Climate Emergency in Australia and the Need for Inclusion of Indigenous Peoples in Solutions

Hayden Burch1 1 University of Melbourne

Hayden Burch is a dual Doctor of Medicine and Master of Public Health student at the University of Melbourne.

Key learning points

• Australia’s greenhouse gas emissions are continuing to increase, with Australia set to drastically miss its Paris Agreement targets and face worsening implications on the health of Australians and the practice of healthcare. • Current federal policy still relies on fundamental Western principles that exclude time-tested, Australian-specific Indigenous expertise on strategies to address greenhouse gas emissions and broader sustainability. • To achieve meaningful inclusion of Indigenous experiences the fundamental causes of exclusion must be acknowledged and addressed such as constitutional recognition and ratification of Indigenous people’s rights.

Abstract

Introduction: Climate change is the greatest threat to human health this century. With a view that the planet’s resources are infinite, the ongoing production and consumption of fossil fuels is driving environmental changes that undermine the determinants of health. In accordance with the Paris Climate Accord, it is imperative that societies transition to sustainable existences to keep the earth’s temperature below two degrees Celsius. To date, Australia’s responses to climate change continue to propagate the marginalisation of Aboriginal and Torres Strait Islander populations. There is an increased burden on Indigenous peoples as a known vulnerable population. Further, nearly all policy areas that contribute to increasing greenhouse gas emissions, such as agricultural systems, could achieve immediate and significant reductions in Australia’s carbon footprint if they embedded evidencebased and native alternatives. Summary: This article outlines the benefits of including the voices and experience of Aboriginal and Torres Strait Islander peoples. Through collaboration and shared political decision-making with Indigenous peoples in a genuine and substantial way, Australia may better support self-determination and address exclusion as significant drivers of ongoing health disparities amongst Aboriginal and Torres Strait Islander peoples. Contemporary Australia may also gain access and privilege to time-tested, Australian-specific expertise on both adaptive and mitigative strategies to the greatest existential threat to civilisation this century. Keywords: Climate Change, Health, Indigenous Peoples,

Human Rights

Introduction

Our identity as human beings remainstied to our land, to our cultural practices, our systems of authority and social control, our intellectual traditions, our concepts of spirituality, and to our systems of resource ownership and exchange. Destroy this relationship and you damage — sometimes irrevocably — individual human beings and their health.

Pat Anderson 1996 (page 15)[1]

Why is a changing climate an issue?

The health impacts of climate change are already being felt today, with future projections presenting unprecedented risks to the human right to health [2]. As such, climate change will alter the way in which we manage and seek to ensure the highest attainable standards of health for billions of people within Australia and worldwide [2,3]. The major threats to humanity are via increased temperatures and extreme weather events leading to changing patterns of disease, water and food security, vulnerable shelter, population growth, and migration. The impacts will be both direct and indirect, especially among vulnerable populations [2-6]. Globally, the disease burden depends on the existing climate and development of particular nations. For example, underdeveloped countries are experiencing a larger burden from vector-borne diseases, while more developed countries are experiencing a greater burden from cardiovascular and respiratory diseases [2,7]. Australia is particularly vulnerable to the impacts of climate change [4,8-10], due to high susceptibility to increased temperatures and the resultant disasters of heatwaves, bushfires, droughts and flooding that are occurring with increasing frequency and severity. Australian agriculture is particularly under threat as a result of growing water scarcity and population growth in flood zones [8]. Additionally, the frequency and duration of heatwaves is increasing, with Melbourne projected to experience twenty-four days per year over 35°C, with the urban heat island effect anticipated to amplify the impact within cities [11].

