The Royal Flying Doctors, Outback Australia

Broken Hill is a remote mining city in the far west outback of New South Wales. The station had been the location for the ’80s television show The Flying Doctors. The town had received its name from an entry in the diary of explorer Charles Sturt, who mined silver ore there in 1883. The break in the hills that the explorer noted no longer existed, having long since been mined away. The Royal Flying Doctor Service (RFDS) was started by Rev John Flynn, superintendent of the Australian Inland Mission about forty-five years later. In the early days, it was called the Aerial Medical Service, and it provided emergency and primary healthcare for people living in remote areas of Australia.

I was excited about my new position, and my colleagues in Melbourne started to tell me stories they had heard about the RFDS. There were three doctors in our team: John from New Zealand, Tim from Cornwall, and me. We shared the RFDS house in the town and got on extremely well. On occasion, we had to drive to the hospital in Wilcannia, a small town two hundred kilometres east of Broken Hill. The town had once been one of the biggest inland ports in Australia, on the Darling River, which snaked through, carrying bales of merino wool under the coolabah trees and out to the harbours on the south coast. With the advent of the railroad, the town lost its significance, and many people drifted away.

The hospital was staffed by older nurses, experienced in doing X-rays and stitching whatever lacerations came their way. One of our duties was to do a weekly ward round in the hospital, which was mainly filled with local Barkindji people, eager to be discharged.

‘This is George, a forty-three-year-old Aboriginal male with haematemesis for two days,’ a nurse told me on one of my visits.

Haematemesis was the medical term for vomiting blood, and it could be profoundly serious in some circumstances, especially if the patient had ripped the lining of the stomach. It was usually associated with excessive alcohol intake, although one had to be careful that there was not a gastric tumour on board. He had been “scoped” a few times at the Broken Hill base hospital, and the nurses usually discharged him with medication after he had settled.

‘Well, George, what happened to you?’ I asked.

‘I fell out with the lady from the lake,’ he replied.

I was amused by his reply but thought little more about it and went to see the patient in the next bed. My next patient was something of a surprise: a one-hundred-and-fifty-kilogram male victim of domestic violence. I was intrigued when he also told me that he “fell out with the lady from the lake”.

‘We’ve done a skull X-ray, Dr Treacy, and he had a small parietal fracture, but his neuro obs have been OK for the past two days, so we’re just letting him home,’ the nurse told me.

Next, we reviewed a fifty-four-year-old white female suffering from gallstones, awaiting transfer to the base hospital for removal of her gall bladder. This condition can be extremely painful, and patients are often admitted for analgesia before they are operated on. These procedures had been done in Wilcannia hospital in the past, but the facility had been downgraded as the population had diminished.

After that was a below-the-knee amputee with Type 1 diabetes, who had sustained some facial lacerations when he had fallen from his wheelchair and had been kept in for observation. His home circumstances weren’t good, but he seemed to be a favourite with the nurses.

‘So, what happened to you?’ I said.

When the patient told me, he had “fallen out with the lady from the lake”, I had to take the nurse aside and ask her what the saying meant.

‘Well, the native Aboriginal population here likes to drink those cheap three-litre boxes of red wine,’ the nurse explained. ‘They can’t pronounce “Cabernet Sauvignon”, so they call it by the Renoir picture on the outside. It’s of a gentleman rowing a lady in a boat on a lake. It’s responsible for a lot of business around here.’

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