Rural Health Bingo

Understanding the Privileges of Metropolitan Medicine: My Life-changing Experiences Working in the Remote Thursday Island Hospital

Sarah Perry James Cook University (VI)

My final year of medical school has been one of contrast. I began the year with a clinical elective in my hometown at the Royal Hobart Hospital (RHH) Emergency Department. After that, I travelled to the top end of the country, undertaking a 10week rural placement on Thursday Island (TI), Queensland. When it comes to climate, geography, and even medicine, I doubt two placements could be more opposite in nature. My experience on TI has been among the most exciting and eye-opening I’ve experienced in university, and gave me valuable insight into the possibilities present in rural areas such as TI.

To compare the two hospitals, the RHH is a well-resourced tertiary referral centre with 558 beds.1,2 Skilled consultants across the majority of subspecialties are available at the drop of a hat. In contrast, TI has a 26-bed general medical ward, a 6-bed maternity ward and a single operating theatre. There is no access to CT, or even an MRI.3 Despite this, TI Hospital and its primary healthcare centre manage to provide services to the islands which make up the Torres Strait region, the two mainland communities of Bamaga and Seisia (3), and prior to the COVID-19 pandemic, even some PNG nationals.4,5

During my 10-week placement on Thursday Island, I had the privilege of working in the ED, on the medical wards, in theatre, and out in the GP setting. I was lucky to have some incredible rural generalists as my supervisors. I was given the opportunity to see my own patients, and present their cases to the senior medical officers — who valued the differential diagnoses, investigation and management plans I suggested. It was such a great learning experience, and I feel my skills dramatically improved in this short time.

As the area’s primary care facility, I was also involved in helipad retrieval cases. We met patients on the helipad, and stabilised them in ED before either continuing their medical management on-site or referring them on to tertiary facilities such as Cairns Base Hospital. This often happened if TI Hospital did not have the appropriate resources, such as CT or specific specialists, to manage them appropriately.

Some of my favourite experiences and learning moments happened in the ED. Because of the ongoing pandemic, the ED ran a separate ‘COVID-19 clinic’ for patients with respiratory symptoms. In consultation with supervising medical officers, I was often involved in managing the care of these patients. In the broader ED, I was also involved in managing acute myocardial infarctions, cellulitis cases, and acute fractures which required splinting, back slabs, and fibreglass casts. On two occasions, I also investigated cases of suspected tuberculosis (TB), and was intimately involved with the referral of patients to the TB specialists. My procedural skills also benefited, often getting to try my hand at the incision and drainage of loculated skin abscesses.

On two occasions, the resident medical officer (RMO), who usually oversees the flow and management of the whole ED, was unable to work. This meant I was given the responsibility of ‘running the department’. I was the first port of call for all patients who walked through the door, independently working to take histories, and arrange and implement management plans. I would discuss my findings and proposed management plans with the rostered SMO, and they would either sign off on these plans, or suggest I undertake different courses of action. I came out of this much more confident in my own clinical ability.

I had an equally positive experience working in the island’s GP service. Witnessing the management of chronic disease in the remote setting, among the largely Torres Strait Islander community, was a great learning experience. There were a few occasions where the clinic was understaffed, and I was given my own list of patients to see— again organising investigations and presenting management plans to the GP on-call for approval. I found this to be an excellent exercise in time management and prioritisation. I also had to work to meet the patient’s specific wants and needs; an important skill to nurture as a junior doctor. The GP centre would also host visiting specialist clinics, and I was fortunate enough to be involved in face-to-face ophthalmology and orthopaedic clinics. These specialists either came from CBH, or videoconferenced into telehealth clinics. Witnessing this disconnect was a great reminder of the privilege I have experienced living and working in larger centres. It gave a meaningful insight into the barriers faced by remote patients, while also showing some of the ways these hindrances can be overcome. The TI Hospital also runs weekly endoscopy lists in the operating theatre. I was lucky enough to observe and assist in these procedures, learning some of the techniques used. The GP-anaesthetists on site were also extremely keen to teach. It wasn’t uncommon for me to roll up my sleeves, draw up medications, and assist with procedural sedations. Additionally, I was taught different methods to manage and maintain airways. This involved using simple techniques such as jaw thrusts, all the way through to inserting laryngeal mask airways (LMAs) and nasopharyngeal airways (NPAs) in more complex patients. This placed me in good stead for upcoming anaesthetics rotations.

Attending the outer island outreach clinics was also a privilege. One such women’s health clinic took place on Poruma (Coconut Island), a 45-minute helicopter ride away from TI. We flew over several other islands on the journey, and I saw turtles, dugongs and sharks from the sky. It was such a surreal experience. It was eye-opening, however, to

Visiting Pearl farms and Chasing Waterfalls!

see the meagre resources available in these remote areas first-hand.

It wasn’t all medicine, however. There was also an amazing social life for tourists on TI. The hospital staff often invited us to meals at the local pub, or to enjoy a sunset beverage at the Bowlo. We routinely went island hopping: visiting pearl farms on Friday Island, chasing waterfalls on Prince of Wales Island, and following in the footsteps of WWII soldiers on Horn Island. We also took trips by 4WD and boat to visit the northernmost tip of mainland Australia. I certainly made some incredible, lifelong friends on this trip, and I am so grateful for the experience I had with them.

This experience on TI is something that I will never forget. I feel privileged to have been so involved and welcomed into this community. I learned a lot about the challenges of remote medicine, but also about the resourcefulness of the staff and community members who call these places home. It has made me appreciate the privilege I experience working in tertiary-level referral centres like the RHH, or even in Townsville, where I plan to start my career. My eyes have been opened to the fantastic possibilities of rural generalism, and I am excited to explore this avenue as a career option. Who knows, I might even practice back in TI one day!

Sarah Perry 2021

1. Tasmanian Department of Health. RHH redevelopment: inpatient beds. Hobart TAS: Tasmanian Department of Health; 2019 [updated 2019 Oct 19; cited 2021 Aug 17]. http://www.rhhredevelopment.tas.gov.au/__data/assets/pdf_file/0006/405906/200203_THS_RHH_and_ Repatriation_inpatient_beds_1.pdf 2. Rockliff J. Hospital bed plan to increase capacity. Tasmania: Peter Gutwein, Premier of Tasmania Website;.2021 June 4 [updated 2021 Jun 4; cited 2021 Aug 17]. Available from: http://www.premier.tas.gov.au/site_resources_2015/additional_releases/hospital_bed_plan_to_ increase_capacity 3. Queensland Health. Thursday Island Hospital Profile [Internet]. Brisbane QLD: Queensland Health; 2021 [updated 2021 Jun 2; cited 2021 Aug 17]. Available from: https://www.health.qld.gov.au/services/torres-cape/torres_ti_hosp 4. Australian Bureau of Statistics. Changing characteristics of the Torres Strait Region and its people [Internet]. Canberra ACT: Australian Bureau of Statistics; 2018 [updated 2018 Sep 12; cited 2021 Aug 17]. Available from https://www.abs.gov.au/statistics/people/aboriginaland-torres-strait-islander-peoples/changing-characteristics-torres-strait-region-and-its-people/latest-release#data-download 5. Torres Strait Island Regional Council Website. Torres Strait Island Regional Council. Torres Strait Treaty and Border Movements [Internet]. Torres Strait Islands: Torres Strait Island Regional Council; 2020 [updated 2020; cited 2021 Aug 18]. Available from: http:// www.tsirc.qld.gov.au/community-entry-forms/treaty-png-border-movements