Friday 27 May 2011

#21 - The Last Post

#21 - The Last Post

The time has come to put the blog writing on pause for a week.   This morning after packing, visiting Peter the crab guy, and Ron the AQIS officer to quarantine pass a couple gifts for the family , I climbed on board the Westwing island hopper and hopscotched from Saibai to Horn island. I swear the plane was smaller than the one that brought me, but I'm here at the Gateway resort on Horn Island, and feel a sense of relief that the planes get bigger from here on to Brisbane. 

Some special people on Saibai deserve a special mention. The nurses Teresa and Tyson AKA Bison. You made me realize that I still have that passion for clinical practice, you helped me shake my Emergency nurse hat, and wear the noble crown of public and primary health. I had a blast with your patience and patients. 
To the staff of the clinic, Mildred, Baiku, Cecelia, Audrey, Elva and of course Nellie, all who taught me about your culture, language, and ways.  I have been blessed and made so much richer for the effort you made to help me feel welcome in your community.
Tim and Dan and Peter, your company on Friday nights gave me opportunity to party and take light relief... I wish I was there for longer to go fishing and flying with you.

The underpaid , overworked, but relentlessly dedicated teachers at the local school, Cass, Bill, Vanessa,  and Sarah.  You made me feel like part of the school community and forging friendships with you was so special.  Friday night dinners will never be the same.  

Father Ron (my brother) our conversations, and your Sunday messages will remain a highlight of my journey.  One that taught me more about my relationship with people and my faith and my love of nursing, serving people and bridging the gap than any other thing I have done. you a a mighty man.

Finally little Paul. One day you will read this blog when you are old enough or when someone with a computer prints it off for you. When I visited your grand mother this morning, you hobbled out to see me and said I was your best friend in the world. Mate you made my day. You are a brave champion and I look forward to miss Teresa letting me know how you are going. Stay brave good man .

Saibai- yaawaw. 
I'd love to say I'll be back some day... But that is up to Him.
YaaWa

#20- the Final Count down!

#20- The final count down

As a kid I'd count down to something I'm looking forward to in sleeps.  Did you do that? 5 sleeps to Christmas, 2 sleeps till school holidays!!  Well old habits die hard, and my wife and I have been counting down the sleeps for when I come home.  For me that journey starts tomorrow as I board a Mosquito  sized plane and commence my travels south.
I am so looking forward to coming home, but leaving here is bitter sweet. I've fallen in love with nursing again. And whilst I am less than half the man here than I am when I am with my bride and kids, I really think I will miss this place.

   Last night at 2 am the distressed girl friend of a drunken assault victim awoke my slumber.  Her man had been knocked cold and was bleeding from a large laceration.  To be able to tend to him at a time when he had been beaten and humiliated in front of his Kin, was not an inconvenience (as it may have been in my jaded past) but this was an opportunity, to love fellow man. I stitched him the best I could, I tended his wounds and I eased his pain, and though I didn't finish with him til 6am despite a start shift time of 8, the experience was a privilege. 

This afternoon, two of the school teachers marched the year 2/3 class up to the clinic. They were armed with a selection of thank you drawings and letters, and in the middle if a talk I was giving staff on the management of the unconscious patient, 12  six to eight year olds tackled me with affection.   I was so touched to be honoured by them. 

Wow.  Made my day.
Tonight I'm making lobster with lime and Chilli, and a sweet potato/yam curry to share at our regular nurses/teachers dinner. I have loved my time here bit in 2 more sleeps, I'm with my people, and it will be a homecoming that I am so so looking forward to!  

Thursday 26 May 2011

#19- The Markets, malaria, and magic moments

#19- The Markets

Another massive day starts with an early call to a woman with a new case of Malaria. We have these little test kits in the clinic. A drop of blood is placed on a reagent strip, a developing solution is dripped onto the kit and in 15-20 mins you have a result. Much like a pregnancy test you'd buy at a pharmacy, quick, accurate and tests for all 4 strains of malaria.  
Well bingo. My first solo positive. It felt so good to be able to share with this girl why she felt so crook for 4 days!!!

It us relatively easy to treat. Surprisingly easy actually. Four tablets every 12 hours for three days following a protocol. I'll check on her in the morning, but she will have a couple of days of feeling sick to wade through yet. 

The markets came to town today. PNG villagers bring over boatloads of people and hand made goods for sale and trade. I bought a wonderful carving that epitomizes some of the culture here. Women make weaves pampas baskets and mats, mud crabs are sold for a song. Huge barramundi, mud clams, masks, spears and a host of other items are traded with tourists and locals.

Tourists??? You heard right... By tourist, I mean me. Telstra workers, nurses, teachers, tradesmen, and pilots. All short term stayers to the island are tourists.  In fact it is a bit of tongue in cheek really. There is NO tourism on this island. You won't see bus loads of Asian or European photo takers here.  Saibai has a raw, unspoiled charisma about it, and the fact that there is only one food shop, one clothing store and no maccas  makes it unique. Islanders go about their business caring for their island, without having to be anyone to anyone.  There is a sense that I should ask permission to pull out my camera, and I do. 

This afternoon a very sick PNG 5 year old was carried in by his dad.  I was really worried!! This kid was so hot (T=40.7) and dry that he hadn't peed (pispis) for 24 hours. I weighed this kid at only 18kg and he was white as a ghost.  A quick pass of my stethoscope revealed no air in his right lung. This boy had one of the worst cases of pneumonia I've seen.  After whacking in an IV and starting him on fluids, I rang the doctor on Thursday Island. Some Iv antibiotics, given and in just 2 hours, this kid had bounced back from the brink... I swear he was gonna code. 

That's it with children, they crash so fast, but add water and it never ceases to amaze me how quick they pack up. I wandered down to the water front where boat loads of PNG nationals are staging their nightly exodus, and there is my boy, laughing, singing and running with other kids from his village....awe struck.
I love this game!!!

Wednesday 25 May 2011

#18 - Queensland to win!!! My prediction

#18- Queenslander!!

Great day today. One of the things that is synonymous with this RAN work is preventative health. So armed with a kit full of goodies I was parked at the local school today looking in ears, throats, and at any sores or wounds.  Those kids that needed more comprehensive assessment had letters to their folks written and an invitation to visit the clinic at their convenience.  Just one of the strategies that is used to keep our future Queensland State of origin team healthy.

