Frontier! Vol 6 Issue 1 - A New Frontier

AMSA RURAL HEALTH

VOLUME VI ISSUE I 2021

A NEW FRONTIER

Fear of Going Bush; the Misconceptions Surrounding Rural Health Page 13 “I want to be a rural doctor but...”

Page 19

Contents Letter from The Editor

Page 01

Irene Roy

Report from The Chair

Page 02

Jasmine Elliott

Frontier! Editorial Team

Page 04

The Long Way to Medicine

Page 05

Eleanor Gregory

The delicate stillness of terns Yoshua Selvadurai

Fear of Going Bush; the Misconceptions Surrounding Rural Health

Page 09 Page 13

Peta O’Brien

A Call to Aid in Karumba Tianna Graham

“I want to be a rural doctor but...”

Jasmine Davis

How Did I Find My Way Here?

Page 16 Page 19 Page 22

Dr Tanya Davies

Soaring with Seagulls

Page 26

Yoshua Selvadurai

Same Place, Different Disasters

Page 30

Bridget Marshall

The 2021 Floodings

Page 32

Erica Longhurst

A Doctor 20 Years in the Making Tianna Graham

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Letter from The Editor Hello and welcome to another release of Frontier!, Volume 6, Issue I. Frontier! is AMSA’s official rural health magazine that aims to connect medical students to the vast world of rural medicine. We call this one, ‘A New Frontier’- a real page-turner, trust me.

You may be asking, “Irene, what is ‘A New Frontier?’”

While I’m not a fan of dwelling on the past, it seems necessary to reflect on the year that sped past us (it still feels like March 2020). From natural disasters and civil unrest to a raging pandemic, it was nothing short of chaotic.

Irene Roy, Publications Officer of AMSA Rural

Naturally, it was a monumental year of learning.

A year that pushed us to change the lens through which we view our world. A year that drew our attention to the slowly growing cracks in our global systems. A year that highlighted the changes we desperately need to make.

Unfortunately, 2020 made the shortcomings in our rural systems more prevalent than ever and like other things, it has never been more important to look at rural health through a brand-new lens.

In this issue of Frontier!, we discuss the problems and debunk the misconceptions that draw us away from working rurally. We introduce incredible people that have taken unconventional paths that led them back into the country. Authors and artists reflect on our ever evolving environmental crisis and the way it has disproportionally affected our rural towns – a call for action.

One man by the name of Henry Ford once told me, “If you always do what you’ve always done, you’ll always get what you’ve always got.” We can all be catalysts of change when we approach rural medicine with ‘A New Frontier.’

Words cannot express how proud I am of the Editorial Team. Amani, Bridget, Nipuni, Will, and Zoe. You are all incredibly diligent people and an absolute blessing to work beside. This magazine wouldn’t be here without you guys. To Sarah, a partner in crime, thank you for being a shoulder to lean on when Frontier! took off. To the AMSA Rural Health Committee, thank you for being willing to lend a helping hand wherever it was needed. I hope you’re all as proud of the final product as I am.

On a parting note, I hope this reaches as many screens across the country as possible. From the depths of Tasmania to the corners of the West, you lovely readers are the future faces of rural health! I can’t wait to be working beside you someday. However, for now, grab a cup of tea, sit back, and please enjoy this showcase of incredible talent from across the country.

Page 01 // Letter from The Editor // Irene Roy

Report from The Chair Welcome to ‘A New Frontier!’ I am so, so excited for you to read this amazing compilation of articles, artworks and photos from those passionate about rural health from across Australia.

‘A New Frontier’ addresses a new chapter for all of us, within our communities, nation, planet and healthcare system.

The year of 2020 threw things out of balance — I’ll use the cliche ‘unprecedented’ to describe the situation it placed us all in. There were particularly damaging effects on rural Australia, for in our fight against location determining health, 2020 made our addresses a determinant of so much more. There was the difficulty of those in border towns struggling to access maternity services across state lines and rural medical students trapped away from their friends and family to keep their new communities safe. All of these measures to protect the ‘safe-haven’ that rural Australia was believed to be, and yet, there was still so much anxiety that came with ‘what if.’

Jasmine Elliott, Chair of AMSA Rural Health

What if this community did have an outbreak?

How would we manage?

The workforce was stretched further when inter- and intrastate travel was halted; locums were less accessible, and training rotations were frozen for medical students and vocational trainees. We saw medical students being hired as assistants in rural communities, unsure of whether this was related to COVID-19, or the more insidious shortages that exist in the peripheries. We saw difficulties accessing PPE and groceries, and the diminishment of human connection.

It wasn’t all doom and gloom though, as the accelerated adoption of telehealth meant these more accessible consultations became part of our ‘new normal’. This moment also marks a new chapter in the life-cycle of this publication. Frontier! has now moved solely online, and is being helmed by our amazing Publications Officers, Sarah and Irene, along with a talented subcommittee of editors and designers. As for the broader Rural Health Committee, I’m excited by the passion our team is bringing, implementing fresh projects in new ways, and rethinking how we undertake design, engagement and advocacy. This year also marks the first ‘bi-state’ Rural Health Summit, taking place in Queensland and Victoria under the amazing leadership of Stephanie and Mara.

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We might know ‘New Frontier’ as a Star Trek series, but Wikipedia tells me the phrase was first famously coined by John F. Kennedy in his acceptance speech: “We stand today on the edge of a New Frontier— the frontier of the 1960s, the frontier of unknown opportunities and perils, the frontier of unfilled hopes and unfilled threats. ...Beyond that frontier are uncharted areas of science and space, unsolved problems of peace and war, unconquered problems of ignorance and prejudice, unanswered questions of poverty and surplus. ... I’m asking each of you to be pioneers towards that New Frontier. My call is to the young in heart, regardless of age. ... All mankind waits upon our decision. A whole world waits to see what we shall do. And we cannot fail that trust, and we cannot fail to try” I look forward to working with you — whatever your background or future aspirations — to shape this new frontier of healthcare and life in general.

To make it a Frontier! that addresses the healthcare needs of all Australians, regardless of postcode.

If this magazine sparks a fire in you, or if you just generally have questions or suggestions about how AMSA Rural Health can represent, connect or inform you, please get in touch! We have Facebook, Twitter and Instagram, and can also be emailed at rural@ amsa.org.au.

Photo by Hamish Weir on Unsplash Page 03 // Report from The Chair // Jasmine Elliott

The Long Way To Medicine Eleanor Gregory James Cook University External Communications Coordinator

Growing up on farms in rural Victoria, Dr Megan Bates had no idea what she was going to do when she left school.

She’s the first to admit her path into medicine was anything but straightforward. But as she starts her intern year at Mount Isa hospital, she’s also the first to admit the journey has been well worth it. This is her story.

I grew up in the high country before moving down to the Victoria-New South Wales border, along the Murray River. I came from an area where most of the kids were farm kids, and while some of them went on to university after school, a lot didn’t. There was a lot of pressure to go get a qualification, but I didn’t really have any idea at that stage of what I wanted to do. I got into nursing, but failed dismally. Then I just ran away. I decided I was going to spend my time driving around the country doing anything and everything. I went to work in the shearing sheds and worked as

a rouseabout. I worked in abattoirs, poured beers in pubs and worked as a cleaner. Then I took off to the Northern Territory and lived in a remote community, running the general store for a few years.

It was only when I became pregnant with my son that I realised I had to pull my socks up and do something — noone was going to do it for me. In this way, there’s nothing like pregnancy to snap you into focus. By this time, I’d moved back south, so I saved up and enrolled in a Health Sciences degree.