Impacts on Indigenous Australians

Indigenous Australians are known to be more vulnerable to climate change due to existing vulnerabilities resulting from

historic and ongoing colonisation [8]. For example, there is unequal access to primary health care, effective sewerage systems, rubbish collection services and housing. These effects are amplified by the undermining of environmental determinants of health such as clean air, water, and sufficient food [3]. The significant socioeconomic disadvantage experienced by Aboriginal and Torres Strait Islander people places them at increased risk of suffering from environmental health risk factors [12]. These impacts are of particular significance to medical professionals whom are tasked with managing the health consequences of these broader sociopolitical drivers. The consequences not only relate to the right to health but recognise that health is closely related to, and dependent on, other determinants such as access to food and water that promote the conditions for a healthy life [13]. This is of particular relevance to all Australians. Therefore, there is an impetus for Australia to reduce greenhouse gas emissions in line with the preservation of the human right to health for all and with particular focus on those most marginalised and vulnerable. Despite the current and future threat, addressing climate change also poses the greatest global health opportunity of this century [2]. Meaningful actions toward a sustainable economy will accrue co-benefits that reduce the burden of disease in line with achieving the Sustainable Development Goals and the 2015 Paris Agreement [2,14].

Australia’s current responses to climate change

Australia is one the world’s largest emitters of greenhouse gasses per capita with over 22 tones per person in 2015 [11]. Under the Paris Climate Accord, Australia has an international responsibility to address the social, economic, and environmental impacts that threaten the right to health across the globe [15]. In 2015, the Australian Government announced a target to reduce national emissions by 26-28% below 2005 levels by 2030 [16,17]. This target, known as the Intended Nationally Determined Contribution (INDC), is supposedly to be achieved through the Australian Government’s newly rebranded Climate Solutions Package [18]. The package contains two main approaches - soil sequestration of carbon dioxideand a reverseauction mechanism through an Emissions Reduction Fund (ERF). These have the objectives of “lowering business costs, improving competitiveness, and protecting the environment for current and future generations”[19]. Despite the political rhetoric [18], independent analysis has demonstrated that the package is neither substantial enough to meet Australia’s Independent Nationally Determined Contribution (INDC), nor meet the targets set under the plan itself [18,20-22]. For example, approximately 60% of the Climate Solutions Package emissions reductions are relying on hypothetical soil sequestration schemes that exist within unsustainable agricultural models for the Australian landscape. The remaining mechanisms rely mostly on funding the largest polluters through the reverse-auction mechanism of the Emissions Reduction Fund [17,19]. In relation to Indigenous Australians, the current Climate Solutions Package does include the Arnhem Land Fire Management Strategy [17]. This strategy employs Indigenous rangers to utilise long-standing landscape and fire management knowledge to methodically burn bushland, such that the release of methane and nitrous oxide is reduced and carbon dioxide is maximally sequestrated in dead organic matter. The project is celebrated by the Australian Government as partnering “thousands of years of Aboriginal traditional land management practice with modern scientific knowledge” [17].

Absence of Indigenous expertise

Beyond the inclusion of a Northern Territory specific fire management strategy, there is a clear absence of Aboriginal and Torres Strait Islander input. Climate change is an interdisciplinary and multifaceted issue which Indigenous people can, and have the right to, participate in. A national climate policy package that embedded Indigenous sustainability values into the upscale of renewables, food and agricultural production, waste management, acceleration of electric vehicles, and energy efficiency in homes and industry would be able to achieve carbon neutral status by 2050, whilst growing the economy at 2.4% per annum [21,23]. In regard to current federal policy, the Arnhem Land Fire Management Strategy is not transferrable to other states or territories. This is because the environment, bush density (fuel load), local building codes (regulations regarding constructing new buildings), and burn-off protocols (bushfire prevention protocols) differ significantly [24]. Additionally, in areas such as the Kimberly, government incentivised burn-offs have resulted in approximately 30% of ochre rock art being destroyed that had previously been preserved for thousands of years [25]. In regard to agriculture, approximately one fifth of Australia’s emissions are attributed to the sector [6]. Over the past 200 years, 60% of the Australian landmass has been managed by farmers who, despite improving technology and efficiency of their practices, undertake land clearing, rely on fertilisers and pesticides, and persist with growing non-native and unsustainable crops, such as cotton or cattle, that are all large emitters of greenhouse gases [1,26]. Conversely, Indigenous peoples have been conducting experiments in their regions for thousands of years and have an expertise regarding traditional ecological knowledge [26]. A recent report by the Farmers for Climate Action emphasises that the agricultural sector will face significant threats to viability unless there is a structural transformation of food production and land management in line with ultimate sustainability objectives [27]. This has already been witnessed in the last twelve months alone. Three mass fish deaths across Australia have occurred due to drought and excess water diversion for irrigation of Western-style managed land [28]. Addressing these agricultural choices and principles is a fundamental issue of long-term sustainability and land management that is neglected under Australia’s current strategy yet central to the culture and experience of Indigenous Australians. What is clear is that the landmasses around the world that have the best sustainable outcomes are those that are managed by Indigenous peoples [26]. Agricultural growers who have

