#39
The Penultimate day on Darnley started with an ABC radio interview as a follow up to one I did when posted in Saibai. It was a surreal moment waiting on hold while David Illifffe was reading the miserable weather forecast for Toowoomba and surroundings ... I was sitting on my unit verandah, in 28 degree comfort, nice breeze blowing from the ocean in my front yard, and watching the island dogs taunt something in one of the rocky fish traps .
A million miles from anything that closely resembled winter.
I arrived at work and again packed an Esky for my Immunisation out-clinic. with 50 Flu Vaccinations in my kit, paper work, anaphylaxis kit, ambulance, and a spring in my step, I preceded to jab away till my esky was spent.
One of my facebook buddies (a nurse who will remain nameless) commented that this was about 45 mins work, and what was I going to do for the rest of my day...??? Well Andy, the rest of the day was that most noble of time wasters; the documentation! I swear that the routine immunising of people is so stitched up with red tape that there is no wonder that immunisation nurses have to complete a special course!!! 1 day on immunisation, and 5months 3and a half weeks of paperwork....sheesh!!!
On my return to the clinic, it was Annie our permanent nurse's turn to fly off the island. Her and Chris her husband left to catch the flight, and was to be met by Juerg, our swiss doctor. You have to see the Calendar in Juerg's office...It is photos the village in the Swiss Alps, from where he came just a few months ago. I am not sure if he knows what he is in for during the Torres summer!
The rest of my day was punctuated with minor procedures, dressings, sutures, digging out 'something' from a girls foot. Something that she stood on a month ago and which is now oozing something that looks like it crawled out of my 16 year old son's sock drawer. Nothing that an incision, a toothbrush scrubbing, and industrial strength antibiotic, and an exorcism of what was at one time, probably a form of vegetation, embedded deep in her foot.
My couple (See earlier blogs) who during a disagreement about who He should be texting on his phone; returned also today. It was lovely to see them walking together, chatting, laughing, to have their sutures removed. But, I notice that in our culture (I am a Kiwi born white Australian with British heritage) a couple will often walk hand in hand. That doesn't happen in the islander culture. I cant recall having seen one couple showing public affection towards one another. Public affection towards babies, and small children is open and lavish and flamboyant. Toddlers and babies are showered with kisses, by Aunties and Aka's (old women), but spousal affection is not seen.
Tomorrow is School sports day. I have a new nurse to collect from the air strip and orientate. Then I will take the ambulance and some first aid gear down to the school "just in case". The kids have been practicing their island dancing and singing for weeks, so whilst they probably really don't need me there as first aid...I really want to go for the spectacle, and photo opportunities.
I reflect on the job I am doing here and to be seen out in the community, builds relationships, and trust. Often up to year 7, these children only ever come to the clinic to see a nurse if they need antibiotics for a tonsillitis, or infected wounds...then it is a shot in the bum. The may only see us for their immunisations, then it is a shot in the leg, and or arm. To the children, the Nurse is someone pictured as a needle giver, and to see us in a different light - fishing on the jetty, walking down the road, playing marbles in the dirt, exploring on the reef, or just sitting outside the shop chatting to the adults, then I think that that goes a long way to expel the misconception that I am a bad guy....Slowly slowly, I feel that I am getting through...Saibai was the same. You just feel that you have developed that trust, and Im on a plane and flying home.
Today I made firm plans to bring my family up to the Torres for the experience, 1 - for my kids to see a different side to Australia / Queensland. 2 - because a change is good, and no risk means no growth. and 3 - because I really believe that being here for longer, and with my family by my side, I can really contribute to these communities. This exercise was meant to be a short 2 x 3 week stints, and it has left an indelible mark on my life, and my ambitions, and my direction. There was never any intention of coming here for more than this 6 weeks that ends tomorrow, but when all is said and done, Ive been bitten by the Torres Bug, and my ever adventurous bride and children are dead keen to sample the life up here with me.
I am wrapped that this wonderful organisation has offered me this opportunity, and also offered me the opportunity for my family to come with me to Badu Island in August, as I again go...
Over the Top.
Timmo goes Over the Top. ... the title refers to the fact that The Torres Strait Islands are off the northern most tip of Cape York Queensland Australia. ... In May-August 2011. Rob Timmings took a clinical sabbatical away from his Teaching and desk job, to get his hands dirty again working as a Remote Area Nurse (RAN) in 3 remote Islands in the Torres Strait . Saibai, Darnley, and Yam Islands. This Blog is the journal of that experience.
