¶ Intro / Opening
It's just your average suburb, but there's a whiff of someone playing silly duckers.
Kids clothes. pinching.
I'm Dr. Ann Jones and I've secured an interview with Leonardo da Pinci, the criminal cat, thieving mastermind, for my podcast series, Nature's Most Wanted. On ABC Listen or wherever you get your podcast.
ABC Listen, Podcasts, Radio.
🎵 Music
¶ Introduction to Remote Bush Doctor
Damien Brown is a doctor who works in places that are often very beautiful, but where patients come in with the wild assortment of problems. He's worked in Africa with Medicine Saint Frontier, treating wounds of war and malaria and malnutrition. And then he shifted the focus of his work to remote Australia, to the territory and far north Queensland, to desert country and to salt water country.
Where medical treatment he says can sometimes be summarized as car versus tree, croc vs leg, propeller vs forearm, stinger versus thigh, bull versus arm, and tooth versus knuckle. Joining the Royal Flying Doctor Service, Damien was often in a race against the clock to fly out across the Outback to treat people who were barely hanging onto There's so much that's wrong with the way things work in this part of the world, but the wins he's experienced are real and life changing for the patient.
Damian's memoir is called Bush Doctor. I like Damian.
Hi Richard.
Bull versus arm? Crock versus leg. Ow. Ow, really? Seriously? Bull versus arm.
Um it's it's always sort of summarized as two almost always non compatible objects. Something animate and something inanimate. Uh the croc versus arm I didn't get. Um but the bull versus arm was a phone call I got. Uh it started mid sentence as the the dramatic phone calls often do. You'd you're in the in the hangar taking the phone.
And um I answered it and I just got a kind of a a live action in the background of like, Get the bull away from him. Oh, how do I give the morphine? Hello and I'm like, sorry, who is this? And where are you calling from? Um yeah, so the the the phone calls that begin mid sentence or or with role play in the background are usually problematic.
¶ Early Life and Medical Fascination
You were born and had your early life in South Africa. Do you remember when you had the thought, I want to be a doctor?
I I I grew up in a somewhat medical family. My uncle and my grandfather are pharmacists. Um, and so I had some exposure to it. My parents told me that it was when I was really young I swallowed a piece of Lego accidentally trying to get two bricks apart. And biting it off and ran into the living area saying, I'm gonna die, I'm gonna die. And my great aunt at the time was a nurse and she reassured me and opened the encyclopedia and showed me, um, you know, a drawing of the digestive tract and
that it was gonna come out the other end at some point. And I was both horrified and relieved. And mum and dad say that since then I was quite obsessed and they used to pull out the encyclopedias, um And then that my grandma lived near a vet uh a couple of doors up who had his surgical practice, like literally in the suburbs, um next to his house. And he very kindly invited me um one day or a few times actually to watch him operate and I I think that spiked the interest.
Have you ever lost that sense of wonder about the human body, this strange thing that we are, this mix of brain and guts and skin and this and that and blood that somehow operates and becomes creative and walks through the world? Have you ever lost that fascination?
No, never. And I think I think that's I think if you did you'd be in the wrong in the wrong job. I mean certainly you can have weeks when you're on and it can just feel like a conveyor belt of, you know, one after another of problems. Um but I don't think you ever get to the point. I've never met a periretirement doctor who said, I've seen it all. Um you you never get to that point.
¶ Living Under Apartheid's Shadow
You were living in South Africa during the final years of apartheid, which was quite an exciting time, but were you too young to remember that or what do you what what kind of impressions do you have of that era?
Yeah, I we were I was o uh almost fourteen when we left. So I I went to, you know, primary all my primary school there and first year of high school. So I remember quite a lot. Um
I you know, I I'm sort of embarrassed to say in retrospect, but I suppose, you know, anyone from that generation I I was born into the system that, you know, I didn't know another system. So You know, I i i it's ridiculous to say in retrospect, but you'd go to the beach, um, you know, frequently and there was just a sign on the beach that said whites only and this is the whites only beach and there'd be a park bench that said whites only.
um and everyone at my school were uh was white only. Um but the the all the media was government controlled, um so heavily curated and you know, not at all making excuses, but I don't think I really understood the full extent of apartheid um and its atrocities until we moved to Australia.
¶ Driven to Humanitarian Aid
So you moved to Australia, you did a a degree in medicine, but all along Europe you wanted to join Medicine Sans Frontier, Doctors Without Borders. W what's what is where does that come from, do you think? Is it a uh an earnest desire to fix broken things? Is that kind of like being a doctor plus or what do you think drove that that desire to join Medicine sans frontier?
Yeah, I think, you know, in retrospect it was just a a combination of everything I wanted to do and also kind of what I believed I should do. I Africa was well South Africa anyway was unfinished business. I I always missed it once we migrated and I always thought that I wanted to go back and live there and be a doctor there. Um the HIV AIDS epidemic was really ramping up when we left.
And I I kind of thought that just seemed like a you know, a good role to go back as as as a doctor and and kind of, you know, give back Um, and then, you know, I was a keen backpacker at uni and I love travel and I love the feeling of being in a foreign place where you just don't understand the language around you and um, you know, everything's just different. I absolutely love that. Um
So I think it was a combination of those things and just um you know, I s I suppose at some point you can just keep rolling your eyes at the news or you can kinda roll up your sleeves and and and do your bit. So there was definitely idealism in there as well.
¶ Angola: A First African Mission
So they take you to Angola. Angola. Was that what you were hoping to be taken to? A place like Angola? This is post civil war Angola, this must be said, right?
