Community Project: Case Study

Dr Andrea Miller

Challenges of diagnosis and management of tuberculosis in a remote Indigenous community in Far North Queensland
Completed in: Weipa, QLD

About the Community Project

The Community Project forms part of the population health requirement of the Rural Generalist Fellowship and makes it unique to other rural general practice fellowships. Completed over 6-12 months during your time in a rural community, it is a valuable opportunity to get to know the community and improve health outcomes – including a quality improvement activity undertaken within a general practice with the primary purpose to monitor, evaluate or improve the quality of healthcare delivered by the practice.

The RACGP Rural team spoke directly to Dr Andrea Miller about her Community Project in Far North Queensland.

North Queensland

In my practice in a primary care clinic in remote Far North Queensland I found myself as the principal medical officer managing an endemic case of active pulmonary tuberculosis, in collaboration with the public health unit and the primary care staff.

This case presented with unique challenges due to its remoteness and the social and cultural factors of the patient, and was a learning experience for myself and the health service. I thought it would be useful to write up the management of this case and the lessons learned as my Fellowship project and as a quality improvement activity for the health service.

My work involved collaboration with the primary care staff that were directly involved in the case including the lead clinical nurse and the Aboriginal and Torres Strait Islander Indigenous Health Worker, and consultation with a research fellow in Occupational therapy.

I completed this whilst working as a GP Registrar for the Weipa Integrated Health Service in Far North Queensland, and this case was managed in the primary care clinic in one of the surrounding indigenous communities.

At the time I completed my project I had already completed my Advanced Skills Training in Adult Internal Medicine and was employed as a Rural Generalist – Provisional Fellow for the Weipa Integrated Health Service. I was also working on completing the rural components of my Fellowship as well as my RACGP fellowship. 

The biggest challenge was probably one of time management and finding the time to gather the information, analyse and articulate. This project required a comprehensive chart review process that was hampered by the limitations of a paper-based system. It also required extensive consultation with all parties involved to ensure that all relevant challenges were described and that information was accurate. Added to this were the additional demands of studying for the RACGP fellowship exams, completing the Fellowship electronic module and balancing on-call and family life.

I think the outcome of this case (eradication of tuberculosis) was rewarding as it meant that we as a team were successful in overcoming the challenges posed by this difficult case. With respect to the project, it was rewarding to be able to outline these challenges and use this experience to inform our practices when we are faced with this situation in the future.

It was beneficial to reflect on the processes involved in the management of this case. In future, I believe that I will be able to carry the lessons that I have learned to future cases and apply these lessons generally to the holistic management of indigenous patients.


For further details please contact the Rural team on:
1800 636 764