Times up ... well almost. There's still a bit to do before we fly out. I'm going on an outstation visit to Fossil Head. Joy will scratch at the mountain of yet-to-do health reviews and management plans.
It's Stuart's last day as well. He has been the clinic manager as well as a Remote Area Nurse for the last year or so. He's open about it being a tough time, and he's ready to go. We've looked around at the other staff here who we have got to know, but really hardly know at all. For some, the crusty exterior protects against the all too frequent coming and going of new staff. There are ideas about how to increase ownership by local people, but no-one really knows how to implement them. It's particularly hard when the wage for a Health Worker is much the same as the unemployment payments. It doesn't even seem to be clear where the policies and directions for the clinic and health work here are made.
We're sad to leave. This has been a rich and challenging experience.
We are already planning our next locum here. Wadeye has got under our skin.
Friday, 9 September 2011
Tuesday, 6 September 2011
The Long Grass
We'd never heard about going long grass before coming here. It's a colloquial term meaning absconding to drink grog. People stay in the long grass. In a dry community, it's a real issue for those going to Darwin. It's a big temptation to have a few drinks...
Do you remember "Bruce"? He has been sick, mostly because he has had rheumatic fever in the past, and a heart affected by alcohol over the years. He has been struggling. His younger brother came to see me about him. This brother is a big bloke, and has a commanding presence. He has been able to avoid grog, and felt so strongly as a 23 year old, nicked a front end loader from the shire depot and bulldozed the back of the pub. (The shell of the pub still stands - the ultimate pub with no beer.) This brother's advice was that Bruce would find a trip to Darwin a strong call to the long grass.
But what to do? His blood tests suggested a heart attack, and we needed to know what was going on. Lots of talk later, he did go, and managed for a while. Last Thursday he wasn't in the ward that he was meant to be in, and was no where to be found.
Bruce's wife is delightful. She has been dropping in a couple of times each day, anxious that I might be upset with him. She suggested a family meeting. "OK, 11am on Tuesday."
Today at about 10.45, she came in saying there was a mob outside for the meeting. With one of the nurses, I sat with 20-25, mostly women and children. We took over the education room. Two blokes sat at the side. It was a fun time of talk, laughs and a few tears. Most of the talk was MurrinhPatha. One bloke wandered in at 11, annoyed that no-one woke him up in time. We decided together that we would look after "Bruce" the best we could in Wadeye. After about 30 minutes of talk, something happened and everyone got up and left.
I asked later what was the talk about the meeting. Apparently they think that "Bruce" must have cancer! How did that happen? I guess I have a bit to learn!
And "Bruce"? He was found today and is back in hospital. I think.
Do you remember "Bruce"? He has been sick, mostly because he has had rheumatic fever in the past, and a heart affected by alcohol over the years. He has been struggling. His younger brother came to see me about him. This brother is a big bloke, and has a commanding presence. He has been able to avoid grog, and felt so strongly as a 23 year old, nicked a front end loader from the shire depot and bulldozed the back of the pub. (The shell of the pub still stands - the ultimate pub with no beer.) This brother's advice was that Bruce would find a trip to Darwin a strong call to the long grass.
But what to do? His blood tests suggested a heart attack, and we needed to know what was going on. Lots of talk later, he did go, and managed for a while. Last Thursday he wasn't in the ward that he was meant to be in, and was no where to be found.
Bruce's wife is delightful. She has been dropping in a couple of times each day, anxious that I might be upset with him. She suggested a family meeting. "OK, 11am on Tuesday."
Today at about 10.45, she came in saying there was a mob outside for the meeting. With one of the nurses, I sat with 20-25, mostly women and children. We took over the education room. Two blokes sat at the side. It was a fun time of talk, laughs and a few tears. Most of the talk was MurrinhPatha. One bloke wandered in at 11, annoyed that no-one woke him up in time. We decided together that we would look after "Bruce" the best we could in Wadeye. After about 30 minutes of talk, something happened and everyone got up and left.
I asked later what was the talk about the meeting. Apparently they think that "Bruce" must have cancer! How did that happen? I guess I have a bit to learn!
And "Bruce"? He was found today and is back in hospital. I think.
Sunday, 4 September 2011
Old Mission, and Nimbi beach
Yesterday we explored some more. It's been great to have the use of one of the clinic cars after hours (it's used for clinic work during the day and we keep it at our place overnight and weekends). So 5 of us went out- we took Dan (med student) and a couple who've just come back after 2 years away. They lived here long enough to learn some MurinhPatha and make some significant relationships.
They took us to Old Mission, which is a small outstation on the beach. We sat under a tree with the traditional owners Anthony and Benigna, some kids, a cat and dogs. Anthony told with great enjoyment a story of some Indonesian fishermen who landed on his beach looking lost: "What island is this?". "Australia" was met with disbelief. They told stories of the mission's early days on that site. There's a pure white memorial statue of Mary and baby Jesus, reminding visitors of the strong Catholic involvement. Benigna is very devout, and has one room in her house as a dedicated prayer room. We wandered on the beach, then drove along to Nimbi, looking for nautilus shells along the way.
Tim is doing great at 4 wheel driving! It was amazing driving along the beach - low tide, a big expanse of firm sand. A creek to cross (I missed the photo unfortunately, but took another of a smaller creek). Nimbi is not far from our other beach BBQ spots: round the point and sheltered. It's a beautiful bush setting, and there's even a picnic table! We had a great walk across the tidal wet sand, and enjoyed a BBQ and chat. Brin is working as a RAN (remote area nurse) again, and Sarah, also a RAN, is doing a PhD about traditional birth practices. It was quite dark when we left, and the tide coming in. We drove home on bush tracks, connecting with the "main" road to the beach.
