importantly, it’s worth considering that the way you travel affects the society that you are visiting.

Every year people from affluent Western countries (gringos) travel to South America and dabble in as much coke as they can squeeze into their backpacking budgets.

And it seems fairly harmless. After all, this is Bolivia, where prisoners can make cocaine, and drug-dealers can hand out their business cards in the square, because that’s just how it works here. Similarly back home in Australia, our cocaine usage per capita is one of the highest in the world. However, the real cost of cocaine is not covered by you at the tourist discount price of $20, but by the local people.

Regardless of how many grams you buy, the local people suffer to get you that little bump.

There has been much written about the mass murder, extortion and intimidation inflicted upon the local populations by the drug industry- decapitations, faces sewn onto soccer balls, lines of innocent people executed by a single sledgehammer. And this is a problem that spans the continent. Peruvian kids (mochileros) are sacrificed to make dangerous journeys trafficking backpacks of drugs across the Andes, during which they are often killed, die of disease, or are betrayed and imprisoned for life. In Mexico tens of thousands of people simply disappear or are killed each year in a civil war between the cartels and the state, and although that little white bag that Crazy Dave is plugging seems a far cry from things like torture and unmarked graves, as long as we keep buying, locals will keep suffering.

As medical students it is interesting to consider that the issues that cause the most mortality are often logistical and social problems rather than medical – for example malnutrition kills three-hundred thousand annually, and causes a third of all the deaths in young children worldwide. This is obviously also the case for war, displacement, oppression and, it seems, for the cocaine trade.

Prominent surgeon and writer Atul Gawande claims that being a doctor is as much about enabling wellbeing as it is about Medicine. If this holds true, then it is up to us to consider our engagement with society broadly, and consider the consequences of choices we make both at home and overseas.

If we care about where we source our eggs, our sneakers or our jeans, then we owe the same consideration to the impact of industries like cocaine. I’m not writing this op-ed due to any strong ideological stance against drugs per se- everyone is free to make up their own mind. But, the choice should be an informed one.

And also because Crazy Dave and Magic Mike bothered me, and I think it’s important to write about the things that bother us.

As described here, you can drink ethically sourced coffee and eat free-range eggs all year but for cocaine, there’s no such thing as fair-trade.

The views and opinions expressed in this article are those of the author and do not necessarily represent those of SUMS. 



Meet the Co-Directors of Program

By Prof Inam Haq and Prof Jane Bleasel

We are thrilled to be invited to contribute to Innominate as the (relatively) new Co-Directors of the Sydney Medical Program.

Firstly, we would like to welcome all the new students in Stage 1 and welcome back all other students. We aim to be available and receptive to your feedback, so please let us know if something is not working, or ideas on how to improve our Program.

In 2016, we are working on “refreshing” and renewing the Program. We have already done a number of focus groups with students, Sydney Graduate interns, patients and members of the faculty. We hope to be able to have some open feedback sessions with all the different stage groups, so we look forward to meeting you.

So you have some insight into who we are, a few personal facts:

  • We are both rheumatologists
  •  We both love dogs
  • We are both passionate about education
  • Jane is a keen ocean swimmer (see oceanswims.com), skier and scuba diver (see attached pictures)
  • Inam is a sci-fi enthusiast (see photos taken in his office)

 

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