On that point. Fun and games as flags of both colours were flown on houses, cars and bikes. Kids were painted in blues and maroons coloured zinc cream, and the electric atmosphere of this whole village was exciting to say the least. Ribbing and practical jokes were abound as the banter came thick and fast between blue and maroon supporters. Tonight all hands will be on deck armed with suture kits and IV fluids... Just in case.  With the barge arriving and bringing alcohol for the canteen, there us a little anxiety afoot.

Still.... Go the Maroons!!!!!

An interesting afternoon pulling an inch long stick out if a blokes thumb. Splinter occurred more than 2 weeks ago, and the wound was protesting fiercely.  Ring block, fluclox and he should do well. Nasty!!!

Well that is about it for today. We are settling down to a feed of rock lobster sautéed in beer tonight, as the count down to the game is underway!

Queenslander!!!!

Tuesday 24 May 2011

#17 - Worms 'n' All.

#17 - Worms n all

Well Tuesday comes and is a day of reckoning for the intestinal parasites (worms) in the folks of the village. Armed with de-wormer and Albendazole I hit the circuit today and dosed everyone who has had an elevated eosinophil count in the last 2 months. I got those worms running scared. Mrs Enosa (one of our health workers) and I cruised the street (yes singular- only one road with houses) and dosed people, collected blood tests and generally got out into the community to do what has been termed "core business" primary health.  It was surreal sitting on the beach taking blood tests, visiting homes and getting out into the fresh air armed with charts and a detective like yearning to track down all the "health check up" dodgers.

Tomorrow as promised I'm down at the primary school and screening kids for those sores. Compliance with antibiotics is a massive problem in aboriginal and Torres Strait communities.  If you give a parent a course of antibiotics for bacterial infections, there are slim chances that they will finish the course, leading to resistant strains of the bugs that followup antibiotics won't kill. So the strategy is to seek the kids with infected sores early, and kit them hard with big doses of penicillin in the form of a nasty (and I mean nasty) IM injection in their bum.  The parents win because , by their own admission, aren't "hassled" by having to remember to give medicine 4 times per day.  We win because the needle is so big that it lasts for the a week - it is a virtual silver bullet!   The kids, though the limp out with tears and vengeance in their eyes win because their wounds heal and they dont end up on kidney dialysis or renal transplant in their 20s.   It is a big deal.  Wounds and scratched insect bites turn into festering craters called Tropical ulcers, that resemble volcanoes. So tomorrow , I'm off to school to screen the 90 or so kids....I might ask about worm symptoms since I'm on a crusade.

The supply barge made it here this morning after the week long trip around the islands with our supplies, boxes and boxes of stuff, some if which we ordered, some we didn't.  In the firm I am convinced it was "crockery coffee cups" we ordered 6. But the order form "number required" box was not items required...it was cartons of cups....whoops.  6 cartons of 24 cups arrived!!!  We ordered 10 metres of oxygen tubing and got 10 cartons of 10m rolls!!  Our new ambulance stretcher arrived also but they didn't take the old one. We just got a call saying that the old trolley is still sitting on the boat ramp. So we have one ambulance, and two trolleys, with no where to put the spare.   It is a comedy if errors. 

The sun sets on another Saibai day. The swell laps at the shore, the long boats of PNG nationals are drifting out with the tide, and tranquility settles on this island paradise.  Rest well Saibai, because come this time tomorrow night and the atmosphere of State of Origin football with it's electricity will shatter your silence, and we your nurses will be armed with gloves, drips, and suture kits to patch up your people when it all goes pear shaped. 

Monday 23 May 2011

Post 16 - Yumi tok ya- lost in translation.

#16... Yumi tok ya- lost in translation.

Have you ever been somewhere an felt like the only one that understands what you are talking about? Well that has been an experience that I am living with on Saibai. For the islanders here, An old language or local ya (words) Is a language called Kawaw Kalaw Ya (KKY). It is predominately spoken by the older folks with a common replacement being a broken  English or creole being preferred by the younger Saibai islanders.

That said, the language for day to communication, in my job here is English, however with such a strong accent, complex medical and medication instructions is difficult.  The kids here all speak a version of KKY , creole and English, and often the communication with people employs all three languages all in the same sentence. Challenging is  an understatement.
I love to speak to the health workers and give them the info, then sit back and listen to them weave my monolog into something meaningful to my patient. You can't help but wonder how much is lost in translation.  It is kind of like Chinese whispers you played as a kid.  The dynamic changes when PNG patients arrive - it's another language again.  Then something strange starts taking place.  You start to understand the lingo, then suddenly you find yourself speaking it.  Not intentionally, but automatically.  It's s bizarre thing. 

Now I can say phrases in many languages, but to switch a language on and off, without even having to think about represents somewhat a triumph. The weird thing is I can't do it when thinking about it, and a person has to start talking to me in creole first, then I just get it. 

Today, our receptionist was not well, so I spent the best part of the day filing and sorting out follow up appointments and pathology testing.  Tomorrow I'll head out to the village, armed with an esky full of gear and seek those patients that need medications, and blood tests.  This us one of the big differences here in the islands. Health care comes to them.  I have an amazing photo of me sitting on the sea wall ( I'll discuss that one in a moment) with a PNG patient giving an Intravenous Antibiotic. The backdrop of the Western point of Saibai and the Arafura Sea in behind us.  This community outreach is one of the things I love about this work. I'm not confined to a clinic or an emergency room, I get out and about.  The smiles on the faces of those I pass makes it feel that I'm doing a good job. 

Now the sea wall. The island is at best only 1 metre above sealevel. In windy days, or king tides the ocean encroaches onto the island and floods it. Some years ago the local council decided to build a sea wall that sits 2-3 feet higher than the island, and serves as a sam of sorts to stop inundation. The wall is in a state of disrepair and subsequently, water often homes in leading up to the full moon.  This leaves a huge low lying hollow in the centre to become a swamp. Like the hole in a donut, this hollow is a fantastic breeding ground for anopheles Mosquitos which carry malaria. Two weeks before I arrived there was an outbreak of malaria among villagers and the whole swamp was fogged twice to kill mozzies. The net result is that there have been none while I've been on Saibai. 

