Bringing it home

THERE WAS NEVER any question in Dr Shehnarz Salindera’s mind that she would one day return to practice in the regional beachside community in which she grew up.

“For me, doing medicine was always about serving my community. It’s an important principle that I grew up with. My parents and members in my family are actively involved in community service in different ways, from local council to supporting and looking after migrant and refugee people in our communities. 

“And as a Sikh, it’s an important principle as well. So it was always the goal and to me it was the most meaningful way that I could serve my local community.”

Dr Salindera was born in Coffs Harbour and grew up in Woolgoolga, a small town just 25 minutes north. Woolgoolga is unique in that it is one of the first Indian settlements in Australia. The Guru Nanak Sikh Temple, also known as the Temple on the Hill, is a distinctive landmark and symbol of the area’s cultural and religious diversity.

“It’s a very multicultural community but at the same time a very Aussie beachside area to grow up in.” 

Dr Salindera is a general surgeon, who subspecialises in breast and oncoplastic surgery. She offers outpatient services at Coffs Harbour Breast Clinic.

While she always wanted to become a doctor, Dr Salindera took a non-linear route to medical school. After completing her Bachelor of Science at the University of Sydney, she went on to do a Masters in Health Law. 

It was there that a convincing classmate – Clin A/Prof Saxon Smith, who went on to become President of AMA (NSW) from 2014-2016 – encouraged her to join the AMA.

Dr Salindera received a Rural Australia Medical Undergraduate Scholarship – a scholarship scheme for students with a rural background who are studying medicine at university – and chose to do the rural program at Flinders University in South Australia.  

“Flinders University has a really good rural medicine program, with excellent rural clinical placements and an ability to give an immersive experience that helps prepare you for rural practice,” Dr Salindera says.

After graduating medical school in 2010, Dr Salindera returned to NSW to complete her internship and residency at Coffs Harbour Base Hospital. 

She enjoyed surgical rotations in med school and during her training liked working as part of a team in an acute environment. So, she applied for surgery.

“I didn’t actually think I’d get on but I was encouraged by local surgeons Dr A Warrier and Dr W Ross,” she says. “I went into the surgical program with very little experience, as a PGY3, and with very little practical operative experience. I could not do any procedure by myself – I really had to learn from the ground up.”

She acknowledges it’s a tough specialty; there is a lot to learn and it’s a high-pressure environment to learn in.

“There were challenges throughout my training, but I also felt that knowing why I was doing it and having such a strong sense of purpose and a goal to give back to my local community really sustained me through some of those difficult times.” 

Dr Salindera adds that having family support and mentors and supervisors who believed in her journey was also crucial to her success. 

She credits Dr Sally Butchers, a surgeon in Lismore, for being a role model to her – not only as a female surgeon, but one who works in a regional area. Associate Professor AJ Collins, a consultant endocrine and breast surgeon in Bega has also been influential.

“He really showed me that you can deliver high quality care, even sub speciality care, in a rural / regional setting. You don’t actually need to be in the city to be a sub-specialty practitioner.”

She completed her general surgery specialist training program at Prince of Wales Hospital Randwick in 2017.

During her training, Dr Salindera witnessed first-hand the important role surgery plays in the treatment and cure of breast cancer. She was also very familiar with the stories of family and friends in the Coffs Harbour community who experienced breast cancer and were in need of this treatment pathway. For both these reasons, she chose to sub-specialise in breast & oncoplastic surgery.

She undertook additional training in oncoplastic breast surgery, melanoma and surgical oncology at the Royal North Shore Hospital & Melanoma Institute Australia with funding from the Friends of the Mater Foundation and then at the Westmead Breast Cancer Institute.

“I have been fortunate to have ongoing support from mentors from my fellowship such as A/Prof Elizabeth Elder at Westmead and Prof Andrew Spillane at North Shore. I can discuss patients and complex cases due to these connections which is very helpful for working in rural.”

Her credentials also include a Masters of Surgical Science and Practice from the University of Oxford and completion of the Harvard Business School’s Value Based Healthcare Delivery program.

Dr Salindera returned to Coffs Harbour in August 2019. The Coffs Harbour Health Campus is a regional referral level 5 base hospital. The area is also home to the Mid North Coast Cancer Institute. With her experience and training, Dr Salindera is able to provide a breast reconstruction service to the community that previously didn’t exist.

While her passion for providing access to healthcare services to residents in rural, regional and remote NSW communities has determined her own professional career, it has also led her to be an influential voice in making system-wide improvements.

Dr Salindera appeared on behalf of AMA (NSW) at the NSW Parliamentary Inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales. 

Whilst AMA (NSW) acknowledged the challenges of delivering health services in rural areas, our submission emphasised what improvements could be made to ensure access to adequate and reliable medical services.

We prepared our submission with the input of our members who have experience working in these areas. The input covered experiences from doctors-in-training to senior practitioners. 

Dr Salindera played a pivotal role in representing the submission and views of regional doctors to the committee during the inquiry hearing.

“I was absolutely thrilled to have the opportunity to advocate for rural communities and attend the parliamentary inquiry in person. It’s something I’m very passionate about and I do think that delivering modern high-quality care close to home is a realistic and reasonable expectation of Australians living in rural and regional areas. The challenge, of course, is how do we achieve that? 

“I think the AMA’s focus on deliverable ideas and deliverable change is the right way to go.”

Dr Salindera’s thesis for her Masters in Surgery focused on rural recruitment and retention of surgeons. Through her research, she looked at the challenges of providing healthcare in centres without critical mass.

“In a rural area you may be isolated as a clinician and that can present many challenges – from the day-to-day clinical work to your personal/professional well-being. 

“It can be difficult to stay up to date with the type of care you are trying to deliver, and you also have the stress of working in a high-pressure environment where you are isolated. 

“Developing regional hospitals into centres that have a critical mass of people, as recommended in the AMA strategy, is an important step forward. 

“This will require flexibility in workplace arrangements. It will require incentives for relocation and incentives for retention. I found in my research that there is evidence that those strategies work.”

Dr Salindera adds that these solutions also require governance structures that help clinicians work in a safe environment.

For example, for generalists to practice with an extended scope they require a network that not only helps them maintain their skills but provides support should they need to escalate a patient’s care or gain input on consultation with other experts in a particular field.

“Having those structures in place for people in regional and rural locations to provide that extended scope of practice is a really important step forward for how we can develop better care, safer care, and a critical mass of clinicians in our regional hospitals.”