Mhqautumn2014 web

QUARTERLY

autumn 2014

Pregnancy obesity risk | Hepatitis B research | Mobile dialysis | Aboriginal health

MORE THAN JUST MEDICINE How the new Children’s Cancer Centre will help families

www.monashhealth.org2

6CoverFamilies of children with cancer will benefit from the opening of expanded facilities at the Monash Children’s Cancer Centre. See story, page 6.

Photograph Chelsea Arnold

For permission to reprint any part of this magazine, please contact the editor. Opinions expressed are not necessarily those of Monash Health.

EditorChelsea Arnold

e: [email protected]

ContributorsShane Butler Holly Gilligan

Contact UsMonash Health Quarterly is published by the Public Affairs and Communication Department.

Monash Health Locked Bag 29 Clayton South Victoria 3169

03 Mobile dialysis unit for patients

04 Making news

05 World-first heart patients reunited

06 Children’s Cancer Centre expands

08 Obesity risk in pregnancy

09 Better access for Hepatitis B patients

10 Research into a good night’s sleep

11 Generosity improves Aboriginal health

12 Have the chat that saves lives

At Monash Health we are proud to provide a world of healthcare to the community we care for.

We provide healthcare for every stage of life. We’re experts in so many areas including heart, cancer, renal, women’s and paediatric healthcare and much of our work and research is internationally renowned.

Essentially, nowhere else in Victoria is there such a dynamic world of healthcare within one organisation.

In this edition of Monash Health Quarterly we share with you some of the amazing work our people are carrying out to benefit the lives of our patients.

Read about young Charlie Garcia’s experience at the Children’s Cancer Centre and learn how the newly expanded facilities, made possible through the generosity of a number of community partners, will make an immeasurable difference to the lives of our youngest cancer patients.

We also share with you the wonderful research into improving healthcare access for patients suffering from Hepatitis B, an initiative to improve the quality of life of our dialysis patients, and about an incredibly generous donation which has seen the refurbishment of a flat for use by the families of our Aboriginal patients.

A special donation of a different kind is organ donation. Organ donation is a significant decision and I was privileged to welcome many families of donors and recipients to participate in the inaugural Monash Health DonateLife Commemorative Service.

The ceremony was marked by an emotional balloon release in which 31 balloons represented the 31 families who had consented to organ donation in 2013.

Please take a moment to think about your organ donation wishes and have a chat with your loved ones.

Shelly Park Chief Executive

Message from the Chief ExecutiveHello and welcome to this edition of Monash Health Quarterly.

Read about our latest breakthroughs. Have each edition of Monash Health Quarterly sent straight to your desktop. Subscribe today.

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Inside this issue

QUARTERLY

autumn 2014

Pregnancy obesity risk | Hepatitis B research | Mobile dialysis | Zero dental wait list

MORE THAN JUST MEDICINE How new Children’s Cancer Centre facilities will help families

MONASH HEALTH QUARTERLY Autumn 2014 3

A world-first initiative to offer dialysis patients a better quality of life.

INSIDE STORY

Travelling dialysis

Vince Tripodi had one dying wish. In 2011, the dialysis patient expressed

a wish for a mobile dialysis unit which would enable patients like him to take holidays with their families and friends.

Life for dialysis patients can be very restrictive. Most require dialysis up to five hours at a time, three days a week either at home or in a hospital.

They don’t often have the luxury of being able to take a holiday.

Last month, Mr Tripodi’s dream became a reality.

Health Minister David Davis officially launched the Big Red Kidney Bus Mobile Holiday Dialysis Unit at Parliament House on World Kidney Day.

The Big Red Kidney Bus is a community partnership between Monash Health, Kidney Health Australia and Latrobe Valley Bus Lines.

Through the world-first initiative, thousands of Australians living on dialysis will now be able to take a holiday, without missing life-saving treatment.

The bus will provide mobile holiday dialysis, travelling to popular holiday spots where it will set up for six weeks at a time, staffed by Monash Health renal nurses and technicians.

The bus will travel to popular destinations such as Mallacoota, the Grampians and Mildura. The first destination will be Lakes Entrance in August.

Monash Health’s Director of Nephrology Professor Peter Kerr has long supported the project.

