Coonabarabran: rural medicine

So after the previous few posts on Coonabarabran, you might be wondering whether I actually got around to doing any medicine during my placement there. Indeed I had plenty of medical practice in Coona and it was an amazing experience! (As with previous posts on Coona, the photos below and more can be found on my Flickr photostream).

Placement sites

I was based at Warrumbungle Medical Centre (59 Cassilis St), with husband/wife general practitioners Drs Aniello Iannuzzi and Eve Tsironis as my principal supervisors. Warrumbungle Medical Centre is the main medical practice in Coona (there are two other medical practices in town), with Drs Iannuzzi & Tsironis, two GP registrars and two registered nurses (RNs). My role at the medical centre was mainly clinical observation and assisting with clinical procedures. I also spent some time at the co-located Orana Pathology Service collection centre (a courier does a twice-daily run to Dubbo with the samples). I learnt a lot about general practice and rural medicine from all of the doctors and nurses, to whom I’m very grateful for the experience. Dr Iannuzzi, a recent candidate for AMA national president, and I also engaged in some interesting discussions about life, politics and medicine…

Warrumbungle Medical Centre
Warrumbungle Medical Centre

The doctors at Warrumbungle Medical Centre are also visiting medical officers (VMOs) at the local hospital, as is the norm in many rural settings. Coonabarabran Health Service is a 20-bed district hospital (with a 3-bed emergency department) operated by the Greater Western Area Health Service, with the main referral hospital being Dubbo Base Hospital (c. 1.5 hours away by ambulance). At Coona hospital, I was put on-call in the emergency department (ED) for triage categories 3–5 for three 24-hour periods during my placement – in practice, this meant that I’d be called-in by the ED RN to assess the patient then report my findings and clinical impression/diagnosis to the doctor on-call (who would decide on the course of action from there). I also attended ward rounds with my supervisors, assisted in clinical procedures and with the visiting endoscopy service (see below). Incidentally, I was provided with accommodation at the hospital nurses’ quarters during my placement.

Coonabarabran Hospital ED sign
Coonabarabran Hospital ED sign

Emergency Department, Coonabarabran Hospital
Emergency Department, Coonabarabran Hospital

Nurses quarters, Coonabarabran Hospital
Nurses’ quarters, Coonabarabran Hospital (N.B. MacBook & monitor are mine)

Medical firsts

It’s almost a truism that rural general practice is where you really get to develop and practise clinical and procedural skills, and indeed this was true for my placement. There were many medical “firsts” for me, including: successful insertion of (many) IV cannulae, venesection using a 16-gauge needle (for a patient with haemochromatosis), venepuncture by needle & syringe (cf. Vacutainer/Vacuette), parenteral (SC/IM/IV) administration of medications, manually pushing IV fluids, local anaesthetic infiltration in a conscious patient, needle thoracotomy and thoracentesis of (>2 litres!) pleural effusions, suturing of a wound (using 6-0 monofilament), surgical debridement (severe tinea + MSSA cellulitis + maggot infestation!), admission of a patient, ophthalmic work-up (incl. slit-lamp exam + fluorescein), assisting in resuscitation and early management of severe trauma (motor vehicle accident), etc.

The flying doctor

When Dr Iannuzzi mentioned that one Dr Peter McInerney was flying into Coona to perform endoscopy at the hospital, I assumed that he must’ve chartered a flight to Coonabarabran Airport (which no longer has regular commercial services). It turned out that Dr McInerney was literally flying in – he piloted the plane himself, flying from his hometown of Scone (c. 175 km away). I learnt quite a bit from Dr McInerney during the day I spent assisting him in the operating theatre, including a quick tutorial on how operate the endoscope. It also turned out that his daughter and I had studied pharmacy together – it really is a small world!