Yes. Yeah, I I got there um a few years after the civil war had ended so the country was still really impoverished and the infrastructure was quite sort of decimated. But it was, you know, ostensibly quite safe. Um, the landmines in the the area we were were the the only real risk, but um there'd been disarmament so there weren't a lot of guns around.
So in I think it was a good first posting and a lovely introduction to to rural Africa. But uh my parents were slightly horrified when I got the posting. It was the only posting I got offered. Um that was sort of this is what we're gonna give you, you're inexperienced, take it or leave it.
Um and you know, the irony was that my father had been conscripted, um, as all South African men in those white South African men back in those days were, and he'd been sent to the Angolan border, um, with the South African military. um they were involved in the Angolan Civil War back then. Um And part of the reason my parents migrated was to avoid me being conscripted. So me then twenty, thirty years later, signing up to go back to that exact region.
Putting your hand up. It was like it was like sheer the sheerest madness to them, I suppose. Yes. Once you got there, why were you grilled so much by the local workers about why you were there?
You know, I thought that I could speak, you know, basic to intermediate Spanish. I'd backpacked a bit and I told MSF, Oh, I could speak a bit of Spanish.
Portuguese.
Exactly, yeah. That's...
No, no. What what kind of questions were the were they asking you about why you were there?
One of the guys one day I mean, I never expected a red carpet as a volunteer. You I I did expect that you're gonna have to you you gotta earn your keep, you gotta prove your worth and and you're you're there transiently and these people are there all the time. So, you know, you have to earn your um the pro proof that you're there to to kind of do some good. But I remember having a conversation that
Uh the language was a huge barrier and and I think there was some resentment that they'd sent this sort of eighteen year old looking doctor um who couldn't speak the language out to help. Um but one of the guys one day he said I mentioned that I was a volunteer and he said, Ah what do you mean a volunteer? And I said, Oh oh well like sign up as a volunteer and he said, You mean you you're not paid for this? And I said, No And he said, Oh
Well does does that mean you're not very good? You can't get a job in Australia? Like why would you come out here for free?
And what did you say?
Well I thought I thought it was probably a fair question given um how inexperienced and young I was. I didn't have a lot to sell. But um uh I No, I said, you know, the issue really, uh uh paradoxically, was getting any time off the training program in Australia. Like it was actually quite hard to get over there and
There was a safe room you write at that clinic. Was that necessary, given that the civil war had come to an end?
Well, yes. Um occasionally there would be gun fights in and and this was something I'd find in in various contexts Sudan as well, there'd be gun fights, um
¶ Surviving Gunfights in Showers
just because there's still rival clans, um, you know, rival issues. And so the risk usually for us everywhere I've been has not been targeted as much as just being caught in crossfire. Um, people having it out near you. So occasionally you just hear gunfights or someone would yell something and then you just have to make a beeline for the safe room. Yeah.
Tell me about the day that gunfire caught you while you were in the shower, D.
Yeah. I well you have a little grab bag in in your hut um or your bedroom ready to go and that's your passport and um just essentials that if if if she really hits the fan, you're just gonna grab this little thing. get to the safe room and then if need be evacuate, you know, be that down the river, in the car, down this back road. So you kind of have a plan. I was in the shower one night, which is really was just a pipe of cold water into a little brick room.
And um all of a sudden the gunfight started and I'd walked to the shower stupidly in my towel, so I had no clothes to put on. And I heard the others yell that they were all running for the safe room. Um and I had this kind of brain freeze moment of like
Oh underwear or safe room? And I thought I don't you know I don't know if you're gonna get'cause sometimes you can get it stuck there overnight or for a couple of days and there's a food supply there. So I thought, Oh no, I definitely need underwear.
So I shot across the yard and I could hear the cracks of the bullets and it was a full moon and I'm quite bald. So I was like kind of in my in my head, I probably wasn't, but in my head I was kind of weaving and ducking and you know, worried that my head looked like a flare. Did you
Did you get to the underpants though?
I did. I made it. I got the grab bag. I got the underpants. Got back to the um got back to the safe room last and had to pound on the door for them to open'cause they'd locked it and everyone was like, But how were you? you know, it took far too long and I was like, I had to get these
So after serving in Angola, suddenly you're you're back in Australia, in between these stints with Medicine Sans Frontier. Is th how strange is that? How weird is that? I haven't talked to people who've been working as foreign correspondents in war zones or people like yourself.
¶ The Oddity of Returning Home
And the thing that really bothers them most when they return to Australia Are people bitching and moaning about parking? Yes. Sort of thing.
Many times. It it's it's very difficult and the cliche is that coming home is harder than being there. Because when you're there Um, yes, it's a culture shock. Yes, you know, the the medical conditions are, you know, quite overwhelming. But you're busy and you've got a role and there's a team of you and you crack on with it.
And then you come home to this kind of quite you know, zero gravity emotional environment and I remember I actually to steal a um or to borrow a phrase from a another book written about MSF, the author called it New Fridge syndrome.
What is that?
You you come home and you catch up with old friends and then they're like, Oh, you know, how was the trip? And you're trying to sum up six months of the most overwhelming experience. You don't want to over egg it but you're like, Oh, you know, and we got evacuated and it was this gunfight and It's quite sad, you know, we had a few deaths.
My underpants and the gun and the gunfire, that kind of thing, yeah.
