A semi-trailer-load of hope for rural heart patients who might otherwise be at fatal risk
For the past year, cardiology expertise has been trucked in to rural Queensland on a mission to to help address the medical tyranny of distance in the bush – and save lives in the process.
Denis Cook slips his mobile phone into his pocket and starts the mower. He completes a couple of strips of his back yard in Charleville, about 700km west of Brisbane, before declaring: “I feel crook.” His wife, Billie, is there when he falls “head-first, face-first” into the ground. She rolls him over, but in her panic cannot find his phone in the pocket of his trousers. Billie runs into the house and dials triple-0, telling the operator that Denis, the Murweh Shire Mayor, isn’t breathing and she fears her husband of more than 40 years is dead. He’s 65.
Billie has no idea how to perform cardiopulmonary resuscitation. But fortunately, Denis regains consciousness by the time paramedics arrive minutes later. They take him to Charleville Hospital, where he’s kept overnight and discharged before his tests are back. Soon after he arrives home, the hospital receives his pathology results and calls to say: “Get back up here quickly; he’s had a heart attack.” That night, the Cooks are booked on a commercial flight to Brisbane,
where Denis is admitted to the Wesley Hospital at Auchenflower, in the city’s inner west. A week later, he undergoes triple bypass surgery after doctors find badly blocked arteries. Surgeons also replace a damaged heart valve. He’s had a lucky escape.
Figures provided by the Heart Foundation show that adults living in regional Queensland are up to 27 per cent more likely to have heart disease than Brisbane residents. The death rate from diseased arteries that supply blood to the heart is also 44 per cent higher in Australians living outside major cities. Heart Foundation health director Rachelle Foreman says risk factors for heart disease, such as high blood pressure, smoking and obesity, are significantly greater in rural and remote areas of Queensland.
More than three years on from his heart attack, Denis Cook admits he failed to act on the warning signs in the months leading up to that “not particularly hot” October day. He told himself he had heartburn, chewed on some antacid tablets when he felt a twinge in his chest, and ignored his wife’s suggestions that he should have a check-up. “I said: ‘No, I’ll be right’,” Cook says. “I didn’t think there was much wrong with me.”
Living in remote Queensland, attending a specialist’s appointment can sometimes drain days of a person’s time and hundreds of dollars from bank accounts in travel and accommodation costs. Cook was deluding himself that his symptoms were not serious enough to bother leaving Charleville. “That’s how men are out here,” he says. “They’re working on their properties or they’re working in town. They’re too busy. They’ll say: ‘I haven’t got time. She’ll be right’.” Sometimes that has deadly consequences.
For the past year, a fledgling service dubbed Heart of Australia has been bringing cardiologists, sonographers and diagnostic equipment to parts of south-western and central Queensland on a mission to help address the medical tyranny of distance in the bush – and, hopefully, save lives. The aim is to diagnose and treat cardiac disease before it results in a heart attack, stroke or cardiac arrest. Cook is one of its loudest supporters.
Aprime mover pulls a custom-designed, 25m-long, air-conditioned mobile clinic through the outback Queensland dust. The clinic, with wheelchair access, has a reception area, toilet facilities and two consulting rooms, including heart stress testing and ultrasound equipment to assess cardiac function. The truck visits 11 towns – Dalby, Roma, Charleville, St George, Goondiwindi, Barcaldine, Charters Towers, Emerald, Hughenden, Moranbah and Longreach.
In a huge logistical exercise, private cardiologists and sonographers are regularly flown in to hook up with the truck for a few days before flying back to Brisbane. During its first 12 months, Heart of Australia provided 2500 patient appointments, identifying 76 urgent cases, including 13 people who required open-heart surgery. Another 300plus patients needed ongoing follow-up care with a cardiologist. The semi-trailer has clocked more than 70,000km, saving an estimated average of 680km of travel per patient, per visit.
Balonne Shire Mayor Donna Stewart, whose
it’s how men are out here. they’re working on their properties or they’re working in town. they’re too busy. they’ll say: ‘i haven’t got time. she’ll be right’.
local government area takes in St George, has no doubt the service is keeping hearts beating in the bush. “It’s providing the opportunity for patients who would not travel to the city to see a cardiologist,” says the woman whose family has lived in the Surat and St George region for six generations. “Bush people find it very difficult to get to the city, not only because transport is difficult, but they don’t like going there. Without Heart of Australia, they would not go and have these tests to identify health problems. They would literally stay in the bush and die. The difference this service has made coming right to our doorstep is just amazing. People here have embraced it.”