Photo by Sebastian Palomino on Pexels Page 05

That was where I discovered a love for anatomy and physiology, and I ended up majoring in genetics. Then I found out I could apply for medicine. It had never, ever been on my radar because it was something I never thought I could do. To me, medicine was

something kids did straight out of high school. Mine had been a very long journey, so it took a lot of self-belief to apply. But I made sure I got the grades I needed, because as a mature age student with a young child, I was desperate to secure our future.

A Rural Calling I’d lived in Townsville during my travelling years and had really liked it. Then I found out JCU had a medical school up there with a focus on rural, remote and Indigenous health. For me, that really did it.

During my time in the Territory I lived in towns with Indigenous communities and it was the biggest culture shock. I didn’t know people lived like that. It was truly an awakening.

I love the toughness that comes with being in remote places.

They’re not easy to live in, and the people out there are the best in the world. There’s a real resilience to them.

Dr Megan Bates on rural placement during university.

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I love the area of remote and Indigenous health because what I saw in the Territory had shocked me to the core. We were still in Australia, but there was such a difference in healthcare compared to the city. If you have accidents out there, you are buggered. There’s not an ambulance coming, it’s just the back of a truck that might get there within the next few hours.

Studying medicine at a university which focused on rural and remote health really appealed to me.

Originally, on applying, I was accepted into the Medical Laboratory Science course. For me, I was at the point where it felt like I’d wasted my last shot — and I decided if I didn’t get into medicine, I was going to give up on that dream. But, I got in.

Dr Megan Bates’ son Julian joined her while completing her rural clinical placement in Cloncurry in her final year of university.

The Ultimate Juggle Juggling a four-year-old and medicine was always going to be a struggle. I’d already found it hard managing back in Victoria with day care, study and the commute. But my mum was originally from Cairns and was happy to head back north to help out if I got in. I would never have been able to get through this degree without her sacrificing her life down south. She’s definitely been our rock.

It can be really tricky as a mature age student juggling rural placements, but I’d have to say they’ve been the highlight of my degree. I had two wonderful placements in Cloncurry which changed my life. In Cloncurry, everything was right: the right people, the right team, the right place and the right time. I really felt I’d found my people out there. It was truly life changing. My fourth-year

Photo by Karolina Grabowska on Pexels

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placement in Cloncurry was so spectacular that I organised with the local superintendent to come back and do my entire sixth year there. I had the most incredible clinical exposure and was given such fantastic teaching. I couldn’t have planned it better, and am so ready for my internship.

Graduating at the end of 2020, I felt like I’d come to the end of a long tunnel. Perseverance is one of the traits I have in abundance, and so no matter how hard it got, I never deferred.

Dr Megan Bates (right) celebrating completing six years of Medicine with friends at the JCU Medicine Class of 2020 Graduation Ceremony.

A Future With Passion I’m off to Mount Isa for my internship in 2021, on the Rural Generalist Pathway. I am so excited as it was my first option. Luckily, I got it.

My future lies in rural general practice. I love both the concept of cradle to grave medicine, and if it wasn’t already obvious, the rural lifestyle. My plan is to combine this with advanced skills training in fields like anaesthetics, emergency, Indigenous health and rural and remote medicine in Mount Isa. One day though, I’ll head back to Cloncurry and carve out my own little slice of paradise.

Permission has been received from the initial publisher for this republication

Page 08 // The Long Way to Medicine // Eleanor Gregory

The delicate stillness of terns Yoshua Selvadurai University of New South Wales (IV)

“But once arriving in those warmer climates, why would migrating birds come back in the summer?

It is really a question of how a species’ ecological necessities balance out, a delicate calculus that varies tremendously with species of bird, and over time.” Pokras, M, “Why Do Birds Return after Winter?” (2010) 4 Tufts University Journal 11.

Thin brown fish float on the waterhole like fallen gum leaves. Then they reveal their true identity, coming alive to coalesce and fire apart like a small cosmic explosion.

Carefully parting drooping myrtle and stepping over dark tree roots, she wades into the green water flecked with topaz hues. Tiny animals freeze and watch through the dark tunnels of leaves. She needs this time in Smithton, to breathe, to put together the pieces that had threatened to separate forever under the frantic glare of Broadbeach.

The sun is moving further up in the sky now and round droplets of light spill through the spaces between leaves, warming her Photo by Daniel Morris on Unsplash

skin. Taking a deep breath, she glides into the centre of the waterhole and flips on her back to feel the lulling of the water and the warm weight of the sun on her eyelids.

It was in this same waterhole that she had started to teach Noah to swim. As they stepped onto the silty sand, warm light had flowed over them like water itself, brushing their shoulders and lapping around their ankles in golden pools. She had taken the day off from working at the Smithton travel agency, saying ‘even a Tassie boy needs to be a strong swimmer’. Noah had watched her in his usual serious way, not thinking to question her, assuming that her words described the way the Page 09

world worked. Holding her hand, he had traipsed through the sand, tracing pictures of shells and seagulls with a long trembling stick. Then scooping him up, she had carried him into the luminous water. He was still light, small for his age.

At first, he had twisted away from the dark water but her voice soothed him until he leant into the water’s embrace, letting the ribbons of water thread through his hair. She had held him from beneath the gentle waters, laughing “Good job Noah!” until the sun above melted in sheer joy.

She never did finish teaching him to swim that summer. In their subsequent telephone conversations, filled with her long rambling questions and his stilted answers, she could never bring herself to ask again.

job. She had sped away to the airport, leaving Martin a letter on the kitchen table, about following her inner voice and stepping into the exciting, unknown possibilities of life. But even as she wrote it, she knew that her quiet, decent husband would never understand. It was a symbolic offering, like a chocolate on a pillow or a cup of tea after news of grief. It would offer no real nourishment. She had found herself a nice studio on Burleigh Road and asked Noah to join her. The theme parks, the skateboard ramps, the killer surf. Nothing seemed to impress.

Her offers had been refused without explanation.

Comforted by her inaction in the waterhole, a flock of sea terns descends from the sky. Like a white floral bouquet, they flop down on the water next to her, each one a petal floating along. Through eyes half-closed against the summer glare, she smiles at their delicate stillness and how immaculately their beaks match their feet.

Now, watching the wind rib the water, she had trouble remembering what she had so desperately wanted to escape.

There were those weeks after Laura first left when she had wandered the beach at night and the locals had thought her crazy. There is something wrong with that Marlene, walking alone in the middle of the night at the water’s edge. Don’t know how Martin can put up with her nonsense.

Small minded rural folk. It would be better on the Mainland.

It had been a very different winter morning when she had silently let herself out of the back door and waited for a taxi. It was nearly a year ago that her daughter Laura had left to study in Sydney and Noah had slid into a private world, closed to everyone but his dad and that lumbering Neanderthal of a friend Waldy.

And Carl Mendez…well Carl had seemed like the answer at the time, with his compliments, talk of her great potential and plan to move to the Gold Coast together. Putting to use the confidence that was delivered to her with her TAFE certificate, she had sent an application to a Broadbeach travel agency and got a

And Broadbeach was all that had been promised. The shops that lined its beach promenade were open at night, squares of neon cheerfully festooned with pineapple decorations and surfboard knick-knacks. The ocean there was warm frothy bathwater, with no ribbons of cold current to suddenly twist around your body. And the sunrises were confident blazes of orange and gold, unshrouded by the brooding grey mist that usually clung to the Smithton horizon. Her phone was full of photos. Her favourite was of a monkey which had escaped from a local show and was sitting on the head of a Wally Lewis statue. The statue was

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bronze with a chipped nose revealing the wires beneath. The monkey was brown and scruffy with neurotic, unblinking eyes. Rings of excited tourists had quickly formed around the monkey as it sat, sphinx-like, with its tail wrapped around Wally’s ear. Maybe that was why she never fully embraced the Gold Coast, she could not bring herself to behave like tourists, snatching at every opportunity for happiness. And after Carl left she even tried her agency’s ‘European Alpine Wonders’ package. And when gazing at the snow-crowned peaks of the Appenzell Alps and the lustrous sheen of Lake Lucerne, she was duly impressed. But somehow those European landscapes had never warmed her from within. They stood apart from her, demanding adulation but offering no substance. Standing there, she knew that one day she would return to Tasmania, to breathe, to be connected once more. She had proverbially traversed the ends of the earth to find that

Noah was right when he cried out on Marracupa Promontory that autumn day that there was nothing better out there.