Well that is about it for this post.  Light on detail I know, but  it is not every day that the exciting stuff happens... Tomorrow is exciting the SeaSwift barge arrives. It will have supplies for the shop here, the school here, the clinic here, and most importantly the pub; which ran out of beer 3 days ago... Cliche I know, and I'm aware that the late Slim Dusty even sang about the Pub with no beer, but this is really happening... And it has been a tragedy of injustice!!!
All the town will be applauding the arrival of the SeaSwift, and I'll be waving the flags along side them! Bye fir now. Mipala tok yu later!

Sunday 22 May 2011

#15 - Matthew and the Starfish

#15- If there isn't enough for all, it is best that my people have nothing!

Church this morning. And I find myself in a blur of colour and sound as the choir of island voices blended with the hypnotic beat of the island drums offered praises and glorification to God.  Taking communion in someone else's church is a wonderful experience that unifies as all as His sons and daughters.

I've had a relaxing day watching chick-flicks and romantic comedies, but after seeing the multitude of ways that boy can win the girl, the last movie was an old Patrick Swayzee (? spelling) movie called City of Joy.  It journals an American doctor who goes to the slums of Calcutta India.  A corrupt godfather type figure opposed to the charity work of the medico utters these provocative words "if there isn't enough for all, it is best that my people have nothing."  Aid money pours into PNG but seems not to filter down to the villages on the fringe.  I was sitting on the shore here on Saibai last night looking towards the western point of our island with it's Telstra tower, TV aerials, lighting, the doofdoof music from houses dotted along the shore.  Saibai by night is very pretty.  Then I gazed over to the villages of Mabudawan and Sigabaduru on PNG. No electricity, no lights, no techno or hip hop. Just a faint glow of a fire on the beach there, and in the fresh breeze whispering through the coconut palms here, I could hear singing. I could hear laughter.  They have nothing, yet everything that matters.

The sense that the grass could be greener is one that plagues all of us that have seen it.  But in the simple cool of the evening breeze here, I realized that happiness is not the things you have.  I'm pretty sure that is is the influence that you have on people. It is the difference that you attempt to make rather than the success at making it.

In Matthew 25, verse 31 on, it talks to us about feeding the hungry, taking in a stranger, visiting the sick and persecuted. v40 Because you have done these things to the least of my brothers, you have done them to me.

City of joy, is all about that. It is what I am seeing here on Saibai daily. Not as intense, I'm not that grandiose, but service that exceeds simple nursing.  And I love it.

A colleague said there are only three types of nurses that work in places like this. Mercenaries here for the money (and it can be huge), runaways- those nurses that are escaping something or someone; and missionaries- nurses who want to save the world.

Well after two weeks seeing what I've seen and experiencing what I've experienced, I'd like to suggest a fourth category.  Nurses that just come for an experience that will offer some perspective... And that is me.  I have just 5 more shifts here in this amazing place. I will leave thankful for what I have, and blessed for what I have achieved, and devastated for what I couldn't do.  But far richer in spirit than the nurse that left Toowoomba just 13 days ago.

These blogs are for me to reflect. I tell my nursing students to journal, because penning your thoughts is cathartic and reading them back is altruistic. When I go from here to my next assignment, life will go on and the starfish will still be on that beach just 3 km away. But I'll know that I did what I did with right intentions, and that some will swim again.

Saturday 21 May 2011

14 - the Jack of all trades.

Blog 14- a long night tonight as another nasty assault at a PNG village spills it's human carnage across the water to Saibai. A poor woman who was septic from wounds that she received months ago, has resulted the need for a medivac. So after being at the clinic from midnight to 10 am on this day off I was thrilled to have a bit of time for a snooze. I'm still on call til 8 am, so praying for a quiet afternoon.

History. I had the opportunity to chat to Uncle Cedric this afternoon. An elder. He toldmme about the island in detail and the clans. There were 5 clans. Aik, crocodile, snake, emu and shark people. They used to live all over the island but some years ago the island was devastated by a king tide that washed the 5 clans away. In the spirit of community, it was decided to bring all the people together in one village. Some of the clans decided to relocate to the tip-of cape York (3 weeks by canoe) .  This community became to villages called Bamaga and Seisa.  Some of the old people on the island still use these names as their surname.  Each house in this village has the totem animal painted on their house to denote which clan is their heritage. On many house lots there are four or five families living in dwellings  all on the same block of land. If a villager needs our help and can't CRT themselves to the clinic, we go out in the ambulane and collect them from their home.  A medical door to door service.  It is a service and does get abused as a taki run. I just got a call from an old lady flying back to Saibai from horn island . She has asked me to collect her at 515 and drop her home. Well I'm not doing anything else so why not.

So far on this last 2 weeks I've been a vet, a midwife, a nurse, a coffee boy , a laundry maid, and now a taxi.... It kinda cool.

Ohhh I better go it's 5:10  ... I don't want to keep her waiting.

Friday 20 May 2011

Lucky 13- Handwashing, helicopters, and Handsets.

Another week down.  Celebration!!! A girl I've been called out to a few times this week , (PNG villager) and one who I've been trying to "sell" to doctors on Thursday Island, has finally left the island.  After temps in the low 40s all week, she developed an acute abdomen, and now the docs think it's abdominal TB. This poor kid (16yo) had only ever been on an aluminum tinny previously, and to load her and her mum into a chopper, with fear and excitement on her face was magic.  I am so relieved, I have watched her Hb drop from 57 to 31 in just 5 days ( Hb is the blood protein that carries oxygen around the body- in normal bodies it is 120-160 and is responsible for the red colour in our blood). So 31 is pretty bad!!! With TB the spleen starts to eat red blood cells which house the Hb.  She us now in s real hospital, and will get real treatment. I'm so happy.

Today I went to the school and addressed assembly. About 80 kids . I taught them three lessons. How to wash their hands and why. I left an alcohol based hand gel in each class. I also discussed the rummaging through the dump problem and talked about germs and worms.  Some of these kids are so full of worms and bacterial sores, that it takes really strong antibiotics to clear them out. The third lesson was about tropical ulcers. The smallest coral cut, scratched mozzie bite or skin scrape up here can become infected in no time, and resemble festering volcano like sores that discharge a fetid mucopuralent ooze. If not covered, the bacteria that infects them can infect surrounding healthy skin giving rise to rampant school sores.  These kids need routine antibacterial soap washes, and the sores must keep covered to minimize spread throughout the house. I told the kids this, and this afternoon at 3pm we got hammered at the clinic as children came in droves for ptomaines dressings to cover every spot!!! Primary health care gone mad. 

