Surgeon takes flight

John Kyngdon at home in Gisborne with his Canon IDX camera sporting a 500mm telephoto lens with 1.4 extender.

JOHN Kyngdon has a thing about birds. He has thousands of photographs of more than 550 species shot in Borneo, the Galapagos Islands, Antarctica, North and South America, Australia and New Zealand.

The Gisborne-based surgeon says capturing an image of a rare and beautiful bird is akin to the thrill and challenge of big game fishing or hunting, but with a camera instead of a rod or rifle.

Next in his sights is the exquisite quetzal in Costa Rica . . . but in the meantime, John has sprouted his own wings and has become a flying surgeon.

In August last year, the surgeon of 30 years — including 19 at Gisborne Hospital as general and vascular surgeon and clinical director of surgery, and at Chelsea Private Hospital — took up a position with the South West Queensland Health Service in the Flying Surgeon Service.

Based in the small Outback town of Roma 500km west of Brisbane, John has spent the past 14 months doing three-week stints as a surgical specialist for the service, returning home to Gisborne for three weeks in between. John’s Australian-born wife Janet, a registered nurse, often accompanies him.

“The job is demanding and tiring but incredibly exciting,” says the 65-year-old, who left his position as chief medical advisor, medical director and general surgeon with the Bay of Plenty District Health Board in Tauranga last year to take up the role.

Far from being retired, as some of his colleagues are, John now works without a break for the three-week blocks, during which he is on-call 24 hours a day.

“It’s a high-pressure job but I love it,” he says. “I saw it as an ideal opportunity to travel to Australia’s remote Outback communities and use the generalist skills I’ve developed over my many years in Gisborne and Tauranga.”

The Flying Surgeon Service (FSS) employs three pilots, three surgeons, three obstetricians-gynaecologists and two anaesthetists who work in teams comprising one of each. The Royal Flying Doctor Service (RFDS) is contracted by South West Queensland Health Service to fly the teams to 12 remote hospitals in the Queensland Outback where there are no surgeons. The most isolated hospital is Longreach which is 700km from Roma.

The FSS began in 1959 with a Cessna 182 aircraft based at Longreach. They now use a Beechcraft King Air B200 that flies an average of 400 hours a year covering 16,000km. It’s a highly-sophisticated aircraft equipped with twin-flight management systems, the same as large international planes, says John.

“The service employs hugely-experienced pilots. One is a former 747 pilot from South Africa. You get to know them very well. I have total faith in those guys. We fly in all weather which is sometimes pretty scary, especially skirting the fringes of recent Cyclone Marcia.

“Fog can ground us though, because the pilots need 400ft visibility to land. There are other hazards too. Around Goondiwindi we have to stay low to avoid the Royal Australian Air Force planes that are flying above us. This is in turbulent air, especially around December and January.”

The team sees about 1200 patients a year for surgery ranging from elective scopes and hernias to emergencies and trauma cases.

“We start out each day from the airport in Roma, a town with a population of about 6500 and the biggest cattleyards in the Southern Hemisphere — they average 7000 head of cattle at twice-weekly sales.

“We are airborne by 7am and arrive back between 5pm and 8pm with an average of two hours’ flight-time each day. We get a schedule a week ahead so we know where we are going and what cases the hospitals have lined up for us . . . unless there is an emergency and we are diverted.

“The hospitals save the work up for us so when we visit every three weeks, it’s very busy. They collect patients from a vast area and book them into clinics, which is a huge logistical operation in itself. Patients might travel 300km by dirt track to see us and some are quite unwell.

“You have to factor in situations that would never happen in New Zealand. We try to see those who have travelled long distances early in the day so they are not driving into the sun, which increases the risk of hitting emus and kangaroos. This is an ever-present danger on Outback roads in Australia. The roo bars are not just for decoration.

“In a recent incident, a man suffered internal injuries in a fall at Cheepie, a very remote part of the region. His two sons found him and called an ambulance but it hit a kangaroo and was disabled. Another ambulance was dispatched but someone had turned a sign around so that further complicated the rescue mission. Fortunately the barely conscious patient could tell the driver which way to go.

