The Flying Doctor Delivery – Dr Jared Watts – Specialist Obstetrician

Hanya Oversby

Business Strategist and Management Consultant, Business Health Network

Hanya Oversby spoke with Dr Jared Watts, specialist obstetrician and gynaecologist, about his extraordinary life working in rural and remote areas of Australia and in challenging conditions in countries such as Nigeria with limited resources.

This interview formed part of the Doctor Diaries Podcast and has been reproduced for The Private Practice Magazine.

Dr Jared Watts is a regional obstetrician gynaecologist from Western Australia and currently the Head of Obstetrics and Gynaecology in the Kimberley of Western Australia. He's also the Director of Obstetrics and Gynaecology for the WA Country Health Service, and a WA Clinical Senator. Quite impressive!

He's current chair of the ACRRM, RACGP, and RANZCOG Joint Committee for GP Obstetrics and Certification Regional Fellows Committee, and more recently led the working group to develop the college's organization values. He's completed further studies in medical administration, public health, and tropical medicine, and has worked internationally in several low resource settings, including Nigeria, Cambodia, Laos, and Syria.

Jared as you can see, is passionate about rural medicine and the role of the generalist, and the essential part they play in ensuring women have access to high quality clinical care, close to their home, family, and support networks.

So, Jared, that's a very impressive resume and to me, you were introduced as this amazing doctor that flies around the Kimberley delivering babies. Can you tell me about your journey about getting here, where you are today?

Absolutely. So, I guess just to ruin the ending, I actually was born at the hospital I trained in, and on my very last shift before I become a fully qualified specialist, I actually got to work with the midwife who delivered me. So, I haven't really moved on far in life! A bit of a story between that, as well.

My parents were school teachers, so we moved around every four years. My life changed to a different country town every four years. And it was in my high school year that I was always going to work in a laboratory, testing the blood that the GPs would send in. And I went to do that in year 11 and 12 of high school, but that day they couldn't take a student, so they sent me to see the physiotherapist to see if I wanted to become a physio and the local surgeon was in town. It was a very small country town and he'd come to town that day and he invited me to theatre.

That day I stepped into the operating theatre, I never turned back, and decided that was going to be for me.

I did get a little bit of resistance from my high school teachers, that country public school kids don't do medicine. But I thought I'd prove them wrong, so I went to university.

When I was a younger my parents always tell me that I wanted to become a Royal Flying Doctor and I was very disappointed at a young age to find out the doctor doesn't fly the plane. I said that was about the only time early in my life that I wanted to become a doctor, but that was only because I thought I got to fly a plane. So instead, I wanted to become a pilot after they told that that didn't happen. It wasn't until a bit later in life I wanted to pursue medicine, and then just ever since then it's been an incredible journey and there's some research says that people wouldn't choose that occupation again, but I would choose it many times over. It's fantastic.

Brilliant. And I can't help but observe how young you look. You've achieved so much at such a young age.

Oh, thank you. It's all Botox!

So, it's interesting that you say that you are a country boy from a public school and the teachers are going, "You're kidding, aren't you? You’re doing all this?" How did you make that happen? How did you get the grades and have the drive to get to that next stage?

I think that one thing about my personality is you don't want to tell me I can't do anything, because that will really...I think I was sort of just interested in medicine, but when I got told I couldn't do it, that was it. I was going to do it!

I'm glad that I actually do love the job, because I probably started off for the wrong reasons, being told I couldn't do something! Medicine was exciting until the fifth year when we could actually choose to go and do a year in the country, and I got to go to Broome. And then my life has been Broome, Broome, Broome ever since, so been exciting.

Broome's not home, is it?

Broome is my hometown. That's where I'm based around about 40-50% of the time.

But as I think one of our mutual friends said, that I do spend most of my times in planes, flying around delivering babies. That is true. I do look after five country towns, with a whole team up in the Kimberley of Western Australia. But I do have a house in Broome that I sometimes get to see.

And you studied in Perth?

Yeah. I went to UWA, University of Western Australia, which was the only medical school at that stage, in Western Australia. And then once I graduated, I started my internship at Sir Charles Gardner Hospital.

I had some amazing opportunities. One of them at that stage was they would send us to the Northern Territory, so I went to Alice Springs for half a year, and they also, once again because of my connection to Broome, they sent me to Broome.

I actually started some of my training as a general practitioner, so I wanted to be rural general practitioner, like the surgeon back at high school I'd seen. But I decided that in general practice, I had to know way too much. That was way too hard.