It is a long way from anywhere here, but I am ever so thankful for the telecommunications. My iPhone has access and without this these blogs would not be able to happen. Amongst the "lack of services" on this island, there us the stark contrast of bare footed people every where, and they all have a mobile phone... It is surreal. Im chatting to a group of kids under a coconut tree, and there are symphonies of ringtones going of all around me.  This place is truly a canvas brushed with colour.

Thursday 19 May 2011

#12-Christmas Clinic style

Blog 12- Christmas comes monthly.
For most remote area nurses, the day that the stores arrive from back ordering (medical supplies, pens, toiletries, toilet paper, pharmacy items, cleaning products , the list goes on), This day is a buzz with excitement as  cartons upon cartons are cut open to reveal pressies (supplies).  I grew up in a nursing world where you run out if stuff, phone the stores people and it is either collected by a wardie, or arrives the next day.  Out here, stick replenishment is so far and few between that it is like Christmas when stuff arrives.   I've never been so excited about loo paper! 

Another interesting phenomenon is laundry. When a sheet and pillow look soiled;) we strip the bed and wash the linen our selves. No linen baskets, just a washing machine and dryer in the clinic. In fact there us so many  tasks,  that because I've been working in big hospitals, I've been spoilt.  Rubbish. When a clinical waste bin is full, in good faith we nurses think it gets destroyed / burned. But not here. Council just dump it at the tip along side household waste.  This is a real problem, because with no playground in town, the local kids go to the dump and see what's doing.!!  One of the school teachers asked me if I could come to the school tomorrow and talk about the dangers if this play activity, and so, armed with antiseptic hand wash, 100 toothbrushes and toothpaste, and some free "boats- injection trays ( injection trays were turning up at school along with bluey underpads .... eeeeeeuuuuuww), I'll address assembly with some hand hygiene education and a talk on germs n worms. Then dish out a few freebees.
Public health is a big part of this job.  In my world of emergency nursing, you deal with stuff as it comes along.  The RAN nursing role is primary care.. Prevention of disease. There is a long way to go, but I expect health promotion activities from my students doing the RIPRN course, so this is a case of practicing what I preach.  It's kinda cool. 
There are 90 kids at the school here... Prep to year 7. All kids in high school have to go away to school, or home school. Different strokes for different folks I guess. 
And so ends another day, full if interesting bibs and bobs that I wind bore you with, but send by God no doubt, to teach me something.  Merry Christmas my faithful readers....I'm off to a disco tonight...(I hope her mother's not gonna be there!)!

Wednesday 18 May 2011

Blog- 11- worm your kids!!!

Day 11
This place is insane! I've just walked out after a clinic day where some patients have waited since 730 am. It is now 730pm!!! They need a doctor here more often. 
A baby with an awful cleft palate can't eat and drink because every time he swallows the food comes out her nose and she chokes. Cairns and TI speech / dietitians sent a special teat, but no food for a woman who can't afford formula for this child. She is 12 months old and is the size of a 7 mth old baby. Thank God for the angels at my church who sent 9 cans of formula today!  It should arrive in two weeks, and we should see some improvement.

A 7 year old girl came in with a haemoglobin of 20!  It should be 120-160 . Her blood was so thin that when I bled her it was like watered down rose wine. Her spleen and liver are highly inflamed and she is a walking worm and parasite farm.

I gave her 5 ml of this medicine, and 5 ml of that medicine.  6 different drugs in total and an ice block... She beamed.  She had never had one before and didn't know how to eat it (one of those water icy blocks in the plastic sleeve).  Her dad said "...this was the most food she eat in 1 week".  ....it WAS NOT FOOD It was MEDICINE!!!!

sorry for the short blog but 10 x 12 days in a row, have taken it out of me, and I'm having an early night... Until I'm called out!!

Do me a favor people, give your kids a feed and a dose of vermox!

Give to your local church... I'll be calling on them any day now!

Tuesday 17 May 2011

#10 - Too Bad so sad!!

A crazy busy day today as the Doctor came to the village for a clinic...All the complicated patients that needed their medication reviews, and annual Doctor type check ups.

My day was one where the harsh reality of being in a place that services some but not others hit home again.  I want to be strong for my wife when I ring her each night, but when she asks me "how was your day?"  there is a protective part of me that just wants to say "Fine"  and a little boy inside me that really wants to tell her how it really was.

A 9 year old boy came with a letter from a village across the water (PNG) today, He has been blind in his left eye for two years and arrived to have his eye assessed....He only has a cataract, An impressive one but still just a cataract.  It could be fixed permanently  with a 15 minute operation by an eye specialist, but because he is from PNG Queensland Health doesn't want to know him.  I suggested that the man should take his boy to Port Morseby to be treated by a specialist, he saddly told me that they cant afford the journey.  So after telling him that I cant offer him anything but a cup of coffee and a sandwich, and suggests that he goes home now, he turns to me and tells me that they spent all their savings on the Outboard motor fuel to get here, believing that once in Australia, we would help him.

What do I do with that??
It is gut wrenching!!

The day was another day of firsts.  I heard word that my lady with the retained placenta was doing well.  That was nice.  A small boy came in with a nasty, nasty dog bite.  One of the village dogs ( a mongrel with no owner/name) bit him.

This is the same dogs 8th victim.  I asked how this can happen with out him being put down.  But there is no council rules about dogs on the island, and no vet.  1 every year or so a vet comes across from Northern Territory to "clean up" the stray dogs, and left some "Green Dream"  in our drug cupboard for Just in case cases.  Well I put the case forward that this was such a case, and after a phone call to my own Vet in highfields to get some advice on dose and technique, orchestrated a task that I have never had to do.  We sent the dog on a Long vacation to doggy heaven....aided to by some expired valium in his "last supper" to make hime super sleepy, prior to me inserting an IV to administer the drug.

That pooch wont bite anyone else.  Humane? I will let you be the judge, I am placing the public safety ahead of animal rights on this one, and will sleep well tonight knowing that the village kids are a bit safer with this mut out of the gene pool.

