The 4-decade remote rural pharmacist

This Rhonda White MPS opened her pharmacy in the opal mining town of Lightning Ridge, New South Wales in 1983, and never wants to leave. 

What has led you to pharmacy?

Lightning Ridge is my home. My parents moved here when I was a teenager, so it’s where I grew up. When I finished school I completed a year of a music degree, but preferred a science-oriented degree with a job at the end of it. I had enjoyed a short school work experience at Walgett Pharmacy. When I finished my pharmacy degree my dad was not well, so I moved close to home, working at Walgett Pharmacy and then Towers Drug Co at Bourke, until the Lightning Ridge community pressured me to build and open a pharmacy in the Ridge, which I did with much help from my parents and husband.

What good changes came in that period?

Computers! This meant not having to use typewriters for labels or handwrite repeats AND handwrite patient history cards for regulars. Nor did I need to manually code scripts for the Pharmaceutical Benefits Scheme (PBS) claim which had to be posted once a month. Computers meant proper patient histories to work with, and interaction checking, and so much more like online connection to Medicare and ability to check instantly if all aspects of a script were correct to enable a claim.

What changes have created challenges?

Patient contribution discounting is a big one. This has increased the divide between remote and urban pharmacy practice. It has decreased remuneration per script and increased the administration burden for claiming what we once did as part of the PBS fees. Also, generic prescribing has confused consumers. And then there are supply shortages – they disadvantage remote patients more than most others.

What gaps do you plug for professional healthcare workers not locally available?

Continuity of care. Most GPs don’t stay long. We also get veterinary problems such as animals wounded from fights with other animals. And poisoning with Ratsak needs vitamin K, not easily obtainable in tablet form any longer, so have to refer owners to the closest vet in Coonamble, more than 2 hours drive away. The vet visits the Ridge a couple of times a week but is often not here when things happen.

What challenges do you face that colleagues in city areas do not?

Stock deliveries have a long way to come. Delays, due to floods and other road problems, or breakdowns push time to the limit to get one order in before having to send the next order.

Then, if the delivery is put on the wrong truck it will be 24 hours late and people waiting for medicines are “not happy”. It’s not like there’s another pharmacy nearby. Walgett and Collarenebri are each about 70 kilometres away. Power outages are not uncommon, which stop script processing. Till transactions need to be written down to be rung up later. If the power is out for longer than 30 minutes, fan-forced fridges do not hold the temperature, so stock must be put into eskies with ice bricks – even after hours.

What do your patients battle that metropolitan-based patients may not?

Distance, which means time and expense to travel to get scans or see specialists. Lack of opportunity to get a “second opinion” or to see the same doctor 2 months in a row.

Storing medicines without good air-conditioning when the outside temperature is closer to 50 ºC than 40 ºC is another hurdle. Some people living on the opal fields in camps need to use a pit toilet – even these days.

What about those 40 years?

We opened on 7 February 1983. During the 40th celebrations in February this year a customer said: “Congrats on 40 years. You’ve saved quite a few lives in that time.” It took me back a bit and made me think, but I suppose I have.

It’s been both a duty and an absolute privilege and honour to have done what I do, with a few more [years] to come, thanks to the full support of my family, the community – and some wonderful staff. In rural pharmacy you really can make a difference to health outcomes.

A typical day in the life of Rhonda White MPS, owner, White’s Pharmacy, Lightning Ridge, New South Wales.

9.00 am And it starts

Computers and tills up and running, dispensary tech checks the fridges, doors open and in they come, mostly putting in scripts for later. Sort out a DAA change so it can be packed, and keep checking and counselling as patients collect.

11.00 am Orders and deliveries 

Breaks over (always better after a second coffee)! Store order made, delivery truck at the back door, sign in dispensary order.

11.30 am Tracheotomy complications 

Patient from 60 kms away presents with a script for tiotropium capsules, salbutamol inhaler and metronidazole tablets. He has a tracheotomy! Prescriber called away to the hospital, could be gone for hours and patient needs to leave town by 1 pm. Consult Don’t Rush to Crush and advise options to take metronidazole tablets (suspension out of stock), but need new authority script for tiotropium respimat.

12.30 am Mail truck finally arrives 

Check Remote Prescription Collection Service scripts for mail truck to Goodooga. 

1.00 pm Doctor still away

No answer re tiotropium by 1 pm but learn later doctor prescribed Spiolto Respimat. 

1.05 pm  Alleged lunch break 

Last customer gone, door locked, staff at lunch. Check store and dispensary orders. and/or NDSS. Grab a biscuit for my 5 minutes left as nearby cafe closed for renovations. 

3.00 pm Busy, busy, busy 

Orders have made 3pm cut-off, but dispensary is banked up and the printer has a paper jam. 

5.30 pm  Still busy 

Last-minute patients sorted; door closed. Tills to ring off and count. Disinfect surfaces. DAAs and scripts still to check, DDs to enter, mail to open and reconcile, bills to sort to take home and pay. Get to supermarket before 7 pm closing or little to eat tonight!