A passion for rural general practice has been a highlight of the medical career of Bill Jackson, a past President of the RACGP and foundation co director of the Western Australian Centre for Remote and Rural Medicine
Focus on rural practice
Bill Jackson always wanted to be a doctor. He remembers that as a choirboy in Hobart he was inspired when listening to Dr Paul White, the 'Jungle Doctor' speaking at a service, "hanging on every word". He also read all the books by George Sava. "Each of these medical authors enjoyed wide popularity when I was a young man. They romanticised the profession and deepened my interest".
Nevertheless his path towards achieving his ambition was littered with obstacles.
His early secondary education was at the Hobart Junior Technical College. After gaining his Intermediate Certificate he entered the workforce as an electrical apprentice. A year later he negotiated his release to return to school for there were rumours of scholarship support for Tasmanian medical students. It did not materialise. He studied for matriculation during two years at Hobart High School and was required to cover a five-year course of Latin in that time for the language was then a prerequisite for medicine. The second World War ended during his final school year in 1945. He was school captain during that year.
He completed his first year of medicine in Hobart in 1946, but he was unable to take the next essential step to win a place at Melbourne or Adelaide university. A shortage of places was due to preference very properly given to returning service personnel. So he joined the navy. In 1947 and 1948 young Bill was a sick berth attendant spending most of his time in Flinders Naval Hospital, Victoria.
When he completed his two-year term of service he was accepted at Melbourne University to resume his studies. He graduated MB, BS in 1953. Bill, a fourth generation Tasmanian of Irish-English stock, born in Hobart in 1927, was the first professional in his family.
He was an RMO at Prince Henry's Hospital before entering solo rural practice in Pyramid Hill, Victoria, until 1963. During that time he worked closely with Peter Graham in the nearby town of Cohuna. (Dr Graham was the notable doctor featured in AFP, February 1993.) He recalls with gratitude Peter's competent support during those years, and he and Doris still number the Grahams among their closest friends. The Jackson family moved to Launceston, Tasmania, where Bill worked as surgical registrar for a year before entering general practice in that city in 1965 and continuing until 1990.
Advancing rural practice
In 1990, Bill and his wife of 43 years, Doris, were appointed by the University of Western Australia to develop a new venture - the Western Australian Centre for Remote and Rural Medicine (WACRRM). They greatly enjoyed the interest and challenge of their position providing as it did opportunity to pursue research and innovations in rural general practice. Many fine rural people and professional colleagues assisted them. Professor Max Kamien and Dr Frank Mansfield were always supportive.
The Centre development was predicated on the belief that 'a resident doctor is pivotal to the wellbeing of many isolated communities'.
Strategies devised included encouraging rural high school students to consider a career in rural medicine and nursing, a students' club to nuture rural interest in undergraduates, meeting family needs for housing, income and education.
"Doris and I feel privileged that we were given the opportunity to establish WACRRM, Max Kamien's brainchild. Our sojourn deepened our respect for all those people in our remote and rural areas who contribute so much to Australia. It broadened our esteem for our rural colleagues in all health disciplines. WACCRM is now a model which might well be a template for developments in other States. We feel comfortable that our successors will maintain its impetus."
Their contract of three years ended in February of this year when they returned to their home in St Leonards, a suburb of Launceston, Tasmania. Launceston is a very pleasant provincial city that permits them to enjoy a rural lifestyle though only seven minutes from the city centre. The city was founded in 1804 and much of its lovely heritage has been preserved. It offers ready access to excellent medical, educational and cultural facilities while it is also close to the mountains and rivers of great beauty.
His main professional focus is rural general practice and he has been especially interested in obstetrics, paediatrics, trauma and teaching - in the general practice context.
Beyond medicine, his interests include rural life, farming, bushwalking, amateur theatre, and writing. He has written a book of poems and has a collection of editors' rejection slips attesting the fact.
Doris trained as a nursing sister at the Alfred Hospital, Melbourne. Over the years she has gathered considerable skills in practice management and the role of the practice nurse. As a team they opened Tas mania's first community health centre in Kings Meadows in 1976. They continued in that position for seven years.
Family values
Bill and Doris, the parents of four children, have always placed great emphasis on family values.
"While it might have been nice to have one of our children follow me into medicine, we never imposed our wishes on them,"
And the occupations of the four children indicate in some way the independent spirit that Bill and Doris inculcated into family life. Susan is a Bachelor of Nursing, Russell a helicopter pilot, Jeremy a deep-sea diver, and Amanda, who lives in the United States, a professional stylist. Her work includes costume design for actors in videos and movies.
College President
While he was a general practitioner in Launceston, Bill Jackson was elected President of the Royal Australian College of General Practitioners. This appointment came after 15 years as the holder of various offices in the Tasmanian Faculty of the College. He represented his Faculty on College Council, of which he was Chairman for two years.
In his association with the College, Bill has travelled widely. He was a speaker at the 5th World Conference in General Practice in Melbourne in 1972. He represented the College at WONCA meetings in Malaysia, the Philippines, Montreux, New Orleans, and at the inaugural meeting of the Hong Kong College of General Practitioners.
