Dr Christine Sanderson is building rural palliative care from the ground up, creating pathways for doctors to train where communities need them most.  

Rural Australians often face impossible choices at the end of life: stay in their community without specialist palliative care, or leave home, family, and country to die somewhere unfamiliar.  

Dr Christine Sanderson has spent years working to change this. A palliative care specialist based in Alice Springs and Clinical Lead of the Rural and Remote Institute of Palliative Medicine (RRIPM), she is creating a pathway to train specialist palliative care doctors in rural locations, keeping them where they are needed most.  

“The people who really want to work as specialists here are already here,” Dr Sanderson says.  

“We don't have to drag them in from the cities. A lot of them are rural generalists who've worked here for years or trainees who are already in our hospital. We shouldn't send them away to train, because when we do, they often can't come back.”  

RRIPM provides flexible, rurally based training opportunities, connecting doctors with specialist supervision while they remain embedded in their communities.

Path to palliative care   

 Dr Sanderson discovered palliative care later in life. After leaving medicine for 15 years, a friend introduced her to a palliative care unit in Adelaide.  

 “I saw the unit and thought, that’s it. That’s what I need to do.”   

She returned to medical school and found palliative care came effortlessly, soon becoming a life passion.  

“It’s whole person care. When medicine can’t fix people, we can always keep doing something to make things better. It’s by far the best and most interesting medicine.”   

When she moved to Alice Springs for a locum, she fell in love with the place and stayed.  

Being based in a community rather than just visiting changes everything, she says. “When you’re actually part of the community, everything shifts in terms of what’s possible. Your understanding of what’s happening for people, and your ability to really put together a good plan.” 

A pathway to train rurally  

When a colleague, a rural generalist in Alice Springs, decided to pursue specialist palliative care training, there was no local pathway. She had to leave her career, home, and community.  

“I cried for about two weeks, but then I thought, hold on, this is ridiculous. Why can’t she train here?”  

Dr Sanderson soon realised her colleague’s problem was bigger than one person. Without a pipeline of trainees, rural services face sustainability challenges, and services are at risk when specialists leave.  

Her colleague moved her family and children multiple times during training and, after qualifying, rather than returning to Alice Springs decided that they could not move again, which is a common outcome, says Dr Sanderson.  

Building the pipeline   

Dr Sanderson applied for a Flexible Approach to Training in Expanded Settings (FATES) grant to create a solution, which led to the creation of RRIPM.  

Today, the Institute is a collaborative network of rural palliative care specialists, training doctors across the country.  

“Once that RRIPM connection happened, that made a huge difference for me. I actually had people to talk to about things. I had my community of practice.”  

RRIPM works to remove barriers to rural training. Previously, sites needed two specialists to host trainees; a threshold many rural services just can’t meet. Through RRIPM, doctors can train with more flexible supervision.  

“I can definitely provide good training. And through RRIPM, we can support each other to provide that extra supervision people might need.”  

RRIPM is increasingly flexible, accrediting rural terms for integrated training that match local realities. RRIPM has developed a Roadmap 2025–28, identifying 21 rural locations across Australia capable of sustaining advanced palliative medicine training.   

Working to change   

The goal is to double the number of rural palliative medicine fellows by 2035.  

“I reckon we can easily do that,” Dr Sanderson says.   

Without local specialists, rural communities face tough decisions. In her community, patients are often sent to Adelaide for investigations and procedures for some specialist services that aren’t available locally. Many return physically and emotionally exhausted, sometimes only at the very end of life. 

A core rural skill is considering who should be sent away and when sending them is the wrong choice, says Dr Sanderson.  

The impact of local palliative care is already visible in Alice Springs. A community-driven palliative care unit opened in 2018, providing a safe option for patients who can’t stay at home, and many of these are First Nations people.  

“People know they can stay here. Most people have had a family member or someone they know cared for by the team. It gives them confidence and pride.”   

Learning in community   

Working with remote Indigenous communities has completely changed how Dr Sanderson practices palliative care.  

“I do palliative care completely differently. I talk to people differently. I sit with people in a different way.”   

She’s learned the cultural sensitivities and hard choices patients face, such as dialysis patients deciding whether to leave home for treatment. 

“We don’t use the D word much because it’s culturally insensitive.”  

The team has adapted care to meet the community’s needs. For instance, the rates of dialysis in the Central Australian community are some of the highest in the world, and there is a lot of trauma and distress around dialysis decision-making. So, in Central Australia, patients can remain on dialysis while receiving palliative care, even sometimes as inpatients in the specialist palliative care unit, because this otherwise presents people with an intolerable choice.  

Families feel comfortable welcoming the team into their homes, creating trust and connection that visiting specialists can’t easily replicate. Specialists trained in the communities they serve develop skills and relationships that visiting doctors can’t easily replicate, says Dr Sanderson.  

This is the core of RRIPM: every rural specialist trained in their own community not only provides direct patient care but also contributes to systemic improvements. By mentoring and supervising other clinicians, they strengthen local capacity and create sustainable change. 

Keeping the road built   

RRIPM has achieved significant change: the The Royal Australasian College of Physicians is opening doors, new training pathways exist, and rural palliative medicine trainees are more supported. But funding remains limited.  

“I'm optimistic. I think we are a national palliative care project in the making.”   

While the road has been bumpy at times, Dr Sanderson says the work RRIPM has achieved has made it all worthwhile.  

“It's been a career high for me. To identify that issue and then have the chance to do something about it, to give back and make something good happen with great colleagues, to see the changes happening. It's been fantastic.”   

Through RRIPM, Dr Sanderson is demonstrating that with the right support and training pathways, rural communities can have sustainable, high-quality palliative care. And in turn, it can transform the experience of dying for thousands of Australians.