Dr Carol Cox came to Australia from Scotland in the mid 70s expecting Skippy the bush kangaroo. What she found was life-changing for both herself and the rural people of Queensland she serves.
Rural medicine is close to the heart of Dr Carol Cox.
Based in Toowoomba, on southeast Queensland’s Darling Downs, Dr Cox is a medical officer with the Rural Women’s General Practice Service (RWGPS), a division of the Royal Flying Doctor Service (RFDS).
She is, in effect, a fly-in, fly-out (FIFO) general practitioner. In the week she spoke with the MJA, Dr Cox had been in a different outback town every day for five days — including Cunnamulla, Thargomindah and Quilpie — before heading back to Toowoomba for her shifts at the Mary Street practice.
Scottish-born Dr Cox was a medical student at the University of Edinburgh when she first came to Australia in 1975.
A trip with the RFDS to Mt Isa and Mornington Island in far north Queensland proved to be a life-changer.
“It was a complete eye-opener”, Dr Cox says. “My introduction to Australia up until then was [television show] Skippy the bush kangaroo. Little did I know.”
She had already met her future husband, John, an Aussie studying paediatrics in Edinburgh, and after marrying in 1977 they returned to his homeland in 1978. It was John who had suggested the elective study with the RFDS in 1975.
“We’ve been in Toowoomba since 1981 and we’ve had the best of all possible worlds here”, Dr Cox says. “It has all the advantages of being a regional centre, in that it’s slightly less frenetic, as well as being a university town.”
Toowoomba is also the gateway to Queensland’s outback with a rail hub, decent-sized airport and the major highway west running through it. That’s made it a great jumping-off spot for the FIFO doctors.
And there’s never been more need for health services in the bush, with Queensland in the grip of a horror drought.
“It’s a terrible time out there”, says Dr Cox. “It’s the driest I’ve seen it since I started working with the RWGPS in 2001.
“There have been instances of people shooting their beasts and then shooting themselves in recent times — a measure of very real desperation. The men feel like they’re letting the family down. The young people do not want to stay so the older people are working themselves to death. Women are trying to find off-farm income.”
Towns are losing their permanent GPs. Cunnamulla is a case in point. With a population of around 1200, the town lost its full-time GP three or four years ago and has relied on FIFO GPs ever since.
“The ethos of the FIFO doctor is not a bad model”, Dr Cox says.
“It provides a relative continuity of care for non-urgent medical problems and women can expect to see the same doctor about six times a year. That’s important to them.
“It’s arguably better than having a series of junior doctors who are perhaps out of their depth.”
Dr Cox is currently a senior lecturer at the University of Queensland’s School of Medicine’s Rural Clinical School, and the topic of encouraging young doctors into bush practices is one she feels strongly about.
“Rural doctors have tried very hard for a long time to make rural training more attractive for medical students”, she says. “If you’re young and single, the social life in a country town can be very limited — the person you’re going out with may turn out to be a patient, for example, which is an ethical dilemma.
“And if you’re already married, then something has to be found for the spouse to do that is satisfying for them.”
As medical graduate numbers continue to increase and employment opportunities in the cities dry up, Dr Cox feels rural training and practice will become steadily more attractive.
“There is much more back-up these days with telehealth and supervision much more accessible than it was. Market pressures will eventually operate to help fill the gaps in the rural areas.”
The ubiquitous “if you were Health Minister what three things would you fix” question doesn’t stump Dr Cox for long.
“We’ve fallen into a very muddy place in terms of the lines between private and public health care”, she says. “A decision needs to be made — make the public system free for everyone and organise the private system so people who pay premiums are not also paying huge gaps.
“It’s become a nebulous, ghastly mess, particularly here in Queensland, and we’re not doing the best by anyone.”
Her second wish would be to improve generalist skills in rural areas.
“We have been deskilled out in the bush. It’s ludicrous, for example, that women can’t have their babies closer to home”, she says.
“There needs to be an attitudinal shift. At the moment we’re dealing with expectations that there will be a perfect outcome to every birth, that we’re going to live to be 100 and that there are spare body parts we can just put in place.”
Her third wish goes to the heart of medicine’s purpose at the end of life.
“We need to have an open debate about end-of-life treatment, quality of life and the way we fight to keep people from dying”, she says. “We — doctors as well as patients — are very squeamish about what to do when treatment becomes futile. We need to be having this debate — morally, ethically, economically.”
In January, Dr Cox was named as a Member in the General Division of the Order of Australia “for significant service to medicine in rural and remote areas as a general practitioner, to education, and to professional medical organisations”.
“I’m very happy and content with my life”, she says. “I have to pinch myself sometimes. I’m looking forward to retirement and spending much more time with my five lovely grandchildren.”
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