My first boarding pass read “Bavelin Gill” with the departure point as Cairns International. I landed at Grand Forks International Airport 11 plane flights later, and significantly colder. Misted breath, glittering snow, and bright sunshine was my first experience in Harvey, a small town in the mid-western state of North Dakota in the United States of America. After 32 hours of travel the ute (or pickup truck) arrived at my destination and I jumped out, ready for my next experience – a rural medical placement in a town with 2000 people.
My mentor, Dr Nyhus was a key person in the town of Harvey. He was involved with the local hospital, St. Aloisius Medical Centre and the Central Dakota Clinic. He consulted patients at the hospital, was on-call for serious health issues and emergencies, and treated patients with a holistic approach at the Central Dakota Clinic. On weekends with Dr Nyhus and his family, I took part in various activities that a local North Dakotan would do, such as ice fishing, sledding, cross country skiing among others.
The Central Dakota Clinic was where I spent most of my time during placement. At the clinic, Dr Nyhus and I consulted many patients from all walks of life. After observing Dr Nyhus with his patients for a couple of days, I became confident in my own ability to see people coming into the clinic. Upon recognising this, Dr Nyhus allowed me to see patients on my own. During the consultations, I took histories, listened to heart and lung sounds, and performed various clinical examinations. We also attended to patients at the emergency department and the outreach clinic in Fessenden where I was able to again get hands-on in the rural community. My confidence increased through the continual encouragement and opportunities to step outside of my comfort zone and practice new skills.
Once a month, Dr Nyhus performed colonoscopies at the local hospital. With a passion to learn new skills, this was a definite highlight from my placement. I tied my hair up and headed into the theatre, excited for the procedure. The rush of adrenaline from being in the theatre was exhilarating. Dr Nyhus was particularly supportive and he was willing to teach me the ropes. He did the first colonoscopy himself while explaining the technique. Under his guidance and supervision, I performed the retraction of the following colonoscopies for the day. This was definitely a privilege and an experience I was grateful to take part in.
When it came to rural medicine, there were similarities to rural Australia, yet startling differences were also present. Health conditions such as diabetes, hypertension and arthritis were common in both Australia and the United States. In the frigid climate, cases of the common cold and frostbite were more apparent. Differences in rural medicine were significant in the access to healthcare facilities and the costs associated with seeking health care. Unlike rural communities in Australia, much to my surprise, Harvey was extremely well-equipped, with a hospital and three GP clinics to serve the community of fewer than 2,000 residents. Dr Nyhus also shared stories of patients who accumulated bills of $70,000 for emergency presentations. Ironically, with the abundance of healthcare services available to the residents of Harvey, these facilities became inaccessible due to the substantial costs associated with seeking healthcare.
Every weekend was filled with wonderful different activities. On two occasions, we travelled to Dr Nyhus’ family lake house in Minnesota. Despite the four-hour journey, the breathtaking views of the icy lake never failed to revive our spirits. Dr Nyhus’ family was very welcoming, they also invited me to their son’s graduation, Christmas lunches, and dinners. I was able to truly indulge in the North Dakotan culture, I went sledding in the dream-like snow, flying in the picturesque sunsets, hunting in the fields of sword-like cattails, and clay shooting, which left me with a painful souvenir - a big blue beginners’ bruise.
For a girl who grew up building scarecrows with sticks, the opportunity to build a snowman out of cold, crunchy snow was a whole new delight. My fondest memory was one wintry night when the temperature was ‘warm’ around -7°C and we chose to relax in a hot tub while the snowfall peacefully became one with the hot steam. In hindsight, I can’t believe I forgot to pack my swimmers!
One month in the North Dakota winter was so long yet so short. I immersed myself in the loving community and the rural medicine I was so eager to practice, but I could easily spend another month with the incredible people I met.
A core element of my life has been a constant search for new experiences that challenge me mentally, physically, and emotionally. This thirst for new adventures has most definitely broadened my horizons as it has allowed me to gain a more holistic and global perspective on rural healthcare. Although the young farm girl in me felt uneasy when packing her boots and Tim Tams to share, her worries were quickly swept away by the warm hugs and love she received. Needless to say, I will forever long to sit in front of the fireplace with the Nyhus family and a hot chocolate warming my hands.