It is 9pm and I have just had a call out to a sick baby with nasty ears.  First dose of antibiotics and a chance to log this blog in the mandatory waiting time.  After anyone is given an antibiotic, there is a period of time (usually 20 mins - half an hour) where they may have an allergic reaction.  At it's worst an anaphylactic reaction can kill someone in under 4 minutes.  The waiting game can be nerve wracking at the best of times, but when it is 9pm at night and you are 500 km away from the nearest "real"emergency department with doctors , bells and whistles, an anaphylaxis is a bit of a drama to say the least....even for a hard old bastard like me!!

As the business of this place soaks in, I ponder what my week would have been like had I stayed home, and whilst I miss my people terribly, my normal day job seams like a distant memory and a yawn encroaches on my face. I would not change my week for a moment.  There is something very cool about isolated practice, and frontier nursing.  There is something very satisfying about tossing one or two starfish back into the ocean, even if the beach is littered with millions.  As least I can make a difference to those few.  And that is what it is all about...Making a difference, and believing that no matter how small you are and how insignificant the task, you are loving the highest of His creation.

Send Chocolate!!!

Monday 16 May 2011

#9 - You want me to do WHAT??!!

# 9 - You want me to do WHAT?
Back at work after a relaxing weekend (well relaxing Sunday). It is not long before my first emergency call comes in. A 24year old girl from a village in PNG Is in a tinny on our shore and needs an ambulance. She gave birth at 10pm last night in the village, and has retained her placenta!!!! It's been 12 hours and she could be getting septic by the minute! 
I assess her, BIG cannula, two funny looking lumps on her abdomen... She isn't too distressed, but inside I'm sh1tting myself... Those who know me know I'm not a midwife... That is secret women's business as far as I am concerned, and but for the birth of my two, I've only ever seen one other baby being born.
So I ring the doctor... He was brilliant, talked me through the process step by step (i am thinking"You want me to do WHAT??!!" ) and warned me of the risk of bleeding.
I covered her with every antibiotic, some laughing gas so she would see the funny side of what I was about to do, and wham, I was in elbow deep, evicting the stubborn placenta.
Now those of you who are nurses or midwives, or even worldly types will understand the mechanics of what took place next.... For those that aren't, perhaps you should have a chat to your aunties and mums about where I went fishing, but the net result, is that with a firm hand,  a lot of sweat and prayer, I managed to extract that sucker, and wow!!!!! The enormity of it is just sinking in!
The poor girl had a nasty tear from the delivery last night, but after what she had just been through, (and I'd been through) the idea of stitching her up was the least of our worries.  Once that drama was over, the day was a breeze.

The day was punctuated by the usual malaria reviews, tropical ulcer dressings and fevers, rashes, ears and throats.  An impressive case if "red eye" came in a 5 year old girl. I have seen few cases of purulent eyes, but this one will stand out. It was full of yellow pus.  Mum suggested that she had just cleaned the eye, but it was full of pus again.  I'm thinking " yeah right" it hadn't looked like she had cleaned it to me; so I did it myself. I then went into the drug cupboard and collected her eye ointment and drops (Chlorsig), and by the time I had labelled the bottles with instructions, the eye was full of fresh pus again... It was amazing.  I've never seen anything so fast to purulate. Anyhow, drops, ointment, regular cleaning and I will review her in the morning. Sorted.

After lunch ( which was 2pm ) I have another ambulance call out at the waters edge... An old man is being lifted out of a dingy by some other men.  The story..." please yu help my father. He is having trouble with his pisspiss (urine). Family are telling me "Him no have pisspiss for 3 days!!!"
The poor old bugger had an abdomen that was the size of a 5 month pregnant woman!!! It is no wonder he was so sore!
I pulled a health worker in with me to translate while I passed a catheter.... Bang!!! I hit the jackpot- 2000mls urine.... The relief on his face was magic.  And I reflect on my day, and feel so blessed that God has put his trust in me to lead me through cases, and tasks I have to contend with here on Christine Anu's island home. The poem "Footprints" comes to mind. When I felt most alone it was then I was being carried!
What a great shift.

Sunday 15 May 2011

#8- Sunday in the Roman Paradise

Sunday in the Roman paradise
Well I wake this morning, and back on the job at 7:30. Today is my second day off (the clinic is open m-f) but the nature of seeing emergencies often requires that you do follow up and reviews, dressings and bloodtests.   Due to this malaria outbreak, any patient who presents with vague flu symptoms and a fever over 38.5 requires a finger prick malaria tests daily for three days, so we are obliged to do these, and part of the nature of this job, is that often these villagers won't return for follow up, so we go out and find them.
This work is so far removed from what I usually do, that it actually feels like a novelty.  

This took about an hour and a half, so after 9am, the day was all mine as I handed the on call "baton" over to Teresa, another nurse. And what a magnificent day it was too. Today for the first day that I've been here, the sun came out.  It was amazing. The water of the Arafura Sea was like a melted aquamarine gem with deep blue sapphires peppering the waters. Barramundi, turtles, reef fish and stingrays could be seen clearly, and a gentle breeze was whispering through the coconut palms... It was like a holiday paradise.

At 9:30 the church bells at the Holy Trinity were ringing to call villagers to worship. When in Rome you do as the Romans do, right??  So I went to church. 
It was incredible, all the women were wearing bright floral dresses, some of the elderly men in cloth skirts like a Fijian sulu. You take off your sandals before you enter and sit on wooden pews in a stone whitewashed church with beautiful stained glass windows.  At the centre of the mahogany raked roof trusses was a life size wooden crucifix with a Black Jesus, and two black angels blowing trumpets. 
The sermon was in creole which is a broken English spoken across the islands of the Torres. Whilst some of the sentences were lost on me I actually understood the gist of the message which was delivered with power by the priest. Good solid teaching about using your faith, not just having faith. A dear friend of mine Katrina, put it this way..."if your faith hasn't changed you then your faith hasn't saved you".

After the sermon, there was lots of singing and very loud wailing and whistling and some good old fashioned hymns, with and island drum as the only instrument. It was awesome. The voices of those nanas in mumus, was like a legion of angels singing... Man they can bang out a tune.

