[00:00:00] Dr Sanjaya Senanayake: Hi, this is Dr Sanjaya. Personalised Medicine is a new approach to health care, looking at a patient's genetic profile to help prevent, diagnose and treat disease. My latest guest on Behind the Curtain, Dr Simon Jiang, is leading in this groundbreaking work right here in Canberra. Let's jump into our chat.

[00:00:36] Dr Sanjaya Senanayake: Welcome to our Behind the Curtain Podcast where we have found another extraordinary personality who works at Canberra Health Services. Today we have Doctor Simon Jiang who is a Senior Staff Specialist at Canberra Hospital, a Renal Physician and also an Associate Professor of Medicine at the ANU. Welcome, Simon.

[00:00:58] Simon Jiang: Thanks, Sanjaya.

[00:00:59] Dr Sanjaya Senanayake: And what are you up to at the moment? Are you doing clinical work at the moment or?

[00:01:03] Simon Jiang: So currently I split my time between work, clinical work as a Nephrologist at Canberra Hospital. And then also running a research laboratory over at the John Curtin School of Medical Research at the ANU.

[00:01:17] Simon Jiang: So, I work, I do a full on call for Nephrology, and then I also do my outpatient clinic work.

[00:01:28] Dr Sanjaya Senanayake: And so, for those listeners out there who don't know much about autoimmune disease, they've heard about it. Do you want to explain that, please?

[00:01:36] Simon Jiang: So autoimmune diseases, so our immune systems are designed to have the ability to recognise bacteria and viruses, those things that are constantly trying to infect us.

[00:01:48] Simon Jiang: But at the same time, it has to have the ability to discriminate between what's invading organism and then what's self-tissue. So, when the immune system loses the ability to distinguish between those two things, it can start to attack the body, and then that in itself can start to cause a kind of a chronic, damaging illness.

[00:02:09] Dr Sanjaya Senanayake: When did you realise that you want to do research? Because I can tell you, a lot of us clinicians, we are interested in research in terms of consuming it, using it to guide our practice, reading about it, to some extent doing hospital-based research, so clinical epidemiology, looking through hospital records of patients to find associations between diseases and certain risk factors and outcomes, et cetera.

[00:02:36] Dr Sanjaya Senanayake: But going to a lab and doing research, and mixing that with medicine, that's something altogether. What was it? When were you drawn into that?

[00:02:45] Simon Jiang: I think my tipping point was actually in my intern residency in terms of wanting to go and do more or understand more, and again it comes back to these immune mediated diseases.

[00:03:01] Simon Jiang: So, we had a few people that I looked after who had quite severe autoimmune diseases. And I just remember while I was on the term we struggled for weeks and weeks to even make a diagnosis.

[00:03:12] Dr Sanjaya Senanayake: And Simon there was one particular woman in her 40s.

[00:03:16] Simon Jiang: Yeah, she's the one that stands out in my mind. She'd had, from childhood, quite a significant autoimmune disease. When she came in as a result of treatment and some side effects from the disease, she'd had a kidney transplant and some hip replacements, and she came in and she was just very unwell. And we spent a long time trying to figure out why she was unwell.

[00:03:43] Dr Sanjaya Senanayake: Let me just say 40 years old, you've already had a renal transplant, you've already had hip replacements. That's crazy.

[00:03:49] Simon Jiang: And that speaks to the debilitating nature of these autoimmune diseases, they come, and they go, but they tend, even when they go, to leave behind a bit of damage.

[00:04:04] Simon Jiang: So, she was already very sick, and we tried our best, really tried extremely hard and despite best efforts she just got sicker and sicker. And so, it actually ended up being that she passed away. And I was quite young at the time, and it left a very indelible mark for me that we don't understand these conditions well.

[00:04:33] Simon Jiang: And our lack of understanding of these conditions means that people don't do as well.

[00:04:39] Dr Sanjaya Senanayake: So, this particular woman, did she have a clinical diagnosis? It was autoimmune disease of unknown cause.

[00:04:47] Simon Jiang: It was what we would call a mixed connective tissue disease. Which you would say is like a kind of a throw it all in one basket where it's got a bit of this and a bit of that doesn't. It looks a little bit like one and a little bit like something else, but it's not really quite clear.

[00:05:02] Simon Jiang: And that happens an awful lot in autoimmune diseases.

