Australian Clinical Pharmacy Award 2024 oration

Susan Trevillian^1,2,3,4,5

BPharm, PGradDipHospPharm, FANZCAP (Lead&Mgmt, RuralHlth), FAdPha | susantrevillian@hotmail.com

1. Chair, Rural and Remote Specialty Practice, Advanced Pharmacy Australia (AdPha), Collingwood
2. Councillor (AdPha) & Board Director, National Rural Health Alliance, Deakin
3. Deputy Director of Pharmacy, Northeast Health Wangaratta, Wangaratta
4. Pharmacist – Education, Training & Research, Benalla Health, Benalla
5. Teaching Associate, Monash University Faculty of Pharmacy & Pharmaceutical Sciences, Parkville

Perhaps she wasn’t far off though, when we talk about death from potentially avoidable causes.  Men in rural areas are 2.5 times more likely and rural women are 2.8 times more likely to die from a potentially avoidable cause than their metropolitan counterparts.²

So for me, as a rural 47-year-old woman, two years younger than my Dad when he had a major stroke, the fight for better rural health outcomes gets more important and urgent by the day:  Danger illustrated.¹

So, am I like my parents?  You be the judge.

I have no memory of this, but apparently on my first day of primary school at age 4¾ years, I made it clear “I go by meself” and marched down the driveway, a few hundred metres along the side of the highway, and into the school gate.  Mum watched from the window, and she and Dad still disagree on whether there were tears.

At age eight, I drove my first truck.  The paddock around our house was filled with newly baled hay, and rain was coming.  The mission — this hay, this truck, that shed.  Dad could do it on his own, walking along with nobody in the driver’s seat while the truck idled along in first gear, but it’d be faster if he had someone to keep the truck going in a straight line.  So I drove, idling in second gear and steering while dad walked alongside and lifted each small square bale onto the back. I couldn’t reach the pedals, but Dad could move fast if something unexpected happened. Never having done it before wasn’t a barrier to me being useful.

I remember how proud I felt to be doing this new thing that only 16-year olds were allowed to do, giving dad the ammunition to remind his mates that their sons were “as handy as an ashtray on a motorbike”, unlike his three daughters.

Nowadays, we strive to replicate this feeling amongst our pharmacy students and interns, with early responsibility, nearby support, a ‘have-a-go’ and ‘we’ve-got-your-back’ attitude. We send them back to metro as changed humans who’ve had a chance to feel like a pharmacist, and for some, to feel like an adult for the first time.

My teenage years were spent at Foster High School (which changed its name to South Gippsland Secondary College), on the farms, and at weekend sport, netball and golf. My parents were active volunteers in the local CFA [Country Fire Authority] and golf club, moving between different roles on the committees and instilling in us kids the value of volunteer service. I treat my membership of AdPha like they did their clubs: this is my church. This is where I heal my hurts.³

Teenage life was full of more of Dad’s well-worn phrases like “you can handle anything as long as your hands are clean”. Also, some cringy ones, “I married one, bred three more, and still had to buy a mechanical dishwasher”. Gosh, if I had $1 for the 6.5 billion times I’ve heard that one, we could fix the healthcare underspend for the 7 million rural Australians who have about $850 per head less spent on their healthcare each year, than their metropolitan counterparts.²

And the weirdest combinations, “you kids can be anything you want, except a police officer” alongside “little girls should be seen and not heard”, and “no good complaining, nobody will listen anyway”. I think it’s only really in the last few years I’ve untangled myself from those last two, figuring out how to complain without whingeing, keeping burnout at bay by looking in the future, using my clinical pharmacy training to anticipate what will be my next few moves after hearing “yes”, or after hearing “no”. 

The person who’s most enabled that transition — to feeling like a leader — is David, my Director of Pharmacy at Northeast Health Wangaratta.  He’s undoubtedly the father of our department, and leads our team with care, kindness, and an ever-present helping hand. His leadership style is one of seeking forgiveness rather than permission. When I asked him about whether I should put up my hand for the first ever elections for AdPha (then SHPA) Specialty Practice in 2017, less than a year after we began working together, he dismissed the question with “stop asking me if you can do things – if you think it's the right thing to do, then go ahead and do it”.

So my 4¾ year old self has been doing that with rural health advocacy ever since.

And so, as I work out what I’m going to ask for next in rural health advocacy, rural pharmacy workforce development, rural pharmacy workforce attraction and retention, the narrative is largely based on sharing my own and my family’s experiences in rural health. Plus, your deidentified experiences as they come to me.  You know me now, so don’t be shy, no idea is too crazy, and no problem insurmountable.

But a few people early on enabled me to get into and through the starting gate, in pharmacy and beyond:

• Max and the late Rosemary Wood, lifelong friends of my parents who recommended the residential college I lived at while studying pharmacy, and whose house I boarded in while completing student hours in Korumburra Pharmacy.
• John (real name Glenn) and Maureen Masterman, proprietors of Korumburra Pharmacy, who’d heard on the South Gippsland golf clubs’ grapevine in 1995 that Jim and Nancy’s daughter from Welshpool was studying pharmacy. They were happy to arrange a six-week summer student hours placement for me. Maureen particularly enjoyed me being there, as she worked on her golf game. On the day that my first-year uni results arrived at home in the snail mail, Dad phoned them through to the pharmacy landline that afternoon. John wasn’t bothered that I’d failed my first year, as he quickly told me he had also done, but was more worried I’d abandon the placement. They kept me on all summer and on the rare occasion that I’d work alongside Maureen in the dispensary, she’d remind me how good it was to be able to work on her game. Just like now, 30 years on, with lots of rural pharmacists not really getting much chance to take leave due to workforce shortages.
• Garth Birdsey, who I followed around on a second-year summer placement at Geelong Hospital, which has also changed its name since then, and was the first fierce clinical pharmacist I saw in action.  I remember him being generous with his knowledge, and stopping mid-sentence one day, apparently enraged at the post-it-note a well-meaning nurse had attached to the front of a bedside folder. Post-it-notes were quite new then, and it was made clear to me they had no place in communicating medication-related issues in a ward setting.
• Kevin de Vries and Maryanne Molenaar, both of whom agreed that I could do six months of my internship in Kevin’s community pharmacy, and six months in Bendigo Hospital with Maryanne’s team. Such was the state of the workforce shortage back then, I was their only intern prospect. 
• Jeff Hughes, Peter Tenni, and Andrew James, clinical pharmacy tutors during my Clinical Pharmacy Residency year in 2000, who made me believe that I might actually be good at this.
• And everyone that’s inspired me over the 25 years since, who are mostly linked to AdPha.

Finally, to my husband Richard, who shared his surname with me 10 years ago, and has been a long-suffering source of level-headedness, calm and support since we first met in my “second first year” at residential college almost 30 years ago.

And as I embark in the coming days on the next thing that’s outside my comfort zone, fear addicted¹ and attending my first National Rural Health Alliance Board Meeting as an elected Director, Richard reminds me that my accomplishments are worthy of supporting.  To do that, he and our mighty girl are keeping the home fires burning. She’s nearly 9, so is clearly overdue for her first driving lesson, although she has had a go at racing in Richard’s video gaming setup. Perhaps when I get home we’ll pop the Corolla in the orchard and see whether she can keep it straight.

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