School of Rural Health

One weekend my friend Nilay (on placement in Gilgandra) and I decided to visit Dubbo, which for me involved a drive of just under two hours down A39 Newell Highway. We had some friends based at the School of Rural Health (whom we hadn’t seen since the start of third-year) and also wanted to visit Taronga Western Plains Zoo. After spending several weeks in a small town, the City of Dubbo felt like being back in suburban Sydney – it was a bit of a shock to encounter the first set of traffic lights in weeks. It was great to catch-up with our friends (and interesting to observe the bountiful resources of the School of Rural Health), and the open-layout Taronga Western Plains Zoo was also well worth visiting.

School of Rural Health, The University of Sydney
School of Rural Health, The University of Sydney

Meerkat – Taronga Western Plains Zoo
Meerkat – Taronga Western Plains Zoo

The dinner

One of the traditions for students completing their placement with Drs Iannuzzi & Tsironis is that the students are expected to cook a meal for the doctors and their families at the Iannuzzi residence. I was a little trepidatious about this at first, as I’d never cooked for 13 people before… Fortunately, the other medical students (Kate and Shanela from the University of Notre Dame Australia) and I rose to the challenge, putting in a successful joint effort to cook-up an international buffet. My contributions were miso soup (味噌汁), fried rice (炒飯) and genmaicha (玄米茶) – I had some forewarning from previous students, so brought many of the ingredients (unavailable in Coona) with me from Sydney. Kate and Shanela prepared: green salad, papadums, raita, lamb rogan josh, salmon & teriyaki chicken maki-sushi, Moroccan chicken, kheer, barfi, and mango lassi.

Being mindful of one of the registrar’s preferences, this was also the first time any of us had prepared halal food. I had to email one of my friends in Sydney to clarify which foods were permissible, and we were fortunately able to source some halal chicken meat from Coona Food Suppliers (35 Timor St). Being careful during preparation of the food to avoid any contamination, we were able to make many of our dishes above halal (including both of mine).

Miso soup
Miso soup (味噌汁)

Fried rice
Fried rice (炒飯)

Coonabarabran NSW 2357

This post is a collection of some of my thoughts and experiences living in Coonabarabran during my recent rural placement (and is by no means comprehensive or authoritative). Photos of Coonabarabran and the Warrumbungles are available on my Flickr photostream.

People/lifestyle

Coona is a small country town with a population of 2,601 (2006 census). The town is classified RRMA 5 (“other rural area”) and ARIA+ 4.51 (“outer regional”) in the two major indices of rurality/remoteness used in Australia. That said, I love the country lifestyle in Coona! After living in Sydney for over 20 years, you really appreciate the friendly down-to-earth people, fresh air, wide open spaces and relaxed pace.

Kangaroo sign
Kangaroo hazard sign on John Renshaw Parkway, Coonabarabran

In my travels around Australia I’ve noticed some regional variations in vocabulary/grammar, which is perhaps unsurprising in a country this size. In Coona, I noticed that most people substituted “in the” with “of the”. For example, a patient might come in stating that his cough “is worse of the morning” or that he takes “one tablet of the morning and one tablet of the night” of a particular medication.

Warrumbungle National Park

The nearby Warrumbungle Mountain Range, located within the heritage-listed Warrumbungle National Park, is perhaps the most important tourism drawcard for Coona these days. The volcanic rock formations and rugged landscape of the Warrumbungles are the result of millions of years of erosion of an ancient shield volcano. The national park is a great place for bushwalking, with a variety of tracks of various grades, and I plan to go back to try one of the more challenging trails next time. The easiest way to see the Warrumbungles, however, is either White Gum Lookout or from the deck outside the Anglo-Australian Telescope at Siding Spring Observatory.

White Gum Lookout, Warrumbungle National Park
White Gum Lookout, Warrumbungle National Park

Burbie Canyon, Warrumbungle National Park
Burbie Canyon trail, Warrumbungle National Park

Around town

Coona township was founded in 1860, but the greatest development of the town occurred during the economic booms of the early 20th century, as reflected in the Federation and Art Deco architectural styles that predominate on the high street (John Street).