transitioned to focussing on plant nutrition, soil health, and diversity founded on Indigenous regenerative agricultural practices are reaping the benefits of fundamentally embedding sustainability into practice [29]. Agricultural businesses in Western Australia are obtaining the same grain price as farmers who are not undertaking regenerative techniques, however, regenerative farmers are benefiting from boosted productivity of up to 30%, increased pasture and soil quality, reduced soil erosion and chemical use [29]. More so, these positive consequences also result in larger carbon sequestration into soil, with further benefit to Australia’s carbon neutral ambitions.

An example of deep-rooted racism?

Firstly, the minimal engagement with Indigenous peoples to contribute their in-depth knowledge and understanding on sustainability across many sectors of modern Australian society points to the longstanding issues of colonisation still present today. Secondly, it points to a failure of our economic system to adequately price the services the environment provides – such as clean water, arable land, fisheries, and a climate conducive with human existence and development. This valuation of biodiversity is embedded into thousands of years of Indigenous culture [24]. Understanding why Indigenous Australians are not included in a meaningful way is to understand the historic and ongoing socio-political context of Australia. In 2007 the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) was released calling for recognition of the land and territorial rights of Indigenous peoples [30]. Australia voted against the declaration. All of the members of the United Nations Human Rights Council and 143 other country representatives voted in favour [30]. Underpinning the ongoing resistance from Australia is the absence of Truth Telling[31] surrounding Terra Nullius, the dispossession of ancestral lands, impacts from genocide, conflict, and forced assimilation into mainstream society, loss of control over natural resources, and knowledge and integration into the market economy [32]. In line with the historic structural violence imposed on Indigenous peoples, it is of benefit to colonising interests to portray Indigenous peoples as tribal and simplistic. This strategy ignores the wealth of evidence-based experience on living sustainably in Australia and allows for specific portions of Australia to profit. If climate change was indeed appreciated as the existential threat to human existence described by scientists [8,10], the inclusion and collaboration with people whom have expert engineering, scientific, agricultural, geographic, economic, and astrological knowledge would be occurring “in a canter” [8, 17].

High-level solutions

For Australia to catch up to world leaders on both Indigenous rights and climate change, mitigation recommendations that address both overarching racism and greenhouse gas emissions are central. Such responses require leadership at the highest level. To date, Australia still opposes the United Nations Declaration on the Rights of Indigenous Peoples. Recognition and respect for Indigenous people’s rights, as contained in the UNDRIP, acknowledges Indigenous peoples as environmental managers with immense ecological knowledge and as crucial collaborators in efforts to address the loss of biodiversity and climate change [30]. Early engagement and participation by Indigenous peoples with relevant skills and expert knowledge can assist in subsequently reducing Australia’s emissions. Second, the Uluru Statement from the Heart brings together over 250 Aboriginal and Torres Strait Islander leaders calling for the establishment of a ‘First Nations Voice’ in the Australian Constitution [33]. Supporters argue that basic inclusion and recognition of Indigenous peoples within modern Australian society is at the core of addressing the longstanding issues that continue to impact on Indigenous Australians and obstruct their opportunity to flourish and contribute to all facets of modern Australian society. This includes contributing experience regarding environmental sustainability.