The Heart of Australia service is not set up to provide intricate heart procedures. Patients need to be sent to a city hospital for that. But its health workers can identify problems, refer patients for more complex testing and surgery, and then provide follow-up appointments once people have returned from operations in the city, potentially saving them thousands of kilometres in travelling.
The man behind Heart of Australia is Brisbanebased cardiologist Dr Rolf Gomes. Gomes has been developing the idea since he was a junior doctor being sent out on rotation to regional Queensland, where he saw for himself the dire need for specialists. “It certainly had a profound impact on me,” he says. “I don’t think I was the same person when I got back.” Heart of Australia has become his obsession, despite having had no link to the land before his medical career.
The 42-year-old was born in the bustling Indian city of Calcutta (now Kolkata), far removed from the isolation of outback Queensland, and immigrated to Australia with his family as a nine-year-old. He grew up in Victoria and studied electrical engineering at Melbourne University. Gomes worked as an engineer for two years before deciding to switch to medicine, lured by his love of people. “I think medicine is an enormous privilege, to have that insight into people’s lives,” he says. “I wanted to be in a job where I chatted to people all day, used my brain and helped them at the same time.”
Gomes knew he wanted to be a heart specialist by the time he finished his graduate medical degree at the University of Queensland. It was a good fit for the former engineer. “Cardiology made a lot of intuitive sense – the heart being a pump, with plumbing and valves and an electrical system,” he says. “The first time I saw open-heart surgery, it confirmed to me my fascination. The patient’s chest was opened and you could see the heart squeezing and pumping blood. It just looked so alive. It was an amazing experience. I remember being in theatre seeing it for the first time and being absolutely mesmerised.” The fact that the heart is one of the most studied organs in the human body was also attractive. When specialists do detect problems, they have treatments and procedures that can make a big difference.
Gomes launched Heart of Australia in late 2014, just four years after qualifying as a cardiologist. He ignored the naysayers who warned the equipment would not survive being hauled around on rural roads, patients would stay away and the concept would struggle to attract government support or private backing. If man could walk on the moon in 1969, he mused, why couldn’t cardiology services be transported to the Australian bush in the 21st century? He took a leap of faith.
Gomes says most of the concerns raised about the project have been unfounded. He was given a combined $500,000 in seed funding from the state and federal governments and has been helped by a long list of sponsors, including Kenworth, which provided the prime mover, Brown and Hurley, which keeps it maintained, IOR Petroleum, which supplies fuel, Bridgestone, Telstra, Bayer, St Andrew’s War Memorial Hospital and Arrow Energy. “It took me about three years, going down a lot of dry gullies and knocking on a lot of doors before I found some like-minded companies,” he says. Private backing allows Heart of Australia to offer the service to bush patients at the same fee as those in the city, including bulk billing for people in need. In the first 12 months of operation, indigenous patients made up a quarter of the appointments.
Gomes also refinanced his Brisbane home to start Heart of Australia with an $800,000 loan. “I had to change banks,” he says. “The third bank I asked lent me the money. They said: ‘We’ll revalue your house and extend your mortgage.’ They wouldn’t have given me the money without a secure asset.” The loan went towards transforming the back-end of the truck into a cardiology clinic. “I didn’t want to go out thousands of kilometres with just my stethoscope,” Gomes says. “That doesn’t reflect how we diagnose these patients. If we were going to go out there, I wanted to bring along all the tools we needed to do the job. It’s really like my private practice on wheels.”
At a Heart of Australia fundraising ball late last year, the father of three children – Jacqueline, 7, Lenny, 6, and Patrick, 3 – recounted some of the real-life stories behind his determination to create the service. He spoke of a farmer who chose to plant seed after rain rather than take a week off
to see a city specialist about a “nagging pain in his chest”. The farmer was later found dead in a paddock with a bottle of antacid by his side. “If none of us would trade our circumstances … then I believe we have a moral duty to do something,” Gomes told his audience.