Yep. And then people, you know, they listen and they give you your few minutes and then um, you know, they kind of just go, Yeah. We got a new fridge last week. But the problem is you don't want to be an you know, you don't want to be that sanctimonious uh So as well at dinner tables just being like you know, for the price of this meal, I I think we should all just pause and think about it. You know, kids are starving. You don't want to be that guy.
Nice, isn't it? Nice, nice nice ridge that is.
Yeah.
¶ Treating Wounds of War in Sudan
So then you'll redeploy to Mozambique and then South Sudan, with its on again, off again war or civil war, however you want to frame it, depending which part of Sudan you're from. I just wonder how hard it is treating people in a situation Quite different from the one in Angola with the man with the gun has so much power in any given situation.
I I mean my introduction, my flight into Sudan I think like just set the tone for for what it was gonna be like for me. I we got diverted um in a little MSF plane as we were flying into my project from Kenya. um or the project I was gonna be in I should say. But we got diverted and we landed on this dirt runway in another community because there was someone critically injured and they wanted to take him to the bigger project I was going to with a surgeon.
And we landed and there were just these armed guys on the side of the runway blurring past, you know, the the the aircraft and um and then You know, the aircraft door opened and these guys quickly bundled in a young man who'd been shot in the neck, was still very much alive, but
um had a really bad neck injury with bandages loosely applied and they bundled him in and then we just turned around, took off and went off and that was, you know, my first two minutes on the ground in South Sudan. If It's difficult because you you've got all the all the other conditions, the malaria, the T B, the HIV, y a and then on top of that you've got this constant kind of instability in the background where you don't know when the project's gonna have to be evacuated or
when when a a a a truckload of critically wounded people are just gonna arrive. Um and then of course, you know, there's a staff safety issue in the background as well.
Yeah. What do you do when there's a guy with a gun who walks into your your hospital or your your clinic? And you can't help the ki the guy he wants you to help and he's not ready to take no for an answer.
It's very difficult because the organisations I mean, the safety is really predicated on being neutral and ex you know, taking care of everyone. So yeah, our safety isn't really on, you know, big fences and armed security guards. So really anyone in that context could wander into the hospital and often did and our men would wander in
¶ Militia Pressure in the OR
We had a really unwell man on the ward one day who had a um a badly infected um gunshot wound and it was becoming gangrenous and he was septic. So he was critically unwell. Um and I didn't think he'd live another day or so. But we couldn't fly him to a bigger project where there was an orthopaedic surgeon because the it was a wet season and the plane couldn't land and it was going to be days.
So it was kind of this decision of like he's about to die on the ward, I think, or we try and deprive this wound, but he might die in the operating theatre. And his family and militia, you know, or or uh militia men or colleagues came in, um, you know, armed, we'd ask him to please not bring their guns in and most of them complied, some don't.
And they were like, He's not to die. You must save his life. We cannot accept this. Like you you know, we won't accept him dying and um you know, so you talk obviously the Sudanese health workers are doing all the interpreting and and and the sort of the cultural stuff. Um but they were like, nah, they they they want you to save this guy. I'm not a surgeon.
I can sew things up and trim things, but we took him to the operating theatre, myself, you just give a anesthetic ketamine, really just sedative, um, myself and the nurse and we just try to trim away the the dead tissue and his militia men colleagues were standing outside armed and I just remember thinking, like, if he dies, which is not an in insignificant risk. I don't know what I'm gonna do. Uh go at the back door and just leave or
So so what what were you able to do with this guy?
He fortunately survived that and um in the subsequent hours and then we just uh I escalated it, you know, to the the head of mission um in another town and we just uh made phone calls and and found an aircraft that that would come and evacuate him because at that stage then it's a security risk for the whole team and and really the whole project.
A bit shaky after all that?
Yeah, completely. Yeah, yeah.
¶ Australia's Own Medical Frontline
So y after all these deployments in Africa you came back to Australia and then signed up for rural medicine and emergency departments in uh regional hospitals of that and They sent you to Central Australia. What kind of advice did you get about working there?
I took a casual job because I needed money. I I at that stage I was still in my mind gonna be uh a city specialist. I wanted to be an emergency doctor in in in the city, um and that was my training pathway. And I came back and I needed money'cause, you know, volunteering doesn't pay that well. And I was about to go to a training job which
you know, uh also didn't pay amazingly. And so I asked around and a friend said, Oh, this is hospital in Central Australia. They're always short. I I'll totally take you. Um here's a you know, here's the email address or phone number, you just give'em your dates. And the person who recommended me was herself a far more experienced aid worker and she cautioned me before I went. She said, I'm warning you, it's harder than working overseas.
Because you don't expect it to be and because it shouldn't be. And I think I was realistic enough that I I didn't think I was arrogant enough to be like, I've seen everything. But I did kind of think, oh, you know, I've just been the only doctor in a in a a region in a little corner of Africa, I'll be fine. Um yeah, and it was uh I I wasn't.
What was the hospital like? In central Australia when you got there.
Yeah, so it was um a few hundred kilometres out of Alice Springs and I'd never been to this region at all. I drove into the town, um, you know, lots of shoes hanging over the power lines by laces. steel shutters over the shop fronts. Um and the hospital was small, um, twenty, maybe thirty beds. um an X ray machine, but no scanners, no operating theatre. Uh there were four doctors at a time then. Um it's far better stuff now.
And uh yes, a long way from anything. So, you know, five hundred kilometers to get a patient to a bigger hospital or thousand kilometers if if they need, you know, major intervention um elsewhere.
