Introduction by Croakey: The presidents of leading medical colleges have issued a joint statement calling on the Australian Parliament to maintain the Medevac legislation and the Independent Health Advice Panel (IHAP) process.
They say the Medevac legislation has improved access to appropriate healthcare for refugees and asylum seekers being held offshore, and that “previous delays and failures to transfer ill asylum seekers resulted in preventable suffering”.
One of the signatories is the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), which is planning to step up its advocacy on the wider determinants of health more generally, as will be discussed at its annual scientific meeting in Melbourne this week.
Amy Coopes previews some of the conference discussions below, ranging from efforts to reduce stillbirth to the impact of clinicians’ mental health upon the safety and quality of healthcare.
Also, make sure to follow #RANZCOG19 this week for live-tweeting from the conference, and see a selection of tweets at the end of the article below, including from cultural safety and other workshops held ahead of the conference.
Amy Coopes writes:
As the peak body of experts in Australia and New Zealand for women’s health, it is time for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to speak up on the social and cultural determinants of wellbeing for women, an annual trans-Tasman summit of the specialty will hear in Melbourne this week.
The RANZCOG, the training and accreditation body for specialists in women’s health, should also be a leading voice on systemic issues including gender equity and access to care, its annual scientific meeting will be told.
The mental health of trainees, political pledges on pelvic pain and stillbirth, and women’s reproductive rights following the recent decriminalisation debate in NSW are some of the other headline topics to feature at the meeting.
Themed ‘Stop. Start. Continue’, the meeting will bring together more than 1,000 obstetricians and gynaecologists from the two countries to explore the latest advances in the field, and reflect on future directions for the College, which has been buffeted in recent years by the controversy surrounding use of pelvic mesh.
The mesh issue featured prominently in last year’s program (read our coverage here), and ASM convenor Associate Professor Joanne Said said this year’s theme aimed to take the discussion forward, asking delegates to stop and reflect on their professional practices, think about what needed to continue or cease, and start some difficult conversations.
“Mesh was something that was introduced, and I guess one of the good things was that a degree of ongoing surveillance identified problems,” Said told Croakey ahead of the ASM, which gets underway in Melbourne on Monday.
“That’s an obvious example where the recognition of harms made it easy to take that decision to stop, whereas sometimes it’s a lot more subtle than that. There are therapies that we introduce because we think they’re good and we think they’re evidence-based but actually you realise there is not a strong evidence base for them and over time they may not be doing any harm, but they’re not actually doing any good.”
International keynote speaker Dr Ranee Thakar, president of the International Urogynaecological Association and a subspecialist in urogynaecology at London’s Croydon University Hospital, will present on the lessons from mesh as part of a plenary on pelvic pain which will focus on endometriosis, singled out as a new priority area for research by the Federal Government last year.
Stillbirth will also feature prominently on the program, with a dedicated plenary session on Tuesday afternoon timed to coincide with the launch in Canberra by Health Minister Greg Hunt of the Safer Baby Bundle, a suite of eLearning resources to be rolled out nationwide following a $3 million grant from the Medical Research Future Fund.
Six babies are stillborn in Australia every day, a rate significantly higher than comparable countries, and last year’s Senate Inquiry made a suite of recommendations aimed at reducing rates by 20 percent over the next three years, through targeting gaps between evidence and practice.
The Safer Baby Bundle, which was launched in Victoria earlier this year, comprises five main pillars:
- Foetal growth restriction
- Smoking cessation
- Maternal sleeping position
- Foetal movement awareness
- Timing of delivery for women at risk.
The national launch, at Parliament House in Canberra on Tuesday, will be held on International Pregnancy and Infant Loss Remembrance Day, marked annually on October 15.
RANZCOG has stepped up its public profile in recent years, and though this was partly necessitated by the mesh issue, President Dr Vijay Roach said it also reflected a growing expectation from its members that the College be more outward-looking, and outspoken on issues affecting women’s health.
“We are the peak body in women’s health in Australia and New Zealand, and therefore we should be at the forefront of advocacy in issues such as gender equity, as well as social and cultural determinants of health,” Roach told Croakey. “We recognise that there is a growing appetite from our members for a voice in social and political issues as well.”
RANZCOG recently spoke out on the Djab Wurrung birthing trees, saying their cultural and spiritual significance meant protecting them had “immediate relevance to our work in women’s health.”
The College has not historically been outspoken on such issues, but Roach said the profile of RANZCOG’s membership was changing, and that trainees and fellows were more engaged and expected the College to be more representative.
“I think that we are an important voice, we represent women’s health – 2,000 fellows 2,000 diplomates, 1,000 trainees, two countries – and what we can lend to the discussion is our experience and our knowledge,” said Roach, nominating RANZCOG’s contributions to the recent abortion decriminalisation debate in NSW as a clear example.
“The College had a very important role to play in advocating for women, and in being very clear about what abortion law reform actually meant, because that’s what we do.”
Dr Paddy Moore, who was vocal during the debate, will present on abortion and equity of access at the ASM on Wednesday morning.
If RANZCOG was serious about improving the health of Aboriginal and Torres Strait Islander and Maori women, Roach said “we also need to be involved in discussions that are relevant to Indigenous people beyond just clinical medicine.”
“Cultural history and experience is a significant determinant of health outcomes, not just in terms of access but also in terms of how the patient experiences their health, and how doctors then respond to those health needs,” he said.
“We often see that there are terrible disparities for people of diverse cultural backgrounds because the system only looks at healthcare through a single cultural lens, and it’s important that we recognise that another person’s cultural lens could have a profound impact on their experience of the system as well as their experience of health and ill health.”