References Global leadership examples

These solutions ultimately require social and political will. To date, the Prime Minister does not support enshrining a voice within the constitution [34]. Ongoing advocacy regarding the role of Indigenous peoples as important knowledge holders and land managers, crucial to reducing greenhouse gas emissions, is important to achieving health and wellbeing for all Australians. Other governments have demonstrated implementation pathways through higher-level inclusion and active listening to First Nations people. For example, New Zealand have integrated Maori First Law with contemporary law after parliamentary vote [32]. This has led to the Whanganui River receiving status as a legal person. This means that the environment and biodiversity can operate hand-in-hand with contemporary law and society.

Conclusion

Bipartisan support is critical for contemporary Australia to address both climate change and the ongoing disparities commonly experienced by Indigenous peoples. The opportunity to combine traditional Indigenous knowledge with contemporary practices is crucial to taking meaningful steps towards greater inclusion and participation of Indigenous peoples in line with the highest standard of human rights, and to provide a genuine attempt by the Australian government to rapidly decarbonise in a time-tested, sustainable way. By focussing public health efforts at the highest level, promoting the signature of the UNDRIPs, and promoting the Uluru Statement from the Heart, Australia can achieve multiple benefits for the community, the environment, and the local economy. Implementation ultimately lies with the voting constituency to support bipartisan agreement allowing for constitutional inclusion and collaboration to begin.

