Dr Thileepan Naren

Listen to Thileepan’s story below.

What did you do prior to rural general practice and Aboriginal and Torres Strait Islander health? 

I am a general practitioner. I work at the Bendigo and District Aboriginal Cooperative [BDAC] in Bendigo in regional Victoria. I've been here for nearly four and a half years. I have really enjoyed my time working at the ACCO [Aboriginal Community Controlled Health Organisation]. It's one of the most rewarding jobs that I’ve ever had.

I have been GP Fellow since 2014 and I worked in suburban Melbourne for a couple of years, worked as a locum for a year and then did a locum in Cherbourg, in South East Queensland. This was my first exposure to Aboriginal health and I found it really interesting and really rewarding. The job in Bendigo came up, so I moved my life up from Melbourne to Bendigo and it's one of the best decisions I’ve ever made.

What do you enjoy most about rural medicine and working in Aboriginal and Torres Strait Islander health?  

The work is interesting and it's probably the most meaningful work I’ve ever done in my life. I’m a big believer in practicing medicine where it’s most needed, and I think you'll find few areas are harder pressed in the medical system or health in Australia that need good quality primary care, than Aboriginal health. We've got a really good team here. I'm surrounded by excellent colleagues: nurses, Aboriginal health practitioners and support staff who really make you feel welcome. If you don't know the answer to something or you are unsure about how to approach a problem, you've got a lot of people around you to talk to and they are happy to assist you.

Our patients are amazing, really beautiful, lovely people and resilient. Very different to the stereotype that a lot of us in healthcare and maybe the broader community think about Aboriginal health and Aboriginal people. I found all of my patients are very receptive to getting health advice, value my opinion, follow my health instructions and, in fact, so value my opinion that, even if a specialist tells them about a new medication to take or a different pathway to take, they come in double check with me that it's okay.

I think that's one of the most rewarding things about general practice, but Aboriginal health in particular is that you really reap the benefits of that ongoing continuity of care, having a really positive impact on someone's health. Following their trajectory through the healthcare system and the advocacy as well, because of a lot of our patients need someone to help them sometimes. I found a lot of my patients have been poorly treated by the healthcare system and have been victims of racism in particular, and it's quite shocking in this day and age to see it. Advocating for your patient, trying to ensure that your patient gets the best outcome possible it's not only the right thing to do as doctors, but it also helps build that relationship and helps build that trust, which is, I found really paramount in Aboriginal health and Aboriginal healthcare, but you can argue for healthcare in general.

I’ve learned medical skills that I didn't have when I started here and I’m much more aware of the social determinants of health. Before I was quite medically oriented, I just asked about past history, what medications are you taking. Now I ask about housing, finances, can you afford the medication that I’m giving, how many people are in the house, mental health and the impact of mental health with medication compliance and trauma, historical trauma … all things I’d never even thought about asking or considering are now are routine in my healthcare approach to patients. I think I’ve become a lot more whole person focused than when I was when I started at BDAC.

Can you describe the diversity of services provided?

BDAC was the 2019 RACGP GP Victorian Practice of the Year, and I think we won it, mainly because of our multiple services. A standard medical clinic is doctors, nurses, reception staff, of which we have plenty.

We've also got Aboriginal health practitioners, who act as conduits into community, help patients get to clinic, explain medical conditions to patients, aid with compliance of treatments and medications; drug and alcohol services [AOD], so we have male and female AOD workers; a dual-diagnosis clinician who manages our patients with significant mental health and substance use disorder issues; aged care service, a HACC [home and community care] service, which helps some of our patients get home care packages to keep people in community longer, so people can stay at home in good health, with community, which we know is what most of our patients want; [and] integrated team care program, which is about helping fund patients to access specialist care that's not available here in Bendigo, whether that be public or private, transporting patients to and from specialist or allied health appointments, and also helping advocate for patients in their care and also case manage patients as well, so that we're on top of some patients who've got multiple medical conditions going simultaneously.

