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The wide blue yonder
  1. I D Wacogne
  1. Chief Resident, Royal Children's Hospital, Brisbane

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I once met someone in Wolverhampton who had never travelled as far as Birmingham, a journey I made daily—sometimes by bicycle. In addition to amazement and fascination at the different way in which people live their lives, I felt a certain smugness about my own worldliness and modern attitude to distance. This, despite sometimes finding the walk to the shops a bit of a stretch. Then I came to Australia.

Australia is a big place. This is obvious to anyone who has looked at a map, especially a Peter's projection, or a globe. However, it is worth restating; Australia is a very big place, and it is frequently unsettling to be reminded of the vast scale of this country. Some examples:

Working in Mt Isa, in the remote north west of Queensland, the consultant paediatrician and I shared on-call duties over a health district covering 209 000 square kilometers. For comparison, mainland UK is 218 476 square kilometers. However, the UK does have a few more bodies than Mt Isa District's 25 000 people. Mt Isa is about 500 km inland of Townsville which is where, some weekends, the next paediatrician after me could be found.

The paediatric grand round is teleconferenced across Queensland, sometimes with the presenter here in Brisbane, sometimes in the other centres. Cairns is the current Northern limit, which at 1600 km away is about as far as London is from Warsaw or Seville. From Cairns north to Cape York, Australia's most northern mainland point, is another 500 km

In conversation with a patient in clinic one day, I asked where they lived, as I didn't recognise the name of the town. It turned out that they'd driven 580 km that morning, mostly on unsealed roads, to come and see me. This is the equivalent of a trip from London to Glasgow, although without the delights of the M1 or M6. They didn't ask for, or need, more than 15 minutes of my time, and were—after a light lunch—going to drive straight back home again.

In telephone conversations with people back in the UK I'm asked if I've seen Uluru (Ayer's Rock) or the Sydney Opera House yet. In my mind's eye I see the road sign a couple of kilometers from our apartment which states that Sydney is 996 km away.

I went to do an outreach clinic at the next town. I borrowed a hospital car, filled it with petrol, bought a couple of litres of water and some freshly baked bread (the latter a mandatory gift) and set off. I arrived a little over two hours later, 195 km through sun-parched outback. I'd seen no one in between, except the occasional car heading in the opposite direction. No houses, no shops, just the road and the outback for mile after hypnotic mile.

By an odd contrast, however, Australia is one of the most urban countries in the world, surpassed only by city states like Hong Kong and Singapore. Most of the population lives in the big, sprawling cities, with the vast majority of the rest clinging to the coast, from Adelaide, south via Melbourne, and then north via Sydney and Brisbane to Cairns.

Many of my colleagues here find it even stranger than I do that one of the few seats which changed hands in the 2001 British general election was on the basis of a campaign to keep open one hospital in order to prevent folk from needing to travel ten miles to another one. Of interest, though, is that of the five largest cities in Australia, three have two or more children's hospitals (or hospitals with tertiary children's services) separated by less than twenty kilometres. It is interesting to speculate—but impossible to prove—that whatever people's tolerance for distance, it is political suicide to be seen to be closing a children's hospital. It is perhaps impossible to explain to the public the wisdom of specialisation and centralisation of services, especially in the emotive world of children's illness.

Now, if you'll excuse me I'm just going for a quick bike ride to Uluru . . .

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