1. Weir S, Youngentob K. The benefits associated with caring for country: Literature review Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS); 2011. 2. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P, Cai W, et al. Health and climate change: policy responses to protect public health. The Lancet. 2015;386(10006):1861-914. 3. World Health Organization [WHO]. WHO Global Programme on Climate Change & Health Switzerland 2016 [Available from: https://www.who.int/globalchange/mediacentre/news/globalprogramme/en/. 4. Bureau of Meteorology CSIRO. Climate change in Australia: projections for Australia’s NRM regions: Technical Report. Canberra: CSIRO; 2015. 5. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet. 2009;373(9676):1693-733. 6. Watts N, Amann M, Ayeb-Karlsson S, Belesova K, Bouley T, Boykoff M, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. The Lancet. 2018;391(10120):581-630. 7. Campbell-Lendrum D, Manga L, Bagayoko M, Sommerfeld J. Climate change and vector-borne diseases: what are the implications for public health research and policy? Philos Trans R Soc B. 2015;370(1665):20130552. 8. Hanna EG, McIver LJ. Climate change: a brief overview of the science and health impacts for Australia. Med J Aust. 2018;208(7):311-5. 9. Potsdam Institute for Climate Impact Research and Climate Analytics. Turn down the heat : climate extremes, regional impacts, and the case for resilience. Washington, DC: World Bank; 2013. 10. Zhang Y, Beggs PJ. The Lancet Countdown down under: tracking progress on health and climate change in Australia. Med J Aust. 2018(208):285-6. 11. Independent Expert Panel on Interim Targets. Independent expert panel: interim emissions reduction targets for Victoria (20212030). 2017. 12. Australian Human Rights Commission. Social determinants and the health of Indigenous peoples in Australia – a human rights based approach Online 2007 [Available from: https://www.humanrights.gov.au/about/news/speeches/socialdeterminants-and-health-indigenous-peoples-australia-humanrights-based#endnote45. 13. The Committee on Economic Social and Cultural Rights. CESCR general comment no. 14: the right to the highest attainable standard of health (Art. 12). 2000. 14. Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. The Lancet. 2009;374(9705):1930-43. 15. United Nations Framework Convention on Climate Change. Conference of the Parties on its twenty-first session, FCCC/CP/2015/10/Add.1. Paris: United Nations; 2015. 16. Commonwealth of Australia. Australia’s intended nationally determined contribution to a new climate change agreement. UNFCCC NDC Registry; 2015. 17. Liberal Party of Australia. Our plan: protection our environment 2019 [Available from: https://www.liberal.org.au/ourplan/environment. 18. Maiden S. Morrison unveils $2 billion Abbott-era climate policy: The New Daily; 2019 [Available from: https://thenewdaily.com.au/news/national/2019/02/25/morrison -climate-change/. 19. Commonwealth of Australia. Emissions eduction fund white paper. 2014. 20. Climate Change Authority (CCA). Reducing Australia’s greenhouse gas emissions: targets and progress review draft report. Melbourne: CCA; 2013. 21. Hopkin M. Climate Change Authority calls for 30% emissions cut by 2025 Online: The Conversation; 2015 [Available from: https://theconversation.com/climate-change-authority-calls-for30-emissions-cut-by-2025-40554. 22. Rocha M, Hare B, Parra P, Cantzler J, Analytics C, Höhne N, et al. Australia set to overshoot its 2030 target by large margin. Online: Climate Action Tracker; 2015. 23. Haines A, McMichael AJ, Smith KR, Roberts I, Woodcock J, Markandya A, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. The Lancet. 2009;374(9707):2104-14. 24. Heckbert S, Russel-Smith J, Reeson A, James G. Indigenous Australians fight climate change with fire. Solut J. 2011;2(6):50-6. 25. Chris Ray. 'There'll be no park to preserve': Australia's fuming wildfire-control debate. The Sydney Morning Herald. 2018. 26. Schultz Rosalie. Australian Indigenous land management links Indigenous, community and planetary health and wellbeing. Doctus Project. 2018. 27. Lisa Cox. Farmers call for national strategy on climate change and agriculture: The Guardian; 2019 [Available from: https://www.theguardian.com/environment/2019/aug/08/farmer s-call-for-national-strategy-on-climate-change-and-agriculture. 28. Bret Walker SC. Murray-Darling Basin Royal Commission Report. Online Murray-Darling Basin Royal Commission; 2019. 29. 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Acknowledgements:Within this feature article Aboriginal and Torres Strait Islander peoples are referred to as ‘Indigenous peoples’. In doing so, I acknowledge the distinct cultures and societies of different Aboriginal peoples and Torres Strait Islanders. The term ‘peoples’ is also used to recognise the collective aspect of Indigenous people, with distinct cultural beliefs that differentiate them as a group from other Australians.

Conflict of interest statement: The author has no conflicts of interest to disclose. Funding: None Author contribution statement: Hayden Burch is the sole author of this manuscript.

Cite as: Hayden B. Climate emergency in Australia and the need for inclusion of indigenous peoples in solutions. Aust Med Stud J. 2020;1:748–51.

Correspondence: Hayden Burch, hburch22@gmail.com

Date of submission: 18 July 2020 Date of acceptance:: 11 August 2020 Date of online publication: 22 September 2020 Editor: Mabel Leow Senior Proofreader: Emily Feng-Gu Proofreaders: Margaret Hezkial, Ivy Jiang

Continuity of care; a final year medical students’ professional and personal experience in rural Australia whilst on a longitudinal placement in Broken Hill, New South Wales.

Sarah Wray1 1 University of Wollongong

Sarah Wray is a postgraduate student with a passion for both women’s health and critical care. Initially from Cairns, she has an interest in tropical medicine and scuba diving!

