Stay engaged, keep saying yes

Cate Swannell
Med J Aust
Published online: 9 March 2020

A HAIRY moment in a very small plane hurtling towards earth reminded orthopaedic surgeon Dr Annette Holian that her “chequered career” had left her with no regrets and a deep sense of satisfaction.

The occasion was a training flight during a 5-week aviation medicine course, and the purpose was to make Dr Holian – and everybody else on the course – vomit. And while it failed on that score, it certainly provoked some thought.

“I had a Top Gun moment walking out strapped into a G-suit, carrying my helmet and my oxygen mask and the flying gloves,” Dr Holian tells the MJA.

“Then the pilot took this plane, screamed it up into the sky, a very long way up and then dropped it over and we did a cartwheel off to one side and cut the engines.

“I was sitting behind him, looking straight down thinking, ‘I could die; well, it's been a good one; this could really be it’. And then I thought, ‘I've done the things that I wanted to do; I’ve reached out and had adventures, and had courage, and I’ve tried to bring the kids up the same way’.”

In 1986, when Dr Holian began her training, she was one of only two women in the country taking on orthopaedics as a specialty. Today, 34 years on, there are still less than 60.

“Everyone talks about, ‘Isn't it great we've had this great improvement?’”, she says. “I'm sorry; it was 60 women over 30-odd years. I don't call that great progress.”

Earlier this year Dr Holian was elected as 2nd Vice-President of the Australian Orthopaedic Association – the first woman ever elected to the presidential line.

“One of the main reasons I went for it was to try to be a role model for the women. They say that people can't be what they can't see. Well, I've always been what I can't see because there was no one ahead of me.”

Bullying and harassment are behaviours she has witnessed in the workplace from the very beginning of her medical life, but they are things she is no longer willing to walk past.

“It was a whole career of suck it up and get on with it,” she says.

“You have to try and ignore it and move on. I just did it my own way really, but I didn't challenge people nearly enough.

“I let things go, which now I won't let go. I stand up and call stuff out and hope that gives the younger people some empowerment to do the same. I can’t let those things go because if I do, the juniors will think that [bad behaviour] is acceptable.

“I found it very challenging – calling them to account, without being rude in front of others.”

The turning point came in 2015 when senior vascular surgeon Dr Gabrielle McMullin commented that women in her field should protect their careers by “complying with requests” for sex.

“I was so shocked by [that] statement,” says Dr Holian.

“I had a daughter in internship that year and I could not bear the risk of her being given such advice. So, I ran for the Royal Australasian College of Surgeons Council and was successful.

“That launched me into studying governance, risk and reading financial statements. I’m coming up to the end of my fourth year on Council.

“I came on with a group of women. We drove through the RACS providing breast feeding/ expressing facilities and child care at all meetings and conferences. RACS then went for and received the Australian Breastfeeding Association’s employer tick of approval.

“We've just finished Council sitting this week, and I see what a positive impact our evolving progressive Council is making.”

Dr Holian’s career has been broad, storied and opportunistic, in the best sense of the word.

“In retrospect, I chose orthopaedics because my mother had polio as an infant, and so she had muscle weakness in her legs and motor challenges that had always been part of my life,” she says.

“I enjoyed, in my internship, seeing people with injuries and then being able to clearly see something wrong, being able to fix it and moving on. I very much liked that mechanical aspect of fixing people and helping them get back towards living normally again.”

A paediatric fellowship in the UK was followed by a return to Australia and a practice in paediatric orthopedics. And then Papua New Guinea and the Royal Australian Air Force came into her life.

“In about 1996-97, we had some kids come down from PNG who were supported by Monash to have surgery. Then I started visiting up there with [neurosurgeon] Elizabeth Lewis, who was our Head of Children's Services. I was seeing kids who had polio, other untreated injuries, and terrible bone and joint infections without much in the way of treatment.

“I got a bit hooked on doing that type of work.”

On 17 July 1998, a 7Mw magnitude earthquake struck off the north coast of PNG, followed by three catastrophic tsunamis which killed at least 1600, injured 1000, and displaced more than 10 000 people.

“I'd been working at Vanimo and Wewak and I tried to contact the Australian Defence Force to get some help,” says Dr Holian.

“I just put on my big girl pants and rang Richmond Air Force base. I said I wanted to speak to a person in charge of the [rescue] operation and offered the services of the Monash orthopaedic team.

“We worked up there independently, but the ADF transferred us up and back. While we were up there, we worked a bit with the medical teams and the aeromedical evacuation team from the Royal Australian Air Force was moving our patients around. It was just so challenging.”

When the troubles in East Timor broke out in September of 1999 orthopaedic specialists were asked to consider joining the RAAF for humanitarian service in the area.

“I was like, ‘that's fantastic, exactly what I want to do’. At that time, we hadn't been in a war for a very long time. And then we were in a war for a very long time.”

Being in the Air Force has given Dr Holian “enormous” opportunities to do a variety of work in conflict zones and other disaster relief in uniform. She was on active duty in East Timor, the Solomon Islands, and three tours in Afghanistan. She was in one of the first Australian teams on the ground in Indonesia after the Boxing Day tsunami in 2004, and the earthquake in Western Sumatra 3 months later.

“I became quite different to most other orthopedic surgeons in terms of career path,” she says. “I had this military trauma, disaster type stuff as well as my pediatric work.”

Dr Holian has worked with the International Committee of the Red Cross – “we wrote a document about the care of people with traumatic injuries” – spent time in Darwin as a fly in fly out surgeon fortnightly for some years; is the RAAF’s Clinical Director of Surgery and Perioperative Services; and is a Governor of Melbourne’s Shrine of Remembrance. She still practices “for money” one day a week, and her work at the AOA and RACS takes up the rest.

All of this while raising three children.

“I had a son while I was still in medical school,” Dr Holian says. “Then there was a 12-year gap while I finished my surgical training, and then I had a daughter. At that time, there was absolutely no possibility of having a child and continuing training. That was too novel a concept.

“And then I had another daughter after my fellowship in the UK.”

Her advice to medical students and doctors-in-training is to stay open.

“It doesn't matter what you choose at the start. Your medicine can take you in all sorts of different directions. I chose pediatric orthopaedics at the start, then I did trauma and military – who would have guessed that?

“There’s no predicting where you can go. Say yes to things, be engaged.”

  • Cate Swannell



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