ANZCA Bulletin June 2011 - Australian and New Zealand College of ...

RURAL PAEDIATRIC EAR,
NOSE AND THROAT
(ENT) HEALTHCARE IN
WESTERN AUSTRALIA
DR ALISON CARLYLE
CONSULTANT PAEDIATRIC ANAESTHETIST,
PRINCESS MARGARET HOSPITAL
Otitis media with effusion (glue ear)
is a huge healthcare problem for
children in rural Australia which can
lead to serious complications such as
mastoiditis and perforation. Repeated
attacks and chronic disease cause
hearing loss with delayed speech and
language development, and impair
socialisation and performance at
school. Many studies have shown that
indigenous children suffer higher rates
of otitis media and have more serious
complications than non-indigenous
children.
The Kimberley covers almost half a
million square miles in northern Western
Australia. One third of the region’s
population are Aboriginal or Torres
Strait Islanders. Thirty per cent of the
population is under the age of 15 years:
this unusually high percentage refl ects
trends related to the demographics of
Aboriginal Australia and the migration
of young families to work in the region.
The Country Health Service in the
Kimberley organises outreach ENT
team visits to regional centres including
Derby, Broome and Kununurra. The
trips consist of pre and postoperative
clinics (some of which take place in fairly
remote communities), and operating
sessions. The team originates from
Perth and includes an ENT surgeon, an
anaesthetist with an interest in paediatric
anaesthesia and an audiologist. I was
lucky enough to go on one of these trips
to Kununurra late last year. I was keen
to become involved as it was a good
opportunity to see another aspect of
the healthcare system in WA, and it also
meant facing the challenges of working
in a fairly isolated site away from my
familiar tertiary hospital surroundings.
Kununurra is a regional town in the
North East Kimberley on the Ord River
downstream from the massive Lake
Argyle. Its hospital has two wards, an
emergency department, maternity and
a single operating theatre. The theatre
nurses are a competent and welcoming
group who are well used to working with
visiting surgeons of all specialties who fl y
in for one and two-week operating trips.
Each day the nurses rotated surgical
and anaesthetic assistant duties to
maintain and improve skills. Resident GP
anaesthetists from the hospital also had
the chance to attend theatre sessions
for up-skilling in paediatric anaesthetic
techniques.
From left: Royal Perth Hospital.
On our one-week trip the emphasis
of the surgical work was on elective
operations such as myringotomy
and insertion of grommets, and
myringoplasties, mainly in children,
though we also performed a couple
of unexpected “removal of foreign
body” procedures (including an insect
in an ear). On trips lasting two weeks,
adenotonsillectomies are performed
in the fi rst week to allow for surgical
intervention if there are secondary
tonsillar bleeds. Mums and aunties
generally accompany the children from
remote communities and attempts
are made to organise operations for
siblings on the same trip. Preoperative
assessments are made and operation
lists are drawn up on day one, with the
fi rst operating session starting on the
second day of the trip. After a couple of
days’ post-operative recuperation the
patients return to their communities
and are reviewed at the next clinic.
In addition to the elective ENT surgery,
occasionally on these trips one may be
asked to assist in emergency cases. I
was unexpectedly called into the hospital
in the early hours one morning to help
with the resuscitation of a premature
newborn who was delivered in a fourwheel-drive
vehicle en route from one
of the community clinics. The baby
was estimated to be about 25 weeks
gestational age and, although making
some reasonable respiratory effort,
required intubation and ventilation
and umbilical venous and arterial line
insertion before transfer to the Darwin
neonatal intensive care unit. The
intubation was quite straightforward but
I was glad to have recently attended an
advanced paediatric life support (APLS)
course to brush up on my umbilical
cannulation skills!
In summary, participating in rural
healthcare in WA provides a unique
opportunity to experience a beautiful,
remote part of Australia whilst
providing an invaluable service
to local communities.
ANZCA Bulletin June 2011 29