¶ Facing Health Inequity with Billy
Tell me about this young guy you met called Billy. What kind of a man was Billy when you met him?
Uh, one of the first guys I met, he he knocked on the door um and he was wearing a lovely cowboy hat, you know, old school ringer, um, Aboriginal man. And he was really short of breath. Really sweet guy came in but panting like he'd been running and sw got him into into um one of the emergency cubicles. And he had severe heart failure and it turned out like really needed a a heart transplant and had been on a nice edge for years in terms of medications just try to tide him over.
What was Billy?
Well, you know, I assumed given that medical history that he was old, but Billy was younger than me by a few years. And at that stage I was in my mid thirties.
In his thir he was in his thirties?
Yeah.
Yeah. And he's presenting like a very old man.
Yeah. And that you know that still for me is the most striking thing in these places. It's not just the burden of disease or the the rates of of illness, but it's it's the age of onset. You know, aging is kind of fast forwarded and just these things compound. Um
So how does a guy like Billy, who was so young, get s such serious heart and kidney problems?
You know so so for bi in Billy's case
Yeah.
A a lot of bad luck and a bad environments. Um you know, those biggest systemic factors. So, you know, with any of these illnesses there's obviously well there's a genetic predisposition, which is obviously just, you know, uh unfortunate um for some individuals. But the rates of things like diabetes. So Billy had diabetes and he'd had, you know, really hard to control diabetes and multiple heart attacks, um, you know, from his early thirties onwards.
So his heart was failing and from the medications his kidneys were now failing as well. There was a dialysis unit in this tiny town, um that I think per capita is probably one of the biggest, if not the biggest dialysis unit on the planet. I cannot find anywhere that has more dialysis machines per capita than this town in Central Australia. Um, you know, such is the burden of illness up there.
Has that got something to do with the fact that pretty much all the food that comes in has to be imported and is heavily processed?
Yeah, and that and that was really like a shift for me. I I I I'd always just assumed, um, and totally wrongly that, you know the the illness was was a result of um of just bad luck and and maybe lifestyle decisions and stuff but
When you just see the same patterns over and over again like you do with people like Billy, and Billy wasn't an outlier, unfortunately. I saw many people in in a similar situation to him. It's these bigger systemic factors. So it's the environment and they you know they call it the social determinants of health.
¶ Roots of Indigenous Health Crisis
So it's the crowded housing um that, you know, causes repeated infections um, you know, from from early in childhood. So things like chromatic heart disease, um it causes, you know, uh inflammation of kidneys and all kinds of kidney disease. Um, it's the terribly poor food. You know, I've paid ten dollars for a rubbery little knob of broccoli before. Um,'cause everything has to be trucked in, obviously.
I see you might as well get a packet of cheezels for dinner instead. Totally.
yeah yeah cook truck and a coke or some some dimmies up at the server you know gonna get you further yeah
This has the effect you say of accelerating the aging process by and light. So you see a lot of very old young people in this part of the So that's the larger part of your work in in many ways?
The chronic diseases um are absolutely the bread and butter of the work up there. And and that's one of the biggest differences to me, um, from coming back from Africa. Africa was really well rural Africa I should say. I mean obviously Africa's many things.
But the pockets of rural Africa that I worked in, it was really infections. So malaria, diarrhea, chest infections. And they're generally very easy to treat. You know, short course of medication, maybe a couple of days on the ward and people go home feet. the chronic diseases, so diabetes, heart disease, um, kidney disease, um and then uh you know, also I I would put mental health um illness up there is uh or
uh, you know, quite a significant issue as well. These things are far harder to treat because they require daily medications, um, you know, a a large team approach, um Obviously the patient's gotta want to um engage for their entire life, um which is a hard sell.
And they've also got to want to come into the hospital too, don't they? I mean, is that a problem? Because very often in indigenous communities there's a distrust of white authority figures, mm, people standing there in a in a coat or something and uh a stethoscope who's talking university language m to them, which and and very often these are people for whom English isn't their first language if they have any English at all. Is that a problem too, getting people to trust doctors?
It is. And I I think one of the biggest things that makes a difference is continuity of care. Um so many times uh, you know, people will just respond so much more positively to a familiar face. Um and I I think, you know, the other thing is often treatment so for someone like Billy who needs a heart transplant, um, that means having multiple appointments
not just the operation, which would be significant, and then all the follow up um, you know, in another city or another state. And that means being away from your family, being off country and a lot of people just really don't want to do that.
But rather die, rather than be off country for a long time.
Um you know, I can't speak for them, but um that Y you know, Billy specifically didn't want to be away from Ka he'd had he'd been down south for a few assessments and appointments and they'd made it clear he'd need to be an ICU and have, you know, lots of follow ups and he just didn't want to.
And I had a few times that sort of the ceiling of care, end of life conversation with him that down south I'd normally have with someone in their eighties or nineties. Um, you know, I was talking to someone younger than me up there saying You know, I don't wanna have this conversation, but if it does come to that, when it comes to that moment, are we gonna fly you out down south? Do you want all the big tubes and the breathing tube and
maybe wake up in another hospital or not. Um, or do you want us to just look after you up here? And, you know, unequivocally he was always like, nah I want to be here. It's my people.
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Then you were off to Cairns for a while, I mean working with the Royal Flying Doctor's service out of Cairns. How does that life work? Are you just hanging around the base waiting for a call that call to come in and then bang you're off? Is that how it goes?