The sun has fully risen now, tempting the long-legged terns out of their burrows to scratch for food at the water’s edge.

The wind has picked up too, stirring the gums and sending down new showers of trembling leaves. Perhaps, she would be able to convince Martin to return home from Fitzroy. After all, they still had their house. And Noah and Laura, maybe they would come home too. Take her back.

Bowing her head, she dives under the jewel-encrusted surface so that her tears blend into the green waters, and her drifting fingertips brush the crawling weeds on the riverbed. Under the water there are no memories, no regrets, no words, only the still calm silence at the centre of being.

Photograph by Harry Cooke on Pexels

“A cornerstone of Migration Theory is the assumption of the existence of a surrogate currency. It is often assumed that food source is the only relevant currency. However, alternative currencies include energy and mortality risk or some combination of different currencies, and these will sometimes prevail.” Houston AI “The Strength of Selection in the Context of Migration Success,” (2000) 267 Proceedings of the Royal Society of Biological Sciences 2393.

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About The Author: “I am a 4th Year Hons student from UNSW. I grew up spending my summers in Burnie, Tassie with my grandparents. I like to write to internalise feelings and capture moments, lucky enough to win the Global Creative Competition for Medical Students. I also like athletics, footy, chocolate, strawberries but not strawberries with chocolate.”

Burnie, Tasmania

Photo by David Mark from Pixabay

Yoshua’s Inspiration: “I grew up spending my summers with my grandparents in Burnie, a small coastal town in north-west Tasmania. Over the years, I watched as rurality fractured families in all sorts of ways. I noticed that a common issue among people in Burnie was that they often felt like they were missing out on something. For better schools and healthcare, people often felt they would have to go to the Mainland. Eventually, however, they would discover the irreplaceable value of what they had left behind. Wandering around Tasmania, the profusion of bird activity cannot be ignored! This overarching bird migration framework supports the story’s exploration of motivations for relocation and return.”

Page 12 // The Delicate Stillness of Terns // Yoshua Selvadurai

Fear of Going Bush; the Misconceptions Surrounding Rural Health Peta O’Brien - Australian National University (II) The state of rural healthcare in Australia grows grimmer with each passing year. Small towns are experiencing difficulties recruiting and retaining local doctors, and vital services such as maternity units are being closed down due to a lack of adequately trained staff.

The extent of the situation was laid bare in 2019, when the Western NSW Primary Health Network (WNSWPHN) predicted that 41 small towns in the region would be without a GP within 10 years1.

For years, the Commonwealth’s answer to this crisis has been to issue 10 year moratoriums of service for international medical graduates (IMGs) coming into the country.

Under this legislation, IMGs can only access Medicare benefits if they work or train in ‘priority’ areas. Often, these are exclusively rural and remote regions. As a result of this policy, in 2012, 41% of rural and remote doctors in Australia were overseas-trained2.

But, in 2018, the Australian Government announced it

Photo by Daniel Morton on Unsplash

would be cutting 800 visas for IMGs over the coming 4 years3. With this announcement came an unspoken promise; the number of locally-trained doctors in rural areas would have to increase.

It is now commonly accepted that the ‘rural doctor shortage’ is, more accurately, a geographical maldistribution of doctors. Australia has a sufficient amount, if not a surplus, of doctors — in fact, the number of medical graduates has doubled over the past fifteen years4. The problem — as it has always been — is encouraging medical graduates to move away from the city.

Many initiatives have been implemented to try and achieve this. Medical schools have received funding to establish rural clinical schools, graduates have partaken in ‘bonded’ work schemes, and rural placements, cadetships and incentives have all been introduced. With so much work being done, how exactly did we end up with this current crisis and why isn’t the situation getting any better?

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Photo by Daniel Morton on Unsplash

A variety of reasons have been offered to explain why doctors don’t want to practice rurally. Many of these are practical in nature, such as needing to stay in a metropolitan centre for spousal work, or to access specialty training pathways. But it seems that some doctors also hold on to misconceptions which affect their willingness to go rural.

A recent media report suggested that doctors are reluctant to move to rural areas as they will have less patients5. This belief is underpinned by the fact that rural towns have smaller populations. However, what urban doctors may not realise is that due to the undersupply of rural doctors, and the geographical distribution of populations, the GP-to-patient ratio is often higher in the country1. Consequently, rural GPs are often fully booked for weeks in advance. And it’s not just GPs who find themselves in this position.

For example, the town of Wellington, in the Central-West of NSW, only has one on-duty doctor at the local hospital. They serve a population of more than 4500 people6. So, not only would doctors moving to a rural area find themselves with more patients, but they would also be assisting by reducing the patient-doctor ratio to a safer level.

Urban doctors are also reportedly concerned that they would have less opportunities to use their skills if they were to relocate to a rural area5. Research shows, however, that rural GPs actually perform more procedural work compared to their metropolitan counterparts7. In order to meet the needs of their communities, rural GPs must also often learn skills across the emergency, obstetric and anaesthetic fields. Research Page 14

has also shown that rural interns are often afforded more responsibilities than their urban counterparts, and are given more opportunities to perform clinically-based work8.

It has also been reported that rural medicine is not challenging enough in order to attract high achieving doctors5. Even a cursory review of the rural doctor’s job description provides evidence to the contrary. Data shows that rural patients suffer from higher rates of chronic illness. Rural doctors must care for these patients with fewer resources, and in environments that are often understaffed9.

Furthermore, due to the difficulties that rural patients experience in accessing specialist care, rural GPs also routinely oversee the management of very specialised and complex conditions.

Doctors and medical students also seem to hold misconceptions about the options available to them in the field of rural health.

The majority of discussions about rural medicine focus on generalism. Medical students can often be heard saying that they enjoy the rural lifestyle, but can’t practice rurally as they don’t want to be a GP. While it is true that those pursuing specialty training will likely have to do so in metropolitan facilities, in the longer-term, students should consider a move to the country. Rural areas have a persistent need for both specialists and generalists. Specialist ratios decline from 143 per 100,000 people in metropolitan areas, to just 22 per 100,000 in very remote regions9.

The factors contributing to the maldistribution of doctors across Australia are complex. However, as this article has demonstrated, several of these factors are reliant upon falsities.

Moving forward, universities, student bodies, and the media all have a responsibility to properly represent rural health.

Dispelling harmful misconceptions will be key to attracting more doctors to settle in rural communities.

Peta O’Brien is a second year medical student at the Australian National University and has a strong interest in rural health issues. She also holds a Bachelor of Clinical Science from Charles Sturt University.

References 1.

Western NSW Primary Health Network. Securing the future of Primary Health Care in small towns in Western NSW [Internet]. Mar 2019 [cited 5 Apr 2021].

Available from: https://www.wnswphn.org.au/uploads/ documents/corporate%20documents/Securing%20 the%20future%20of%20Primary%20Health%20 Care%20Services%20in%20Small%20Towns%20in%20 Western%20NSW.pdf 2.

