Jellybean #64 Michelle Withers - An Adventure that never ended

An Adventure that never ended. You thought you were just trying to pass a medical exam but then you ended up in the Australian version of the Paris-Dakar Rally. Sounds like another Gonzo-Medical-Jounrnalism moment.

Options. Options. Options. Rotation options. Where do you want to go to further your training? What informs your choices? Is it the specialties available? Is it a certain person that you want to learn from? Is it the real estate prices? Is it the commute?

Do you take the safer option or do you look for a bit of adventure? Michelle Withers chose the adventurous option and she is still on that adventure. Michelle started in Zimbabwe and ended up in Alice Springs via a few ivory towers. Taking the adventurous option may seem like the risky one but maybe staying in your comfort zone is risky too.

All over rural and remote areas there is often a lack of medical/nursing/para-medical skills. Yes there are opportunities to see new things, opportunities to be exposed to new things. If you are thinking about one of the off the beaten track jobs then you need to research it. Even though somewhere might look very exciting on a map you don’t want to end up Smolensk like Bulgakov did. (Although that did usefully inspire a collection of short stories; “A Country Doctors Notebook”.)

Here on the Jellybean Podcast we are big fans of little places. Thus in order to shed some more light on the less illuminated parts of the world, to help you decide if you want to go and work there, we go and talk to the people that have done these weird and wonderful jobs.

It turns out that Alice is hardly a secret anymore. We might think of it as the middle of nowhere but the folks from the Alice think of it as the middle of everywhere. 1500 klms from nearest referral centre and 1500 klms from the nearest anything. No interventional cardiology. (Stick that in your guidelines and see what happens.)

We have spoken to Penny Stewart from the Alice Springs ICU before and it turns out that for a town of approx 25000 people Alice has quite a lot going on.

It is an interesting combination of the worlds oldest civilisation and some of the worlds most recent trends. You may be a fly in fly out miner, you may be a well paid government consultant, you may be a displaced aboriginal elder living in a “town camp” but everyone, absolutely everyone, ends up in the same emergency department if they get sick. That is one of the best things about emergency medicine. You meet everyone. No selecting the type of person you work with/for, the door is open, anyone can come in.

Alice Springs ED has a fascinating aeromedical retrieval position as a referral centre and referring centre. The retrieval service has been very closely associated with the emergency department. It could all be a bit crazy but the calm way Michelle describes it makes it almost seem normal. (Calm sounding people like Matt McPartlin and Michelle Withers make people like me seem a bit nutty.)

Michelle and Matt talk about Tennant Creek and how the Emergency department collaborates with smaller emergency services that are too small to have emergency specialists. Michelle refers to “Rural Generalists” at remote locations and mentions FACRRM which stands for Fellow of the Australian College of Rural and Remote Medicine. Never forget how much excellent emergency care is delivered by persons other that card carrying emergency specialists. It’s a great big spectrum, all the way from REBOA to Finke.

Whats Finke? Well, Fine is a small remote aboriginal community but it also the end of a big and very dangerous car and bike race. Think of the Paris-Dakar with lots of macropods and better snakes!

Sound scary? The medical folks in the centre sensibly use it like a big annual disaster planning exercise. With real injuries and real drama.

(Photo Credit Justin Brierty)