Mobile medics

The Heart of Australia

The risk of a dying of a heart disorder is nearly twice as high in Australia’s remote regions as in its major metropolitan areas. The main reason: diagnosis and treatment are far away. Mobile medics might change this.

“We can’t simply ignore this imbalance,” says Dr. Rolf Gomes. “We need to fix the supply chain, because we can.” The Brisbane-based cardiologist is not one to make demands and whine; this is a man who solves problems. During his medical residencies, he spent a great deal of time travelling in rural areas like Queensland, a state four times the size of Germany and Austria combined – inhabited by a mere five million people. Every day he witnessed how physicians were forced to work with limited means. While he ultimately settled in the state capital of Brisbane, he never forgot those people in the outback. He would look around his office, taking in the treadmills, ultrasound units and cardiac rhythm monitors. And he would ask himself: “Why can’t all this equipment be packed into a vehicle and brought to the people who urgently need it?”

A quite simple idea in theory, but an expensive, ambitious undertaking in practice. For five years, Gomes planned and fought; he sought and found partners and sponsors. He created a mobile clinic on paper and convinced colleagues to join the effort. Finally, he put his plan into action. Since 2014, the “Heart of Australia” has been travelling thousands of kilometers, transporting medical personnel and equipment across the state that is home to the Great Barrier Reef in the east and rainforests in the north. His initial semi sporting the license plate “Heart1” has long been joined by others of its kind. In February, the fifth mobile clinic took to the roads. “We no longer serve five locations like in the beginning. Now our semi stops at 32 stations located along three fixed routes,” says Dr. Gomes. “In the meantime, our 23 medical professionals have treated more than 11,000 people and saved at least 500 lives.” The big trucks are flanked by a smaller one that is deployed in emergencies. The physicians and ultrasound specialists fly or drive to their assigned locations for shifts lasting several days; then they are spelled by a new team. “When you dream up a project like this, you can’t really be sure it will work,” Gomes says in retrospect. “But today the team and I are very proud of what we’ve accomplished.” And the population’s gratitude knows no end.

Deluge instead of Day Clinic
The stretch from Dalby to Stanthorpe is 260 kilometers long. A modern semi can cover this distance in a good three hours – or even faster if it’s the “Heart 2,” a Kenworth K200 that tows its 44-ton, 25-meter-long diagnostics clinic through fields and forests. This morning, however, the 34 wheels of this mobile medical marvel aren’t turning. Within a scant 24 hours, some 300 millimeters of rain have drenched Dalby and its environs. Rivers have risen over their banks, rural roads and highways are flooded. Instead of echocardiograms, pulse rates and ultrasound images, the “Heart of Australia” team is checking water levels and weather forecasts. Maria Abrigado is in charge of logistics: she is now rescheduling appointments, cancelling accommodations, phoning with emergency personnel and road services.

Jack-of-all-trades Ben Williams serves as both driver and cook, making him a key part of the bush-doctor team alongside Maria Abrigo, Kyle Fan and Dr. Thomas Dover.

“We physicians usually find a solution; if necessary, we fly to the locations to see patients,” says Dr. Alexander Dashwood in Brisbane. “I’m from England, I know my way around rain. But I’ve never seen the likes of what’s bucketing down from the sky out there.” If the truck can’t traverse the flooded areas, flying in a cardiologist doesn’t make sense. Luckily, this happens very rarely, under extreme weather conditions: such as this year’s very wet La Niña summer in the southwest, or if there are cyclones or forest fires. Even under such circumstances, the drivers are often able to find a detour – like Ben Williams, who has circumvented the worst in “Heart 2.” Just one day late, the team has arrived in the 5,000-soul hamlet of Stanthorpe for day two of planned diagnostic work.

Routine Exams and Special Cases
As soon as Williams has parked on the fairgrounds behind the high street, the local residents stop under their umbrellas, watching the metamorphosis from semi to clinic. The trailer is as long as a swimming pool. What’s more, its width can expand to nearly the same length at the touch of a button, when the treatment rooms slide out sideways. The team unfurls a canopy, attaches stairs, and tests the hydraulic wheelchair ramp. Abrigado arranges the furnishings in the consultation rooms, checks the telephone line and internet signal, and connects the diagnostic equipment: echocardiograph, treadmill monitor and spirometer. Meanwhile in the galley, Williams prepares a round of tea; in the treatment room, endocrinologist Dr. Thomas Dover runs up the computer. The past two years, Stanthorpe has seen only droughts, but for the past two days it’s been raining cats and dogs. Williams quickly puts out buckets for the umbrellas. Australia’s largest specialized mobile clinic is now ready to treat its first patients of the day.

In the past they needed a six-hour drive, now the doctor basically shows up at their doorstep: Beverley and Kenneth Hargans report to the clinic on wheels for their routine checkup.