When I was doing my GP qualification to deliver babies, they asked me "We really need some specialists out in a country area." And so one of my mentors, her name's Ann Karczub, just said to me, "Why don't you think about being a specialist out in the country? Really hard to get specialists out there." Then decided to look into that pathway and go down that trip.

Fascinating, to go down that specific path. But before that, you had practiced, you'd been working and done some medicine in Nigeria, Cambodia, Laos, and Syria. Was that during your Fellowship year?

A lot of that was just towards my final part of my training and then as a specialist. That sort of more recent work, I sort of fell into it a little bit, but I was asked to firstly go to Laos and Cambodia to do some upskilling of the doctors there and everything, so basically in ultrasound training for obstetrics. That was fascinating. Just the most passionate people. They didn't really have many resources, but they would come out. It was a little bit disheartening at times, because you could only do so much. But it just really opened another world to me.

I was in Canada, at a conference, just the World O&G Conference that happens every three years. And like many conferences they have trade shows and I was walking around there and I came across Doctors Without Borders, so Medecins Sans Frontieres. I just chatted to someone there, and didn't realize, but the O&G headquarters, obstetrics and gynaecology, headquarters for MSF are in Sydney. MSF is actually five big organizations that come under one umbrella, actually has their headquarters in Sydney, and she was from Sydney.

So here we're having a conversation in Canada, in Vancouver, with the head O&G for Doctors Without Borders. And once again, she was telling me what she did, and I pretty much signed up on the spot.

Had to wait because the Doctors Without Borders are very good that they say that until you're good enough to work in Australia independently, they won't employ you overseas. And so, it was another year and a half before I graduated as a specialist, and then I went across to Nigeria to start with MSF, which was a completely different world.

Maybe you could share some experiences? I imagine you would have had your training in Australia and the resources available?

Yeah. When I was about to graduate as a specialist, my ultimate job was to go back to Broome and be a specialist in the Kimberley at this stage, because from my med school training time and all my connections to the Kimberley. I thought it'd take me five or six years until that job became available, because it was a very sought after job.

Wouldn't believe it, two or three weeks before I graduated, that job was advertised. I went to Broome straight away. I found my ultimate job day one of being a specialist. Being in Broome for a little while, and being in the Kimberley,

I had a very good mentor. Her name was Dr. Wendy Hughes, that had taught me how to be self-reliant, how to get out of trouble when you've got very little resources. Because quite often in the Kimberley when we're operating and everything like that, the next specialist might be in Darwin or Perth. That's how extreme they can be, a fair distance away. I learned from her to be quite self-reliant and not need to have all the fancy toys, because they're just not available, and then I got to Nigeria and those skills really came in when needed.

We work in very remote areas, and there's nothing there unfortunately, in the way of resources. We were having to use techniques that might have seemed very old fashioned in Australia, but to save those mothers. It's interesting that I had never seen a woman die in childbirth ever, and unfortunately after that I'd seen many. It was very disheartening to start with, and I thought I was a bit of a failure I must admit, until as I was leaving, they said to me, "We've had a couple of months with the least maternal deaths we've had," because myself and the American doctor, I think we'd worked well down there.

The Nigerian local doctors, they are incredible. We'd had a good team and worked hard together to try and get some good care. The number of women we were delivering, it was just bigger than any hospital in Australia. And there was three of us.


And so it was very eye opening to see what the rest of the world has to deal with.

And I take my hat off to these women, to the doctors that live there. I had to come out a couple of days early just because of some conflict close by and just to get back to Australia to make sure the pathway was safe and everything like that. I was a bit disappointed when they told me to start with, once I got back and realized how exhausted I was, working had for those few months that I was there, and these Nigerian doctors, they do that day in, day out. They just work so hard. And these women have three women per bed, and they'd walked hundreds of kilometres. They traveled hundreds of kilometres to get some help.

We're very lucky to be in Australia, and I came back with eyes wide open and realized how blessed we are to be in this country.

Absolutely blessed, and the women in regional area of WA are very lucky to have you. It would be interesting to hear practically I suppose, how you would work this - is a woman going into labour and you're scooting off in your plane, or off to the area? How does this all work?

It's a very fascinating and sometimes it's a gut feeling at this stage. If a woman's deemed very high risk, we might try and get her down to Perth or sometimes to Darwin.

Prior to COVID that was quite common, to those big tertiary centres that had the resources to be able to care for these high risk pregnancies. But sometimes that doesn't happen, and we have to just manage them wherever they are, and then if they're medium to high risk, they might come to Broome which is where we have 24 hour specialist cover.

