A tribute to Dr Mark Craig: A warrior for rural medicine and a life well-lived

A TRIBUTE TO DR MARK CRAIG: A WARRIOR FOR RURAL MEDICINE AND A LIFE WELL LIVED

ABSTRACT

This paper documents many of the activities and achievements of Dr Mark Craig MB BS; DipRACOG; FRACGP; FACRRM drawing on contributions from his friends and colleagues. Dr Craig has worked tirelessly in several fields of medicine and academia and has demonstrated throughout, his ability to enlist and inspire his fellow workers and his generosity in the recognition of their achievements.

EARLY YEARS

Mark was educated at the Church of England Grammar School in Brisbane and the University of Queensland Medical School. He was always a top student. He graduated in 1979 to long and loud ovation. Mark had acquired portal hypertension from a perinatal umbilical cord infection and his life was plagued by frequent episodes of life threatening upper GI bleeding. He had hundreds of blood transfusions and acquired hepatitis C from one of them. This was not cured until 2015 and has resulted in liver cancer.  

His ongoing serious health problems caused him to miss four clinical terms. However, with the help of teachers and mentors, he made up clinical time in vacations and breaks and was able to graduate with his cohort. This ability to overcome adversity and beat the odds has become one of Mark’s strongest defining qualities and has underpinned the different phases of his career.

A further quality evident at this time was his loyalty to friends and colleagues, many of whom became lifelong supporters of his work. He always gave credit where credit was due and members of the Class of 1979 became inextricably linked to his later work. He credits his gastroenterologist, Owen Harris, with saving his life more than once over the ensuing 40 years and making it possible for Mark to continue his career. Always at the forefront of new developments, Mark was one of the first patients in Australia to undergo successful sclerotherapy for oesophageal varices. 

MARK’S FAMILY

In 1981 Mark married Vickie and they had two daughters, Laura 32 and Anna 30 who both live in the USA. Mark and Vickie separated in 2001 and divorced in 2004 but maintained their friendship and support for each other. After his diagnosis of liver cancer Vickie returned to look after him.

BEING A RURAL DOCTOR

Mark completed two years RMO training in Brisbane, gaining his DipRACGOP and was offered specialties in both Obstetrics and Paediatrics. However, he decided that his calling was to be a rural GP Obstetrician and he trained in a range of procedural skills at Cairns Base Hospital prior to starting practice in Atherton in North Queensland. He spent 5 years there, delivering over 300 babies, providing procedural care in anaesthetics and obstetrics and running a busy solo private practice.

When it came to the political fight for Rural Medicine, Mark did not have to imagine the scope of rural practice, he lived it. He was, with many of this cohort, the archetype rural proceduralist, responding to the famed “tyranny of distance” via the range of skilled and emergency services that he was trained to perform. In the next phase of his career, he fought the odds again, to legitimise the definition of a rural doctor and to fight for the resources necessary to retain them.

DR CRAIG:  THE MEDICAL ACADEMIC

Rural Politics and the RDAs

By 1989, Mark’s health problems necessitated living closer to specialist care in Brisbane. He gained a position as lecturer at the University of Queensland and also became the Training Co-ordinator for the Postgraduate Medical Education Committee, a position he held until 1993. He started the Cunningham Centre in Toowoomba aimed at training rural health professionals. His first innovation there was to set up the Advanced Life Support Program that is now a mandated program for all rural doctors.

Many believe that his most enduring legacy will be the major academic and political role he played in the advancement of Rural Medicine at this time. There were several key indicators of change:

Firstly, a paper published in 1989 by Craig and Mudge, Training for Rural Practice – Still in the Too-Hard Basket which was a discussion paper for the RACGP- FMP aimed at improving training for isolated rural practice. This initiated an idea for discrete training and support for the discipline and formed the starting point for the FRM and eventually for ACRRM.

Secondly, Mark generated interest for the development of the Cunningham Centre in Toowoomba, which provided a focal point for training and support of rural doctors and Health Professionals, headed by the incomparable Vicki Sheedy. This created a point of contact for interested parties and a model that eventually became Australia wide, with support from Roger Strasser in Victoria, Brian Williams in Western Australia and Paul Worley in South Australia.

In 1991, from these beginnings, came the first National Rural Health Conference in Toowoomba. This formed a key sounding board for the issues, discussion of possible solutions and the engagement of government in the process. Mark edited the Proceedings of this Conference, which became a reference book for the early years for Rural Medicine and Health. The conference was a powerful influence on progressing activity for improving rural and remote health care.

During this time, the RDAQ formed as a strong alliance of rural doctors, (the Rural Mafia), seeking action for the support, education and training of Rural Doctors. The RDAQ, other State bodies and finally the RDAA took on the role of the political arm of the movement which would eventually result in the formation of the rural college. Mark was a key member of this tenacious and “politically savvy” group which included Col Owen, Bruce Chater, Tom Doolan, Alan Wallace, David Mildenhall from WA and Jack Shepherd from South Australia. Meeting regularly (and sometimes interminably) each Sunday night for ten years, the group mapped the route for political recognition of Rural and Remote Medicine.

