Médecins Sans Frontières has projects in more than 70 countries that might be affected by natural disasters, armed conflict or disease outbreaks. Its clinics see over two million emergency room admissions a year and another 16 million outpatient consults. Emergency Paediatrics consultant Josephine Goodyer and ID consultant Tasnim Hasan are two of more than a hundred Australians and New Zealanders who contributed to MSF’s missions last year. Between them they have covered practice settings as varied as Kiribati, South Sudan and Gaza. In this interview they describe the experience shipping out with MSF on their first assignment and then the kinds of responsibilities one is given with more experience. We’ll also hear how gaps of six months or more affect career progression and financial stability back home.

Chapters
3:05 Starting out with MSF
15:04 Practicing in a conflict zone
50:53 Career impacts

Guests
Dr Josephine Goodyer FRACP (Canberra Hospital; Australian National University)
Dr Tasnim Hasan FRACP (Western Sydney LHD; University of Sydney)
Dr Aidan Tan (Sydney Children’s Hospital Network)
 

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Intimacy’ by Alex Kehm, ‘At the end of nothing’ by Silver Maple, ‘Below the Horizon’ by Dawn, Dawn, Dawn and ‘Nagba Algooah’ by Ebo Krdum. Image by Pablo Tosco ©2018 used with permission by MSF. Editorial feedback kindly provided by members of the podcast editorial group Dr Aidan Tan, Dr Stephen Bacchi, Dr Rahul Barmanray, Dr Maansi Arora and Dr Leon Li. 

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A 75 year-old man with severe aortic stenosis is deemed unsuitable for surgery on the basis of a porcelain aorta detected with cross-sectional imaging. The patient had, a decade earlier, been diagnosed with hypertrophic cardiomyopathy after presenting with cardiac arrhythmia. A dual chamber ICD was implanted at the time for secondary prevention and other comorbidities were managed. 

The patient is now being considered for staged alcohol septal ablation (for the HCM) and transcatheter aortic valve replacement (for the aortic stenosis), however, additional complications force an experimental two-in-one procedure.

Guest
Professor Ross Roberts-Thomson FRACP (Central Adelaide Local Health Network; University of Adelaide)

Hosts
Associate Professor Stephen Bacchi FRACP (Northern Adelaide Local Health Network; University of Adelaide)
Dr Alistair Leslie (Central Adelaide Local Health Network;)

Key Reference (Spoiler Alert)

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Two-in-one: Combined transcatheter therapy for hypertrophic cardiomyopathy and aortic stenosis [IHJ Cardiovascular Case Reports (CVCR). 2020]
 
 

Production
Produced by Stephen Bacchi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Desert Whispers’ by Tellsonic and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPDto record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

The record for the longest space-flight is held by physician-cosmonaut Valeri Polyakov. Back in 1994-95, he spent 437 days on the Mir space station and grew 4 centimetres in height through elongation of his spine in micro-gravity. Polyakov had an uncomfortable ride back to Earth in the very precisely customised descent module. 

Microgravity also causes demineralization of weight-bearing bones that is faster than age-related decline. But the cosmonaut had worked out religiously for the entire mission and after his capsule parachuted to the ground he made a point of walking from it relatively unassisted. One of the main objectives of the marathon flight had been to prove that walking proudly onto the Martian surface after a 9-month journey might be possible, given it only has 37 percent the gravitational force that Earth does.
 
Microgravity additionally results in adaptive plasticity of the vestibular and sensorimotor networks and deconditioning of the cardiovascular system. Indeed, several years ago there was a medical emergency aboard the international space station when an ultrasound investigation revealed thrombosis of the internal jugular vein in one astronaut. In this podcast we discuss how management of cases like this has many parallels with remote medicine on earth. Part 1 of this series examined the risks of cosmic radiation and spaceflight-associated neuro-ocular syndrome among other things.  

Guests
Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace)
Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)

Chapters
1:08 Bone mineral density
 15:35 Circulation and a case study in remote medicine
35:04 Historic medevacs from space

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Spring Water’ By Chill Cole, ‘At the End of Nothing’ by Silver Maple and ‘Mega Woman IV’ by ELFL. Music courtesy of Free Music Archive includes ‘Snowfall’ by Kai Engel. Graphic is AI-generated and shared online with a Creative Commons licence. 

