Faculty of Medicine
Memorial University of Newfoundland
Memorial's medical graduates work around the world, often at rather unusual jobs. Dr. Tia Renouf (Class of 1984) spent year in Australia as a flying doctor, and she wrote this account of her experience for MUNMED.
The Royal Flying Doctor Service, or RFDS, is close to every rural Australian's heart. Five aircraft in Alice Springs cover central Australia, an area of desert about the size of Spain. People in need call the flying doctor, hundreds of miles away, by telephone or radio. These aircraft, really airborne intensive care units, can be wherever help is needed in 45 minutes.
Rural Australians keep the flying doctor radio on, much like the ubiquitous CB radio here. Listening to the chat gives a sense of security to those living on thousand-acre homesteads in the desert. Our radio operator, Diana, would say good night and good morning each day, to be answered by a chorus of "g'day" and "behave yourself this evening" from her listeners.
Flying doctors are important to those travelling through the desert. Picture standing in the middle of a sandy beach, only there's no ocean and no trees. The horizon is visible, unchanged, if you turn slowly in a circle. There are no clouds, only the deepest blue sky, and the ground is red. Occasionally the line between sky and ground is broken by a small tornado or dust devil, called a "willie willie" here. There are mirages, mountains on the horizon, with silvery reflections stretching for miles -- all in a moving haze like the Northern Lights.
Negotiating this dry ocean is like sailing: it's a vast terrain where one is unlikely to encounter anybody else, and where a fatal outcome lurks if the means of transport breaks down. Vehicles are fully equipped with spare everything, radio contact and detailed maps. Routes are called "tracks", aptly, as they are often just a line in the sand. Choppy terrain, waves of dunes; if too much speed is unwisely used, it's all too easy to flip over. Many people carry a winch for getting out of deep sand; some vehicles are equipped with a snorkel for travelling through the temporary rivers created by flash floods. A standard fixture in Australian four-wheel drives is the Flying Doctor radio, whose voice might be the only one heard for long stretches of the journey.
Central Australians are a long way from medical help. If someone is sick or injured, the RFDS is called. As the doctor on call, I would be phoned or radioed for advice. Based on the information I could get, and it was often patchy, I would decide whether the situation could be managed where it was, if a plane and a nurse should collect the patient, or if I should fly out too. I consulted with patients, family, community nurses, Aboriginal health workers, and barmaids.
Working in the air is unique. I remember being diverted on the way back to Alice Springs with a bronchiolitic who was stable enough to stay aboard another two hours while we flew in another direction to assess somebody else. The second patient was a young Aboriginal football player who had dislocated his shoulder. Normally I could have reduced this on the ground and let him stay in his community. Today it was getting late, and the aircraft had to take off before dark, since there was no way to light this airstrip. So we brought the boy aboard, started the IV, and mixed the drugs as we taxied. We reduced his shoulder after we took off.
Each aircraft was beautifully equipped. There were cellular phones, so I could call a consultant if need be, but only on the newer planes. On the older Chieftain, there was an intercom between pilot and nurse, and radio between pilot and the doctor on call in Alice Springs. I was puzzled one day to be told, via the pilot, by the nurse, that the patient they were transporting had a run of "Victor Tango." It took a while for me to realize the nurse was telling me about ventricular tachycardia. The Australian sense of humor being what it is, the patient could just as easily have been trying to dance.
Most of our patients were Aborigines. The average life expectancy for male Aborigines is only 50. Their health problems are many, relating largely to malnutrition, low socioeconomic status, cultural displacement and squalor. Alcoholism is common, as is Type II diabetes. More than 50 per cent of that population has progressive, severe renal failure. Acute rheumatic fever is common, as are other streptococcal infections. For a variety of reasons, Aborigines are vulnerable to strep and other pathogens; septicemia happens suddenly, and by our standards unexpectedly, frequently resulting in brain and spinal abscesses. Pneumonia is rampant in all ages. Unfortunately, violence is common, both because of alcohol abuse and because some degree of physical retribution for crime is culturally accepted.
Aborigines don't complain. I was surprised one evening in Emergency to pick up a chart which had "headache" written as the presenting complaint. I approached the patient, sidled up crab-wise, no eye contact, touched his arm and asked what tribe he was from. Tried to gain his trust. He told me he'd never been in hospital, never been sick. When I asked him to remove his cap, I found his shaved scalp a complete road map of recent scars. His notes revealed he had been run over by a train less than a month ago; a CT report said he had broken every bone in his head. It's amazing he was alive, let along that he took his own leave from an intensive care unit a week after the accident. Perhaps a ceremony, hundreds of miles away at home, required his presence. There could also have been an important card game....
More dramatically, another Aboriginal man checked in, saying he "felt unwell." He had a knife in his right eye. Escorting him quickly (and carefully) into the resuscitation room, he told me it had been there a week. I really thought the language barrier was playing a role here, but his family later confirmed that he had been stabbed seven days ago. While arranging to the surgeons to come, I asked why he'd left it there so long. "It didn't hurt," he said with a shrug.
There were more rewarding moments, a smile from a grandmother as she thanked me for fending to her little ones. Eye contact was rare, and flattering to me.
We attended clinics when not on call, flying each morning to an Aboriginal homeland. They were great fun; those days often included invitations to ceremonies and dances, and opportunities to watch the local people, many of whom are famous artists. Most communities had a clinic and one or more resident nurses, along with Aboriginal health workers. These workers helped communicate through cultural and linguistic differences (there are 12 languages spoken).
Not all of our patients were human. I remember speaking to Elizabeth, a colleague, on the phone, I was on call in Alice Springs and she was in Nyrripi, an Aboriginal community 100 kilometres away. Suddenly she shrieked: "Oh my God, there's a pig in the clinic!" I heard squealing and grunting and scuttling sounds like cats on linoleum, losing purchase on a right turn. Colin, wonderful Colin, the nurse at Nyrripi, had sewn the village pig's cuts, and now had to remove its stitches.
Superficially, Aboriginal life appears Western. In reality, traditions and beliefs are intact. Aboriginal Elders appoint a "Kadache man" to "payback", or right a particular offence which might happen in a community. Nobody but the elders know who the appointee is; someone different is assigned to deal with each deed. The Kadache man works at night, hiding his identify by camouflaging his footprints, as Aborigines are expert trackers. To this end, he drags emu feathers, dipped in blood, behind him as he walks through camp, look for the individual he must pay back.
These men exist. The nurse who runs the RFDS in Alice Springs tells of working in Queensland in a small surgical hospital. In her care were patients with IVs and drains, and one in a body cast after surgery for spinal tuberculosis. The patients were nursed outdoors on verandas, as the climate there is hot and humid. The nurse was horrified to find, one morning as she began her rounds, that all the patients were gone. Nowhere in sight, and not seen again. The Kadache man had been by, and had left his "footprints." The patients knew better than to stick around.
Last updated 18 Jun 1997 by 