Damien Brown, author of 'Bush Doctor', recounts his experiences working as a doctor in the remote Northern Territory, where the challenges of distance and limited resources are immense. After serving in post-conflict zones with Médecins Sans Frontières, he thought he was prepared for anything. But the reality of treating patients in a 20-bed hospital serving an area the size of Norway proved even harder.
The Challenge of Distance
The distances are a major obstacle. The hospital, far from Alice Springs, serves a region the size of Norway with a population of about 8,000. Healthcare needs are high, and help is far away. One of Brown's first patients was Billy, an Aboriginal man with severe heart and kidney failure. He needed intensive care and a team of specialists but received only Brown. Billy declined transfer to a larger hospital, preferring to stay on his country. Fortunately, he recovered.
Another patient arrived with a life-threatening heart attack. The team administered clot-busting drugs and stabilized her, but the nearest center capable of managing her treatment was 1,000 km away—equivalent to traveling from London to Berlin for urgent care.
High Rates of Chronic Disease
Chronic diseases are rampant. Brown recalls a teenage patient with a metallic heart valve from rheumatic heart disease, caused by repeated streptococcal infections due to overcrowded housing and poverty. Rates of rheumatic heart disease in the region are among the highest globally. Kidney disease is also widespread; a dialysis unit runs six days a week with 16 machines—the highest per capita in the world. Diabetes is three times more common among Aboriginal patients in remote communities compared to other Australians, and heart disease more than twice as common.
Access to affordable, healthy food is a major contributor. Brown once paid $10 for rubbery broccoli in the only supermarket, making chicken wings, chips, and Coke better value on a budget.
Social Issues and Trauma
Social issues, shaped by historical trauma and ongoing inequality, are pervasive. One night, a man walked in with a knife blade still embedded in his chest. He received a blood transfusion, chest tube, antibiotics, and an urgent flight. Mental health crises are common, and Brown witnessed more psychological trauma than in any other place he had worked.
Despite initial reluctance to return, Brown has specialized in rural and remote medicine, even moving to the small town for a year and now doing fly-in/fly-out work. The work gets under your skin, he says, and the warmth of the people makes it hard to leave. A local artist declined a free trip to Paris, preferring the barramundi season at home.
The Impact of Social Determinants
Brown emphasizes the impact of social determinants of health—upstream factors like poor housing, nutrient-poor food, limited employment, distance from services, historical trauma, and substance abuse. Much of his work is reactive. Of the 17 Closing the Gap targets, few are on track, and some are worsening. He reflects that working in remote Australia is harder because it shouldn't be, not in a wealthy country.
Bush Doctor by Dr. Damien Brown is published on 28 April by Allen & Unwin.