Living in Broken Hill, New South Wales (NSW) for the past 14 months has been an interesting glimpse into rural life. I was initially appointed to Broken Hill for a 12-month longitudinal placement, as part of the rural component of my medical degree. The unforeseen global pandemic extended my stay in Broken Hill as my original overseas electives were cancelled. Such a stay has provided me with a number of interesting learning opportunities. Page and Birden comment that in comparison to metropolitan hospitals, rural placements provide access to a wider variety of unique learning opportunities [1]. Anecdotally, I agree. Broken Hill has been a unique learning experience both professionally and personally. The Royal Flying Doctor Service (RFDS) has been one of the key highlights of my placement, it has encouraged me to reflect upon my experiences, particularly with continuity of healthcare in rural settings.

Continuity of care is difficult to define but is in essence, is a strong health practitioner – patient relationship which retains patient choice and satisfaction [2]. It is a multifactorial concept that is reliant heavily on therapeutic communication and access. Continuity and access to healthcare has been an ongoing issue for many years in rural Australia. With regards to the provision of healthcare services in rural and remote areas of Australia, healthcare providers face the challenges of geographical spread, low population density, limited infrastructure, and the higher cost of delivery [3]. These barriers limit the ability of Australians living in rural and remote areas to access quality and continuous primary and specialist health care. Consequently, Australians living outside of metropolitan areas have a lower life expectancy, with higher morbidity and mortality rates associated with chronic disease [3]. One of the unique and iconic ways Australia has addressed this is through the RFDS.

Throughout the year I have had the pleasure of experiencing a number of outreach flights across far western NSW with the RFDS. One of the most memorable flights was to the remote town of Tibooburra. If you look on a map of NSW, you would spot Tibooburra near the far northeast corner, a stone’s throw away from Queensland. To put this in perspective, Broken Hill is 1143 km from Sydney and Tibooburra is 331 km north of Broken Hill. Most of the roads to Tibooburra are unsealed, making them a challenge to access by road.

Tibooburra, with its population of 134 people, is an example of a rural community with no permanent general practitioners (GPs), dentists, or allied health professionals. The community is reliant on a once weekly RFDS outreach clinic for their primary healthcare needs [4]. Specialist appointments are few and far between and most individuals have to travel hundreds, if not thousands, of kilometres to attend their appointments. This set of circumstances, however, is not unique to Tibooburra and is the norm rather than the exception for many other rural towns in Australia. In 2017-2018, the RFDS facilitated 16,209 primary health visits and held 44 clinics per day across remote Australia [4]. Thankfully, Tibooburra and 17 other remote locations are serviced by the Broken Hill RFDS outreach clinics.

Abstract

A final year medical students professional and personal experience of a longitudinal rural placement in Broken Hill, New South Wales, Australia. The placement was 18 months in duration and highlighted some of the hardships of working and living in a rural area. The particular area of note was the accessibility to services and the continuity of healthcare in this isolated location. Continuity is a difficult concept to teach and one that hopefully all medical students will be able to appreciate through rural and remote placements.

Keywords: Rural, Continuity Of Care, Medical Student Placement.

The experiences I have had whilst living and working in Broken Hill for the past 14 months have enabled me to better understand some of the challenges associated with health care in a rural setting. One of these challenges is continuity; being on a longitudinal placement has meant that I have had the opportunity to experience what continuity means to a patient. A key value of a longitudinal medical student placement is establishing the value of continuity of care, which is difficult to appreciate with short-term placements [5]. Wright comments that understanding and gaining clarity of continuity of care is a difficult task and has been referred to as ‘continuous confusion’ in some literature [2].

During my stay I have realised that rural GPs have busy clinics with appointments few and far between. According to the Australian Institute of Health and Welfare (AIHW), 21% of people living in rural areas waited longer than they felt was acceptable to get an appointment with a GP, compared to 18% in major cities [3]. Since the global pandemic, GP telehealth and phone consultations have temporarily become the new norm, which has improved appointment availability. I found that when trying to book an appointment for myself, the only appointments available were phone consults. Unfortunately, when I tried to book a face-to-face follow up, I was told the GP I wanted to see was based in Melbourne. I was extremely surprised that my phone consultation was with a Melbourne based GP. I was disappointed and frustrated at the thought of having to reiterate my story to another doctor, delaying the process of investigation even further. I realised that this lack of continuity is exactly how rural Australians must feel. This was a moment of individualised learning, as it was my first personal health experience whilst living rurally. According to the AIHW, this is not an unusual situation; 33% of rural Australians reported that they could not see their preferred GP on one or more occasion, compared to 25% in major cities [3].