A string of success stories in the past year, such as that of Raymond Flohr, have firmed the cardiologist’s resolve to expand Heart of Australia into other regions. Gomes says Flohr, known to everyone, including wife Valda, by the nickname “Tiger”, was a “walking time bomb” when he stepped into the Heart of Australia clinic last March in Emerald, about 900km north-west of Brisbane. Four days after cardiac testing inside the travelling clinic, and a consultation with Gomes, Flohr was in Brisbane having treatment at St Andrew’s War Memorial Hospital in inner-city Spring Hill. The 74-year-old, who has been married to Valda for more than 50 years, had stents inserted into two clogged arteries to improve blood flow to his heart. One of his arteries was 90 per cent blocked, the other was more than 70 per cent obstructed. “When you looked at pictures of his worst artery, it was like a hairline slit which needed to be expanded – quite frightening, really,” Gomes says. Flohr was a heart attack waiting to happen.
Like Denis Cook, he says his body was giving him warning signs of a problem with his heart. “I used to get a little pain in the chest, dead centre,” Flohr says. “I’d have a few sips of water and it’d disappear. This went on for quite some time. There’s a hell of a lot of us old bushies, we’ve been living out here all our lives. You get all sorts of things. You get bumps and bruises and rather than go to the doctor, you put up with it.”
But when the pain lasted for 40 minutes one night before he was able to “finally drown it”, Flohr made an appointment with his general practitioner in Clermont, about 60km north-west of his home in Capella. He was referred to the Heart of Australia truck and was lucky to get an appointment in Emerald (50km south of Capella) the next day. The father of four, grandfather to 11 and great-grandfather of three now refers to the clinic as a “mobile human service station” and advises other “old bush folk” not to leave it too late before checking in for a service. “You don’t wait for your car to break down before putting it in for a service, do you?” he says.
Emerald GP Dr Ewen McPhee, president of the Rural Doctors Association of Australia, says the clinic on wheels is opening up an extra mantle of safety for regional Queenslanders, particularly the elderly and disabled who have the most difficulty travelling long distances. “There’s been a great need for this service,” he says. “I think it has saved lives. We’ve had several examples where people have had timely testing, a serious problem has been found and they’ve had treatment, whereas with delays, they could have got into all sorts of bother. It means when they do travel, they can be going for treatment rather than for the test.” McPhee says key to the Heart of Australia service is the diagnostic equipment, giving patients access to tests close to home that would otherwise not be available to them given the “chronic underinvestment” in rural hospitals.
Nytha and Robert Peart have lived on an isolated beef cattle property in the Arcadia Valley, about 700km north-west of Brisbane, for more than half a century. Their nearest ambulance station is 130km south, at Injune. The road outside their 4000ha property was paved with bitumen for the first time last year. “It was a very joyous day when we got the road,” 78-year-old Nytha says, recalling rainy days in times gone by when cars would become bogged on the dirt road. “I didn’t think I would live to see it – a bitumen road right down our valley. It’s been a shocking road for the last 50 years. We have bitumen all the way to Brisbane now.”
The road was still dirt towards the end of 2014 when Nytha started to feel breathless and feared she was blacking out. She was doing nothing more strenuous than sitting with her husband in their car at a gate to the property, waiting for their nephew, Rowan, to arrive from a nearby farm. “I thought I was going to faint,” she says. But the moment passed quickly, she was not in any pain and life moved on. “It’s not worth thinking about,” she told herself at the time.
Nytha didn’t mention her dizzy spell straightaway when she saw her GP in Roma, about two-and-a-half hours’ drive south, a few weeks later. But when he asked her towards the end of the consultation, “Is there anything else you need to tell me?” she recounted those few seconds of struggling to catch her breath. The Heart of Australia was a new service at the time and it was about to come to Roma. Nytha’s GP organised an appointment for her at the truck, where an ultrasound discovered she had a weakened heart.
Gomes’s colleague, Dr Rob Perel, a specialist in cardiac electrophysiology, including heart rhythm disorders, is part of the thriving Brisbane-based Queensland Cardiovascular Group, but devotes three days a month to the truck in Roma and Charleville, where his mother, Margaret, grew up.
To have this heart problem was quite a shock. I’m so grateful for this truck. I could have dropped dead. NYTHA PEART, grazier, heart of australia patient
Many of his cousins still live in the region. Perel and Gomes met during their first year of medical school. Both worked in different professions before finding medicine; Perel was a vet. He’s been listening to Gomes’s vision about bringing cardiologists to the bush since they were junior doctors together at Royal Brisbane and Women’s Hospital.
Perel was on Heart of Australia’s maiden voyage and Nytha was one of its first patients. When the ultrasound detected a problem, he referred her to St Andrew’s hospital in Brisbane where she was diagnosed with a type of cardiomyopathy, or disease of the heart muscle. She was fitted with a defibrillator – a device that can deliver an electric shock to restore her heart to a normal rhythm if she goes into a cardiac arrest. “To have this heart problem was quite a shock,” Nytha confides during a check-up with Perel in Roma. “I’m so grateful for this truck. I could have dropped dead.”