Memorial Clock Tower and Imperial Hotel, Coonabarabran
Memorial Clock Tower (1926) and Imperial Hotel (1930s)

Coonabarabran Courthouse
Coonabarabran Courthouse (1878)

Commonwealth Bank, Coonabarabran
Commonwealth Bank, Coonabarabran (1935)

There was formerly a railway service operating to Coona on the Gwabegar Line (a branch of the Main Western Line). The Gwabegar Line reached Coonabarabran in 1917 and became an important mode of goods transport. Regular rail services ceased in 1990 and the Gwabegar Line north of Binnaway (including Coona) was closed in 2005.

Gwabegar Line (abandoned), Coonabarabran
Gwabegar Line (abandoned), Coonabarabran

Surprisingly, there are two Chinese restaurants on John Street – Golden Sea Dragon Chinese Restaurant (金海龍酒家) and Golden Fountain Chinese Restaurant (金源酒家). Golden Sea Dragon has a very kitsch interior design, but is apparently more popular with the locals and seems to be a bit cheaper. Neither of them serves particularly authentic Chinese fare, but nor would you expect them to out this way. (And yes, you have to ask for chopsticks at both restaurants).

There are two main pubs (Imperial Hotel and Royal Hotel) in town, with the Imperial generally considered to be the better of the two. Both were described to me as “real” Aussie pubs, so it was perhaps unsurprising that the three of us medical students stuck out like sore thumbs when we walked into the Imperial one night!

Imperial Hotel, Coonabarabran
Public bar – Imperial Hotel, Coonabarabran

Royal Hotel, Coonabarabran
Royal Hotel, Coonabarabran (1912)

There are three cafés on John Street, although only one of them actually calls itself a “café”. My pick of the three was Raquel’s Café (good foccacias), though apparently The Jolly Cauli is also quite good when the owners are around.

Cornucopia motif, The Jolly Cauli
Cornucopia motif – The Jolly Cauli café (ex-Union Bank, c. 1920s)

More photos of Coonabarabran and the Warrumbungles are available on my Flickr photostream.

Coonabarabran: astronomy capital

Coonabarabran is the astronomy capital of Australia, by virtue of hosting the Siding Spring Observatory (SSO) – Australia’s key site for optical astronomy research and the location of the largest telescopes in the country. Coona also holds the annual Warrumbungle Festival of the Stars (usually in October), which celebrates the town’s connections with astronomy.

The SSO site was chosen for its clear skies, low light pollution (being hundreds of kilometres from Sydney, Canberra and Newcastle) and relatively high altitude. These advantages are also true of the town itself and I was amazed to see so many features of the night sky, normally hidden by light pollution in Sydney, even just standing outside my quarters at Coonabarabran Hospital. As I looked up at the sky (and took a few photos – see my Flickr photostream), I wondered how many fellow Sydneysiders would grow up never seeing the Milky Way arc across the night sky.

The Milky Way from Coonabarabran
The Milky Way from Coonabarabran Hospital

Anyway, a bit of commentary (and photos) of some of my astronomy-related adventures around Coona!

Siding Spring Observatory
John Renshaw Parkway, Coonabarabran NSW 2357
www.mso.anu.edu.au/info/sso/

Taking pride of place at SSO is the 3.9 metre Anglo-Australian Telescope (AAT), the largest optical telescope in Australia. Its location at an altitude of 1165 metres helps to reduce astronomical seeing and makes the AAT dome a visible landmark from town. The location of AAT also makes the deck outside a great place to view the Warrumbungles. The telescopes are not publicly accessible (professional astronomers have real work to do), however the AAT can be viewed from the observation deck (tip: if you don’t feel like walking up four flights of stairs, enter AAT using the door on the left and take the lift). There is also a small “exploratory” exhibit at SSO, but it’s really only of interest to astronomy beginners.

Anglo-Australian Telescope dome
Anglo-Australian Telescope dome

Anglo-Australian Telescope
Anglo-Australian Telescope

Warrumbungle Observatory
“Tenby”, John Renshaw Parkway, Coonabarabran NSW 2357
www.tenbyobservatory.com

While SSO telescopes are not accessible to the public, there’s a nearby private observatory run by former SSO manager Peter Starr. Warrumbungle Observatory offers nightly sky and telescope viewing sessions under the knowledgeable guidance of Mr Starr and the opportunity for astrophotography through his telescopes for those with an SLR camera (see my Flickr photostream). I highly recommend going there if you visit Coona.

