• Rural General Specialist and Paediatric Emergency Specialist in Australia, Dr. Ishani Nanayakkara on how Sri Lankans have earned the trust and respect of the Australian Aboriginal community 

Doctors in rural hospitals often face extreme challenges — limited resources, remote communities, and high-stakes cases. Dr. Ishani Nanayakkara, who currently holds two fellowships and a range of qualifications in multiple competencies, has navigated these with exceptional skill, providing critical care across Queensland’s most remote regions. From emergency medicine and paediatrics to anaesthesia and Indigenous health, she mentors future doctors and champions community-centred healthcare. We explored her experiences and insights on Kaleidoscope last week.

Following are excerpts of the interview:

You've spent so much time in rural hospitals. What's it really like working with remote communities?

I find it very rewarding and challenging. Of course, I give my whole heart when I go into the remote bush outback. My work is pretty much what is called a Fly-in Fly-out (FIFO) doctor, where I need to fly to these rural areas. My areas stretch from Western Australia to Queensland, and North-East Queensland. In Western Australia, I work mostly in Derby, the Fitzroy Crossing, and Kununurra. These are very remote areas, which belong to the Modified Monash Model (MMM), which is under the Australian categorisation of remoteness. So, MMM Four to Seven are based on locations which are tagged most rural-remote and where there are no specialists. That’s why FIFO doctors, bring skills that are needed the most.

In rural North Queensland for example, Palm Island is an Indigenous community — an island where they need Indigenous expertise. We deal with trauma, violence, mental health issues, and chronic diseases. Those are the areas where I can give my best. In Derby, Western Australia, they don’t have many paediatricians, so, that’s where I help as a paediatrician, by giving my skills in neonatal resuscitation when there are unwell newborns. Wherever I can give my skills, I’m more than happy to.

Indigenous health has been a major focus for you. What have you learned from working closely with the Aboriginal and Torres Strait Islanders communities?

This country belongs to the indigenous communities — the Aboriginal people; it is their country. Sadly, they are the forgotten past, mainly because of the Stolen Generations. For any doctor, medical personnel, or anyone working with Aboriginal or Torres Strait Islanders communities, cultural awareness and respect are very important, and trust is the most important. As a doctor, I find that being from an Asian country helps. They accept us warmly and appreciate us coming all the way to help them. Building trust is not an issue for me as a Sri Lankan. We are very well recognised, and they love us. 

Each tribe is different. Aboriginal communities are very diverse and spread across different areas mostly in Western Australia, Queensland, and the North of Australia, around Alice Springs and Darwin. Because of their cultural heritage and the trauma of the Stolen Generations, there is a lot of mental health burden. The trauma is deep. There is also alcohol, drugs, violence, and tribal conflict when different groups come together. 

You must be aware of all of this when you work in different communities. Some doctors find that discouraging, but, if you are open-minded, you can learn so much. 

For me, my first exposure was in Townsville when I worked in the neonatal intensive care unit (ICU) as a paediatric registrar. Then I worked in Aurukun, in Cape York — untouched nature. There are different tribes there, and during my assignment, I realised that there is so much pathology to learn — syphilis, sexually transmitted infections, tropical diseases — things you don’t usually see in metropolitan regions. I loved pathology. It was an eye-opener. 

Most people would love to go into metropolitan settings. Why did you choose to go into the remote areas and do your work?

One thing that motivates me is the opportunity that I get to work more. I have worked in metropolitan tertiary hospitals as a paediatrician, and in neonatal ICUs. But, in the rural and remote areas, I get the opportunity to do much more. As an emergency doctor, you get exposure to things that you would never get in a big tertiary hospital because there are so many trainees and so much hierarchy. As a junior doctor long ago, getting opportunities for invasive procedures was very difficult because everyone was waiting to be trained. But, when you go rural, you have no option — you are in the deep blue sea. You have to do it. Chest drains, intubations, trauma, etc., become the norm and you learn to stabilise the patient before requesting the retrieval team to take them by air or by chopper. I wanted to keep upskilling myself, and that’s why I chose rural work.

