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

ANAESTHESIA IN WA
CONTINUED
RURAL AND
REMOTE SPECIALIST
ANAESTHESIA
DR ALEX SWANN
DEPUTY HEAD OF DEPARTMENT
– FREMANTLE HOSPITAL
SENIOR CLINICAL LECTURER –
UNIVERSITY OF WESTERN AUSTRALIA
Western Australia covers a huge area
and land mass, and relies heavily on
small peripheral centres for medical
care.
Often these centres are tiny nursing
posts or small hospitals services by
GP Anaesthetists and Senior Medical
Offi cers. The huge distances to travel
to a tertiary centre necessitate the
need for visiting specialists to run
clinics and basic surgeries. Currently
there are specialists from general
surgery, orthopaedics, obstetrics and
gynaecology, opthalmology and ear, nose
and throat (ENT) visiting several centres
most weeks of the year.
Over the last few years I have travelled
once or twice a year with Dr Fiona
Whelan to perform ENT surgery for the
local population of Kununurra.
Kununurra is the largest town in Western
Australia north of Broome, with the
closest town being Wyndham, 100
kilometres (62 miles) away. Kununurra
is 3040 kilometres (1889 miles) from
Perth via the Great Northern Highway.
The town is situated in among the scenic
hills and ranges of the far north-east
Kimberley Region, having an abundance
of fresh water, conserved by the Ord
River Diversion dam and the main Ord
River Dam. Amongst the industries,
are huge mango farms, sandalwood
plantations, chia crops, mining and
tourism. It is an amazingly beautiful
part of the world.
Kununurra has a transient population
and including outlying areas and
communities numbers about 7000. An
infl ux in the dry season (From April to
September), of tourists and itinerant
farm workers pushes up the population
to around 10,000 on any day during the
dry season.
The hospital is small, with 35 beds and
one theatre. There is a small emergency
department staffed by a dedicated band
of GPs and resident medical offi cers,
and they deal with everything that comes
their way including paediatrics and
obstetrics.
Surgery is performed by the visiting
speciality teams throught the year, with
the district medical offi cers tackling only
the occasional emergency surgery. When
stable enough for transfer, patients are
fl own back to Perth using the Royal
Flying Doctor Service (RFDS), and there
is an arrangement to transfer critically
unwell patients to Darwin which is
much closer.
Usually, we travel to Kununurra for a
week long trip. “Glue” ear and recurrent
ear infections are endemic in the local
Aboriginal population and operations
including grommets, myringoplasties
and myringotomies form the majority of
cases on a typical one week ENT trip.
During this time we have three days in
theatre, operating and several specialist
and pre-operative assessment clinics.
This allows the team to review patients
with serious ENT problems and decide
which we need to transfer to a tertiary
centre for their surgery. Twice a year
there is a two week long “tonsil” trip. We
perform tonsillectomies on the fi rst two
days, and other ENT operations for the
rest of the time. During the two weeks,
we are constantly on-call for posttonsillectomy
bleeds.
The theatre is well equiped with modern
anaesthetic machines, diffi cult airway
equipment and well trained staff. The
theatre team is multi-skilled, working
with a diverse range of specialities, and
extremely keen and enthusiastic! We
have a lot of fun as well as working hard
when we visit.
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ANZCA Bulletin June 2011