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Bringing ENT to the Cape

19 February 2021

GP registrar and rural generalist, Dr Steve Johnston has come through James Cook University medical training from undergraduate to postgraduate and is a strong advocate for rural and remote medicine. Now based in Weipa in Cape York, with skills in anaesthetics and ear nose and throat medicine, he is passionate about the training program and providing medical services to those most in need. He is also dedicated to supporting others through the program as a Registrar Liaison Officer.

JCU Medicine - The perfect fit

A trip to the sunny north for a medical school interview was all it took for Dr Steve Johnston to fall in love with the region, farewell Victoria, and set his heart on a future in medicine in Queensland.

“When I was doing my interviews in Melbourne it was the middle of spring yet still cold and miserable and everyone was wandering around in suits. Then I came up north and people were in shorts and thongs. After my interview, I went across to Maggie Island and had an absolute ball of a time. It was my first real experience with living around islands and beaches and things like that. I just fell in love with the place. When I found out I got into JCU I was over the moon,” Dr Johnston said.

But while he was prepared to farewell Victoria, the one thing he wasn’t prepared to give up was his focus on rural medicine.

Coming from Bairnsdale, three hours east of Melbourne, he’d grown up with a love of rural life and knew the value of great general practitioners in regional and rural communities.

“There were some really great docs in the community, they were always involved in the local events and sports teams. You went to school with their kids, they were people you really looked up to and respected.  Everyone in the community did, and they did so much for all of us,” Dr Johnston said.

“I was always interested in health, and always wanted to do something that would bring me back to a rural area. I just didn’t expect that would be in Queensland!”

With a passion for the country, JCU’s medical program with its heavy focus on rural placements and experiences was the perfect fit.

Falling in love with rural

While Dr Johnston admits first-year medicine wasn’t quite what he was expecting, his first rural placement in country Victoria, toward the end of that year, reminded him of what it was all about.
“It was a real kick in the bum, a reminder of why I wanted to do it, and it all just sort of skyrocketed from there,” he said.

“I got more and more involved with the rural health clubs and the rural side of things. I started going out on rural placements, which were fantastic. I went out to Mount Isa in my second year, and again in my fourth year. I had an absolute ball. The people I met were awesome. The mentors were all fantastic and my love for it really grew.”

If his first five years of medical school confirmed Dr Johnston’s passion for rural medicine, it was his sixth year in the remote western Cape York town of Weipa that opened his eyes to where he wanted to live and practice.

“I absolutely loved the hospital up there. I was with a couple of mates. Every weekend we would take the boat out and go up the Cape. You get such a great balance of work and play and are supported by the docs very well.

“The range of medicine you get is just unreal. You go from anaesthetics to emergency, and then to a lot of outpatient stuff. You go up to Napranum and Mapoon, which are some of the outreach clinics in the communities.”

The Rural Generalist Pathway

It wasn’t just the location that made a lasting impact. The scope of work available for rural generalists in the remote region also hit home.

“I loved my placements in Mount Isa and Boulia, but no other place that I’d worked had allowed me to do that much medicine. The whole generalist thing just appealed to me from the get-go. When I came up to Weipa and met the team it was awesome. I loved it. I was pretty much heart set on it from there, and Weipa was my number one goal.”

With his long term plan to return to the far north, Dr Johnston opted to explore more of the state during his intern and early training years, heading to Toowoomba and rural Stanthorpe in southeast Queensland. While the medicine may have differed somewhat between north and south, he noticed the scope of practice for the rural generalists he worked with remained just as broad.

“They just cover so many different parts of medicine, and it just drilled into me time and time again how great rural generalism is,” he said.
He also found the approach to work hugely appealing.

“Those guys work hard, but their lifestyle matters to them, family life matters to them, and that is one of the biggest differences I have seen between the rural generalists and a lot the specialist consultants in the bigger hospitals. That really draws you back to it. It’s about work, but it’s also about being able to enjoy life outside of the hospital.”

