Doctor's Review: Medicine on the Move

August 20, 2017
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The Wizards of Oz

Australia's Royal Flying Doctors treat everything from skin cancer to scuba-diving accidents

What's your first impulse when you get an emergency call? If you're Bernie Carty or Caroline Jaffee, both general practitioners in Australia's Royal Flying Doctor Service, you ring a nurse and page a pilot to rev up the flight engine. For both doctors, being on call means flying off in a heartbeat to remote locations in Oz, as the Aussies fondly dub their land down under.

Flying out of their bases in the northeastern state of Queensland, they see a lacy underwater tapestry of coral reefs and islands that fringe the emerald land as far as the eye can see. This is the Great Barrier Reef, the earth's largest living entity, stretching 2000 kilometres along the continental shelf of Queensland's coast, biologically supporting the most diverse ecosystem of marine flora and tropical fish. The reef outlines a territory that is like no place else on earth -- a coastal treasure trove of the earth's most exquisite reefs, oldest primeval forests and rarest wet tropical forests. Indeed, it boasts three designated World Heritage sites: The Great Barrier Reef, the pristine Wet Tropics in Cape Tribulation's Daintree and Fraser Island, the world's largest sand island.

But for all its beauty, the vast wilderness teems with adventurous challenges to flying physicians like Dr. Carty and Dr. Jaffee, who live by the motto, "Always There."

The heart of Queensland hasn't changed much since 1928, when a young roving missionary named Reverend John Flynn, who was appalled by the lack of medical care available to Australia's pioneers, founded the Royal Flying Doctor Service. Back then, roads were rough and communication to remote areas was virtually impossible. A year later, when an electrical engineer named Alfred Trager invented a pedal-operated generator that could power radio transceivers, emergency service was off to a flying start.

Today, Queensland's Royal Flying Doctor Service has doctors on call around the clock, seven days a week, providing aeromedical assistance to more than 35,000 people a year. Of these, some 150 are considered Priority 1 life-threatening emergencies, some 1700 are Priority 2 medical emergencies. The primary duty of RFDS is the emergency retrieval of patients to larger medical centres in aircraft that serve as mobile intensive-care units. But to thousands of people, particularly those in aboriginal communities, mining towns, and farming and grazing communities, RFDS is their family doctor. In isolated hubs where people don't have access to clinics, RFDS maintains some 1800 "Medical Chests" containing items like drugs, dressings and instruments to be used in conjunction with telephone and radio consultations.

ISOLATION ISSUES
Doctoring is a day-to-day adventure for Dr. Carty and Dr. Jaffee. Dr. Carty is based in Cairns, the coastal city known as "Australia's gateway to the rainforest and the reef." Cairns is the largest of Queensland's six RFDS bases, serving 32 clinic locations, with a staff of 10 doctors, 27 nurses, an Indigenous Health Liaison Officer who's versed in cross-cultural issues, plus a clinical psychologist who helps people deal with such mental-health stresses as isolation, drought and continuing rural recession. Six pilots man the various aircraft, including two Beechcraft King Air C90s and a SUPER King Air 0C which, capable of speeds up to 500 kilometres per hour, is used for emergency retrieval. A neonatal unit provides emergency care for babies. Of course, all the aircraft are pressurized in order to duplicate the conditions at sea level -- an essential requirement in the treatment of many serious injuries.

Dr. Carty's team often evacuates three patients a day from remote areas as far out as Cape York, Weipa, Cookstown, Bamaga and Thursday Island to Cairns Base Hospital or the larger, tertiary hospitals in Townsville or Brisbane for severe trauma, head injuries, major surgery or complicated obstetrics. Townsville has a recompression chamber (one of only three in Australia) which is helpful for treating diving injuries and carbon-monoxide poisoning. The team also assists patients over telephone or radio with the help of the RFDS Medical Chests.

"A flying doc requires a variety of skills," says Dr. Carty. "You must know airwave skills. Particularly in the case of head injuries when you're in the middle of nowhere, you need anesthetic training, and to know how to ventilate for oxygen, and weigh the optimum way of transporting the body.

