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08 Nov 2016

By Dr Alexander Saxby, Royal Prince Alfred Hospital and Sydney University

From the moment the plane’s wheels leave the runway at Bankstown I begin to smile. I know I am with friends. I know I am going to a very special part of Australia that relatively few get the opportunity to visit. I know I am going to spend two busy but rewarding days, hopefully making a difference to a couple of communities which have become very dear to me over the last two years.

For me, quite simply, it is a breath of fresh air.

We all lead hectic lives in the city, where we can become overwhelmed and enveloped by our clinical commitments, operating, teaching, lecturing, researching and so on.

My trips to Brewarrina and Bourke every couple of months are a reminder for me of what is really important. Making a difference to people who really need our help and really appreciate it.

Since 2014, I have been very privileged to be the ear, nose and throat (ENT) surgeon on a team that travels out to the communities of Brewarrina and Bourke. Our entourage includes an endocrinologist, a social worker and myself as the ENT surgeon. But our small plane always accommodates additional team members which, depending on circumstances, might include students, registrars, allied health practitioners or others whom we feel could benefit the project. The program is coordinated through the University of Sydney’s Poche Centre for Indigenous Health, which was established in 2008 following the generous philanthropic actions of Greg and Kay Poche, who have gifted more than $50 million to Aboriginal Health in the last decade.

Brewarrina is a small community of about 1100 residents lying approximately 800 kilometres north-west of Sydney.

It has a very rich Aboriginal history and is home to one of the oldest man-made structures in the world, the Brewarrina Fish Traps, which are a beautiful reminder of the location’s important cultural significance. Dating back 40,000 years, this collection of rock pools has been used for thousands of years to catch the fish of the mighty Barwon River.

We land on the small strip of tarmac just outside of the town and are met by the fantastic team of the Brewarrina Aboriginal Medical Service. Our clinic runs for the greater part of the day, where I will see a wide diversity of ENT conditions.

There are many challenges in treating patients from remote communities, not least the huge travel distances involved should surgical intervention be required.

Sydney is about 12 hours’ drive from Brewarrina. Families will then often need to stay in the city for a prolonged period in case of any complications, which poses accommodation difficulties and keeps patients away from their communities. Follow up is possible at the next outreach clinic, but that may not be for a number of weeks.

A key aspect of the Poche model is that the same physicians are used on each trip, improving trust and rapport with patients in order to achieve better continuity of care – something we feel is crucial for the success of outreach programs like this.

A wonderful feature of every trip is the dinner held on the night between the two days of the clinic. Poche realised that this represents a wonderful opportunity to bring all of the carers involved together. The dinners are attended by the local GP, nurses, care workers, hospital administrators, pilots and anyone else involved with making the trips a success.

In the winter we will sit around a roaring fire under the stars and exchange stories and ideas.

This is one of the most enjoyable and, I am sure, beneficial parts of every trip. It brings the local and visiting teams closer together and promotes communication and comradery which we believe translates into a better standard of care for all involved.

Outreach clinics like this are one way to overcome the geographic isolation of these communities, enabling access to specialist services like otolaryngology.

Telemedicine, mobile hearing screening buses, Australian Hearing rural centres and, most importantly, the local team of nurses, general practitioners and community health workers, are other critical features in providing the care required.

One problem is that such clinics are often independent, run either by philanthropic organisations such as Poche or individuals who generously give their time, but with little knowledge of what other outreach programs are in existence.

This is something the Poche Centre is actively trying to rectify in an upcoming audit project commencing this month. The O.P.E.N. Survey (Outreach Programs for ENT services in NSW) has been set up with the collaboration of Aboriginal medical services, researchers and doctors from the University of Sydney and UNSW and the AMA. It intends to map all of the current outreach ENT programs taking place in NSW to better understand where gaps in coverage exist, and to better coordinate provision of services to these rural communities.

Ear health statistics show incredible discrepancies between Indigenous and non-Indigenous Australians. Approximately 10 per cent of Indigenous children experience ear problems, compared with just 3 per cent of the non-Indigenous population. Indigenous children are twice as likely to experience otitis media as their counterparts.

The impact of this increased ear disease and hearing impairment is huge, and can affect language development, education, social interaction and employment, with far reaching implications for more complex social dynamics such as contact with the criminal justice system, so treating such issues early and effectively is crucial in redressing the balance for these remote and rural communities.

I would highly recommend anyone who is contemplating becoming involved in an outreach program, whatever your medical discipline, to jump at the opportunity.

The rewards for you are just as big as for the community you will be helping.

It is incredibly fulfilling, exciting and interesting and, thanks to the efforts of groups like the Poche Centre, we really can make a difference for the future.

An ABC News story on the Outreach Clinic was broadcast last month and can be viewed at:

For more information about the Poche Centre for Indigenous Health, go to:

Published: 08 Nov 2016