“Having access to the Big Red Kidney Bus is going to make a big difference to the lives of Australians who live on dialysis,” Prof Kerr said.

“This initiative will give patients the kind of

flexibility to get away and take a break that many of us take for granted and ultimately we believe this will lead to an improved quality of life for patients who use the bus.”

Patients on haemodialysis in a hospital dialysis unit, in a satellite unit or on home haemodialysis will arrange and pay for their own holiday accommodation and travel arrangements but will be able to access the service free of charge.

Kidney disease affects people of all ages. It is not uncommon for people to lose up to 90 per cent of their kidney function before getting any symptoms.

There are more than 11,500 Australians living on dialysis.

“Monash Health is proud to partner with Kidney Health Australia to bring the Big Red Kidney Bus to life and deliver this wonderful program to the community,” Prof Kerr said.

Patients and families are grateful for the opportunities the Big Red Kidney Bus brings.


Moorabbin Hospital

Work to start soon on new Monash Children’s Hospital

MAKING NEWSThe top news stories from www.monashhealth.org

Exciting world-first Botox trial results

Work is set to start in July on the new Monash Children’s Hospital. The 230-bed dedicated children’s hospital, due for

completion in late 2016, will be co-located next to Monash Medical Centre.

The purpose-built children’s hospital will ensure many more Victorian children and their families can benefit from world-class specialist paediatric services and will include: 96 acute paediatric inpatient beds, 10 paediatric intensive care unit beds, 64 neonatal care beds, 20 same-day medical and surgical beds, 12 same-day oncology beds and many more services.

Before works can begin the Monash Medical Centre helipad will be relocated to Fregon Reserve, Browns Road, Clayton.

The helipad is being moved due to the construction of the new hospital on the existing helipad site. The helipad needs to be relocated prior to site possession and major works starting.

Monash Health Chief Executive Shelly Park thanked the community for its understanding and support during consultation about the relocation of the helipad.

A comprehensive study of helipad relocation options was carried out with air traffic consultants, Air Ambulance Victoria, Road Ambulance Victoria, the Department of Health, and key clinical service providers from Monash Medical Centre and statewide critical care services. The study recommended Fregon Reserve to be the safest option for patients and Monash City Council agreed to a request to use the site.

Minor works are being carried out at the reserve to ensure the safety of users and residents and ambulance access during heli-copter landings.

Monash Health has consulted widely with the community including the reserve’s sporting groups to establish clear safety protocols in the event a helicopter is required to land while the reserve is in use.

The helipad will be reinstated within the Monash Medi-cal Centre site upon completion of the new hospital.

A world-first clinical trial at Monash Health using botulinum toxin or Botox® to treat severe vocal cord dysfunction in

patients with asthma is reporting exciting results.

Vocal cord dysfunction is a condition where the vocal cords move in an abnormal, uncoordinated way, causing episodes of severe breathlessness and wheezing.

The research has been led by Professor Philip Bardin, Director of Respiratory and Sleep Medicine for Monash Health, and Dr Malcolm Baxter, ear, nose and throat surgeon.

The trial involved injecting Botox directly into the vocal cords of patients with severe asthma that results in upper airway problems.

“We trialled other methods of delivery, but we found the greatest benefit was achieved when we used a bronchoscope to guide our injections to a very specific area of vocal cord tissue, where we inject a small amount of Botox.”

“This partially paralysed the muscles and caused the voice box to relax and allow air through,” Prof Bardin said.

Eleven patients received a total of 24 injections, with about 60 per cent of those patients observing a significant reduction in symptoms.

“This treatment may not be suitable for all patients, but the early indicators are that it may be an option for those with severe upper airway distress, which is very exciting,” he said.

“Many of these patients’ symptoms are severe, so it has been tremendously satisfying to provide them with some relief.”


World-first heart patients reunited

Deakin University researchers are exploring the effects that

laughter yoga therapy is having on dialysis patients at Monash Health’s Moorabbin Hospital.

The study led by Deakin’s Associate Professor Paul Bennett examines the effects that voluntary laughing has on decreasing anxiety and improving the mood and blood pressure of dialysis patients.

Prof Bennett hopes to expand the research with the aim of implementing laughter yoga programs in all dialysis units across Australia and overseas.

The unique therapy has provided the whole

Researchers help patients find the funny side of dialysisdialysis ward with a much needed boost.