Thursday, 23 June 2011
Wednesday, 22 June 2011
#38 - Black out
#38 - The Black out
Well they have been talking about it for a while...The flash new generator. The fortnightly quality checks require us to go out to the shed, and test the generator, fuel, water, oil, switches, battery condition. The Island has a good power source, and so does the hospital. The telephone and communications, computer system and PABX all rely on a continuous supply of electricity. For safety the computer and PABX system is connected through a UPS (uninterrupted power supply) system as added insurance.
Well this tale started last week. A power surge caused our UPS system to start beeping. The beeping was an annoying high pitched tone emitted every 3 seconds, and after a week of it beeping had become white noise. Though it signified a problem in the Big electronics box out the back of the clinic, it had been reported but every thing seemed to work, so it's urgency to be repaired or even looked at was considered low priority.
Last night sitting in this very spot, the power to the island went down. Nothing. No radios, no TVs, no lights. Even that bloody UPS beeping had stopped. Bliss. Pitch black, dead quiet, just the breeze through the almond trees, coconuts and banana palms. The waves gently lapping at the coral.
It was an eternity but probably only 15 seconds or so, but the Hospital generator kicked in, and lights, TV, and air conditioners blinked to life. I breathed a sigh of relief. If the generator had failed then all the Vaccines in the fridge at the clinic would have needed to have been packed in an esky with ice packs, and required hourly temperature monitoring over night. So you can imagine my delight when that generator came on, and injected a spark of life into the clinic.
I booted up my computer where I was updating this blog, and the computer wouldn't connect to the server. I made a cuppa, and tried again...nothing!!! Now there is not much more lonely a man can be without company , beer and internet!!! Facebook and this blogger has been my contact with the outside world. I rang my family at home, to let the princess Amy know I wouldn't be able to chat to her on facebook that evening. Phones were dead. Our phones in the clinic and units are PABX digital phones, that use the computer system, and in the power surge last week that damaged our UPS, then the blackout and Generator boost that occurred last night, our telecommunications were fried.
Then a chilling thought. If I cant make a phone call out, and I had a sick patient; how was I going to contact the medical team at TI to commence a Medivac?? There is no mobile service here, so that was not a go.
These challenges are all part and parcel for a Remote Area Nurse, and I was thank full that when the going gets tough, I can always fall back on my assessment skills, and primary and secondary survey.
If I just maintain an Airway, Breathing and Circulation, then no one dies. It seems to simple, and I have been teaching these principles of "Pink is good, and Blue is bad" for the best part of 1 and half decades, yet in my isolation that evening, there was a twinge of anxiety as I had to give myself my own pep talk.
ABC..as easy as 1 2 3.
You know, I have spoken to so many young nurses who claim that they couldn't do this isolated practice Remote nursing. They are scared of what they don't know, but at the end of the day, you just do your best, and follow those fundamental principles, and if you can just maintain ABC, then you deliver a live patient. It is sometimes 8-12 hours before assistance and medivac can come. I know in my heart of hearts that what I do is not special or even specialised, and whilst I do have experience and skills, it is the basics that helps me to thrive here in the face of adversities.
I will look back on all these experiences as fertilizer, for the garden that is my career...Grow little jungle...grow.
Well they have been talking about it for a while...The flash new generator. The fortnightly quality checks require us to go out to the shed, and test the generator, fuel, water, oil, switches, battery condition. The Island has a good power source, and so does the hospital. The telephone and communications, computer system and PABX all rely on a continuous supply of electricity. For safety the computer and PABX system is connected through a UPS (uninterrupted power supply) system as added insurance.
Well this tale started last week. A power surge caused our UPS system to start beeping. The beeping was an annoying high pitched tone emitted every 3 seconds, and after a week of it beeping had become white noise. Though it signified a problem in the Big electronics box out the back of the clinic, it had been reported but every thing seemed to work, so it's urgency to be repaired or even looked at was considered low priority.
Last night sitting in this very spot, the power to the island went down. Nothing. No radios, no TVs, no lights. Even that bloody UPS beeping had stopped. Bliss. Pitch black, dead quiet, just the breeze through the almond trees, coconuts and banana palms. The waves gently lapping at the coral.
It was an eternity but probably only 15 seconds or so, but the Hospital generator kicked in, and lights, TV, and air conditioners blinked to life. I breathed a sigh of relief. If the generator had failed then all the Vaccines in the fridge at the clinic would have needed to have been packed in an esky with ice packs, and required hourly temperature monitoring over night. So you can imagine my delight when that generator came on, and injected a spark of life into the clinic.