[00:05:06] Dr Sanjaya Senanayake: And so again, this wasn't as a registrar, a fairly senior doctor, this was as an intern. You saw this and you decided there must be a better way of doing this.

[00:05:20] Simon Jiang: Yeah, I kind of vaguely remember the thing in my mind was surely this can't be the best that we can do.

[00:05:26] Simon Jiang: At the time was kind of doing some CT scans which didn't work very well because of the hip replacements, some blood tests, physical examination, white cell scans and things like that. So, trying to do a couple of tests and really the best that we could do to me at the time felt like a very superficial level.

[00:05:50] Simon Jiang: And then the fact that she didn't do well just left me this thought that we must be able to do better than this.

[00:05:57] Dr Sanjaya Senanayake: How did that seed that was planted grow over the next couple of years into research.

[00:06:03] Simon Jiang: So, I did my basic physician training in Canberra. When I passed the exams, then I started to do a lot more research.

[00:06:13] Simon Jiang: And I was really at that phase where I knew I wanted to do research, but I was just trying to figure out is it, as you're saying, clinical trials or cohort studies or basic science. And there wasn't really a lot of basic science that I was exposed to in Canberra at the time.

[00:06:32] Simon Jiang: But I obviously had a very strong interest in immune diseases by that point. And I was just trying to figure out what would be the thing that I enjoy the most that’ll allow help me to improve our understanding and research these new diseases. And so I went and did a transplant year at Royal Prince Alfred in Sydney.

[00:06:52] Dr Sanjaya Senanayake: They had a TV show, didn't they?

[00:06:54] Simon Jiang: They had a TV show. Yeah. So, I remember actually, at 2 a. m. in the morning I was doing a kidney transplant on someone, and I spent an hour doing all the work, and then the surgeon came in and told me to go over behind the desk.

[00:07:10] Simon Jiang: The surgeon came and talked for five minutes with the cameras and then disappeared. And then I had to stay for another hour to help stabilise the patient. So, I was like, that was a good experience in media. But I had actually thought when I went there that I would get exposure, because they had the University of Sydney on campus and other kind of big institutes, that I’d get a lot of exposure to fundamental basic science research.

[00:07:34] Simon Jiang: And there was a little bit, but nothing in the autoimmune space. And so, in that instance, I came back because at the ANU and at the John Curtin, there was a couple of very prominent basic scientists working in immune diseases, and I kind of realised that would give me the skills that I need.

[00:07:52] Dr Sanjaya Senanayake: Advanced scientists working in basic science?

[00:07:56] Simon Jiang: We'll call it translational science or fundamental science rather than clinical science, which is the randomised controlled trials and cohort science.

[00:08:12] Dr Sanjaya Senanayake: And actually, just before we continue with your journey, we hear about translational science, translational medicine. Can you explain what that is?

[00:08:22] Simon Jiang: What we're talking about is trying to identify fundamental insights into different things, whether it's cell biology or genetics or RNA. So, something on a very basic or fundamental science level.

[00:08:38] Simon Jiang: But then taking that and bringing it into the clinic and using that in a way that has clinical impact; improves diagnosis of patients or improves their treatment.

[00:08:49] Dr Sanjaya Senanayake: Yeah, so translating a discovery from the lab to the bedside. Because otherwise we know that we see these wonderful studies done in mice models etc, where a drug or some intervention looks extremely promising for a debilitating disease, but it doesn't get to the bedside for 20 years.

[00:09:10] Simon Jiang: Yeah, exactly.

[00:09:11] Dr Sanjaya Senanayake: Translational medicine is about trying to get it there more quickly, is it?

[00:09:14] Simon Jiang: Yeah, exactly. And so, one of the big things that we deal with is trying to go from the clinic to the laboratory and make fundamental discoveries but bring that back to the patients in a timeframe that's clinically meaningful for the patients.

[00:09:36] Simon Jiang: Because there's no point figuring out and discovering what's going on and, you know, how to treat it and things like that. And then the person's passed away.

[00:09:46] Dr Sanjaya Senanayake: Exactly. As you said, you found these amazing scientists at John Curtin.

[00:09:52] Simon Jiang: Yep.

[00:09:52] Dr Sanjaya Senanayake: And so, then what happens?

[00:09:55] Dr Sanjaya Senanayake: I'm a clinician, I'm going to be a renal physician, but I'm really interested in research. Can you give me a table in that lab over there, or how does it work?