Laughter yoga therapy gives patients an aerobic workout that gets their blood pumping and oxygen flowing. The process comprises 30 minutes of stimulated, laughing exercises with controlled breathing and movement.

Barbara Blackman, a Monash Health dialysis patient at Moorabbin Hospital, said she found the exercise a welcome break from her treatment.

“The whole program has been very beneficial in improving our outlook and lung function,” Ms Blackman said.

MonashHeart has hosted a reunion of the first three people in the world to

receive the lotus valve heart procedure.

The women known as ‘the golden girls’ all experienced aortic stenosis, a condition which causes the aortic valve to narrow. The lotus valve was their only solution.

The women were too frail to undergo invasive open heart surgery which would be given to younger patients with the same condition.

Instead, a replacement heart valve was inserted on the end of a wire through a small hole in the groin.

The lotus valve is a unique synthetic device that opens up like a flower once inside the heart and can be easily repositioned.

Professor Ian Meredith, Director of MonashHeart, performed all three lifesaving surgeries.

“Aortic stenosis can be extremely dangerous, it leaves people unable to breathe and in most cases they won’t survive 12 months,” Prof Meredith said.

Two years after the successful surgery all three women are living healthy, active lives.

“The trial had a 100 per cent success rate and was a huge step for the treatment of

severe aortic stenosis, it’s fantastic to see the living proof of how this procedure can change lives,” Prof Meredith said.

Muriel Satchwell, 88, was the second person in the world to receive the new valve and said it has completely changed her health. “I no longer feel my age, the way I did before surgery,” she said.

Professor Ian Meredith with Muriel Satchwell, Jean Fox and Judith Nicol who underwent the lotus valve heart procedure.

Professor Paul Bennett can see the benefits laughter yoga is having on dialysis patients.

The lotus valve.


A PATIENT’S STORY

More than medicineExpanded facilities at the Monash Children’s Cancer Centre will ensure an even greater level of care for children and their families.

When Charlie Garcia celebrated his seventh birthday in October his

family threw a party with 25 of his friends.

But in a selfless act, the youngster asked his friends not to give him presents but to make a small donation to the Children’s Cancer Centre at Monash Children’s Hospital.

Generously, the children donated $529 in support of their friend’s cause.

The Children’s Cancer Centre is Charlie’s home away from home.

At age five, he was diagnosed with acute lymphoblastic leukaemia (ALL), news that upturned the lives of his parents Angela and Tom Garcia and his siblings Rebecca and William.

ALL is the most common form of childhood cancer, but overall it is a rare disease accounting for only 0.3 per cent of all cancers diagnosed.

“It all began with a virus that led him to the Emergency Department but he wasn’t getting better, he was getting sicker,” Mrs Garcia said.

The world changed in a heartbeat for the Bentleigh family.

Charlie began his course of chemotherapy

and was a regular at the Children’s Cancer Centre.

“When you first hear the diagnosis, it changes your priorities and it gives you a huge amount of perspective and you soon learn where your support comes from,” Mr Garcia said.

“You realise your child is running a very fine line between life and not being here.

“He’s very tough and resilient but every time he gets a fever he is back in hospital. The doctors and nurses here are extraordinary. You need them and you would be lost with-out them. You need them so you won’t lose your boy.”

Mrs Garcia said that Charlie is now in maintenance, receiving monthly intravenous chemotherapy plus daily oral chemotherapy. He is due to complete his treatment in mid-December 2015. He is back at school and enjoys playing basketball and Auskick with his friends.

“It’s been a very big up and down journey,” she said. “He’s pretty good about it all but as he gets older he realises this is not going to go away, it’s for two more years.”

Mrs Garcia said the centre is so much more than simply medicine and treatment.

“It’s about all the other things that are offered to the children like the play therapy and the music therapy. The staff really know how to turn a negative into something positive. You trust them implicitly.”

The Children’s Cancer Centre, initially funded by the generosity of Peter Bodman and the Kids with Cancer Foundation, has recently undergone an expansion and refurbishment, ensuring it offers the highest quality facilities to meet the needs of children faced with cancer. The space is vital for families like the Garcias.

The new facilities will bring smiles to the faces of the children at the cancer centre.