I booted up my computer where I was updating this blog, and the computer wouldn't connect to the server. I made a cuppa, and tried again...nothing!!! Now there is not much more lonely a man can be without company , beer and internet!!! Facebook and this blogger has been my contact with the outside world. I rang my family at home, to let the princess Amy know I wouldn't be able to chat to her on facebook that evening. Phones were dead. Our phones in the clinic and units are PABX digital phones, that use the computer system, and in the power surge last week that damaged our UPS, then the blackout and Generator boost that occurred last night, our telecommunications were fried.
Then a chilling thought. If I cant make a phone call out, and I had a sick patient; how was I going to contact the medical team at TI to commence a Medivac?? There is no mobile service here, so that was not a go.
These challenges are all part and parcel for a Remote Area Nurse, and I was thank full that when the going gets tough, I can always fall back on my assessment skills, and primary and secondary survey.
If I just maintain an Airway, Breathing and Circulation, then no one dies. It seems to simple, and I have been teaching these principles of "Pink is good, and Blue is bad" for the best part of 1 and half decades, yet in my isolation that evening, there was a twinge of anxiety as I had to give myself my own pep talk.
ABC..as easy as 1 2 3.
You know, I have spoken to so many young nurses who claim that they couldn't do this isolated practice Remote nursing. They are scared of what they don't know, but at the end of the day, you just do your best, and follow those fundamental principles, and if you can just maintain ABC, then you deliver a live patient. It is sometimes 8-12 hours before assistance and medivac can come. I know in my heart of hearts that what I do is not special or even specialised, and whilst I do have experience and skills, it is the basics that helps me to thrive here in the face of adversities.
I will look back on all these experiences as fertilizer, for the garden that is my career...Grow little jungle...grow.
Monday, 20 June 2011
#37 - Needaliddle-needle
#37 - Needles!!!
If I never see another bum that needs a needle this side of next week it will be too soon. Oh my God I need debriefing. Today being Monday, it was needle day. I sweare that a bus load of kids pulled up out front and started a wailing chant of wimpering for what was to come. I have been talking about these kids that get purulent sores and tonsilitis, infected with Group A Streptococcus (GAS) developing Rheumatic Fever. The scourge of this is that they need a monthly injection in their bum. A painful, large, white satanic injection, that was invented purely to give credibility to the expresion " you have to be cruel to be kind!"
Well today was LA Bicillin day at Darnley Health centre, and while Annie was completing a stock take and a pharmacy order, I set about doing 4 year old immunisations, and a heap of LA Bicillin shots. I armed myself with a box of colourful stickers, a brazen attitude and a good strong arm, and jabbed anything with a pulse. After the first 7 or 8 kids, I got used to the gut wrenching cries as these poor darlings, heard their names being called from the waiting room. This injection for you non clinicians, or remote nurses, is thick white syrup that has the look and consistency of semi-dried liquid paper. It has to be given through a 21 G needle which is 1-2 sizes bigger than the needles that are usually used for injections. It is slow to give because of the viscosity, and after about 15 sec, you are still only half way through the syringe. By this time they are already crying, and biting on the pillow.
By midday, I had the hang of it and must have looked and behaved as battle hardened as the most barbaric of warriors, because kids started to realise that resistance is futile, and they were getting their needle by hell or high water. I remember during my immunisationcourse back in 2004, hating giving needles to children. Well there is a whole new level of hate now. LA Bicillin day on Darnley...Nasty business.
On another tack, I have tried to make these blogs not just personal and interesting as a diary read, but also informative. Today I learnedmore about some island culture. Child gifting and Tomb stone opening.
The practice of child gifting is common on the islands. A couple may be given a baby as a wedding gift by a sister or sisterinlaw, cousin or other family member. It is an informal adoption process that allows for deep familial links and genetic ties to become blured. If my wife and I had two boys and my sister had all girls, we might feel sorry for them that they dont have a son, and so should my wife have another child , and that baby was a girl, it would be given to my sister so she could have one too. In many respects it is a lovely gesture, but the legal paperwork (if it is ever done) must be a nightmare.
