Challenges and rewards of Torres Strait healthcare
Dugongs, crocodiles and turtles. And that’s just on the helicopter ride to the office. Being a GP in the Torres Strait is never routine
18 September 2019,
For Dr Allison Hempenstall, a registrar with ACRRM, the chance to complete her training in the Torres Strait came with a feeling of being “extremely lucky.”
As a junior doctor at Cairns Base Hospital, she first experienced Thursday Island while on a three-month hospital rotation. This experience opened her eyes to the need for continuity of healthcare in this remote region and the unique community that calls the area home.
“Experiencing Thursday Island as someone from the city, was probably the key determining factor for me coming back,” she tells The Medical Republic.
Fast forward three years, and Dr Hempenstall has been living and working as a rural generalist registrar on Thursday Island for more than 18 months.
“The doctors on Thursday Island are all rural generalists. Many of them have gone through ACRRM training, and a lot of them have also done RACGP training, so they know what the process is like as a registrar,” Dr Hempenstall says.
Dr Hempenstall’s rural generalist training has also been supported by the Generalist Medical Training (GMT) organisation.
In her first year working in the region, GMT flew her to Cairns three times that year to participate in intensive training workshops with other rural generalist registrars across far north Queensland.
“And then, when I would go back to Thursday Island, we’d have weekly webinars with the people that I met face to face, my colleagues, so I’ve been really lucky in how much support I’ve had,” she says.
But with the experience of working in the Torres Strait region being so different to that of the mainland, Dr Hempenstall says she enjoys living in a tight-knit medical community which “understand and appreciate the specific nuances of rural and remote medicine”.
Her week usually begins with two days in practice at the primary health care centre on Thursday Island. Dr Hempenstall then spends a day at the island’s hospital where she conducts phone consults to assist health staff on outer islands.
“If there are nursing staff that need help from a doctor they’ll call and I’ll provide them with healthcare advice over the phone,” she says.
But while the phone service is necessary, Dr Hempenstall also takes a helicopter a few days a each fortnight to see patients in person. “It’s a very surreal experience to think that most people will be in a traffic jam or catching public transport or riding their bike or walking to work. Getting a helicopter to work is one of the unique experiences of working in the Torres Strait.
“The helicopter ride can take up to an hour, and you are able to have this amazing experience where you see the beautiful landscape and reef underneath as you’re going from Thursday Island to an outer island.
“It’s pretty incredible and quite often we will see turtles, dugongs, crocodiles and, of course, the extensive reefs across the Torres Strait,” Dr Hempenstall tells The Medical Republic.
There are 15 health services across the Torres Strait which are run by the Torres and Cape Hospital and Health Service. Most rural generalists live on Thursday Island and will travel to outer islands to provide healthcare on a regular basis.
— Allison Hempenstall MD (@Dr_Hempenstall) July 9, 2019
“I’ll be the only doctor in these small clinics, with usually only one nurse and one or two Indigenous health workers providing primary care,” Dr Hempenstall says.
The health needs in these communities are also complex and vary depending on the proximity of the island community to either Australia, or to neighbouring Papua New Guinea.
“Those who live closer to Papua New Guinea, or who frequently visit outer islands such as Saibai Island and Boigu Island, may experience infectious diseases that are more easily transmitted between the border of the Torres Strait and Papua New Guinea,” Dr Hempenstall said.
The Torres Strait Treaty allows free movement (without passports or visas) for Torres Strait Islanders and Papua New Guinea nationals for cultural exchange and traditional activities.
But while this open border policy has its cultural and social benefits, it also leaves the Torres Strait population open to a range of communicable diseases still prevalent in Papua New Guinea, such as tuberculosis.
In addition, leprosy diagnoses are more common in the Torres Strait than elsewhere in Australia, prompting Dr Hempenstall to co-author a research letter on that topic which was recently published in the Medical Journal of Australia.
Like most doctors who studied medicine in Australia, Dr Hempenstall once thought leprosy was a biblical disease that she would never diagnose. She still says the experience of making a clinical diagnosis is a nothing other than a “bizarre experience”.
“I was on Saibai Island just last week and I diagnosed leprosy.
“It’s a bizarre experience because here I am on Australian soil seeing these diseases that are historically found in developing countries, which Papua New Guinea is.
“This is something we as clinicians need to keep in the back of our minds when seeing patients, primarily from Papua New Guinea but also Torres Strait Islanders who may have close family ties with communities in Papua New Guinea,” Dr Hempenstall says.
However, one of the biggest challenges in working between these two colliding worlds of healthcare is not always being able to follow up with patients who are from Papua New Guinea.
“If you treat a PNG national in the Torres Strait, unlike Australian patients where you can get them to come back and see how they feeling in a week’s time, we can’t do that.”
But despite the challenges, Dr Hempenstall has also developed a deep appreciation for Torres Strait Islander culture and how it intercedes in patient health.
Torres Strait Islander peoples are very family and community-orientated, which means decision-making in healthcare, and the priorities of an individual’s health, often incorporate family and community in that process.
“In Indigenous communities, and in particular on Thursday Island, everyone relies on the support and care of their family and their community,” Dr Hempenstall says.
One of the ways Dr Hempenstall has adapted to this cultural shift is to give her patients more time to build trust, a reality which can’t happen in 15-minute appointments.
Many residents have experienced a high turnover of medical staff because of the island’s remote location and the challenging nature of the health work.
“Because of this, Torres Strait Islanders take a while to build up trust with their healthcare providers, so you really need time in a consultation to not only build a good rapport but also to explore comorbidities.
“If you don’t get through all their health concerns, they might not come back to for several months.
“But I’m really lucky I work in an area where I don’t have the same sort of pressure of short consults that happens in other private general practices.”
Dr Hempenstall likes to spend her free time on the weekends taking boat rides with friends to smaller surrounding islands and fishing and swimming.
But going to the mainland for a visit is a more complicated affair.
Thursday Island residents first have take a boat to nearby Horn Island and from there board a flight to Cairns.
“Which is great, if you’re going to stop in Cairns. But if you want to go anywhere else from there, you’ll have to wait for your connecting flight,” Dr Hempenstall says.
For every trip off Thursday Island, Dr Hempenstall has to budget for an extra day at the beginning and end to accommodate for the long commute.
But Dr Hempenstall says she wouldn’t have it any other way.
Her plans, at least for now, are to stay on Thursday Island and provide a continuity of healthcare to the local community.
“We’ve been able to provide good continuity of care for patients in more recent times,” she says. “And as for me, I’m very happy on Thursday Island.”