Research

The rural medical movement had few funds for expansion in 1990. It says much about the relationships, that Mark and his medical colleagues had with their key staff, that salaries and job security became of secondary interest to the loyal few - Marita Cowie, Vicki Sheedy and Anna Nichols.

Under the auspices of Dr Peter Livingstone, Former Director-General of Queensland Health and Medical Services, the PGMEC obtained its first research grant to examine the training needs of rural doctors in Queensland and the factors necessary for their retention. The key results indicated the necessity of procedural skills and the need for training, support and recognition of the skill set - results that made everything else possible. Research at the time was clear- that the capacity to practise safely and the recognition of the rural doctor as an expert teacher were essential factors in the retention of this unique workforce.

Mark, assisted by Anna Nichols, enlisted help from Rural Doctors and Specialists to develop the Curricula for Procedural Training in Surgery, Anaesthetics and Obstetrics for Rural Practice. Funds for this activity were provided by the Commonwealth Government’s RHSET Grants Program, directed at the time by Des Murray, a great supporter of Rural Health and Education projects. This set the scene for the training of rural GP registrars in major provincial hospitals in Australia, under the supervision of interested regional specialists. Mark was also influential via his mentorship and assistance to Dr Neil Beaton, a devoted worker in Indigenous Health, and the principal author of the RACGP’s, and later, ACRRM’s Curriculum in this complex area of care.

ACRRM AT LAST

In 1992, the advocacy of the ‘Rural Mafia’ led the RACGP to set up a Faculty of Rural Medicine. This had the same status as a state faculty. Mark was a foundation member and became its first censor. He wrote the options paper on rural training, advocating a four-year training program that integrated rural general practice skills with procedural skills, followed by a rigorous assessment leading to a Fellowship in Australian Rural Medicine. This Fellowship became a sticking point between the rural doctors and the RACGP. Their Council considered that a RACGP-FARM would devalue the standing of the basic GP qualification of the FRACGP.

In 1995 RDAA used the Australian Electoral Commission to conduct a plebiscite of Rural Doctors. One thousand of the 1500 rural doctors surveyed, supported the establishment of a rural college. Work began to develop the Prospectus for the Australian College of Rural and Remote Medicine in 1996 and ACRRM held its first Presentation of Fellowships in 1997. Mark, became ACRRM’s first Censor from 1997-1999.

ACRRM has gone from strength to strength in the past two decades and although Mark ceased active involvement in the College in 1999 he remained a financial member and continued to take great interest in its progress and success. In 2017, he was honoured with a Life Fellowship of ACRRM, which he regarded as one of his greatest achievements.

In recent years, he devised a Bursary for ACRRM to enable a staff member to further their professional development and bring that knowledge and understanding back to the Rural College. He was passionate about the preservation of the basic knowledge and dedication that made the College what it is today. He wanted the work of the pioneers and true believers to be more than just a vague understanding of current holders of office.  

THE BACK DOCTOR

As a warrior for Rural Medicine and Censor of ACRRM, Mark gave a great deal of himself to the rural cause and wisely designed a change of direction for his skills and enthusiasms. His early interest in musculo-skeletal medicine developed into an outstanding practice in Brisbane where he is rightly acclaimed for his ground-breaking approaches to treatment and for his standing in the profession.He has used his persuasive and political skills to further this field of medicine, but he never forgot his rural roots.

Mark started his final career in 2001, did postgraduate courses and then developed one man clinics in Milton and Southport called “The Back Doctor”. They are state of the art practices offering in-house US-guided joint injections assisted by MSK sonographers. His special interests include back pain, visco-supplementation and neuro-modulation of joint pain. He is booked out weeks ahead.

IN CONCLUSION

This is a life well lived. Mark brought a quiet rationalism and deadly determination to his work, passionate but never ego-driven. Its achievements and triumphs tempered by pain and illness, opposition and disappointment, but he never gave up, facing adversity with grace and courage and never forgetting those who travelled with him. Neil Beaton speaks for us all when he says that he was a good friend and colleague and rural medicine should be indebted to him for pioneering the National Rural Generalist Training Program and demonstrating that even under difficult circumstances, anything, including our impossible dreams, are possible.

MARK HAS THE LAST WORD

Since birth I have had three life-threatening illnesses, beaten two and will die from the third. I am not angry or, as an atheist, fearful of dying. My disappointment is that I can no longer work, teach, travel or indulge in my expensive sports cars which have always been my passion. I missed my daughter’s wedding and will not survive to see my grandchildren.

I have always loved practising and teaching medicine and would choose the same career again if I had the opportunity.

Mark Craig: 29 October 2019

Contributors:

Anna Nichols and Max Kamien drawing on contributions from Neil Beaton, Bruce Chater, Marita Cowie, Tom Doolan, Denis Pashen, Vicky Sheedy and Jack Shepherd.