They took us to Old Mission, which is a small outstation on the beach. We sat under a tree with the traditional owners Anthony and Benigna, some kids, a cat and dogs. Anthony told with great enjoyment a story of some Indonesian fishermen who landed on his beach looking lost: "What island is this?". "Australia" was met with disbelief. They told stories of the mission's early days on that site. There's a pure white memorial statue of Mary and baby Jesus, reminding visitors of the strong Catholic involvement. Benigna is very devout, and has one room in her house as a dedicated prayer room. We wandered on the beach, then drove along to Nimbi, looking for nautilus shells along the way.
Tim is doing great at 4 wheel driving! It was amazing driving along the beach - low tide, a big expanse of firm sand. A creek to cross (I missed the photo unfortunately, but took another of a smaller creek). Nimbi is not far from our other beach BBQ spots: round the point and sheltered. It's a beautiful bush setting, and there's even a picnic table! We had a great walk across the tidal wet sand, and enjoyed a BBQ and chat. Brin is working as a RAN (remote area nurse) again, and Sarah, also a RAN, is doing a PhD about traditional birth practices. It was quite dark when we left, and the tide coming in. We drove home on bush tracks, connecting with the "main" road to the beach.
Saturday, 3 September 2011
The Town of Wadeye
The buildup is starting. Last week the Top End had its hottest days this year. Everything is dry. No-one talks about the weather here, as each day is the same. Well, almost. People are starting to think towards the wet season. There's lots to do before then. Travel by car is impossible from November. All the flat areas will apparently be under water. Hard to imagine at the minute. The red dust, dry grass and more dust tell another story.
Wadeye (the locals say "wod-air" ) has a reputation. Like anything, no-one notices this part of the world until there is a Problem. Sadly, the reports of the last 10 years have been stories of unrest, intervention, failed policies and unfavourable statistics. That's not what we have seen though. There is still Judas Priest and Evil Warriors graffiti, reminding residents of high tension, particularly between the two gangs styled on heavy metal rock bands. While there might be unrest around the fringes, there are lots of positives happening that don't get reported.
It must have been tough at times. If you are interested, a good article to read is:
It must have been tough at times. If you are interested, a good article to read is:
http://www.theaustralian.com.au/news/features/a-town-like-wadeye/story-e6frg8h6-1111114787006
We have heard stories of the fights on the footy oval condoned and even arranged to relieve tension. After an 18 year old was shot by the police in 2002, troubles have flared at times. The clinic nurses who have been around for a while tell stories of evacuations of all the white people, being confined to their houses, and frightening experiences like trying to drive the ambulance and being surrounded by 200 -300 people jostling the vehicle. They have learnt that if the women and children go bush, they need to be alert. We have heard from one person who counts 7 break-ins in to her home during her time here.
With all of that, each day has given a glimpse of another picture. The way the community cares for an unpredictably psychotic man, the depth of feeling when a diagnosis of cancer comes back from the Royal Darwin Hospital, the tolerance of locals of white people representing a dominant and sometimes demanding culture. We have spent time with one white couple who never lock their house and have never had a problem. Yesterday we met Boniface Perdjit. He is a Traditional Owner of the local area, and is Australia's first married Catholic deacon. He's a gentle, wise man who mirrors peace with a twinkle in his eye. One hardened white fella said of him that Boniface's brand of religion is almost enough to make him follow Jesus' teachings.
We are recognising people enough to have a yarn outside the store or in the street. We're still not exactly sure what the role of doctors should be, but we are glad we are here.
We have heard stories of the fights on the footy oval condoned and even arranged to relieve tension. After an 18 year old was shot by the police in 2002, troubles have flared at times. The clinic nurses who have been around for a while tell stories of evacuations of all the white people, being confined to their houses, and frightening experiences like trying to drive the ambulance and being surrounded by 200 -300 people jostling the vehicle. They have learnt that if the women and children go bush, they need to be alert. We have heard from one person who counts 7 break-ins in to her home during her time here.
With all of that, each day has given a glimpse of another picture. The way the community cares for an unpredictably psychotic man, the depth of feeling when a diagnosis of cancer comes back from the Royal Darwin Hospital, the tolerance of locals of white people representing a dominant and sometimes demanding culture. We have spent time with one white couple who never lock their house and have never had a problem. Yesterday we met Boniface Perdjit. He is a Traditional Owner of the local area, and is Australia's first married Catholic deacon. He's a gentle, wise man who mirrors peace with a twinkle in his eye. One hardened white fella said of him that Boniface's brand of religion is almost enough to make him follow Jesus' teachings.
We are recognising people enough to have a yarn outside the store or in the street. We're still not exactly sure what the role of doctors should be, but we are glad we are here.
Friday, 2 September 2011
Friday snippets
I'm sad to report that the yoghurt took 24 hours to set this week. But at least it set..
It's been a funny day today, yesterday too - the clinic has been really quiet. Lots of people have gone to Daly River for the Daly River festival. More dodgem cars, music. It's probably good the clinic was quiet - we've had computer problems for the last 2 days, needing to log off frequently for re-setting the password. It's hard to get 8 or more clinicians to log off at once! "Just finish what you're doing and LOG OFF". It seems to be sorted now.
I've been able to finish the health assessments at the aged care home, where "Mary" lives. I've really enjoyed getting to know these women with so much life experience, so different from mine. One can hardly speak, but is able to communicate by slight head movements, and smiles. It's lovely to see the staff care for her so well, and her family too. Another lady is 95, and the mother of the traditional owner of the area here (Wadeye, and also Air Force Hill). We met him yesterday. He's a wise and caring man, carrying quite a load of responsibility. "Mary" is still alive, but seems to be deteriorating.
