The medicine is unique, owing to population characteristics and remoteness. This includes plenty of work in GP, emergency, hospital wards, and outreach clinics to the outer islands of the Torres Strait (via helicopter!) or the other communities in the region via road. Unfortunately, the burden of diseases like diabetes, obesity, heart disease and their preventable complications are key health issues for Torres Strait Islander Australians. In Bamaga, I came to know many patients well and recognise the underlying issues affecting their health. Distrust or dislike in taking medication, difficulties in quitting smoking or sugar, or previous dissatisfaction with health care were some of the challenging barriers that we encountered often.
Like the landscape, the medicine too changes with the seasons. During the wet months, infection is a predominant presentation. For weeks, the ward on Thursday Island was mostly skin infections. Diabetic wounds in adults, or skin sores and bug bites in children, were the most common denominator. Additionally, the usual antibiotic regimes down south are rendered useless here, as superbugs such as Methicillin-resistant Staphylococcus aureus (MRSA) rates are well beyond 30%. For children, this meant frequent painful injections with a long-acting antibiotic to prevent acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Holding these children down while they cried in pain was very difficult indeed, but something that I had to get used to. Despite our ongoing efforts, ARF and RHD here have the highest prevalence rates in the world, and during my time in Bamaga I saw several cases of ARF including the kidney complications that come along with it, and plenty of RHD.
There are also many environmental dangers present. Toward the end of my placement in Bamaga, a young patient passed away from a fatal box jellyfish sting while fishing nearby. It was the first jellyfish fatality in Australia in 15 years, with the last one also from Bamaga. I dared not step foot in the water for the entire time I was there because of this.
Despite its highlights, this placement was the most difficult I have been on thus far during my six years of medicine. This type of medicine is not for the faint-hearted. With the endless rain, roads up the Cape flood and become impassable, and flights into the region are often cancelled making the feeling of isolation and remoteness more apparent. For much of the placement, I experienced significant isolation and loneliness. I found that becoming connected with colleagues and the local community was vital to surviving in such remote places.