Born and raised in the Netherlands, DR ED BOETS reached a turning point in his life and career. After nine years running his own practice, he wanted a change of pace and mapped out an alternative future in regional Australia.
In a bold and exciting move, Dutch-born ophthalmologist Dr Ed Boets left his well-established career in his homeland, deciding that his family’s future lay in Australia. He quickly began exploring employment options to fast-track his relocation.
The search led to a position with Vision Eye Institute (VEI) in Mackay – a Queensland region where ophthalmic services are in short supply and his expertise in glaucoma, cataract and strabismus would be put to good use.
As one of only four ophthalmologists in the area, his skills are vital to the community, but the shift to Mackay had much to offer Boets, 42-years-old at the time, his wife Sandra and their three children (two-, five-, and nine-years-old at the time).
“The lifestyle was certainly one of the selling points behind our move,” he recalls. “I’m fortunate to have beaches and national parks nearby where my family and I can go camping, and the Whitsunday Islands are only a two-hour drive north. It doesn’t get better than that.
“And, of course, the connection to wildlife is wonderful. I’m surrounded by wallabies, multiple bird species, bandicoots, bats and snakes. You can also spot whales and turtles along the coast. I never had this back in the Netherlands.”
The transition to a country lifestyle meant no longer dealing with the hustle and bustle of metropolitan living. It’s also kept his clinical skills sharp, which he expands on later in the article.
“Driving on country roads is much more relaxed than driving through the city’s peak hour traffic. Commuting to work takes me 20 minutes, and I only drive through three intersections with traffic lights. I much prefer this to the bumper-to-bumper metro traffic. Plus, the stunning country landscapes are beautiful to drive through,” he says.
Lending a hand of support
Boets’ idyllic lifestyle was no simple feat to achieve. Relocating to Australia required what he described as an incredible level of support from VEI.
He felt fortunate. VEI took it upon itself to employ an agency that handled all the migration paperwork for his family and covered some of the costs for their emigration.
“My income was even guaranteed for one year,” he says. “They provided a reference to RANZCO, so I was able to gain fellowship without delay. The whole emigration process was a smooth success.”
Years later, VEI still provides Boets with the support required to navigate the challenges of regional healthcare.
“Vision Eye Institute takes away a lot of the noise around my work. One of the main issues encountered when working and living in a rural area is access to resources. Vision Eye Institute willingly troubleshoots many of these issues so I can concentrate purely on practising medicine,” he says.
“For example, if I’m interested in some new equipment for the practice, they’ll help me do the sums and manage the whole process. There’s a lot of flexibility and they really listen. There’s a whole lot of knowledge that I can tap into – and it’s only a phone call away.”
Providing ophthalmic care to an area of need
Geographic spread, smaller populations, limited access to medical resources and the higher costs of delivering remote healthcare are some barriers that affect rural communities.
Boets notes that any form of vision loss can be problematic, given the lack of public transport in the region and the reliance on driving, highlighting the need for ophthalmology services to preserve the quality of life within rural communities.
Those who serve rural areas, like Boets, must be equipped to take on any case that enters their clinic using the tools at their disposal.
“Working in a remote location means abundant clinical variety compared to what my peers might see in an inner-city clinic,” he says.
“You really need to be versatile and resourceful when treating patients with restricted adjunct services – your clinical skills and judgement are key. The decision to refer a patient to a large city for additional testing or medical opinion is not made lightly.
“And as one of only four ophthalmologists in the region, I have an endless stream of patients. Word-of-mouth recommendations are far more effective out here than an advertisement.”
Additionally, living and working in a rural location, where there is only a small group of doctors, Boets has found that it fosters a clinical community.
“The four ophthalmologists refer to each other for specific problems. Paediatric and strabismus patients are referred to me, while cases relating to retinal surgery, extensive eyelid surgery, cornea conditions or glaucoma are usually referred to the other doctors,” he says.
The challenge of limited resources
Resource shortages are one of the most clinically challenging aspects of working in a remote area. For Boets, this means restricted access to healthcare services and, in some cases, going without medical services entirely.
“We don’t have access to neurology and neurosurgery in Mackay. There are visiting specialists that travel from Townsville, but patients still have to wait for an appointment,” he explains.
“What I really lack in support is an orthoptist. A large portion of my patients are young kids and adults with strabismus. An orthoptist could have a full-time job in Mackay seeing pure orthoptic pathology.”
Boets says that’s not to say he is without the fundamental services and equipment: “Our clinic consists of six consulting rooms. Two rooms are used by the doctors, while the rest are for ancillary testing. We have a YAG and Argon laser, Humphrey Field Analyser, OCT and Pentacam, Optos and Lenstar, and A-scan.
“The latest phaco machines are available in the local day surgeries, but there is no excimer or femtosecond laser in Mackay, so we refer our patients requiring refractive surgery to our Vision Eye Institute colleagues in other locations.”
Essential medical services are also within arm’s reach.
“Day surgery is in the nearby facilities, and a pathology collection point and pharmacy are on the opposite side. Mater Hospital is located across the street, where we refer patients for x-rays and MRIs,” he says.
When Boets doesn’t have the equipment needed for testing, he refers patients to Brisbane (970km away) for diagnostic support.
“However, electrophysiological testing to examine the visual pathways requires patients to travel to a Sydney-based hospital,” he adds.
Even simple clinic appointments can pose a geographical challenge. He says some patients travel up to four hours or more for an appointment. If patients are unable to drive themselves, someone must accompany them for the day. But technology is helping overcome some geographic barriers.
“To ease the burden of travel, patients are co-managed locally by their optometrist and treated based on what their optometrist sees or by using pictures sent to our clinic via email,” he explains.
A chance to give back to the community
A nature enthusiast, Boets has taken it upon himself to care for the local wildlife, using his ophthalmological skills to tend to their eye injuries and helping them recover before releasing them back into the wild.
“I’m friends with wildlife carers, so animals are often brought to me to examine,” he says, noting that he treats injured koalas before releasing them back into bushland.
After moving to a foreign country, it’s an example of how Boets was determined to embrace the local community.
“Joining the rural fire brigade gave me a chance to volunteer and give back, and at the same time learn about land management – we have 13 acres on a hill ourselves. It also gave me a chance to discover more about the people in the region and visit places where you normally would not venture to,” he says.
Although rural ophthalmology has its challenges, the scenic locations, diverse clinical medicine and relaxed lifestyle are the ultimate payoffs for Boets’ move.
“The day-to-day variability and exposure to a range of cases have provided tremendous opportunities that aren’t available in metro areas. This, combined with working in close-knit communities, is why rural practise appeals to me.”
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