Dr Solange Costermans is passionate about delivering high-quality healthcare to rural and remote communities through her work with the Royal Flying Doctor Service.
Western Australian GP Dr Solange Costermans found her transition from one rural area to another to be a natural move, despite the locations in question being on opposite sides of the world.
Originally from the Brie region in rural France, Dr Costermans began her medical schooling in her home country before moving to Australia in 1999 and completing her degree at the University of New South Wales in Sydney. Not long after graduation, Dr Costermans began taking up rural placements for her general practice training, including in Daylesford in north-west Victoria.
It was during this time that Dr Costermans first learned of the Royal Flying Doctor Service (RFDS) and decided to write to the organisation.
‘While I was an intern I sent a letter to the RFDS and said, “I think what you’re doing is amazing and, even though I’ve just graduated, I’d like to work with you. I’m really fascinated by the work you do”,’ she told Good Practice.
Making contact with the RFDS turned out to be an act that would assist with Dr Costermans’ eventual transition back to rural life. About two years later, in 2008, she received a call from the organisation offering her a general practice registrar position in Broken Hill, in the far west of New South Wales.
‘It was supposed to be a six-month position, but after a couple of months they asked if I’d consider staying. I thought about it for half a second and said yes, and that’s how things got started. I got hooked,’ she said.
Dr Costermans’ passion for rural life continued to grow when she became immersed in Australia’s unique outback.
‘I find the Australian outback absolutely fascinating,’ she said. ‘I really enjoy the communities. They’re resilient, they’re tough, and they have a strong community spirit [similar to the one] that I grew up with.’
Becoming accustomed to the traits and attitudes of those living in Australia’s remote communities helped Dr Costermans understand the need for general practice growth in order to keep those communities thriving, just like in urban areas. She feels the support these more isolated communities receive from organisations like the RFDS is vital to their livelihood.
‘I really wanted to do something useful and I find rural areas are in the greatest need of doctors,’ she said.
Dr Costermans believes that mental health is one area of healthcare where extra support and resources are needed on an ongoing basis, particularly in rural and remote areas. RFDS visits allow doctors to connect with members of these communities in a relaxed environment, and discuss any mental health issues they may be experiencing, without the formal setting of a clinic.
‘By going to these locations and creating a bit of an event, it allows us to get access population we don’t usually get to,’ Dr Costermans explained. ‘In terms of mental health, there are advantages in getting everyone together like that because it’s an informal setting.
‘People are quite happy to have a chat with the drug and alcohol counsellor around a cup of tea or a piece of cake, then talk to the psychologist.
Then they’d go for a walk and have what we’d call a “proper consultation” away from everyone else, without the stigma of making an appointment to see the drug and alcohol counsellor or the mental health worker.’
Dr Costermans has found these situations often help to ease the burden some locals may be experiencing with their mental health and break down barriers to treatment. However, she does see the sense of stoicism evident in rural communities can sometimes act as one of those barriers.
‘One of the things I admire about people in rural areas is their resilience – they never ask for help and think they can do everything,’ she said. ‘But there’s also the stigma associated with mental health, which is sometimes seen as a failure to achieve what you’ve set out to achieve.
‘[But by] having started the conversation and having introduced ourselves, it’s not that scary mental health stigma of an unknown service or unknown person. It comes from a personal relationship, which makes everything a lot more accessible.’
After working in Broken Hill for several years, Dr Costermans recently ventured west to the RFDS in Western Australia following completion of her advanced rural skills training (ARST) in anaesthetics. She has been grateful to experience the variety of day-to-day life that being a part of the RFDS team offers.
‘There are two different aspects to the work with RFDS – primary healthcare and emergency retrieval – and that’s why this job really appeals to me,’ Dr Costermans said. ‘I really like doing a bit of everything, I really enjoy the relationships you develop with your general practice patients, and the procedural aspect of the emergency side of things.’
The balance of general practice and being on-call for emergencies keeps it interesting for Dr Costermans. Since working in Western Australia, where the RFDS emergency retrieval services covers around 2.5 million km2, she has spent more time tending to medical emergencies on board the aircrafts.
‘A lot of the flights we do are over two hours, so it’s very much like a flying intensive care unit where you actually have to manage the patient for hours before they get to their final destination,’ she said. ‘And my training in anaesthetics gave me a fantastic opportunity to further my skills and give me extra confidence in managing those very sick patients in the outback.’
In addition to the excitement of being a member of the RFDS, Dr Costermans has recently obtained her Fellowship in Advanced Rural General Practice (FARGP), establishing the ‘fly around’ clinic as part of her FARGP project when she was based in Broken Hill.
This clinic involved flying to remote NSW towns that have limited coverage in various specialist areas of healthcare, such as mental health and eye health.
‘We would decide on a particular area of health prevention that we wanted to address, then gather a team – including a psychologist, a drug and alcohol worker, and an ophthalmologist – an aircraft
and some funding, and spend a week flying around the state to areas that we don’t usually go to, and provide that particular health prevention activity,’ she said.
‘The idea of the fly around clinic was to be prepared for the future in terms of mental health, physical health and eye health.
‘It’s been fantastic to have had the opportunity to do the FARGP and ARST.’
First published in Good Practice April 2017:22-23