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.