Somebody pinch me, please?
I’ve just had the most terrific two-week
holiday locum on the gorgeous Kangaroo Island, Australia’s third largest island, located off the coast of South Australia. KI is known for its pristine wilderness, abundance of native wildlife, high quality produce and it’s enthusiastic rural doctors. I was based at the KI Medical Clinic with some obstetric on call and a smidge of after hours cover at the Kangaroo Island Hospital. With a population of ~2000 in the capital of Kingscote, and ~4500 people on the island, this was easily the smallest town that I’ve been to on my locum adventures so far, but also one of the most relaxing.
The island is classified as Remoteness Area 4 (“remote”) which at first I was a little skeptical about. After all, it was a mere 20 minute flight from Adelaide – a similar duration to my old 5km commute to work in peak hour city traffic! But it didn’t take me long to figure out that working on an island poses its own unique set of challenges, separated as it is from all other health infrastructure by 18km of ocean and a long drive on country roads.
Let’s take a hypothetical example of a patient with a hard knock to the face who has bruising and vague tenderness over the zygoma. It’s probably not fractured but in order to be 100% sure I would normally send the patient down the road for an xray and review later that day. Only, on KI, the radiologist only visits once a fortnight and although the nurses at the hospital can do basic emergency xrays, they aren’t credentialled to do facial views. Yet it’s not serious enough to send to Adelaide for imaging…
Or how about a patient who’s taken an unknown quantity of paracetamol which is probably not enough to cause toxicity but who needs a paracetamol level to make sure. But, the pathology specimens only get flown to Adelaide once a day and the decision whether or not to start NAC needs to be made hours before the result will be available…
I quickly realised that being so far removed from the luxuries of urgent pathology, imaging and specialist opinion can lead to some pretty tricky situations, and that my clinical skills were being tested far more than usual. It’s made me reflect that perhaps I’ve become a little over-reliant on investigations in some aspects of practice and maybe I need to trust my examination skills a bit more. A resource limited environment like this certainly makes you think about first principles a lot more, and follow-up and safety-netting become an even more important part of the consultation.
Admittedly, despite some of the challenging aspects, I didn’t feel like I worked all that hard while I was there. I think all of Tim’s loyal patients wanted to wait until he got back rather that see some strange locum doctor, so I wasn’t hectically busy. I was on call for obstetrics for pretty much the entire duration, but the only baby that was born decided to arrive on the ONE DAY that I wasn’t on call. How’s that for bad luck? I suppose when the island only has 40 0r 50 deliveries a year it was never going to be super busy on labour ward, but still, it would have been nice to have one!
Mind you – I wasn’t complaining. KI is a pretty nice place to be un-busy in. I got to visit some beautiful bays and beaches, eat the most amazing fresh seafood, take some awesome long walks & runs, see baby seals frolicking on the beach and penguins coming in from the ocean. I even had to give way to an echidna on the road! And the honey – the most delicious I’ve ever eaten. I was devastated to not be able to bring any back to Western Australia so my only choice, of course, was to eat as much as possible while I was there. If I had to have one grizzle it was that was a bit on the cold side, rarely creeping above 17°C while I was there. But the bracing sea breeze certainly helps to clear the mind and invigorate the soul.
Socially, I found it less lonely than some of my other locum placements. Partly because it was only a short placement, partly because my dear old Granny came to visit me while I was there, and partly because the doctors at the clinic were so lovely and welcoming and I had lots of dinner invitations. The transit through Adelaide also gives me a great excuse to catch up with my interstate cousins which I really appreciate. I’ve worked in quite a few medical centres now and the KIMC is definitely up there in terms of one of the nicest bunches of people I’ve come across. Once again I was reminded of just how important social connectedness is for contributing to a sense of happiness and wellbeing.
I was also very privileged to be able to participate in the Kangaroo Island Rural Doctors Masterclass which I found very valuable learning experience and also a great opportunity for networking. It was particularly great to be able to catch up with some of the doctors from my previous locum placements in Murray Bridge, Kununurra and Broken Hill and remember some of the great times I’ve had this year. I hope to be able to post a separate review of the masterclass on the blog shortly – stay tuned!
And as always, the inevitable question… “Do you think you might come back and stay for good?”
I have to reluctantly say that no, at this point in time, I don’t think KI is the place for me. The GP work is great but there’s not really enough obstetrics to keep me happy. And while the island itself is a fantastic place to visit, at this stage of my life (and despite the best matchmaking efforts of the locals), it’s a little bit too small a place for me to settle just yet. Besides, recent new commitments have meant that I’ll be staying in WA for the next couple of years at least.
However, if there are any other GPs out there looking for a change of scenery, with diverse and interesting work and great people in a fantastic location – I’d certainly encourage you to think of Kangaroo Island. And just maybe one day I’ll find my way back there…