Charlie selflessly requested his friends donate money for the centre in lieu of birthday presents.

Charlie cuts the ribbon with Chief Executive Shelly Park and Head of the Children’s Cancer Centre Peter Downie.


“It’s an amazing space. It’s a place of hope.

It’s a place of love and laughter and happiness.”

“It’s an amazing space. It’s a place of hope. It’s a place of love and laughter and happiness,” Mrs Garcia said.

“It’s such a journey for the family. The centre and all the staff really celebrate the fun side of being a kid.”

Monash Health Chief Executive Shelly Park said the Children’s Cancer Centre expansion would help meet the increasing needs of more families using the service.

“We continue to experience an increase in

the number of childhood cancers. We need to respond to this so that we can reduce waiting times and allow more children to access the treatment,” Ms Park said.

“It’s a frightening time when a child is diagnosed with cancer and the lives of everyone in the family changes.”

Head of the Children’s Cancer Centre, Peter Downie, said the centre had “to be the best it can be” for the families.

“The trauma is more for the parents and

grandparents than for the children themselves,” Mr Downie said.

“For every patient like Charlie who gets diagnosed it’s a three-year journey. It’s my very strong belief that it’s better for children to come in for treatment and then go home at night than stay in hospital.”

The expansion and refurbishment was made possible by the generosity of the Children’s Cancer Centre Foundation, Koala Kids, Bayside Police, Bailey’s Day, and May Gibbard.

Charlie celebrates the launch with parents Angela and Tom Garcia.

Everybody can make a difference to the lives of children living with cancer and their families. With the kind support of the Children’s Cancer Centre Foundation and the Kids with Cancer Foundation, Australians everywhere are making a difference. Contact the Monash Health Foundation on 9594 2700 or visit www.monashhealthfoundation.org.au for details.

MonashHealthFoundation

Everybody can help


Already overweight mothers-to-be are risking the lives of their babies and their own health, with one in 10 Victorian mothers now clinically obese.

Obesity brings serious risks to babies’ health

Just as smoking and drinking alcohol is now taboo during pregnancy, maternal

health experts are calling for a public health campaign to re-educate women about the risks of excess body fat.

With some Victorian mothers-to-be tipping the scales at almost 200kg during pregnancy, doctors are warning that women are risking increased chances of stillbirth and birth defects, and are also leaving themselves at risk of diabetes, cardiac problems and complications during delivery.

The percentage of obese first-time mums with a body mass index higher than 35 at Victoria’s busiest maternity service, Monash Women’s, has almost quadrupled in eight years, from three per cent in 2005 to 11 per cent last year.

A woman of average height, 161cm, is considered obese if she weighs more than 78kg.

Monash Women’s birth suite manager Lynne Stewart said many women were unaware of the stress a nine-month pregnancy added to already strained bodies.

“We’ve reached a stage where being impolite is necessary. We are seeing far too many obese women who are unaware of the serious health risks they and their unborn babies face. The complications are huge,’’ she said.

“Just like women think about taking folic acid before they fall pregnant to prevent Down syndrome, we should be saying, if you want to get pregnant you need to be at a safe weight.’’

Ms Stewart said while women who had never exercised should not start strenuous programs once pregnant, it was important obese women maintained their weight during pregnancy, through healthy eating, walking or swimming.

“Their heart, kidneys, liver and other organs are already under such pressure and strain from the weight being carried. You add pregnancy to that and it just heightens it all.’’


Improving outcomesResearch looks at improving access to healthcare for hepatitis B patients.

Monash Health’s Deputy Director of Gastroenterology Dr Anouk Dev is

passionate about ensuring everyone has access to the healthcare they need.

The Monash Health catchment has the largest population of people from non- English speaking backgrounds in Victoria, and many come from countries with a high background prevalence of hepatitis B. Some of these patients may not know their hepatitis B status.

Dr Dev and a team of hepatologists, hepatology nurses, research fellows, medical students and interpreters have implemented a program comprising a series of research projects aimed at improving access to medical care for patients with hepatitis B.

“The major objective is to improve access to tertiary level care and thereby improve treatment rates and decrease morbidity and mortality,” she said.

“An integrated approach involving

community groups, general practice and specialists is the model of care we believe will be the most effective. I am passionate about this because I can see that through improving care we can make a difference.”

