Author Archive | David Hogg

GURRMS18 conference a massive success in Portree

Last week we highlighted the programme for the GURRMS (Glasgow University Remote & Rural Medicine Society) conference in Portree.  Over 80 students and delegates attended this event last weekend, and as expected, it was a superbly positive event that covered many aspects of rural practice in Scotland and beyond.

James McHugh, GURRMS President

It must be highlighted once again, that tickets for this event sold out within 15 minutes of becoming available online.  Behind the conference was a ton of work, ably overseen by GURRMS President and final year Glasgow medical student, James McHugh – who compered the activities along with his committee with aplomb, tight organisation and enthusiasm.

A good line up of varied speakers featured on the first day of the conference.  Dr Emma Watson opened the conference, and after this I gave a presentation on ‘Rural GP – Is it What It’s Cracked Up to Be’ – with an honest portrayal of opportunities and challenges that exist within a career of rural practice.  I used some of my own stories to highlight the privilege that many of us feel in being able to provide primary care (along with all the additional services of rural practice) to our communities, along with the breadth of practice that keeps days interesting, challenging and demanding of effective teamwork.  We touched upon some of the current challenges of getting health policy adequately rural-proofed, and reflected that this is a worldwide challenge – which makes for truly international career opportunities.

This was followed by Dr Luke Regan talking about ‘Why I Love My Job and You Should Too’ – he is an Emergency Physician at Raigmore Hospital in Inverness with experience of delivering rural emergency care both in Scotland and Australia. His talk included a simulated walk-through of a rural cardiac emergency, ably assisted by student ‘volunteers’ from the audience.

Prof Phil Wilson explored the research and academic opportunities available to rural GPs, and considered the ethical obligation on us all to appraise and share lessons learned from service and therapeutic innovations.

Phil Wilson on Scottish trials to use transcranial ultrasound to diagnose thrombolysable stroke

Dr Jacqueline Bennebroek then offered an insight into her work as a Rural Practitioner at the MacKinnon Memorial Hospital in Broadford, Skye.

Jacqueline on her role as a Rural Practitioner on Skye

Ben Price on the role of BASICS Scotland and emergency responders across rural Scotland.

Workshops were run on ‘The Lesser Spotted BASICS Responder’ by Dr Ben Price, and a Training Perspective of Rural Practice by Dr Ian Pooleman and Dr Ailsa Leslie.  Three well-delivered presentations in Pecha Kucha style featured from Duncan Stewart, Isla Kempe and Ellen Gardner on their student experiences, from elective placements to reflections on being a student on the new Longitudinal Integrated Clerkship now offered to Dundee 4th year students. The verdict – a big dose of reassurance that LICs offer a fantastic environment for learning medicine, and the fears about having gaps in knowledge did not materialise.  Indeed this has been shown in repeated reviews of LIC learning that students conclude their LIC placements with greater knowledge, insight and propensity to pass exams.

Rural surgical legend Dr David Sedgwick talked about his Life and Work as a Rural Surgeon over 25 years – most of which was at the Belford Hospital in Fort William.  The fact that David had just arrived back from teaching in Rwanda the previous day was particularly impressive, and highlighted again the role that rural doctors and surgeons can have in global healthcare.

Prof Sarah Strasser during one of the student workshops

The keynote talk ‘Rural Health Worldwide’ was delivered by rural health stalwarts Prof Roger Strasser and Prof Sarah Strasser.  They had travelled into Scotland the previous day, covering even more impressive mileage than David Sedgwick… it is perhaps testament to the GURRMS committee that they facilitated such experienced input, and that Roger and Sarah were willing to travel from Canada and Australia respectively to make it to Portree.  Their talk was followed by a particularly engaging question and answer session, and it was clear that delegates were inspired and enthused by the perspectives that Roger and Sarah brought to the conference.

10 Skills of a Rural Doctor – from talk by Roger and Sarah Strasser

The day concluded with an evening reception including ceilidh.  The next day GURRMS successfully ferried delegates across north west Scotland – with some walking in nearby scenery, some opting for whisky tasting, some going for mountain rescue training and some travelling to the Western Isles for a 2 day trip to see the hospital in Stornoway and the surrounding area.