“The RFDS had been alerted so we picked him up, stabilised him and seven hours later, he was safely in hospital in Brisbane. He was a tough character and lived to tell the tale.

“But the statistics are sobering — the further west you live in Queensland, your chances of survival in acute situations are significantly reduced. It’s just a fact of life in the Outback.”

When the team gets back at night, they deal with any acute cases at the hospital in Roma. John has recently operated on a patient with stab wounds to the heart and a man crushed when a road train rolled over him.

“Where surgical cases are bigger, we regularly stay overnight at the hospitals in Emerald and Longreach, or patients come to Roma for more difficult surgery.”

John has learned to carry a toothbrush and shaver with him at all times.

“We are on-call day and night, with a plane on standby to fly back if problems arise post-operatively. You have to be prepared for anything, like cancelling an entire operating list at the last minute when a plane is diverted to an emergency. A recent case involved one of our own GPs with a massive gastrointestinal bleed who had to be flown to Townsville,” he says.

“Most of the cases we operate on involve acute gallbladder problems, bowel obstruction, appendicitis, or elective colonoscopies and hernias. I also perform cross-specialist procedures such as carpal tunnel surgery.”

The team provides teaching whenever the opportunity arises.

“We run evening sessions for local doctors and nurses on our overnight stay-overs, and these have been well-received.”

John also does tele-consultancy.

“Patients in Outback areas can be assessed easily with a local nurse, doctor or support person. They are so appreciative at not having to travel for hours to be assessed and sign bits of paper, all of which can be done on the day of surgery.”

John is intrigued by the people of the Outback.

“The characters I’ve met are beyond belief. I reckon I can spot a roo shooter a mile away — they have a sort of hang-dog, very Outback look about them.

“Roos are a huge problem for Outback farmers. One of our nurses who runs the clinic at Cunnumulla looks after an 80,000-acre station while her husband runs another property. Their land was overrun with kangaroos which compete with sheep for grass.

“She employed roo shooters to cull them but that put her off-side with the neighbouring wildlife reserve. So she laid out a 10km fence, got in her plane — she’s also a pilot — rounded up the roos with the aid of some motor bikes, herded them into the reserve and then erected the fence.

“That should have kept everyone happy . . . except that the wildlife reserve had not bargained on an influx of over 6000 roos in one hit. They now realise they have to do some culling.

“The Outback women are amazing — very independent and used to dealing with extreme isolation,” he says.

“Other real characters are those in the gem fields who dig for sapphires, emerald and opals. They are often very unusual, solitary, secretive, almost counter-culture types living in caravans on leased plots. They are happy to talk about their experiences, especially when they score a find.

“I’m constantly surprised by the people I meet. One hard-bitten rodeo rider left school at the age of eight and had broken in his first horse by time he was nine. He’d been scrapping, drinking, smoking and outside in the harsh sun all his life, so at 51 years of age, his body was completely worn out,” says John.

“I get on well with the people and they accept me even though I’m a Kiwi and I like rugby. I think they like my frankness and my mature age. Some travel for hundreds of miles to be seen, and are incredibly appreciative and uncomplaining.”

Surprised at the health issuesJohn has been surprised by the health issues he has encountered in the Outback.

“The mortality rate is higher due to smoking, poor diet, diabetes, drug and alcohol abuse and dependency. Even the tough, rugged farmers you see are not necessarily healthy individuals.

“Obesity-related problems are also a major issue among the white Australian population. We have to limit surgery to those with a BMI (body mass index) of 45 without co-morbidities like diabetes or asthma, or 40 with co-morbidities, because we just can’t look after them.

“Illiteracy is another surprising thing.”

John has caused a bit of controversy during his time with the service. He recently addressed the Queensland State Surgical Meeting by invitation with the aim of trying to improve regionalisation and standardisation of services.