My own experience of telehealth with a GP across the country made me reflect back to my experience in Tibooburra. The GP I was working with had been visiting Tibooburra once per week for a few months. The first patient of the day walked in and said “thank goodness it is you this week”, as the GP had returned from three weeks of holiday leave. The patient continued to comment that repeating their story and feeling like they were starting at ‘square one’ with a new GP at each appointment had proven extremely frustrating. I was empathetic towards the patient at the time but did not fully appreciate her frustration until after my own experience. It is well documented that continuity becomes a challenge if the same provider cannot be regularly accessed. Interestingly, a study conducted by Wong and Regan analysed rural patient perspectives on accessing primary care [6]. Participants emphasised that a lack of continuity of care through high turnover of staff, lack of specialists, miscommunication between teams, and ‘feeling comfortable’ was a major challenge. Leach supports this and outlines that improved continuity of care results in better patient satisfaction and treatment compliance [7].

My experiences outlined above has allowed me to understand and appreciate the importance of continuity of care. It is a term regularly used in healthcare delivery but the importance of it easily overlooked. However, as previously mentioned, continuity of care is difficult to traditionally teach and is best appreciated through experience.

To conclude, living in Broken Hill and the experiences I have had with the RFDS outreach clinics have been invaluable. It has opened my eyes to some of the challenges that people face in rural Australia, particularly with continuity of care. As mentioned above it is an easily overlooked aspect of health delivery but arguably one of the most important. I have appreciated that high standard medical practice is both a science and an art.

References

1. Page S, Birden H. Twelve tips on rural medical placements: what has worked to make them successful. Med Teach. 2008; 30:592-96. 2. Wright M. Continuity of care. Aust J Gen Pract. 2018; 47:661. 3. Australian Institute of Health and Welfare. Australia’s Health 2018. [internet]. Sydney. 2018 [updated 2018; cited 2020 Nov 20]. Available from: https://www.aihw.gov.au/getmedia/0c0bc98b-5e4d-4826-af7fb300731fb447/aihw-aus-221-chapter-5-2.pdf.aspx 4. Flying doctor clinics [internet]. Royal Flying Doctor Service; 2018 [updated 2020; cited 2020 october 14]. Available from: https://www.flyingdoctor.org.au/what-we-do/clinics/ 5. Vogt HB, Lindemann JC, Hearns VL. Teaching medical students about continuity of patient care. Acad Med. 2000; 75:1-58. 6. Wong ST, Regan S. Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural Remote Health. 2009;9:1142.

Acknowledgements: I acknowledge the supporters and employees of the RFDS, and the Broken Hill Hospital who hosted my placements throughout the previous 18 months.

Conflict of interest statement: A former student of the Rural Department of Health and Broken Hill Hospital, with a longitudinal placement at the RFDS base.

Funding: None to declare

Author contribution statement: SW wrote the feature article using her personal experiences during a final-year medical student placement in Broken Hill.

Cite as: Sarah Wray. Continuity of care; a final year medical students professional and personal experience in rural Australia whilst on a longitudinal placement in Broken Hill, New South Wales.. Aust Med Stud J. 2021;1:748–51.

Correspondence: Sarah Wray, Sew062@uowmail.edu.au Date of submission: 16 May 2020 Date of acceptance: 26 January 2021 Date of online publication: 28 January 2021 Editor: Onur Tanglay Senior Editor: Mabel Leow, Justin Smith Senior Proofreader: Emily Feng-Gu