Blugibbon meets Locum Doctor Bishan Rajapakse
Bishan or “Bish” as he likes to be called, kindly gave Blugibbon his time for a frank discussion on all things emergency medicine, wellbeing, why locums are important and being accosted by a humpback whale, an incident that went viral worldwide.
Bish is currently an Emergency Medicine Physician (FACEM) in the Illawarra region of New South Wales, at Shellharbour Hospital.
What is going on right now for you Bish?
Right now, today, I was doing a non-clinical day. And gave a talk to the interns orienting around in the lower region. We had a great session. Actually, it was an interview with one of the provincial training directors talking about their experiences. As well as discussing strategies for staying well, not only in Shellharbour or the hospitals in the region. And it’s not just for Shellharbour or hospitals in the region.
Where did it all start for you in Australia?
Although I am now a FACEM at Shellharbour Hospital, I actually took 20 years to become a Consultant because I was involved in various training pathways. I started with surgical training, then I went to emergency as an advanced trainee.
I took about six months off, which turned into two years and then four years as I did research in that time during some timeout. Specifically, I found out about research in rural Sri Lanka and ended up with a PhD in knowledge translation.
My passion is medical education, as well as making a difference at ground level. I came back to my emergency training and I moved to Sydney in 2011 because that’s where my supervisors were.
How did you become a locum doctor Bishan Rajapakse? What is your story with Blugibbon?
I was working in various Sydney hospitals but with the write-up of the PhD thesis, I needed to take time out to write and that’s when I met Sam (Blugibbon Founder). I went to all sorts of amazing locations as a locum doctor. Realising that locuming was in alignment with what I am trying to promote as an emergency physician. And effectively a “new age” doctor, encouraging people to stay well in order to be better for the community.
Locuming can give you that boost of positivity that’s needed. Away from the autonomy, and to me it’s an antidote to burnout. I locumed in Port Hedland and made a song via video about it.
There have been some amazing experiences and some bad experiences. And I think that is why the job that Blugibbon does, and others like you, do to try and place people in good places and support them in that journey is an important role.
What have been some of those challenging locum experiences?
One that stands out was where the staffing was particularly poor. Which sometimes can be why a hospital is using locums.
The behaviour by some of the staff was not what I considered right, I am about civility. There are a lot of stresses in emergency medicine. But shouting is something I feel is not needed and something I experienced there.
The CMO in question had been difficult to work with. And was out of line with their behaviour to other staff also. So I went to the Director the next day and made them aware. And then let my locum agency know I did not want to go back there.
Now I am on the other side of the fence, as a Consultant representing others, we want to promote a culture and experience where people come and want to stay or return. Although we do a hard job! We want to provide a setting where we love to work and we love to be part of the community.
What was key about the good locum experiences?
The places that have been good are the places that you cannot wait to go back to. Everyone remembers you from the last time and you go out and do social things together. As well as being great team players at work.
That’s why we love emergency medicine. It’s a team sport. And from negative experiences you can have inspiration, being inspired to do things in a different way.
What is it about the Illawarra Region you want to promote?
It sounds simple but we have a group of people connected through WhatsApp, real time communication between us.
There are many leaders in this group that respect that kindness is actually at the core of what we do in healthcare. And even with cross-disciplinary people across hospitals, we will share messages and stories within that WhatsApp group.
It has become a great resource that you can return to for some important background information. It has been running for around two years. And I am definitely championing this communication culture that we bring into our meetings and ward round “huddles”. Such as discussions about culture and mental wellbeing. I would never have dreamt of such things, previously when I was doing my training ten years ago. Something I was so passionate about but had only found in pockets in smaller hospitals.
That being said, unprofessional behaviour in hospitals can happen, it does happen. But I have always told people there are those that care and that you should get yourself mentors. There are people out there that fully embody this. They are authentic and champion it, even though we work in pressured environments. Then we work as a team as this turns into high performance.
What other reasons should a LOCUM doctor come to the Illawarra?
This particular hospital has a personal feel to it. One of the reasons I am attracted to rural medicine is that you still have the acuity of the tertiary hospital in a sense.
