Chandra, developmental paediatrician, stands in front of late and mountain

Meet the Team: Chandra

Hi, my name is Chandra Ayer and I’m a Developmental Paediatrician at Royal Far West.

What does your role involve?

I work as part of the multi-disciplinary team within Royal Far West’s Paediatric Development Program. First and foremost, I’m involved in the neurodevelopmental assessment of children to identify and diagnose specific diagnosable conditions when they present, such as autism or ADHD. I am also involved in the medical treatment of these conditions and the most obvious example of that would be medication treatment for a specific behavioural dysregulation disorder.

Throughout this assessment process, one of the most important roles I undertake as a Paediatric Medical Doctor is to assess children for a possible underlying medical cause for their problems. This could be things like genetic disorders or neurological disorders. It is really important that these things get identified so the family and health team around that child have an explanation, but it also helps in predicting and planning for how things will develop for that child.

I consider one of the most important parts of my role is to support and counsel the carers and parents of the child. Families need to understand the complexities of their child and then have the confidence to navigate an often complex pathway following the assessment and diagnosis. I want to help them make sense of all this new information and where to go to next to ensure the best support and outcomes for their child.

How did you come to specialise in paediatrics?

It has been quite the journey to paediatrics for me. Originally, I began studying electrical engineering at university but before too long I realised that electrical engineering didn’t like me, and the feeling was mutual!

After a short break from study, I came back to study science which ended up becoming Honours in Molecular Genetics, which then opened an opportunity to study medicine.

Studying medicine was a lot of fun but I still wasn’t entirely sure what I wanted to do. While taking a break and travelling overseas, I then completed a Master of International Public Health and then returned home and began specializing in emergency medicine, which sparked my interest in paediatric emergency. That’s when I switched over to work at the Children’s Hospital. Over the course of all this, I got married and had three kids, and that undoubtedly was a major factor in me shifting my focus to paediatric medicine and away from emergency.

What led you to work at Royal Far West?

I was born and grew up in Armidale, so I consider myself a country kid at heart and that will always be part of who I am. When the opportunity arose to work at Royal Far West, I jumped at it. The country means a lot to me, and I have a strong connection with the country way of life and country people.  Many communities in regional and rural Australia have a lot less access to things that they really should have easier access to, and that includes medical specialists, and developmental specialists in particular. It makes sense for me on a personal and professional level to couple my connection to the country with my expertise as a Paediatric Medical Doctor to work for an organisation like Royal Far West which does so much to help country kids overcome some of these big hurdles they face.

What makes working at Royal Far West so satisfying?

Working in a multi-disciplinary team of highly skilled and experienced clinicians is an incredible thing, no matter where you are located, city or country. It is quite rare to have so many highly competent and diverse paediatric clinicians working together to support the child in a wholistic approach. The team of professionals I work with are passionate about the health needs of country kids and so we have a similar commitment to the purpose of our work, and that is quite a privilege to work amongst.

Since you’ve been here, have you seen any changes in the sorts of issues children are facing?

I’ve been here at Royal Far West for four years now, and while it is difficult to quantify trends over that time, I think it’s fair to say we’re seeing an increase in the complexity and severity of cases. This trend probably predates my commencement with Royal Far West, but a lot of our clinicians are seeing children present with more complex issues and at a younger age. It’s difficult to say whether this is a real increase or whether we have just become better at identifying them. It could be a result of increased awareness from teachers and medical professionals in country communities who are now more likely to refer kids who may be struggling in school. Obviously COVID has also provided another dimension to the cases we’re seeing and has contributed to the increase in severity and acuity of cases. The challenge is to ensure we have the clinical resources to keep up with this demand.

What do you consider the biggest challenges for children and families in country communities?

A little while back, I completed a study which looked at inequities in rural and regional Australia. When it comes to developmental disorders, children from the country face a triple whammy effect. Firstly, by virtue of growing up in rural and regional Australia, they are at a much higher risk of having a developmental disorder – that’s the first hit. The second hit is that they are much less likely to have that developmental disorder identified as a child. And thirdly, when they do have that developmental disorder identified, they are much less likely to be able to access any treatment for it. So, it’s a triple whammy effect and the result is that by the time a country kid starts school, they are more likely to start with higher rates of developmental problems which affect reading, writing, social skills and emotional competence, when compared to children from urban areas.

These are big challenges and inequities to overcome, which is why Royal Far West is here. We will continue to work to support these families in the early identification of developmental disorders and support them in their treatment.

What’s the best thing about working with the families that come into contact with Royal Far West?

Staying at Royal Far West in Manly is an extraordinary experience for the country families that come here, and they are always incredibly appreciative of the multi-disciplinary team and support staff working around them. There is really no other place quite like Royal Far West. The families give us a lot of positive feedback about their experience, and we get to see a change, whether that is in the child’s progress or in the family’s understanding and confidence in navigating the future pathway for that child. The team I work with works incredibly hard for these children and the work can be emotionally taxing. It makes it all worthwhile when we see the lives of these children and the families around them improved through the work we do.