Broadening the perspective of rural medicine

In March 2022, I was incredibly fortunate to shadow general practitioners (GPs) at two Aboriginal community medical clinics in rural New South Wales (NSW). Dr Sue Amarasena and her husband, Dr Janitha Balasuriya (Dr J), moved to Tamworth from Sri Lanka 12 years ago. After a few years of hospital work, they started at the Coledale Clinic. Prior to their arrival, GPs at this clinic had only stayed a few months and then moved on because, as Dr J told me, it is ‘very difficult work and a challenging environment’.

However, Dr Sue and Dr J have been doctors at the clinic for more than seven years and have managed to build a strong team of nine GPs. I would love to share everything I learnt about their journey as doctors, and the impact they’ve had on the Tamworth community, because I found it incredibly inspiring. However, it would be impossible to fit into this space. So instead, I will attempt to briefly summarise how this experience has impacted me personally and broadened my perspective of rural medicine, general practice and Aboriginal health.

My first day of placement involved shadowing Dr J at the Coledale Clinic. He saw a diverse range of Aboriginal patients with a variety of clinical presentations such as a breast abscess, back pain, chronic obstructive pulmonary disease, psychological distress, diabetes and asthma. I noted that he was frequently writing scripts and referrals, which didn’t interest me as much and made me reflect on whether I would find being a GP repetitive or boring. While I was immensely grateful for the opportunity to be there, I left the clinic that day with the understanding that I definitely loved the rural lifestyle but general practice was probably not for me.   

Twenty-four hours later, my attitude towards becoming a GP had completely shifted.

On day two, I was lucky to have the opportunity to join Dr Sue on one of her fortnightly visits to the Walhallow Aboriginal mission in Caroona, a one-hour drive from Tamworth. The community has the only school in NSW where all of the students are Aboriginal. Dr Sue started a walk-in health clinic there five years ago and is the only doctor who has ever visited the community. She knows every person’s name, family, story and where they live.

Nearly every patient who visited her while I was there wanted to tell me about how grateful they are for her. Multiple patients emphasised that she is the only doctor they trust. In fact, that day there was a meeting discussing the 10-year strategic plan for the Walhallow community, with several council members and community Elders. Dr Sue was invited in and asked to give her input on the community’s health. All in a few hours, I witnessed how a single GP can have a past, present and transcending impact on the lives of multiple individuals and a community as a whole. Indeed, many of her patients would already be dead without her.

I have always imagined myself being a community-centred doctor and somehow making a positive impact, but I was never sure if there was actually a need for me anywhere or if I was ‘dreaming too big’. Dr Sue proved to me that my dream is not only possible but there is so much opportunity for it in rural areas all over Australia. She embodies the kind of doctor that I want to be in a myriad of ways, but particularly in how she has combined her adventurous spirit with her career in medicine. She explained to me that her work scares her all the time but if she wasn’t that adventurous, the clinic wouldn’t be here. I was inspired to see how this attribute has made her career more rewarding and meaningful and I plan to weave my own adventurous nature into a life-long vocation.

In many ways, I learnt more from my conversations with Dr Sue on the two-hour return drive to Caroona than I did in the medical clinic. Her advice that I must ‘choose my journey and always stick to my values’ prompted me to think about what I value more: connection with people or money? I realise that the choice to work in a marginalised community is often more challenging and less lucrative, but the journey I want to choose for myself as a future doctor is one that values people first.

Exploring the GP pathway was not something I had ever seriously considered for myself, but this short visit to Tamworth showed me the power of general medicine in the bush … and has quite possibly changed the trajectory of my life.