After the service, I decided to wander down to the boat ramp and jetty, and wet my line. I wandered down with one of the school teachers who i met at church and within minutes, we were surrounded by 9 kids aged 4-14 to teach us how to fish. One small boy called George put it best by saying..."Mr Rab (Rob) mifala know youfala know how to fish, but mifala will teachim how you catchem fish."  and boy could this kid catch fish. I was there for 2 hours and he and the other kids were pulling in fish after fish. Their bucked looked like an aquarium.
Me... Nada! Nil! Zip! But it was a great afternoon chatting to the local kids about fishing, and their customs and their aspirations.

Tonight I sit in my flat reflecting on the best day here so far. The icing on that cake, was a mice long chat with Jo and Ben and Amy.  I really wish that they could be here to experience this with me. It really is an amazing experience.

Tonight marks the end of my first week on Saibai. I have so many great stories and have learned so much already. I think to really feel comfortable here you need to immerse yourself in the lifestyle and the culture.  I'm trying my best to do that, but speaking Roman when in Rome is not as easy as I thought it would be... But I'm game on for the challenge!! 

Saturday 14 May 2011

#5-My third day- a day of contrasts.

A day of raw contrasts.
What is your definition of opulence? Ostentatious exorbitance? I have lived my life having thought it was the place you live, the clothes you wear and the exotic and expensive things that you eat.  Today I was humbled and angered by the contrast of the "haves" and the "have nots".
Here on Saibai the islanders enjoy a simple life, devoid of clutter, hustle and bustle, and the material things of metropolitan Australia. Some might even suggest that these people live in the third world. But these islanders enjoy health care at their beckon call. If they need to be flown by chopper to the mainland then "so it shall be done". Adult and child health checks are routinely performed, by us; primary health nurses. The service and resources offered to those villagers is better than the primary health we get in Toowoomba!!! Yet 3 km away on PNG, in Sigabadu, and Mabaduan, the clinic is non existent. On Duan, the bed is there with no mattress. There is no medications and the clinic has no nurse/ doctor or support. PNG nationals make the journey in over crowded dingies, with boat fuel prices that approximate $5/litre for their outboard motors. Those that can't afford fuel sail across in makeshift outriggers or converted tinnies with bamboo rigging... Just to access Our health care! For these folk there is no accommodation , no food, no access unless it is an emergency, and if they need admission but it is not urgent... Stiff !!
I had a man today, his wife and 20yo son. The man was 42. 1 month younger than me... He looked 62. He has been fitting for 3 days. . It took me 5 hours to work him up, diagnose and treat (very long story and impressive history) but the net result I'd that he is a brain damaged nursing home candidate, living in the PNG jungle with his family who care for him around the clock, with no resources, no phone, no clean water, no electricity, no Blue Nurse visits... Nothing. And when I had finished with him today... That is what I had to send him back to! But this man had no way of getting back to PNG, because there was no boat for him, the dingy he came across on has broken down!!!  After feeding him and his family (a no no!!!) and using our phone and car to look around the village for a local that might house him and his family for the night, I carried him into my ute, and drive him to this slum where he was put to rest on a plank of wood under a verandah.  And this is where he and his wife and son will spend the night in the pouring rain.   If he was blessed enough To have been born here ( just 3km away) , he'd have been an Australian citizen, and flown to a warm hospital bed in Thursday Island. My heart bleeds for his situation. A man my age, who was not blessed as I have been blessed.
Now before you get all "harden up Rob" on me.  Know this, ... there us no way, that having seen what I've seen today, that u can tell me that there us justice or fairness and equity in this world.

I bought a fish of a villager today. It was 20kg Barramundi. I bartered the price down to $40. That same fist in Brisbane fish markets would sell for $15-$25/kg ($300 - $500).... Now that is opulence. This $40 dollars  (I earned in under 1 hour) will feed that family for 3 weeks, of flour, rice, sugar, and other staples. So I have a dilemma; did I do these people a favour? I feel like I ripped them off, yet they are feeling they won the lotto.
I know I'm rambling, but I'm unsettled tonight, and when I reflect on my day, I feel a bit sad, and a bit lonely, and a bit culture shocked, and a bit angry with natural injustice, and a whole lot blessed for what I have.

Friday 13 May 2011

#7 - The Day off...NOT!!!

A lovely evening last night (Friday). I invited the school teachers, Crayfish man and a couple of Chippies to the flat for one of my curries.
A Dahl, and that Barramundi I wrote about stewed in local fresh coconut, with my own blend of spices. I was , for me, a touch of normality, and an escape from a busy week on Saibai. The house full of white folks talking english and speaking about their work, interests, challenges, aspirations. It was nice.

The consumption of locally made PNG whisky and Rum, made for a difficult rising, this morning, and being on call today (Saturday) has tested my intestinal fortitude. My first call out was at 0930 ..a PNG man whom I have asked to stay on Saibai while I treat him with IV antibiotics for an abscess, has knocked on the door to the house. He asks for my help as his wife and 4 year old son have no food to eat, and are very hungry. This is not part of the job, but when I reflect on the extravagant meal I had last night, and look at this man's situation where he doesnt even have a slice of bread to feed his famly, I ache.

Ive raided the clinic fridge and the friut bowl in my flat. I am reminded that of that proverb that I can give a man a fish, to feed him for a day, or i could teach the man to fish and feed him for a life time....I am thinking....I just dont have time to teach him to fish!!!
Vegemite, butter, crackers, corn thins, 3 apples, and half a loaf of bread. It isnt much but to him and his family you would have thought that I had brought them a three course meal. I guess you just have to take Caring, one step further in these circumstances.

A few home visits and some malaria tests to run in the village, and I have my next patient. A 16 year old girl who has a temp in the 40s. She is so sick that it takes me 5 attempts to secure an IV line, and give her some fluids. I check her lungs...Crackles, and wheezes. I check her urine...Pea soup. I check her blood sugar - 2.8 (should be 4-8). I check her Haemoglobin = 6.5 (11-14 is normal)
This one is as sick as I have ever seen. although a PNG national and very dark skinned...she looks pale, like she has been diluted. She is breathless and I am thankful that Tyson another nurse is here to collaborate. We have to call the doctor in Thursday Island for this one, but with someone so sick , and from PNG the y wont retrieve her. Makes me feel a bit lonely.

It has gone 2 pm , and the normality of a dinner party last night seems like a distant memory. Ive been in the clinic for 5 hours on my day off, and i cant see myself leaving any time soon.

Before you ask...This blog is being written while I wait for an Intravenous antibiotic infusion on my girl to finish. I am sure she'd say Hi, but Im not sure that she's ever seen a computer before.