[00:10:05] Simon Jiang: Well, pretty much. So, I reached out to Carola Vinuesa. She published very seminal works in immune biology and autoimmunity.

[00:10:18] Dr Sanjaya Senanayake: Yep.

[00:10:19] Simon Jiang: I said, look, I'm interested. I've got no lab experience, I've never held a pipette before, but I'm quite interested in basic science research and immunology.

[00:10:27] Dr Sanjaya Senanayake: I’ve dropped a pipette before.

[00:10:31] Simon Jiang: I think I was holding mine upside down the first time I was there and everyone was shaking their head.

[00:10:34] Simon Jiang: So I reached out and said I'm interested, and I think Carola actually started by saying, why? She's like: why would you leave the clinic? You're fully trained, you can go start a job as a consultant. Why would you come back and do this? At the time, my thought was just, I want to learn how to do it, I want to learn how people make fundamental discoveries.

[00:10:59] Simon Jiang: Not really sure where it's going to go, but I want to learn that skillset. It was kind of like a big reset, I kind of went back to being a medical student. I finished all my training. When you went back in the lab, I had no skillset. People talked in a language that I didn't really understand, the scientific jargon, and I just had to kind of go in and learn it.

[00:11:19] Dr Sanjaya Senanayake: So, your early days in research in the lab, what sort of things were you working on? Was it different to what you're working on now?

[00:11:26] Simon Jiang: Yeah, it was. The first 12 months of my PhD, I was working on two very healthy mice. At the time, my supervisor was saying I think these mice are going to have something wrong with them. We're not really sure.

[00:11:42] Simon Jiang: And I spent 12 months doing a lot of work on these mice and they were profoundly healthy. At the end of the first 12 months, I just said I don't think there's going to be a PhD coming out of this. Because these mice, no matter what I do, they seem very healthy. Maybe we can study them as exceptionally healthy mice.

[00:12:09] Simon Jiang: But I did pick up a lot of skills in terms of learning in lab, basic science and things like that. In my second year I said we probably need to change my project. Then it started to move closer to what I do now.

[00:12:27] Simon Jiang: We took patients with autoimmune disease, lupus in this case, who underwent whole exome sequencing. And we were kind of the first to try and identify genetic variants that were causing immune disease in humans. And so that ended up being my PhD studies in terms of proving that genetic variation was causing sporadic autoimmune disease and not familial autoimmune disease.

[00:13:01] Dr Sanjaya Senanayake: And it's built up from there now and I think you call it personal medicine, isn't it?

[00:13:06] Simon Jiang: Personalised medicine.

[00:13:07] Dr Sanjaya Senanayake: So, you target the patient. The specific patient.

[00:13:12] Simon Jiang: Where we are now is probably 12 or 13 years of, not just the research, but development of the approach to understanding.

[00:13:26] Simon Jiang: So, it's not just genetics. We don't just use whole genome sequencing, but we had to kind of build special bioinformatic pipelines to handle next generation sequencing and all these other, you know, specialised ways to analyse the white blood cells of patients, measure their cytokines and things like that.

[00:13:46] Simon Jiang: Probably in the first five or six years, it was really just, can we even show that genetic variants in patients with immune disease cause autoimmunity? And so, the first couple of years was just knowing that we could do that. And then we had a couple of very big discoveries showing that yes, actually you can.

[00:14:08] Simon Jiang: Coming all the way back to the patients that I looked after when I was an intern that kind of left that mark on me. I had now developed a skill set where I could understand immune disease at the genetic and the cellular and the RNA level.

[00:14:26] Simon Jiang: What we hadn't really done is, why can't we then use that information to help them, to treat patients? And so the last five years has been a very strong push to understand it, the basis of autoimmune disease, and use that translationally to actually change what we're doing in the clinic.

[00:14:51] Dr Sanjaya Senanayake: So rapid technological advances in the lab but bringing it to the bedside as soon as possible to help people, which is great. Has there been a eureka moment? I think you've got an exciting career ahead of you over the next few decades. So far has there been a eureka moment where you go, oh my god, this is it? I understand now. This is going to be great.

[00:15:19] Simon Jiang: There's been a lot of them actually. It was hard yards to get that training and skill set. But now I know I can never go back. Almost every week we're discovering something completely new. And when we say new, it's a gene in which we didn't know a function of or a biological process or something like that. Which no one else has discovered. It’s constant discovery in the lab, it’s really exciting.