Yes. Yeah. So the job there it's um it's split you do some weeks you do clinics. So you fly it to remote communities and you stay up there. But then when you're on um they call it retrieval, which is like the aeromedical rescue service. So you do that for a few days and that yeah, you literally um your office is attached to the hangar, which is on the side of the runway at the commercial airport. Um and the pilot and the nurses uh, you know, just the offices next door.
And yeah, you just take calls and anything comes in.
And when the call does come in, is it like what you said earlier, everyone of course when the call comes in the the person calling is in a state of some distress and confusion, you get this kind of word salad or something that that you have to make sense of?
Uh yes. Uh certainly for the dramatic ones, yeah. They just often start kinda mid mid sentence and you know, mid paragraph and you're like, Oh sorry, sorry to cut you off. Um but but uh y uh probably half the calls are are from nurses in the in the nurse run clinics up north. Um so they're obviously, you know, uh
pretty great um to deal with because they they do this all the time. So you you're speaking to another healthcare professional um and it's all kind of packaged and and you just sort of they're just running a story past you.
¶ Urgent Rescue After Fuel Explosion
Tell me about the call out you got to a cattle station once where there'd been a fuel tank explosion.
Yeah, this was Uh, this was not long after I started and um again one of those dramatic kind of mid sentence phone calls where I I I picked up the phone and um there was a guy just saying, You gotta come, you gotta come, um they're on fire. And then it cut out and I didn't have caller, we didn't have caller ID um on that phone and I couldn't see a call. I couldn't call them back and I was like, Oh my god And I thought he I thought I heard him say two, there's two and they're on fire.
I was like, I guess two people. I mean, uh two what? So I I quickly went over to the pilot and the nurse on that morning and just said, Hey, I I just got this phone call but I don't know where and I don't know. if we're gonna be the closest base, but w you know, what do we do? Do we start loading? And so we decided we just sort of planned for the worst. So we loaded the plane um with, you know, two ventilators, two stretchers and a bunch of equipment for for two patients.
Um but the pilot can't load the fuel until you know, you know, where you're going to. But then the guy called back from the station and and gave us the details and two guys had been welding a fuel tank and were badly burned. So we quickly load it up.
Well welding a fuel tank?
Yes, I know I know it was well, it was so sad. Yeah, that that emptied it. Um Yeah.
Uh so what did you see when you got out there?
So we flew um really, really rough dirt strip um on a cattle station somewhere in the middle of Cape York, um, in a daylight landing and Two youths picked us up, we put all our equipment in and drove to this house and there was just this huge truck out the front that was still smoldering, um, melted tyres and you could just smell the burning and
There were a few blokes. It was a a cattle a working cattle station and one of the guys was like, Oh, you know, thank God I mean they would have waited an hour for us to come.
Are they still alive, these men?
Yeah, and I I it just would have been the longest hour. Um so one of them was alive talking, um and you know, probably fifty percent burns, which is Then the other guy was in the shower, um, lying down and they'd try to cool him, you know, which is the first aid for burns and um I went in and he I couldn't see any burns. He was just very pale.
Um, so quickly did our A B C, you know, the airway breathing, you do your initial assessment. And he was just talking to me normally. He was like, Oh, thanks for coming, Doc and like, Yeah, oh, you know, it was a beautiful bloody morning. I can't believe we've done this and I was like, Oh g'day, you know, l lover to meet you and um I'm so sorry this happened, we're meeting like this, but look, we're gonna take good care of you and
So I did an assessment from top to bottom and I I still couldn't see burns. Um and I was like, I d I don't know what I'm missing but it was very pale and then my colleague came in and and we both we just sort of double taped and stood out later and Like I think he had a hundred percent burns. We sort of couldn't see where he wasn't burnt. Um
So it was very sad. We we we stabilized these guys. Um the the guy who was critically burnt, we put him on a ventilator. So, you know, incubated is the the term. We and put him on kind of, you know, life support really. um to stabilise him and the other guy um we got good painkillers and didn't put him on a life support, just sort of kept him awake.
And this is all on the back of a Cessnerist.
actually doing this. Yeah, this well this was on the balcony of a old house on um you know uh on this cattle station
But you've got to get them in this ventilator in the Cessna with all.
Yeah, exactly. Yeah. So then you've got to get it it's it's a very modern expen incredibly expensive aircraft. They're King Airs like uh turboprop, twin twin props and they've been refitted to have two stretchers and quite a lot of
uh medical equipment in them with a tiny door in the back. So, you know, these these stretches then once you've got the once you've got the patient and all the equipment is well over a hundred kilos and you've got to kinda lever that up and you know, wedge it into the back and and get it around a tight corner in the plane.
this point but by this point night had fallen. How how how do you take off? Out of a cattle station on an airstrip which which is in complete darkness.
Yeah, so again, just this this tension. So we as as as the the medical side, we're like, Oh, these guys are really unstable, their blood pressure was all over them. We want to stabilize them, but the pilot and the pilot is absolute, you know, the the chief. in terms of safety and you you really need to do in all these jobs the pilot has final say.
So the pilot, um, who's a lovely guy, I mean they're all fantastic and um and really experienced and he was like, We gotta get going. Like, I cannot take off in the dark and it was it was dust. Um it was a short runway with no lighting and it was on a cattle station, so there's cattle everywhere. It's like we gotta hustle, like you guys are gonna have to sort this out in flight.
So we loaded the guys, quickly, um, you know, shut the door, I sat in the front with the pilot because there was no room in the back with all the equipment and I'd jump over later. And then He went to start accelerating and we were aiming for a Ute light at the end of the runway. So there was it was a short runway with like a a a barbed wire fence at the end and then a Ute parked at the end.
