For East Gippsland Regional Clinical School student Lauren Tanzen, working in the High Country in a rural GP environment was an unexpected high point. Here is her story.

The GP component of Year 4, primarily at Omeo and Swifts Creek, has not simply been a matter of another year down, attendance ticked off and signatures gathered for the log books.

I’ve found it rather difficult to leave.

To provide an overview of the area and access to health care, Omeo, Swifts Creek and Ensay have a population catchment of around 2,100 across 5,500 km² in East Gippsland, Victoria.  This population is served by one of six rotating, very busy Consultant GPs.  The Doctor on duty provides a 24 hour service at any given time from Sunday afternoon to noon the following Friday. It is no ‘sleepy hollow’.

The GP is supported by nurses at Omeo, bush nurses at Swifts Creek and Ensay, and a daytime ambulance paramedic based at Omeo Monday to Friday.  I learned a lot from drawing on resources around me in the nurses and the practice manager, Tracey Ah-Sam, who taught me much about health economics as well as the auditing and accreditation process (which Omeo flew through).

The Swifts Creek and Ensay bush nurses comprise two of the 15 highly qualified bush nurses in Victoria and, like the GP, are also very busy.  They provide care ranging from maternal child health and immunisation services to medical and surgical emergencies, often traumatic.

The bush nurses are also issued with Ambulance pagers and when able to respond to support the Ambulance service who, for the most part in these areas, are Community Volunteer Ambulance Officers.  These volunteer officers also have day jobs and as such are not always available to respond immediately, leaving the bush nurse as primary response.  The closest 24 hour Ambulance branch is in Bairnsdale, a winding 120km drive from Omeo.

The Swifts Creek outgoing bush nurse, Pauline Fox, a self-proclaimed ‘£10 Pom’, retired in June after 22 years, leaving big shoes to fill.  She is a strong believer in community health promotion and would attend the Omeo show and cattle sales to capture the farmers for health checks, such as blood pressure and random blood glucose checks. She realised the farmers were always too busy to come to the clinic for an assessment so she would be opportunistic at such events.  The incoming bush nurse, Sue Carroll, was the perfect candidate for the job and has seamlessly picked up where Pauline left off.  Below is a photo of Pauline getting to work during a flood – there is generally a half decent flood that blocks off some of the population and closes the road each year.

This is just one example of the calibre of the people that provide health care to these communities, who are a very close-knit and a social lot, which made the year all the more enjoyable.  It’s not hard to catch up for dinner with someone or gather a crowd for a catch up any day of the week.  I particularly enjoyed curry night Wednesdays at the Albion Hotel in Swifts Creek – best Victorian country pub award winner three years running now.

My view is what you put into a placement like Omeo is what you get out of it.  Sometimes I would start at 7.30 a.m. to help with pathology as there were days I knew a dozen patients would be coming in.  The issue with pathology is that it all has to be done and spun by one nurse in the space of about an hour prior to 9 a.m. The courier comes at around 9.15 to take the esky down to the closest lab at Bairnsdale.

After pathology I would then head down to the hospital and touch base with the Doctor and nursing staff.  Omeo hospital comprises an emergency resuscitation bed, four acute care beds, a further 10 high level and 4 low level care beds.  I would do a ward round with the GP when required, write up progress notes and attend to tasks as directed.  This was also the case during the consulting day, in which I would parallel consult with the GP, who is generally fully booked.

The ED is a great set up.

In addition to the clinic, the GP also has to attend to patients presenting to ED, together with patients/residents in the hospital that required reviewing and treatment during the day.

I felt a useful part of the health care team by assessing extra-clinic patients and writing them up.  I would hand over to the GP who would then see the patient and leave me to further management as directed.

I would also go on-call overnight.  I had an arrangement with the nursing staff and GP that if appropriate, with the patient’s consent and without delaying or compromising patient care, I would be called before the GP.  I would then attend, assess and write up the patient, call the GP and give a phone handover.  The GP would then attend, give direction and oversee management.

During the year some palliative patients spent their final hours or days at the hospital.  Omeo has a great palliative set-up.  They cater for family members who may have travelled quite some distance and perhaps need to stay for extended periods during the last days of their loved ones.

Assisting the GP overnight and spending this time with families before, at the time and afterwards, has been quite a valuable experience.  Treating the family is every bit as important as treating the patient.  This may sound obvious, but I was taught many subtleties to this that are difficult to put into words.

In down-time, there’s plenty to do to stay active.  The riding and skiing are awesome, as is the walking and horse riding.  Dinner Plain/Mt Hotham is a 35 minute drive away and you will become very good at climbing high country hills on the bike.

There is much we take for granted in cities and major regional centres, for example, imaging was quite a consideration.  Clinical diagnosis and close follow-up was at the fore.  A plain x-ray or CT is a full day exercise for this population, let alone co-ordinating something like an MRI, 300km away, and then only available two days per week. Otherwise it’s Melbourne, 450km away.

The closest pharmacist is also in Bairnsdale.  Scripts need to be faxed to the pharmacy by 1 p.m. so the pharmacist could have everything ready prior to the local bus returning to Omeo, who would then deliver medications to the depot in town by 4 p.m. for patient’s to pick up.  Patients after 1 p.m. would have to wait until the following day, drive to Bairnsdale themselves or pay for medications that may have been available in the hospital store.

Mental health services for the region come in the form of a wonderful social worker, Bill Neucomen.  He taught me much about the community, the daily and seasonal ebb and flow of farming, associated stressors and ongoing history.

For example, in the 2003 bushfires there was no loss of human life, but the generations of stock blood lines lost have quite an ongoing effect today.  It takes generations to rebuild and having to do this in a difficult financial climate whilst being seriously hampered by feral dogs takes a huge toll.  The intricacies of farming is something rural doctors need to appreciate in much more depth than I previously considered and I am in awe of the resilience of these people.

Witnessing how people seamlessly rally and overcome access barriers to provide both urgent and ongoing health care has been invaluable.  I have certainly seen 4WD utes come into their own in patient retrieval, as well as friends and neighbours checking in on each other, getting each other to appointments and out and about for some Vitamin D.

The greatest compliment an ‘L’ plater like me can receive is a patient telling you they’ve been discussing taking up a collection to keep you. And to make sure I phone in my results so they can go up on the blackboard at the pub – a very privileged place to have your name indeed.

I highly recommend future students seek out a location such as Omeo as a great introduction to GP and rural practice.  You will be most welcome by the health team and community and won’t be left short of broad experience and resourcefulness that cannot be replicated in the city.

–          Lauren Tanzen, Year 4C 2012, East Gippsland Regional Clinical School, Bairnsdale campus

This entry was posted on Monday, February 4th, 2013 at 2:33 pm and is filed under East Gippsland RCS, Public, Student news. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.