There are 500 patients involved in the study, which looks at how patients access primary and tertiary care, barriers to accessing treatment, the patient experience in the healthcare system and the response to current medical treatments.

“We have a community of affected people who are culturally, linguistically and socio-economically diverse. We have to develop culturally appropriate models to improve all aspects of patient care,” Dr Dev said.

“One of our research projects is examining a model of promoting patient advocacy and leadership. Our aim is to create open conversations about hepatitis B that are culturally relevant thereby increasing awareness and knowledge. Handing out pamphlets has been the traditional way of

educating patients, but variable rates of literacy mean we have to examine different ways of imparting information.”

“Part of the approach has been to establish community clinics in Clayton, Springvale and Berwick where we take tertiary care into the community. This acts as a one-stop-experience for our patients where interpreters are provided and patients can access specialist care, pathology and pharmacy in one location and receive anti-viral therapy.”

Another area Dr Dev’s team is investigating is the effectiveness and side-effect profile of hepatitis B medications. Patients may undergo an intensive treatment which includes weekly injections of Pegylated Interferon for 48 weeks or potentially long-term treatment with tablets Entecavir or Tenofovir. While in the majority of patients there is no cure, these medications work to suppress the virus, and may significantly reduce disease progression and the development of liver cancer.

RESEARCHPatients like Kuok Ruot Gatwich will benefit from improved access to hepatitis B treatment.


Obstructive sleep apnoea is one of the most common medical conditions affecting the community.

Getting a good night’s sleep is something most people take for

granted but Director of Sleep Medicine Research Dr Garun Hamilton hopes to help diagnose and treat more patients for one of the world’s most common medical conditions.

Obstructive sleep apnoea (OSA) involves repeated episodes of airway obstruction during sleep due to relaxation of the tongue and airway muscles which causes breathing to stop, disturbing the sufferer’s sleep.

Most sufferers report feeling fatigued during the day and are likely to have high blood pressure but the long-term health issues include depression, cardiovascular disease and stroke.

Once diagnosed with OSA the most com-mon form of treatment is the use of a Continuous Positive Airway Pressure (CPAP) machine. The small device pumps air at a continuous pressure through a mask worn over the patient’s mouth and nose. The pressure ensures the airway stays open, preventing it from closing, allowing normal breathing.

Monash Health conducts 48 sleep stud-ies in the public laboratory each week. The number of sleep studies could increase

tremendously if Dr Hamilton’s study shows they can be carried out equally as effectively at home.

“About 10-15 per cent of the population will have OSA if we test them but not all of them will be symptomatic. A lot of this goes undi-agnosed which is why we want to make the process a lot simpler,” Dr Hamilton said.

“We diagnose OSA here at the hospi-tal and it’s a very labour-intensive and costly test. There is potentially now the ability to do this at home focussing on some of the key pa-rameters but using less equipment and allowing patients to feel more comfortable. This randomised controlled trial is designed to test patient outcomes.

“We are looking at the utility of limited channel sleep studies carried out in a patient’s home against sleep studies carried out in the hospital setting. The trial will consider results returned from sleep studies conducted in the hospital which involve electroencephalograms, leg sensors and video cameras to measure movement,

and oxygen and heart rate recordings, in comparison with results which review oxygen and breathing levels and heart rate only. We will be looking to see exactly how well this can perform at diagnosing obstructive sleep apnoea and whether the treatment recommended by doctors changes based on the results.”

The study will involve more than 250 people across Australia.

“In terms of health services delivery this study is quite an important one,” Dr Hamilton said.

“Currently, the waiting list for a sleep study is about six to eight weeks. If we find the results to be satisfactory and

there is no significant difference between the results of patients who undergo a sleep study in hospital and those who carry out the study in their own home, this will enable us to conduct more tests at home, reducing the wait for patients.

“People are more likely to have diagnosis and treatment if it’s easy to access. This will have benefits because it will mean cheaper assessment and less burden of disease in the community.”

Sleep studyRESEARCH

About 10-15% of the population will have obstructive

sleep apnoea if we test them.

Dr Garun Hamilton with patient Bruno Thatcher

who was diagnosed with obstructive sleep apnoea

during a sleep study at Monash Medical Centre.


the Danks Trust for the renovation and refurbishment of apartment 7, to be named Wominjeka, which fittingly means welcome.”

