From Victoria to the Cape

The jetty on Friday Island

By Meagan McKelvie James Cook University (VI)

Meagan McKelvie, a sixth-year Medicine student from James Cook University, reflects on her recent eye-opening rural placement to Thursday Island and Cape York.

Ferrying across the jewel-blue skin of the Torres Strait, visiting its numerous islands, the tip of mainland Australia glimmering in the far distance.

Gazing down at turtles and dugongs from the sky, breaching the surface of the ocean below.

Driving through dense rainforest to Pajinka.

These are just some of the highlights from my 10-week placement on Thursday Island and in the Bamaga/Northern Peninsula Area (NPA). Arriving in January, amidst the thick of a humid wet season, was a shock to the system at first. Hailing from Gippsland, Victoria, it took me some time to get used to the frequent rain storms that hover over the coast. Nonetheless, the world up here is full of beauty and splendour. The rainforest of the Northern Cape envelops the communities of the NPA in an electric green, the earth below a rich, volcanic red. Metres-high termite mounds tower over the sides of the roads. Wild dogs and horses roam the township, slinking between the trees. In the Torres Strait, the islands are fringed with sprawling turquoise reefs, and the ocean sparkles under the glare of the equatorial sun.

The people of the Torres Strait and NPA live their lives with a resilience and sense of culture that makes them unforgettable. I was welcomed by their communities warmly and enthusiastically, meeting the elders and even learning a bit of the language. Here, people are dedicated to their families. Everyone knows everyone, and is related in some way through family, friendship, work or leisure. Both on Thursday Island, and in Bamaga, I would be stopped by the kind locals I had met on placement to have endearing yarns on the street.

The medicine is unique, owing to both population characteristics and remoteness. There is plenty of work to be done in all kinds of settings. My placement included rotations through emergency, GP clinics, hospital wards, and even outreach clinics to the outer islands of the Torres Strait and NPA (via helicopter!).

Unfortunately, conditions like diabetes, obesity, heart disease, and their preventable complications are key health issues for the Torres Strait Islander and Aboriginal Australians here. Sadly, they suffer from some of the worst health outcomes in Queensland. In Bamaga, I came to know many patients well, and began to recognise the underlying issues affecting their health. Distrust, dislike of taking medication, and difficulties in quitting smoking or sugar were some barriers that we encountered. However, many patients were also proactive, mindful and receptive of the health advice.

Meagan in a helicopter on her way to the region’s outer islands

Like the landscape, the medicine, too, changes with the seasons.

During the wet months, infection is ubiquitous. For weeks in my summer stay, the ward on Thursday Island was at capacity with skin infections. Diabetic wounds in adults, and skin sores and bug bites in children, were the most common presentations. Additionally, the usual antibiotic regimes are rendered useless here, with occurence rates of Methicillin-resistant Staphylococcus aureus (MRSA) well beyond 30%. For children, this means frequent, painful injections with a long-acting antibiotic — necessary to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Holding these children down, while they cried in pain, was very difficult. Unfortunately, it is something that you quickly become accustomed to. Notwithstanding ongoing public health efforts, these areas have the highest prevalence of ARF and RHD in the world. During my time in Bamaga, I saw a case of ARF and its renal complications — and sadly, RHD was all too common in patients.

Always, as well, hidden dangers lie beneath the calm sea. Toward the end of my placement in Bamaga, a teenager died from a fatal box jellyfish sting while fishing. It was the first jellyfish fatality in Australia in 15 years, with the last one also occurring in Bamaga.

Despite its highlights, this placement was difficult. This type of medicine is not for the faint of heart.

With the endless rain, roads up the Cape flood and become impassable, and flights into the region are often cancelled. This renders the feeling of isolation and remoteness all the more acute. For much of the placement, I felt this isolation keenly. I found that meaningfully connecting with my colleagues and the local community was vital to surviving as an outsider.

To future students considering a placement here, I recommend it for the amazing medical experience and breathtaking landscapes.

However, to best enjoy Cape York and avoid cabin fever, a 4WD is a must. Without a good car or dry roads, there is little chance of getting around — and one certainly risks going a little stir-crazy. On Thursday Island, switch out the 4WD for a boat.

In the future, I wish to pursue locum work to help fill gaps in the remote healthcare system. I also have an interest in general practice and rural generalism. I would love to work in a well-connected regional location, where I can hopefully strike a balance between city luxuries and the wild and wonderful outdoors.

Find out more about how James Cook University is making rural health matter:

jcu.edu.au/college-of-medicine-anddentistry/making-rural-health-matter

Meagan at the most Northern point of the Australian continent