RHD... Rheumatic Heart Disease. I've been given the job of reviewing these patients, in preparation for the cardiologist's visit in October. Many of you (those a bit older - say no more) will remember rheumatic fever, and how it can affect the heart. It's not common in mainstream medicine, but is a reality here, as people have many streptococcal infections and some develop rheumatic fever. They then require a monthly injection of long acting penicillin, to prevent recurrences which may make the heart effects worse. The team here have found that it's sometimes easier for them to go out and see the people in their homes.
Reviewing the patients has pushed me out of the comfort of the ivory-tower clinic. I've taken the nurses' maps of the community and driven round the streets, stopping at the relevant houses and asking if the person is there, then sitting on the verandah or the tiled floor inside, and doing a check up. I've found people generally helpful and welcoming, and I've had some good times with them. Sometimes I've needed to go back to a home several times before I connect with the person concerned. I've realised that people have their English name, that we know them by, and they also have a name in their language, that they call each other by. They all know the English names as well. It's another example of how much the people need to know, in order to work within systems that are so white-mainstream-western.
Anyway, we leave on Friday, and I'm not sure I'll have seen everyone I need to. That's chronic disease - the work goes on and doesn't finish. I'll be able to leave a list for Dr Simon to follow up. It's good to know that he's here 3 days a week, working with chronic disease patients. This week, Rosemary came back. She's been coming for 10 years. She's come back to be the chronic disease coordinator.
Meanwhile, Tim has been working on the acute side. Hopefully he'll write something!
Tuesday, 31 July 2012
Sunday, 15 July 2012
Hope?
I've just finished reading "Listening to Country" by Ros Moriarty. I highly recommend it! I found it inspiring and very moving. I wonder, is there hope?
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Briefly:
Ros is a white woman who married John Moriarty, a man from Borroloola, who was stolen from his family, and reconnected much later. She describes the journey of connection with family, traditional Law and culture, and what it means that the young people haven't wanted to embrace the traditions. She describes richness of family life in the midst of poverty and the gradual but inexorable breakdown of culture. Interwoven with this story is the story of their family life and their business, Balarinji, now an international design agency, with well known Indigenous designs - the painted Qantas planes, for example.
As a newcomer here in Wadeye, a different community, I can only guess how the principles apply here. But - it does seem that traditional culture isn't strong in the town here.
I'm struggling to see how Indigenous cultures can flourish and progress in the context of white/mainstream/dominant culture, which sets the agendas and the rules. Is it possible for these two cultures to live side by side with mutual respect, and openness to the other?
Is it too late to undo the damage of European settlement and takeover?
Andy sent us a link to an article suggesting that we, the white community, need to become powerless, in order to make a difference, to allow Indigenous people to develop appropriate community programs.
http://blog.whywarriors.com.au/2012/letting-go-of-our-power/
It makes interesting reading. Is this a hopeful way forward? To trust Indigenous leadership enough, and to take a supportive role?
Ros Moriarty says, "Talk is cheap and words and symbolic gestures, while vital to the effort, will ring true only when we write a new Australian story that is scripted for John's family as well as mine. Pragmatism and empathy in balance might begin to turn the tide."
In the meantime, we are here in Wadeye, doing a medical job as part of a clinic team. I hope that as we go about it, we communicate respect - and I hope we empower people in their health. That's our goal in mainstream Leongatha medicine! It's not always easy there! So spare us a thought, and write them down!
Briefly:Ros is a white woman who married John Moriarty, a man from Borroloola, who was stolen from his family, and reconnected much later. She describes the journey of connection with family, traditional Law and culture, and what it means that the young people haven't wanted to embrace the traditions. She describes richness of family life in the midst of poverty and the gradual but inexorable breakdown of culture. Interwoven with this story is the story of their family life and their business, Balarinji, now an international design agency, with well known Indigenous designs - the painted Qantas planes, for example.
As a newcomer here in Wadeye, a different community, I can only guess how the principles apply here. But - it does seem that traditional culture isn't strong in the town here.
I'm struggling to see how Indigenous cultures can flourish and progress in the context of white/mainstream/dominant culture, which sets the agendas and the rules. Is it possible for these two cultures to live side by side with mutual respect, and openness to the other?
Is it too late to undo the damage of European settlement and takeover?
Andy sent us a link to an article suggesting that we, the white community, need to become powerless, in order to make a difference, to allow Indigenous people to develop appropriate community programs.
http://blog.whywarriors.com.au/2012/letting-go-of-our-power/
It makes interesting reading. Is this a hopeful way forward? To trust Indigenous leadership enough, and to take a supportive role?
