Fly in fly out model

Dr Lou Sanderson
Miwatj Health – Galiwin’ku Health Centre

Dr Lou Sanderson


Dr Lou Sanderson started doing remote locums 4 years ago in North East Arnhem land with the Yolngu and now splits her time evenly between her home state of Victoria and Elcho Island, Northern Territory in a “fly in, fly out” model. 

Galiwin’ku is an Aboriginal island community of at least 2500 people.

When she is “home” she provides part time remote support to the remote health service including checking of results, documents, emails, scripts and telehealth.


The challenges in the community are poverty, overcrowding, poor food security and ill health. These are the social determinants of health that make East Arnhem land the area with the highest incidence of preventable deaths in Australia.

The challenges to the clinic are understaffing, high staff turnover and a lack of clinic space to meet the needs of a rapidly growing community.  The work is challenging medically with extreme health issues being encountered on a daily basis that are seen rarely in non-Indigenous health settings.

The cultural gulf is huge with engagement across language and cultural barriers sometimes very difficult. Varied levels of cultural awareness and sensitivity amongst non-Aboriginal staff can create challenges in establishing trust with the community and can create interprofessional discomfort in the health team.

Being remote and on an island in the tropics means that patients with the full range of medical conditions must be managed at the health service until retrieval can occur. Retrieval can be delayed or hampered by weather, high demand and equipment failures.

Living in a remote setting can be challenging with a lack of access to the facilities of urban centres.

Practice model

Working as a fly in fly out GP balances the intensity of the hard work on site, with time to reflect on the work and the challenges, and time for professional development to be able to improve Lou’s ability to provide services in this context.  She can return to the community refreshed and inspired to keep going!

Providing part time remote support enables her to remain connected and aware of the ongoing health journey of members of the community and to maintain contact with staff whilst not on site.

She hopes to be able to keep returning to the community for many years and that this can be a sustainable model that benefits the community through improved continuity of care over time. Improved understanding of both language and culture over time enhances Lou’s ability to provide appropriate care, to model appropriate care and better understand how we as health professionals can work with Yolngu together to improve health outcomes.

Australia is a first world country, however the First Nations people of this country experience health and living standards of a 3rd world country. This model enables the skills and quality of Australian health professionals to be shared with the First Nations people of this country, whilst also enabling non-indigenous people as individuals to learn and experience so much of the rich culture of Australia’s First Nations people.

The benefits

  • Continuity of relationships with community and colleagues
  • Sustainable model providing time in community and away from community
  • Opportunity to experience a rich and ancient culture
  • Challenging, stimulating and rewarding medicine
  • Experiencing the adventure of being in a remote setting
  • Great opportunity for collaborative team work

Top tip

GPs are not emergency specialists. However in remote medicine in NT, GPs are well supported by highly skilled remote area nurses, specialists in major centres and retrieval services. This is an opportunity of a lifetime, to be a doctor, and to experience an amazing culture. Another world awaits!


You’ll need humility, tolerance, adaptability, respect and kindness.