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No, we do not have a CT scanner

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BY DR SANDRA HIROWATARI, CHAIR, AMA COUNICL OF RURAL DOCTORS

The term “Ivory Tower” refers to an erudite and learned institution considered to be an ultimate source of expertise but who is out of touch with the realities of life and hardships on the front line. For rural doctors, it sometimes feels like our colleagues in metropolitan locations do not quite understand life in the Outback.

I make calls to the Ivory Towers frequently for assistance.  At the outset, I am hoping against hope that I do not have go through a little Australian geography lesson to the harried young registrar on call overnight for the intake requests.  I hope for their understanding of our resources and what it is like to be distant from equipment, consultants, good internet and other supports.

Sometimes we are lucky and the voice from the Ivory Towers has experienced life in the Outback. These individuals can commiserate with our work and are sensitive to our need for support.  However, here are some of examples of the conversations I have had as a rural doctor:

“Hi, I am calling from (e.g.) Ngaanyatjarra, that’s pronounced ‘nununduda’. If Australia is a kidney bean, then a little to the left of dead centre of the bean is where I am calling from. You know, “the desert”.  I don’t imagine you have been here but you’d see Uluru on the way.  Also the canyon (sorry the “gorge”) that is voted the best gorge in all of Australia.  Never heard of it?  Kings Gorge (sorry Canyon).  On my drive through the “Lands”, we saw and saved a little thorny devil.  No, I am not being cheeky, that is the name for those cute little creatures.”

“No, I have not obtained a CT scan of the brain.  We are a 24-hour road trip to the nearest CT scanner.  Either “Kal” (i.e. Kalgoorlie) or “Alice” (i.e. Alice Springs) is about the same distance.  That is WHY I am calling you.”

“Hi, I am calling from Northwest WA. I need to ask you to take on this patient for ORIF of femur.  I am calling interstate because, doctor in Darwin, NT, you are about nine hours by road away but Perth is 36 hours by road and by air requires a jet aircraft to transport my patient because a prop plane will have to refuel.”

“G’day, I am calling from mid-size town, QLD. Yes, we do have a CT scanner in this town! … but the only person who mans it works normal banker’s hours.  I realise that for you to give me good advice, we need that image of the fracture but it is a bumpy road to the CT scanner and requires an ambulance trip to the scanner and then back again. We also need to wake up the one and only radiographer who has to work a full day tomorrow.  Could you take this patient on by retrieval because the time and effort in getting a local CT scan is not worth the amount of pain it will cause given the patient will likely need to be transported anyways?”

“Sorry doctor in Brisbane, I have not done platelet count. That is not included in our point of care testing.  Yes I know, the coags are important, will an INR do for you?”

“Good Evening, I am calling from Aurukun.  No that is not in India, it is a town in the Cape, within Australia, in fact we are just a little Northwest of you.  Looks close on Google maps but in fact we are about 24 hours by road, but no matter, the roads are flooded, there is a river going over it this season.  No I have not obtained an ultrasound of the testicle because the only ultrasound person here is me and I have not been trained in testes.  That is why I am calling you.”

“No, doctor in Adelaide, I have not done a BNP, I cannot do that here by istat.”

“Thank you for sending Flying Doctors to me see in Ringers Soak. Now, I need to get out to the airstrip now to chase the kangaroos off the runway.  Ringer’s Soak?  Well, it is a little south of Halls Creek. No, not Falls Creek. No, not Halls Gap.”

“Thank you for sending Careflight to me, we need to now drive to the flooded road, get our little tinny out to punt our patient across the new creek, by the way, did you know that we have lots of crocs here?  They like creeks and feeding at night.  Hope they are not hungry.  On the other side we have signalled for a 4 wheel drive on meet the tinny to transfer our patient to the airstrip on the other side of the flood.  Wish us all luck and good torches.”

Thank you, Ivory Towers, for taking our calls and not rolling your eyes at us.  Thank you for your patience and for understanding the Australian Outback.  Come visit us sometime, we can take you fishing (just not in the creek with the crocs).

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