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Hello, I'm Norman Swan.
Welcome to this very special Rural Health Education Foundation program.
It's on women and rural medicine.
There are more women than men training in medicine,
starting to be more women going into general practice,
particularly in the country,
particularly international medical graduates.
And there are issues which are specific to women making this choice.
We need more female doctors in country areas
because country people want female doctors,
as well as male doctors.
There often are real issues that might be happening in families
that can be spoken about to your female GP,
and... 'cause the women on the farm are also gonna have issues
that maybe they can't go and talk about to the male GP
if he's friends with their husband.
There's a lot of challenges in getting doctors into rural and remote areas.
I work in an area that is relatively close to Melbourne -
depending on the traffic, you can easily get there within a couple of hours.
But even there, we can't attract doctors.
They don't seem to want to come and do the style of medicine
which we do,
which is very sad because I think it's a very exciting place
to practise medicine.
In over 12 years, I did flying clinics
out to places like Bullyard and Birdsville,
and you're flying over really some of the most beautiful parts of Australia.
And... you know, I used to think sometimes, looking out of the aircraft,
'Oh! I'm being paid to do this!' I mean it was absolutely beautiful.
NORMAN: And now let's meet Jen Delima, who currently works in Alice Springs.
JEN: Hi, Steve. Wanna come through?
She initially left Sydney to work in a remote community in Central Australia.
JEN: Kintore is 540km due west of Alice Springs.
We had to catch a chartered plane out there,
a little four-seater plane.
And when we first went out to have a look at the community,
um... Alice Springs or Central Australia had a big wet.
So Kintore had not had any communication with Alice Springs for two plus weeks,
which meant there was no food that had gone into the community,
no money, no provisions.
So we were the first plane that had arrived in there,
um... and with us came the money tin for the people to be paid,
to be able to go to the shop to buy food.
There was a lot of people,
the whole community there, speaking a different language.
I had landed in another country... and I was scared.
My first impression of that place was I was terrified,
and I wanted to get back on that plane, and back to Sydney... quick.
But the plane had left and we were stranded
for at least another 36-48 hours before the plane would come back.
I'm thankful... very, very thankful, because we then met the community.
Our son had time to just play and enjoy himself
while we were talking to the elders and...
At the end of that 36 hours,
all three of us knew that we were coming back.
The community were very, very welcoming.
They couldn't facilitate more than... than they did -
socially, work-wise.
Some of the women there took on to be my mentor.
Without them, I'd be lost,
because so many times I would start off in the wrong direction,
and they would be, 'No, this is how we do this.
This is how we'll do this.'
They were... they were my great advisers,
and they may not have had medical training,
but they made life easy.
My greatest fear was would my emergency skills
stand me in good stead?
Could I actually manage without all the props of an emergency department -
all the facilities, the amenities, the other staff?
Um... could I do it?
Would I ever be able to go to a proper Third World environment
and survive and be useful?
I've always been a city person,
so general practitioner was the general practitioner in the city,
who did the start of things, never got their fingers dirty,
never got to do things,
and so, that could never be me.
But going out to the community,
the generalist medical practitioner does everything.
You've got the emergency medicine stuff,
which, you know, sets your adrenaline on fire,
but then you've also got that patient, their background, their home -
you have the potential to do a door-to-door service.
You're involved in the transport,
you're involved in their social situation,
you're involved in their financial situation,
you're involved in every aspect of that person.
- You've got Rotary tonight? - I'm going to Rotary.
JEN: Paul was studying with the School of the Air,
but that requires an adult to be a tutor with the child,
and take them through... specially through primary school.
And that was Peter's prime role.
So he was Paul's tutor.
And Paul had not been doing that well in Sydney with his studies,
um... and this child just blossomed.
Within... within three months he had blossomed,
he was learning with such enthusiasm,
and the two of them just... were working so well together.
I think it's a great opportunity for children,
and it takes them outside of their comfort zones,
as it does for most people that take on a new position or whatever.
So Paul was readily accepted
into a group of young Aboriginal boys and girls,
and they'd just disappear for hours,
and quite often we wouldn't see them from sunrise to sunset.
When we quizzed them as what they did all day,
they were just roaming around the bush and the sandhills,
and... you know, eating native foods and berries,
and even to the point of catching birds and having them for lunch.