Ros Moriarty says, "Talk is cheap and words and symbolic gestures, while vital to the effort, will ring true only when we write a new Australian story that is scripted for John's family as well as mine. Pragmatism and empathy in balance might begin to turn the tide."
In the meantime, we are here in Wadeye, doing a medical job as part of a clinic team. I hope that as we go about it, we communicate respect - and I hope we empower people in their health. That's our goal in mainstream Leongatha medicine! It's not always easy there! So spare us a thought, and write them down!
Thursday, 12 July 2012
When is obsessional, well...obsessional?
Like Joy said, it's good to be back. I'd forgotten the dogs though! They don't sleep, and sometimes it seems that no-one else does as well... They really do howl when there is a full moon. Despite them, we are feeling like this is home for this brief time and are very happy here.
The dogs remind me about "Jack". He was the first indigenous patient I met last time we were here. He sticks in my mind - a big, broad, healthy looking man with a bad cough. We arranged for him to be checked in Darwin. Sadly, his chest XRay showed a nasty cancer. I asked about him this time. Apparently his health declined quickly. Back for a while in Darwin, but no useful treatment available. The staff told me with some emotion about his return. He was loaded in Darwin onto the Careflight plane unconscious for his trip home and palliative care. The plane landed at dusk. A few minutes later, there were people everywhere waiting respectfully, some quiet, some crying. No-one quite understood how everyone knew to come. Somehow they just did, as if they had a sense that he was coming home. And even his dogs and a lot of other dogs came and sat on the tarmac while he was unloaded. Even though he wasn't responsive, a nurse said "Jack, welcome home". To her amazement, tears ran down his face. Five hours later he passed away.
Not all the stories are sad. It has been wonderful to be able to talk and laugh with local people we remember from last year.
The first morning we were late to work. Only 3 minutes, but the 8 am team meeting was well underway. Oops! That and a myriad of daily events highlights to us the challenges of running a health service here. Rigidity about rules concerning time in a cultural context that sees time very differently is tricky. Sometimes it feels that the more local people seem relaxed about the clock, the more white people live by it. But not just time. Our program is vast and complex. There are numerous health plans, care plans, review checks, consultant recalls, and complex audits of them all.
Overlying that is Medicare. Our health system was not designed with the Northern Territory in mind. I guess that makes sense. Only 200,000 people live here. While my brain is barely coping with what care plan to do when, I have to remember whether the medicare number is a 715, 732, plus a 23 or 36 plus a 10991 incentive item, or perhaps a 721 or 723 bearing in mind that the last 2 can only be done once in 12 months, the 715 once in 9 months, or it could be a 703 or a 705, plus a number relating to other services given.
Last time, we commented on the lack of Indigenous Health Practitioners. That hasn't changed. Maybe we should scrap the clinic and have a yarn with people under the nearby gumtree. Would that change our impact? We certainly wouldn't be able to get the care plans done! Is it realistic to expect local people to come to work at 7.55am, sit in an office and share the consultation with a patient and a computer screen?
Having said all that, I'm sure we are helping. I met a teenager this week who talked about his family. His cousin plays football at an elite level in Darwin. He's pretty proud of him. This bloke can't do that. He had rheumatic fever when he was 10, and already has significant heart problems. He inspired us to want to do all that we could to prevent this sort of disease. And there are lots of good things happening. Some great strategies for health, good care of people of all ages, and really caring people doing it. It has to be worthwhile... But maybe being obsessional isn't always the answer.
A CareFlight arriving to take someone to Darwin for treatment
The dogs remind me about "Jack". He was the first indigenous patient I met last time we were here. He sticks in my mind - a big, broad, healthy looking man with a bad cough. We arranged for him to be checked in Darwin. Sadly, his chest XRay showed a nasty cancer. I asked about him this time. Apparently his health declined quickly. Back for a while in Darwin, but no useful treatment available. The staff told me with some emotion about his return. He was loaded in Darwin onto the Careflight plane unconscious for his trip home and palliative care. The plane landed at dusk. A few minutes later, there were people everywhere waiting respectfully, some quiet, some crying. No-one quite understood how everyone knew to come. Somehow they just did, as if they had a sense that he was coming home. And even his dogs and a lot of other dogs came and sat on the tarmac while he was unloaded. Even though he wasn't responsive, a nurse said "Jack, welcome home". To her amazement, tears ran down his face. Five hours later he passed away.
Not all the stories are sad. It has been wonderful to be able to talk and laugh with local people we remember from last year.
The first morning we were late to work. Only 3 minutes, but the 8 am team meeting was well underway. Oops! That and a myriad of daily events highlights to us the challenges of running a health service here. Rigidity about rules concerning time in a cultural context that sees time very differently is tricky. Sometimes it feels that the more local people seem relaxed about the clock, the more white people live by it. But not just time. Our program is vast and complex. There are numerous health plans, care plans, review checks, consultant recalls, and complex audits of them all.
