Hello! My name is Becky, I am a final year UNSW medical student in 2023 and I have just returned from a two-week elective placement with the Royal Flying Doctors Service in Broome, WA. This was an opportunity that I was eligible to apply for in the context of studying at UNSW’s Wagga Wagga Rural Clinical School. It was an experience that I’ll never forget!
In short, my time in Broome was close to the best two weeks of my entire medical school experience so far. At several moments during the placement, I pinched myself just imagining how excited 15-year-old me would have been knowing that she’d one day be doing and seeing these things. The whole experience was truly amazing. The medicine was fascinating and varied. Oh, and I got to fly home in the cockpit twice too…
I chose to apply for this elective placement because I was hoping to increase my exposure to remote and indigenous medicine. Australia is almost the only place in the world that is large enough and simultaneously well-resourced enough to facilitate this type of remote medical retrieval service on such a large scale. And of all the places in Australia to get the best sense of this, WA is the place to go. Furthermore, I felt like I had thus far been somewhat limited in my exposure to indigenous medicine, and it was important to me to rectify that before I enter the workforce next year.
For those of you who don’t know, Broome is a town of about 15,000 locals (and up to 30,000 tourists during the dry season) located about 2250km north of Perth and 1850km southwest of Darwin. It hosts the largest referral hospital in the northern-most part of the state which services the many remote towns, indigenous communities, farm stations and mining sites found in the Kimberly region. Broome airport hosts the second largest RFDS base in the state with three of the more famous Pilatus PC-12 turboprop planes and one of the state’s three new larger jet-engine aircrafts. These planes can transport more patients and are able to travel further without having to divert to refuel. As a consequence, the Broome base frequently services patients in the Pilbara region too. This was just one of the many ways that being placed specifically at the Broome base improved upon my experience. I was able to get a better sense of the mammoth task that is coordinating the distribution of RFDS resources across the state. There was more than one instance when we were already on the tarmac preparing for take-off when we’d be re-tasked to pick up a sicker patient further afield.
Ultimately, I flew every day of my placement often traversing the distance of Sydney to Cairns and back on successive days. Western Australia and especially the Kimberly are ridiculously beautiful from the air. In the same day we’d fly over turquoise coastline, semi-arid desert, and areas still flooded from the latest monsoon season. The extent of remoteness and WA’s often hostile climate (the humidity KILLED me - 90%+ most days) proved how the management of both common and rare pathologies is made all the more complicated/interesting simply because of the setting in which you’re practicing.
The logistics and money involved in the delivery of healthcare to patients in remote areas was honestly hard to wrap my head around. It was truly mind blowing to me that Perth is the only city in WA that has a hospital with an intensive care unit. Crazier still, was the fact we transported patients the entire length of the west Australian coastline just to undergo surgical treatment of a broken arm or to get an MRI. Being on placement with the RFDS did sometimes mean getting involved in mid-air resuscitations, but more often than not it meant providing a rather exciting version of a patient transport service. This was something I was glad I understood before I arrived because otherwise I might have been disappointed by the relative lack of prime-time TV level drama. However, for every slightly underwhelming case of a broken arm, there was many more cases where we transported patients because they’d gone into acute organ failure, or so they could be worked up for a new cancer diagnosis or receive treatment for serious burns.
There was one particularly memorable instance where I had flown out on a charter plane with a team of general practitioners and allied health professionals to a primary care clinic in a remote indigenous community over 500km from Broome. We had been seeing patients for several hours already when a patient walked into the clinic in late-stage septic shock. To make matters worse she then developed an anaphylactic reaction to our first-line antibiotics, and we had to figure out how to keep her alive and get her back to Broome with only two vials of adrenaline, 4 litres of fluid, no resuscitation drugs and no RFDS plane available to pick her up for 10 hours. This particular case provided me with a lesson in clinical resourcefulness that I’ll never forget. It's safe to say that I was inspired by the whole RFDS team – the doctors, nurses, pilots, and operations staff alike.
This case and the broader experience of the elective also made me appreciate how tough people living in remote regions of Australia are. They cope and cope and cope and only seek help when they really need it, it’s like toughness and resilience is coded into their physiology.
Sadly, this case was the first of many cases that exposed me to the reality of Indigenous healthcare inequalities in our country. I saw lots of acute rheumatic fever, and rampant early onset type II diabetes and kidney disease. The obvious impacts of mental illness and drugs and alcohol was evident and heart-breaking too. Being able to put faces to the devastatingly familiar statistics made them all the more enraging. It’s unbelievable these kinds of disparities could exist in a country as affluent as our own.
On a separate but equally sombre note, it is impossible to deny the enormous carbon footprint of this aerial healthcare delivery model. For now, I guess it must be the price we pay as a society for equitable access to healthcare for all Australians. Unfortunately, I did see first-hand the impact that climate change has had in the Kimberly region in last few months. Massive flooding events have wreaked havoc, washing away roads and bridges leaving whole towns completely cut off in both directions to either Broome or Darwin. It was a timely reminder that dealing with the medical consequences of environmental degradation and climate change will be a part of my scope of practice regardless of the area of medicine I end up going into.
I’ll finish up on a less serious note though. During my stay, I lived at a backpacker hostel in Broome. When I wasn’t watching them from the air, I caught every ocean sunset down at the beach with the friends I had made at my accommodation. I might as well have travelled thousands of kilometres overseas for my elective - I think I was one of two Aussies living at my seventy-five-odd bed hostel. My trip also coincided with the Mardi Gras Festival which as you can imagine was a rather large night out.
All in all, I feel extremely fortunate to have had this amazing experience. Honestly, the only things that could have made this placement better would have been if I could have gone for longer and if I’d had an opportunity to fly in the helicopters too. I want to thank everyone who helped to make this placement possible and strongly encourage all of you to consider applying for rural and remote medical placements during the course of your degree at UNSW – I promise you’ll regret it if you don’t.