Yeah, it went really well.
PETER: It had a very positive effect on him,
and also, I think, now that he's 16,
we're seeing a high level of independence in him.
Um... and self-resourcefulness.
And I... I'd put that down to, you know, those sort of experiences.
I think we realised that we were going to be...
..never returning to Sydney as our home
probably within that first year of being out at Kintore.
For our family, it was where we needed to be,
the space we needed to be, the lifestyle that we wanted.
Um... for Paul, I couldn't better his schooling.
I suppose, for me, that was number one - I could not better his schooling.
Career-wise, for me it was...
career-wise it was where I could... there was... the world was my oyster.
Um... the permutations, the combinations of practice were just...
..and have been just enormous.
NORMAN: Eventually, Jen settled with her family in Alice Springs.
So is that an early morning meeting or is it later in the day?
JEN: The whole day, so that's the whole day.
Now I've actually slowed down and so I'm doing drug and alcohol medicine,
so addiction medicine and *** assault medicine.
Um... and between those two clinical roles,
I'm involved with education of medical students and GP registrars,
some of them as remote GP registrars.
So they're out on the remote communities.
And I'm regularly teleconferencing with them...
Hello, Peter. How are you? How's your week been?
..as their support person, their mentor and also as helper with their training.
OK, Peter, I'll fax that through to you. I'll mark it up.
In the big picture,
the finances are not at that level of what the city person would earn.
And I guess you do...
I know that OK, I would be earning differently
if I was in that city environment.
But... the balance on that is the lifestyle that I'm enjoying.
Um... the balance is the career challenge.
(Birds chirp)
PETER: Alice Springs offers everything.
I'm definitely not impressed by traffic and the humdrum push of cities.
I'd much rather live in a small community and have an identity as well,
you know, where you go into a shop and someone remembers your face.
JEN: The ability to use your time, every moment of your time,
is valuable time.
Every activity you're involved with can be a quality activity,
rather than sitting in the car for 2.5 hours driving.
I have a bicycle as well.
I'm getting myself coordinated in cycling,
and, you know, it's lovely to be able to cycle to work,
and there's no smog,
and as I'm not a hugely confident person in these sporting arenas,
um... for me to be able to do that is a huge step outside of the box.
Right, Steve. How have you been?
- Good, thank you. - Good.
JEN: For someone who really wants to practise medicine in its purest form,
that is be a health healer/carer,
this is the environment that allows you to do it -
to look after your patient as a whole person
that links with their community.
- Sleeping well? - Yes.
JEN: You can't do it in any other environment, I don't think.
This is where people are in need and I can make just a tiny difference,
bring that humanity, bring my skills, bring whatever little I have to offer.
So you get that... the city has lots of doctors,
lots of services, lots of everything in comparison.
And this is where you've got that match
between what you went into university to study, to do,
and you can do it.
NORMAN: That's all very well for the rural GP,
but how about her husband or partner?
My husband was a teacher originally.
He elected... we decided that he would be the main person at home
and I would go out to work.
And so he stayed home, brought up the children,
and has seen no need to go back teaching.
I work with my husband. He also is a GP, rural doctor.
My husband came to the rural practice
because he wanted to work in the country,
he wanted the breadth and the independence, I think.
The reason I actually went there
was that my husband had started a business there,
and... which involved him visiting Cloncurry.
And we just thought it was an opportunity
to try and actually do something with Cloncurry.
NORMAN: And that was a lucky break for Cloncurry.
SHEILAGH: From a situation where, three years ago,
there was one locum doctor
trying to look after a hospital and a community of 5,000 people,
totally on his own, being on call day and night,
and going, you know, really... almost crazy with tiredness,
we now have a situation where we have between four and five doctors.
We have a brand-new facility, we teach medical students,
we have registrars.
NORMAN: OK, well, let's now go to a rural practice in South Australia,
where there are two women GPs,
one of whom is an international medical graduate.
ANNETTE: Barmera's about 250km north-east of Adelaide,
on the Murray River.
Barmera has a huge, beautiful lake - Lake Bonney -
which you can yacht on, you can windsurf,
and the birds are... well, we take the birds for granted,
but everybody else notices the birds.
It's a population of about 4,500.
We service about 6,000
'cause there's quite a few small, little towns around us.