So we were aiming for a huge tail lights and that was the only lighting we had. Sometimes people if they don't have lamps will um light. Dunny rolls. They'll soak them in kerosene and light them down the side.
Flaming torches of the yeah.
Yeah, yeah, yeah. So you get like a dunny roll landing or a dunny roll takeoff. That's the that's a real sort of plan B U but.
And is there a there's gotta be a time limit on that one too, doesn't there? Like the the doneny roll but what what do you get? Five minutes, ten minutes if you're lucky on the dunny roll.
Exactly. You want the double ply, right?
So you were able to fly these men safely back to
Yeah, so it was a dramatic take off and um you know, we we took off on the pilot. I was sitting next to him, we took off just before the the the fence and um I I thought we were gonna hit it at one point and he was like, Oh, we bloody made it and I thought oh shit, I think he's surprised but he definitely knew what he was doing.
And then we've got the guys back to Cairns um emergency department alive. One of the guys then well you hand over to the other staff, obviously, you know, there's a waiting your phone ahead and there's a waiting team ready to accept them. And one of the guys then went down to a bird center a burn centre I should say and and did okay. It was you know, it's a long recovery. And the other the gentleman who had the hundred percent burns unfortunately passed away in the next couple of days. Yeah.
¶ The Power of Incremental Care
The nature of the work has been described, you say, uh by the phrase the heroism of incremental care. I like that phrase a lot. I I like it because it's again there's not the dramatic, is it? It's not really the dramatic, but it's really that healthcare in small steps that really does improve people's lives.
Uh totally. And I I I borrow that phrase from Atl Gwande, who's um uh American surgeon and and writer. Um but I think You know, so often and I thought when I started, I thought it was about the dramatic rescues and I mean obviously that's a extremely important role and side of the job. But really you wanna you wanna avert all these things and and that guy we were talking about, Billy, you know, with with his end stage heart disease in his thirties.
Not saying in his case, you know, it w any w any one individual failed, of course, or or made a different you know, could have could have offset that. you know, those relationships and treating diabetes through trust and seeing people weakly and just shifting those things. uh minutely over time, that is I think I I don't think I know that is where the big impacts will be made. Um
These are parts of Australia which were among the last places to be colonised.
Yeah.
Mm and they're also the they were the kind of the last to be decolonized, if you like. You still see the ongoing effects of that in that part of the world?
It's so tangibly recent. Um, when I was just so blown away when I first started working on bear at how many people um would just openly say, I'd be like, you know, just make polite conversation while you're trying to load up the the file and waiting for the internet, you know, they're they're looking for their file and say, Oh yeah, so did you grow up in community?
And so many people are like, uh no, I grew up on the mission, um, you know, and then I was sent here and then I was sent there and then I was sent to Palm Island and um so it's in in this current lifetime for many people, um It's it's extremely recent. And in Central Australia, um in the town I worked in, uh, you know, very similarly, I mean it was really only in the late sixties that the people, the indigenous people there, were allowed back.
to settle into their own town or their own community or their their own land. Um and the names of some of the you know, some of the addresses just on the medical files constantly catch me by surprise. Like that people settled back into camps. Um and there's now there's now housing. There's a severe shortage of housing, but there's formal housing in in the, you know, so called camps. But very often, um, you know, someone's address will just be like Um dump camp.
I'm like, okay. Um, you know, or tin shed past Dumbcamp, care of post office.
It's the problem with the grog there and I'm really conscious of how the word grog itself is a real first fleet term, isn't it? The problems with the grog and the violence that's associated with that. Tell me about the patient who came to you one day. Asking knocked on the door asking for some pananol'cause he had a bit of a problem with his chair.
Yeah. Um so after hours you kind of see, you know, the underbelly of the town a bit. Um and I had a a a yeah, just a gentleman knocking on the back door. Uh doors are obviously locked after hours and Well uh you know, i in in in the hospitals up there and um this guy knocks on the door and I I went and opened it and I was like, Oh yeah, how you going? What can I do for you? And he said, Um, oh just some panoroles, a bit of chest pain. Oh, chest pain. Oh no worries just come in.
And I turned my back and sort of you know, he followed me and then he turned and I I noticed a huge blood stain on the side of his shirt and I was like, Ooh, what's going on there, fella? And he said, Oh, this one and he lifted up his arm and I could see the handle of a knife poking out and you know, the blade was still embedded in his chest.
You're pointing to the left hand side of the body. It's was it near his heart?
What? Um but yeah, totally embedded um and and still in his lung. Uh so you know, it goes from two panodol to instead a blood transfusion, um a a a a big tube into his chest to drain all the blood and reinflate his lung and an urgent flight to a surgeon.
What are some of the more bizarre cases that have come your way? I mean there's plenty of those in Metropolitan stories. I d I don't doubt that there are uh bizarre cases that come your way every once in a while where someone's a little bit emba a bit embarrassed to report what's wrong with it.
Yeah. Well, I mean the stupidest case I've seen, um, and this wasn't uh in Central Australia, so I I feel okay calling it stupid, was a guys footy team loss. Um, and he was so pissed off with him that he took out his gun and shot the tattoo of his forty team with the insignia, which was on his ankle. I don't know how he didn't connect those two things. Um so shatteries for it.
Collingwood supporters are not to be sh trusted with firearms in such situations. He shot his own footy logo on his ankles.
I'm from Fitzroy, I have to play the fifth on that.