Astronomical viewing at Warrumbungle Observatory
Astronomical viewing at Warrumbungle Observatory

Lagoon Nebula M8 (NGC 6523), Warrumbungle Observatory
Lagoon Nebula M8 (NGC 6523), Warrumbungle Observatory
Canon EOS 30D, Meade XL200 (14″)

World’s Largest Virtual Solar System Drive
www.solarsystemdrive.com

Lastly, a rather more touristy aspect to the astronomy capital – the World’s Largest Virtual Solar System Drive. This is a scale model of the solar system where the 37 metre diameter AAT dome represents the Sun. Scattered at approximate scale distances on the main roads to SSO/Coona from Dubbo, Gulgong, Merriwa, Tamworth and Moree are billboards featuring scale models of the planets (including Pluto). During my travels around Coona I eventually managed to see all the planets – it really gives you a sense of the vastness of space and just how small our planet is in the grand scheme of things.

Earth: Worlds Largest Virtual Solar System Drive
Earth: World’s Largest Virtual Solar System Drive

Destination: Coonabarabran

As promised earlier, this is the first in a multi-part series on Coonabarabran, where I had an amazing experience on rural placement for Community Rotation in the Sydney Medical Program. So without further ado, my first post about my time in that wonderful little town the locals call “Coona”… how on earth I managed to get there!

The New South Wales Geographical Names Board database (circa September 2009) entry for Coonabarabran includes the following comment:

“A town of on the Castlereagh River and in the Warrumbungle Mountains. It is 465 km from Sydney having good road, rail and air facilities.”

Whilst the comments regarding transportation may have been true some 20 years ago, alas this is no longer quite accurate. Commercial flights no longer operate to Coonabarabran Airport and the railway service ceased in 1990 (replaced by a CountryLink coach service from Lithgow). There is a good road connection, however, with national highway A39 (Newell Highway, the main Melbourne–Brisbane route) running through town. It was clear that the best option for me was to drive to Coona.

Former Coonabarabran Railway Station
Waiting for the train that never comes… Former Coonabarabran Railway Station

Getting there from Sydney, however, is somewhat indirect. There is no way to drive to Coona on A-roads without lengthy detours via Bathurst/Dubbo or Maitland/Gunnedah. The only reasonably direct routes involve travelling mostly on B-roads and minor roads – the two main routes used by Coona locals are via Mudgee or the Hunter Valley, which I’ve outlined below. Travelling time is around 6–6.5 hours by either route (depending on traffic/breaks).

N.B. The information below is provided as a general guide only and driver discretion is advised – both routes involve driving on minor roads of variable quality.

Sydney to Coonabarabran via Mudgee

West on M4 Western Motorway and continue on A32 Great Western Highway via Blue Mountains, exit onto B55 Castlereagh Highway and continue north-west via Mudgee and Gulgong, west on B55/B84 Golden Highway via Dunedoo, north-west on B55 Castlereagh Highway via Mendooran, north on Mendooran Road* via Mollyan, north on A39/B56 Newell Highway into Coonabarabran.

M4 Western Motorway
Heading west on M4 Western Motorway, near Penrith NSW

Sydney to Coonabarabran via the Hunter Valley

North on M1 Pacific Motorway, exit onto B82 Freemans Drive and continue north-west on B82 via Cessnock and Pokolbin, west on Broke Road, north on Wollombi St, north-west on Charlton Road, briefly east on Singleton Road, north-west on Wallaby Scrub Road, north-west on B84 Golden Highway via Denman and Merriwa, north on Vinegaroy Road and continue on Cassilis Road via Coolah, north on Black Stump Way, north-west on Warrumbungles Way via Binnaway, north on A39/B56 Newell Highway into Coonabarabran.

B84 Golden Highway, Merriwa
B84 Golden Highway directional signs, Merriwa NSW