“I would like to offer my sincere thanks to Associate Professor Andrew Danks, Trustee of the Danks Trust and Head of the Neurosurgery Unit here at Monash Health, for bestowing the funds needed to renovate and refurbish apartment 7. Your generous donation will make a difference not only to our Aboriginal patients, but also to their families for many years to come.”

The Wominjeka apartment will: ► Enable Aboriginal clients to walk to the hospital in less than a minute, and to easily support a family member in hospital. ► Allow families to spend as much time as possible with their hospitalised family member. ► Enable families to readily take part in decision-making about treatment options, and to meet the medical and nursing staff caring for their ill family member.

“The value of these benefits to our Aboriginal patients and their families cannot be underestimated,” Ms Park said.

Ms Park also acknowledged the efforts of General Manager Allied Health Donna Markham and Aboriginal Hospital Liaison Officer Leanne Sumner who put forward the idea to renovate and refurbish the flat.

Wominjeka is only the second facility in Melbourne specifically accommodating Aboriginal families attending medical treatment.

Flat for the familiesFamilies of Aboriginal patients can now access better accommodation.

Families of critically ill Aboriginal patients now have access to a newly

refurbished apartment, thanks to the generosity of the Danks Trust.

The apartment has been specifically designed to assist Indigenous families who live in rural and remote areas to relocate closer to loved ones in hospital while still feeling at home.

The self-contained, two-bedroom apartment can accomodate four adults and includes a kitchen, lounge room and bathroom.

In opening the apartment, Chief Executive Shelly Park said Monash Health worked closely with the Aboriginal and Torres Strait Islander community to improve their health outcomes and wellbeing.

“The socio-economic barriers affecting many members of our Aboriginal community can mean that they are often unable to access appropriate health services and facilities, or are required to do so without the presence of family – and family support is vitally important within the Aboriginal community,” Ms Park said.

“For more than 20 years, our Social Work Department has operated a block of 10 apartments. These are an accommodation service for relatives of critically ill patients from rural Victoria, who would otherwise be unable to travel to and from the hospital. Unfortunately, the set-up of this has not been ideal for Aboriginal families.

“In May last year, the Monash Health Foundation received a generous grant from

There are many ways you can make a difference to the health of the community with the Monash Health Foundation.

For more information, contact the Monash Health Foundation on 9594 2700 or visit www.monashhealthfoundation.org.au


Help us help others

Monash Health Chief Executive Shelly Park, Associate Professor Andrew Danks, Aunty Ruby, Aunty Pat and Dandenong and District Aborigines Co-operative

Chief Executive Andrew Gardiner inspect the refurbished flat.


Together we can improve the health of our community The Monash Health Foundation supports the wonderful work of our dedicated staff across all sites and

departments within Monash Health. We work hard to raise awareness of the important services Monash

Health provides and to develop partnerships across our community in support of these services, our staff and

our patients. For more information, contact the Monash Health Foundation on 9594 2700 or visit

www.monashhealthfoundation.org.au


It is the most valuable gift of all - the gift of life. Last year, 31 Monash

Health patients consented to organ donations helping 80 other people.

Monash Health held a commemorative service on 24 February as part of DonateLife Week for friends and families to remember those who selflessly donated their organs.

It was a bittersweet event for the families who were invited to write messages to their lost loved ones and attach them to pink balloons which were released to symbolise each donor.

Guests also heard from double-lung transplant recipient, Murray Brown, 20, who suffers from Cystic Fibrosis, a

GIFT OF LIFECelebrating the

genetic condition that affects the lungs.

He told those at the event about the generous donation he received from his “hero”.

“My donor not only saved my life but also the lives of another six people, and that’s something I will never be able to repay.”

The event encouraged people to ‘have the chat that saves lives’.

Last year, Victoria had the most organ donors in the country contributing more than 25 per cent of the national total.

To find out more about organ donation visit www.donatelife.gov.au

Double-lung recipient Murray Brown shared

his story.

Kumar Siriwardene spoke of the sudden loss of his daughter, Michelle.

Family and friends released balloons in memory of their loved ones.

The simultaneous release of balloons moved loved ones to tears.

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