I recently had the privilege of travelling to Halls Creek in Western Australia for my 5th year selective. Halls Creek lies in the heart of the Kimberley’s and has a population of 1,499, 65% of whom are Aboriginal and/or Torres Strait Islanders. I chose to do my selective here as I wanted to get experience in rural and remote medicine as well as working with our indigenous population.
My placement at the Halls Creek Health Centre was divided into emergency medicine, general practice and attending an outreach clinic on Wednesdays in the small Aboriginal community Yiyili (one hours drive from Halls Creek).
My role as a senior medical student was varied: there were no interns nor registrars. Due to the lack of junior medical staff, tasks that would normally fall to them, ended up falling on me. I found myself integrating quickly into the environment and stepping up to more demanding roles. Due to the lack of female doctors, and only one nurse being able to complete female health checks, I sometimes had to step up and perform these examinations on my own, as generally female health was considered “woman’s business”. I found myself feeling grateful that I had been able to perform so many papsmears on my GP placement and that I had been on the breast & endocrine surgical team for my surgical placement earlier that year. I think I would have been quite lost without these. This highlighted the disparity in health care faced by women in rural and remote areas. I also had tasks such as re-stocking the pharmacy, mixing up medications and assisting in wound care such as debriding necrotic tissue.
As my placement progressed I quickly learned about other difficulties faced by the community in accessing health care.
One of the big issues was the rapid turnover of locuming doctors, which made it hard to maintain continuity of health care. Continuity was further limited by inaccessibility or difficulty in accessing patient data as various computer program packages were used for different services. For example, although a GP clinic existed within the health care centre, and although all doctors working in the GP clinic also worked in the emergency department, different programs requiring different logins were used for both without any communication between the programs.
Another issue was the extreme limitation in investigations. X-rays were only available if someone was there whom had a WA X-ray license. Sometimes we would go a couple of days without being able to do an X-ray. Most blood tests had to be sent away with the grey hound bus, and even a full blood count could take days to come back. Halls Creek was equipped with a quick CRP, quick haemoglobin and blood gas machine. This meant that we relied heavily on diagnostic acumen and often sent patients home with lots of safety netting whom we would have likely kept in hospital in a larger centre until results were back. We also had a portable ultrasound that was used extensively from diagnosing pneumonia to appendicitis. However, the use of the ultrasound was heavily user dependent as the skills varied between medical staff. To get any other imaging done we would have to send patients either to Broom, Kunnunurra or Perth, depending on what was required.
Further, due to lack of means of transport many of the Aboriginal people coming in for a medical appointment walked hours to get there. This meant that a lot of presentations were delayed and often patients presented with complications that could otherwise have been prevented. Although there was a community bus during the day, patients often still ended up walking, especially