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.

The Courier-Mail - QWeekend - - INSIDE THIS WEEK - STORY JANELLE MILES PHO­TOG­RA­PHY RUS­SELL SHAKE­SPEARE

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.

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