Issues Magazine

Outback Medicine

By Jacinta Spry and Claire Seiffert

Two young women share their experiences as medical students in the Northern Territory.

Becoming a Bush Doctor

When I was a secondary school student in northern Queensland I really got the travel bug. I did a 6-month exchange program to Canada, but that just made my travel bug worse! I discovered that I loved to explore new places, new people and new ideas. When travelling I am never bored, always challenged and often inspired by this amazing planet. And, although I’m not one to get homesick easily, going away does make me appreciate where I come from a little bit more.

After school I wasn’t sure what I wanted to do but I had an interest in science and health, so I enrolled in a 3-year Bachelor of Science at the University of Queensland. At the time, a few of my uni friends were studying science, hoping that it would lead them into Medicine. At that time I couldn’t think of anything worse! I once thought the medical profession was stuffy and old and the health care system was like a prehistoric institution. I decided I was much more interested in going camping around Australia, and planning trips to Thailand, North America, New Zealand, South America, India, Sri Lanka, Russia and Europe.

Travelling also gave me my first experience of being sick and vulnerable in a foreign environment where you don’t know the language. I saw first-hand the impact of a lack of infrastructure and resources like food, clean water, housing and education, and how this impacted on people’s health. I could not believe my own good fortune growing up and living in Australia and how my health and ability to make informed choices had allowed me to do virtually whatever I wanted.

But when meeting indigenous people from Australia and overseas I realised that not everyone has been given the same opportunities and ability to make informed choices or the same access to health care and other resources. Sometimes the social, cultural or physical environment can really impinge on a person’s rights, including their right to health care.

I found this outrageous and decided that as a healthy, able person with everything I ever needed, I could perhaps be useful helping others to reach their potential as well. I enrolled in a Bachelor of Medicine and Surgery at Flinders University in Adelaide. I thought: “I just have to study hard for another 4 years before I can bust out again and travel the world with my new-found medical skills”.

But I was wrong again! With medicine the learning never stops – even when you graduate it’s just a different kind of on-the-job learning experience. Also, I didn’t have to wait until I’d finished my studies, nor did I have to travel overseas to discover amazingly rich and diverse cultures, and new and different people and places.

I put my hand up to spend the third year of my medical studies at the Royal Darwin Hospital and really discovered for the first time Aboriginal Australia and the remote Northern Territory. Aboriginal people have so many things to be proud of and there’s no doubt that traditional Aboriginal beliefs and practices are alive and well.

I also discovered how third-world living conditions and diseases like rheumatic fever and tuberculosis, problems in education and cultural insensitivities can really make participation in more mainstream Australian life very challenging. For many of the patients I met at Darwin Hospital, English was their third or fourth language. The more I learnt about this complex situation, and the more Aboriginal people, dedicated health professionals and particularly Aboriginal health workers that I met, the more interested I became in being a part of an innovative and flexible system that provides the same opportunities, no matter who you are or where you live.

Now I am in my final year of medical studies and am one of the first Flinders students to participate in a new rural stream for fourth-year students. I am fortunate to have received an Australian Rotary Health Research Fund Rural Medical Scholarship and a small grant from the Northern Territory branch of the Australian Medical Association to support my interest in indigenous health.

This year I have already spent 3 months in Nhulunbuy. It’s a remote, vibrant and welcoming township of 4000 people on the north-eastern coast of Arnhem Land, only 15 km from one of the largest Aboriginal communities on the Gove Peninsula. It is also the hub of a number of medical and other services that support eight other major Aboriginal communities and many more homelands and outstations in the area. For the past 36 years it has been the site of a massive bauxite mine and refinery that produces 3.8 million tonnes of alumina per year and employs nearly 1500 people in the area.

The Yolngu people of East Arnhem have a fascinating life, law and language. The complex and sophisticated Yolngu systems of kinship, rights and responsibilities, creation, land and ceremony still permeate everyday life. I discovered how people, animals and places belong to one of two moieties called Dhuwa or Yirritja. I’ve learnt, for instance, the morning star, water goanna and stringy bark are Dhuwa, while the evening star, stingray and cycad are Yirritja.

