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Outback with the aboriginal bush men

After 22 years practising in a small Devon town, Dr Andrew Stainer-Smith took 'early retirement' and went to work in Australia's harsh Northern Territory ­ he found a world where children still die of rheumatic fever and most black people die in their 50s

After 22 years practising in a small Devon town, Dr Andrew Stainer-Smith took 'early retirement' and went to work in Australia's harsh Northern Territory ­ he found a world where children still die of rheumatic fever and most black people die in their 50s

I had always thought of a career move at 50. I wanted to do things while I still had energy and good health. I fancied a real change, and wanted to do a useful job. But where could a family go that was English-speaking, hot and brought true adventure?

We pored over maps and e-mailed. One day I listened to a radio programme broadcast over the internet by a young doctor learning Yolgnu Matha ­ an aboriginal language of East Arnhem Land, in Australia's Northern Territory. I called my wife. We were amazed. Was this the different culture we longed to experience ­ and have the privilege of touching? We contacted the local health organisations and found a system crying out for quality medical input from anyone with a sense of commitment.

I negotiated a flying retrieval job with the AeroMedical Service of the Northern Territory, administered from Darwin. I was based in Katherine, 186 miles south on the Stuart Highway ­ the town where Paul Hogan in the film Crocodile Dundee 'staggered out of the bush, past the hospital and into the nearest pub'. It's a hard place with rough edges.

My patch extended from the Tiwi Islands north, down to Tennant Creek and out east to Nhulunbuy and Borroloola. I was the point of call for remote bush nurses and the few true bush doctors. I had to make the decisions and fly out to assist transfers.

Airway skills

There were hairy moments. I quickly refreshed my airway skills and learnt to use a round-the-neck ventilator. I had to give rehydration advice over a satellite phone to aboriginal health workers ­ they just wanted the baby concerned transported out, but the weather made this impossible.I saw active leprosy, children dying of rheumatic fever and horrific domestic violence ­ and watched my thrombolysis revert ST segments at an altitude of 30,000 feet in an aircraft.

I saved lives from diseases you may never have heard of. Look up melioidosis. I also saw overwhelming social problems of deprivation and marginalisation.There were delights for us all. We couldn't swim in the amazingly beautiful sea edged by endless dense mangrove swamp, as within eight minutes box jellyfish would have killed us. But some waterholes, and a few patrolled stretches of river, were relatively crocodile-free. There were 25lb barramundi fish to be caught.

Over the two years we spent there we took holidays. We visited Sydney, Perth and Cairns. But we also drove across Queensland in the wet season, saw Kakadu and had a luxury week in Tahiti. We ate bananas from the palms we had planted.

Our son ­ then aged 11 ­ started at ordinary local school, running at least a year behind UK levels. After a while we realised that he wasn't really learning. So I changed my job to travelling and staying in distant aboriginal communities. I negotiated for my family to come with me to work, so he enrolled with the Katherine School of the Air. This school is ideal for mobile youngsters up to year eight.

In the aboriginal communities, we learnt what real deprivation means. Generations are being lost from any effective education in a world running parallel to white affluence. We gained an intimate understanding of how institutionalised discrimination works. The heart of my job was advocacy ­ to try to get the medical help needed. There were obstacles at every turn. I spent hours getting appointments arranged in Darwin, only to find that someone had been turned off the bus because they didn't have shoes. That's why people die. Some care, some don't.

There for a reason

I worked with a mixed bunch. Everyone was in the Northern Territory for a reason. There were dedicated, selfless bush nurses, there were aboriginal people who had made the grade and got useful jobs. There was also a tranche of professionals who had blotted their copybook elsewhere. Some had drug and alcohol problems. The Ozzie nature has a touching streak ­ to give everyone a second chance. This can be OK, but I had to work around some issues that could have compromised my integrity.

With a visa linked to my job, and technically working under 'supervision', I was vulnerable. Overseas doctors working for agencies also have restricted visas. The answer is to find a job yourself and negotiate directly with the immigration department in the state where you want to work.

On the basis of UK MRCGP, I was given complimentary FRACGP, which gave me unrestricted registration for work anywhere in the Northern Territory. I found the Australian College refreshingly grounded.

Being aged over 50, I could have obtained residency from 'sponsored migration'. Outside inner cities, all of Australia counts as open to overseas doctors. But there are pitfalls. My initial letter of sponsorship was invalid and I quickly had to find an alternative ­ tricky after I had paid for the flights.

Overall, though, I would advise anyone interested to go for the experience.

Andrew Stainer-Smith practised in Okehampton, Devon, for 22 years; he left in 2002 and did varied locum work before leaving to become a flying doctor (district medical officer) in Katherine, Northern Territory, Australia ­he welcomes e-mails of inquiry: contact

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