Letter from Australia This week’s newsletter is from our Australian bureau. It’s written by Julia Bergin, our Northern Territory correspondent.
No medicine, no tools, no team: these are the working conditions for remote doctors in Australia.
When this happens, when doctors don’t have adequate pharmacies, operating rooms, or extra staff, their job is no longer medical, but logistical.
Remote GP Rhys Harding said he was asked questions in his daily work that his counterparts in big cities never had to consider: “What’s wrong with me? Who’s here? When will it get dark? Can the plane land?”
He will then need to master a range of medical skills, such as treating complex head injuries, taking X-rays and extracting teeth.
“I’m much more comfortable with the oral cavity than most doctors,” Dr. Harding says.
For doctors working in Australia’s most remote areas, practicing medicine can be restrictive, isolating and extremely challenging. The environment is harsh, doctors often work alone and the physical and mental demands are greater than in any metropolitan hospital.
Royal Australian College of General Practitioners vice-president Dr Michael Clements said it had less to do with remoteness and more to do with resources.
“We can do a lot with just our hands, but generally we like to have medicine, we like to have toys, we like to have a team,” said Dr Clements, who served as a doctor in the Australian Air Force for 13 years, taking him to places like Afghanistan, Djibouti and Somalia.
Dr Clements, who is based in the eastern Queensland town of Townsville, flies medical services to remote communities in Queensland, the Northern Territory and Western Australia, where he says medical conditions are worse than in most war zones he has visited.
“In the military, we have access to surgeons, CT scanners, anesthesiologists, orthopedic surgeons and a lot of people to help,” Dr. Clements said, adding that whenever a soldier has a “itchy throat,” they are treated immediately.
This is in stark contrast to regional health care in Australia, where scarce resources mean patients may have to wait weeks for an assessment, prescription or X-ray.
Dr Clements added that communication was also a challenge, with spotty mobile phone and internet signals in remote parts of Australia making it difficult for doctors to seek second opinions. Instead, they relied heavily on what he called their “network of friends”.
This means finding a friend or acquaintance who works at a local hospital and setting up a referral or contact service.
“In the Middle East, I can easily call colleagues and non-GP specialists in Australia wherever I am in the middle of nowhere,” Dr Clements said.
Dr Harding spent 18 months as the sole doctor at Australia’s Antarctic base. He said he had “all the medicine in the world”, plenty of instruments, an operating theatre and even a dental chair. Despite the isolation of Antarctica, he said it was easier to be a doctor there than in remote Australia.
But Antarctica also presents unique challenges, such as the possibility of having to practice medicine on your own. To avoid this, Australian doctors sent to Antarctica had to remove their appendixes.
Australian Antarctic Division chief medical officer Dr Geoff Eyton said the policy was put in place after an Australian doctor in the 1950s had a dangerous evacuation after he needed emergency surgery for acute appendicitis.
A decade later, a Russian doctor on a mission in Antarctica also developed appendicitis and had an expedition teammate hold up a mirror to perform surgery on himself using only local anesthesia. There have also been cases of self-diagnosis and treatment of heart disease and self-removal of breast lumps.
To prevent certain medical emergencies, your doctor may have to accept additional precautions before he or she is qualified to be dispatched. Can Possible future problems must be addressed. Heart valve changes require surgery, and doctors usually monitor for such changes. Under normal circumstances, gallbladders are not removed, but for doctors in remote areas – whether in Antarctica or on military deployments – it may be a prerequisite for prevention.
Despite the many obstacles, threats and risks that telemedicine faces, Dr. Harding said the challenges are also what make the job appealing.
He added that the environment insulates him from the toughest part of the hospital system — layers of hierarchical decision-making.
Dr. Harding likens it to a person with a broken hand who goes to the emergency room and is referred to an orthopedic surgeon — who might say, “Oh, no, we only treat the wrist” — and then to a plastic surgeon — who might say, “Where is your boss, why can’t you handle this?” — and then sent back to the emergency room.
Instead, Dr. Harding said, when working remotely, every decision is his own.
“It’s really freeing to feel like, ‘I’m the best person here for this job,’ ” he said.
Here are this week’s stories.
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