[00:15:43] Simon Jiang: We had one individual, and fingers crossed we’re in a very top tier journal, but we've essentially identified a new cause of autoimmune disease. We did create a mouse and were able to show that the mouse developed all these abnormalities in the immune system.

[00:16:24] Dr Sanjaya Senanayake: And look, research jargon. You created a mouse?

[00:16:29] Simon Jiang: We first start by trying to understand, identify genes that have some preliminary data that the mutation is doing something. If we really want to get into it and start to try and figure out a treatment for them, we end up creating essentially a mouse avatar.

[00:16:43] Simon Jiang: So, if they've got a particular gene mutation, which we think is driving the disease, we use CRISPR editing to create a mouse carrying that mutation so that we can then go and study it in depth and its response to treatment. So, this is an individual who's been in Canberra for 15, 20 years, had a severely severe immune disease for that period of time and had gone through a number of immunologists and rheumatologists.

[00:17:10] Simon Jiang: He became known to me because he had a kind of very low blood phosphate, so my renal hat.

[00:17:16] Dr Sanjaya Senanayake: Yeah.

[00:17:17] Simon Jiang: We brought him into the Personalised Medicine Program and found a genetic variant that hadn't been found elsewhere. And we're basically able to show that it was causing his immune system to become hyperactive. We created a mouse which replicated what he had and were able to, with that insight, treat the mouse.

[00:17:40] Simon Jiang: The mouse dampened down the hyperactive immunity and we gave the patient the tablet and then his disease went into complete remission. Then we actually found there was probably another eight or nine people in Canberra alone who had a similar mutation in the same gene, who had autoimmune diseases, and several of them have now started the same treatment.

[00:18:02] Simon Jiang: So essentially what we're able to do is find a complex disease, which wasn't diagnosed, find the genetic basis and how to treat it.

[00:18:11] Dr Sanjaya Senanayake: There are two aspects that I'd just like to talk about. So, first is the identification of the abnormal gene, which you've done. But now you've identified it. Then you talked about treatment. How do you treat? Now, for example, I know with sickle cell disease in the US, they've used CRISPR editing to actually create a couple of medications that can target sickle cell disease and potentially cure it at a genetic level. Is that what you're talking about here?

[00:18:40] Simon Jiang: No, we’re not treating it at the genetic level, because I think the ethical and the legislative frameworks for that are not really established to deal with CRISPR editing. We would need to be editing germline, basically bone marrow editing and doing an autograph or something like that.

[00:19:02] Simon Jiang: There's no agreement on that. The principle is, if we understand it better, we can treat it better. When I say that we identified the gene, we did a lot of work showing exactly what the mutation does to the immune signalling within these single T cells.

[00:19:23] Simon Jiang: So, we're able to identify a thing called NFAT, a nuclear factor of activated T cells, and it was supercharged inside anyone who carried this mutation. And there's a drug which we use all the time in kidney transplant and other diseases, tacrolimus, which targets NFAT directly. So we were able to use a cheap as chips on the shelf drug to target just because we understood what was going on better.

[00:19:50] Dr Sanjaya Senanayake: Okay, wonderful. Tacrolimus like all medications does have side effects. But at the same time, you're not using it in combination with other immunosuppressants, so it reduces the side effect, the pill burden, everything.

[00:20:03] Simon Jiang: Yeah. So, for him, his outcome was pretty phenomenal because he was wheelchair bound, he couldn't get below 15 or 20 milligrams of steroid, and he was wasting phosphate. So he had a lot of fractures and things.

[00:20:21] Dr Sanjaya Senanayake: Yeah.

[00:20:22] Simon Jiang: When we were able to get him onto the Tacrolimus, he's down to four or five milligrams of prednisone, walking with no fractures and things like that. He actually did break his collarbone because he climbed onto his roof and emptied out the gutters, but the burden of the illness and the burden of these treatments had kind of dropped off.

[00:20:43] Simon Jiang: When he came to me, he was taking about 60 tablets to replace his phosphate per day and the pill burden alone is crazy. So with the Tacrolimus, all of that phosphate requirement went away. So it's gone from like 64 down to zero.

[00:20:57] Dr Sanjaya Senanayake: So basically, you've improved his quality of life enormously?

[00:21:00] Simon Jiang: Yes, and that was exciting. Very exciting. The other big eureka one is the flip we had. We again used CRISPR to create a mouse. So, we found a gene with a mutation increasing the risk of immune disease. And actually what we found, we've since understood it though, at the time I thought it might make other mice with immune diseases get worse.

