Case studies

Quality care brought to the doorstep

A Poche centre clinician steps off a plane

The Poche Centre has brought top-quality cardiovascular care to the remote town of Brewarrina in northwest New South Wales. At bi-monthly clinics, cardiologists Harry Lowe and Leonard Kritharides see up to 20 patients in a day.

Not only do the people of Brewarrina now have access to specialist care they once had to travel 400kms or more for, they are also receiving the advantage of better equipment. Two pieces of technology purchased by the Poche Centre have dramatically increased the quality of care offered to rural communities.

A compact cardiac ultrasound (small enough to fit in a suitcase) allows Professors Kritharides and Lowe to bring the latest in specialist diagnosis to Brewarrina. The other device, a portable heart rhythm monitor, allows people to go about their daily routine while the machine collects data on their cardiovascular health and transmits it to be read remotely by a cardiologist.

Previously, a patient faced the potential for additional suffering and expense after having made the journey to Royal Prince Alfred or Concord Hospital in Sydney for bypass surgery or a pacemaker. Now the patient receives ongoing care in their hometown from the same specialists who cared for them before and after they were in hospital.

Working alongside local GPs, these specialists have become familiar and trusted faces in the community. The advantages of this level of ongoing care are obvious, and can even be lifesaving. In some cases clinicians met with patients who hadn’t been seen in five years, and discovered depleted batteries in their pacemakers.

The Poche Centre-funded clinics are making a profound impact in communities where heart disease is a significant burden. Where before it might have been impossible for someone to travel to hospital to receive an accurate diagnosis, now they can receive the same quality of advice and treatment as anyone in an urban setting.

Challenging students, confronting disease

Saline solution in a clinical setting

Most doctors will never see a patient with rheumatic fever, as it has all but disappeared from Australia. However, this disease is still present in some Aboriginal communities.

Left untreated, what begins as a sore throat or streptococcal skin infection can develop into joint pain, a rash and inflammation. In severe cases it can cause damage to the heart valves, leading to congestive heart failure.

Cardiologist Warren Walsh is appalled that rheumatic fever still exists in Australia. He also feels keenly the fact that Australia’s burden of chronic disease is largely borne by Aboriginal peoples – illnesses such as diabetes, kidney disease, hypertension, and heart disease.

So every three months Walsh flies into the Northern Territory with a team that includes a physician and two cardiac nurses. They spend a week visiting patients in Tennant Creek and Alice Springs. Medical students accompany the team. Together they perform cardiac ultrasound studies, investigate medical conditions and develop management plans, such as a program of monthly, preventative injections for patients with rheumatic fever. In advanced cases, the team organise transfers to cities for surgery.

Though some of the medical students that work in Tennant Creek have found the experience confronting, they also describe it as ultimately rewarding. With the support of the Poche Centre, these students are playing their part in helping to eradicate rheumatic fever in Aboriginal communities, while also gaining the invaluable experience they need to become future leaders in public health.

Restoring teeth, restoring health

A Poche Centre dentists examines an x-ray

One of the major dental problems in Aboriginal communities is lost teeth. Many people, from teens to the elderly, have no teeth at all. This has a huge impact for overall health and wellbeing. A full set of healthy teeth allows someone to talk clearly, be easily understood, and eat properly. Missing teeth create nutritional challenges, and can contribute to diabetes if someone does not get the proper dietary intake. For young people, missing teeth can have a devastating impact on self-esteem. Also, because eating is a very social activity, it can prevent people of all ages from fully sharing in community life.

When dentist Dr Steven Naoum first went to Bourke to investigate its dental facilities he found two surgeries, one of which was being used as a storeroom. Dr Andrea Lenard had been providing dental care to the community and was looking for some help. With the support of the Poche Centre, both surgeries are now operational and Naoum and fellow dentist Dr Peter Salameh use them to hold monthly clinics at Bourke Area Health Service.

One of the services they provide is replacing teeth, after a series of mould-takings and fittings. Before, people in Bourke who needed dentures had to travel to Dubbo for five separate appointments: a major disincentive. With 20 people in Bourke now sporting new dentures, thanks to the Poche clinics, word has quickly spread and there is a waiting list of others eager for the procedure.

The team’s regular presence in Bourke has allowed them, along with senior clinical educators and final year dental students, to do more than symptomatic treatment. They have organised mouthguards for children – to reduce the incident of teeth being knocked out through sport such as boxing. They visited high schools to talk about oral hygiene, and how to prevent cavities and infection. They also spent time with nurses at the base hospital to teach them how to manage facial swellings due to tooth abscess and trauma. As this can be a potential fatal situation, it’s critical that nurses know what to do when a dentist is not available.

Naoum and Salameh recently commenced providing treatment to children under general anaesthetic at Bourke. This has allowed children to be treated locally, reducing travel and other expenses for their families.

The visits have already made a major difference to the wellbeing of this remote community. For two days every month, the people of Bourke now have access to a range of dental services equivalent to what would be provided in a major capital city. And they’re smiling like never before.