Plus the Riverland's actually five towns, all round about the same size.
So sometimes we see people from other towns as well,
and they see our patients as well.
(Birds chirp)
We have 3.25 full-time equivalent doctors here,
two full-time male doctors.
I work about three-quarters time and the other female doctor works half-time.
We also have a registrar at the moment.
We often have two registrars and we have full-time students all the time.
- Here's the flu injection. MAN: Alright.
OK, to the nurses. Good morning!
ANNETTE: Elizabeth's our half-time doctor.
She came with her husband as an overseas-trained doctor from Kenya -
came about seven, eight years ago.
When we did the interview to come over to Australia,
they did want to find... they did ask us what exactly we wanted -
did we want to work in the city, rural country,
and about how big a population would we want to... would we be happy to work in.
We had not much idea about Australia, but we gave them an idea.
And when we did come for a look-around to Barmera,
we met Dr Newson, who took the day off to actually take us around.
And then all their staff in the clinic, they had a lunch for us, waiting for us.
So they really were welcoming
and they were ready to give us, the two of us, positions,
and be flexible enough 'cause we had two little children.
That was something they really stressed,
that they would give us time to settle in.
Childcare was a problem, so they helped us find childcare.
And then schooling, we were shown the different schools available in the area,
and then housing, where we would have to stay.
They had organised a unit for us.
So we went and thought about it overnight,
and we liked what we had seen, what they had offered us,
and... yeah, when we went back, we decided Barmera would be it.
Elizabeth and Raphael,
honestly, I don't think anyone ever thought about them
being overseas-trained doctors.
They're excellent doctors, so the town was just happy having them.
That was actually quite a surprise.
We didn't think they would accept us that easily,
but they were really quite welcoming.
They came in to see who are these new doctors,
'cause we were already been put in the newspaper
that we are coming in this little village.
So they already knew, wanted to know more about us,
very welcoming.
Um... and some have continued being our patients
since the first day we started seeing them.
They still keep coming back, so... No, it's really been lovely.
Very few minor incidences with very few people,
but they've also turned around.
In fact, they end up becoming your good friends.
Is that all? No other medical problems in the past?
- No. - Have you got sore ears?
No, not anymore.
ANNETTE: I moved here about 18 years ago.
Before that, I was working in the UK. And there were four doctors here.
We were a busy practice with a very busy hospital.
At that time, I did a lot of obstetrics. I used to do about 50 deliveries a year.
Since that time,
more of the services have been concentrated in the regional hospital,
which is 20km away.
Obstetrics has been closed in Barmera, theatre's been closed,
and accident/emergency is now only open
between 8 in the morning and 6 o'clock at night.
And we do a GP after-hours service until 10 o'clock at night,
and then after that, everything is diverted to the regional hospital.
I was Annette's first patient when she arrived in Barmera.
The day before she was supposed to start, the doctor that I was to see
wanted to sneak off and Annette took it on.
- I can't even remember that. Yeah! - I spent a few days in hospital.
That was an organophosphate poisoning. Wasn't it?
It was.
ANNETTE: Because we've lost quite a few services,
we've had to think about how we might attract doctors,
and we felt the best way was to start
to develop a more family-friendly and flexible practice.
So what we've tried to do is make it
that anybody who comes to work in our practice
can develop a work any way that they like.
But I suppose females just prefer to work more limited hours.
We earn a little bit less, but not a great deal less,
and I certainly earn as much as the men do.
Whereas if they want to come here and earn more money,
and work harder, then there's plenty of work.
They can also do accident/emergency work in the regional hospital
that's only 20km away.
And we've made it flexible in the surgery,
so we all work hours which are flexible.
- Mm. - So... which works very well.
Otherwise we wouldn't be here.
I wouldn't be here if it wasn't family-friendly.
It is very family-friendly.
We put a big emphasis on that.
ELIZABETH: 'Cause I'm part of the practice
I'd want to work as much as everybody else, but I just couldn't.
No, you might just need to take some time over the school holidays,
or the children will get sick.
So having a very flexible practice does help.
So you've been keeping well since I last saw you?
- Yeah. - OK. OK.
ELIZABETH: I've really changed my working hours since I came to Barmera.
Still plenty, or have we run a bit low?
