DESPITE being high on the list of essential services needed within a small town, it can be difficult for rural and regional communities in Western Australia to source and then retain medical staff.
In many communities fortunate enough to secure a general practitioner in recent years, those needs have often been met by international doctors who are required to work in a rural distribution priority area for 10 years before being able to access a Medicare billing number.
So it is heartening that a collaborative program involving two WA universities is showing medical students what practicing medicine beyond the Perth metropolitan area can look like, in the hope some may take that career path.
More than 220 medical students from the University of Notre Dame and Curtin University, in March participated in the Wheatbelt Medical Student Immersion Program to experience what it was like to live and work in a rural town.
The students were billeted out to local families in 12 shires over a four-day period to give them an authentic understanding of life in the Wheatbelt, in Bruce Rock, Corrigin, Cunderdin, Dalwallinu, Kellerberrin, Kondinin, Merredin, Moora, Narrogin, Westonia, Wongan Hills and Southern Cross.
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The universities, in partnership with Rural Health West, Rural Clinical School WA, Wheatbelt East Regional Organisation of Councils and the local shires, developed an itinerary of activities for the students to meet with local health professionals and visit local schools, farms and businesses to learn about the challenges and highlights of a rural lifestyle.
This version of the program has been running since 2018 and has grown from including nine towns to 12 in 2023 as student numbers have increased to about 110 people from each university.
Professor Donna Mak, the University of Notre Dame (UND) School of Medicine Domain Chair of Population and Preventative Health, has long been an advocate for providing students with exposure to rural communities in the Wheatbelt and Kimberley.
Professor Mak, who this year is a finalist nominated for the Bush Champion Award at the WA Rural Health Excellence Awards, said the involvement of UND in the program had come from the university's mission of graduating doctors who would contribute to improving health system in areas of unmet need, such as rural and regional WA.
"We wanted something different, for students to work in rural areas and be part of rural communities, something that I was very conscious of after having worked in the Kimberley for 11 years," professor Mak said.
They devised a program in 2005, the original itineration of the current program, that involved educating medical students in rural communities, because local people who are active members of their community have the most to teach the students.
It was to provide the students with both emotional and cognitive learning, with the emotional learning giving them "sticky" experiences that could influence their behaviour and ultimately determine where they chose to work.
Professor Mak said the Wheatbelt was selected as the best location for the first year post-graduate medical students to venture out to because being in week eight of their studies was relatively early, and for many who hadn't ever been into the region, it wasn't too far from Perth.
Yet it was still an area of unmet need.
Importantly, the immersion program is for all students, not only those with a pre-existing interest or background in rural health and living and working in rural areas.
It also aims at providing students who may eventually work in metropolitan areas with an insight into understanding people from rural WA, and giving them more patient-centred care.
Professor Mak said she wanted students to appreciate that some people may have to travel hundreds of kilometres to see a doctor in the city, and that they may require all of their care that day because they couldn't come back the next day.
"So students learn that when they graduate, they are delivering care to the person and their family," she said.
As part of the UND post-graduate degree, all second-year students are taken to the west Kimberley for a similar immersion program, where professor Mak said students were exposed to different issues and ways of life.
She is proud of the unique program in that it wasn't selective about which students did rural placements - they were compulsory and all students had to do them.
"All doctors need to look after people from the country and need to understand the lives of people from there," she said.
She said it helped break down barriers for students who may never have been outside the metropolitan area and remove any fear of the bush they may have.
"They stay with families, who they find to be really nice people, and who show them a world that they didn't know existed," she said.
"It allows them to make an informed choice about their future career path."
For example, some students then chose to spend the whole of their third year in the Rural Clinical School of WA, who may not otherwise, had they not been exposed to rural and remote WA in first and second year.
The program has survived even through COVID-19, with host families speaking to students via video conferences each day for a week in 2022, which professor Mak acknowledged wasn't quite the same as face-to-face, but was much better than nothing.
As well as the students benefiting from the program by seeing the world through a different lens, she said there was also an immediate reward for rural communities.
It was invigorating that there were new people in the town to talk to and community engagement with the local schools allowed local primary and high school students to broaden their horizons.
Narrogin-based doctor Ziech Van Onselen was involved in the immersion program as a post-graduate Notre Dame student about a decade ago and said the experience was invaluable.
The general practitioner said it wasn't the only reason for him settling in the Wheatbelt town - his wife was from the region - it was a good program and played a part in opening his horizons to choose his career path.
