Real Life

Rural doctors: Meet the regional women saving lives

These five tough and dedicated professionals are battling the female doctor shortage in regional and remote Australia.

It’s a typically hot, humid afternoon on remote Thursday Island when Dr Sandi Dawson receives a call-out for a medical emergency that, even by Torres Strait standards, is unusual. In the six years she’s been working here as a Rural Generalist (a GP with specialist training), she’s become accustomed to responding to calls for out-of-the-ordinary medical situations, including, she suspects, some of the highest numbers of coconut and coconut tree related injuries in Australia. This time the patient has been injured by a turtle while hunting.

What follows is a complicated expedition to an outer island via helicopter, boat and dinghy. And then she must do the same trip in reverse with the patient in tow.

Despite the relatively slow pace of life in the community of around 3000 people, Sandi’s workdays are far from quiet. She works across all hospital departments, in her GP rooms and travels to many of the outer islands of the archipelago for fortnightly clinics. She also works part-time as a Retrieval Consultant for LifeFlight in Townsville, and she travels with the Thursday Island retrieval helicopter.

Sandi, 38, is part of a small but dedicated cohort of women doctors working in rural and remote locations across Australia.

The state of healthcare outside our cities is facing a two-pronged dilemma with startling statistics. Studies from the National Rural Health Alliance show that people living in remote areas have a lower life expectancy than citydwellers – 14.1 years lower for males and 12.4 years lower for females. And they die from potentially avoidable causes at higher rates – in very remote areas, that figure is 2.5 times higher for males and 2.8 times for females.

Dr Sandi Dawson is one of many female rural doctors.
Dr Sandi Dawson has been working as a rural doctor on remote Thursday Island for six years and find the experience of providing continuity of care rewarding.

Although the Australian Charter of Healthcare Rights states all Australians have the right to access healthcare services that meet their needs, the number of healthcare professionals working in rural and remote areas is significantly lower than in cities. Generally, the more remote a place is, the fewer healthcare professionals that work there. Remote areas have seven times fewer specialists than major cities. The consequence of this poor access to primary healthcare is higher rates of potentially preventable hospitalisations – the rate in remote Australia is two to three times that of the city. Women such as Sandi want to turn those statistics around.

Sandi says her desire to work in a remote community was influenced by her upbringing. “I grew up in Aurukun, on the remote Cape York Peninsula. My parents were teachers there. Doctors only came when the RFDS [Royal Flying Doctor Service] planes flew in to do clinics or pick up someone sick. We were entirely reliant upon that system for medical care.

“So I knew what it was like to live in a small place with that feeling of community and what it was like to be quite vulnerable from a healthcare point of view. And particularly, how important it is to have consistent, dedicated health care in remote areas.”

Sandi, who lives with her partner Adam, also a doctor, and their young daughter Rosie, says her workdays are so varied that one never looks the same as the next.

“It requires a lot of flexibility and lateral thinking because we work in a logistically challenging location, often without simple things like road ambulances,” she says. “I get to do medicine across the entire spectrum of life from caring for pregnant women to delivering babies and caring for neonatal babies, all the way through to palliative care at the end of life. I also do preventative medicine, like vaccinations and counselling patients on healthy lifestyle choices to prevent disease. I get to see all the ‘run of the mill’ conditions, but also a lot of tropical medicine, like tuberculosis and malaria. Being across that really broad spectrum of medicine is challenging but also extremely rewarding. It’s so valuable when you get to look after a patient during a critical illness in the hospital then follow up with them in general practice to complete that cycle. That continuity of care makes the medicine here really special.” 

Dr Sandra Mendel is one of the rural doctors in NSW.
Sandra says rural women are waiting a long time to see female GPs.

Finding a female GP in a regional area can be frustratingly difficult. And with many women preferring to see female doctors for a host of cultural and personal reasons, the health and wellbeing of country women is suffering. Data from Medicare shows both breast cancer (only 36 per cent) and the cervical cancer (53 per cent) screening participation rates are lowest for women living in very remote areas.

From her co-owned GP clinic in Orange, in Central West NSW, Dr Sandra Mendel sees first-hand the struggle country areas face in recruiting women doctors, and the knock-on effects this has on female patients.