We're looking forward to the weekend, and planning more exploring, hoping to repeat the damper & BBQ. No swimming though: Tim heard from someone that nowhere's safe... glad we didn't know that last weekend! We'll walk on the beach with great care & eyes peeled for crocs.
The countryside is very dry, and grass in our own yard looked almost dead. But it's amazing how it's become green after a couple of days of watering.. there's lots of water here, and sprinklers are going all the time. It keeps the dust down too. Watering the lawn has been another adjustment.
Monday, 29 August 2011
Local health
Today I met "Jean". Her back hurt, especially after travelling to Wadeye yesterday over the bumpy, corrugated roads. She has a disc problem in the lower back, hard enough to treat in mainstream healthcare.
She's in her 70's. Her place is 2 hours drive from here. She comes here because this is her husband's country. She looked at me out of the corners of her eyes. "Do you wanna see my country?" I wasn't sure what was coming next, but she pulled out her mobile phone. We looked at more than 70 photos of a beautiful costal bush, deserted beaches and pristine waterholes. "See the pig in that picture?" I asked whether she caught it. "Nah, all we had was stones. We gave it a fright though!" One photo was a big rocky cliff. "See the heads? There's the man and there's the woman." She said with a look of disgust that her ancestors never told them how they got there. Another photo was a grassy spur pointing out to the beach. "What do you reckon that is?" I didn't know but thought it looked like a crocodile. "Nah, it's a swordfish". She then told me the story about how the fish got tired and lay down to sleep and never woke up. There was something quite incredible about hearing some ancient wisdom and story via a fluorescent orange Nokia.
"Bruce" is 61. He's very dignified, with a bushy crop of grey hair. He shares a common problem here. He had rheumatic fever as a child, has diabetes and kidney disease. He came in late a few days ago with chest pains. The tests were normal. He came in with his wife this morning, still not feeling great. I asked about drinking. That set off a lot of animated conversation in the Murrinh-Patha. He smiled a bit ruefully. "She said to be honest". We jigged his tablets and he'll come in tomorrow (hopefully). I've just had a phone call from pathology in Darwin (it's 8pm) to say that the blood sent today on the plane shows that he actually did have a heart attack. What to do? To send someone to Darwin for care often means that the temptation to abscond and look for grog is strong. I don't even know how I would find him at night.
We're slowly finding out that there is more and more that we don't know. The medical challenges are ... challenging! Today a wound culture came back with diphtheria growing. I didn't know that diphtheria caused skin infections. Placed over the layer of cultural differences, we find ourselves wishing that there were answers in the back of the book. There are frustrations when we arrange for a young girl with a fragile twin pregnancy to go to Darwin, and she disappears just before the flight is due to go. But there are frustrations also when a 2 year old with a stone in her ear canal leaves on the plane with her young mother, and then a fax comes from the hospital in Darwin saying that the plans have changed and could she come next week please...!
Our role here is supportive of the incredibly competent nurses, as well as dealing with acute problems and also trying to get chronic health plans up to date. I can't get my head around the last bit, so Joy does that. It's good to be here together.
She's in her 70's. Her place is 2 hours drive from here. She comes here because this is her husband's country. She looked at me out of the corners of her eyes. "Do you wanna see my country?" I wasn't sure what was coming next, but she pulled out her mobile phone. We looked at more than 70 photos of a beautiful costal bush, deserted beaches and pristine waterholes. "See the pig in that picture?" I asked whether she caught it. "Nah, all we had was stones. We gave it a fright though!" One photo was a big rocky cliff. "See the heads? There's the man and there's the woman." She said with a look of disgust that her ancestors never told them how they got there. Another photo was a grassy spur pointing out to the beach. "What do you reckon that is?" I didn't know but thought it looked like a crocodile. "Nah, it's a swordfish". She then told me the story about how the fish got tired and lay down to sleep and never woke up. There was something quite incredible about hearing some ancient wisdom and story via a fluorescent orange Nokia.
"Bruce" is 61. He's very dignified, with a bushy crop of grey hair. He shares a common problem here. He had rheumatic fever as a child, has diabetes and kidney disease. He came in late a few days ago with chest pains. The tests were normal. He came in with his wife this morning, still not feeling great. I asked about drinking. That set off a lot of animated conversation in the Murrinh-Patha. He smiled a bit ruefully. "She said to be honest". We jigged his tablets and he'll come in tomorrow (hopefully). I've just had a phone call from pathology in Darwin (it's 8pm) to say that the blood sent today on the plane shows that he actually did have a heart attack. What to do? To send someone to Darwin for care often means that the temptation to abscond and look for grog is strong. I don't even know how I would find him at night.
We're slowly finding out that there is more and more that we don't know. The medical challenges are ... challenging! Today a wound culture came back with diphtheria growing. I didn't know that diphtheria caused skin infections. Placed over the layer of cultural differences, we find ourselves wishing that there were answers in the back of the book. There are frustrations when we arrange for a young girl with a fragile twin pregnancy to go to Darwin, and she disappears just before the flight is due to go. But there are frustrations also when a 2 year old with a stone in her ear canal leaves on the plane with her young mother, and then a fax comes from the hospital in Darwin saying that the plans have changed and could she come next week please...!
Our role here is supportive of the incredibly competent nurses, as well as dealing with acute problems and also trying to get chronic health plans up to date. I can't get my head around the last bit, so Joy does that. It's good to be here together.
Sunday, 28 August 2011
History
I read today that "history is always told by the victors. The story of a community is always told from the point of view of the most successful people within that community - and it tends to honour exactly those people." (Matthew Jack)
This makes some sense of the dominant white culture's view on things. We don't easily hear an indigenous view of history, for many reasons. And Richard Trudgeon's "Why Warriors Lie Down and Die" is helpful in addressing that.
