Damien Brown, author of Bush Doctor, shares his experiences working in the remote Northern Territory, where a 20-bed hospital serves an area the size of Norway. Despite his background in aid work, Brown found the challenges of rural medicine uniquely demanding.
The Challenge of Distance
Brown recalls a colleague's warning that remote work in Australia could be harder than aid work. He soon discovered the truth of this statement. The hospital, far from Alice Springs, served about 8,000 people scattered across a vast region. Healthcare needs were high, and help was far away.
One of Brown's first patients was Billy, an Aboriginal man in his thirties with severe shortness of breath due to heart and kidney failure. Billy needed intensive care and specialists but declined transfer to a larger hospital, preferring to stay on his country with his family. Fortunately, he improved under Brown's care.
Another case involved a woman suffering a life-threatening heart attack. After administering a clot-busting drug and stabilizing her, the Royal Flying Doctor Service transported her to a facility 1,000 kilometers away—equivalent to traveling from London to Berlin for emergency care.
High Rates of Chronic Disease
Brown encountered chronic disease rates higher than any he had seen before. A teenage patient had a metallic heart valve from rheumatic heart disease caused by repeated streptococcal infections, driven by overcrowded housing and poverty. The region had among the highest rates of rheumatic heart disease in the world.
Kidney disease was rampant, with a dialysis unit operating six days a week using 16 machines—the highest per capita in the world. Diabetes was three times more common among Aboriginal patients in remote communities compared to other Australians, and heart disease more than twice as common. Access to affordable, healthy food was a major contributor, with Brown noting that a piece of rubbery broccoli cost $10 at the only supermarket, making chicken wings, chips, and Coke a better value on a budget.
Social Issues and Trauma
Social issues, shaped by historical trauma and ongoing inequality, were prevalent. One night, a man walked in with a knife handle visible in the middle of a bloodstain on his shirt—the blade still embedded. He received a blood transfusion, chest tube, antibiotics, and an urgent flight. Mental health crises were common, and Brown saw more psychological trauma than anywhere he had worked.
Despite these challenges, Brown found the work immensely rewarding. He eventually specialized in rural and remote medicine and moved to the town for a year, continuing fly-in/fly-out work. He formed connections with the community, making it hard to walk away.
The Impact of Social Determinants
Brown emphasizes the impact of social determinants of health: poor housing, nutrient-poor food, limited employment, distance from services, historical trauma, and substance abuse. Much of his clinical work is reactive. Of the 17 Closing the Gap targets, few are on track, and some are worsening—a public health crisis.
Brown reflects that working in remote Australia is harder because one does not expect it to be, especially in a wealthy country. His book, Bush Doctor, is published by Allen & Unwin.
