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Surgeon General of the ADF - All in a day's work

By Kathryn Fitch

Commander Terrence Slader, a Naval Reserve paediatric nurse from HMAS Kanimbla, checks the breathing of a local boy from Banda Aceh who has aspiration of the lungs, in the paediatric ward of the local hospital following the Boxing Day tsunami. Photo by ABPH Jarrad Oliffe

Rear Admiral Graeme Shirtley is a busy man. Like many reservists, he balances two jobs - in this case, two days a week as the Surgeon General Australian Defence Force (SGADF) and three days a week plus one Saturday a month in a large private practice as a Radiologist. He's also on call one week a month at a hospital.

As if that isn't enough, he sits on several executive committees and is currently studying a Masters of Health Law, as he puts it, 'in his spare time'.

"I have a terrific wife, who is very supportive - without Debbie's help I just couldn't do this job. I get the glamorous stuff and she gets the hard yards. Like most senior reservists, I couldn't do it without my Home Admiral," he says.

Amazingly, he still made time to sit down and talk to Defence magazine about being the Surgeon General ADF and the medical professionals who serve with ADF Reserves. He smiles as he recalls joining the Reserves in 1969. Ironically he didn't want to do medicine - Rear Admiral Shirtley joined to become a navigator.

"That was a short lived thing. When they found out I was doing medicine at university they said you can join the medical world, son. So join the medical world I did, under much protest at the time, and I've just stayed there ever since," he says.

The SGADF role dates back to 1977. It was initially a permanent position, but was converted to a reservist role in 1998 following a Defence Efficiency Review recommendation.

Rear Admiral Shirtley was promoted to SGADF in May this year. It's an interesting time to have arrived because the Defence Health Service (DHS) is currently evolving. This follows Major General Paul Stevens's review of the area last year, which recommended a long list of changes. Rear Admiral Shirtley says that he and Air Vice Marshal Tony Austin - the new Head Defence Health Service - are working together to implement the recommendations.

"We've been clearly given an indication by CDF and the Service Chiefs that they want to see a change. They want to see a more efficient, more responsive Defence Health Service. Tony and I, and the senior managers will sit down, go through the review, and try to deliver the goods," he says.

But that's just the tip of the iceberg for the SGADF. Rear Admiral Shirtley has a long list of other responsibilities, like DHS's outreach program into the teaching hospitals and the leadership and management of the Specialist Medical Reserves. He also chairs the Australian Defence Human Research Ethics Committee, manages the consultative groups, and leads the National Reserve Health Triumvirate.

He says he doesn't want to try to do too much at once, so his initial focus will be on command and control, and getting the administration processes right. He is also establishing a trauma scholarship.

"I want to improve the structure that we've got in place - some areas are a bit hazy and not quite well enough defined. Another area is support payments. We have this thing called the Employers Support Payment Scheme and it's a good initiative, but it's still a little unwieldy administratively. I'd like to see that tightened up and streamlined," he says.

"I'm also trying to set up a scholarship in trauma medicine in South Africa. The primary focus of course is to make sure we have the skills to provide our troops with the very best medical support when our people go into a war zone, but I also see it as a great recruiting tool for the Reserves."

Almost all of the ADF's medical specialists are reservists. According to Rear Admiral Shirtley, this is because there isn't enough work within the ADF for them to maintain their professional competence.

"When we deploy to Iraq or on other missions we need experienced surgeons, anaesthetists and intensivists to provide our troops with the best standard of care. I work out how many, and what sort of medical specialists we need in the Reserves to support the ADF," he says.

LCDR Libby Webb checks a patient in the Anzac Field Hospital in Banda Aceh. Photo provided by Public Affairs

"We have quite good numbers of people volunteering. We need more - but we've never failed to meet a roster for any of the deployments since the early 90s. That's a great credit to all my colleagues who have put their hand up and said they'll go."

He says that he intends to lift that number by focusing on recruiting and retention, and conditions of service issues. He points out that there are only a certain number of times that you can go to a medical specialist and ask them to help.

"They give a lot of their time to serve their country, but it's a big commitment when they have a hospital or private practice job outside. Even the most willing of them are starting to say 'I've been three times in the last two years. Couldn't someone else go?' That's why it's one of my jobs to recruit - so we can spread that workload more evenly across a greater number of people," he says.

To this end, the Surgeon General's office spends a lot of time on outreach duties promoting Defence Health issues, ensuring groups like state government health departments and the medical professional colleges are aware of Defence's needs.

He thinks initiatives like the scholarship program in South Africa will be a useful training tool for specialists in the reserves, helping to prepare them for the conditions that they might face in a war zone.

"South Africa has an awful lot of trauma. I'm three-quarters of the way through establishing a rotation to the trauma centre in Johannesburg for Defence surgeons, anaesthetists and intensivists. They will be able to go over there and work in the trauma centre for four to six weeks, getting experience of 20 to 30 stab wounds per night," he says.

It seems it will also be a promising strategy for recruitment, and has already attracted interest from the College of Surgeons, who have asked to have access to the program.

"I said sure. Just join the Reserves and I can send you over," he says.

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