We wonder how two such different cultures can live side by side, with mutual respect and growing understanding.
Saturday, 27 August 2011
Aortas
Before we came to NT, Joy and I decided to avoid the word aorta. You know how it goes - Aorta get rid of the dogs, and so on. But it really hasn't been a problem. We have no idea really what aorta do. Interestingly, those we talk to don't dwell on solutions. It seems that policy makers are keen on assimilation. The white fellas who have been here for a while grimace and get on with their jobs.
It is frustrating though. One serious plan was a business taking tourists into the bush, or fishing with indigenous people. But regulations stepped in. The guides had to do tests on map reading and understanding GPS directions. Developing an industry with honey from native bees seems to be facing a hurdle of OH&S rules about food handling and business administration. The local people involved are incredibly skilled, and far better than white fellas, in the practical aspects of these proposals. The bureaucratic barriers reinforce the depth of the gulf that exists between indigenous culture and the dominating white one.
We continue to be very impressed by the care that we see from the RANs - the Remote Area Nurses. They are the ones who provide the health care. They know their local clients well, and go the second mile in doing what they can. My concept of government introduced "intervention" was uninformed health professionals rocking in to small communities, not really respecting boundaries, to achieve better health outcomes. That's not what happens here. Better outcomes are aimed at by appropriate communication and motivation, and provision of high class care.
This afternoon we met the careflight bringing "Mary" back from Darwin. She is an elderly lady with end stage renal failure. She lives at the small aged care house that Joy has been visiting. Last week, the staff there rang to say that she was semiconscious and pretty bad. I wandered around to find 3 of the RANs preparing to bring her back to the clinic. It was pretty clear that she was dying. Back at the clinic, we did some tests that confirmed that her kidneys were not working. (For those interested, Na 115, urea >50, creatinine 672). What to do? She had, with her family, indicated that she did not want any resuscitation. But the clinic is not a hospital with inpatient facilities, and the aged care house does not have nursing staff overnight. She couldn't go back to her family easily.
The system here is that the RANs discuss problems with the District Medical Officer, a doctor in Darwin who recommends appropriate action. Jim rang him. He was very clear that she should be transferred to Darwin. That was tough, as the thought of her dying away from her country was not good. However, she went, and with some Darwin magic, improved.
Her wave as she was stretchered out of the plane was wonderful. We got her into the car we have to use, and took her home. I wheeled her around her fellow residents, who held out their hands and in the best way they could, welcomed her back. It was an emotional moment. She's back for good now.
Well, there's some health stuff. It isn't what I was going to write. That will have to wait.
It is frustrating though. One serious plan was a business taking tourists into the bush, or fishing with indigenous people. But regulations stepped in. The guides had to do tests on map reading and understanding GPS directions. Developing an industry with honey from native bees seems to be facing a hurdle of OH&S rules about food handling and business administration. The local people involved are incredibly skilled, and far better than white fellas, in the practical aspects of these proposals. The bureaucratic barriers reinforce the depth of the gulf that exists between indigenous culture and the dominating white one.
We continue to be very impressed by the care that we see from the RANs - the Remote Area Nurses. They are the ones who provide the health care. They know their local clients well, and go the second mile in doing what they can. My concept of government introduced "intervention" was uninformed health professionals rocking in to small communities, not really respecting boundaries, to achieve better health outcomes. That's not what happens here. Better outcomes are aimed at by appropriate communication and motivation, and provision of high class care.
This afternoon we met the careflight bringing "Mary" back from Darwin. She is an elderly lady with end stage renal failure. She lives at the small aged care house that Joy has been visiting. Last week, the staff there rang to say that she was semiconscious and pretty bad. I wandered around to find 3 of the RANs preparing to bring her back to the clinic. It was pretty clear that she was dying. Back at the clinic, we did some tests that confirmed that her kidneys were not working. (For those interested, Na 115, urea >50, creatinine 672). What to do? She had, with her family, indicated that she did not want any resuscitation. But the clinic is not a hospital with inpatient facilities, and the aged care house does not have nursing staff overnight. She couldn't go back to her family easily.
The system here is that the RANs discuss problems with the District Medical Officer, a doctor in Darwin who recommends appropriate action. Jim rang him. He was very clear that she should be transferred to Darwin. That was tough, as the thought of her dying away from her country was not good. However, she went, and with some Darwin magic, improved.
Her wave as she was stretchered out of the plane was wonderful. We got her into the car we have to use, and took her home. I wheeled her around her fellow residents, who held out their hands and in the best way they could, welcomed her back. It was an emotional moment. She's back for good now.
Well, there's some health stuff. It isn't what I was going to write. That will have to wait.
Friday, 26 August 2011
Snippets
While at one of the outstations, we saw a dingo - she had had puppies. "Who's the father?" led to a wide sweep of the hand, indicating the whole community. The puppies were in a burrow like a wombat hole; we could just see them. The lady kept the dingo away by threatening a stick.
The old man from the community we visited on Wednesday is the last living speaker of his language. Only a very small number of people ever spoke it. (Trev said 400 total, but I don't know how that works out over 40,000 years) A linguistic group from the eastern states somewhere spent some time with him, recording him. The language is not far off being lost - but it's good to see that in some circles at least, it's valued.
The guy who's working with the indigenous rangers is an ecologist and ornithologist. We're hoping to learn from him! Tim has mentioned him before. We appreciate his approach. We've just come from tea at his house. We met a guy there who's volunteering with the rangers, trying to develop native bees & hives. Native honey is not as sweet apparently.
