For country communities, the family doctor is many things to many people.
Comforter, confidant, healer, teacher.
For 50 years, Mount Gambier obstetrician Peter Charlton has been at the coalface of his community's healthcare, including being the very first face that many have ever laid eyes upon, and, sometimes, the last.
"It's a great privilege to be there with people during some of their most testing times," he said.
"To help them through a phase of their lives; whether it's welcoming a child into the world or at the end of a person's life."
Ready for anything
Much has changed in rural medicine, Dr Charlton admits; it has been mostly for the better.
"When I was training at the Royal Adelaide Hospital in the 60s, the average doctor would notch up 135 hours on duty a week and would often not be home for eight days out of ten," he said.
"When I first started practising, it was normal to have one GP on call for the whole weekend, including attending to emergencies and accidents presenting to the hospital, running clinics morning and night, undertaking home visits, visiting aged care facilities, giving anaesthetics and managing the labour ward."
"It has certainly changed over the years, and those expectations don't still apply – which is to the benefit of patients and the sleep-deprived doctors."
Lessons from PNG
Dr Charlton settled in Mount Gambier in January 1973 with wife Sue, a paediatric physiotherapist, and their two young children after a stint in Papua New Guinea.
"After I finished training, I travelled to Papua New Guinea to work – it was eye-opening and challenging as a young doctor," he recalled.
"At one time, it was just myself and one other doctor in a 60-bed hospital, so it came down to whatever care we could provide at the time for any given situation."
"Sometimes it might be draining a blood clot in a skull, or stitching up a bowel that had been perforated by a bit of bamboo."
"I'd have women who would present to hospital with an arm hanging out, after having laboured at home for five days."
"Or a fractured leg with maggots crawling in the wound where the bone was poking through the skin."
"You just had to do your best with whatever came through the door on any given day."
A country practice
Upon arrival in the regional community of Mount Gambier, Dr Charlton soon became entrenched as a trusted family general practitioner, spending more time at the hospital or Hawkins Medical Clinic than at home.
"Practising as a GP was all-consuming," he said
"There was one occasion when my wife actually made an appointment and brought the (by that time) three children in."
"She said, 'I thought I'd make an appointment to introduce you to your children'."
It wasn't uncommon in the early days to have 30 women in a month giving birth, he said, "so that adds up to quite a lot of sleepless nights."
But he said building relationships with families in the rural district "is an enormous privilege"
"I remember the first third-generation child I helped into the world – it was very special, it brings you down to earth a bit I suppose."
Localised care
An advocate for locally based patient care, including less bureaucratic burden on medical staff and more rurally based specialised services, Dr Charlton hopes the next generation of country doctors continue to push for localised care.
He welcomes more rural placements across a wide range of specialist colleges, which he says will lead to medical students developing a greater understanding for country practice.
"I'd like to see more capacity in rural healthcare," he said.
"Maybe we should have a cardiology unit in Mt Gambier to prevent transferring patients to crowded Adelaide hospitals, and to enable people to be cared for locally, in the company of their family."