Finding a future in the Far North

While he loved his experience in the south, Dr Johnston never gave up the idea of returning to the far north.

While waiting to take up his anaesthetics advanced skills training in Townsville, he went back to Weipa. It was then he became acutely aware of the impact ear disease was having on communities across the Cape.

“I got distracted by ear problems in the community, and as I do I get distracted by little things that then grow into big parts of what I do.”

“Ear disease had already been identified as an issue through the Cape but there was no continuity of ENT services in the region. A couple of my supervisors and close mentors mentioned the ear, nose and throat (ENT) Special Interest training post in Logan under Associate Professor Bernard Whitfield and from there it really just grew.”

Dr Johnston admits he didn’t know much about the field of ENT at the time, but he did know there was a huge problem, and while Thursday Island and the eastern Cape were well serviced, the western Cape was left far behind.

“Serious cases were sent to Cairns almost a thousand kilometres away. But many people simply didn’t go. Then they would turn up here again with pus coming out of their eyes,” Dr Johnston said.

“We needed sustainable, and community led care with a consistent ENT presence. So much of ENT medicine is about preventative care, but that needs relationships and trust between yourself and the communities. To build that you need people on the ground, and a consistent service in the community.

“It also needs educating and upskilling, which is easily said, but hard to do when you have to cover such a broad area. We felt a generalist focus would be the best way to try and cover this, so I went south to Bernie, who turned out to be hands down one of the greatest people you will ever meet.”

While building his skills, Dr Johnston and Associate Prof Whitfield also hatched a plan to bring desperately needed ENT skills to Weipa’s surgical lists and conduct outreach clinics across Cape York.

“Bernie was gracious enough to let me fly up to Weipa and start doing outreach clinics around Aurukun, Weipa, Kowanyama, and Lockhart River, and all through the Cape to Cooktown, Hope Vale and Wujul Wujul. Then I would come back and have a case discussion with Bernie, and we'd have a good discussion with the clinical nurses up here and the audiologist. We would then go back to the community and come up with plans about who needed surgery and develop surgical lists for Weipa and Cooktown,” he said.

“It was crazy. About 60 percent of the kids we saw around the Cape had functional hearing loss. One in three to one in two children had a hole in at least one of their ears. It was ridiculous. We put our cards on the table, and with Professor Whitfield’s support and the backing of the doctors of the Cairns and the Weipa Integrated health service we were able to develop and put forward a functional and sustainable ENT service for the Cape region.”

Eighteen months on, and having completed his anaesthetics training and managing around COVID-19 restrictions, Dr Johnston is back in his beloved Weipa, getting clinics up and running again, with hundreds already waiting to be seen. But it’s not been an easy process. To get to this point, Dr Johnston found himself battling red tape, presenting research findings to potential funders, and working closely with the Australian College of Rural and Remote Medicine to have ENT training credentialed as part of their program. But he believes it's been well worth the effort.

Giving back and supporting colleagues 

Along with his training and clinics, Dr Johnston has also taken on a role close to his heart, that of Registrar Liaison Officer within the JCU GP training program. While he enjoys assisting with matters including contract negotiations, billing processes, and advocating on behalf of his colleagues, Dr Johnston admits the most important and understated part of his role is to be there to listen.

“While you encourage people to talk up about their issues and can direct them where to go for help, you really need to be there to give them someone to talk to.

 “A lot of people talk about the value of attending meetings to get your head around what is happening in the training space, and I agree that is very important. But as a trainee myself, and having had a lot of mates go through the same things, one of the biggest things is just having a familiar person to talk to. This can be a hard road, it’s not always easy, but it’s great to know you always have someone you can call if there are any dramas.

“I have a lot of people call who have solved their problems but they have just really wanted someone to talk to and get it off their chest.

“All the JCU RLOs are so approachable. It is amazing. If you have a problem we can address that. If you just need to talk, we are there.”

With his approachable manner, passion for medicine, and rural and remote experiences, you couldn’t imagine a better person to turn to.

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