Harden shows the importance of the holistic management of health conditions.

My first John Flynn Placement was in the twin township of Harden-Murrumburrah within the Riverina Region of NSW. After a picturesque 4-hour drive along the Hume highway I was greeted at the Harden Country Motel by Hilton and Alison. Both were incredibly welcoming and thoughtful - true country hospitality! This allowed me to settle in and get ready to experience rural medicine over the next two weeks.

Harden is quaint town of around 3,000 people. It is surrounded by farmland. It is conveniently located on the regional train network and is half an hour from the nearby townships of Young and Cootamundra and 1.5 hour drive to Canberra and Wagga Wagga.

For a small town the health care facilities in Harden are second to none. The Kruger Medical centre is a modern practice that employs 4 full time Doctors, two registered nurses, multiple receptionists, two physiotherapists and a phlebotomist. The facilities include consultation rooms, a procedure room, a training room, an adjacent hydrotherapy pool and wellness centre. Up the road toward Murrumbarrah there is also an ambulance station, hospital and aged care facility.

Rural medicine is challenging, rewarding and highly diverse.

Clinically, I would spend roughly 8:30am-10:30am with the phlebotomist - Anne. Anne was incredibly knowledgeable and her friendly demeanour immediately put even the most nervous of patients at ease. Going forward, Anne gave me many useful tips for venepuncture such as teaching me the order of draw and techniques for stabilising the needle. By the end of my time in Harden I felt confident in my ability to take blood, having not missed under Anne’s skilful guidance!

Following phlebotomy, I would spend the rest of the day with my mentor Dr Bandgar. A typical day was highly diverse with everything from patients on peritoneal dialysis to mental health cases and more. Dr Bandgar was also interested in skin cancer detection and removal. Harden is home to an aging farming community, meaning skin cancers are rife. This gave me an opportunity to understand the management of BCC’s SCC’s and melanomas. Following excisions I even had the opportunity to put in my first sutures. This firsthand experience is likely to prove invaluable when I study dermatology in 3rd year.

When Dr Bandgar was on call, I would meet him at the local hospital and the adjacent nursing home for the rounds. Here, the he would address the health concerns of patients. The nursing home had great facilities and the staff were caring. Throughout the experience Dr Bandgar was happy to answer any questions and gave succinct but informative nuggets of clinical reasoning.

In addition to spending time in the Doctors surgery, nursing home and hospital, I was also lucky to have spent a day at the adjacent physiotherapy and hydrotherapy practice. Within the hydrotherapy pool Robin demonstrated the value of hydrotherapy for mobilising highly dependent patients (such as those with hemiplegia and degenerative muscular diseases), as well as for recovery following surgery of weight bearing joints. I also spent some time with the land-based physiotherapist Elise who demonstrated the diagnosis and management of musculoskeletal injury through dry needling, massage and exercise. Both Elise and Robin were enthusiastic and knowledgeable teachers and I would recommend spending a day at the hydrotherapy pool as a great learning experience within a world class facility!

In addition to the valuable learning with Dr Bandgar, Anne and the physiotherapists, I was also lucky to be present when a consultant urologist came to the practice to give a lecture on the management of prostate and bladder cancer. His aim was to inform the general practitioners of detection and management techniques to reduce the need for patients to travel to Canberra for appointments.

Throughout my clinical experience in Harden, I asked every patient if they would mind me sitting in for the consultations. Over the two-week, period not one patient said no. I was honoured to be with patients who despite having private and complex problems, were more than happy to have me present to learn.

Whilst, not in the clinic I explored both Harden and the broader Riverina. Harden had most things I needed for day to day living including a local IGA, a bakery, cafes, takeaway food and a pub. The bakery was particularly good! Other amenities include the oval and gym. Many of the people at the gym were incredibly friendly and readily introduced themselves. In my downtime I was also happy just to watch the Australian Open.

Another highlight was visiting the Sir George, a newly renovated pub in Jugiong with Dr Bandgar, Dr Sachi and on another occasion with the other JFPP Scholar, Emily. The company, food, drinks and live music all made for a great night.

Further afield I spent the weekend visiting friends in Wagga Wagga and Cootamundra. In Wagga Wagga visiting the Murrumbidgee was a highlight and in Cootamundra I enjoyed visiting Don Bradman’s birthplace.

My placement was an incredibly worthwhile experience both clinically and recreational. Clinically I felt I learnt and was lucky to have a Doctor and patients that were eager to facilitate my learning. From a recreation stand point I enjoyed my time in such a friendly and relaxed Riverina community. I am thankful for all my experiences on the JFPP!

For future scholars traveling to Harden I would recommend not only spending time with your mentor but also exploring the allied health facilities. This gives a holistic perspective on the management of health conditions.

For my next placement I will endeavour to do this again and also try to spend a day or two with the NSW Ambulance Service. I would also recommend not only exploring what Harden has to offer but also surrounding Riverina towns.

~ Joshua, JFPP Scholar

JFPP