Australia is a BIG country, the land mass is enormous and it provides hundreds of opportunities for health care professionals to support rural and remote communities. The number of nurses in Australia is over 330,000 and we have a population of around 25 million people. Compared to the number of nurses in the United Kingdom, around 300,000 and the population there of 66 million; one of the reasons we need so many nurses in Australia, is because Australia spreads its healthcare over a land mass that is 32 times greater than the UK. If you have ever considered working in a rural and remote region, my advice is go and do it!
At the beginning of 2020 I spent two weeks working with a nurse practitioner colleague in a rural and remote community in the northwest of Queensland. For me, the experience of rural and remote nursing was very exciting, even travelling to the community was exciting. I flew from Sydney to Brisbane, Brisbane to Mount Isa and then Mount Isa to Doomadgee. As I flew further away from Sydney the size of the aeroplanes we travelled on became smaller and smaller!
The size and distribution of healthcare in Australia became apparent even on my flight from Brisbane to Mount Isa. On this flight I sat next to a couple who were visiting a relative in Brisbane, whom had fallen unwell in Mount Isa and was flown to Townsville by the Royal Flying Doctors Service for emergency surgery and then onto Brisbane for definitive surgery. The complexity of healthcare in remote regions astonishes me and I am, as ever, humbled by the dedication of people willing to overcome the challenges of providing care in remote communities.
My experience in Doomadgee was amazing. The community has a population of 1400 people and has a rich aboriginal culture. I worked in a clinic setting with a nurse practitioner colleague, also in the clinic was a medical practitioner, registered nurse and aboriginal health care workers. The team environment was such a joy to practice in, I found my colleagues extremely supportive and also a lot of fun. Most of the team were fly in and fly out practitioners who worked for a two or three week period on a rotation.
The clinic was open Monday to Friday and therefore, the weekend was a time to explore the local area. There is a lot to see and do in rural and remote areas. The wildlife is amazing, and there are many areas of natural beauty. Like most of Australia, the place is full of deadly insects, reptiles, animals and plants that can kill or maim you! I often joke that, even though I have undertaken several operational tours to Iraq with the British Army, Australia is by far the most hostile country I have ever spent time in!
Things I learned and will apply to my own clinical role:
1. Giving and receiving is important. Working in the rural and remote clinic we would regularly give T-shirts away, or kit bags with pens, toys, toiletries, calendars and books in them. It hadn’t occurred to me that when I engage to provide healthcare to a person, they might perceive the things that I do as taking something away from them, their story or their blood or their vital signs. In giving something back in the form of a gift, it perhaps evens the score. I have already tried this in my own clinical role in homeless health and it definitely facilitated engagement.
2. Delivering culturally appropriate care is essential. It is so important to have insight of your own approach and how that may be perceived by others. Using appropriate language is hugely important and making sure that your language is understood by the person you are caring for.
3. Opportunistic care. The aim of any nurse practitioner role is to increase access to care for people. In providing care in the clinic, we would take any opportunity to undertake screening and provide care to people. Sometimes, a person would arrive with their children and even though the parent was the patient, we would offer a health check for the children as well. This often resulted in identification of otitis media and skin infections and sometimes rheumatic heart disease, which is extremely prevalent in the region. In my own practice in Sydney, I now take any and every opportunity to provide preventative screening. This might take the form of a thorough physical examination, or specific investigations.
Finally, I have a resource recommendation for you, the Chronic Conditions Manual & Primary Clinical Care Manual, Queensland Health. These two publications are invaluable resources in providing care in rural and remote environments. If, like me, you are more familiar with presenting complaints in inner city areas, then you may not realise the prevalence of certain conditions and therefore, how to treat them. For example, simple skin infections that you would normally treat with flucloxacillin may require an antibacterial sensitive to MRSA, such as trimethoprim + sulfamethoxazole. The management of chronic conditions can also be complex, particularly in rural environments where access to specialists is intermittent or available only through video conferencing. The Chronic Conditions Manual provides comprehensive guidance on the investigations required for specific conditions and their ongoing management and monitoring.