Well done once again to the GURRMS Committee for a well-organised, good-natured and inspiring conference.  We hope to see plans develop for GURRMS19 next year – and we hope that the Scottish rural GP community will support the event once again.

More photos below…

 

 

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GURRMS student conference in Portree this Friday

The Glasgow University Remote & Rural Medicine Society will hold their conference this Friday and Saturday in Portree, on the Isle of Skye.

This follows a highly successful conference held by GURRMS last year on the Isle of Islay, successfully bringing together a large number of medical students from Scotland and beyond, to hear about rural practice, share thoughts and experiences, and gain a better perspective of career options for the future.

Quite incredibly, tickets were sold out for GURRMS18 within 15 minutes of them becoming available online.  Perhaps it is not so surprising, given the varied and experienced line-up of speakers they have secured for the event, along with activities both medical and social.  The blend of social and educational activities provided at GURRMS17 has also established a positive and attractive precedent for GURRMS too.

You can read through the GURRMS conference programme – just released today – from this link.  Highlights include Dr Ben Price talking about BASICS Scotland activity, Dr Luke Regan discussing ‘Why I Love My Job and You Should Too’, and Prof Phil Wilson on ‘Why Rural Doctors Need to do Research’.  I am delighted to have been asked to speak too, and will be asking ‘Rural GP – Is it what it’s Cracked Up To Be?’.

The Keynote Talk is being delivered by Profs Roger and Sarah Strasser – who are travellig from Canada and Australia as I type, to inspire the GURRMS18 students with their advice and experience from developing innovative rural health education… and the international opportunities that come with rural practice.

The conference has been supported by a number of organisations, including RGPAS, but much of the credit must fall to James and his committee of Josie, Seb, Michael, Eloise and John for all their work to bring this together.

Many students in Scotland have very little exposure to rural medicine, despite almost half of the population living in such an area. The aim of this conference is to promote this career as a viable option and to encourage those interested to go and explore what there is to offer! Here on Skye, we hope you have an authentic experience and truly get to see what rural medicine is.

My own journey was started with an elective on Arran where I learned first-hand how this path is right for me, so we hope that we can give you a glimpse of that with what will be a stimulating programme. We encourage you to get involved in discussions and make the most of the experts here, who have a wealth of experience!

James McHugh, President of GURRMS

Well done to GURRMS for putting on this event, juggling all the logistics (whilst some were sitting final exams) and providing such a brilliant showcase for Scottish and international rural health.  We might even celebrate with a Skye dram or two!

You can follow the conference on Twitter using the #GURRMS18 and #thinkrural hashtags.

Download the #GURRMS18 programme

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Mayara Floss: the challenges for women working in rural health

Mayara Floss

This video of Dr Mayara Floss – rural doctor in Brazil and passionate advocate for international rural health – has recently been publicised via the Rural WONCA email list by Dr John Wynn Jones, chair of the WONCA Working Party on Rural Health.

Mayara was invited to give her perspective on the issue of “Investing in rural health workers for the economic participation and empowerment of rural women and girls” at a meeting of the joint Commission on the Status of Women: a side-event of the World Health Organisation, International Labour Organisation, Permanent Mission of Ireland to the United Nations and Women in Global Health.

John introduced the video more eloquently than I could, and so with his permission, here’s what he said:

Dear All

I want to congratulate Mayara and thank her on behalf of Rural Wonca and all the rural health workers around the world for her presentation and wise words at the United Nations Commission on the Status of Women. Mayara is an exceptional person. I can’t even call her a future leader because despite the fact that this is her first year as a doctor she is already a world leader and an example to us all. It will be the Mayara’s of this world who will take up the mantle for the next generation and its our duty to support them.

Please look at the video of her session. She describes how medical schools in the largely rural country of Brazil do little to promote and teach rural health care. She eloquently describes her own journey against the odds and her quest to work among rural communities and the barriers that she encountered. Everyone needs to watch her presentation! 

During the panel session she implores us first to listen to our patients and are communities before coming up with ” so called helpfull solutions”.

She also asks us to think about the political tragedy that is happening in Brazil and the dismantling of one of the most enlightened primary care systems in the world and its replacement with private health.