“I really hate to say that, in 2024, we still have a lack of female doctors, specialists and GPs in rural centres – even in large centres like Orange,” Sandra says. “It’s very rare to see female specialists in rural areas, so rural women have to wait a long time or travel long distances to see one, which is really not okay. And some people just won’t access services at all if they don’t have access to a female practitioner. We’re fortunate to have fly-in/fly-out specialists, and telehealth is great, but it doesn’t replace face-to-face consultations with local female doctors.”

In Kununurra, in the East Kimberley region of WA, Dr Stephanie Trust is collaborating with local youth mental health service Headspace on a treatment plan for a young man from the community. He has depression and anxiety but rather than simply prescribing medication, Stephanie, 52, who is the clinical director and principal GP at Wunan Health, wants to try a different approach.

The patient would really like a job, however he doesn’t have a driver’s licence, so Stephanie makes some calls to put the patient in touch with the local driver training coordinator, and an employment service to help him write a CV and apply for jobs.

“We definitely don’t just focus on a person’s physical medical diagnosis,” Stephanie explains. “It really is about trying to look after the whole person and understanding that health is much broader than just physical health, like we see in Western medicine. For example, I can talk to someone about medication and their blood pressure, but if they’re struggling financially and can’t feed themselves or afford their tablets, then I need to find other ways to help them.”

Stephanie, a Gidja and Walmajarri woman, says the holistic approach that underpins her GP work is thanks to her upbringing. During her childhood in Wyndham, the northernmost town in Western Australia, she became interested in healthcare watching her mother work as a traditional Aboriginal midwife.

“I’m one of nine children and both my parents were Stolen Generations,” Stephanie says. “They were amazing parents despite the challenges from their upbringing. Although they only went to grade two or three at the mission, both of them were firm believers in education and they really emphasised that with all of us. I had older siblings who’d gone to university, and for our family, that was a big deal. So, my role models were quite close to home.”

Stephanie juggles her busy patient load at Wunan – which sometimes includes unorthodox medical consultations in the aisles of the local supermarket – with supervising and mentoring training doctors, medical students and Aboriginal health practitioner students. However, she values taking the time to really get to know her patients well.

Stephanie, a rural doctor in the Easy Kimberley region of WA takes a holistic approach to patient care.

“What I’ve tried to do at Wunan Health is take all the wonderful aspects of my Aboriginal heritage and bring it into the clinic,” she explains. “We’ve got a fantastic team here and we’re very much a family. We value our Elders and try to bring those kinship systems of large families into the way we run our clinic.”

Stephanie was recently named joint winner for GP of the Year at the 2024 WA Rural Health Excellence Awards.

Chloe Campbell, the registered nurse on duty in the 18-bed hospital in the southern NSW farming township of Bombala, momentarily holds her breath as the doors to the emergency department open. She knows the presenting patient holding their arm wrapped in a blood-soaked towel.

In the country town of around 1500 people, it would be unusual if Chloe, who grew up as a typical farm kid on a sheep and beef property nearby, didn’t know most patients. Although she says there are both blessings and curses to working in such a small community, she hopes to always work in rural medicine.

“It’s hard knowing all the people who walk through the door,” she says, “but sometimes it’s great because you can have a bit of a laugh with them and make them feel at ease.”

Chloe, 25, is now studying to be a doctor at Charles Sturt University in Wagga Wagga. Her career change came after an anaesthetist she was working with suggested she consider studying medicine. She initially laughed, but it planted a seed in her mind. Chloe hopes to one day return to the area she grew up in but for now she’s juggling university with nursing shifts at Wagga Wagga Base Hospital.

“Just think how valuable you’d be if you went back to fill a gap as a female GP.” – Chloe Campbell, rural doctor in Bombala, NSW.

“Seeing how our community supported each other through horrible bushfires and COVID was incredible, but seeing the other side of it and how we were always so short-staffed and the impact that had on the community was quite a steep learning curve.  It makes your heart hurt to see that happening in the community where you’re a seventh generation local.”