......Livin the dream.....
If you are reading this.....you are so blessed beyond your wildest imagination.

#6- consults with ocean views

Consults with Ocean views. I've looked in more ears and throats in the last two days than I had in the previous 2 years. A big difference with this health care model and that in mainland Australian metropolitan areas, is that, here I need to be paternalistic. Now I think I'm good at that. " let me TELL you what you should do..." but providing health care here is a whole lot more..." now you listen to me!!!" Treating kids with throat infections, ear infections, infected boils and sores requires that once I've given an antibiotic, they must come back to see me tomorrow. This is no different on the mainland, but here, reliability is very poor, so part of my job is to grab a local health worker and jump in the ute, and go find the kid to bring them back to the clinic. I feel like a street sweeper / beachcomber. I had heard this before I came up here. And I had mixed feelings. I've always thought "I'll meet u half way, I'll give u care, but u must turn up to appointments and take some responsibility!!" . but now I am immersed in the job, I see that this outreach is good for me to get a glimpse at their life and promote trust from the locals. It is also damage control. The simple skin infections, scabies, tonsillitis needs heavy survalence or the Bacteria that causes these infections can cause severe joint, heart and kidney failure. This condition is Acute Rheumatic fever, it is the biggest killer of indigenous children. It is only seen in third world. If we don't fetch these people for check ups, they can get very very sick. With horrible heart disease and jerky fitting like movements. Some kids come back to the clinic for followup checks, but I collect those who don't! It gets sad when you have to comb the beach, and dingis/ boats for people who slept there overnight because they had nowhere to sleep. Most PNG nationals can stay with locals , but often a mum, dad, and 2-3 kids are all sleeping under a tarp in a metal boat, with their sick child. I sometimes just do the check up on the beach so I don't have to feel the gut wrenching guilt of sending them back to nothing. ... But they are happy! So happy to have so little, and so appreciative for anything you do. It is a good job! Loving your neighbors .

Wednesday 11 May 2011

#4 - An Alien world

The orientation to an alien world
Yesterday, the plane takes off from Horn Island.  It is small, loud, and somewhat intimate as 5 ladies (vying for a spot on the next ‘Biggest Loser’) cram into the plane.  Window seats are also aisle seats and as the indignity of having to be weighed with my baggage, is processed in m mind, I am thankful that I was perhaps the lightest on the plane.  I am not too sure if that is a blessing or something to fear, as I ponder the physics of getting this bird, with all its inanimate and human cargo, airborne.

None the less, we are up and away with short 10 min flights island hopping, all the way to Saibai. The views are nothing short of spectacular, and I am kicking myself that I had just put my camera away when I see a magnificent pod of 18-19 Dugong basking in some shallow waters. 


We arrive on Saibai Island, some 3-4km from the PNG mainland.  I am picked up by another nurse and the facility manager.  It is a dirt track 300m from the hospital.  The Island resembles Vanuatu, the people, the smell, and the vegetation.

All the homes are up on stilts as when the king tides come 2-3 times/year, the whole island floods.  I met a local bloke known as the fisherman.  He houses a pet salt water crocodile in his back yard.  I immediately think, “today is going to be a day of firsts”.

All the homes have elaborate paintings of a totem animal, crocodiles, fish, dugong, cranes, stingrays.  Each picture represents that this hose houses families from specific clans.  It is a way that relatives can identify one another.  As I learn more about this I will blog it, but for now, these pictures work like numbers on our letterbox.  So and So might live at the Emu house on the Western side of the village…no street names.  The other strange thing is that they bury their dead in the front lawn!!!  Huge tombs and head stones right in the front yard!!

The language is a creole, sort of like the broken aboriginal English, pidgin, and Bislama of Vanuatu all rolled into one.  When hearing it slowly and is actually easy to understand, but seeing it written down, it looks chaotic, and illegible.  The health workers all speak a couple of versions of KKY, Pidgin, and English, and so can translate complex instructions to patients for me.

The PNG nationals that live in southern villages on Papua New Guinea, frequently make their way across the water in tinnies and make shift sailboats to trade and seek health care (a treaty exists).  The photo is sunset tonight, looking west across the water from my accomodation..


At this hour, I have been here two days.  Day 1 allowed me to orientate to the clinic and the island; today allows me to fly solo with some of my own presentations.  It was a day of firsts.  Sitting in my ivory castle desk job in metropolitan Toowoomba, I am so far removed from the third world health concerns in our own territory.

Today I saw, malaria, acute rheumatic fever, Tuberculosis, and leprosy all before lunch.  Ive nursed for 25 years and never seen these conditions for real, as my patients. The day before I arrived, they had a few cases of Cholera aged 7 – 41 years.  We are on watch for new Cholera, Malaria, and TB cases.


My day started with an early  call out to an assault.  Some boys fueled up on a homemade 70% proof Rum, they call wine, and decided to have an argument about a girl.  It required iron bars and star pickets, but the end result was one bloke with a broken wrist, and my guy with a laceration on his back, head and chest.  This was my first sutures for the trip.

At lunch time I was starving, so I bought some fish on sale at the waters edge, filleted them and cooked them up for a feed.  Yummo!!! A bit of chilli, Cous cous, lime and fresh coconut to poach the fillets, and I could have been in some schmik seafood restaurant in Brisbane.

It is now 7:30 on Wednesday.  It has been a massive day, and I am on Call tonight.  So I tend this blog, and trust that reading it is at least half as interesting for you as living it was for me. 

This is truly an alien world.

Monday 9 May 2011

Blog 3 - The Gateway.

The Gateway Outside the Horn Island international airport (yes that's tongue in cheek) there are two huge fuel tanks. The type that you see on the back of petrol trucks. An old house falling down and a massive sign that warns " Don't ask here about fuel deliveries. Fine $400! No exceptions" It oozes "we don't ask questions here on Horn." and that is the theme which awaits us here.
 
What goes on tour, stays on tour. Sit down, shut up, hold on, and deny you saw anything.
 
I've arrived on this relatively large island of the Torres Strait. After an age the boyz had unpacked the plane, and we were able to collect our luggage, we boarded a bus that had lost a suspension airbag or spring on one side, and only had 2 gears...1st and 4th. We grinded, crunched and leaned, at times feeling like we were going to tip over into the accommodation.
 
