Beyond the Bush

Captain Clyde Thomson has served with the Royal Flying Doctor Service for 32 years, and is currently the CEO of the South-East Region, an area which stretches from Dubbo in North-west NSW to Launceston, in Northern Tasmania. He is an adjunct professor to the University of Sydney’s Faculty of Medicine, and an MBA, and continues to use his pilot’s licence.

Growing up in a small town in rural South Australia near Oodnadatta, having as a minister the Reverend John Flynn’s successor, Fred McKay, and spending five years travelling outback Australia on oil exploration, he gained a keen understanding of the needs of isolated communities. McKay encouraged him to join the service. He spoke to Sue Cartledge about the RFDS’ new direction into primary care for rural communities, and the challenges it poses.

Sue Cartledge: When you joined the RFDS 30 years ago, it was an emergency service, flying out of the skies to injured people on outback stations. How has it changed, and why?

Clyde Thomson: It was very much a pioneering organisation providing emergency services exclusively to people on pastoral stations in remote areas of outback Australia. Now we are inclusive – we serve everyone in the remote areas.

How did this come about?

In 1993, we had a study on the future of the service, ‘Best for the Bush’, which identified the need to move into a primary care service rather than stay with the narrow, emergency response. We needed to become pro-active in delivering services, including immunisation.

In the South-East Region we have developed partnerships with the University of Sydney, NSW Health’s Greater Western Area Health Service and the Marra Mar Aboriginal Health Service. We teach students at the Rural Training School at Dubbo and Broken Hill, in a wide range of disciplines – medical, dental and allied health. We are also training GPs and rural registrars. Services to our local communities include dermatology, ophthalmology and optical consultation, paediatric, mental health, as well as standard GP consults.

How far does this new service extend?

RFDS provides services in every state. We cover 80 per cent of NSW (everything west of the Blue Mountains), and the primary care model is already in place. Queensland has already got a good model of service, as has Victoria, and it is being rolled out in the other states, subject to funding constraints.

What is the biggest challenge in implementing primary RFDS style?

The biggest challenge is funding. Trying to get agreement between the states and the Commonwealth to work out a funding model. The RFDS has always been seen as an NGO, delivering services beyond the reach of normal medical services, but we have had to step in because of the lack of [normal] medical services in rural and remote areas. People in remote areas need to have the same access to health services as anyone else. The Medicare model doesn’t work for this. Funding is currently under discussion at COAG: we have in principle agreement from the Commonwealth, and varying degrees of support from the states. I’m hopeful we’ll have it sorted out within 12-24 months.

What other challenges are there?

Attracting the right qualified staff to work in remote and isolated areas. There’s a difference between qualified staff and people who can work well with others in remote areas; who are willing to relocate and whose families are willing to relocate. We need to offer them adequate housing, remuneration, and a job that keeps them engaged. For instance, they can be lecturing one day, holding clinics the next, an emergency service the next, and then working at an Aboriginal Health Centre.

Our staff need a wide range of skills and understanding -primary health, public health, population health, emergency. We find that people who have worked in Third World areas adapt better.

How important is the latest technology?

That’s the other challenge, the cost of technology. When John Flynn started RFDS, it was a provider of technology – those pedal wirelesses that connected people for the first time in the Outback. Now we are a consumer of technology, and it permeates everything we do. We use a wide area network to link all our bases; we have an electronic medical records system; we use videoconferencing for teaching and for consultations with dermatologists and psychiatrist; our staff have satellite phones and the global positioning system is used to locate remote airstrips.

Our planes are now pressurised, and we have lightweight monitoring equipment that do the whole range of monitoring so we can actually take a very large amount of equipment in one item to an accident site.

The capital cost of our planes is a major challenge. Each one costs about $7.5 million, and we have 43. We update about every five years.

What are the most satisfying aspects of your work?

The feedback from the communities. People in the outback are extremely happy with the new service. Because we are providing a regular services, not just an episode of care, it brings people together in the small population centres and builds community links. It’s actually a mental health service, as people get together and share their concerns about the drought and encourage and support each other.

To see staff satisfaction and pride in the service. Everyone wants to wear the badge!

And the training of undergraduates and postgraduate students that we will be able to recruit to RFDS.

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