As an emergency physician you have to deal with anything and everything under the sun. Even though we do not have the services of trauma, obstetrics and paediatrics, we still have those patients come through the door and work closely with the retrieval service.
Effectively we do not have an intensive care unit. Which means it is a challenging place. Where you have to see that acuity with two resus beds and two paediatric beds and general medicine.
The culture is friendly, it has a country hospital feel to it. You do get a lot of Consultant contact, but in a more informal way. In other “big city” places, the pressure is sometimes so high you only really get to have those human conversations offsite.
Was there anything that surprised you when you first arrived?
I was concerned about working there as a full time new FACEM. And essentially the lead, and maybe I should split my time with a metropolitan hospital too. So I would not not worry about seeing the same level of presentations I had previously.
18 months later I do not feel that way at all. Everything comes through the door, we get to deal with critically ill people. But we also get to focus on looking after a community. We really feel like we care about our community. And we are constantly advocating for the nearby tertiary hospital too at Wollongong. There is a great camaraderie between the teams and advocacy of patients.
There are also good schools and set up a good life here. We have challenges like every emergency department does, increased by COVID. But we are closely looking at staffing. And I believe Shellharbour also allows you to follow your non-clinical passions, like the art department we have.
You get to work with an incredible and diverse team. That have subspecialty interests such as ultrasound, international medicine and research. We have people that went into management and have management degrees.
Diversity is an ongoing priority, ethic, gender and we will keep striving for more. This really should be a place that is home, not just a job.
What do you want for the staffing situation at Shellharbour?
Ultimately we all want the same thing. Adequate staffing will contribute to wellbeing and I think it’s fairly standard that when you are in a smaller place, or any place today, we are constantly facing shortages.
We have our recruitment processes and the ideal would be to manage this ourselves but of course there are times where third parties are absolutely the right choice. Any third-party such as Blugibbon that makes an effort to actually get to know where they are sending people and have a feedback mechanism, that’s really powerful.
One thing that can always be improved is the feedback mechanism. One of the things that I like to do is to tell locum agencies such as Blugibbon that we are happy to take any feedback that they have because we are always interested in their impressions and we want to proactively improve our culture for people to come and work with us. We are proactive like that. We are interested in what people find valuable, but also find challenging in a department.
Tell us about the whale incident?
I was living in Bondi and I was driving down for shifts in Wollongong at the time, spending most of my time doing my PhD write up and driving across to RPA. One of my friends worked at the research offices across the road from RPA and basically we would go surfing everyday.
It was a Sunday in July, a beautiful winter’s day. And it just so happened that when I was paddling out to the last wave of the day, I saw this big shadow and my mate Chris was there. He signals me to come and I’m paddling out and I thought, “Okay, this must be a good set coming in”.
And there was this shadow. It was too big to be anything that I could conceive. Suddenly, under the water, this massive whale surfaces, gallons of water dripping on its side. It looked like some sort of alien craft with the barnacles and everything.
The whale below out of its blowhole, It was incredible. It was the size of two buses, massive. Everyone was watching from Bondi Icebergs and then the swimmers there jumped off and swam out. A grandfather and daughter started screaming and I think the whale got spooked.
How did the whale react?
The whale took off and then turned around and it popped up right in front of me. I can see in the corner of my eye people are saying “Get out!” I am on my board, pushing up. And looking into the eye of the whale, literally. “Hey how’s it going?” It was a magic moment.
And that’s the last thing I remember. I was told there was this big wave caused by it slapping down it’s tail and it threw me out of the water and then down, knocking me out. It was a near-death experience for sure, I was underwater and then was pulled up by my friend on the board and taken by the lifesavers. Concussion and a minor injury but by the grace of God, I was okay.
I was incredibly impressed by the staff that looked after me. I had not seen it from that perspective before, so I say this to all my colleagues, that we are doing a great job. And it is important, what we do, it is important to treat your patients with kindness, it is important to be aware.
And you only realise that when you are on the other side. Do you want to join Bish’s team? Get in touch with Joe at Blugibbon today on [email protected] or 02 8960 6445. To read our other locum doctor interview, click here.