Dr Joseph Mohan believes he made the right choice undertaking a research project as a medical student in 2016 with the Rural Clinical School of WA (RCSWA) in Broome. 

The resulting research paper which he co-authored - Acute kidney injury (AKI) in Indigenous Australians in the Kimberley: age distribution and associated diagnoses – recognised acute kidney injury, a sudden but often reversible reduction in kidney function, as a risk factor for chronic kidney disease. The study emphasised the importance of addressing underlying environmental and economic determinants of health. 

Joseph says choosing research as part of his RCSWA placement gave him a unique opportunity to accomplish something significant in addition to his regular studies. 

“I think the benefits of choosing research in the medical field, particularly having not done any formalised research in the past, you develop skills in the field, you learn about the ethics process, and how to work through problems and delays. Those things are critical. If you gain some traction, you can progress to a publication or further research,” he explains from his current base of Cairns, Queensland.

“If I had to choose again between the three streams (Research, Service Learning or Coursework), I would choose Research.”

Joseph’s paper demonstrated a high prevalence of acute kidney injury associated with infection in First Nations people in the Kimberley region of Western Australia - a statistic which had yet to be documented. This holds significance because it is well established that acute kidney injury is linked with short and long-term morbidity and mortality, including progression to chronic kidney disease.

The research has also helped raise awareness of how common acute kidney injuries are in the Kimberley region and of the need to reduce barriers to identifying and treating infections in a timely manner. 

The seed for the project was planted when Joseph moved to Broome and was surprised by the numbers of young First Nations people with kidney disease. 

“What I initially intended to do was to see if there were any general trends with this group, and together with Dr Emma Griffiths and Dr David Atkinson we decided to investigate acute kidney injury in more depth,” Joseph recalls. 

“Our team looked at renal function test results for First Nations people who had attended a Kimberley Aboriginal Community Controlled Health Service between 2009 and 2016. We identified that there were high rates of chronic kidney disease associated with acute kidney injury and of a much younger age demographic (15 to 44 years old) than expected.”

Clinical researcher and Joseph’s supervisor Dr Emma Griffiths says regional protocols, educational materials, and messaging around acute kidney injury identification were revised following the study, and prevention and management of the condition were strengthened in the Kimberley and in other remote areas of Australia as a result. 

“I believe that including students in research during their rural RCSWA year is invaluable. It demonstrates to them the need for research that meets the needs of rural and remote communities and encourages students to consider how rural Australia is included and represented when interpreting and using evidence,” Emma explains. 

“It’s so rewarding for me when students get a glimpse of where their research might fit into the big picture, and they feel proud of what they’ve achieved.”

Reflecting on his student researcher routine, Joseph says there were “many afternoons and Friday nights” spent at the Kimberley Aboriginal Medical Services office searching databases.  

“The time commitment was mainly after work, but I think that's the beauty. Regardless of when you do it or what sort of research you do, you just find a way to fit it into other commitments,” he suggests.

“The research complemented well with the rest of our studies, the syllabus, and assessments, and I was supported by research supervisors from the RCSWA program who understood the requirements.

“My supervisors made it easy to arrange meetups in person. Emma Griffiths as a rural general practitioner and Dr David Atkinson having worked in the region for decades were very helpful and offered a lot of support.”

Image: Dr Joseph Mohan.

Joseph continued to write up his conclusions while a final year student in Perth in 2017 and was working as an intern in 2018 when the paper was published. 

The project has given back to Joseph in many ways, not least with the Royal Australian College of Physicians (RACP) awarding him the Jameson Investigator Award for best oral research presentation related to Indigenous health. 

His presentation to the RACP QLD Regional Committee in November 2019 explored how kidney disease impacts our vulnerable Aboriginal and Torres Strait Islander population more than the rest and highlighted additional ways for this issue to be addressed in the acute setting.   

“While grateful to be the recipient of the award, I was most appreciative of the fact that I was able to get the message across. For 15 minutes, I felt like I made the audience care about the plight of our at-risk patients sentenced to a disabling life with kidney disease,” Joseph says. 

While Joseph is currently working as a Registrar out of Cairns Base Hospital, he intends to move to Brisbane in the coming years to be closer to family and continue his passion in being a physician. 

“I still have a soft spot for First Nations' medicine and rural medicine, but I've taken a different route and developed an interest in neurology now. In 2024, I will complete my first year of advanced training in Neurology at Cairns Base,” he reveals.

“The research has given me a deeper understanding of renal medicine, not only medically but culturally, which you don't really get as a medical student. I have a lot more confidence now engaging with First Nations people.

“The benefits of research often come much later than you'd expect.”

FOOTNOTE

One of RCSWA’s current student projects aims to identify First Nations people on dialysis who might be suitable for transplant to overcome barriers. 

Two students have helped with this project so far and the team has already started working on the associated quality improvement program with success.

The following projects are further advancing health outcomes for patients in this space:  

Tze-Iann Lee Broome 2021
Supervisors: Emma Griffiths & David Atkinson 
“Identifying Suitable Candidates for Renal Transplantation in the Kimberley Region: a Continuous Quality Improvement (CQI) Study.”

Kristan Teasdale Broome 2020
Supervisors: James Stacey (KAMS) & Emma Griffiths
“Identifying suitable candidates for renal transplantation in the Kimberley region.”

Marcin Skladaniec Broome 2017
Supervisors: Emma Griffiths & David Atkinson
“Progression of Chronic Kidney Disease in Aboriginal and Torres Strait Islander people - assessment of kidney function decline in relation to Acute Kidney Injury in retrospective study in Kimberley region.”