Standing Committee on Health and Ageing.

Lost in the Labyrinth: Report on the inquiry into registration processes and support for overseas trained doctors. Mar 2012 [Cited 6 Apr 2021]. Available from: https://www.aph.gov.au/parliamentary_business/ committees/house_of_representatives_committees?url=haa/overseasdoctors/report.htm 3.

Hendrie D. Government reduction of visas for overseas GPs to save $400 million 2018. NewsGP [Internet]. 31 May 2018 [Cited 6 Apr 2021] Available from: https://www1.racgp.org.au/newsgp/professional/ government-reduction-of-visas-for-overseas-gps-to.

4.

Medical Deans Australia and New Zealand.

Student Statistics Tables 2021. Available from: https:// medicaldeans.org.au/data/ 5.

Woodburn J. Doctors deterred by regional NSW’s ‘professional isolation’, consider general prac-

tice ‘poor cousin’. ABC Central West [Internet]. 26 Feb 2021 [cited 1 Apr 2021] Available from: https://www. abc.net.au/news/2021-02-26/doctor-shortage-regional-rural-nsw-towns-plead-for-answers/13178224#:~:text=The%20’poor%20cousin’%20of%20 medicine,within%20the%20next%2015%20years.&text=%22General%20practice%20is%20the%20poor,specialties%2C%22%20Dr%20MacKinnon%20said 6.

Drinkwater D. Doctor shortage at Wellington Hospital forces residents to ramp up the pressure.

ABC Western Plains [Internet]. 19 Nov 2020 [cited 7 Apr 2021] Available from: https://www.abc.net.au/ news/2020-11-19/wellington-ramps-up-pressure-toaddress-doctor-shortage/12900460.

7.

Larkins S, Evans R. Greater support for generalism in rural and regional Australia. Australian Family Physician. 2014;43:487-90.

8.

Bailey J, Pit S. Medical students on long-term rural clinical placements and their perceptions of urban and rural internships: a qualitative study. BMC Medical Education. 2020;20(1):188.

9.

Australian Institute of Health and Welfare.

Rural & Remote Health [Internet]. 2019. [Cited 1 April 2021] Available from: https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health/ contents/summary

Page 15 // Fear of Going Bush // Peta O’Brien

A Call to Aid in Karumba

Tianna Graham - Communications and Engagement Coordinator, James Cook University

Tropical Cyclone Imogen crossed the western Gulf of Queensland, near Karumba, late on Sunday, January 3, 2021. The aftermath of the storm left the remote community completely isolated as flood waters cut off main roads. The only way in or out was by air.

Dr Michael Clements, a Townsville-based GP who regularly runs outreach clinics around the Cape, was preparing to fly in and aid the community’s recovery.

Knowing medical staff would be understaffed and under-resourced, he put out the call to final-year JCU students to see if they could lend a hand.

Hannah Kahn and Harjyot Gill were among the three students who jumped at the chance to help the people of Karumba. This is their story.

A privilege to help: Hannah Kahn Getting to go to Karumba was an absolute privilege. When I saw the email saying there was an opportunity to go, I only had to read a few key points before I was sold. Flying in a four-seater aircraft?

Helping a community recover from a natural disaster? Practising medicine in a low-resource environment? I thought, this is it, this is what I want to do! I’ve been grateful for the opportunity ever since.

Flying into Karumba, you could see the extensive flooding. As it was a lower category cyclone, only a few trees were down, but what I found most striking was the degree of inundation. While the town itself was not flooded, the entire surrounding area was, which was immediately apparent from the air.

Seeing the Norman River burst its banks, well and truly cutting off the road, was also impressive to behold.

There are many health implications that can stem from a natural disaster such as this. Often, there are increases in the transmission of arthropod-borne illnesses, skin infections, and multisystem diseases such as melioidosis.

We did see some structural damage to housing within the community, with older properties bearing the brunt of the damage. There was an enormous gum

Pictured: Flying over the flooded Norman River outside of Karumba. Roads were completely cut off to the community after rain from Tropical Cyclone Imogen inundated the area.

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tree down in one elderly couple’s yard, and of course their physical condition prevented them from being able to do anything about it.

out at that time wasn’t really justifiable. This gave me first-hand experience in how clinical decision making is affected by context, both in terms of physical and human resources.

Given that most of the community members Most of the cases we were able to help with have lived in North Queensland for most of were fairly common and not directly linked their lives, they are a resilient bunch. to the cyclone. However, the opportunity to relieve some pressure from the local nurse With that said, it was clear how much strain the and keep things moving efficiently for Dr local nurse-practitioner felt. Her exhaustion Clements was amazing. was palpable. In addition to people physically affected by the floods, patients with pre- We were there and back in a flash. Getting existing mental health concerns were also to go on this adventure, however, was the being admitted, mentally drained by the opportunity of a lifetime. I was privileged to damage to and loss of their properties. play a meaningful role in the acute healthcare of this under-strain community. I may have When we were there we had a number of received a few mozzie bites along the way, opportunities to assist Dr Clements and the but I also gained confidence in my ability to nurse practitioner. There was a patient I help out in a pressure situation. I also learnt helped with who had presented with a venous many valuable lessons from our enthusiastic stasis ulcer. Given the scope of her practice, mentor, Dr Michael Clements. I would go the nurse practitioner was uncomfortable again in a heartbeat! managing this patient in the community.

Under normal circumstances, the patient would have been sent on an aeromedical retrieval flight to Mount Isa. However, given it wasn’t an urgent case, flying the patient

JCU Medicine students Harjyot Gill, Hannah Kahn and Tahne Lahiff with Dr Michael Clements on outreach in Karumba after Tropical Cyclone Imogen.

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Dr Michael Clements (far right) flying JCU Medicine students Hannah Kahn, Hajyot Gill and Tahne Lahiff from Townsville to Karumba to assist the community after Tropical Cyclone Imogen.

Supporting the community: Harjyot Gill When I got the call to come help the community of Karumba recover from Cyclone Imogen, I knew this was my opportunity to give back. From my past experiences in natural disasters, most notably Cyclone Yasi, I understood how uplifting it can be to have the help and support of others during such an arduous time. From Dr Clements’ plane, seeing the aftermath of the cyclone, my heart ached for the community of Karumba.

Our day started as soon as we arrived in Karumba at 9.30am. After a quick introduction to the nurse practitioner and registered nurse, we were given our own consulting rooms and patients to see. During my day, I saw a wide variety of patients. This included an elderly man with an infected insect bite, a mother with a wrist fracture, a young man dealing with mental health issues, and an elderly woman suffering from a severe chest infection. Every patient shared their story, and some consults ended in tears. In these vulnerable moments, I was continually reminded of the privilege of being a doctor, and how lucky I was to be able to offer help and solace in such a bewildering time.

This experience also highlighted the unique challenges of rural and remote medicine, as Karumba did not have access to advanced diagnostic testing. On the whole, patients also seemed to prefer treatment in the community.

The next day, we went out into the community for home visits. This was a great opportunity for us to assess patients in the comfort of their own abodes. In visiting patients at home, we can get a better idea of patient risk, and identify their access to safety amenities and family support.

The overwhelming feeling of being wanted, expected and needed in Karumba was sublime.

This truly was the opportunity of a lifetime. I left having learnt invaluable lessons from Dr Clements, and having formed indelible connections with the people of Karumba. My heart goes out to the community of Karumba, and many of their concerns rang true within me. I would like to sincerely thank Dr Clements for this unique opportunity.