[00:21:26] Simon Jiang: But when I bred the mice together, it basically stopped any mouse from developing kidney disease. So autoimmune kidney disease, the presence of this mutation just seems to kind of switch it off. So we're actually in this process now of creating a drug, a first in class drug, hoping that we'll be able to use it to treat, prevent autoimmune kidney disease because no matter what we throw at this mouse, we can't seem to induce autoimmune kidney disease.

[00:21:55] Dr Sanjaya Senanayake: At a clinical level, that means someone with, say, a condition like lupus, where they're prone to kidney disease or other forms of vasculitis, anchor positive vasculitis. And you know that there's a high likelihood that the kidneys will get involved. You're saying giving this drug hopefully will prevent that.

[00:22:13] Simon Jiang: Or even if they develop it, to treat it. This is the weird and wonderful and why I find the translational, the discovery science so exciting. Even when you think you might have a suspicion as to what's going on, things just pop up and they're exciting and new.

[00:22:36] Dr Sanjaya Senanayake: So, these unexpected tangents.

[00:22:40] Simon Jiang: Yeah. I think there's that famous saying, which is that most major discoveries in the lab don't start with ‘eureka’. They start with, ‘that's strange’. You look at things and think ‘that's strange’.

[00:22:54] Simon Jiang: And then it goes completely against what you think is going on and opens up a whole new dimension.

[00:23:00] Dr Sanjaya Senanayake: Simon, you also mentioned kidney disease and your research with personalised medicine. I believe that's taken you to the Tiwi Islands with indigenous people, is that right?

[00:23:13] Dr Sanjaya Senanayake: How did you get there? It's a long way from Canberra to the Tiwi Islands.

[00:23:16] Simon Jiang: It is, it is. The Tiwi Islands are reported to have the highest rates of kidney disease in the world. For an island of two and a half thousand or three thousand people, I think they've got two dialysis units.

[00:23:35] Simon Jiang: It's the leading cause of death. I can't remember what the number is, I think it's something about 20 to 30 percent will have evidence of kidney disease by the age of 30. So huge rates of kidney disease. And these rates seemed not to exist 30 or 40 years ago.

[00:23:56] Simon Jiang: So, there's a whole raft of community elders who have no kidney disease. And at some point, the incidence just suddenly ramped up. Researchers through Tasmania, now the ANU, and the Menzies in the Northern Territory went in and asked that question: is there a genetic element to it?

[00:24:17] Simon Jiang: Working with the Tiwi Land Council, they agreed that they would do genetic studies and whole genome sequencing at the time. Essentially what they were able to show was that 60 percent of kidney disease was heritable, in terms of there was a familial or a genetic component in it.

[00:24:39] Simon Jiang: 60 percent of the risk of kidney disease in the islands was going to be hereditary.

[00:24:43] Dr Sanjaya Senanayake: But it wasn't in the elders though.

[00:24:45] Simon Jiang: That's right, which I'll come to. They were searching for quite some time and then maybe about five years ago, one of the researchers at the ANU found out about our personalised medicine approach where we'd had success in identifying lots of different variants and showing how they cause disease.

[00:25:07] Simon Jiang: They asked if I’d be interested in working with them to try and get to the bottom of what could be the cause of kidney disease. Since, maybe in the last three or four years, we've been working quite intensively on trying to understand what could be the genetic basis of kidney disease on the Tiwi Islands.

[00:25:31] Simon Jiang: Some collaborators of mine published in Nature at the start of this year that the genetic diversity in Indigenous communities across Australia, from East Coast to West Coast, there's kind of the same genetic diversity as between Asia and Europe.

[00:25:53] Simon Jiang: So, there's huge diversity. But what we're actually able to show is that there are quite a number of gene variants in the Tiwi that are having very profound impacts on the immune system. We have created another mouse that is actually developing kidney disease. All the mice are developing really profound kidney disease by about 20 weeks of age.

[00:26:24]Dr Sanjaya Senanayake: Okay, so potentially you see a treatment?

[00:26:29] Simon Jiang: Coming back to your point on why there are healthy elders. These genes and variants are all important in controlling inflammation. Our working idea at the moment is there's something kind of similar to sickle cell where there may be some kind of environmental pressure where increased inflammation, increased inflammatory responses were protective or beneficial.