“I was pretty forthright about the inadequacies of the system and easy fixes — so much so I was dubious I would still have a job there. But not only did they still want me, there’s been a dramatic improvement in the provision of up-to-date equipment for procedures like endoscopy and laparoscopy.

“The more fuss I made, the more they seemed to want to keep me. Now I’m asking for a nurse to co-ordinate the whole service.”

Despite the demands of the job, John says he will stay on for at least another year.

“The longer you are there, the more trust you build up, especially with theatre and ward staff. After a while, you get to know the teams and the quirks of each hospital, their organisation, efficiencies and shortcomings — like a lack of washbasins in consultation rooms. It’s pretty basic stuff in some places.

“I’ve only been with the service for a little over a year — some have been doing it for 15 years, so I’m really just a new chum.”

A regular speaker at conferences and events, John is due to give two keynote presentations on rural surgery at The Belford Hospital in Fort William, Scotland for their 150th anniversary. He is also convening the rural surgery section of the Annual Scientific meeting in Brisbane next year.

In his rare time off — while still on-call — John goes prowling for birdlife or other wildlife to photograph.

“I’m not a birder but I admit I am quite obsessed with finding rare birds. It’s a real challenge photographing these or endemic species in a remote location.

“It’s also a very peaceful experience, out there on my own. And there’s such amazing technology available now with photography, it’s even more addictive and time-consuming.

“I’ve also been to the Carnarvon Gorge in Central Queensland to see the Aboriginal art in the caves. I photographed platypus and echidnas there too.”

Looking back on more than three decades as a surgeon, John has fond memories of his time at Gisborne and Chelsea hospitals.

“When I left, I missed my patients terribly and believe it or not, the urgency of being on call. I got to know the families very well after many years of practice.

“I also missed the incredibly-talented young doctors and the dedicated long-serving nurses who often don’t get the accolades they deserve. It seems like yesterday that I started in Gisborne with three surgeons and an expectation of full cover without locums.

“We often did a week on call at a time. Sub-specialty was in its infancy so we dealt with everything. Alcohol-related road trauma was a regular event. People will remember those early medical staff characters, mainly men — apologies to Shirley Robertson. We are now seeing the decision to train and welcome more women into surgery.

“We had some rough times over the years with management and board issues but over the last decade or so, things have been more stable. Having spent a bit of time on the ‘dark side’ (management), I still don’t totally understand management-speak but I appreciate the difficulties they have in managing all the employment and budget issues that a broad organisation brings.

A rewarding career choice“As a surgeon, I can say that surgery is incredibly rewarding as a career choice. The pain for everyone and burden and self-recrimination when things go seriously awry, as they rarely do, are personal and devastating but you still have to get back on the horse the next day.

“There is an inherent risk of ‘burn-out’ but recognition of ‘system’ factors, better rostering and support and taking of leave is the future direction. I am delighted that Gisborne Hospital general surgery is in good heart with two local Fellows of the Royal Australasian College of Surgeons in practice to carry on the traditions of the college. Fellowship is not conferred lightly and sets the Australia and New Zealand standard for assurance that patients are getting the best advice and treatment.”

Reminiscing about happy times raising their three children in Gisborne, John says he cherishes his time with the Gisborne equestrian fraternity.

“Our growing family had their share of successes and failures at cross country, show jumping and dressage, and they even made me a show jumping judge.”

Seasoned travellers, John and Janet — who was his practice nurse in Gisborne for all his time there — want to fit in as many overseas adventures as they can while they are fit and healthy.

Apart from going to Costa Rica in Central America to “shoot” the elusive quetzal, they have plans to walk Hadrian’s Wall in the UK and are also keen to go to India.

There are also other demands on their time these days. Grandparents of four, with a fifth due soon, they are booked up well in advance as babysitters.

“I’m far more patient with our grandchildren than I ever was with our own three kids. I find them fascinating.”

John also enjoys spending time on his farm at Hexton, playing tennis, game fishing, skiing, golfing . . . and prowling around with camera at the ready, looking for wildlife to “shoot”.