Page 18 // A Call to Aid in Karumba // Tianna Graham

Jasmine Davis University of Melbourne - Rural Clinical School (VII)

I want to be a rural doctor, but...

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If you’re reading this article, there’s a good chance you are passionate about rural health, or have an interest in rural and remote medicine. I’ve never been shy about my passion for rural health. I’ve long known I wanted to work rurally, and being part of the Rural Clinical School (RCS) cemented that belief. In the first few years of my degree, when people asked me what I wanted to do, I was confident in stating that I wanted to be a rural doctor.

Photo by Tima Miroshnichenko on Pexels

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However, the closer I get to finishing my degree, the closer I am to making real decisions about my career.

While my passion for rural health has not waivered, my life circumstances and priorities have changed. I am starting to find myself answering questions about what I want to do with, ‘I want to be a rural doctor but…’.

I’ve heard the same from other peers passionate about rural medicine. What follows the ‘but’, however, is different for us all. I’d like to speak to a few that come up frequently.

‘‘ I want to be a rural doctor but… I want to do XYZ specialty ’’ The lack of specialty training opportunities rurally acts as a barrier to students selecting country internships. Many graduates are also concerned about their ability to move back to the city after extended postings in the country. While there are many wonderful people working to try and improve rural training, it remains a barrier for some junior doctors.

‘‘ I want to be a rural doctor but… my partner has to work in the city ’’ As universities increasingly move to postgraduate models of medicine, students are graduating at an older age. They are therefore more likely to be in longterm relationships, or have children. Having others to think of provides a sizable barrier for students who may otherwise opt to go rurally. Many careers, unfortunately, cannot be undertaken rurally, and it can be difficult to ask your partner or children to move for your own work.

Photo by Larry Snickers from Pexels

Photo by Belle Co from Pexels

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‘‘ I want to be a rural doctor but… all my family and friends are based in the city ’’ We all fear isolation. Knowing the pressures junior doctors face, it is understandable that people want to be close to their friends and family. As I have spent more and more time away from my family and friends over the years, often out on rural placements, I can heavily sympathise with this.

‘‘ I want to be a rural doctor but… I want to experience working at a big tertiary hospital ’’ Many people I speak to, especially those in rural clinical schools, often desire to experience practising medicine in the city. Many want to experience their internship in a hospital with sub-specialties and plentiful resources. This is not a selfish move. In reality, if that person is to return to the country in the future, this can be very beneficial for the communities they serve.

Some ardent supporters of rural health may see the above as excuses.

We need to recognise that this is not the case. There are real-world barriers that are stopping otherwise passionate people from making the move out bush. The more we contemplate these barriers, and empathise with those who face them, the better we will be at taking away the ‘but’. We all need to work together to overcome these barriers, and find ways to provide flexible alternatives that enable junior doctors to become rural doctors.

If you find yourself asking the question, ‘I want to be a rural doctor but…’, remember that you are not alone. It is not something to be ashamed of, nor does it render false your passion for rural health. Remember, going rural is not an all-or-nothing task. If you have a genuine passion for rural health, there are many ways you can work to reduce health inequities, whether you’re in the country or not.

About the Author: Jasmine Davis is a Doctor of Medicine and Masters of Public Health student at the University of Melbourne. Jasmine holds a current position on the Australian Medical Students Association (AMSA) National Executive as the National Projects Officer. In this role, Jasmine oversees initiatives such as AMSA Queer, AMSA Gender Equity, AMSA Mental Health and the Vampire Cup project. She also facilitates the growth of AMSA’s initiatives through taking on new projects and supporting medical students in their passions. Alongside this, Jasmine is passionate about rural and remote medicine, women’s health and LGBTQIA+ health.

Page 21 // I Want to be a Rural Doctor But... // Jasmine Davis

How Did I Find My Way Here?

Rural Queensland

Dr Tanya Davies

1985 Melbourne

Started Medical School and graduated in 1991 (including a gap year with 4 months in Ghana, Western Africa)

Darwin

Rural Victoria

Rural Victoria (again!)

Whew! It sounds exhausting looking at it, but it was a wonderful journey of growth and learning (both in medicine and my personal life). Was it what I had planned? No. But I don’t think you can plan for the sort of work I wanted to do.

My medical journey started when I was 15 and read a book called ‘The Ugly American’ by Lederer and Burdick. It talked about all the aid projects that different governments and aid organisations ran in a small, fictitious Third World country during the Cold War.

Adelaide

Finished GP training in 1998

Remote Northern Territory Locums

Utopia Community, Central Australia 2000 - 2002

2002 Wau in Sudan with MSF Numbulwar Community Eastern Arnhem Land

Needless to say, it referenced all sorts of different types of approaches — from big, government-level programs (both Western and Communist ones), to the different, idealistic approaches adopted by smaller aid organisations. I decided that I wanted to do this as a doctor (a GP, specifically), so that I know my patients when they are well as well as when they are sick. And, that I would do this in Africa.

2006 - 2012 Darwin Doing systems, policy and advocacy

1 year trip to the UK doing both clinical work and management/systems.

2012 - current: Katherine, Northern Territory

I worked hard to get into medicine, which I did in 1985. I had to leave my home in the USA and come to Australia (where my mother was from). I knew what I wanted to do with my life — study medicine, and then move to Africa and ‘save the world’. During my journey, particularly in medical school, there were constant expectations placed on me.

There was pressure from the establishment to follow the well-trodden paths to general practice or further specialisation. Luckily, each time I started to listen to others, I would meet someone who had done something ‘different’ and done some Third World work.

It wasn’t long till I would be re-inspired to get back ‘on track’ with my life.

However, life saw fit to throw me a curveball every now and again.

Generally, I describe my journey like being on one side of a big lake. Entering medicine, I could go anywhere I wanted on that lake. For me, I aimed where I wanted to go, jumped in a motor boat, and then put the throttle on ‘fast’!

But, then life came and hit me from the side — WHAM — with the suicide death of my father. I tumbled out of the boat. When I got back in, I did the same thing. Very fast, in a direct line to where I wanted to go. WHAM — life hit me again, this time with the suicide death of a very close friend. Again, I tumbled out.

control through the ‘oars’, but the row-boat allowed me to move with the wind and the tides. Eventually, at a more gradual clip, I reached a place that was both very similar and very different to what I had initially planned.

Along the way, I had the most amazing experiences. In Ghana, I experienced the wonderful people and culture of Western Africa. I was living in a rural town (Donkorkrom). We would go on trips to help remote villages accessible only by boat, situated within the huge Lake Volta on the Afram plains. I learnt local dance techniques — the exhibition of these techniques often being met with a loud cacophony of local laughter (all in good fun!). In Ghana, I also met a range of different clinicians and representatives of aid organisations, all with very different approaches. One would build on local strengths, improving handdug wells in remote villages. Another would follow organisational rules and use Western farming techniques to cultivate crops. This was despite the completely different context, land and plant make-up. I certainly could see the parallels with ‘The Ugly American’ book and the different aid approaches.

In a remote NT community, I was adopted into a local family. Here, I learnt of the complicated expectations inherent to community relationships. Being involved in circumcision ceremonies as the doctor, as well as being allowed to sit and observe I did that more than twice. It took me a while other ceremonies, was a huge honour. It to learn my lesson. But, eventually, I changed was confronting though, to see the range of to rowing a boat with oars. I still had some illness and disease suffered by our very wise Page 23

and proud First Nations people. This included adult-onset diabetes in young people, and severe eye injuries (requiring me to remember the rules for caring for penetrating eye injuries while flying). I also saw meningitis in a small baby and pulled a cockroach out of an ear (yuck — my most hated procedure!).