How about the grey nomad who needed a bit of help with a metal washer one day?
Oh yeah, some fell so the the grey nomads are you know, the retired middle classes travelling up and down and this fellow rolled up and he was He didn't want to say to the triage nurse, who was a woman, what was going on? He said, Oh nice, need to see a bloke and um so that was me. And uh I went in and he was so sheepish and clearly uncomfortable and he took his pants off and
Look, I don't know how much detail I can give, but he had an industrial thick washer. Like I don't know if he could have found a thicker washer. And he'd managed to put all of his genitalia
What, all of it?
All of it.
Right. Meat and potatoes, the whole thing, right? The mixed grill.
And I was just like, why? And he was like, ah, I don't want to talk about that. It's just spicing things up with the missus, you know, romantic.
And Damien, which one of us can honestly say we haven't put our genitalia through an industrial washer from time to time? So this So so he couldn't get it off, I think, was clearly the problem without without hurting himself.
Yeah, no. And and we struggled. I mean it was w we're a little little ring cutter which we ran blunt and then like a a a little metal grinder and So I had the intern called the intern in and they were kind of holding some of the package out of the way and then had had another med student dripping water on it to keep it cool and I was kind of grinding it, uh like council workers trying to get through a slab of pavement.
Yeah.
Yeah, yeah, like a small little angle grinder and
And how did how was he taking all this?
Oh, you know, it was kind of I mean by this stage there was just no pride left.
Yeah, I got a new fridge.
Ha ha ha.
Wow. Um
¶ Carol's Life and Deep Realities
Tell me about Carol, an elder you met while you were up in the north, too. She sounds like a wonderful person.
I tried for a while to Uh you know, as I mentioned earlier, like you you meet all these people with just incredible backstories. I mean, pretty much everyone and and people would just mention they grew up on a mission or they grew out on this, you know, really, really remote site. So For a while I'd I started I'd ask people, I'd say, look, can we catch up for a yarn sometime? And I had no no real agenda with it. I just I just wanted to hear more. And the clinics were always quite rushed.
So I gathered a bunch of um people were just very generous. They were like, Yeah, here's my phone number, here's my address, like anytime, give me a call, come past. And then the opportunity always passed and then this lovely grandmum came in one day looking after her granddaughter who, um was quite stoned and she wanted me to talk some sense into the granddaughter, but the granddaughter just wanted some sandwiches. It was very sweet and um I wasn't in a position to engage. So I was like, look
Why don't you come back tomorrow? Go have sandwich, sleep and you know, we'll we'll catch up tomorrow. And As she was leaving, because she was so warm and she was so she said, Oh, you know, the young fella's always getting into trouble. And my day it wasn't like this. So on the way out I just said, Hey, could we have a yarn sometime? Like could we do you mind if we catch up? She was like, Yeah, I can do that now. I'm like, Oh no, I've got to work, but like could I could I come past sometime?
I said, Yeah, of course. And um and then, you know, things get busy and the evenings are checking results and callbacks and and and some time went by and I got a message from her. We swapped numbers and I got a message from her and she said, What, we're gonna yarn or what? Like when are you gonna call me?
So oh goodness, yeah, I forgot. Um and then we caught up and a friend I mean Carol's backstory is just incredible. She grew up in a Roma community and just had this absolutely incredible story that she was just so generous to share. But it was so awkward because then, you know, the the awkward white fella are now trying to do this properly and respectfully, so
I told her I t I told her a mate, um, who's also a colleague up there, I said, Oh, I'm gonna go catch up with this lovely Aboriginal and um go yarn with her and she said, Oh yeah, what for? And I said, Oh, she's just gonna give me her backstory and I just wanted to ask her about what's going on in town.
I said, Oh, you better take something. You better give her something And I was like, Oh what do you mean give us something? And she said, Well it's like I don't know, you better give her some money or take her
For a time.
Yeah, yeah. She was like, you know, it's a bit transactional, like you're getting stuff from her I can't, you know, I'm not gonna give'em money. That I mean that's just awkward and weird and I thought I would take her a box of chocolates and she's an old grandmum, but oh you know, is that is that kind of like a date then? It's gonna make it weirder. So I went and filled I I got a few bags of groceries and was all
You know, quite uncomfortable about it. But I thought I'd just be nonchalant and I went to pick her up um and she said, Oh, did you bring the fishing gear? And I was like, Oh no, I don't have any and um and I took the groceries out and she was like, What what are these for? Groceries for and I was like, Oh, I just I I bought too much and I was trying to downplay it. And she was like, nah.
Nah no good. Like I don't know, maybe my daughter wants'em. Put'em back in the car and I was like, Oh my God, I I've made this so awkward. But then we went and had this lovely chat. Um and she was just so generous. She shared so much of a backstory and she wanted to know all about my family as well. Um and we've caught up a lot since. Um
But, you know, one of the things with with her is um I find like every time I catch up with her, she's she always just wants to know about what I've been up to. Um and then I have to really kind of like be like, Oh no, tell me more about like how was your week and
She'll just have this incidental roll call of really kind of heavy difficult things that just happen to her, but she she'll never volunteer them. It's just coincidental, you know. I'll be like, Oh, you know, how was your week? She's like, Ah, no good.
Kids smash the windows of my car, you know, some kids from community and we've got to drive like a thousand kilometres to a funeral next week and you know it's gonna be a bit windy and son's in ICU and I'm like, Oh my god, what happened? Oh he got stabbed in Darwin and you know, it's just this Just it it always this really sobering thing. It it seems like we're going for a Coke and meat pie and then and then I'm always just like, Oh my god, like I I just really have no idea.
um you know, the the the the the situations people sort of deal with in the background.