After spending all her life on the land, the mother of four and grandmother of nine exudes a stoic acceptance when she speaks about being isolated from medical services. “You’ve got to take that risk. It’s part of living in the bush. We choose to live here,” she says. “You just do what you’ve got to do and we were very fortunate. If we had an asthma sufferer or something like that, the tyranny of distance would certainly have been a huge consideration of living so far away.”
Nytha’s second son, Christopher, was not yet five when he died instantly from a fractured skull in a fall while climbing a stockyard fence in 1971 at the nearby property of brother-in-law Wally. “Our phone was out of order that day,” she says quietly. “But no-one could have saved him, poor little lad.”
A couple of years later, when daughter Elizabeth was born in the Roma Hospital with dislocated hips, Nytha packed up her new baby and eldest child, Matthew, then eight, and spent the next nine months in Brisbane so her little girl could be treated at Royal Children’s Hospital, while Robert worked the farm. “Being so far away from home was a great inconvenience to the family,” she says. “But you just have to get on with it. Apart from that, we’ve been quite healthy.”
As she approaches her 80th year, Nytha and Robert have retired to a cottage on the property, which is now run by Matthew. Internet access is still “a bit iffy”, but the bitumen road outside their gate and services such as the Heart of Australia are making life easier in their later years. “I’m so grateful,” Nytha says. “It’s wonderful.”
Statistics compiled by the Heart of Australia team reveal a hidden benefit of the service – it saved patients an estimated 1.7 million kilometres in travel during its first year. Roma’s John Macfarlane, who has a leaky heart valve, says he would not have driven hours for a consultation with a city cardiologist, despite being five years overdue for a check-up. But he was happy to undergo testing and consult with Perel when the semi-trailer pulled up among the bottle trees at the Roma showgrounds late last year. “It’s something that’s needed,” he says. “If it didn’t come out here, I probably wouldn’t have got myself checked.”
The 51-year-old spends a lot of time driving as a pipeline operator with energy company AGL and working as a disc jockey on weekends. He says “shocking” sections of road, more trucks than in the past and the “ice [methamphetamine] epidemic” made driving in the region risky. “Drugs are in plague proportions,” Macfarlane says. “There are so many lunatics out there.”
Gomes’s ultimate vision is to turn Heart of Australia into a health provider on a par with the Royal Flying Doctor Service, established in 1928. While the RFDS provides emergency retrievals and GP services to the Australian bush, his plan is to expand Heart of Australia into more regions, and more medical specialities, beyond cardiology. “We started off with cardiology because that’s what I know, that’s my bread and butter so that made sense,” Gomes says. “But there’s no reason why we can’t bring other specialties on board. The problem with the way we try and deliver specialist doctors to regional areas [is] there’s no framework, there’s no brand, there’s no focus.
“I’d like Heart of Australia to become the organisational framework for providing specialists to regional areas. That’s the big picture.”
The next small step is to branch out into more areas of Queensland with a second semi-trailer. Gomes hopes to eventually provide services nationally. The need is indisputable. He regularly receives letters about taking Heart of Australia to new towns. “The latest are from Cunnamulla, even Bundaberg,” he says.
The Heart of Australia founder started the service with “a little bit of bravery” and a lot of self-belief. But he says to turn it into a bush institution, with a fleet of semi-trailers in every state, will require ongoing state and federal government funding.
For more information or to donate: heartofaustralia.com
MATTERS OF THE HEART… MURWEH shire MAYOR DENIS COOK (LEFT) AND ROMA-BASED PATIENT JOHN MACFARLANE ( ABOVE, UNDERGOING A CARDIOGRAM) ARE VOCAL SUPPORTERS OF THE HEART OF AUSTRALIA SERVICE, LAUNCHED BY INDIAN-BORN, BRISBANE-BASED CARDIOLOGIST DR ROLF GOMES ( OPPOSITE PAGE).
CHECK -UP… specialist rob perel with pat ient nytha peart , who lives on an isolate d property .
FILLING A NEED … EMERALD GP EWEN McPHEE, PRESIDENT OF THE RURAL DOCTORS ASSOCIATION, SAYS the heart of australia prime mover HAS BEEN A LIFE-SAVER.