Tropical Medical Training

Like quite a few islands, Boigu isn’t large enough for a runway, so Dr McIver’s clinic visits are done by chopper. “It’s a pretty good commute, roaring along at 500 feet over these beautiful little equatorial islands.”
Small planes and helicopters are the main mode of transport between the islands – and because Lachie has skills in anaesthetics, he’s occasionally required to do retrievals for critically ill and injured patients. 
Part of the orientation training before he started on Thursday Island included how to escape from an underwater helicopter, he adds.
But it’s not all island-hopping; tomorrow, he’ll be back at Thursday Island Base Hospital to do the anaesthetics for an orthopaedic surgery list.
Lachie grew up in far north Queensland, on a small beef cattle property outside the Atherton Tablelands and says that because his mum was a midwife, he was familiar with some aspects of medicine.
He was offered a full academic scholarship at Monash, and went to Melbourne to study medicine. He also received a John Flynn scholarship and went to Halls Creek in the Kimberley region in Western Australia for several years running. At university, Lachie had been involved in the Rural Health Club from an early stage, and had an early taste for indigenous health.
After a couple of rural placements in far north Queensland and final year electives with infectious diseases in Darwin, he realised that he really didn’t want to stay in the metropolitan hospital system. 
“I spent six months in the Kimberley and in Alice Springs doing public health and emergency medicine, trying to decide which of those two I was going to pursue for a career.”
His final decision, though, involved a bit of everything. “I realised what I most enjoyed was working in the rural hospital context but considering the population health aspects – that takes in the primary health care, the chronic disease management as well as all the acute care and infectious diseases and tropical stuff that I had always enjoyed.”
For Lachie, training as a rural generalist with the Australian College of Rural and Remote Medicine ticked all the boxes. “I could combine all the things that I was interested in – emergency medicine, public health, indigenous health, chronic disease management and tropical medicine in the one vocation, with the outcome being registration as a GP.” 
“As a rural generalist, I don’t do much in the way of the office-based or business side of General Practice – there’s a lot more emergency, ward work and either anaesthetics, obstetrics or surgery than most GPs. Nevertheless, a significant part of our training is still chronic disease management and primary health care.”
There’s no such thing as a typical “Day in the Life of Dr McIver” on Thursday Island, he says, but these are the events of a recent day that illustrate the diversity he encounters.
He was rostered on emergency for the day. It was a busy morning with sick kids, some orthopaedic patients and a hip fracture to sort out, plus a patient with a stomach abscess that had turned septic had to be flown by the Royal Flying Doctor Service (RFDS) to Cairns for emergency surgery. Then a woman came in with a complete heart block – her pulse was 30. 
“I had to try and increase her heart rate with various mechanical means, then I called the RFDS plane and said, ‘Stop! Don’t go anywhere – we’ve got another patient for you!’. She had to go to Cairns urgently for a pacemaker insertion,” Lachie says.
However, the RFDS plane was a nurse-only flight, so he flew down with the two critically ill patients and had them admitted at Cairns Hospital just after 5pm.
“I guess that’s not really a typical day, but it’s one where I’ve got to the end and thought, yes, this is why I do this job. I’ve since seen both patients … they’re back here and doing just fine.”
In his current position, there’s a lot of overlap between clinical and hospital work, and with the position’s salary funded by the State health system, that’s not difficult to manage. Other rural positions often involve employment by indigenous community-controlled health organisations.
The work is hard and the hours are long – more like that of a Hospital Registrar than a GP Registrar – and he admits that most doctors are proceduralists, on-call for emergencies and for other skills – usually anaesthetics or obstetrics.
“It’s not everyone’s cup of tea, but for those of us that do it, we think it’s the country’s best kept secret. We live in paradise and work with some very interesting communities that have health problems shared more by developing world communities than by other Australians. We have a wonderful lifestyle where we live in the islands, muck around in boats and go water skiing and fishing and camping on the weekends. It’s great.”


This case study first appeared in the Going Places Magazine, part of the Going Places Network which promotes the choice of General Practice as a career option to prevocational doctors within the hospital system. The Going Places Magazine and the Going Places Network is an initiative from GPRA. For more information visit www.gpaustralia.org.au/goingplaces