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr Stephen Bacchi.
 
Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

In 2027, NASA’s is planning to land astronauts on the moon for the first time in 53 years with the expectation that there will be a permanent base there by the early 2030s. And the ever-humble Elon Musk reckons he’ll be sending people to Mars by then too. 

This has prompted a renewed interest in the prolonged effects of space travel on the human body, and a lot of fascinating research has been conducted aboard the International Space Station over the last two decades. 

The main objective risk to astronauts is exposure to galactic cosmic radiation. This can be reduced to some degree by shielding of space habitats, however, the impacts of microgravity are much harder to engineer away. In part 1 we’ll discuss spaceflight associated neuro-ocular syndrome and other sensorimotor impacts. In part 2 we’ll focus on the effects of microgravity on bone density and the circulatory system. 

We’ll also talk through the management of a cases of suspected thrombosis on the international space station from a few years ago. Medical care on orbit has many parallels with the remote medicine you’re already familiar with. 

Guests
Professor Gordon Cable (Australian National University; Co-founder, Human Aerospace)
Dr Alicia Tucker FACEM, FAWM (Royal Hobart Hospital; University of Tasmania)
Dr John Cherry PhD FACRRM (Deputy CMO, Australian Antarctic Division)

Chapters
4:55 Cosmic Radiation
18:34 Spaceflight Associated Neuro-ocular Syndrome
33:01 Occupational Hazards 

Production
Produced by Mic Cavazzini DPhil. Recording of ‘Also Sprach Zarathustra’ by Richard Strauss, licenced under Creative Commons from the Lud and Schlatts Musical Emporium Conducted by Philip Milman. Music licenced from Epidemic Sound includes ‘Orthosie’ by Ben Elson, ‘Spring Water’ By Chill Cole and ‘Temple of Runha’ by ELFL. Music courtesy of Free Music Archive includes ‘The Undertake’ and ‘Operation A’ by Borttex. NASA audio downloaded from SPACE.com YouTube channel. Image courtesy of NASA and WikiCommons. Image of first US moonwalk by Ed White courtesy of NASA and WikiCommons. 
 

Editorial feedback kindly provided by members of the podcast editorial group Paul Cooper PhD, Dr Aidan Tan, Dr Rahul Barmanray, Dr Simeon Wong, Dr Fionnuala Fagan, Dr Maansi Arora, Dr Jia-Wen Chong, Dr Aafreen Khalid and Associate Professor Dr Stephen Bacchi.

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

A 72-year-old female presents to an Adelaide emergency department with bilateral eye pain and redness lasting several days. She has a history of hypertension, hypercholesterolemia and age-related macular degeneration for which she has received a range of medications. Anterior uveitis is identified as the proximal cause of the ocular pain but there are many possible aetiologies that require careful consideration. Pomegranate [Case Reports] have been developed to help Trainees rehearse diagnostic problem solving and case presentation.
 
Guests
Associate Professor Jagjit Singh Gilhotra ,FRANZCO (Queen Elizabeth Hospital; University of Adelaide)
Dr Yong Min (Shane) Lee FRACP (Royal Adelaide Hospital)
 

Host
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes  ‘Desert Whispers’ by Tellsonic  and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. 

Key Reference (Spoiler Alert)

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Bilateral occlusive retinal vasculitis secondary to intravitreal faricimab injection: a case report and review of literature [Lee, Eye Vis. 2024]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Australia has just approved a second amyloid-targeting therapy for patients with incipient Alzheimer’s dementia. Lecanemab (Leqembi) now joins donanemab (Kisunla) on the Australian Registry of Therapeutic Goods but the impact of both has been modest in Phase III trials to date. After 18 months of therapy they delay progression of disease, as quantified on neurocognitive tests, by around 5 months on average. 
 
For some, the prolonged independence and dignity will justify the $60,000 to $80,000 a year price tag for the drugs. But for the Pharmaceutical Benefits Advisory Committee “the high burden of [donanemab] treatment on both patients and the health system, combined with the risks and modest clinical impact, makes the drug unsuitable for PBS subsidy”.
 