This was all while being immersed in a culture that is more than 40,000 years old, and trying hard to adopt to modern customs.

In Wau, Sudan, I worked with some of the most amazing people. The local staff were suffering as much as the community they were serving, but had to endure through famine, massacre and other painful challenges. Seeing how they responded to a measles outbreak was

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impressive. We couldn’t do anything without the local people, who are always the unsung heroes of international humanitarian aid.

AMSANT is the Northern Territory’s peak body for ‘Aboriginal Community Controlled Health Services’ (which are run by Aboriginal boards). Here, I learnt a lot about the strength of the Aboriginal community and their elders.

It is critical to listen to their voices when trying to work out what the issues are, what they want to address, and what the possible solutions are. We (mainstream white society and politicians) try too hard to identify ‘the problems’ and ‘the solutions’ without listening to local groups. The issues and solutions are very different for different groups of people.

Where Am I Now?

My Take-Home Messages

Currently, I am the Medical Director of an Aboriginal Community Controlled Health Service in Katherine, up in the Northern Territory. We provide health services to 3500 people over 75,000 square kilometres (the size of Tasmania) with 9 community clinics, 4 GPs, 30 Remote Area Nurses, 8 Aboriginal Health Practitioners, a range of Allied Health professionals and other clinical and nonclinical staff.

» Keep your eyes and ears open for opportunities — you never know what doors will open when you seize a new opportunity. » Pause long enough to notice those open doors! » Take a chance — have confidence in yourself! We have excellent training here in Australia, and you have the skills! » Don’t forget TEAMWORK. Your teammates are your greatest assets. » Humility — the doctor is not always the most experienced person in the room.

Your teammates have amazing things to teach you about the care of the patient.

You are just one cog in the wheel. » Most of all – ENJOY the journey!

Is this where I was aiming for, when I was standing at the edge of the lake?

Actually, YES! - I have been involved in delivering healthcare in many underprivileged areas, both in good times and bad (which was my aim). But I’ve not spent the last 20 years in a developing country. Instead, the Aboriginal people in remote NT communities, particularly in the Sunrise region, have become my people. Hopefully, the work I do will aid them in taking over their own care.

If I could work myself out of a job (that is to say, be followed by an Aboriginal doctor), my work would be complete.

Page 25 // How did I Find My Way Here? // Dr Tanya Davis

Soaring with Seagulls Yoshua Selvadurai - University of New South Wales (IV) The roar of the highway outside our Fitzroy apartment sounds like the ocean I once knew.

In the mornings as I walk down the narrow staircase to go to school, I like to pretend that I am about to step onto that same Smithton Beach. I can feel the warm coarseness of the sand, and hear the frothy crash of the waves.

And although I know this is just a silly game, it is always a bit of a shock to crack open the rusty door and confront the metallic rush of the highway. Peeling billboards instead of fluttering seagulls, high-voltage power poles instead of sinuous gums trees, and a chain of nudging cars where the arcing surf should be collapsing onto the beach.

Waldy and I used to ride our bikes under the endless skies of Tasmania, laughing at seagulls being blown off course by the Bass Strait winds. Crouched on an isolated promontory in north-western Tasmania, the small fishing village of Smithton faces the brunt of the wild ocean gales. Sometimes, we used to kayak out on the glacial swell beyond the headlands. Sometimes, we’d let down a few crayfish pots and fry our catch on a Council BBQ. Waldy and I were no fishermen but we managed. Not sure what we were really.

We had a policy of not doing much. Most of the time, we’d ride around the deserted foreshore, muck around the fossil-veined rocks and disrupt the polished surface of the water with our skimming stones.

Waldy and I were both thirteen, but Waldy was massive, well over 6 feet, always nattering

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excitedly about some footy ref’s decision, and wearing the same red flannelette shirt.

There was nothing remarkable about me.

Eyes the colour of clear plastic, hair the colour of potatoes, average height. At least that’s how my sister Laura described me in her journal. I found it under her bed after she went off to study on the Mainland. Timmy, my old Jack Russell, still hung with us though.

He couldn’t run as fast as he used to, but he still scampered a few metres ahead, pausing every so often to look over his shoulder to check that he had got our trajectory right.

I reckon our wonderland there was better than the one shown in those Gold Coast brochures.

All I ever wanted to do was gaze at the drifting seagulls, until their flight ached in my shoulders and the sun slipped behind the distant dunes. The house was pretty quiet now. I think Dad took up extra shifts at the paper mill just to get away from all that quietness lurking around at home. Even Mr Mendez from next door was not around anymore. But outside was a carefree place where nothing sad could ever happen. The strong voices of the trees in the wind and the crash of the surf made talk unnecessary.

Maybe it was the way the trees embraced you with their cool shade or the way evening fell so softly, gently shifting from pink to mauve to indigo, that it made you feel nature was gentle, even kind.

But Waldy was full of half-baked plans for conquering the place. If we uncovered a cave, he wanted to crawl through its darkest crevice, if we found a dune, he wanted to discover its powdery zenith.

So when we found an old tinnie by the side of the Surf Club, Waldy went nuts.

“Let’s give it a burl! Beyond ‘em breakers. I’ve heard there’re oyster beds out there.”

“But there are rocks.” I ventured.

“And currents.”

I looked again at the tinnie, it looked a bit like a toy boat that I once had, its jaunty orange trim promising escape. Agreeing to meet after our folks went to sleep, we cycled back to our homes to await the night.

Waldy was already there when I got back. We waited until the chalky moon emerged from behind the clouds, then pushed the toy boat into the water.

I scanned for rocks.

Drowned daggers. Shards of basalt. I knew they lurked below.

“Noah, you’re such a wimp mate! Maybe it’s because your mum and old Mendez…”

Waldy began in a frenzy of flapping hands.

I stopped him right there.

“We’ll go.”

Photo by Huy Phan on Pexels

Unfazed, Waldy sliced the tinnie through the waves, guffawing as we flew past the cliff’s jagged edge. Below us, submerged rocks glistened like cursed relics from an ancient civilisation. I wanted to tell him to be careful but I reckon I’d have sounded like my dad.

Waldy cut the engine, and we slid up to the silent swaying oyster beds.

different to drowning people. Swimmers in distress flail about and shout and carry on, but drowning people can go unnoticed. In that moment, I guess I was a drowning person, slipping unnoticed towards the ocean floor.

But as I gave up, I felt my body start to slowly drift up. The dissolved moon grew larger and larger until I shattered the glassy ceiling and emerged gasping for air. Watching out for me, Waldy reached over and grabbed my arm, hauling me over the side of the tinnie and sending me crashing onto its metal floor.

As I lay heaving on the cold steel, I could see the dim silhouette of the petrel birds flying peacefully in the night air.

I climbed onto the ledge to pull us closer but as I stood on the tinnie’s narrow lip, I slipped on its dewy steel and lost my balance, stumbling head first into the water. For a moment, it was quiet, real quiet under there.

Still. Peaceful even. Soft ribbons of seaweed threaded my hair. Cool fingers of currents curled around my body. Above me, the moon Quiet for once, Waldy cranked up the engine lay dissolved, gently floating on the shifting and muscled the tinnie home. Waiting on the surface of the water. wharf, my dad and Mr and Mrs Waldhauser willed us to land with the silent intensity That serenity did not last for long, it was of their gazes. That night as Dad drove me replaced by a leaden weight in my lungs home, he shook his head and muttered, that made me want to scream and shout “It’s no good you gadding about this place, for air. I clawed towards that pale orb, but getting into trouble because there’s nothing even as I flailed, I sank back, deeper into the to do.” Then throwing an accusatory glance darkness where the moon could not follow. at the dark ocean, he continued with more Instinctively, I reached for the arms that were conviction, “Mate, I know you are loyal to coming to hold me from beneath. This was Smithton, but this place is a dump.” I followed the moment, when the buoyancy drained his gaze to the shimmering stillness of the from my body, when I thought I was going sleeping ocean and breathed in its soft deep down, but then the arms came and lifted me calm. “Yes Dad,” I murmured. above the waters.