The lady from Traralgon I'd spoken to while still in Leongatha, the one who works at the women's centre, was at tea tonight. She was talking about the value of homeland communities, how well people do on their own land, and how sad it is that the government's policy is moving people away from them to bigger centres like Wadeye. It's do to with centralisation and assimilation. Development?
The new med student is Dan. We've been here a whole week longer than him, and we feel a bit familiar with things. So we can see progress! We think we'll take Dan & one of the nurses (who is new here too) around the sights on Sunday. We need longer here really, to explore it all - go out in a boat, fishing, visit communities, look for bush foods.
We're covering 2nd on call tonight & tomorrow night. Tim's at the clinic now - one of the girls I saw at the outstation on Wednesday is having an allergic reaction to penicillin.
I've enjoyed visiting the Aged Care residence and I've been doing some health assessments. Will need to take some blood for parathyroid hormone next week.. at least I know how to process it now!
I brought a 1kg Jalna youghurt with me from Darwin. It's finished now, but I'm really pleased: I used the container to make another kg, with an esiyo sachet mixed with tepid water & then sitting in a saucepan of boiling water. It took 12 hours to set well.
Thursday, 25 August 2011
On the way to the community
The second of "double creek" which is so full in the wet season, that the community is totally cut off. All the people move to Wadeye. It's said the children learn better in their small community school.
One week down
Tim here - does it get confusing? I said I'd write about health, and I will, because that's why we're here. But not just yet. We've had a great week. We've explored some water holes, lit a fire on the beach and cooked and shared food with a few others, visited outstations (well Joy has), laughed with local people and listened to the stories of some real personalities. We even had a party at our place last night. It has been almost enough to push aside some of the disquiet about living in a strange cultural gap.
Back to the party. Julia (our medical student friend) left today, and we decided to have people around last night. She invited about 15, and we revved up the BBQ that was sitting in the corner of the shed. It seemed to work OK even if a bit slow. After a while, we realised that the pipe was perished and was leaking. That's when it caught fire. It's funny how things can happen in slow motion at times. My two thoughts were about how I would explain the house burning down to the clinic manager and about how Wadeye might be in the news for reasons different to usual. However, we got the fire out with wet tea towels and proceeded to have a fun night.
There are some really interesting people in the non-indigenous community here. Some come for one-month-on, one-month-off work, with family elsewhere. Some have been here for years, like the sprightly 95 year old catholic nun. Some seem to be escaping, and have interests limited to drinking and watching AFL on TV. Our plumber friend is doing a 5 year contract maintaining all the houses here and in the surrounding area. He has been in the army and has experienced some tough stuff. But he's a passionate reader and has a robustly passionate view on life that is enormously refreshing. Some are in the honeymoon stage of culture shock, and others seem a bit jaded and weary. With all of that, we continue to be challenged and impressed by the genuine care of the clinic staff. Tomorrow night we have been invited to dinner with a ranger, who I have come to respect deeply, and his Balinese wife, who is a passionate fisherwoman. We're looking forward to that.
If you are still reading, well done! I'll save the medical stuff until next time.
Back to the party. Julia (our medical student friend) left today, and we decided to have people around last night. She invited about 15, and we revved up the BBQ that was sitting in the corner of the shed. It seemed to work OK even if a bit slow. After a while, we realised that the pipe was perished and was leaking. That's when it caught fire. It's funny how things can happen in slow motion at times. My two thoughts were about how I would explain the house burning down to the clinic manager and about how Wadeye might be in the news for reasons different to usual. However, we got the fire out with wet tea towels and proceeded to have a fun night.
There are some really interesting people in the non-indigenous community here. Some come for one-month-on, one-month-off work, with family elsewhere. Some have been here for years, like the sprightly 95 year old catholic nun. Some seem to be escaping, and have interests limited to drinking and watching AFL on TV. Our plumber friend is doing a 5 year contract maintaining all the houses here and in the surrounding area. He has been in the army and has experienced some tough stuff. But he's a passionate reader and has a robustly passionate view on life that is enormously refreshing. Some are in the honeymoon stage of culture shock, and others seem a bit jaded and weary. With all of that, we continue to be challenged and impressed by the genuine care of the clinic staff. Tomorrow night we have been invited to dinner with a ranger, who I have come to respect deeply, and his Balinese wife, who is a passionate fisherwoman. We're looking forward to that.
If you are still reading, well done! I'll save the medical stuff until next time.
Chronic disease
Part of what the clinic staff want me to do, is chronic disease. How does one "do chronic disease" here? It has certainly put me on a learning curve. Part of it is the computerized medical records system. It's online and centralised (NT Dept of Health), so wherever people happen to be, their health record is there. We both did online training for the system before leaving home, which was helpful, but it feels like we're starting to get the hang of it now.
Chronic disease involves care plans to ensure that necessary tests and allied health and specialist assessments happen at the right time, along with GP or RAN (ie, Remote Area Nurse) clinical examinations and pathology ordering. I've learnt how to deal with a parathyroid hormone sample - purple top tube, not gold top, and centrifuge, pipette off serum, put in a small tube, the whole thing in a urine spec jar, fill with water & freeze! send it off in the plane ensuring it stays frozen. I didn't know all this, which explains why results came back "inappropriate sample, test deferred".
A big part of what I need to do is chat to patients about their illness, medications, treatment. Not taking prescribed meds is thought to be quite a problem. It is anywhere, really. But in this context, the difficulty for people to understand their illness and treatment is so important, and so hard, when the treating team are from such a different culture. How best do we explain things?
