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14 Mar 2019

BY DR SANDRA HIROWATARI, CHAIR OF THE AMA COUNCIL OF RURAL DOCTORS

A hero is someone who ignores the risk to themselves and runs headfirst into danger for a greater good. When we think of heroes, examples like the firefighters running into the World Trade Centre come to mind, but I’d like to acknowledge the unrecognised and unsung heroes of rural Australia. You do it so habitually you do not recognise this yourself, not until one of you is harmed because you ran headfirst into danger. I’m talking about Australia’s rural doctors.

Do you recognise yourself in one of the following stories?

It is a remote area town, not accessible by road in the wet, big enough to warrant four doctors.  But there are only two doctors with no hope of backup. That means you are on a one-on-two emergency room rotation. You cannot leave the other doctor to work 24/7 so you work your 100-plus hours over a six-day period. So does she.  It takes courage to wake up after two hours of sleep to try to attend to an emergency.  Some would call it stupid courage. But we do not give up and we continue to hope that another doctor comes to the community. Are we heroes or robots?

I imagine the firefighters felt a bit of that stupid danger as they climbed the stairs in the World Trade Centre.  Some of them must have felt the hopelessness, the dangers, knowing that there was little they could do. But it’s what they do – it’s what we do – in an emergency. Administrators, hiring agencies, hold yourself accountable to this inhumane roster. Ask yourself, what if there is a bad outcome to the community and the patients? Acknowledge the bad outcomes already occurring for the doctor: ulcers, insomnia and post-traumatic stress. Do not allow that doctor to self-recriminate because she could not keep up with an impossible roster, do not allow her to lose her self-esteem. Instead, see that her efforts are recognised, make sure she is debriefed and assured that this will not happen again. Use Telehealth, use phone consults, just let her sleep. Tell the daytime staff not to wake her for low acuity daytime patients. Working more than 100 hours over a six-day period would be illegal.

Doctor, you know you have trouble with alcoholism, depression, thoughts of suicide.  You try to find meaning in the practice of medicine. The urban rat race practice made you feel even more suicidal, so you changed. You set out on a new path full of risks, challenges and dangers – emergency medicine, trauma medicine, unexpected births. You put your wellbeing aside to help others in the most challenging circumstances.

The Beyond Blue survey found that doctors in general, but especially isolated rural doctors, were in greater danger of experiencing depression and substance abuse.  Urban and Rural Colleagues, keep your eyes on that isolated doctor, they are fragile heroes, and may be lonely. Communities, take the doctor fishing, to a dance or a corroboree. Doctors are members of the community too.

You have a family in big city Melbourne, your spouse does not want to go outback, that is your calling, not theirs, so you fly-in-fly-out. You are providing a service to a community that no one else can or will. The danger is to your family, to your most important relationships.

Rural workforce agencies need to recognise the impact on spouses and families of the pioneering doctor. Provide a stipend to visit their loved one in the outback, give the rural doctors plenty of opportunities for isolation relief. Community leaders, ask the doctors about their families. Even better, entice the family to live rurally, help them to plant roots in the community. 

Fit and healthy healthcare worker, you need your exercise, but there is no gym or swimming pool, and the tyres on your bike won’t survive the spinifex. So you go for a jog in the gathering dusk, Fitbit on your wrist, but out of nowhere a feral dog bites you right on the ankle. A few days later, you need a course of intravenous antibiotics to counter the cellulitis. You come back to the community, but now when you go running you carry two sticks, the dog batters.

Community leaders, rangers, Councillors, please control the dogs. Do not let them run wild, neuter them, make the communities own and tag each dog. Better yet, provide us with gym equipment. Rural incentive payments cannot be used on services that do not exist. We need the infrastructure to keep living our lives. We don’t expect all the modern city life, we don’t want that, but we need the basics. Hiring agencies, why not provide some gym equipment in our units?

Rural doctors, we love our vocation, but we want support. Governments of all levels need to recognise the risks the rural doctors face. It is hard to keep being heroic when you reflect on what it costs. Don’t send us running into 100-plus hour work weeks, don’t cut us off from our families, and don’t send us out into that paths of feral dogs. Acknowledge what we do, acknowledge the personal risk and sacrifice. Support us in your communities. Recognise the heroism.


Published: 14 Mar 2019