This burden includes specialist consults, gene screening, multiple MRI and PET brain scans, and delivery of monthly or fortnightly infusions, adding up to another $20,000 in costs. Even before considering these logistical requirements, Australian memory clinics don’t have anywhere near the capacity to address the 245,000 new cases of early dementia or mild cognitive impairment every year. 

Advocates see these disease-modifying therapies as a turning point for dementia research and argue for further investment in the systems infrastructure needed to roll them out. Sceptics argue that the available evidence instead questions the importance of amyloidosis in the Alzheimer’s disease cascade.

Guests
Professor Michael Woodward AM FRACP FANZSGM FAAG FAWMA (Austin Health, Melbourne; University of Melbourne)
Dr Chrysanth Pulle FRACP (Prince Charles Hospital, Brisbane) 

Chapters
13:16 Time Saved
16:18 Costs of treatment
26:44 IMJ paper on resourcing
39:10 Scepticism and staging

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘RGBA’ and ‘Pulse Voyage’ by Chill Cole, ‘A Forest Melody’ by Tellsonic, ‘Axon Terminal’ by Out to the World, ‘Organic Textures 2’ by Johannes Bornlof and ‘Fugent’ by Lupus Nocte. Image courtesy of Wikimedia Commons and University of Pittsburgh. 

Editorial feedback kindly provided by physicians of the podcast editorial group Ronaldo Piovezan, Aidan Tan, Hugh Murray, Joseph Lee, Rahul Barmanray, Simeon Wong and Sebastian Lambooy. Thanks also to Profs Bruce Campbell, Mike Parsons and Amy Brodtmann and registrars Jamie Bellinge and Karan Singh for additional insights into research methods. 

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

A 27-year-old male wakes up with weakness in the left arm and leg and gets himself admitted at Royal Adelaide Hospital. Shockingly, for an otherwise well young man with no significant medical history, a right middle cerebral artery acute ischaemic stroke is identified by CT angiogram. His condition deteriorates in hospital, and a mediastinal mass is discovered on review which gives a lead as to the distal cause. This conversation describes the expedient workup and methodical consideration of some rarer causes of ischaemic stroke.

Guest
Dr Rudy Goh FRACP (Lyell McEwin Hospital, University of Adelaide)
 
Host
Associate Professor Stephen Bacchi FRACP (Lyell McEwin Hospital; University of Adelaide)

Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP.

Key Reference (Spoiler Alert)

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Disseminated Aspergillosis with Mediastinal Invasion Causing Fatal Stroke in an Immunocompetent Young Man [Case Rep Neurol. 2024]
 
Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Diabetic ketoacidosis can be life-threatening but there’s some variability in the way it’s managed between health settings. Intervention involves intravenous insulin administration, hydration, electrolyte replacement and treatment of the underlying precipitant. In a survey of practitioners from 31 different hospitals in Australia there was an even split between those organisations which followed a fixed rate insulin infusion protocol, usually based on bodyweight, or a variable rate infusion protocol, titrated against blood glucose concentration. 

Three quarters of survey respondents had worked at another hospital that had different DKA management protocols raising concerns about the cognitive load on junior health staff moving between institutions. In Europe there has been some normalisation towards fixed rate protocols, despite there being no good quality evidence for superiority. In this podcast we hear some theories from two of the authors of the study published recently in the Internal Medicine Journal.

12:40 SGLT2 inhbitor-associated ketoacidosis
17:26 The cognitive burden of variation across settings
25:11 the challenges of researching this questions

Guests
Dr Lisa Raven FRACP PhD (St Vincent's Hospital, Sydney)
Dr Mahesh Umapathysivam FRACP DPhil (Southern Adelaide Diabetes and Endocrine Service; Royal Adelaide Hospital) 

Guest Host
Dr Mervyn Kyi FRACP PhD (Royal Melbourne Hospital; Northern Hospital)

Production
Produced by Dr Mervyn Kyi and Mic Cavazzini DPhil. Music licenced from Epidemic Sound ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Aidan Tan, Hugh Murray, Stephen Bacchi and Aafreen Khalid. 

