With no full time doctor on staff, we spent the two days of our trip assessing new admissions, and cleaning up minor scrapes, cuts and abscesses, whilst waiting for the locum doctor to turn up. The nursing staff were on hand to help out, and were very keen to keep us busy, they also informally, but comprehensively gave us a run down on how health services, and in particular Aboriginal health services, are provisioned in the local area. Throughout the two days they detailed some of the troubles they have moving their chronic patients on to tertiary hospitals. In part due to the tyranny of distance, and is some cases the unwillingness of hospitals to accept patients.
Our two days saw the whole gamut of admissions, from minor cuts to a head injury that required evacuation to Dubbo for a CT scan. Whilst we were somewhat dissapointed not to have been allowed into the Aboriginal Health Service, the staff at the Bourke Hospital made up for it well and truly.
Thank you once again for the opportunity to go to Bourke.
James Doherty, Stage 3 medical student
We landed at the airport, with only one terminal in sight. Soon after landing, we were greeted by one of the Aboriginal Medical Center staff who then took us through the town.
We were shown Fred Hollow’s Grave, wild kangaroos which were roaming close to the town due to the flooded Darling River, the wharf, and our hotel.
The entire town tour was completed within a few hours. After orientation, I was paired with the Smoking Cessation Coordinator who allowed me to observe and participate in discussions with patients. We saw a whole range of patients, from those who recently started the program, to those who had successfully completed and were enjoying the benefits of cleaner lungs and financial savings. Following that, I was introduced to a nurse who outlined her role in the medical center and discussed some of the major chronic diseases faced by this population.
It was interesting to note that patients who attended the clinic had drivers come to fetch them so that they were able to make it for their appointment. I wish we had this luxury in Sydney! By 4pm all members of the team had completed their duties and we were off to the Riverside Hotel. With the sun shining overhead it was difficult to turn down the offer to go swimming. We enjoyed the cool waters and then headed out for a community gathering where all new members to the community were welcomed. Upon our arrival we were instantly spotted as newcomers. As a choir was singing, different members of the community came to greet us with platefuls of food.
We introduced ourselves and unfortunately, had to make an exit for our prearranged dinner plans. On our walk to dinner we all gushed about the community feel for the town and how easy it is to fall in love with Bourke. It was such a huge contrast to the busy bustling city of Sydney where newcomers can easily feel isolated. Dinner was a small pub close to the hotel, we enjoyed a tasty meal and headed straight to bed after the long day.
The next day began early for the 8am start at Bourke Hospital. Another medical student and myself were paired together to attend a hospital session. The nursing staff and the General Practitioner greeted us upon our arrival. We joined the team for morning rounds and were quizzed on the different conditions. It was great to see the hospital well equipped and maintained however the lack of personnel was quite astonishing. Around 3 nurses ran the entire hospital and only during extreme scenarios were doctors involved.
After the physician had completed rounds he left for clinic and we joined the nursing staff. We assisted with wound dressing for burns patients and patients with severe abscesses. We also had the opportunity to take patient histories from individuals who were recently admitted to those who were under aged care.The small hospital allowed us to get acquainted with a majority of the patients and truly understand their stories. This familiarity is lost in major hospitals where there are so many patients with a myriad of conditions – it is easy to lose track of who you are treating. During our lunch break we explored the city to locate a place to eat.
We reflected on the major issues affecting the Bourke community and interventions we could try to apply to help resolve them. Alcohol, smoking, diabetes and psychological issues were some of the major culprits we could identify. Everything from youth education programs, travel scholarships to Dubbo, to mentorship programs were ideas that were discussed. Following lunch, we were also greeted by the Aboriginal health worker, who also seemed to double as a shoe repairman as she helped me put my shoe together after it managed to rip in half!
We really were in good hands. It would have been great to stay for a few more days and truly put our thoughts, ideas and medical skills to use. But alas, our time had come before we knew it, 3 o’clock had snuck up on us and we were rushing to get to the airport to regroup with the rest of the team. We boarded the flight and waved goodbye to Bourke.
This experience truly changed my view on rural medicine. In smaller communities you are able to see the change you can bring by using the skills you have been taught. You are able to build lasting relationships with a whole host of people and feel as though you are part of a greater team.
Many thanks to the Royal Flying Doctor Service for allowing me to participate in this trip with them. And also, to Dr Lilon Bandler and the POCHE Centre for Indigenous Health for providing us with this opportunity.
Priyanka Dixit, Stage 3 medical student