We are all very proud of her and the many other members of Rural Seeds who are working so hard around the world to build their careers and make a difference for rural communities.

Kind regards

John

Mayara speaks in the video below for 20 minutes, at 30 minutes in, and there are subsequent (excellent!) contributions to the discussion thereafter.

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Our Scottish Government needs to recognise the potential of Scottish rural practice

The agreement of the new Scottish GP contract has triggered real concerns about just how seriously the challenges facing Scotland’s rural communities are being considered by our professional and political leaders – and how rural NHS services are being considered in the context of the overall NHS Scotland team.  In RGPAS (the Rural GP Association of Scotland) we believe that there has been little attempt to rural-proof the contract, and any plans to do so have been sidelined until ‘Phase 2’ which, of course, might never happen.

Rural GPs tend to be a robust lot.  We have to be, particularly with the professional isolation and sometimes downright scary clinical presentations to manage, with distance and geography providing an ever-dynamic challenge. Much of our professional resilience and stamina is generated by the support and trust that is handed over to us by the patients we work for, and the teams we work with, in ways that spark professional satisfaction greater than any other career imaginable to us.  And it is that privilege, responsibility to advocate and sense of duty, that has driven our concerns about the future of Scottish general practice as defined by the new contract.

Articulating our concerns has, at times, been difficult: we lack the political vocabulary, media experience and strategic confidence to communicate these concerns as effectively as we might if we didn’t have a significant day and night job to do.  Challenge has also presented in terms of time; returning home after a busy day in the surgery and a night oncall, to find 20 messages from journalists seeking an informed and on-record representative view is, I suspect, a world away from the luxury of a media team and press officers.  But surely we shouldn’t have to employ a media team to represent rural communities in a GP contract?

We have, however, had extraordinary encouragement, including from some who have been able to offer expertise in the areas of media and strategic engagement.  Throughout, we have been determined to maintain a respectful tone with our colleagues, confreres and appointed representatives.  Despite the shortcomings of the contract, I really believe that those involved all aim to act as professionally and ambitiously as any of us.  However we suspect they just don’t understand rural practice enough to see the opportunities that many of us saw for a new contract to sustain healthcare to rural communities in Scotland.  Throughout, it has been stimulating to work with bright, impassioned and committed colleagues.  And whilst journalists might collectively get a bad name, we have been fortunate to engage with ones who have respected our need to continue the day job, and put up with our own limitations of returning calls and emails between otherwise busy days.

It is clear that the new contract has failed to take into account the challenges and opportunities of providing healthcare in rural Scotland.  The honest admission from one of the SGPC Senior Negotiators during a roadshow that rural practice has been “parked” until a Phase 2 of the contract that might not even happen, was a bombshell moment for many of us listening in Inverness.  It appears that rural practice has been put on the ‘too difficult’ pile for the time being.  And there is ongoing confusion around the much-promised Short Life Working Group for rural practice.  Our First Minister advises that it has been set up.  Government tells us that it hasn’t, and won’t be for another few months.  RGPAS members are ideally placed to offer much-needed perspective, ideas and innovative ways forward, but we understand that because we raised concerns about the proposals, our invite to the group may not be forthcoming.

At this point I should make clear that I have no political affiliations. Personally, I used to think that SNP was doing a good job of managing NHS services in Scotland, however it has been extremely disappointing that the needs of rural communities have not been better reflected in the GP contract. I am keen to see that reversed, and believe there is the potential for that to happen.  It is surely incumbent on any party in power to reflect the needs of Scotland’s rural communities in its policies.

Click to download the report (2.6MB)

In November last year, I worked with our vice-chair Alida MacGregor and the rest of our committee to rapidly write a response document that provided positive solutions for the key issues that were identified in the proposed contract.  Informal feedback was complimentary about the realistic and constructive tone struck.  We realise that coming up with a Scotland-wide contract is difficult.  There are huge challenges across the primary care landscape of Scotland.  The efforts to identify some effective and realistic ways forward were recognised in our response.  Unfortunately, however, we have yet to receive any formal recognition or reply to the suggestions made in this document – from our negotiators or Scottish Government.  The document includes an executive summary, which summarises our key areas of concern.

