Bringing the lab to the bush: pathology in rural and remote communities

The welcome sign at Nhulunbuy airport –  pathology samples are flown to Darwin for complex tests during rainy season

Poor access to health services in rural and remote communities presents a huge problem to people living outside metropolitan areas. Fortunately Australian pathology is addressing the issue.

John Callahan, a medical scientist based in Melbourne, has previously worked as a Senior Scientist in Nhulunbuy, a small mining town in remote Northern Territory. The town has changed a lot recently – the closure of a nearby smelter cut the population from nearly 5,000 to just 1,000.

The hospital provides healthcare services to remote Aboriginal communities and previously, to a substantial transient mining population. With 40 beds and a pathology laboratory staffed by only two people it’s a totally different world to that of a city hospital.

John’s work in the laboratory was essential to managing the health of the local Aboriginal community, at high risk of diabetes, renal failure and tuberculosis. It also taught him a lot;

“Nhulunbuy Hospital was such a rewarding place to work. All the staff knew one another and you really felt part of the wider healthcare team.  You also got to know a patient’s health story a lot more intimately than you typically would in a larger laboratory.

Although we dealt with less than 20 samples each day, a lot of the tests had to be done manually due to the reliability of equipment, so we were always busy. You rely heavily on the foundations of your training and you become pretty self-sufficient when it comes to fixing equipment.”

His experiences in Nhulunbuy emphasised the importance of communicating complex medical topics to patients in simple terms;

“I remember one case where a young Aboriginal lady was told she had an iron deficiency. It was a bad case and the doctor wanted to treat her with an iron infusion. She became extremely agitated, thinking they’d be pumping iron filings into her wrist. Good communication of test results and treatment is vital, particularly when there is a different culture involved.”

Cultural differences arose frequently. Local Aboriginal populations had complex naming systems and some patients would provide a different name each time they came in; a real problem for record-keeping. Many patients were unaccustomed to sleeping under a roof so they spent most of their time in the grounds. If an Aboriginal patient died in the hospital, hundreds of community members would arrive to take them home.

“From a scientific point of view the work was quite different from what you’d expect elsewhere. I was often testing for diseases that are largely non-existent in the Caucasian population – tuberculosis, leprosy, and scabies. Before coming to Nhulunbuy I was not even aware of Melioidosis – an infectious disease caught from walking on wet sand.”

One issue in places like Nhulunbuy is physically reaching the patients. Teams of doctors and nurses would drive or fly out to remote homelands for a week or longer to perform on-site check-ups and collect samples to bring back to John for analysis.

For four months of each year, the town is cut off due to flooded roads. Residents rely on planes for supplies, and pathology is no different. Complex tests that could not be performed in the lab were flown to Darwin each night at 10pm so John could have the results the next day.

Fortunately, the emergence of drones in recent years has opened up the possibility of retrieving pathology samples from remote patients in a fast and cost-effective way.

This year Australia’s CSIRO have made this the focus of their annual unmanned aerial vehicle challenge. The organisation has been running the challenges since 2007 and decided to make 2015’s competition all about pathology.

The challenge is based around a character called Outback Joe. Each year he is placed in a fictional scenario in outback Queensland and teams of engineers and drone enthusiasts from around the world compete to help him. In previous years scenarios have revolved around search and rescue but this year, Outback Joe needs to have a sample retrieved for urgent testing.

Entrants will need to fly a drone fitted with a camera through a 20 kilometre transit corridor to reach him, land safely so he can place the sample in a small compartment on the drone, then return the sample to the start point.

Doug Froubisher, from CSIRO, is one of the main organisers.

“Pathology testing is integral to many branches of healthcare and speed of results can mean life or death, so we knew we wanted to use this in a challenge. Because pathology samples are often small, collection by drone is a genuine possibility in the near future.”

The top prize is $50,000 and is based on completing the challenge and scoring the most points for aspects like technical expertise and team coordination. It’s possible though that CSIRO may not even get a winner – it sometimes takes up to two years to complete the challenge well enough!

To find out more about the competition visit the UAV Challenge website.