I felt my body grow limp, reliving the shock, feeling tremors so deep that I did not even shake. I once heard one of the Smithton lifeguards say that swimmers in distress are

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Photo by Jeremy Bishop on Pexels

Short note on inspiration and relation to rural issues

Fitzroy is waking up now. Threading through the traffic, I arrive at the school with its wirefenced playground of cracked concrete. The guys in grey trousers and impossibly white shirts are being strangled by their own ties.

Not a red flannelette shirt in sight.

A truck rumbles past, making the spindly plants on the side of the road tremble.

Back in Smithton, the trees are free. Here, the plants look like they are struggling to breathe, struggling to matter to someone.

Pausing, I lift my head up to the sky and drink deeply its strong, cobalt warmth. Even as I lower my eyes and walk through the gates of the school, I can feel the warm gaze of the endless sky above me, and some small part of me rises up and soars with the seagulls on the wild thermals of Tasmania.

Permission has been received from the initial publisher for this republication

I grew up spending my summers with my grandparents in Burnie, a small coastal town in northwest Tasmania. Over the years, I watched as the rural location fractured families in all sorts of ways. I noticed that a common issue among people in Burnie was that they often felt like they were missing out on something, for example, better job prospects and health care, and left to go to the Mainland. Eventually, they would discover the irreplaceable value of what they had left behind.

I hope that my story will evoke consideration among readers as to the enduring influence of a treasured past on present reality.

This won the Questions Future Leaders Writing Prize in 2017. It was then published in the book produced by the competition called ‘Fragility and Hope in a World of Uncertainty.’

Page 29 // Laughing at Seagulls // Yoshua Selvaduari

Same Place, Different Disasters Watercolour and felt tip pen Bridget Marshall University of New South Wales (VI) These three artworks represent the challenges regional and rural Australian communities are facing due to increasing natural disasters.

I moved to Port Macquarie at the end of 2019 for the final two years of my medical degree.

At this time, the Black Summer bushfires were raging across the region. The spectacular beaches of Port Macquarie were emptied by the smoke in the air. As soon as people started to trickle back in, COVID-19 arrived. Once again the beaches were quiet, the tourists were gone and blue masks littered the sand. This was followed by a wet summer and an even wetter March, with the Mid-North Coast experiencing significant flooding. Homes and businesses were damaged, and the beaches once again were littered with debris.

Every-time our rural communities start to get back on their feet, they receive another blow. As a community, country, and people, we need to think about whether this is the ‘New Frontier’ we want. If the answer is no, we need to decide now what actions we’re going to take.

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Page 31 // Bridget Marshall // Same Place, Different Disasters

The 2021 Floodings Erica Longhurst - University of New South Wales (V) The recent floods in New South Wales showed us that, more than ever, we must brace ourselves for unexpected environmental events.

In Port Macquarie, a multitude of events over the last year-and-a-half have been described as ‘unprecedented’ or ‘devastating’ — be it the 2019 droughts, the bushfires, the pandemic, or now, the floods. In the face of these climaterelated disasters, it therefore seems just that we look to ‘A New Frontier’ to protect the interests and health of rural Australians.

Our beautiful country is no stranger to extreme and adverse weather events. We are, after all, the land of ‘fire and flood’. There is no denying, however, the increased frequency and severity of these once freak weather events. The MidNorth Coast was one of the most affected regions in the 2021 floods. The flooding began around the middle of March, and affected everywhere from the North Coast to the City of Sydney. It was described by Gladys Berejiklian, the Premier of New South Wales, as a ‘one in a hundred year event’, and ‘the worst flooding in 60 years.’ Communities in Queensland and Victoria were also affected by heavy rainfall as well. The Australian Government declared many parts of the East Coast as a natural disaster zone. Over 18,000 people were forced to evacuate, and over a thousand required flood rescue1. This event occurred less than 18 months after Australia was affected by the ‘Black Summer’ fires of 2019. Unfortunately, a lot of towns that were just starting to recover from the bushfires were hit.

In my area of the Mid-North Coast, there was a series of mind-boggling events throughout the middle of March. Amongst others, a house 1. Emma Elsworthy. NSW flooding forces 18,000 people to evacuate, schools closed, workers told to stay home [Internet]. [place unknown]: Australian Broadcasting Corporation; 2021 [updated 2021; cited 2021 May 16].

Available from: https://www.abc.net.au/news/202103-22/nsw-flooding-forces-evacuations-and-schoolclosures/13266072 2. Rolfe MI, Pit SW, McKenzie JW, Longman J, Matthews V, Bailie R, et al. Social vulnerability in a high-risk floodaffected rural region of NSW, Australia. Natural Hazards.

2020;101(3):631-50. doi: 10.1007/s11069-020-03887-z.

was seen floating adrift down the Manning River in Taree, and a bride and groom had to be helicoptered out of Wingham to attend their own wedding. So many different events occurred all around the region, and everyone was affected in unique ways. I have been on medical placement at Port Macquarie, and was on my Paediatrics placement at the time. In my fourth week, I did a newborn check on a baby girl with lovely parents. This little girl’s ‘baby check,’ which should be performed within the first 72 hours of life, was delayed by six days.

This was because they had been completely isolated from their house, and had to stay at a hotel in Wauchope. It was tough to think that only a few days prior to this young girl’s birth, the father had been trying to salvage valuables from their flooding house. When I chatted with them, they said that their baby was a gift, and that having her was worth all that they had been through. This really affected me as they were such a young family. They lived out on a farm, and so their entire crop was flooded, and their livelihood ruined. Although floods aren’t foreign to this region, this was something that no one had ever seen before.

Other stories popped up from around the hospital. As I talked with my fellow students, I learned there was a platelet shortage, as the plane transporting replenishments couldn’t land on the flooded runway. The wards were ‘flooded’ with patients, with some people having no viable home to return to. This particularly affected patients in the Mental Health ward, where extended stays were associated with increased distress. Patients were also arriving with very delayed clinical presentations, as a result of being trapped by the flooding.

Photo by Miguel Á. Padriñán from Pexels

Living in Port Macquarie and watching this unfold was devastating. Driving through town, so many places I frequently saw, like Settlement Point and the North Shore, were submerged. Friends lost their cars and belongings overnight. There are insidious mental and physical effects that come with these environmental extremes.

In natural disasters, the people who are most devastatingly affected are those already suffering from disadvantage. A study of Lismore, after Cyclone Debbie in 2017, showed that 80% of individuals whose residences were affected were part of the lower socioeconomic group2. These individuals already had poor access to healthcare, were at a financial disadvantage, and often had pre-existing mental health burdens. For them, natural disasters aren’t so easy to recover from.

One of the most important medical impacts of flooding is the mental effect. In Lismore, after Debbie, a chaplaincy program was implemented to provide emotional and psychological support to small business owners. Similar services would undoubtedly still be of use in Port Macquarie and the areas of Sydney that were affected by recent events. The mental health effects of flooding are compounded by a huge amount of financial instability. A lot of the worst affected individuals were farmers, who depend on agriculture for their livelihoods.

Food shortages also occurred, and wholesale prices were driven up, highlighting how these disasters can also impact the whole country. In the aftermath, there have also been increases in homelessness. Driving through Camden Haven you could, and still can, observe water damaged items strewn out across the lawns of damaged houses.