We wanted early on to avoid creating too much division between urban and rural effects of the proposed contract.  General practice across Scotland is in need of increased resource.  The system has been in a state of crisis for some time, and there is no prospect of improvement unless big changes and more funding is provided.  Collapsing practices are becoming too common an occurrence across Scotland, and – particularly as a small country – we would like to see #RealisticMedicine recognised in a #RealisticContract: to work together as GPs to boost the sustainability of primary care across the country.  Workload is the rising tide that needs to be addressed, along with tackling the premises issue also seems to be a major stress-point for our urban colleagues.

And yet, as we learned more about the process, intentions and impact of the new contract, it became evident that the challenges of rural practice have been sidelined and placed on hold for a number of years yet.  Even more surprisingly, we learned that inner-city deprivation and health inequalities have been apparently forgotten in the new contract too.  It is widely accepted that measuring rural deprivation is difficult, and scores such as SIMD (Scottish Index of Multiple Deprivation) still do this poorly.  SIMD is far more robust for detecting and measuring urban deprivation.  However even despite the excellent work of the Deep End Project to focus on ways of alleviating urban health inequalities, it seems that an opportunity has been missed to address urban health poverty and deprivation.

The funding allocation has not produced the consistent increase in funding to Deep End practices that would allow unmet need and the inverse care law to be addressed. In reality this means that funding streams for patients in the most deprived third of Scotland are not at parity with the rest of the population. This situation will continue to impact on A&E departments, hospital use and premature mortality and morbidity, as documented in many Deep End reports. That is an unfortunate consequence of the inaccuracy of the weighting formula.

Dr Anne Mullin, Chair of the Deep End GP Project (December 2018)

Returning to rural, our negotiating colleagues will highlight the steps forward with golden hellos and relocation packages.  We note them but are not very convinced – they haven’t worked so far.  They will also highlight that ‘no practice will lose out’, and that our practice funding is protected for the foreseeable future.  However being placed on ‘income support’, whilst discovering that the official workload estimation formula greatly underestimates the true workload in rural GP practices, is not the strategy that we see fit for a country where 20% of the population lives rurally, and many more visit for their holidays.  The many additional services that are currently provided for our rural patients have gone completely unrecognised.

Prof Phil Wilson, Professor of Rural Health & Primary Care at the Centre for Rural Health in Inverness, and RGPAS Committee member has commented:

Prof Phil Wilson

The new workload allocation formula is based on an outdated and unrepresentative sample of practices (the PTI dataset was abandoned as worthless by SGHD in 2013), and relies simply on consultation numbers (or Read codes) per patient as the driver for allocation of funds to practices.

Funding allocations are now simply calculated on the basis of patient numbers, age and SIMD scores, and the cost of supply of medical services (higher in rural areas) is now excluded from the formula for reasons that have not been made clear.

Arguably it is patients in rural and remote areas that are most reliant on their practices to deliver health care. They have no option to register with a nearby practice or attend an A&E department if their practice collapses. Over 90% of practices in the northern Health Boards will be in the income support category. It is rural practices that have the biggest problems recruiting GPs and there are already large swathes of Caithness, Sutherland and the Isles where patients cannot access a doctor without travelling huge distances.

Yes, we are protected from the considerable cuts that would otherwise occur (up to 85% for some practices!), but there is an absence of any additional resource which is so greatly needed in some areas.  In addition, it seems that it was left to us to work out the impact for ourselves – using carefully mapped ISD data and some helpfully released contract impact data, to visualise the impact.  If the impact of the new contract was sufficiently scrutinised from the outset, why not address the rural/urban issue from the outset, instead of relying on others to process the figures?  As a result of this, some of us found the contract proposals to be a ‘scratch and sniff’ document, and unfortunately many times we found ourselves scratching through rhetoric and aspiration, to find a smell that was not particularly rosy.  Expert academics have lambasted the interpretation of econometric analysis provided by Deloitte: they were particularly surprised as Scottish Government have a reputation for normally doing workload allocation formulae rather well.