Overlying that is Medicare. Our health system was not designed with the Northern Territory in mind. I guess that makes sense. Only 200,000 people live here. While my brain is barely coping with what care plan to do when, I have to remember whether the medicare number is a 715, 732, plus a 23 or 36 plus a 10991 incentive item, or perhaps a 721 or 723 bearing in mind that the last 2 can only be done once in 12 months, the 715 once in 9 months, or it could be a 703 or a 705, plus a number relating to other services given.
Last time, we commented on the lack of Indigenous Health Practitioners. That hasn't changed. Maybe we should scrap the clinic and have a yarn with people under the nearby gumtree. Would that change our impact? We certainly wouldn't be able to get the care plans done! Is it realistic to expect local people to come to work at 7.55am, sit in an office and share the consultation with a patient and a computer screen?
Having said all that, I'm sure we are helping. I met a teenager this week who talked about his family. His cousin plays football at an elite level in Darwin. He's pretty proud of him. This bloke can't do that. He had rheumatic fever when he was 10, and already has significant heart problems. He inspired us to want to do all that we could to prevent this sort of disease. And there are lots of good things happening. Some great strategies for health, good care of people of all ages, and really caring people doing it. It has to be worthwhile... But maybe being obsessional isn't always the answer.
A CareFlight arriving to take someone to Darwin for treatment
Tuesday, 10 July 2012
Back in Wadeye
We've been here a week. It's good to be back: so much is familiar. We're earlier in the season this time, and some of the gums are flowering, stunning orange blossoms. Little corellas screech and nip off the buds. It's been cooler overnight - rather nice. (but it's all relative)
We have 5 weeks here this time. It was great to have a week in NT before starting - we hired s campervan and enjoyed Litchfield National Park & Berry Springs, especially the chance to join with Tim's brother Nick and his family for Nick's 40th. Jerry came up as well. What a great time! Nick & Rosie looked after us really well, and how their 4 have grown! It was special to renew connections. Josh is into fishing, Matt is always seeing birds before anyone else and knows what they are! Zach loves crocodiles (not quite sure why), and Abbey makes friends wherever she goes.
So back to Wadeye. Some of the staff are the same, and also we new ones to meet. The team seem to be working well together, and morale is good. Saturday night we cheered for the clinic at a basketball game, Clinic vs Police - clinic lost, but tried hard! We had a BBQ together afterwards.
There are still no indigenous health workers, and I miss the opportunities this would bring: help with understanding people's issues, and help in explaining medical concepts of disease and treatment. This is important in all our work at the clinic, and I'm very aware of it - I'm working in chronic disease again this year, and I often feel the lack of communication skills. Part of it is basic language difficulties, but I know there's more to it. I'm still not sure how to "do" chronic disease, especially as I'm so short term. I feel humbled when people share their lives with me - it feels like an unexpected gift.
It's good to be back. We hope our being here is worthwhile for team and community. We appreciate the opportunity to slow down a bit in the work context, even though there are busy patches. We appreciate the working day finishing earlier, and evenings without the usual demands of home. We appreciate the beauty of the bush around us. We had a great walk on the beach at sunset last night, with some others from here.
So we will post!
We have 5 weeks here this time. It was great to have a week in NT before starting - we hired s campervan and enjoyed Litchfield National Park & Berry Springs, especially the chance to join with Tim's brother Nick and his family for Nick's 40th. Jerry came up as well. What a great time! Nick & Rosie looked after us really well, and how their 4 have grown! It was special to renew connections. Josh is into fishing, Matt is always seeing birds before anyone else and knows what they are! Zach loves crocodiles (not quite sure why), and Abbey makes friends wherever she goes. 
There are still no indigenous health workers, and I miss the opportunities this would bring: help with understanding people's issues, and help in explaining medical concepts of disease and treatment. This is important in all our work at the clinic, and I'm very aware of it - I'm working in chronic disease again this year, and I often feel the lack of communication skills. Part of it is basic language difficulties, but I know there's more to it. I'm still not sure how to "do" chronic disease, especially as I'm so short term. I feel humbled when people share their lives with me - it feels like an unexpected gift.
It's good to be back. We hope our being here is worthwhile for team and community. We appreciate the opportunity to slow down a bit in the work context, even though there are busy patches. We appreciate the working day finishing earlier, and evenings without the usual demands of home. We appreciate the beauty of the bush around us. We had a great walk on the beach at sunset last night, with some others from here.
So we will post!
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| the dry season burn |
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