In the Gove Peninsula and surrounding area, most Yolngu belong to one of 16 clans, of which eight are Dhuwa and eight are Yirritja. Yolngu Matha is the second most commonly used language in the Northern Territory and there are numerous different clan languages. It’s not easy when there are five different ways of pronouncing the letter n! But people were only too willing to assist in any attempt I made at speaking Yolngu. It’s been a really amazing experience to go with Yolngu families hunting, fishing, walking and gathering bark for painting. They know that land so well. It’s been fascinating to listen to their stories about the past and their hopes for the future.

This diverse learning environment suited me and there was ample opportunity to create my own experience and timetable. I worked in Nhulunbuy township at an Aboriginal health service and went to remote bush clinics in the Aboriginal homelands. I could be on the wards, in the emergency department or in clinics with visiting specialists at Gove District Hospital. I could fly out on aero-medical retrievals or fly to large communities like Milingimbi or Ramingining with the mental health team or district medical officers. Doing medical consultations in the town’s mainstream GP clinic or at the mine site clinics was also on offer.

My boyfriend and I have travelled south to Alice Springs for a further 5 months to compare and contrast another remote town and Aboriginal health setting. We feel equally excited to be in Alice with many more cultural and clinical opportunities on offer. We’ve been camping at breathtaking gorges, beautiful dry river beds, and watched the desert night sky stretch out forever. I’m spending time on the paediatric and surgical wards, doing a few weeks in the emergency department and attending a course in Pitjantjatjara, one of the local indigenous languages spoken in the area around Alice Springs and also in the top of South Australia. I’ve “travelled bush” to two Aboriginal communities and homelands where some wonderful people and brilliant artists have shared with me why this land is so special, and how there’s so much life in the desert if you know where to look.

I am very lucky to have these experiences when I am still studying. The aim is that students will have such a good time they might plan to come back one day – and it is working! So if you love travelling, exploring new places and cultures and think that being healthy and happy is something we can all strive for, there are many journeys to be had in remote and indigenous Australia. There is nothing stuffy or boring about being a bush doctor!

Jacinta Spry

Oenpelli Encounter

I set foot on the dirt airstrip at the Oenpelli airport, having survived a single-engine aircraft flight from Jabiru just after midday in mid-summer. I was immediately overwhelmed by the mozzies, heat and sauna-like humidity. My 5 weeks of Top End tropical delights and the war on monster mozzies had just begun …

Oenpelli, otherwise known as Gunbalanya, is a small Aboriginal community of approximately 800 people located in the middle of the floodplains on the edge of both Kakadu and Arnhem Land. In the wet season it is cut off by the swollen East Alligator River. Jabiru is only about 45 minutes away when the river can be crossed. The community has its own store (very expensive as one onion costs $4), a famous arts centre (Injalak Arts), a club where alcohol is served for 2 hours on 3 days of the week and a school. It also has a health clinic that hosts one GP, one junior doctor, three locally trained Aboriginal health workers and five nurse practitioners.

Having previously visited the community in May 2007 during my rural term, I felt like I was returning home (except for the heat!) and within 2 hours of arrival I was consulting patients (many of whom I had met the year before). The teamwork, camaraderie and lack of egos are striking features among the clinic staff. The nurses are amazing and the GP is simply brilliant – patient, culturally sensitive, encouraging and open-minded.

I spent a large proportion of my time in Oenpelli in single-engine planes, praying for dear life, with the outstation nurse. Once or twice per week we would fly out to very remote communities in Arnhem Land and conduct clinics out of sheds or on verandas. Everything from antenatal checks to rheumatic fever and tuberculosis would be encountered. I quickly became an expert at delivering massive glue-like Pan Benz injections into a squirming child’s buttock while ignoring the ensuing screams.

Expensive food, stifling heat and man-eating mozzies were the only lowlights but the scenery well and truly outweighs all of these.

This short description by no means does justice to my amazing cultural, medical and personal experiences. I highly recommend a visit to the Top End and a remote Aboriginal community for any students considering a career in health.

Claire Seiffert