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