In his President’s address on Wednesday morning, Roach plans to make the case for RANZCOG as an advocacy group in all areas that affect the welfare of its patients, and on issues including mental health, domestic and family violence, “recognising that health care outcomes are determined by many, many factors and we have a responsibility to speak about them”.
He will also launch RANZCOG’s Gender Equity and Diversity Working Group report, which lays out a blueprint for improving the College’s record on women in positions of leadership.
RANZCOG was spurred into action following last year’s ASM, when Hobart-based obstetrician Dr Kirsten Connan presented evidence of a startling gender gap in the upper echelons of the College and urged affirmative action.
Roach said the report recognized that there are “systemic issues that preclude women from taking leadership positions, and the College has a role to identify those”. Childcare, travel, timing of meetings or “potential unconscious biases where women do not feel empowered or encouraged to participate equally in the leadership of the College” were just some examples, he said.
Setting the scene for Roach’s address and the gender equity report launch will be a keynote from Professor Lesley Regan, who heads up the Royal College of Obstetricians and Gynaecologists – RANZCOG’s UK equivalent.
Regan is just the second-ever female RCOG president, and the first in sixty-four years. The title of her talk is ‘How We Are Going to Achieve Sustainable Development Goal 5: Gender Equality for All by 2030’.
The session featuring Regan and Roach on Wednesday morning is titled ‘Starting the Conversation’ and will also have a focus on trainee mental health, with a special presentation from Richmond Tigers legend Merv Keane, who was inducted into the AFL Hall of Fame earlier this year.
Keane will share the story of his daughter, Emily, who died while undertaking O&G training in 2017. Merv’s grief-stricken wife Kaye took her own life a few weeks later.
Emily’s story is now used in workshops with trainees, and Keane started an initiative called Emily’s Gumboots – the title of his talk – at Melbourne’s Royal Women’s Hospital, her former workplace, to raise awareness of health and wellbeing amongst junior doctors.
Emily was renowned for wearing fluorescent gumboots into the hospital theatres, and the junior doctors at the Royal are now gifted a pair of these boots as a reminder to check in with one another and seek help if they are struggling.
Mental health and quality of care
Former RANZCOG President, Dr Steve Robson, will also speak in the session.
Robson wrote a piece about his attempted suicide as a junior doctor for the MJA last year, which went viral after a colleague who had trained with him posted an extraordinary, heartfelt response detailing how anguished those around him had been and the “desperately staged intervention” that had saved his life.
MJA Insight+, which ran both pieces, has described them as some of the most impactful pieces they had ever published, and Robson said the response had been “utterly overwhelming”.
When asked why the two pieces resonated so strongly, Robson said: “I think it said two things. It said that people can feel awful and not disclose it, and people around can know something is going on and not know what to do about it.”
In his talk, Robson will impress upon colleagues that their own mental health and that of their colleagues is not just important at a personal level, it also contributes directly to adverse outcomes and impacted patient care.
I go to a lot of morbidity and mortality meetings and there’s a lot of root cause analysis, and people are looking at why things happen, but you almost never hear ‘Actually someone made a really poor decision because their mind was just not on the job that day because they were worried about something, or they weren’t feeling well, or they were depressed’, that never comes out.
But my sense is it probably is an important part, and the data back that up, of providing care.”
Instead of being stigmatised, and subject to the legislated barrier of mandatory reporting, Robson said good mental health should be promoted as just as integral to patient care as hand hygiene and antimicrobial stewardship.
We need to take this into account, we need to destigmatise it, and I think the only way that’s going to happen is with strong leadership, people giving personal lived experience.
We have to totally change the paradigm, and I think personally looking at it from a patient outcome perspective might be a key to trying to turn people around.”
Robson and Professor Martin Delatycki – clinical director of the Victorian Clinical Genetics Services – will also present an update on Mackenzie’s Mission, with clinical trial recruiting to begin very early next year. If the trial of 10,000 couples is successful Robson said the carrier screening program would be rolled out nationally.
“And that’s unique in the world, there’s no other country that has this sort of system,” he said. “This is a population-based paradigm and if it works it’s really going to alter the way that people think about genetics and the family.”
Associate Professor John McBain will deliver the Arthur Wilson Memorial Oration on the changing landscape of fertility management. McBain was instrumental in the development of IVF, both in Australia and globally, and led the charge for equity of access for same-sex couples and single women, successfully suing the Victorian government and, in turn, being counter-sued in the High Court by the Australian Catholic Bishops Council.
Other keynote speakers at #RANZCOG19 include:
- Prof Basky Thilaganathan from London’s St George’s Hospital, on prediction and prevention of pre-eclampsia
- A/Prof Sawsan As-Sanie from the University of Michigan, on pelvic pain
- Prof William Grobman, from Northwestern University, on induction of labour
- Dr Abdul Sultan from Croydon University Hospital on perineal and anal sphincter trauma
- Prof Laura A Magee from King’s College London on hypertension in pregnancy and postpartum
- A/Prof Ryan Hodges, from Monash University, on research to progress new therapies. Hodges, who has pioneered the use of stem cells to treat newborn lung disease, will present the Ella McKnight Memorial Lecture.
Meanwhile, the #RANZCOG19 tweets are already flowing…
The 2019 RANZCOG ASM will be held from Monday October 14 to Wednesday October 16 at the Melbourne Convention and Exhibition Centre. Amy Coopes is covering it for the Croakey Conference News Service.