Monday and Tuesday I went on outstation visits, with the outreach nurse Trevor, and med student Julia. We visited 3 communities. I'd printed up health summaries for the "chronic disease" people Trev thought we might find, bearing in mind that they might be in "town" (Wadeye), or just not there. It seemed important to me to have some idea about what I due, or overdue of their "chronic disease" things.
(What path to take?). In the end the main thing turned out to be sitting and chatting. I showed photos of family and where're we live down south (rolling hills and cows, beach). Julia did all the hard work! Lots of cleaning wounds and dressing, giving penicillin injections, weighing children, checking haemoglobin.. (thanks Julia!). I did find one kid with a discharging ear, cleaned it with tissue spears, saw 2 perforations and gave antibiotics.
These outstations are a few houses, about 3/4 hour's drive through beautiful country. On leaving yesterday, Trev asked permission from the old couple I'd been seeing, to take us by the creek (they are traditional owners). Trev says people are often healthier out there, eating more bush foods. The school there is closed at the moment, no teacher, but it looks out over the lovely small bay.
Coming back to the clinic, it's time to write up all the notes for the day and click off some of those overdue items..
Today I went to the aged care house, 2 doors away from the clinic. I need to spend time thinking about the medical issues of the 8 residents, and also helping prepare advance care directives for them. It was lovely to see how the staff care for the old ladies. One catholic nun is leaving soon. She's been here on & off fir 28 years. There's no facility for men, and no respite beds... they suggested I could write a letter saying it would be a good idea. I'm not sure getting involved in politics is the right thing to do. We're anything but expert!
Will try to post some community photos.
Chronic disease involves care plans to ensure that necessary tests and allied health and specialist assessments happen at the right time, along with GP or RAN (ie, Remote Area Nurse) clinical examinations and pathology ordering. I've learnt how to deal with a parathyroid hormone sample - purple top tube, not gold top, and centrifuge, pipette off serum, put in a small tube, the whole thing in a urine spec jar, fill with water & freeze! send it off in the plane ensuring it stays frozen. I didn't know all this, which explains why results came back "inappropriate sample, test deferred".
A big part of what I need to do is chat to patients about their illness, medications, treatment. Not taking prescribed meds is thought to be quite a problem. It is anywhere, really. But in this context, the difficulty for people to understand their illness and treatment is so important, and so hard, when the treating team are from such a different culture. How best do we explain things?
Monday and Tuesday I went on outstation visits, with the outreach nurse Trevor, and med student Julia. We visited 3 communities. I'd printed up health summaries for the "chronic disease" people Trev thought we might find, bearing in mind that they might be in "town" (Wadeye), or just not there. It seemed important to me to have some idea about what I due, or overdue of their "chronic disease" things.
(What path to take?). In the end the main thing turned out to be sitting and chatting. I showed photos of family and where're we live down south (rolling hills and cows, beach). Julia did all the hard work! Lots of cleaning wounds and dressing, giving penicillin injections, weighing children, checking haemoglobin.. (thanks Julia!). I did find one kid with a discharging ear, cleaned it with tissue spears, saw 2 perforations and gave antibiotics.
These outstations are a few houses, about 3/4 hour's drive through beautiful country. On leaving yesterday, Trev asked permission from the old couple I'd been seeing, to take us by the creek (they are traditional owners). Trev says people are often healthier out there, eating more bush foods. The school there is closed at the moment, no teacher, but it looks out over the lovely small bay.
Coming back to the clinic, it's time to write up all the notes for the day and click off some of those overdue items..
Today I went to the aged care house, 2 doors away from the clinic. I need to spend time thinking about the medical issues of the 8 residents, and also helping prepare advance care directives for them. It was lovely to see how the staff care for the old ladies. One catholic nun is leaving soon. She's been here on & off fir 28 years. There's no facility for men, and no respite beds... they suggested I could write a letter saying it would be a good idea. I'm not sure getting involved in politics is the right thing to do. We're anything but expert!
Will try to post some community photos.
Sunday, 21 August 2011
more festival photos
Really it was fun. We wondered how children didn't get lost in the dark, watching the music and wandering here and there. It was fun to be part of it. We chatted to other white people, including a lady from Traralgon who works in the women's centre. She's been here on & off for 5 years. I'd talked to her on the phone, via a circuitous route (thanks Dean!) and she was very welcoming.
A nurse visiting for the weekend came across a lady who'd been beaten up and was frightened. Tim got peripherally involved. She knew he is the new doctor - people must talk! Fortunately she wasn't too badly hurt. The police (plain clothes) took her to the Safe House. That's what happens.
We'd heard of a mum who had "absconded" from Darwin with her child, for treatment of the child's club foot. But she came back to Wadeye for the festival. Some on the team were annoyed/frustrated. But the festival is once a year! Sounds like she wants to go back next week. Fair enough.
Everything seems big here
Blogs don't have to be politically correct. Right? And what I think can be understood as the ramblings of a new bloke with sensory overload. OK...
I thought climate change and carbon policies were complex issues. They seem to be as sorted as Collingwood winning the grand final compared with the challenges in policy making and living here. Maybe it takes more than 3 days to figure out what is going on! But it seems that the too-hard-basket needs to be an industrial skip.
First up, we are really enjoying being here. We feel welcomed by the white community, have good accommodation, think that the work we do will be helpful and are loving the weather. With all of that, we're strugging to understand why things are like they are.
The Health Centre is a beautiful big and modern building with lots of skilled and experienced white staff. Until last week there were 3 Aboriginal health workers, but 2 of those have just resigned. Apart from the one remaining, there is an indigenous driver. Even the cleaning is done by a lovely couple from Taiwan. Such minimal direct employment and involvement by local people isn't what we expected. We had hoped that there would be indigenous workers to help us with communication challenges and cultural pitfalls.
