The road to rural health

I was 8 years old, and I remember it so clearly. It was my first big camping trip with the family, driving from Adelaide to Darwin and back. Three kids squashed in the back of the car, Mum and Dad in the front with the Eagles playing too loud to hear us arguing.

We stopped to get more diesel in Yuendumu, an Aboriginal community 300 km north-west of Alice Springs, on a dusty red road leading to the petrol station, which sold kangaroo tails. It was such a culture shock.

Life in Yuendumu was so different from what I had experienced growing up in Adelaide. It turns out that holiday was the start of a bigger journey, one that’s taking me towards a career in rural medicine.

The first of my many fine role models was Dr Phillip Duguid, at the Mount Compass Surgery in South Australia’s Fleurieu Peninsula. He took me in for work experience when I was studying biomedical science and showed me the value of general practice in a town of 700 people.

Bend in the road

The next bend in the road to rural health occurred after being accepted into the University of Adelaide medical school. One of the first things I did in “O-week” was join the Adelaide University Rural Health Association (AURHA), one of 28 rural health clubs that belong to the National Rural Health Students’ Network.

This has allowed me to do more for rural health within the university, like organising AURHA’s activities for Indigenous festivals in Ceduna, Port Augusta and Port Pirie.

These festivals are a platform for health students to engage with primary and secondary school students and their teachers, and go back to the basics of what constitutes a healthy, well balanced life. The bonus is seeing the children smile as they put the plastic organs in the right places in our medical mannequin “Gutsy Gus”, listen to their friends’ heartbeats with stethoscopes or play arm wars with their newly formed plaster casts.

Context and positive reinforcement for these experiences was given during my Indigenous Health elective. This fantastic course was run by Dr Dylan Coleman, author of Mazin Grace. She opened my eyes to the history of Aboriginal culture and the complexity of the challenges of Indigenous health today, and helped me develop a deeper understanding of the previously mysterious term “culturally appropriate”.

My partner and I were inspired to make a tangible contribution to a more positive future for Indigenous health. With the help of friends and family, we raised $3720 for the Indigenous Literacy Foundation to supply the Mimili community of the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands with “book buzz” packs for every preschooler.

Another key influencer has been the Australian College of Rural and Remote Medicine (ACRRM). They offered me a John Flynn Placement Program scholarship, where students are buddied up with a rural doctor for at least two weeks a year.

Take me to the most remote town possible, I asked. One flight, two trains and a bus later, I was in Baradine, about 500 km north-west of Sydney. It’s a cute town with one supermarket, one butcher, one mechanic, one coffee shop and two pubs.

My John Flynn mentor, Dr Paul Saad, has since relocated to Quirindi, a larger and quite different country town where I continue to immerse myself in rural medicine. My experience there has included irreplaceable opportunities like going out to Walhallow with the Aboriginal health team and taking blood pressures under the shade of a gum tree. I am certainly looking forward to my next placement in January 2015.

A fortnight to remember

I also have ACRRM to thank for a trip to the Tiwi Islands off the coast of Darwin. As part of my ACRRM President’s Prize, I visited Wurrumiyanga (formerly Nguiu) on Bathurst Island.

The fortnight there was really something else — the fishing, the art, the medicine. Most mornings I would go to the school and help serve breakfast for the kids before heading over to the clinic for the day, sitting in with Dr Clinton Leahy or accompanying the local nurses on home visits.

A shorter but equally memorable experience was organised for me by Dr Jill Benson, AM, from the University of Adelaide.

Dr Benson is the founding medical director of the Kakarrara Wilurrara Health Alliance in the remote Aboriginal communities at Yalata, Oak Valley and Tjuntjuntjara. She arranged for me to spend a day with Dr Md Moniruzzaman at Yalata.

It’s a small community where the landing strip needs to be checked for camels before the plane can land. While there, I witnessed a patient present with acute onset chest pain and the GP clinic was transformed into a single-room emergency department.

Diversity in medicine is part of the attraction of rural health and psychiatry is one of many elements you can explore. As part of my Indigenous Psychiatry elective, I joined visiting specialist Dr Nigel Cord-Udy on his trip earlier this year to the APY communities of Indulkana and Mimili.

The local Aboriginal health workers and resident staff are brilliant, having an obvious and deep understanding of community life. Some consults were in the clinic, some were on the patio, and some were literally sitting on a rock. On one occasion we had grandchildren sitting on the floor and brothers, sisters, cousins and community elders all in the room — all supporting their family member through the rough patch they were enduring. My family only ever gets those numbers at Christmas.

The APY connection remains something of a personal commitment. Together with fellow medical students Millie Osti and Amy Hoile, I’ve been working on a project with the Adelaide Medical Students Society (AMSS) and Dr Tim Kelly from Adelaide to Outback GP Training, to create an ongoing tie with the Mimili community.

It has culminated in the AMSS Mimili Youth Holiday Program, driven in no small part by the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara (NPY) Women’s Council. Our first event this year involved flying up to Alice Springs, and then driving with two Shine SA Close the Gap workers to deliver a week’s program.

Cooking up a storm

We ran sporting activities, arts and craft, and healthy cooking every day for any kids who wished to attend, along with many community events. “The Voice” night to support local artist ZK was a great success. We took roo tails and vegetables out to Victory Well and had an incredible day cooking up a storm with 50 community members aged 6 months to 65 years.

Also, as it was NAIDOC week, on our final day in the community we held a barbecue with face painting, bracelet making, music and games. Our thanks to Adelaide to Outback GP Training, NPY Women’s Council, Shine SA Close the Gap team, Nunkuwarrin Yunti, Aboriginal Oral Health Program – SA Dental Service, and the Indigenous Literacy Foundation for making it happen.

This array of community encounters has been a privilege to experience. They have taken me far beyond the pathology that you see in the city general practice setting.

I’ve been inspired by those who embrace the challenge of delivering health care in extraordinary settings, who commit to deliver care appropriately in line with the culture and wishes of the patients, and who have enabled me to enfold myself in the absolute humanity that permeates every moment of rural health.

To my fellow medical students, I simply ask you to consider the possibilities in rural and remote health — you never know where the road will lead you