Fundamentally, the approval and implementation of a resource allocation formula that so drastically works against rural areas is surprising from a Government that should be reflecting the demographics of a country that is proud of its rural landscape.  We explained this in our letter in December to Shona Robison, our Cabinet Secretary for Health.  The question that our leaders in education, social work and other public services have been asking: ‘is this the precedent for future funding to rural areas?’.  For easy reference, here’s that map again:

Turning to the recruitment elements of the contract: we need to recognise that a strong driver for recruitment is retention.  Students and trainees who see fulfilled, fairly-treated and adequately resourced GP teams are more likely to go into general practice.  Golden handshakes, relocation allowances and bonded undergraduate education can all be implemented with some effect.  However, we need to embrace the pipeline model of recruitment & retention.  We need to recognise that leaks further downstream (particularly if for negative reasons) can be hugely detrimental to recruitment.  We need an integrated, positive, pragmatic and holistic approach to why folk come to and go from work in rural communities.

The internationally regarded Prof Roger Strasser, Professor of Rural Health & Dean/CEO of the Northern Ontario School of Medicine in Canada, is considered an expert in rural health recruitment, retention and delivery.  He has been moved to comment:

Prof Roger Strasser

This situation seems paradoxical. On the one hand, the Scottish government is investing in education, training and service initiatives to improve health in rural and remote areas, and on the other hand the government is undermining these initiatives by undervaluing and demoralising the rural practitioners who are the cornerstone of care.

It appears to be a classic example of decisions being made to address issues/concerns in the cities/dense population areas that have unintended negative consequences for people in rural and remote communities.

Unfortunately rural practitioners and their communities are left questioning whether these consequences are truly ‘unintended’.

The ball is now in the Scottish Government’s court.  Rural GPs in Scotland are as ready as we ever have been to continue innovative, realistic and community-focussed healthcare design, and we hope to see our involvement invited in the near future.  We need to see the work of rural GP teams recognised more accurately, supportively and fairly if we are to find a positive way forward from the difficult months that have resulted from a contract that has been inadequately rural-proofed.

Rural practice in Scotland has always been fertile ground to serve up great solutions for the challenges of modern healthcare.  This new contract has delivered a body-blow to rural GPs and their teams.  Give us respect, recognition and realistic resource and we will deliver.

Find out more about RGPAS concerns regarding the new contract at our #RememberRural information page: http://ruralgp.scot/rememberrural/

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@GURRMS 2018 Conference: Skye, 23-25 March

Tickets for the 2018 GURRMS (Glasgow University Remote & Rural Medicine Society) are set to go on sale for students tomorrow evening.  Following on from the highly successful GURRMS 2017 conference that was held on Islay last year, GURRMS 2018 is set to take place in Portree on the Isle of Skye, at the Aros Centre from 23-25 March, and another action-packed and stimulating programme is taking shape.

James whilst on an Isle of Arran Medical elective.

I caught up with the chair of GURRMS, James McHugh, this afternoon to find out more about how plans are coming together.  Once again a full range of speakers has been organised, and the committee are busy sorting out finances and logistics to ensure that this year’s event runs smoothly.  Kudos to them given that these guys are also coming up to their final exams, with the stresses and time involved with that.

Full details will be announced over the next while on the GURRMS Facebook page, and tickets are due to become available in the next day or so.  Last year’s event sold out within hours and so be sure to keep an eye out for the tickets being launched.

GURRMS 2018 is receiving financial support from RGPAS (the Rural GP Association of Scotland) along with a number of other funding streams, and RGPAS has been keen to support and encourage student activities like this, so we’re delighted to see plans take shape so promisingly.

We wish the best of luck to GURRMS in running their second conference, and we’re looking forward to meeting students who are keen to find out more about rural practice – see you in Skye!

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Prof Paul Worley – Rural Health Commissioner for Australia

In a really interesting development for rural health internationally, Australia has appointed its first Rural Health Commissioner.

Charged with the responsibility of overseeing and driving a wide range of activities around supporting ‘rural generalism’ the post offers a chance to provide more co-ordinated leadership across domains, regions and disciplines to make rural health strategy more cohesive in Australia.

