Dr Nick Williams
In Australia, he has provided Royal Flying Doctor Service (RFDS) evacuations and community medical services to remote Aboriginal communities and currently works in a Community Health Service in a multi-disadvantaged area of Adelaide.
Dr Williams’ work outside Australia has taken him to remote areas of Africa, a Cree Indian community in Canada and Pakistan’s North West Frontier Province.
Here is his story.
Inspired to do medicine by the GP in my hometown of Jamestown in the mid north of South Australia, my future was set after a student elective in the highlands of PNG in 1978. The “see one-do one-teach one” school of remote medicine I experienced there shaped my future career.
I learnt how to cross-match blood under kerosene lamplight from a pidgin-speaking Clinical Health Worker; how to do a lumbar puncture from the local nurse; and how to resuscitate a flat neonate from the community midwife. I was strongly drawn to Third World Medicine.
With the goal of getting enough confidence with clinical skills to work in Africa, I completed a Diploma of Obstetrics in Australia and headed off to England to do anesthetics. Nine months later I was the only doctor in a remote hospital on the wild coast of Transkei, a homeland of South Africa. I was overwhelmed by the burden of illness the community faced. Cholera, malnutrition, tuberculosis, bilharzia, were all new to me. Measles was a killer disease with 40% mortality in children. I watched neonates with tetanus convulse with every sound or movement in the nursery until the sedatives mercifully relieved them of their pain. I will always remember the experience of putting in a spinal block before performing an emergency caesarian section and resuscitating the baby whilst a nurse assistant controlled the uterine bleeding. There was no knowledge or skill that was not taught and shared for purely pragmatic reasons. It was an experience. I moved on later to work in paediatrics in a large hospital in Bulawayo, Zimbabwe.
After four years in Africa I headed back to Australia to do paediatric training in Sydney. Working in a First World Tertiary hospital was a huge culture shock. I was doing emergency retrievals of 600gm neonates across the State with more equipment and technology than I ever had at my disposal. My previous experience was that if a neonate could not survive with a bit of head-box oxygen (when there was oxygen) then it had no chance. I could not see my future in hospital medicine.
It was 1988 when I headed back to Africa to work in rural Zambia and in the three years I had been away AIDS had arrived. Many of the health advances of the previous decade were being lost. It was heartbreaking.
It was at this time that I finally realised that there was little point concentrating all my efforts in the hospital when the causes of all the health problems were in the community.
I started to go “upstream” and try to stop people falling off the bridge rather than plucking them out downstream. We trained Community Heath Workers and supplied them with ORS (oral rehydration salts) and chloroquine. We brought in Traditional Birth Attendants (TBAs) to spend two weeks in the maternity ward with the midwives. The amazed reaction of the TBAs when they saw a LSCS (caesarian section) is something that stays with me forever: they would be gowned and gloved and leaning over me almost pushing me aside to get a better look at ‘this bag’ the baby had been in. It was the best training I had ever been involved in. The incidence of women presenting with a ruptured uterus and babies with tetanus dropped dramatically over the next two years.
Being one of two doctors serving a population of 150,000 in rural Zambia was always going to be a hard act to follow, and perhaps it was inevitable that on returning to Australia in 1990 I ended up as a District Medical Officer in Alice Springs.
Working with remote area nurses and Aboriginal Health Workers was what I was accustomed to. Providing RFDS evacuations and community medical services to remote Aboriginal communities had its own challenges. These challenges were hugely supported by my involvement in the Central Australian Rural Practitioners Association (CARPA). I was and remain a passionate supporter of CARPA and was very involved in the first three editions of the Standard Treatment Manual, one finger typing most of the first edition. The ‘bible’ has gone on to become a fully entrenched part of health service delivery in remote Australia. During my time in Central Australia I consolidated my Public Health knowledge with a Masters, so finally I was a ‘master’ of something and not just ‘a jack of all trades’.
After eight years in Central Australia, interrupted by a year in a remote Cree Indian community in northern Manitoba, we made the ‘kids’ education’ decision and ended up in Adelaide for the high school years. Having seen the wheel re-invented two or three times by health service bureaucrats in Remote Health, it was time for a break anyway! Working in a Community Health Service in a multi-disadvantaged area of Adelaide has been a change of pace. I have managed to keep in touch with remote area work with several locums in remote communities in the Northern Territory and through my involvement with the CRANAplus Remote Emergency Care (REC) program. I am a proud member of CRANAplus.
I have always wanted to remain a true generalist, combining clinical knowledge and skills with a public health passion. I work in an ED one night a week and teach a little at University.
Inspired by CRANAplus members (Libby Bowell and Chris Cliffe) I became involved with Red Cross a couple of years ago. I subsequently spent three months in 2009 as an ICRC Health Delegate in the North West Frontier Province (NWFP) of Pakistan during the complex emergency created by military action against the Pakistani Taliban. I remain on-call for International emergencies.
CRANAplus will remain part of my professional life into the future which will almost certainly involve more remote work with people I love and admire and in environmental settings that people normally pay to go to.