A modest setting of besser brick and fibro, with a huge bar reminiscent of Tangalooma resort in the early 1990s. It is not hot, but definitely a far cry from the drizzly Toowoomba I left that morning. The air is thick with humidity, and the small airconditioner in my room is like a welcoming old nana with a big hug.
 
The room is nice. Old, but not any more run down than others I've stayed in... Oh did I mention that the air conditioner worked!!! We are informed that dinner is on at 6:30. And that chicken was on the menu. Chicken three ways!?! That sounds like some native fertility ritual. I wasn't sure exactly what chicken three ways was until I saw it simply meant drumsticks, wings and something you might call a nugget with some imagination. Accompanying chicken three ways was potatoes three ways (mash, chips&wedges) with gravy three ways (brown, brown with bits of onion, & brown with lumps) The desert cakes were yummy and by not thawing them out fully, one got a sense of what it might have been like if they had served it with ice cream.
 
There are a group of Telstra boys staying. Overnight and heading off to various islands in the group. They have been drinking at the bar ($8.50) cans of rum and cola, for 3 hours, and are getting a bit noisy. One of them asks me where I'm going in the morning, and when I reply Saibai island.... There is a awkward silence suffixed by a unanimous laughter. I'm feeling a little worried. That "going to the dentist" kind of worry! So it is now 5:27 am, I'm awake and getting organized to fly to the dentist (Saibai). I'll blog tonight after my official day 1.

Airport Musing

Attack on the senses.

It is just after 8 am. Im at Brisbane Domestic which lives every bit up to its name. Whether it is the overly spiced Thai Tom Yum soup I am attempting for breakfast, or the touch of the greasy food court tables; it may be the bagpipe-like drone of a million conversations around me, or the click click clicking of the whole population of the airport texting off messages to the faceless multitude. It could be the aromas, nay the odours of half trained baristas attempting to make that perfect pre-flight skinny half strength decaf soy mocha latte, or it could be the illumination from flouros with starter motors log past their maintenance schedule for replacement, but this place can only be described as some 21st century psychological torture chamber on my senses.

The journey begins with an iPhone alarm sounding 4 minutes after I had actually woken at 3:30. why is it that we rely on devices when our body clock , supercharged with nervous energy, was always going to ensure I was awake anyway? Or haven’t I slept yet? Who knows.

The princess was woken for a last good bye cuddle. The prince stirs and calls out “see ya Dad”, it is music to my ears. The 15 year old usually needs a sternal rub or Trapezeus twist to arouse teenage slumber, yet, here in the peaceful house with the hypnotic beat of rain on our tin roof, all my people are awake to see Dad on his journey.

The Bus, due to arrive to take me to airport at 4am, has gotten itself bogged to the axles in Oakey. A taxi is called to transport me to Toowoomba, to meet the bus’s replacement.
The Toowoomba bus transports 6 irritated and overtly inconvenienced travelers waiting for me to the 2nd coach waiting for us in Gatton. I sit at the front with Warren, the driver. 6 pairs of eyes hot with distain are boring into my back, and I am thankful that we live in a land with tight gun laws. Like I bogged the bus!!!

We arrive at the MacDonalds in Gatton, where a coach of 15 more travelers are waiting for our hook up, and the journey to the airport is underway.

I boarded the coach and sit next to a delightful lady with a familiar and distinctive voice. We got chatting and she is off to New Zealand to visit Duncan, her brother and his children and their children in the North Island. Pleasantries are exchanged , and then the inevitable questions around vocation and personal interest encroaches on our conversation. An avid gardener, and owner of a nursery in Pittsworth, with a passion for heritage roses, and a lifetime of expertise on all things horticultural. The woman is none other than Penny McKinlay from the ABC gardening talk-back show on Saturday morning. We had the loveliest chat for the 3 hour trip to Brisbane.

One look at that Ipswich road , and Western Freeway, as reminder enough of why I live where I live.

So here I am after a morning of adventure, a trip on 3 vehicles and I have not boarded my first (of 3) plane. From the peace and quiet, of Meringandan (my sanctuary), to the audtory, gustatory, olfactory, tactile and visually insulting Brisbane airport. I feel like I have done a whole Day, and I haven’t even left.

Saturday 7 May 2011

The Day before it all begins

It is may 8th 2011.  Ive just spent a relaxing morning at home with Jo and the kids having packed my suitcase for this , the longest trip away from family that I have ever spent.

As a nurse educator teaching Rural and Isolated practice nurses, I feel well equipped with a multitude of skills. Ive worked in the biggest of emergency departments and intensive care units in metropolitan tertiary hospitals.  Ive worked in the interesting field of hyperbaric nursing, and Ive enjoyed the fantastic experience of helicopter retrieval nursing.

Ive worked in rural and remote locations in western Queensland where the desert meets civilization, at places like Quilpie and the Yowah Opal fields RFDS clinic, and my involvement with the Australian College of Emergency nursing has taken me all over Australia and New Zealand teaching Trauma nursing .  So what is the final frontier for me??? 

Ive never been to Cape York, and nursed in indigenous communities.  So when an opportunity came up for me to work on Saibai Island and Darnley(Erub) Island in the northern and eastern Torres Strait; it was one that was too good to pass up.

This first entry is the beginning of what I hope to become a running journal/diary of my experiences, good and bad, happy and sad.  I warn the reader that they may be raw, and rough, and at times full of jargon.  But they will be real, and honest.  Those of you who know me will see me in these blogs.  Those that dont, will perhaps get to know me a little more than you do now.

So...I am packed.  I think!   I think I am packed.  I think I am ready.  I am excited, but scared of what will transpire.  That age old fear of the unknown.  I am so so thankful to my bride, and best friend Joanne.  The mother of my children, who on this day (Mother's Day) is bravely going about her business, and putting on the positive face.  I know that she is dreading me going .  I know that she already misses me, but all that stuff is unsaid, and I am ever so thankful for supporting me on this adventure.  She is an amazing woman, and my rock.

At 4am, the Airport flyer will pick me up, and take me to uncharted waters.  I will fly to Cairns, and on to Horn Island, and then Tuesday....I am off to my first assignment to Saibai Island located 3-4 km south of the Papua New Guinea mainland.  I invite you to come with me (Timmo)
as I go

...   Over the Top!!