There's one of our specialists always on call there. And then at the other side, we deliver our low to medium risk people who have these GP obstetricians. The GP obstetricians are just the most incredible people. They can do anesthetics, they do emergency medicine, they deliver babies, they resus the babies, and so they look after those other sites. And in Broome, they're the first that look after the patients there, as well. Sometimes things just don’t go to plan, someone might go into labor in the middle of a community or something like that.

I finally got my wish and a few times over the last couple of years, I've been sitting at my desk and the Royal Flying Doctors call me up and say, "We've got a woman who's delivering" or, "She's delivered and she's bleeding quite heavily. Can you please come and jump on a plane with us?" Yeah. I got my wish that I'd be sitting at my desk, I remember one day, and the Royal Flying Doctor calls me up and the person is out in a smaller town, when they needed some specialized help and so I got to rush to the airport and get on the RFDS plan, which I've always wanted to do. As I said, I was two or three and my parents used to tell me that I wanted to become a Royal Flying Doctor, so I finally got to get that wish and I flew out with the Royal Flying Doctors and we stabilized the patient there and then they actually flew on with that patient to a larger centre, and I then came back to Broome at this stage.

I always say with my job, I never know where I'm going to end up by the end of the day, and I absolutely love that.

So, I can wake up in Broome and that night I'll be sleeping in a hotel in Kununurra, because I've had to rush up there and like that. It's always an adventure.

It sounds like we need to strap a GoPro to you. Make a show, because this sounds fascinating!

No. I do fly out a lot to the community, so we do run six or seven of the smaller towns, we have clinics at. We may not deliver babies, but we provide gynaecological services. It's a better use of our time to fly out to these communities and fly back, and see patients in the day and a few of the pilots have been a little bit sneaky, and let me have a go at holding onto the steering wheel and fly the plane.

Wishes come true. I mean, it's not common what you do, so are there communities you turn up to and they go, "What the heck? How are you here and why are you providing your time?" ... Because I imagine if you're in a remote location, you're quite used to not having access to your level of expertise. So, has there been times when you've turned up and people go, "Oh, how are you here?"

I think it's always interesting. Things that we have to take into consideration are like the weather, for example. The pilot will just be ringing me up and say, "Look, there's a massive storm coming, you need to go, go, go." We never know when our clinics are going to start and finish and everything like that. I do get the absolute honor of looking after a lot of aboriginal women from the East side of the Kimberley. So, coming from the very remote communities on the Northern Territory/Western Australia border, and these women are absolutely fascinating.

So, not now but when I was a medical student and I had my time in Broome, I got to meet some of these people who in their lifetime had seen as they would say, a white person for the first time and everything like that.

They would tell us stories, through interpreters obviously at that stage, and these women out there, they're very strong women. They are very culturally based. They're the caretakers of their families and everything. They have incredible health challenges, so through many different reasons and everything like that.

And I think quite often they are quite surprised to see me as earlier in my career, a white person out there, talking to them about women's problems, and it did for the first few months, people were a bit worried that they wouldn't come in to see me. But I've got the nickname ‘Lady Doctor’, out in those communities now.

The clinics are quite often the women come in, and they talk to me, they let me into secret women's business, and I know how much as a male, and as a Caucasian, that is such an honor to be allowed to do that. They share with me everything so that's a huge honor. I know it's not allowed to many people.

That is amazing. I imagine there'd be so many cultural or religious barriers to you being allowed into this very sacred part of their lives. It's amazing. It's so good that they are accepting of you in that way, so that's amazing. Moving forward, I suppose, this is all in the public work?

Yeah. I have three jobs and so three days a week that I work publicly, providing the services throughout the Kimberley, and then one day a week I work into the slightly more administration role, as the director for the country hospitals. So, looking after all the country hospitals' obstetrics services and gynaecological services in Western Australia. And then just recently, another one of my life goals was to start working at a university, so I now one day a week get to teach medical students, which is good. Because they always ask you questions that you've forgotten the answers, and then you have to keep up-to-date yourself and everything like that with teaching. I guess everything I do in the public sector.

In the public sector and the obstetrics services you're providing, and it's an amazing service through that sort of Northern part of Western Australia, where do you see it going next? How is it going to improve? How are things going to change? Or, what would be on your wishlist perhaps?

