Thargomindah Outpatients - A nurse-led clinic in remote southwest Queensland

By Primary Times Chief Writer Melanie Irwin

Source: APNA Primary Times Summer 2022-23 (Volume 22, Issue 2)


Every working day offers new challenges for Margaret Harris, a rural and isolated practice registered nurse (RIPERN) who runs a community clinic in the outback Queensland town of Thargomindah.

‘You have to deal with whatever walks in the door!’ Marg says. ‘Sometimes people will wander in just wanting a chat, because they’re not feeling great. Others will have acute conditions, such as chest pain. You really need to be prepared for anything.’ 

With a population of 270, Thargomindah is about 1000 km west of Brisbane and 400 km from the nearest regional centre, Charleville. Marg has been working in Thargo for the last 18 months and shares the role of director of nursing and facility manager on a 3-week-on/3-week-off rotation. For the 3 weeks on, it’s a 24/7 commitment: ‘The clinic is open Monday to Friday, and the Royal Flying Doctor Service (RFDS) comes on Thursdays. We’re on call throughout the night and we provide clinical support for the ambulance.’ 

It's been difficult to find and retain additional nursing staff in Thargo. The clinic has a part-time administration officer and a part-time operational services officer (who also drives the ambulance), but the directors of nursing often work solo, including administrative duties and some cleaning when the other staff are not available. 

As a rural generalist nurse, Marg’s work involves advanced decision-making and diagnoses, including the use of medicines. She relies on the Queensland Government’s Primary Clinical Care Manual,1 the principal clinical reference for rural, remote and isolated health-care settings. Where required, she liaises with the on-call RFDS medical officer to discuss patient needs, treatment plans or patient retrieval. Other situations require consultation and collaboration with multidisciplinary teams, including Retrieval Services Queensland, the Telehealth Emergency Management Support Unit, and a range of allied health professionals and specialists who visit Thargo or who can be contacted via telehealth or video link. 

One of the biggest challenges working in such a remote location is the unreliability of the telecommunications networks. ‘Our internet cut out recently due to damaged wires in Toowoomba,’ Marg explains. ‘It really disrupts and compromises our work because the care we provide for patients is often in consultation with colleagues in other locations, so if we can’t get through on the phone or on video, it can really slow things down.’ The ambulance has a satellite phone, which is a good option when the network goes down, but even that can be unreliable, as it depends on the location of the satellites in the sky.  

‘This is a remote outback location, but we try to align the care we provide to that of metropolitan areas.’ 

‘You need to have a broad scope of knowledge and really good communication skills in this job,’ says Marg. ‘Even when the line is unreliable and breaking up, you need to find ways to get your message through. You need to ensure that colleagues in other locations understand the limitations we have with transport and available resources. Having good systems in place allows for a smooth process.’ 

In addition to the vast distances, the changing weather conditions can cause problems too. ‘The RFDS’s visits are weather-dependent’ Marg explains. ‘If it’s too windy or the visibility is poor, they can’t fly, and we use telehealth. We sometimes get dust storms in summer, and you have to ensure that people with asthma and lung conditions are prepared.’ 

‘As soon as it rains, you get bogged,’ she laughs. ‘We take the ambulance out to treat people in different places, and we find ourselves traipsing through mud, carrying equipment, because we don’t want to get the ambulance bogged.’ 

Thargomindah is located on the Bulloo River, with a long causeway just out of town. When the river floods, the Shire Council runs a flood truck (a large flat-tray truck) that ferries vehicles from one end of the causeway to the other. ‘I had a palliative patient requiring transport to Cunnamulla Hospital (200 km away) via ambulance, and the causeway was flooded. The flood truck got us across, in the ambulance, and from there I drove the patient halfway, and the ambulance from Cunnamulla took her the rest of the way. Just another example of multidisciplinary services coming together to offer quality care for our community.’ 

On a cold winter’s night, a road accident resulted in a fatality in Thargo when Marg was on call. With the help of locals, she secured the site until the police could arrive. ‘The police had to come from Cunnamulla’, Marg recalls, ‘because our local officer was on sick leave. I had to remain with the body through the night and it was very cold. It was 6 or 7 am before the police arrived. The victim wasn’t a local, but he knew a lot of locals. It was very sad and distressing for the community.’ 

Thargo’s population can swell sometimes when there are rodeos and festivals in the area. There’s also a steady stream of travellers that pass through with their caravans throughout the year. ‘People walk into the clinic and ask for blood tests and other treatment. They’re often disappointed, as we can only do pathology tests on Thursdays when the samples can be kept fresh and transported to Charleville with the RFDS. They also try to stock up on their pills, but we don’t have a pharmacy here. I have to explain that the nearest one is 200 km away.’ 

‘My job is demanding, but it’s very rewarding’, Marg says. ‘My colleagues and I work hard to ensure that the Thargo community has access to quality health care. We work alongside and collaboratively with other teams to deliver a holistic service. This is a remote outback location, but we try to align the care we provide to that of metropolitan areas. I often have to put creative problem-solving skills to good use, but I enjoy the challenge!’ 

 

Reference 

  1. Queensland Health, Royal Flying Doctor Service (Queensland Section), Primary Clinical Care Manual, 11th edn, Office of Rural and Remote Health, Queensland Government, Cairns, 2022. 

The Australian Primary Health Care Nurses Association acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respects to elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.


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