When you have agreed to be a doctor at a remote Australian Antarctica base, you can literally take your life into your own hands.
Dr Cathryn O’Sullivan learnt that when she was involved in an accident more than 3,400 kilometres from Hobart and was worked on by tradies.
“Because there’s only a single doctor and they’re isolated over winter for up to nine months, we actually ask the doctor to have their appendix out before they go,” the Australian Antarctica Division (AAD) chief medical officer Jeff Ayton said.
“We’re working in an extreme environment, we’re using machinery and things like that.
“So people generally are having things like slips, trips and falls and minor injuries — all can be dealt with by the single, lone, rural generalist-type doctor that is common around Australia.”
In 2015, Dr O’Sullivan made her first trip to Antarctica. She was to be the sole generalist doctor at Casey Station.
However, after a minor car accident, she was the one in need of medical attention.
“In the real world, it wouldn’t have been a drama, but I broke a bone in my hand, and unfortunately the type of fracture it was, it was quite out of place and it needed to be put back into place,” she said.
It was the middle of winter, which meant an evacuation was not an option.
The fracture was in her dominant right hand, which meant she could not treat herself.
But advances in technology meant she could get expert advice.
She had a tele-health hook-up with a Hobart hand surgeon who was able to diagnose the severity of the injury, determining the fracture would have to be treated in Antarctica.
Although Dr O’Sullivan was the only doctor on the base, she was not the only one with some medical training.
“In Antarctica, we have what are called lay surgical assistants, and these are four usually tradesmen or technicians who are down in Antarctica doing other jobs, the plumber, the electrician and so on,” she said.
“They are given two weeks of training at the Royal Hobart Hospital on how to be lay surgical assistants, so how to assist the doctor in a surgery, or if someone was unwell and needed medical care.”
She had also carried out her own monthly training sessions with her tradesman students.
“As we were halfway through the year, I had trained them already in putting plasters on, and I’d showed them the X-ray system,” she said.
“It was quite fortunate because we had to use all those skills.”
With Dr O’Sullivan out of action, the tradesmen were tasked with “quite a specialist medical procedure” under the guidance of an anaesthetist and hand surgeon.
The experts were both watching the procedure and monitoring her vitals like her blood pressure and heart beat through a live video link-up back in Hobart.
As Dr O’Sullivan recalled, they had to first inject anaesthetic into her wrist to bathe two nerves so that her hand became numb, and then were able to put the bone back into place, plaster it up, and take X-rays that were beamed instantly back to Hobart to be assessed.
Her hand has recovered fully, and she saw out her time at the base.
Sharing the expertise
It is this kind of expertise and technological innovation the AAD wants to share with other remote areas through the establishment of the new Centre for Antarctica, Remote, and Maritime Medicine (CARMM).
It is a partnership between the Australian and Tasmanian governments and the University of Tasmania, and based in Hobart.
Dr Ayton said the AAD’s six decades of history working in Antarctica could be used to teach others about treating patients in remote areas.
“Our doctors provide support for expeditioners up to 5,500 kilometres away on Australian Antarctic stations and on ships plying the Southern Ocean,” he said.
“We also have a well-established support network of specialists in Tasmania and around the country to support healthcare delivery.
“CARMM will bring all this acquired knowledge together to help provide highly specialised care in other isolated and extreme environments, such as offshore islands and remote communities.”
Professor Ben Canny from the University of Tasmania said innovations driven by the experience in Antarctica could help improve health care for people in Australia.
“What tele-health has told us is that you don’t need the expert laying on of hands or being there to deliver the care if you can have someone who can remotely communicate with the expert,” he said.