With the advent of COVID-19 and the subsequent border closures, many remote Aboriginal communities such as Tjuntjuntjara were left without their usual fly-in fly-out (FIFO) medical staff. For most of these, the Remote Area Nurses (RANs) and Aboriginal Health Workers and Practitioners (AHWs) are the backbone of the health service, with the support of the Royal Flying Doctor Service (RFDS) for emergencies.
However, the chronic disease management, subacute care, mental health and public health issues that are usually managed by the FIFO medical staff were at risk. We know that those living in remote Aboriginal communities suffer higher morbidity and mortality due to cardiovascular disease, diabetes, mental health issues, COPD and chronic kidney disease because of the cumulative risks of remoteness, race, poverty and other social determinants of health.
Thank goodness the internet in most of our communities is reasonable these days, so we could convert many of our services to telehealth.
Tjuntjuntjara is one of the most remote communities in the world, about 700 kilometres east of Kalgoorlie in the Western Desert region of Western Australia. They are a very traditional community of about 150 people.
I have been going there as a FIFO general practitioner for the past 12 years as part of the Kakarrara Wilurrara Health Alliance, that flies health professionals from Adelaide to Yalata, Oak Valley and Tjuntjuntjara.
In March 2020, I started doing telehealth clinics at least two afternoons a week, Zooming into the clinic to see patients in the presence of a RAN, AHW and sometimes with an interpreter present (often plus a few dogs).
Because I know the clinic and the community well, the local people did not seem to be particularly bothered by the fact that I was online and would still joke with me, bring others into the conversation, tell me stories and whisper secrets.
The nurses did their observations and sent things like photos of skin lesions, video otoscope pictures of ears, ultrasounds, spirometry, ECGs, audiograms and retinal scans. I could watch them palpate abdomens and backs and move the laptop around to look at swollen ankles and children’s hair.
The clinic notes were available to me remotely and everything we did is uploaded to My Health Record, as the community is very mobile further into Western Australia and across the border into South Australia.
We also ran specialist clinics where I would set up a three-way videolink with the specialist, the clinic and myself. I put together a ‘package’ for the specialist with investigations, past letters and discharge summaries and their own previous notes from the clinic. I would then coordinate the consultations so that changes in medication, further investigations or questions could be answered straightaway.
These have been so successful that some of the specialists have said that they would prefer to do some of their visits this way, as they saw more people and it was more streamlined. Often they will arrive in a community having flown five hours from Adelaide, to find that most of the people they would like to see have gone hunting for the day.
This has been a similar experience for the allied health professionals in our team. We have had renal physician, cardiologist, respiratory physician, psychiatrist, endocrinologist, dermatologist, physiotherapist, diabetes nurse, dietitian and psychologist visits this way.
Now that we can return to seeing people face-to-face we are again very busy. We have prioritised flying in people who really can’t do telehealth – optometrist, ophthalmologist, audiologist, podiatrist and, of course, the general practitioners.
We can’t put in implanons online, do cervical screens, do an environmental scan of the houses, remove skin lesions, do a full neurological examination and so on. We also can’t go to the women’s centre, the ‘rage cage’ to play soccer, chat to the shopkeeper, watch the old people paint, laugh under a tree or enjoy the beautiful sunsets.
Now that we’re used to it, we’ll continue using telehealth, as the chronic disease management has actually improved! But, for a time, it was enough.