It's very much a wraparound service, and even in the clinic, we do we do a lot of medicine that might not be in most clinics, just because a lot of our patients feel quite happy and safe coming to the clinic. So we do a lot of hepatitis C medication, an s100 prescriber and HIV s100 prescriber. We do antenatal shared care, medical terminations of pregnancy, chronic disease management. We try and provide as many services as we can, within the clinic so we don't have to refer out if humanly possible.  

What did you know about the community before you arrived? Did you perceptions change? 

I didn’t know that much about Bendigo, I’ve never really visited Bendigo before I came here. I knew it was a relatively bigger town, but that was just based that on a Wikipedia search. I didn't know too much. Bendigo is a pretty large regional centre. We have a very good hospital that has the vast majority of medical services required; it's still probably not a tertiary hospital, as you would expect in Melbourne, so it doesn't have the full gamut of services, you would see Melbourne. We do have to refer patients to Melbourne, but you are well supported by the hospital. We're a small ACCO, we don't have that many GPs around, but there were a few GPs there at the time, and they welcomed me. We have a paediatrician on site as well, so he was also quite welcoming. It was good to have people around you could talk to, discuss cases with and how to manage things as well, especially when you are new to any job or place, it's always good to get a second opinion and just double check that you doing well, and that's medicine.

What do you do in your spare time?

It's important to separate work from recreational time as well, otherwise you run the risk of burnout. It is important to set those times apart and delineate between both of them. I found, when I first came to Bendigo, people were quite willing to assist with the move and give advice as to where a good location to rent and the other services and what Bendigo had to offer.

There's good restaurants and there's quite a few good pubs. I like a good meal, so this this quite a bit to do there. There's quite a few running tracks as well, so I like to run also so there's that. I do a bit of yoga and meditation and there's a good yoga studio that I go to and meditation I do that at home. Bendigo has a lot to offer, as it's quite a large town. It is like living in suburb of Melbourne in many respects. It's not like the CBD, but it is really like many, one of the outer suburbs. There's a lot of people around as well, like a surprisingly large amount of people, more than I thought. People are very friendly and happy to have a chat and there were a lot of people who've come from Melbourne for work or whatever, so there's a lot of people who are in a similar boat to me, so it's been fun.

What advice would you provide to others considering a career in rural medicine?

I would say, definitely consider it. For me personally, the work I’ve done here at BDAC has been the most meaningful and impactful work that I’ve done in my own career, thus far. I’ve really got a lot out of the work that I’ve done, if nothing else. Hopefully, my patients also benefited as well.

Working in Aboriginal health, it can be stressful. There can be a lot of pressure and you can be dealing with some quite complicated situations. A lot of the time you're not by yourself and there's always people to bounce ideas off and talk to, and the people I usually talk to are nurses, Aboriginal health practitioners and usually, a problem shared is a problem solved. Try to share problems and try to get other people's input, that is quite important. I’d strongly encourage anyone who's interested in working Aboriginal Health to do so. It's a really rewarding field of medicine. And it's really rewarding work and something that does change you, and shape your view and your thoughts about healthcare, social justice, equity, social determinants of health … things that I’ve never really thought about before or just given token notice to.

Bendigo & District Aboriginal Co-operative (BDAC) provides medical care for the Aboriginal and Torres Strait Islander peoples on Dja Dja Wurrung lands and to the wider community. BDAC was awarded the RACGP Victoria General Practice of the 2019.

BDAC was recognised for its multiple wraparound services and multidisciplinary care model. This includes aged care, integrated team care, social and emotional wellbeing, culturally responsive drug and alcohol, family support services, a dual diagnosis clinician who manages patients with significant mental health and substance use disorder issues and financial counselling. The clinic provides medicine that may not be available elsewhere, such as access to hepatitis C medication and medical termination of pregnancy.

BDAC has also taken on an essential role in Aboriginal-led child protection, to ensure children in out-of-home care are placed with Aboriginal families and to support family reunifications. The clinic also supports this program – if a child needs to be seen urgently, the clinic has a commitment to see them on the same day.  

Dr Naren recently departed BDAC after working there for four years. His experience in Bendigo has been memorable.

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