Bill sees the future role of the College as continuing to provide the vehicle through which GPs become involved in and committed to the advancement of general practice, to those who accept its responsibilities and to those whose health needs it serves. This future direction remains no less relevant than when set down historically by yesterday's generation in the second of our Memoranda of Association. It defined the first objective of the RACGP "To establish and maintain high standards of learning, skill and conduct ..."
"If it is to survive and prosper our College must measure all policy decisions against this benchmark. Constant vigilance is required if we would defend our discipline and our patients against incursions which might compromise them.
"The erosion of our areas of responsibility, the limitations imposed on the exposure of medical students to good general practice and exclusion from hospitals are examples.
"But the internal problems of our discipline will also need attention as we see the spread of 9 to 5 shop front practises, the 'drafting gate' type of practice processing numbers rather than servicing needs, the income-maximising entrepreneurs. It needs but few of these to tarnish our image. The RACGP did not choose to politicise health but we must acknowledge that it is now a high profile issue which will demand increasing political awareness.
"Our College has taken a long time to appreciate the importance of getting really close to rural practice. It is humbling to think that the rural initiatives had to come from rural GPs themselves. Now, we finally have a Faculty of Rural Medicine, and Rural Training Units are developing in virtually all States. The challenge is to see how these sit with FMP and University Departments of General Practice.
“Years ago Keith Shaw (another past President of the RACGP) and I did a peripatetic evaluation of the Family Medicine Program (now called the RACGP Training Program) and saw how much disenchantment with College was apparent in our rural colleagues.
"Keith, his wife Anne, and their lovely aircraft were most helpful to us. We fondly remember a whistle stop tour of rural GPs during my presidential years, and more recently a trip that greatly assisted our efforts in WACRRM.
"The call sign of Keith's aircraft was Delta Delta Delta, which often evoked some comment about stuttering. Thank you, thank you, thank you, Keith and Anne."
A sense of humour
"Survival in our discipline requires a sense of humour to balance the pathos which is ever part of the job. We do meet so many funny situations and funny people we need to enjoy. I'm reminded of the distraught Italian at the end of the phone shouting at me, "Eh, doc, you musta come quick to a da wife - I tink she's a missed a da carriage."
In 1988, the Bicentennial year, Bill was introduced to the gentle art of kiting, and to many of those delightful people who are fliers. At a public meeting he found himself chairman of the Launceston Bicentennial Committee, which in turn saw him chairman of the first World Kiting Festival held in Australia.
"It was a marvellous experience," Bill says. "Although not previously very interested in flying kites, at the three-day festival in Launceston I met fascinating fliers from China, Japan, England, United States, New Zealand and elsewhere. It was a great spectacle."
An Australian first
"My most abiding satisfaction has derived from assisting women through normal, comfortable childbirth. What a privilege we enjoy as family doctors to participate in the birth of a family.
“One memorable experience (1963) relates to a situation described in the Medical Journal of Australia. 1 So far as was known my patient, a 16 year old boy with a shotgun wound to his abdomen, was the first in Australia to survive two cardiac arrests through the technique of external cardiac massage."
General reflections
"Medical practice, and its practitioners are undergoing dramatic change though not always for the better. Most of the charismatic characters are gone, and sadly some dramatic teaching styles have departed with them. Too often they have been replaced by intense, often humourless, colourless people knowing more and more about less and less, and offering little inspiration to their students. Where might one find the urbanity of Clive Fitts, the ebullience of an Albert Coates, the doggedness of Weary Dunlop? All inspiring leaders in their own way and all ultimately knights of the realm. The latter appellation is now perhaps as old fashioned as their styles.
"The growing elitism in our profession, beginning as it does at University entrance level, does not serve us well, our patients less. Our fall from grace as a most honourable and honoured profession has been due as much to our own insensitivities to patients' needs as to political depredations by others. We risk becoming artisans of artefact rather than husbands of humanity.
"Our increasingly brutalised world clamours for standard bearers, leaders with real values. Bill Conolly and Clifford Jungfer were men of such stature in the early days of our College.
"My hopes for our profession are renewed as I identify with young people displaying the potential of future leaders. Doris and I met some of them regularly in our undergraduate club for those students of medicine and nursing espousing a rural career, un selfishly and altruistically.
"Three of my favourite books are not medical. I refer to Omar Khayam's Rubaiyat, Aesop's Fables and Bacon's Essays. I like the final section of Bacon's essay 'Regiment of health' and feel it is worthy of further emphasis:
"Physicians are some of them so pleasing and conformable to the humour of the patient as they press not the true cure of the disease; and some other are so regular in proceeding according to art for the disease as they respect not sufficiently the condition of the patient. Take one of a middle temper; or, if it may not be focused on one man, combine two of either sort; and forget not to call as well the best acquainted with your body as the best reputed of for his faculty."
"One's medical career derives inspiration from many sources, among which are the occasional medical giants with whom we work, to whom we listen, or about whom we read.
"We learn much from our patients, but without doubt the single most important factor in the moulding of my career has been the influence of Doris, my wife. In all things we have been partners, in all ways she has been my constant support: whatever modest achievements may be ascribed to me have resulted from a joint effort."
Reference
1. Jackson W D, Sinclair G. External cardiac massage. Med J Aust 1963; 1:468-469
First published Australian Family Physician Vol. 22, No. 10, October 1993