"As somone who moved to Australia as a 19-year-old, it gave me exposure and a great introduction to the opportunities in country health and also helped me to learn about Narrogin," Dr Van Onselen said.
"Even many people born in Australia have no idea what life is like in the country these days, so the program helps give them an awareness they wouldn't otherwise have."
Second-year Notre Dame medical student Holly Protoolis decided to change her career path after working for Rural Health West.
Having completed a masters of public health degree, Ms Protoolis said she could see how much need there was for rural health professionals in regional WA.
She was involved in the hybrid version of the program in 2022, where she conversed with a host family over Zoom video calls and had a day trip to Narrogin, but said it only confirmed her intent to work in rural health.
"In rural areas, GPs are involved in a whole breadth of things, there are a variety of roles they can fill and that is what interested me because I am interested in lots of different things," Ms Protoolis said.
She said the immersion program was extremely important in giving people without any previous regional experience an understanding of life for country people.
"Even if you are working in the city, you are all doing rural medicine because country people sometimes need treatment in the city," she said.
With her husband a fully qualified nurse, the couple is committed to moving rurally at the completion of her degree.
Despite growing up in Harvey, Harry Bennett found travelling to the Corrigin for the immersion program to be a big change in scenery.
Mr Bennett said it was interesting to see the broadacre grain and sheep farming as opposed to the dairy and cattle farms that dominate the landscape around Harvey.
While he was unable to see inside the Corrigin Hospital, the 19-year-old said local doctor, nursing and ambulance staff made up for that by providing detailed explanations of the local facilities and tasks they were required to do on a weekly basis.
While he is still weighing up his future career path, he was keen to keep his options open and said the program reconfirmed that going rural was definitely an option.
"One of the best things about the town is that everyone is so different and diverse, but if something happens, such as a fire for example, everyone bands together and lends a helping hand where it's needed," he said.
Mr Bennett said the experience was made all the better by the billet families.
"We are incredibly grateful to them for their hospitality and opening their homes up to us for the greater part of a week, the program literally could not go ahead without them," he said.
Professor Mak said local people were also in a position of power during the immersion program, because they could teach medical students about their way of life while they were fit and well, as opposed to being a patient in a clinic and unwell, and not as able to advocate for themselves.
"When they are in their own home they feel they can share their life and have a conversation with the student, and that it's a more level playing field," she said.
"The students learn through the conversation and connection with people while immersed in the local community."
Sally Kilburn, from the Curtin University (CU) School of Medicine Faculty of Health Sciences, travelled to Corrigin for the immersion program with 19 students and said it was again a valuable experience for all involved.
Dr Kilburn said the CU students were all in their second year of university as opposed to UND students who were post-graduate and therefore had already completed a degree.
She said like UND, CU was committed to helping students become doctors of the future and hoped some would go rural, while providing those who stayed within the metropolitan area with more empathy and understanding of people living rurally and, in turn, better patient-centred care.
"The students can learn in class about social determinants of health in rural versus metropolitan areas, but to actually go there and see how people live and the level of community support through volunteer ambulance and fire services and how self-reliant people are, was a huge experience," Dr Kilburn said.
She said she found it particularly pertinent given they were in a community that 12 months ago was affected by a devastating bushfire.
"We were really humbled by the way people were prepared to talk about recent experiences and how they had affected their emotional and professional selves, we felt very privileged," she said.
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Since 1989, Rural Health West has been working to ensure rural communities in WA have ready access to qualified and experienced health professionals, believing everyone, everywhere is entitled to good health and that distance should not be an obstacle to accessing healthcare.
Rural Health West deputy chief executive officer Kelli Porter said the independent non-government organisation was grateful to be working alongside the universities to provide the rural immersion experience to medical students.
"We know that providing the students with early positive experiences and exposures can broaden their outlook and help shape the direction of careers," Ms Porter said.
"We hope that the Wheatbelt Medical Student Immersion Program may influence some of the participants to consider rural medicine in the future.
"It is also an opportunity for the students to build relationships with local healthcare providers and to showcase that community spirit, which is so strong across the Wheatbelt."
Ms Porter said the program would not be a success without the warm hospitality offered by host families and extended her sincerest appreciation to everyone who opened their homes to students.
She said Dalwallinu, Kondinin and Kulin were additional towns added to this year's itinerary and had so far received great feedback from both students and the community which they looked forward to continuing.