Professor Paul Worley has been appointed as the first Rural Health Commissioner and this move has been widely welcomed across the rural health community.  He brings an impressive portfolio of experience to the post, including in clinical, academic, educational and strategic development aspects of rural health.  You can watch Dr David Gillespie MP announce the post, and Prof Worley outline some of his visions for the future (at 5min 55s), in the video below.

Twitter and other social networks – including the WONCA Working Party on Rural Health international email list – have been buzzing with positivity about the new post, and it is likely that this approach might pave the way for similar developments in other countries.

In Scotland, we are watching developments with interest.  Rural medicine and health services are of significant importance in Scotland’s National Health Service – 98% of Scotland’s land mass is rural, and 18% of Scotland’s population live in a rural area, with many more flocking to rural areas during holidays.  And yet despite considerable aspects of medical care being delivered by GPs and primary care teams, within community hospitals, A&E units and facilities outwith the usual remit of GPs, there continues to be relatively little in the way of co-ordinated clinical governance and strategic unity to link rural and isolated practitioners together.  These services provided by rural GPs remain considered to be on the ‘fringes’ of general medical practice.  Therefore the opportunities created by appointing an experienced individual to provide leadership, stimulate innovation and inspire positive approaches, are sorely needed in areas other than Australia.

Having met Paul at the WONCA World Rural Health conference in Cairns this year, I’m delighted to hear this news and inspired to think that this is a situation to watch closely.  I have little doubt that we will be reflecting that Scotland could benefit from a similar approach in the near future.

Well done Australia, and all the folks involved in making this happen.  These are exciting times.

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AProf Bruce Chater on Dr MacLeod and #ruralwonca

Today RuralGP.com highlighted the tribute speech given by Associate Prof Bruce Chater to the life and work of Dr John MacLeod of Lochmaddy in Scotland.

I was delighted to catch up with Prof Chater after his speech, to ask him more about Dr MacLeod’s work with Rural WONCA, how the WONCA Working Party for Rural Practice is progressing, and also for some advice to younger rural doctors on how to effect change in their own communities.

You can listen to the recording below…

 

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The legend of Dr John MacLeod remembered at #ruralwonca

Today’s #ruralwonca programme includes a keynote delivered by Associate Professor Bruce Chater: the Dr John MacLeod Oration.

Dr MacLeod was a legend in the world of WONCA and an inspirational rural GP.  I regret that I never had the opportunity to meet him; my own career in rural practice was just starting when he died and whilst a student experience in the Hebrides (Stornoway) was an inspiring part of my own interest in rural practice,  my travels didn’t take me to Lochmaddy.  I was running the RuralGP.com site at the time of his death, however, and you can read more about Dr MacLeod in the obituary, eulogy and tribute that were published at the time by Dr James Douglas and Dr John Wynn-Jones.

His legacy in the WONCA World Working Party on Rural Practice is evident, and I’m looking forward to hearing more from Prof Chater’s perspective in his keynote today.

Dr Sarah Chalmers

In the last few days I also met Sarah Chalmers.  When Sarah was a medical student, she experienced an elective with Dr MacLeod and I was delighted to be able to ask her more about her experience in this podcast.  Coincidentally, she had arranged another elective which had fallen through, and it was a chance conversation at a student event with Prof Chater which led to him emailing Dr MacLeod and thus the elective was set up in Lochmaddy instead!

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Protective personality traits for LICs

Assoc Professor Diann Eley

Today I attended a session at #ruralwonca which was delivered by Associate Professor Diann Eley from the University of Queensland on the role of personality traits on student experience of Longitudinal Integrated Clerkships.

Diann has gained considerable experience in this area, and specifically on how best to support and mentor students effectively whilst encouraging them to reflect on their own personalities – and how that impacts on their clinical decision-making.

I was delighted that Diann gave me a few minutes of her time after her presentation to discuss this in more detail, particularly as this work is highly relevant to the development of LICs in Scotland.

You can listen to our discussion here:

 

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A word with the Auzzies at #ruralwonca

At lunchtime today I was delighted to catch up with Australian rural doctors John Hall, Aaron Sparshott and Katie Chang.  I asked them about their experience of the conference, their current careers and a bit about the success of the Australian Rural Generalist Pathway.

 

John, Aaron, Katie around a typically chilled-out kangaroo that we found in the exhibition hall.

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