This seems like a huge burden for us to carry as we go forth as a country. It has, though, been really incredible to see the amount of support offered to the Port Macquarie community. Despite everyone being affected in some way, there have been so many people who have stepped up, helping supply food and remove debris from their land and homes. There have been so many generous

acts. The SES, Police and RFS collaborated on an amazing outreach program to reach those cut off by the flooding. It is incredible that the government was able to send a thousand extra personnel to help with the clean-up.

Now, as you drive past the beaches of Port Macquarie, there is a dramatic improvement.

Tourists are back and exploring the town as before, boosting the local economy.

Port Macquarie Town Beach covered in debris, a few days after the floods.

So what can we do in the future?

The sad reality is that as the effects of climate change become more apparent, these extreme weather events will become increasingly common. This is the ‘New Frontier’ for rural health. The fires that we’ve seen, the devastating floods — it raises the question, what awaits us in 2022?

One of the most important things we can do is to increase preparedness. We need to have both home evacuation and flood plans. A flood plan may still be a very foreign concept, as opposed to more familiar bushfire contingencies, but recent events demonstrate how important they can be.

Other ways to offer support include donating to volunteer services, such as the SES and Rural Fire Brigade. These organisations have really stepped up and done amazing things. It is also critical that we campaign the government to try and eliminate some of the environmental risks that we have. It’s not a problem in one year, or 10 years, that we will have to face. Climate change is affecting us: right here, right now.

Page 33 // The 2021 Floodings // Erica longhurst

Dr Toby Sen Gupta (right) and his sister Eliza at the opening of the James Cook University Medical School, 5 December 2000

A Doctor 20 Years In The Making Tianna Graham Communications and Engagement Coordinator, James Cook University Dr Toby Sen Gupta is a graduate doctor entering the next phase of his medical training. Born and bred in Townsville, Toby is undertaking his internship at the Townsville University Hospital in 2021. Combining his passions for rural medicine and North Queensland, Toby has set his sights on a career in rural generalism. Here, Toby reflects on his time at JCU, and how his connection to the university unknowingly began as a toddler.

On the 5th of December 2000, when I was three, I attended the opening ceremony for the JCU School of Medicine. My dad, Professor Tarun Sen Gupta, was part of the original group of teaching staff. Reflecting on it, even from a young age, the desire to be a doctor has always been there. It’s been a very straightforward journey for me.

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I chose to study at JCU because I knew about the university’s focus on rural and remote health. My dad was also a great role model for a career in rural generalism, so JCU’s rural focus really appealed to me. I also enjoyed living in North Queensland and couldn’t see myself heading south for study, having to wait 40 minutes in traffic to get to university every day.

Experiencing Rural Medicine The clinical years of the Medicine degree were the highlight of my time at JCU. After three years of textbook-based study, the transition into clinical placement was really, really sorely needed. As a student, it was so beneficial to be in the hospital setting, interacting with real patients and becoming a part of the team. I felt it helped me learn the communication and teamwork skills I would later require to be an effective worker.

In my second year, I had the opportunity to go to Thursday Island, in the Torres Straits, for a four-week rural placement. The Torres Strait is such an iconic and beautiful place and the experiences I had are unparalleled. In particular, the hospital is next to the sea, the operating

theatre boasts ocean views and the helipad floats on the water. I fondly remember one particular morning, when one of the senior doctors walked through the ED at 7.50am, in a wetsuit, with a spear gun over his shoulder.

He’d just gone fishing off the hospital prior to morning handover and starting his shift.

I was also provided the opportunity to help with GP outreach clinics on the outer islands. Along with some of the doctors from the hospital, this involved offshore day-trips via helicopter.

Travelling to these places emphasised how important health and medicine is to every region. It was really nice to experience a completely different and underappreciated part of this vast and beautiful country.

Moving forward, in 2020, I was fortunate to do a six-month extended rural placement at the Ayr Hospital. This experience stands out for me in particular, as nine of the senior doctors were both JCU Medicine graduates and rural generalists. As someone pursuing a similar pathway, it was such a welcome experience to work with like-minded individuals who were welcoming, genuine and willing to teach.

I was in Ayr from January through to late May, during the height of the COVID-19 lockdown. It was quite scary at the time. The small rural hospital in Ayr wasn’t properly equipped to handle a pandemic. This was especially concerning as the Burdekin has a high population of vulnerable people, such as older farmers. I was lucky that my placement wasn’t disrupted, but there was definitely a fear that if COVID reached the town, the whole hospital might have to shut down. Fortunately, as it turned out, we only had one case. This individual came from Brisbane via Townsville and isolated appropriately, and we had no other significant scares.

I felt like those six months did so much for me in terms of my confidence heading into my internship. For me, it cemented that I wanted to apply for the Rural Generalist Pathway. To this end, I will be undertaking this program in 2021 and beyond.

Dr Toby Sen Gupta flying in a helicopter during a 2nd year rural placement on Thursday Island

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Dr Toby Sen Gupta leading the pack during the 2018 ‘Run to Better Days’ charity event

Running To Eradicate Poverty ‘Run to Better Days’ was another standout of my time at JCU. This annual charity relay was founded by JCU students Dan Charles, Brenton Mayer and Laura Koefler in 2012. It aims to raise awareness about global poverty and promote the idea of effective altruism.

The event itself sees a group of 15-20 JCU students run a stretch of 1,200kms down the coast of Queensland, over a period of 14 days (in a typical non-COVID year).

some capacity. I’ve spent many, many hours either plotting various running routes in Google Maps, or trying to juggle the logistical challenges thrown up by such a large event.

I think, as of our last tally, the ‘Run to Better Days’ event had raised over $135,000 for various cost-effective charities over the last eight years. In the course of running 7,000 kilometres, we’ve talked to about 40,000 people from various communities. It’s a In my first year, I participated in the relay. privilege to be a part of such a wonderful In my second year, I took on the task of charity, and I just feel so humbled to be able organising it, along with Matthias Wust, to continually contribute to the vision that Simon Johnston and Julian Pecora. Ever Dan, Lauren and Brenton had back in 2012. since then, I’ve been involved in the run in

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Parting Advice for Students Something I’ve really thought about this year is how everyone I’ve regarded as a ‘good doctor’ has also been a good person. You can study textbooks all day long, but what’s really important is being compassionate in all of your interactions — especially with patients. It’s such a key part of the job.

In the first few years of studying Medicine, we focus on learning everything from books, videos and lectures. But there’s a whole other set of skills you can gain from having hobbies outside of the degree. My one, parting piece of advice is that while textbook learning is an important foundation, it’s the interpersonal experiences that make your life and future practice as a doctor so much more engaging, rewarding and fulfilling.

Dr Toby Sen Gupta hugging his father, Professor Tarun Sen Gupta at the JCU Medicine Class of 2020 Oath Ceremony

Making JCU history Graduating from JCU Medicine in its 20th year, I feel as though I am now part of an increasingly rich history. JCU offers such a unique program. In my final weeks, it’s been humbling to talk to the parents of my colleagues. Some of them are doctors, and remember in the 90s when the JCU Medical School was viewed as a moonshot that would never come off. Fast forward 20 successful iterations, and here they are with their own children now graduating from the program. I think, particularly for someone like my dad, who has been involved since the beginning, it’s a really great thing to see.

During my time as a student, I realised I couldn’t do anything else. It’s quite special to look back on photos from the early 2000s, when the Medical School first opened, and reflect upon the journey that has led up to my graduation, as a member of the Class of 2020.

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Page 37 // A Doctor 20 Years in the Making // Tianna Graham