Key Reference
“Heterogeneity in the management of diabetic ketoacidosis in Australia: a national survey”  [IMJ. 2025]

Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify,Castbox or any podcasting app.

Pomegranate Health has been streaming since June 2015, so we’re going to share a few more classic eps from the last ten years. First up, presenter Mic Cavazzini digs deep to find the origins of the pomegranate, featured not just on this podcast but on the crest of the RACP. The journey starts 500 years ago at an unlikely place, the marriage of Henry VIII and the first of his six wives. You’ll find much of the pageantry reproduced at the web page. 

We then hear from the wonderful staff at Marrabinya, a support service in western NSW that helps connect Aboriginal patients to specialist consultations. As heard in episode 53, and a handful of others, healthy equity for First Nations people is a value embedded in the mission of the RACP. At Pomegranate Health we also try to support physician wellbeing and career development. One podcast towards that end was Episode 55: Starting out in Private Practice. We hear a pep talk from veteran rheumatologist Louis McGuigan about when and how to back yourself in such a business venture.

Another episode with a practical theme was number 56 titled “Billing in Byzantium” where we heard how it is that a few billion dollars are inappropriately leaked from Medicare every year. Finally, in a sample from Episode 69. we hear about some of the structural bias in the health system that results in a gendered understanding of drug effects. All of these episodes and more, are now available on YouTube, as well as all the usual podcast browsing apps. 

Sampled in this retrospective episode:
Desley Mason, Possum Swinton and Kym Lees from Ep53: Marrabinya
Dr Louis McGuigan from Ep55: Starting out in private practice
Margaret Faux PhD from  Ep56: Billing in Byzantium
Professor Zoe Wainer from Ep69: Gendered Medicine 2- Funding and Research 

Production Credits
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Fair Game’ by Mizlo, ‘Salat Alsabah’ by Feras Charestan, ‘Your Wave’ by Cospe, ‘Dusty Delta Day’ by Lennon Hutton, ‘Corn Candy’ by Guustavv and ‘After the Freak Show’ by Luella Gren. Music courtesy of FreeMusicArchive includes JS Bach's ‘March Fur Die Arche’ performed by The United States Army Old Guard Fife and Drum Corps and ‘Notre Dame’ by Jahzarr. Allegri’s ‘Miserere’ performed by Trinity College under Creative Commons licence from archive.org.
 
Editorial feedback kindly provided by RACP staff Kathryn Smith, Arnika Martus and Ruby Nelson.  

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Cerebral microbleeds are a finding on MRI that are usually asymptomatic. There are two main aetiological pathways, one occurring as a result of uncontrolled hypertension and the other from the accumulation of amyloid-beta peptide. The link between cerebral amyloid angiopathy and Alzheimer’s Disease is not understood and even the impact that cerebral microbleeds more generally have on cognition. 

For the study discussed today, clients of an Australian memory clinic were retrospectively assessed for prevalence of cerebral microbleeds and how this correlates to performance on cognitive tests and formal diagnosis categories. Prevalence of multiple cerebral microbleeds was associated with poorer cognitive performance and more severe diagnoses. And there are suggestions of a shared instigator between Alzheimer’s Disease cerebral amyloid angiopathy. But novel anti-amyloid therapies can also cause increased bleeding risk, meaning that multiple microbleeds are a contraindication for these drugs. We hear how clinicians in the memory clinic balance therapeutic outcomes and potential risks.  

Guest
Associate Professor Paul Yates FRACP PhD (Austin Health; University of Melbourne)
 
Co-Host
Dr Duncan Austin FRACP PhD (Alfred Health; Cabrini Health)

Production
Produced by Dr Duncan Austin and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Tree Tops’ by Autohacker and ‘Fugent’ by Lupus Nocte. Image created and copyrighted by RACP. 

Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Joseph Lee and Aidan Tan.

Key Reference
Prevalence and Associations of Cerebral Microbleeds in an Australian Memory Clinic Cohort [IMJ. 2025]

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.