¶ Coping with Trauma, Seeing Progress
There's a risk of course you have with seeing just too much of the Too many terrible things. Do you say that there's sometimes health workers need to wear something like a psychological crash helmet? Mm-hmm while you're doing the work. And I I can sort of see why that's necessary. But then what happens when you've got to take that off, that psychological crash helmet when you come home? Do you have to be careful when you take that psychological crash helmet off or can you ever take
Um, that's a good question. I I think I I I don't I haven't found the right I don't know the right answer and I think um for me over the years I've just occasionally had to pull back a bit, just work a little bit less or maybe take an extended break. I think you know there's a line I there's a line somewhere, a big middle ground, between, you know, empathy, which you need and want to maintain, versus putting too thick a helmet on, you know, for want of a better metaphor, like just
getting too thick skinned. Um Because you do see a lot of things. But um and I think of a line and I I I borrowed it there was a line I heard someone overuse which is um it was returning from aid work and someone said, Oh, how do you cope with the poverty? And the reply that someone else said was like, I don't have to, the poor do. And I feel a bit like that up north. Um, you know, I see things as a sort of vicarious trauma element where you see things that
uh are are sad and you could really ruminate on um or infuriating um and you could really you know come home and and ruminate on it. But the bottom line is I'm far more effective if I sleep well and r arrive for the next week good to go. Um you know,'cause if you if you kinda flame out and are having a big existential crisis every few weeks it that Uh it's understandable but it also doesn't help the roster. So there's there's some middle ground and I I I still work hard at trying to navigate it.
You were talking there before about that the classic Great Australian sil silence about let's not reflect on the recent unpleasantness that thing that tends to prevail in in these matters. And some of that I think comes out of a feeling that these things are Both intractable and unimprovable. But
But you say things are getting a little better in some of these health c outcomes. Things are improving in some places here. And this should and this is why indifference and inaction and apathy Isn't the way to go.
Yes. I think I've been guilty of cynicism uh plenty of times in my career and that's when you step back. I did a masters in public health just to sort of zoom out and get a big picture.
And what does that tell you about some the the overall health outcomes in in in some of these communities?
Mm.
And it's based in news values too, which is there's a negativity virus in how news is report.
Yeah, yeah, sorry. I think I read that like six vaccinations save six lives a minute in in sub Saharan Africa um at the moment. And you know, that's not a headline because you can't say today ha you know, extrapolate that to a day. You can't say that two thousand kids are alive this evening. Headline news There wouldn't have been if we didn't have this funding programme or, you know, these thousands of African health workers, not foreigners. Um
News value sees that it's not something that's happened, but something that didn't didn't happen is therefore not reported.
Yes. Yeah. And I do really think that um we lose sight of progress. So, you know, just some some big obvious numbers, but uh you know, I didn't know this stuff until I went digging for it. But like the under five mortality rate has halved in about twenty years. So half as many malaria deaths have halved in recent years. Um
More than I think.
It it's definitely the majority and I think it's about ninety percent of HIV positive adults in sub Saharan Africa are on antiretroviral therapy. That was unfathomable twenty years ago. Like inconceivable.
And that is a daily thing. I've of course it's jeopardized by USAID and, you know, the craziness that's happening in the US at the moment. Um, it can be undone. But I think there are there are more people out there doing good and fighting these issues um, you know, clear eyed and well than than the converse.
Yeah, no one can afford cynicism in in a terrible situation, I think. And although there are often these intractable problems, how many days do you have where someone comes in with a nasty problem that you can treat, and you can either cure them of it or rep fully repair it or at least just make it things a little better for them? That's gotta bring you enormous satisfaction. Does can do you still let it bring you that satisfaction, Damien?
¶ Celebrating Small Triumphs in Healthcare
I do, but exactly what you said, you have to let it. And I think you can just get into that daily grind of of work work and and you know, i it hasn't things haven't improved as much as they should or you want it to be. And I think Sometimes you just gotta reframe and I certainly do that consciously and and I take the wins. I I I
You know, talking about diabetes and these chronic diseases, one of the things obviously we all reiterate and the the the incrementalism is, you know, exercise. Go walk. And it's hard in these communities. It's steaming hot most of the year. But I went for a um a bike ride on, you know, the old staff BMX uh out past the airstrip in one of the communities um a f uh a while ago and I saw
three older women um from this remote community, uh, all with a lot of health issues, walking on this dirt track out way out of town and I was like, Oh, you know, evening ladies, uh what are you guys up to? What are you doing? And I recognise them from the clinic and they recognise me and And they said, Oh, look, we're going for a walk. You always you're always humbugging us to go for a walk. We're doing it And they'd made a little walking club. And honestly, that for me was like
Bigger than any, you know, swoop in on a dramatic rescue fly. So I was just like, oh my God.
Sometimes the
Works. Yeah.
Yeah.
Absolutely.
Damien it's been wonderful. Thank you for agreeing to be humbugged by me. In this conversation. It's been such a pleasure. Thank you.
My pleasure. Thank you, Richard. Thank you so much.
Damian Brown's book is called Bush Doctor, a memoir from the beautiful rugged heart of Outback, Australia. Today's conversation with Damian Brown was made on the lands of the Gadigal people. Producer was Rebecca McLaren, executive producer is Eliza Kirsch. I'm Richard Feidler. Thanks for listening.
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