In the meantime, specialists in endocrinology, geriatrics, neurology, urology and gynecology are on board, along with a psychologist. They sign up for at least two days per month, in addition to their regular jobs in offices and clinics in the cities. Even after five days on the heart transplant team in Brisbane, Dr. Dashwood enjoys his weekend shifts in the truck: “I like the rural mentality. The people are resilient, pragmatic, tenacious and often overwhelmingly grateful,” he explains, which is why the extra effort pays off. “It’s less of a mental strain; I head home satisfied after work, not least as we make a genuine difference out in the bush.”

Australians refer to areas outside of cities and suburbia as “bush country” – in other words, the outback, where there are no fences and few people, surrounded by huge, endless horizons. The term also encompasses the small towns with 400 to 4,000 inhabitants that serve huge catchment areas comprised of farmland and mining country. The larger settlements often have two or three general practitioners on site; some have a small hospital that attends to broken arms and keeps stocks of antidotes for snake bites. Emergencies are flown to the nearest major city. From the outback town of Winton, for instance, farmers have to drive 10 hours to reach the coast and another five to the capital. These great distances have dramatic consequences: many people neglect regular health checks and ignore warning signs for the simple reason that it seems too arduous to plan two days of travel just to have a noise in your chest checked out.

“A 50-year-old came to see us recently only because his daughter insisted,” Dashwood says. The man had been experiencing chest pain and was on the verge of driving some 300 kilometers into the outback to shear a few hundred sheep.” A stress test revealed that something was definitely wrong with his heart. The doctor convinced the patient to fly immediately to Brisbane instead of tending to his sheep. A stent was implanted that same afternoon, which in all probability saved the farmer’s life.

Meaningful Work
The endocrinologist Dr. Dover agrees with his colleague: “This work is both rewarding and gratifying.” Both physicians love the variety, and working in a small team comprised of a doctor, a paramedic, a driver and an ultrasound diagnostician. Williams used to steer even more gargantuan trucks from the mines of western Australia’s Pilbara region to the coast. But he prefers the “Heart of Australia” job, “because I do more than sit behind the wheel here; I have contact with people,” explains the 43-year-old. He picks up the physicians from the airport if they need to be flown in; he cooks for the team; he helps patients navigate the hydraulic ramp into the truck if necessary, and simply enjoys the overall positive atmosphere. “These people are so happy to see us, and everyone has a kind word.”

Gomes, the “heart bus” inventor who continues to work up to five days a month in the mobile clinics, takes the positive feedback as both acknowledgement for a job well done – and motivation. “Today we have so many different treatment options, but they only help if they’re available to the people who need them,” he says. Now they are: in Longreach, more than a day’s journey from the state capital; or in Weipa on Cape York, which the teams have to reach by air because the gravel roads are too rough for the vehicles. Gomes is no stranger to hard living conditions. At the age of 10, he and his parents and siblings left India for Australia. His eldest brother died at age five, most probably because he was released from a Calcutta hospital prematurely due to a power outage. Gomes’ parents wanted their children to have a better life and decided to emigrate. Rolf initially became an electrical engineer, but soon realized that he was more interested in people than in computers. He began med school in 1998 and knew from the very start that the heart fascinated him most. “It just goes on pumping and pumping, often for 80 years without interruption. What a masterpiece!” At the end of the day, his engineering background stood him in good stead, helping him devise and develop his mobile clinic.

Extensive funding network
Gomes built his very first diagnosis-mobile for one million Australian dollars, at the time the equivalent of 700,000 euros. He had calculated another million for the first year of operation. And he found sponsors: the state and federal governments together contributed half a million Australian dollars at the outset. Gomes himself took out a second mortgage on his home, which was not exactly to his family’s liking. “If you ask other sources for a lot of money, you also need to be willing to invest yourself.” Currently, the Australian government is supporting the “Heart of Australia” project with a three-year grant of 12 million dollars, but the majority of the costs are borne by sponsors like the energy company Arrow, which has companioned the project since its inception. Other companies provide auxiliary vehicles and fuel; clinics donate materials, an airline flies in specialists when required. A German pharmaceutical company sponsors a new talent program for six university students every year: they spend time on the trucks over a period of several weeks, learning by doing. And finally, after hesitating for a long time, Queensland recently invested two million Australian dollars in the construction of the youngest truck. Its motivation: “Heart 5” is equipped with special diagnostic tools, and travels to the mining regions to monitor former miners for lung diseases. For the first time, a truck will be taking X-ray and computer tomography equipment directly to places where they are needed. In the end, the success of the project will hopefully not only benefit the population of Queensland. After all, that was one reason Gomes christened his first truck “Heart of Australia”: “My vision has always been to one day expand the program to the entire continent,” the physician says. “But obviously we have to start somewhere. Now we know how it works. We have taken mobile healthcare a giant leap forward.”

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