"Outside of emergencies, nothing's black and white in medicine here. My practice is a mixture of First and Third World, with much time spent in aboriginal communities, not the typical medical setting. It's a combination of Third-World problems with infections, overcrowding, poor hygiene, malnutrition and scores of problems related to alcohol. Lately, these people are also exhibiting First-World problems: heart disease, diabetes, hypertension, obesity and renal disease."

 

Raised in the tiny coastal town of Hervey Bay (which is the stepping-off point for boats heading to pristine Fraser Island), Dr. Carty, 37, earned degrees in Medicine and Surgery at the University of Queensland in Brisbane. After hospital practice, he worked in the community hospital on Thursday Island, which lies off the northern tip of Cape York, before heading to Birmingham, England, to study anesthetics at New Cross Hospital. "After working for two years in South Africa's Zululand and Pieteer Miritzberg, I figured it was time to come home."

Dr. Carty met his wife, a Scottish nurse travelling around Australia on a work visa, in 1986 while serving a clinic on Thursday Island. They now live together just eight minutes from the airport.

How does the doctor spend his spare time? "Doing a bit of this, a bit of that, but mainly bushwalking. There are a million paths in the wilds around Cairns to explore on foot." After treating one diver who was bitten by a moray eel and another who's arm was severed while diving, Dr. Carty has lost interest in diving and snorkeling.

MEDICINE ON THE REEF
Dr. Caroline Jaffee works for a busy two-doctor "mini hospital" based in Airlie Beach, a small town hugging an unspoiled bay that overlooks the Whitsunday Islands. The general practice also serves Hayman Island, a luxurious resort island on the barrier reef, with emergency air service plus 24-hour telephone consultation for the island-based nurses. "We're called around the clock for everything from authorizing antibiotics to consulting on cardiac emergencies until a helicopter arrives to airlift the patient to the hospital in Proserpine [20 minutes away] or Mackay [one and a half hours away]."

What's an average day like for Jaffee? "Busy! Once a week we fly to Hayman Island to treat the resort's 500-member staff. Procedures, like the removal of small skin cancers, are done in our mainland surgery. Because of our year-round tropical climate, Queensland has the world's highest rate of skin cancer. We expect that to decline in the younger generation: Parents now dress toddlers in hats and old-style bathing costumes with protective sleeves and leggings.

"On the mainland, we do lots of diving medicals. Australia must be the strictest country in the world as far as underwater medicine goes. We thoroughly assess the candidate. I fail about one in 50 people, often for mild asthma, which can be catastrophic, even fatal, during a dive.

Problems occur when divers who are inexperienced in equalizing their ears encounter huge changes in underwater pressure. As a general rule, we tell people you can fly before you dive, but you can't fly for 48 hours after you dive. Patients who aspirate salt water, or develop serious inner-ear problems, are referred to the recompression chamber in Townsville. Most accidents are caused by coral cuts while snorkelling: By the time people arrive, the nasty vibrio bacteria that live on coral have infected the wound. Sometimes, unsuspecting tourists get stung by stone fish. Fortunately, there have been no deaths from box jellyfish since 1968."

As the only female doctor in Airlie Beach, Dr. Jaffee is sought after by local women for gynecology problems, family planning, menopausal medicine and delivering babies.

LOCAL PERKS
After attending medical school in London, England, Dr. Jaffee came to Australia in search of a beach. "I hate cold weather. I love water sports. It seemed silly to live in a country where I could only go windsurfing, swimming or diving, never mind snorkelling, for one month a year." She initially worked in Perth, Western Australia, for eight years.

"I was competing in a windsurfing competition on Shark Bay, where I met a man in the windsurfing business, and married him. Since I'm also a keen sailor, we decided to buy a yacht and sail around the world. We came to Airlie Beach to buy a 53-foot steel yacht. We live on it now, but it's berthed in the marina because I need to be able to step ashore when I'm on call."

What are Dr. Jaffee's ambitions? "Very simple, really. To practice medicine and sail around the world. Right now I'm learning celestial navigation. I've only got one life to live. I want to enjoy it.

"Working and living in Oz is a real bonus. Australians are less formal and easier-going than Brits. They have a great appreciation for nature and each other. You can take them at face value. Doctors here also seem to be more relaxed. There's less hierarchy within the hospital system. I get away with working in casual clothes, which wouldn't be acceptable in the UK. As far as the quality of general medical care, I don't see much difference. Plus, life is just so beautiful here."

 

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