Yeah. So look, I think that distance is a big issue, and at the moment for example, we've got the work season in Broome and sometimes we can't even get planes out to some of these communities. The Royal Flying Doctor can't even land at some of these communities and things like that.

We really have to start to think very carefully about how we're going to provide services - and it's sort of technology... My passion is women in the most remote part of the Kimberley, or any of the remote part of Australia, have the same access and same outcomes to the women in metropolitan areas do, so one of my other interests is looking at how we can use technology to make sure that happens in the future. So I guess telehealth - COVID has been absolutely awful for so many different reasons, but my goodness, has it accelerated the use of technology and things that we thought were going to take us years and happened overnight and everything like that.

That's great that I have delivered a baby by video conference in a community where there was no one that had delivered a baby for about 20 years. I could control the camera, so I was zooming in and out, and watching the ultrasound and could guide that team through delivering the baby. It was very stressful, I think for everyone. I don't want to do that too many times, but it's amazing what technology can do these days, and I think that's the future.

We can keep these smaller hospitals going, but still provide excellent and evidence based care.

Oh, that's inspiring. I totally agree that the technology was fast tracked last year, 100%. Not only that the technology perhaps was always there, it's just the acceptance of the patients and the practitioners and so forth. Now, Jared, are you sharing all your great learnings with anybody else in Australia? Or, are you keeping it, all your great secrets in the Kimberleys?

Yeah. So, one of my mentors again, did say to me, you can only look after one patient at a time. And if you really want to make big changes, you have to get involved in politics, and I'm not a political person. You have to play the games, everything like that, you need to get involved if you want to make real differences.

I think one of the most important things was I got involved in the National Council for RANZCOG, so that's the group that looks at obstetrics and gynaecology and I sit on that council there. That's been an absolute honor to actually get to have face-to-face meetings with federal health ministers and state ministers and things like that. And be involved in policies, because as doctors,

I think quite often we're so busy looking after patients, these policies and budgets and everything like that are decided without our knowledge or our involvement. And therefore when they come out, we complain, because these policies don't make sense.

I'm very passionate about trying to get us doctors and nurses and midwives actually involved in the policy development and in the politics, as well. Hopefully we can share some of these ideas.

I think when I go to Melbourne, where I go quite a bit for meetings, or pre-COVID, they're quite often sick of me saying, "In the Kimberley," but we do have lots of conversations like that.

That’s great to hear that you're an advocate for that rural and remote care of women. Jared, you're busy doing all this. Is there another side of you? Is there a hobby or what do you for recreation?

I like to keep busy. I try to do some study outside of pure medicine, which I find quite interesting. Just keeps the brain going, but a whole different area. I don't think I've actually not been a uni student. So, most times I actually enjoy studying things that are quite random compared to medicine, just to keep the brain going and everything that's not medicine. I love fine dining, and going out, which is always a treasure when I have time.

The Kimberley has some amazing food, but I think I've eaten every menu through about seven or eight times, because I'm not a very good chef or cook. So, quite often to get to go out for those meals, it's always a pleasure.

And then travel, and I always find that actually organizing the travel and planning is just as much fun as a holiday. I normally take months to plan the holidays before I actually go on them. That takes about nine months before I actually get to go on the holiday, as well. They're the things that keep me entertained.

Well, Jared, I suppose a question at the end is here to say, looking back and reflecting on how you've achieved so much now, and being the young student in the country school, is there anything that if you were to look back, any advice that you would give your younger self?

I think if I did, yeah, definitely that it's so cliché, but I think there's something that I didn't always really do and I'm trying to do now is enjoy the journey and don't just always look at the end goal. I've always been so driven that I'm always, ‘at the end of the year, this is what I'm going to have achieved’, and then planning the one year, the five year goals and everything like that.

Quite often I just don't ever stop and just say, "Well, I'm going to actually enjoy today because it's today." I think that that's something that I would definitely tell myself, to probably slow down a little bit and enjoy the journey. It's a long time, medicine, both undergraduate, postgraduate as well. I think the other thing is that you've got a whole life to fill in, as well. Hopefully we all have a whole long life to fill in, as well.

And as one of my mentors in my life said to me once ‘when you come to the end of your life, you're going to say, "I was a specialist doctor for 35 years or 30 years." It's not going to make much difference.

Take your time to enjoy, have variety, try something new. Don't be scared of taking those risks. I think that's what I would tell myself. I've learned to do that now, but I think I would have liked to have known to do that maybe 5 or 10 years earlier.

Good advice. Enjoy the journey!

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