The emotion in Dr Martin Kelly's voice soars above the buzzing and crackling phone line from remote South Australia.
He describes life as a GP in Anangu Pitjantjatjara Yankunytjatjara indigenous communities to a group of politicians sitting in a motel conference room in Whyalla, 1500 kilometres away.
"Half the people who live on the land, I've known since they were born. They matter quite a lot to me," he tells the Senate inquiry into GP services in rural Australia.
Dr Kelly describes the challenges of attracting new doctors to the outback, the lack of housing for staff and indignity of answering to government auditors who briefly fly in from the city.
He pauses, steels himself and recalls the 2016 murder of his friend and Nganampa Health Council colleague, nurse Gayle Woodford. Ms Woodford was killed after being lured into opening a security gate at her home while on-call overnight.
"I was one of the last Nganampa people to talk to her ... and I sat with her family for four days over Easter until her body was found," he says, his voice trembling.
Six years on, the already stretched clinic shoulders the $300,000 shortfall in government funding to provide staff security, a legal necessity enacted after Ms Woodford's death.
"It is a scandal," he says.
The simmering fury over the state of healthcare in country Australia is in the voices of every witness at the inquiry and written on the pages of 216 submissions.
There is one enduring theme: the doctor shortage in rural areas is a desperate situation which is only getting worse.
Witnesses say the barriers to attracting GPs to the bush is a complex combination of government bureaucracy, neglected social infrastructure like housing and schools, and a lack of respect for the specialty.
Those who do work in the country are ageing, overwhelmed and burning out. Many clinic managers have described doctors leaving work at a moment's notice, never to return.
Patients are waiting up to six weeks for appointments in some areas, with fears life-threatening medical problems will be missed, chronic illnesses will intensify or sick people will simply give up hope.
On the NSW northern tablelands, Glen Innes hospital is routinely left without a doctor, something compounded by a shortage in the nearby regional centre of Armidale.
"I've never seen it so bad," NSW Nurses and Midwives Association organiser and nurse Nola Scilinato tells AAP.
"The anxiety is palpable. Nurses fear something bad will happen, that someone will die. They've had a lot of near misses."
While thousands of people leave capital cities looking for a country lifestyle, doctors need more enticement than the rolling hills of Armidale or sparkling waters near Balnarring on Victoria's Mornington Peninsula.
Simon Spalding, a registered nurse and practice manager at Balnarring Medical Centre, says doctors are reluctant to leave the city and bureaucracy only makes it worse.
He turned to hiring an overseas doctor after a futile recruitment drive on job sites, social media and noticeboards in local shops.
With just one full-time and one part-time doctor to cover a long patient list next week, Mr Spalding is frustrated that a new UK doctor is unable to practice while she waits for approvals and paperwork from medical bodies.
"We just cannot get doctors. It's a self-fulfilling prophecy, especially in the bush, when doctors don't have enough staff, it makes the job harder and people leave," Mr Spalding tells AAP.
"And that's what our worry is. We've got older doctors. We lose one or two and we'd have to close the clinic."
The federal health department's method of prioritising understaffed regions is another barrier to providing high-quality, consistent care, the inquiry has been told.
The department uses population and Medicare billing data to grant priority status, known as a DPA, which allows clinics to offer incentives to doctors and to recruit overseas-trained medicos.
But that data often doesn't reflect reality. Some growing areas have suddenly lost their DPA status, so valued overseas doctors have to move to another prioritised region and patients are left to wait.
Mandy Williams, a clinic manager from Carrum Downs in Victoria, says the loss of a DPA has put her staff at risk.
"We've encountered verbal and physical threats daily from frustrated community members," she says.
"Not to mention the GPs, who are often exhausted, frustrated and on the verge of breakdown due to the overwhelming demands on them."
Dr Lisa Fraser, a GP in Gordonvale, a sugarcane district in Queensland, says the personal challenges can be tougher than the professional hurdles.
In a frank submission, Dr Fraser wrote rural doctors can fear for their safety and their children's wellbeing in small towns.
"There are cultural attitudes that are challenging. Poor driving behaviour, visible unhealthy alcohol behaviours, limited non-alcohol activities, racism, homophobia, bullying, blase attitudes to safety are not being addressed at higher, organisational levels."
However, she said, rural medicine can be meaningful and varied, like caring for pregnant women and their babies, and curing skin cancer.
The government is relying on that drive to make a difference in young doctors. Federal National MPs recently opened a medical school at Charles Sturt University in Orange, which trains doctors in the bush in the hopes they will stay.
Deputy Prime Minister Barnaby Joyce told medical students they have an "incredible" job ahead of them.
"You're going to keep people alive. Their quality of life is determined by you.
"We don't get the healthcare that they get down the hill in Sydney, they live longer than us.
"But we actually live longer than the people at Brewarrina, they don't live as long as us. And out at Tibooburra and White Cliffs and Bourke, they don't live as long as us.
"So we have an obligation to meet them and a responsibility to look after those behind us."
Australian Associated Press
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