- No, no. ELIZABETH: That's all settled?
As the children have grown, my working hours have really changed most times.
But now they're more stable, now that they're in school.
At the moment, we probably have got a little balance,
'cause I'm not doing as much emergency medicine anymore.
Did you carry your ballet bag?
So I'm not as stressed or rushed as I used to be.
Because that used to be a bit hard, that used to really take a toll on us,
and that was not good for the children.
You have a good day. All the best. Bye-bye.
Generally we are happy where we are at the moment, in our life.
We've become citizens in the last two years,
so we feel quite settled.
We always think that it's better to have doctors who stay here a long time
than doctors who work incredibly long hours and stay a short time.
So that's why we've tried to make our practice one
that people can choose to work shorter hours or longer hours if they want,
depending on what stage of life they're at.
Do you still work?
Sunday evening - go get the ironing done for the school uniforms.
ANNETTE: Elizabeth only works school hours, which is fine with us,
and the only time she has trouble is sometimes picking kids up from school.
But often the receptionist or one of the other doctors' wives or something,
if they're picking up their kids, will bring them all back to the surgery,
and we might have up to ten kids at our surgery after school.
So we're actually considered the number one place for kids to come after school.
We just run out of biscuits sometimes.
We encourage people to take at least a week's holiday every three months,
so that means at every three months, you get a break.
And then once a year, we take three or four weeks off,
so we can have a long holiday,
and over Christmas, we encourage everybody to take four or five days off.
It might be if you're working Christmas, you get the New Year period off.
You're gonna be good and stay there? Good dog.
Yeah, a few plants. We'll get a few plants out here.
We've... Well, I have grown in the city, but I didn't mind rural sort of setting.
Raphael had done both,
and we just thought for the children,
we'd like to bring them up in the rural country.
It's a fantastic place for kids to grow up.
It's just there's so much to do.
I grew up in an area like this, which is why I love it so much.
You know, you can be out in the bush, you can have animals,
you can be swimming, you can play sport as much as you like.
So it's just a really good, healthy way to grow up.
ELIZABETH: We're supposed to get another chook, we'll get another chook.
I might try and do that for you tomorrow.
We discussed once, many years ago,
about why people came and did... came into rural medicine,
and I think it's because, I came because I love the lifestyle.
That's the reason why I've stayed here.
(Dog barks)
ANNETTE: Now I live on 8.5 acres of heritage-protected land,
which is like living in the middle of a national park.
It used to have three big lawns which we've taken out,
and we've put in a swimming pool which actually is water neutral.
I have no streetlight so my skies are beautiful
and my... well, as you can see, the weather's just magnificent.
Because I'm single, I actually like going back to Adelaide a lot.
So every second or third weekend, I actually drive back to Adelaide.
And if you do the maths, because it only takes me seven minutes to get to work,
I've worked it out that I could drive to Adelaide every weekend,
and still be driving less than someone who drives half an hour to work.
So people always think it's a long way to travel back and forth,
but actually I drive a lot less than most people in the city do.
I always describe myself as a city girl in the country,
'cause I do like all of the city luxuries.
I go to Melbourne every couple of months and I go to Sydney twice a year.
So, you know, the way we've set up the practice,
you don't miss out on anything.
And it's just a really good life.
I'm passionate about rural health.
There's so many rewards when you work in a rural area,
in terms of that you get to know people over a longer period of time
and you can build relationships.
It's not a person that comes in and you never see them again.
You actually get to know them and their family
and have a better understanding of the context of their life as well.
You know when you look through those real estate things?
I look through and I think, 'Why would I move there from here?' You know?
And it's a lovely area,
and... we've got lots of friends here.
So, yeah, we will retire in Camperdown.
I think the rewards are just the pleasure...
..to say that you've solved a problem,
and made a really big difference to a community.
We've thoroughly enjoyed being in the country, we don't regret it at all,
and when we keep looking at our options of where we want to be,
we don't want to go back to the city.
We want to stay within our rural community.
I remember my parents saying to me,
'Well, I suppose you'd better go and do it and get this out of your system.
And then you'll be back, and that'll be done. Ticked!'
Um... I think they were horrified when we then took the next step,
and told them that we're not coming back.
Being a rural doctor is a wonderful thing,
and you can have a great life as a woman doctor in a rural community