There is a store, fruit shop, butcher, furniture shop, PO and variety shop, all run by white people. It's hard to see how the local employment rate can possibly be more than 5%. How can that be good? There do seem to be little positives though. Chris, a ranger, employs about 20 indigenous people. They are dealing with a terrible noxious weed, and he is working on various locally appropriate schemes for job creation.
As much as we try to push the 3 G's to the back of our thinking (grog, gambling and ganja - marijhuana), they keep influencing what we see. What should our role be when confronted by domestic violence? While this is a dry community, people can drive to a town 90km away, get drunk and drive back. Last night there was evidence of that. We have to lock our gate and keep the house locked, as it has just been repaired after a break in a while ago.
There is a very elaborate complex being built to enable secondary aged kids from surrounding areas to board while going to school. Seems like a good model - youth workers on staff, appropriate facilities and good proximity. While there has been a process of consultation, no-one knows if it will ever be embraced or even used. But it is an election promise, and needs to go ahead. To me this sums up a lot of what seems to happen here. It would be better to have local management, involvement and labour, but in the absence of that, better to do something than nothing.
With all that, there is optimism I think. However, the problems of 22 clan groups living together on land that is only country of one of those groups will continue to challenge the most caring and thoughtful policy makers.
We have just had the local festival. Even with a grant from Rio Tinto, the kids had to pay $10 for 60 seconds in e dogem cars. But it was lots of fun, and showed wonderful football and musical talent.
We're hoping that we can write a different story in the next couple of weeks. I'll write about health issues next time.
I thought climate change and carbon policies were complex issues. They seem to be as sorted as Collingwood winning the grand final compared with the challenges in policy making and living here. Maybe it takes more than 3 days to figure out what is going on! But it seems that the too-hard-basket needs to be an industrial skip.
First up, we are really enjoying being here. We feel welcomed by the white community, have good accommodation, think that the work we do will be helpful and are loving the weather. With all of that, we're strugging to understand why things are like they are.
The Health Centre is a beautiful big and modern building with lots of skilled and experienced white staff. Until last week there were 3 Aboriginal health workers, but 2 of those have just resigned. Apart from the one remaining, there is an indigenous driver. Even the cleaning is done by a lovely couple from Taiwan. Such minimal direct employment and involvement by local people isn't what we expected. We had hoped that there would be indigenous workers to help us with communication challenges and cultural pitfalls.
There is a store, fruit shop, butcher, furniture shop, PO and variety shop, all run by white people. It's hard to see how the local employment rate can possibly be more than 5%. How can that be good? There do seem to be little positives though. Chris, a ranger, employs about 20 indigenous people. They are dealing with a terrible noxious weed, and he is working on various locally appropriate schemes for job creation.
As much as we try to push the 3 G's to the back of our thinking (grog, gambling and ganja - marijhuana), they keep influencing what we see. What should our role be when confronted by domestic violence? While this is a dry community, people can drive to a town 90km away, get drunk and drive back. Last night there was evidence of that. We have to lock our gate and keep the house locked, as it has just been repaired after a break in a while ago.
There is a very elaborate complex being built to enable secondary aged kids from surrounding areas to board while going to school. Seems like a good model - youth workers on staff, appropriate facilities and good proximity. While there has been a process of consultation, no-one knows if it will ever be embraced or even used. But it is an election promise, and needs to go ahead. To me this sums up a lot of what seems to happen here. It would be better to have local management, involvement and labour, but in the absence of that, better to do something than nothing.
With all that, there is optimism I think. However, the problems of 22 clan groups living together on land that is only country of one of those groups will continue to challenge the most caring and thoughtful policy makers.
We have just had the local festival. Even with a grant from Rio Tinto, the kids had to pay $10 for 60 seconds in e dogem cars. But it was lots of fun, and showed wonderful football and musical talent.
We're hoping that we can write a different story in the next couple of weeks. I'll write about health issues next time.
Friday, 19 August 2011
Football
We're sitting in the couch in the lounge room, & Tim is watching the footy, doing a sudoku. We could be at home! But here we are in Wadeye, and "home" is a long way away, literally and metaphorically. That's not a value judgement about how things are, though.
We had a great flight here from Darwin. There were 2 indigenous families on the plane, one with a newborn baby, the other with a child with leg in purple fibreglass plaster. The other travellers were white people coming out for various things - 2 we had met in Darwin during briefing, 2 we chatted to while waiting for the plane; they came out fir the day, to talk about paediatric services. Then there was a group of 5 and Tim took their photo (their camera) with all the small planes in the background.
One of the cultural educators had said, you step off the runway onto the dirt. Actually some of the streets are bitumen. It's a flat dusty town. You can tell the white houses: high wire fences and barking dogs. Aboriginal people here have lots of dogs, and we've been warned to carry a stick, but we haven't been threatened at all. We live about 10 minutes' walk from the clinic, and have pretty much got the route sorted now. The cut off corner, bouganvillea, old rusty truck tray, then our lane. The house is great! 2 bedrooms, nice open lounge & kitchen, a verandah at the front, lockable carport (like a garage but more breezy) and lockable clothes line area (similar.. Clothes dry fast). Front gate is locked all the time. The Wadeye knock is a rock thrown on the roof! There have been a few break-ins, and this aspect of living here is hard to accept, even though we know it's just a few people who do this. Even harder is the fact that mostly, only food is taken.