Chronic diseases need ongoing medical care. You’re a FIFO doctor. How do you ensure that ongoing care continues?

Chronic diseases include diabetes, asthma, cancers and mental health conditions. When I worked in Derby as a general practitioner (GP), we used telehealth to communicate with specialists. Once a month, when it was my turn, I would gather all the difficult patients and have them reviewed during the specialists’ telehealth clinics or in-person visits. Otherwise, we as specialist GPs manage them at the specialist level, and that is expected of us. We only reach out to specialists when a patient progresses to something like kidney failure, needing dialysis or transplant. Until then, we manage them. 

I must appreciate how helpful telehealth is. For complex cases like multiple chronic conditions, we have team consultations. In Derby, we had a mobile cardiac clinic that came to our doorstep once a month – heart specialists and lung specialists in a mobile truck. We lined up the patients who needed echocardiograms or lung function tests. Everything was planned before the team came.

As a FIFO doctor, my approach is the daily management of ongoing care, and then, liaising with teams via telehealth when needed. We also have general practice management plans which help with regular screening and follow-up every three months to make sure that patients don’t fall out of the system.

What is the biggest challenge that you have in working with rural communities?

The biggest challenge is the distance. I travel thousands of miles. To go to Western Australia, I take three flights and then drive another 250 kilometres, which I’m happy to do because it’s an opportunity to see the country. The remoteness, and sometimes being on your own, is challenging. When you go into different hospitals, it takes time to understand your team and what resources that you have, the strengths of each person, etc. That is important, especially at night, on call. If there is trauma, you must know who you can rely on. There are many things to be aware of, and having a clear plan for managing difficult situations is the most important.

You've worked in very high-pressure areas like neonatal intensive care and emergency. Has there been a moment or a case that has stayed with you?

When I worked in paediatrics, I was asked to retrieve a baby in a rural remote setting. I was sent on a chopper in the middle of the night to a hospital with no helipad. My only escort was the paramedic and the pilot, and we carried the little Globe-Trotter incubator for the newborn. There was no landing area and the paramedic had to shine a beam light down so that the chopper could lower safely. That was one of my first encounters and I will never forget it. I had to stabilise the baby before transporting it back — making sure that there was no air trapped in the chest, ensuring ventilation, and making the baby safe for the chopper transport back to the tertiary hospital in Brisbane. It was quite an experience, very challenging, and one that I will never forget.

Being Sri Lankan, has it helped in your work? 

I’m always so proud to be Sri Lankan. I always say that I’m Sri Lankan. There is a lot of respect for us in Australia. I salute my colleagues and all Sri Lankans there – they carry the flag with pride. Our cultural heritage gives us a good reputation, which is especially related to cricket. When they can’t pronounce my name or they don’t know who I am, they ask whether I know Sangakkara (a reference to cricketer Kumar Chokshanada Sangakkara) – and the connection is formed. They also love our food. I love cooking; it’s one of my passionate hobbies. Whenever I have time, I make curry and take it to my units. They love it and they’ll do anything for curry. That’s one way to win their hearts. 

Being Sri Lankan, empathy comes naturally. Sri Lankans are born with kindness and hospitality. It reflects in our work, and the people appreciate it.

Whenever they ask me about my primary education, I say that I’m a Sri Lankan and that my basic medical education was in Sri Lanka. I say it with pride and it is accepted with admiration. The cake was baked in Sri Lanka, but, the icing was from Australia.

The writer is the host, director, and co-producer of the weekly digital programme ‘Kaleidoscope with Savithri Rodrigo’ which can be viewed on YouTube, Facebook, Instagram and LinkedIn. She has over three decades of experience in print, electronic, and social media

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The views and opinions expressed in this column are those of the author, and do not necessarily reflect those of this publication