By the end of the study we found that the number of underweight children got down to less than 1 in 20. That’s a really big change over a short period of time.

It’s muggy. We’ve been driving for about 40 minutes, air-con blasting. As we hit the top of the mountain, we decide to get out and have a look at the town below. Nestled on a thin strip of land between the ocean and the mountain we’re standing on, it looks like paradise. The houses, which all look the same, are lined up in a couple of perfect rows. This early in the morning, it is quiet, peaceful.

It’s late October and I’ve headed north to visit Dr Jason Agostino,  a GP in the Gurriny Yealamucka Health Service in the Yarrabah Aboriginal Community, just south of Cairns.

As we take in the view, Agostino explains some of the major health problems the community  is facing.

“The main issue is overcrowding,” he says. “On our health checks, we ask if people live with ‘too little’, ‘too many’ or ‘enough’ people. If someone says ‘enough’, that typically means 8 to 10 people in a three-bedroom household. When you’re in close contact with so many people, it makes transmission of infections, especially skin diseases such as scabies, really easy.”

We arrive at Agostino’s clinic, a welcome respite from the heat outside. It’s a modern facility that services the entire town, providing  GPs, pediatricians and dentists, as well as a range of community health services, such as the Aboriginal health workers who look after the social and emotional wellbeing of patients.

The walls of Agostino’s consulting room are covered with different health posters. One looks like an eye-testing chart, but instead of letters there are different-sized pictures of animals; it’s a sign of Agostino’s particular interest in children’s health.

As we take a seat, he explains how a Cronulla-raised boy came to be working as a qualified GP in Far North Queensland.

“I guess I probably got interested in medicine from my mum,” he says. “She is a nurse who has spent a lot of time in the area of disability. I spent a lot of time in those old group homes that they used to have for disabled kids. Same with my little sister; she’s now an occupational therapist. So I guess being around mum and seeing those things she did inspired us to do it.”

Agostino was drawn to Cape York by an outreach job for which he travelled to different communities every week to provide pediatric services. After two years on the road, he decided he would like to settle in one community.

“I decided I’d come here to Yarrabah as I really like the idea of being part of a community. In my previous job I’d just see a community for a day at a time on a six-week rotation, whereas here I really feel part of the community. It’s taken a while, but I’ve gotten to know a lot of the people here.”

While we speak, Agostino receives a call from Joe, a guidance officer in the local school.

“Joe and I were just talking about ways we can fast-track the eye and ear checks for those children who are falling behind at school,” he says. “And that’s something that only comes from being here and knowing everyone.”

Agostino’s connection with the community is obvious as I watch him work. He seems to know everyone who comes in and is friendly with all.

After treating one child whose foot had become infected after he accidentally caught it in a screen door, Agostino turned his focus to the boy’s brother. His brother had a foot problem from birth that hadn’t been treated yet. Even though he wasn’t the one who had come in for treatment, I could see the determination on Agostino’s face to find a solution to the problem. He pursued it all day.

While Agostino is obviously a talented and passionate GP, he has also long been interested in public health. When he heard about the Master of Philosophy in Applied Epidemiology (MAE) through the National Centre of Epidemiology and Population Health, part of the ANU College of Medicine, Biology and Environment, he jumped at the opportunity to combine his interests.

“I started doing a public health degree but I didn’t quite see it connecting with my everyday practice,” he says. “After talking to a few doctors in the region who were graduates of the MAE, I saw how it could provide a really meaningful contribution to my medical career.”

The MAE is based on taking a practical approach to medical research. Students are required to complete a clinical placing as well as conduct relevant research in the field. Agostino  says that his research project – looking at birth weight trends – is already revealing some positive outcomes and aiding him in his everyday work.

“If you go back to 1999, approximately 1 in 6 Aboriginal children in the Cape York region were underweight.  There are lots of reasons for children being born small. Risk factors include having a high number of children, being a young mum, smoking, alcohol and also mum’s nutritional state. Diabetes can contribute as well. We sort of traditionally think of diabetic mums having big kids, but the opposite can happen as well.”

Agostino’s study looked at the data from 1999 to 2008 and found that these high levels of underweight children dropped dramatically over this period.

“We did an audit of the paper and electronic records from children from nine remote communities around the Cape York region. By the end of the study we found that the number of underweight children got down to less than 1 in 20. That’s a really big change over a short period of time.”

Agostino says three long-term approaches have helped solved this problem.

“The things that I believe contributed to this drop are the new community health initiatives that have been introduced in the region,” he says.

“For example, the amount of primary health care staff has increased over the past few years. Back at the start of the study, a GP would visit three communities in a week with a child health nurse. Now, in each of those communities they would have at least one and maybe two dedicated  GPs and child health nurses all the time.

“There have also been three immunisation programs that have been introduced in that time. They will affect how kids grow.

“And finally, my belief is that recent alcohol management plans have probably helped as well. These plans restrict the sale of alcohol in the community. Alcohol consumption is a risk factor for having an underweight baby and when alcohol is around it means there’s less money around to buy food and things like that. Although we can’t show causality, it’s an association that I think’s really important.”

It is understanding  the benefits of such community approaches that Agostino believes will help him in his work back here in the clinic.

“Doing the MAE and this research has really given me a different way of looking at things. Definitely the research I’ve done on underweight children affects the way I see children when they come into the clinic.

“To be part of health care in the community, you’ve got to understand it’s not just about what happens in the clinic. I think if you are going to make a difference in a community, you need people that are there for a long time; it takes a long time to build trust and a long time to change things. That’s why I came here. I want to give to the community as much as I can.”

As we head over the mountains on our way back to Cairns, there is something comforting in knowing that Agostino  is going to continue his work. Even though I’ve only been here for a few days I can already see the impact he’s having.