We're just back from the festival: the annual Wadeye festival is on this weekend. There's been music and dancing. As a new song was started, a different group would get up from the audience and dance. Someone explained that each group was a different cultural group, and each would get up when it was "their" song, and point to their country. There are several different cultural groups in Wadeye and surrounding area. It seems that they share a common language, which is taught in the school. Both primary and secondary schools here, swimming pool, Catholic church, store (not as expensive as we'd been led to believe), and hey - fruit and veggie shop, and butcher! Also PO, police, centrelink, women's centre, preschool/creche.... And of course the clinic! More about that later.
Back to the festival. We watched the kids enjoying the dodgem cars (footy is finished and Tim has just shown me some photos) and jumping castle. So much fun! Two hot greasy-food vans.... buff or croc burgers.
It all continues tomorrow. A footy match at 3pm - we'll go along to that. I'm sure that one won't feel quite like home! There'll be fireworks to finish off the night, after more music.
We wonder if we can relate in any meaningful way, especially in such a short time. But it's a stretching experience to be here.
We had a great flight here from Darwin. There were 2 indigenous families on the plane, one with a newborn baby, the other with a child with leg in purple fibreglass plaster. The other travellers were white people coming out for various things - 2 we had met in Darwin during briefing, 2 we chatted to while waiting for the plane; they came out fir the day, to talk about paediatric services. Then there was a group of 5 and Tim took their photo (their camera) with all the small planes in the background.
One of the cultural educators had said, you step off the runway onto the dirt. Actually some of the streets are bitumen. It's a flat dusty town. You can tell the white houses: high wire fences and barking dogs. Aboriginal people here have lots of dogs, and we've been warned to carry a stick, but we haven't been threatened at all. We live about 10 minutes' walk from the clinic, and have pretty much got the route sorted now. The cut off corner, bouganvillea, old rusty truck tray, then our lane. The house is great! 2 bedrooms, nice open lounge & kitchen, a verandah at the front, lockable carport (like a garage but more breezy) and lockable clothes line area (similar.. Clothes dry fast). Front gate is locked all the time. The Wadeye knock is a rock thrown on the roof! There have been a few break-ins, and this aspect of living here is hard to accept, even though we know it's just a few people who do this. Even harder is the fact that mostly, only food is taken.
We're just back from the festival: the annual Wadeye festival is on this weekend. There's been music and dancing. As a new song was started, a different group would get up from the audience and dance. Someone explained that each group was a different cultural group, and each would get up when it was "their" song, and point to their country. There are several different cultural groups in Wadeye and surrounding area. It seems that they share a common language, which is taught in the school. Both primary and secondary schools here, swimming pool, Catholic church, store (not as expensive as we'd been led to believe), and hey - fruit and veggie shop, and butcher! Also PO, police, centrelink, women's centre, preschool/creche.... And of course the clinic! More about that later.
Back to the festival. We watched the kids enjoying the dodgem cars (footy is finished and Tim has just shown me some photos) and jumping castle. So much fun! Two hot greasy-food vans.... buff or croc burgers.
It all continues tomorrow. A footy match at 3pm - we'll go along to that. I'm sure that one won't feel quite like home! There'll be fireworks to finish off the night, after more music.
We wonder if we can relate in any meaningful way, especially in such a short time. But it's a stretching experience to be here.
Tuesday, 16 August 2011
Tuesday in Darwin
"Sometimes it feels like a battle that we can't win". In the last two days we have met and learnt from two honest and humble indigenous people. Both are living within two very different cultures. Both want to share their stories, because of a passionate desire to improve the health and welfare of their people. Richie took us on a bush walk, and shared some of his bush knowledge. What an experience! Every tree or bush had significance, as food, medicine, tools for life or pointing to where water can be found. "How many birds can you see over there?" None. Wrong. There were two stone curlews sitting quite obviously when we knew how to look. The call of the curlew tells warning stories. We learnt of the ways of preserving the country for all to be part of. What must it have been like to have white people come and clear the land that is such a big part of indigenous people? And not just that - to kill and dominate....
Ada wants her grandchildren to understand her culture, even though she lives more within non-indigenous culture than they do. Both Richie and Ada live in the now. They don't express anger, don't dwell in the sadness of history. They want their people to thrive. But the elders die young. Those with skill and energy burn out. People come to help but then go again. Programs are started. They all have good and bad sides to them. While there have been changes in some health measures, the stats for health of their people continue to top the tables for the worst in "developed" countries.
We've learnt about basic communication in indigenous communities, culture shock, team work and about strongyloides and meliodosis and other tropical diseases. We've been warned about dogs and crocs. Tomorrow it's medicare and computer software. Then we fly to Wadeye on Thursday. People we meet have polarised views of the community there. I guess we'll have to have our own thoughts. We expect to be part of a team in which the doctor is certainly not the king. We're looking forward to that. We just hope that we'll be able to look and to see, hear and share appropriately.
Ada wants her grandchildren to understand her culture, even though she lives more within non-indigenous culture than they do. Both Richie and Ada live in the now. They don't express anger, don't dwell in the sadness of history. They want their people to thrive. But the elders die young. Those with skill and energy burn out. People come to help but then go again. Programs are started. They all have good and bad sides to them. While there have been changes in some health measures, the stats for health of their people continue to top the tables for the worst in "developed" countries.
We've learnt about basic communication in indigenous communities, culture shock, team work and about strongyloides and meliodosis and other tropical diseases. We've been warned about dogs and crocs. Tomorrow it's medicare and computer software. Then we fly to Wadeye on Thursday. People we meet have polarised views of the community there. I guess we'll have to have our own thoughts. We expect to be part of a team in which the doctor is certainly not the king. We're looking forward to that. We just hope that we'll be able to look and to see, hear and share appropriately.
Saturday, 13 August 2011
The day before
To ensure that we keep up with technology, we are planning to record our time in Wadeye in this format. If you are interested, follow along!
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