The cool air inside Alice Springs Community Health Centre is a welcome reprieve from the searing central Australian heat. Dr Rebecca Lee, the Child and Adolescent Psychiatry Registrar, is on duty. She also works as a paediatrician at the local hospital. Despite growing up in central Sydney, Rebecca, 42, has forged a career in the outback, specialising in Aboriginal health, where she says she receives much more than she gives.

“My mum, who’s Irish, used to be a nurse and was always really interested in First Nations’ history and culture,” Rebecca explains. “I think we have so much to learn from Aboriginal people. I’ve never believed I have anything to give as such, but I’ve always wanted to work alongside them and learn. It’s kind of been the evolution of my career, to develop skills that are actually useful in that area of health.”

It was during her postgraduate medical degree at Flinders University in Adelaide, where she did two years of rural placements, that Rebecca’s inkling she was destined to work in remote health solidified.

“There were lots of opportunities throughout my postgrad degree to spend time on Country,” she explains. “I did an elective in Aboriginal health in my first year, where we spent some time on the APY [Anangu Pitjantjatjara Yankunytjatjara] lands in northern South Australia … I remember getting off the bus in Kaltjiti and feeling the wind coming off that land and it felt like it was talking to me from a hundred thousand years ago. Since then, the north has always called me back.” In fact, she’s soon to begin a new role as Child and Adolescent Psychiatry Registrar at the Royal Darwin Hospital. The challenges Rebecca has faced in Alice Springs are, she says, simple things, like the distance from family, friends. “Trying to get other staff to move here and stay here is a challenge,” she explains. “The bad press it gets has real consequences for workforce and morale. But the pros definitely outweigh the cons. The work-life balance here is absolutely incredible. You’re surrounded by the most beautiful nature and the community is really resilient and supportive. I enjoy the work and it’s such a privilege. It’s the most wonderful medicine you can do.”

Although rural healthcare faces a host of issues (another overwhelming problem is the lack of childcare), promising inroads are being made. One is the federal government’s continued investment in rural clinical schools. These schools work in conjunction with 21 universities across Australia where medical students do part of their training in rural communities. A study of medical graduates from The University of Queensland, published by the BMJ Open medical journal, showed that students who do as little as 12 weeks of placements in a rural setting were three times as likely to work in a rural area once qualified.

Dr Sandra Mendel is also an Associate Professor and the Director of Learning at the School of Rural Medicine at Charles Sturt University’s (SCU) Orange campus. The school, which took in its first student cohort in 2021, reserves 80 per cent of places for country students. This is because students with rural backgrounds (like Chloe Campbell) are also likely to take up rural practice when they graduate.

Sandra says that although these programs take years to take effect, CSU graduates are already flowing into rural communities.

“Some of our students are putting down roots where they’re doing placements,” she explains. “Some have even met their life partners in those communities … I think that’s what will keep them in the country. If you immerse yourself in a community when you’re training, you’re more likely to build up those crucial support networks and stay there long-term. That’s how I wound up living in Orange even though I grew up in Sydney.”

One of the rural doctors in Alice Springs, Rebecca Lee.
Rebecca was drawn to her career, joining a growing cohort of female rural doctors in Australia.

At a more grassroots level, Chloe Campbell, through her role with the Australian Medical Students Association, has created Boots to Scrubs, a scholarship and mentoring program advocating for country women studying medicine. Chloe says Boots to Scrubs is designed to be the “tap on the shoulder” young women may need to encourage them to study medicine.

“I thought back to what would have helped me when I was a kid at a rural high school. We provide free, easy-touse resources that simplify all the rural and First Nations admissions pathways, and [point to] the marks needed to study medicine at all Australian universities. There’s also a financial scholarship for a first-year medical student and a great mentoring program with a host of rural female doctors.”

As Chloe prepares to do placements in a smaller outlying Riverina town she talks animatedly about her love of working in the country and encourages other young women to do the same.

“If you love small towns and those vital support networks that exist in the country,” she insists, “just think how valuable you’d be if you went back to that town one day to fill a gap as a female GP or surgeon.”

If these initiatives result in more doctors like Chloe, Sandra, Rebecca, Stephanie and Sandi working in the bush, the health and wellbeing of Australians living in the country will be in very good hands.

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