Some of the most important moments in rural health don’t happen in the clinic. They happen on a beach track, over a cup of tea, or during a chance conversation with a stranger who just needed someone to walk beside them.
A few weeks ago, I was walking my kelpie, Vovo, near Back Beach in Port Augusta. A man about my age called out a friendly hello and asked if he could join me. He’d been feeling lonely, he said, and would welcome the company. So, the three of us walked on together.
As we went, his story unfolded. He’d come back to town hoping to reconnect with family. His mum had lived here once, but she’d passed away some years earlier. He hadn’t found anywhere to stay yet, and he was struggling to track down relatives who could take him in. More than once he told me how disconnected he felt, and how much the loneliness weighed on him.
At some point, I mentioned that I’m an optometrist, and that I run the monthly eye clinic at the local Aboriginal Community-Controlled Health Service. His face changed. He’d been having real trouble seeing out of one eye, he told me, but it wasn’t only that. He wanted somewhere he could go for the rest of his health too, and someone he could talk to about how he was feeling. By the end of our walk, he’d decided he would come in.
That moment stayed with me, because taking the first step to ask for help is often the hardest part. And it happened not because of a referral form or a campaign, but because a door felt open.
This is exactly what a group of us at Curtin University have been writing about. In a review titled, Care on the Margins, we looked at how healthcare access, housing insecurity, and the behaviours communities sometimes label “anti-social” are tangled up together in rural Australia. What we found, again and again, is that these problems aren’t personal failings. They’re the visible edge of deeper cracks: chronic underfunding of rural health, a shortage of secure housing, services that operate in silos, and the way people can become cut off from family and the places they belong.
When someone is worried about where they’ll sleep tonight, an eye appointment understandably slips down the list. When services feel unwelcoming, or when someone fears being judged, they simply stop coming. Distance and cost make it harder again in the bush, and trust, once lost, is slow to rebuild.
But our review also found what works, and it lines up with what I saw on that walk. Care that is welcoming, locally led, and culturally safe builds the trust that everything else depends on. Services that reach out rather than wait to be found meet people where they are. And a “no wrong door” approach, where someone can walk in about their eyes and leave having also talked about their mental health, their housing, their loneliness, is worth far more than any single service on its own.
The man I met came looking for one thing and found a door to several. That’s not luck. It’s what happens when we design care around connection rather than gatekeeping, and when we go upstream to ask why people are falling in, rather than only pulling them out.
I hope he made it to the clinic. Whether or not he did, our walk to Back Beach reminded me why this work matters.
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