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Postcard from GhanaBrendan Payne, Monash University, Medicine

I heard about Work the World the previous year and decided to look into what they offer. It really was quite easy to sign up to the program and it was reassuring knowing my placement in my chosen destination of Ghana, would be well supported. The fact that accommodation and food were all inclusive was a big bonus too.

The information about the program was very comprehensive as were the instructions prior to my departure. I was contacted several times to ensure my visa, immunisations and other preparations were on track.

Upon arrival, Ezekial from the team in Ghana was there to greet me at the airport and escort me on the bus journey to the Work the World house in Takoradi.

The Ghanaian people were very friendly and always willing to help. All of the staff were great and did their best to ensure the experience was an enjoyable one.

My six week rotation was in paediatrics; however one of the good things about this placement was the flexibility to spend time in other areas of the hospital.

I was able to visit emergency, general medicine and the birth suite, and as many of the doctors were excellent teachers, I felt as if I achieved a good introduction to these areas.

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National Park, where I stayed the night in a tree house and then walked in the canopy; Cape Coast where we visited several castles used in the slave trade; the Eastern Region waterfalls and Nzulezu, a village built entirely on stilts.

All in all I thoroughly enjoyed my trip, although one final word of advice whilst I recommend trying the local cuisine, you’d do well to stay clear of Egusi Stew. Just take my word for it!

Visit mips.com.au/worktheworld for information on how you can plan your elective with MIPS and Work the World.

Generally patients do not present until their condition is at its worst, which is even less ideal in an under-resourced setting. There is a single X-ray machine but no CT. Simple blood tests such as urea and electrolyte, full blood count, blood films and liver function tests can be done, but typically take up to two days to return. Many basics drugs are unavailable or only intermittently available.

The lack of investigations and equipment inevitably led to some interesting (and sometimes ingenious) practices.

My week in the rural village Akwidaa was a great experience. You stay with a local family and spend your day at the clinic, which is staffed by three nurses. I was able to assess each patient when they presented, which was great.

Resources are very limited and it is very difficult and expensive for patients with emergencies to travel to the district hospital. They often don’t want to go, even if you diagnose classical appendicitis.

Weekends were generally full of travelling; I managed to get to many areas of Ghana during my stay, including Mole National Park where I saw elephants; Kakum

When I first considered the location for my elective somewhere in the developing world was on the top of my list, but I was unsure of how to begin the process.

Brendan Payne trying out some of the local fare

MIPS member Brendan Payne in Ghana for Work the World

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Dollars, Defence and DentistryDr Gerry Clausen

matter could be resolved for the sum of $84,000 plus a modest allowance for the legal and other costs incurred to that time.

However the claimant went on to claim that he had not been able to work since 2008, “due to anxiety and panic disorder causally linked to the issues he was having with his teeth”.

The evidence regarding pre-existing psychiatric issues is interesting; since 1994 the claimant had been treated voluntarily and involuntarily at a hospital mental health facility, with a significant treatment history in the thirteen years prior to the dental treatment. In addition, despite not working between December 2008 and April 2009, this failure to work was unexplained.

Finally, Commissioner Gething indicated that “the Plaintiff is prone to “delusions and not telling the truth, such that his reliability is open to serious question”.

You may surmise, after reading the preceding paragraphs that the matter resolved for little more than the costs of remedial treatment. The final summary of damages awarded is at the very least, interesting.

Again, it is significant to note that in the final amount awarded, the figure associated purely with the dental treatment is only approximately 20% of the total sum.

Members need to be acutely aware that the dental area is becoming more litigious and increasingly costly. Unfortunately dental matters are no longer viewed as the ‘poor cousin’ to medical indemnity matters. The importance to all dentists of active risk management strategies has never been greater.

For many years, high profile medical claims have been viewed as the ‘Big Ticket’ matters in the professional indemnity sphere, whilst dental cases have had significantly lower financial implications.

However, recent judgements have seen a increase in the amounts awarded in dental cases, not due to the costs of remedial treatment, but related to associated factors such as loss of income (past and future) and psychiatric damage.

A recent case in the district court of Western Australia is worthy of review, as it indicates how a matter with a defined cost for remedial treatment can escalate.

In this instance the MIPS member, the treating practitioner undertook removal of the claimant’s remaining periodontally involuted teeth, placed implants and constructed implant supported fixed bridges in both arches. Subsequently there were issues with mechanical and biological failures and the further opinions obtained were critical of the MIPS member’s management.

A figure of $84,000 was proposed and agreed upon as the cost of remedial treatment (noting that such treatment was to be performed by specialist practitioners, despite the Plaintiff having initially elected to have treatment with a general dentist).

The MIPS member admitted negligence and one may be forgiven for thinking that the

General damages $80,000

Past economic Loss $148,112

Loss of superannuation – past $13,996

Future economic Loss $70,524

Loss of superannuation – future $4,826

Other head (agreed) $84,000

TOTAL $401,458

Rural re-location payments to $120,000Last month the Federal Government backed the launch of the Go Rural Campaign.

The project managed by Rural Health Workforce Australia in partnership with the national network of not-for-profit rural Workforce Agencies, aims to showcase the benefits of practising in rural medicine.

The campaign offers young doctors and medical students the opportunity to investigate the option and professional

benefits of a career in rural practice.

Over the next year, there will be a series of events available to promote Go Rural Australia. They aim to be a ‘one-stop-shop’ for young doctors and medical students interested in pursuing a rural health career. As part of the incentives for the program, the government are offering reimbursements for HECS fees and relocation payments up to $120,000.

Working in a rural community can enhance the practice of a young doctor or a medical student because it provides a great way to visit these communities and gain experience, which might not be readily available in an urban setting or city hospital.

MIPS can provide you with the support you need during your practice in a rural community through 24 hour Clinico-Legal Support, seven days a week. You can find more information

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