[00:26:59] Simon Jiang: And then when you change the environment, so it's a western environment, there are different pathogens that have been imported from Europe. What was previously protective then maybe starts to be less desirable or starts to cause more inflammation, damaging the kidneys and the heart and things like that.

[00:27:19] Simon Jiang: And the good thing is that this pathway is through something called TNF and there are an anti TNF meds on the table, already on the shelf. We're at that stage where we can show that blocking TNF is going to help prevent that kidney disease in the mice, then there is potentially a therapeutic option.

[00:27:38] Simon Jiang: And no one treats kidney disease with anti TNF anywhere really.

[00:27:44] Dr Sanjaya Senanayake: Is this very novel research in terms of your lab or is this something that other people were doing for a little while in Australia or around the world?

[00:27:56] Simon Jiang: There are aspects of it happening in Australia and around the world. There are people who've been working on what we call immuno genomics: the genetics of immune disease, both immune deficiency and autoimmunity. That's been happening in bits and pieces around the world. People have been trying to understand autoimmunity using different, not just genetics, but different things like flow cytometry analysis of the white cells analysing the RNA of immune cells and things like that.

[00:28:28] Simon Jiang: People have been trying to do use particular technologies to understand the fundamental cause of immune disease. During my PhD, we were probably the first to be trying to do personalised diagnosis or personalised understanding of the mechanism. Probably one of the first in the world.

[00:28:53] Simon Jiang: In terms of bringing it full circle and actually trying to intervene and use it translationally, I'm not aware of anyone else in the world who's actually trying to do that.

[00:29:09] Dr Sanjaya Senanayake: Yeah, fantastic. And even if you are novel, I think people will be inspired by what you're doing and hopefully start doing it elsewhere.

[00:29:18] Simon Jiang: We do have collaborators around the world. We were working for some with the Renji Hospital in Shanghai. We get referrals from people from the U. S., from Europe, and currently working to set things up in Sri Lanka.

[00:29:39] Simon Jiang: In addition to that patient I was talking about, we’ve had other patients who have had very good outcomes, clinicians are starting to refer more within Australia and outside as well.

[00:29:56] Dr Sanjaya Senanayake: Do you see any advantages to being a clinician researcher in Canberra compared to other places?

[00:30:03] Dr Sanjaya Senanayake: And would you certainly recommend someone who's thinking about doing this hybrid career that you've taken on, would you recommend Canberra?

[00:30:10] Simon Jiang: I have been offered positions to go to Royal Melbourne, Wee High and Westmead. I was offered a job in Royal Prince Alfred and said no.

[00:30:24] Simon Jiang: So Royal Prince Alfred, I said no and moved down here to come back to the hospital and also to do the research. I've turned down taking positions at other institutes. That's due to a combination of things.

[00:30:41] Simon Jiang: I think Canberra is a wonderful city. It's got everything that I want. There's lots of space, the people are super friendly, lots of amenities. When I came here the dining and stuff wasn't great, but now it's a foodie's dream.

[00:30:58] Simon Jiang: When it comes to facilities, one of my big things was that I wanted to do a whole raft of different things. There are world class facilities at the ANU to do the research that I do. And then I think there's also an appetite to be able to do new and exciting things in the health service.

[00:31:17] Simon Jiang: And there are a lot of excellent colleagues and things who you can work very easily with. For me it's a perfect melting pot to be able to collaborate broadly with clinicians. The hospital has good facilities, the university has good facilities, and the surrounds offer an excellent lifestyle.

[00:31:40] Dr Sanjaya Senanayake: It’s all close by.

[00:31:41] Simon Jiang: Yeah. Well, everything's 15 minutes from me.

[00:31:45] Dr Sanjaya Senanayake: Simon Jiang, thank you for coming on Behind the Curtain.

[00:31:46] Simon Jiang: My pleasure. Thanks for having me.

[00:31:55] Dr Sanjaya Senanayake: Thank you for listening. I hope you'll join us behind the curtain for our next episode where we'll delve into the story of another of our fantastic health professionals here at Canberra Health Services. If you're interested in starting an exciting career with us, head to our website to join Team CHS.

[00:32:15] Dr Sanjaya Senanayake: And that website is www.canberrahealthservices.act.gov.au

[00:32:46] Dr Sanjaya Senanayake: I acknowledge the Ngunnawal People as traditional custodians of the ACT, the land I’m recording on, and recognise any other people or families with connection to the lands of the ACT and region.