Medicine on the edge

In this first of an occasional series on GPs doing extraordinary things, Dr Robert Dickson tells of his time working in the frozen south

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For Dr Robert Dickson, a registrar with ACRRM, the opportunity to work for the Australian Antarctic Division was a case of being “in the right place at the right time”.

He had applied online, doubting if the division would take a chance on taking a registrar to such a remote location.

While the Australian Antarctic Division is an accredited training provider with ACRRM,  the chance of getting a training position at one of the stations is still considered a rare opportunity.

But Dr Dickson’s experiences training in rural hospitals in the Northern Territory and regional New South Wales had counted in his favour.

To his surprise and delight, Dr Dickson got the call and the chance to work as a registrar at the Casey station for four months under the supervision of the station doctor.

After a series of investigations, vaccinations and assessments, he was on his way to probably one of the most remote general practices on the planet.

Travelling by ship from Hobart across the Southern ocean, the monochrome seascape was a finally broken by the appearance of a single iceberg on the horizon.

“After a few hours, we were in the icy rim that circles Antarctica, just moving through all the sea ice and the pack ice,” he recalls.

“All of a sudden you went from being at sea, where there was nothingness in every direction, to this amazing world where there is ice everywhere, penguins jumping over ice sheets and seals sunning themselves.”

It was striking – the deep blue ocean, grey rocky coastline and unblemished white snow.

“It was amazing to see that lack of colour and then the very bright colours of Casey station, just sitting there on the shore,” he says.

More than 100 people live at Casey station in the summer months. They are “a generally healthy” group who have been thoroughly screened before leaving Australia.

“There’s no pregnancy, kids, elderly people, chronic disease or major drug and alcohol problems,” Dr Dickson says.

“So, that’s a large part of general practice right there which isn’t represented.”

Another major difference from your average Australian general practice is that Antarctic medical practitioners have the responsibility of managing every aspect of a consult.

“Large parts of your day are to do with the maintenance of the equipment or making sure your whole pharmaceutical supply is in good order, everything is checked, and you know where everything is,” Dr Dickson says.

And when you do see a patient in Antarctica, the simplest things can take a very long time. Every consult is entered into a computer system linked to a satellite, which is not always straightforward and delays can be encountered.

“Your role extends to doing dentistry if patients need it and giving them physiotherapy,” he says.

Even taking a simple blood test can turn into quite a process, Dr Dickson tells The Medical Republic.

“You take it yourself and then you spin it down. You then take the serum in one spot and the cells in another and sync the machines up with the computer.”

Dr Dickson says these processes, often onerous and time-consuming, made him appreciate how much work goes into our current Australian primary healthcare system.

“It’s not until you are doing all the re-stocking of all the items and equipment and everything yourself that you realise it’s a huge effort to make our health system run,” he says.

Of course, the major challenge of practising at Casey is the isolation. Even simple medical problems can become complex.

“You are so isolated and logistically it’s so complicated to get people out. There are so many consequences of watching and waiting,” he says.

“There were several times we had to get specimens on planes and get results back so we could make decisions about whether that person could stay in Antarctica over winter.”

Dr Dickson used a telehealth system to get assistance, support and supervision from the Polar Medical Unit in Tasmania.

COMMUNITY ICE-BREAKERS

As an Antarctic medical practitioner, Dr Dickson was also responsible for maintaining the public and mental health of the station at large, not just inside the consulting room. 

“In the clinic room, people tell you one thing and they come and chat to you as a doctor in a formal doctor-patient interaction,” he says.

“Then, later, when you would be moving about the work sites, you would see a different side of people. They started talking to you as a friend and really important concerns would pop up.”

Working and living in such a small community enables you to develop a unique knowledge and understanding of each of the patients you treat, Dr Dickson says. You truly practise holistic medicine and it helps you anticipate future health issues, including mental health issues.

Since returning to Australia this year, Dr Dickson has continued his passion for serving in small, remote communities. He is now working as a GP registrar in the rural town of Queenstown in Tasmania.

REMOTE LEARNING

Dr Dickson says his experience in Antarctica was challenging, inspirational and a bit surreal. It also taught him a “high degree of self-sufficiency”.

“It’s also given me a standard to hold the rest of my medical career to.

“If they can have such a great healthcare solution in Antarctica for medical problems, then why can’t small regional towns have just as good access and service?” he asks.

Innovation and utilising available networks to navigate distance will be the new frontier for improving rural health, Dr Dickson suggests. 

“Finding new solutions to get around old problems of distance are going to be very important parts of Australia’s healthcare future.”

If it’s possible in a region as remote and devoid of health infrastructure as Antarctica, it is possible anywhere.

“If we can achieve it at the end of the planet surely we can achieve a good strong healthcare solution to issues on the ground in Australia too.”