As a young child growing up in the remote island country of Palau, Dr Ralph Mangohig’s early memories of health care gave him a strong, innate desire to always help people in need.
With minimal access to reliable health care for much of the population, Ralph visited doctors’ houses in his local village for minor procedures such as getting stitches for lacerations, where he witnessed healthcare professionals going above and beyond for the good of the community.
Fast forward 20 years and now based in Alice Springs, Ralph exemplifies that working in remote and rural desert Australia is worth all its unique challenges.
Ralph trained with NTGPE, fellowed with RACGP, and is now working with NTGPE as a medical educator.
Ralph, who is a graduate of the Flinders Medical School in Adelaide and did clinical placements through the Flinders Rural Clinical School in the NT, is a living example that GP training in the NT can help fulfil every doctor’s dream – he studied locally, practised locally, and now supports GP registrars in training.
And at the heart of his passion for rural and remote health are the people he cares for.
“My own childhood probably played a role in my choosing a medical career, with wanting the more simple, rural life, whether it be in Palau or Alice Springs,” said Ralph.
“For me, learning is a place where you’re challenged, but not overwhelmed. The NT is such a place for learning.
“In my experience during my training in the NT, I was challenged with multiple scenarios that I wouldn’t have experienced working in the coastal cities.
“It’s so important to build trust between yourself and the patient, particularly in Indigenous health.”
Ralph describes two stories from his time in Yuendumu, an Aboriginal community which sits on the edge of the Tanami Desert, approximately 350km north west of Alice Springs.
“During my last few weeks working in Yuendumu in 2018, I was asked to see an elderly Aboriginal woman, with one of her carers concerned that the lady might be petering on the edge of life,” said Ralph.
“This woman was very traditional and held strong to her culture and would never have wanted to be separated from country for treatment, let alone die separated from country. Therefore, getting her palliated or receiving more aggressive treatment in a hospital 350km away was not an option.
“Historically, she was also reluctant to visit the community’s remote clinic, so I made a home visit, and she was so lovely and welcoming.
“I couldn't understand a word she said, and probably vice versa, but her body language was enough to reveal to me that although she was sick, she was still strong in spirit.
“She had pneumonia, and because I was briefed from her notes and advanced care plan that she wouldn't like any needles, I decided along with her substitute decision maker to treat her with oral antibiotics.
“We were aiming for enough comfort without too much burden of the treatment options. It's a hard balance, like walking on a tightrope.
“It meant regular reviews in the old people's home, and sometimes a home visit.
“In my last day there I did a home visit to her house, complete with other family members and camp dogs.
“She looked much better, and I think she even remembered me. I knew that was the last time I'd ever see her, but she was strong and content with life. She was happy. What more could I ask for?”
Ralph’s other memorable encounter with a Yuendemu resident was while palliating another female Elder.
“This woman was adamant she wanted to die underneath her beloved tree where she had set up a small camp,” said Ralph.
“Her nurses were amazing. They would use the tree branches as IV (intravenous) poles to keep her hydrated and comfortable through an IV drip when she couldn't drink. The same drip was also used to give her pain relief.
“I saw her in her passing and helped lift her into a bed inside her house surrounded by her strong female relatives. It was a powerful moment.
“I know someone who works out bush with such women, and they told me 'follow the women'.
“They meant that if you want to see where a community's strength comes from, then ‘follow the women'. From what I’ve witnessed, this is very much the truth.”
These poignant experiences have reaffirmed Ralph’s decision to move into medicine, first as a young doctor, and now as a clinician and family man passionate about education.
“I’d definitely recommend people to undertake their GP training in the NT,” he said.
“It’s hard and challenging, but so rewarding at the same time. You get to meet some really interesting people, and experience things that you wouldn’t otherwise.
“While I was with NTGPE, my medical educators and supervisors during my training made a huge difference. They helped me pause and reflect and gave timely advice during my training.
“This was backed up by the pastoral care workers who even provided care packages which consisted of chocolate and gourmet jams while I was working remote and studying for exams. These were gratuitous and a nice touch, especially when you’re living and working remotely.
“It’s quite a unique context in the NT, knowing the population you’re working with, and what people are willing to do for each other.”
Ralph is planning a long-term future in the NT, with the excitement of becoming a father for the first time in 2020, and continuing to live his dream of educating the next generation of doctors.
“In five years, I still see myself in Alice Springs, still energised and working with the next group of GPs, hoping they also stay in the NT,” he added.
As Ralph says, what better place to help people in need.