A second practice I learned about is what occures after the death of a relative. In islander culture, the immediate family are informed of the death by the inlaws or an uncle. Should some one 'Pass away" (islanders dont use the word died), then a health worker will find the spouses family, who will be told first, and it is then up to the family to inform the dead patient's wife and family. This starts a time of mourning, where the immediate family are cared for and fed by the inlaws, sometimes for weeks after the burial. Months (sometimes years down the track) the family of the diseased purchase a tombstone, and lay it with the deceased's body. The shrouded tombstone is then opened or unveiled at a massive (and I mean massive) party where everyone who knew the deceased comes to celebrate their life. The party is called a Tombstone opening, and can start in the middle of the day with a preparation of a feast of island food, whole turtle, dugong, and pigs roasted in a Kupmurrie, or gropund oven. Feasting goes into the night, and then when all are full, dancing starts around midnight, and goes through till daylight with a hypnotic trance like troup of dancers, and singers all chanting melodically to the beat of the Kundu (island drum). I have not been to such a spectacle as yet, but others who have wittnessed and videotaped them, say it is a sight to behold. Now Midday to Dawn...now that is a party. During the men dancing, women come out and spray the men with purfume and douse them with talcum powder, as by morning the dancers, fully clad in warrior costumes with spears, arrows and the characteristic Dhari (head dress) are covered white with powder. It is a mark of respect, and all to honour the life of 1 person. I cant wait to have an opportunity to see it first hand.
Well that is it for another installment, as I criuse to the end of the third week, and my last on the island of Erub.
I love the feedback that you have given me as I blog these journeys of discovery. I am a little humbled at the number of hits, and with just 5 more sleeps before I see my family again, I must admit that staying committed to this daily task has not been easy, but os so rewarding, and with out your great support through email and facebook, I would probably have stopped writing these after Saibai.
If I never see another bum that needs a needle this side of next week it will be too soon. Oh my God I need debriefing. Today being Monday, it was needle day. I sweare that a bus load of kids pulled up out front and started a wailing chant of wimpering for what was to come. I have been talking about these kids that get purulent sores and tonsilitis, infected with Group A Streptococcus (GAS) developing Rheumatic Fever. The scourge of this is that they need a monthly injection in their bum. A painful, large, white satanic injection, that was invented purely to give credibility to the expresion " you have to be cruel to be kind!"
Well today was LA Bicillin day at Darnley Health centre, and while Annie was completing a stock take and a pharmacy order, I set about doing 4 year old immunisations, and a heap of LA Bicillin shots. I armed myself with a box of colourful stickers, a brazen attitude and a good strong arm, and jabbed anything with a pulse. After the first 7 or 8 kids, I got used to the gut wrenching cries as these poor darlings, heard their names being called from the waiting room. This injection for you non clinicians, or remote nurses, is thick white syrup that has the look and consistency of semi-dried liquid paper. It has to be given through a 21 G needle which is 1-2 sizes bigger than the needles that are usually used for injections. It is slow to give because of the viscosity, and after about 15 sec, you are still only half way through the syringe. By this time they are already crying, and biting on the pillow.
By midday, I had the hang of it and must have looked and behaved as battle hardened as the most barbaric of warriors, because kids started to realise that resistance is futile, and they were getting their needle by hell or high water. I remember during my immunisationcourse back in 2004, hating giving needles to children. Well there is a whole new level of hate now. LA Bicillin day on Darnley...Nasty business.
On another tack, I have tried to make these blogs not just personal and interesting as a diary read, but also informative. Today I learnedmore about some island culture. Child gifting and Tomb stone opening.
The practice of child gifting is common on the islands. A couple may be given a baby as a wedding gift by a sister or sisterinlaw, cousin or other family member. It is an informal adoption process that allows for deep familial links and genetic ties to become blured. If my wife and I had two boys and my sister had all girls, we might feel sorry for them that they dont have a son, and so should my wife have another child , and that baby was a girl, it would be given to my sister so she could have one too. In many respects it is a lovely gesture, but the legal paperwork (if it is ever done) must be a nightmare.
A second practice I learned about is what occures after the death of a relative. In islander culture, the immediate family are informed of the death by the inlaws or an uncle. Should some one 'Pass away" (islanders dont use the word died), then a health worker will find the spouses family, who will be told first, and it is then up to the family to inform the dead patient's wife and family. This starts a time of mourning, where the immediate family are cared for and fed by the inlaws, sometimes for weeks after the burial. Months (sometimes years down the track) the family of the diseased purchase a tombstone, and lay it with the deceased's body. The shrouded tombstone is then opened or unveiled at a massive (and I mean massive) party where everyone who knew the deceased comes to celebrate their life. The party is called a Tombstone opening, and can start in the middle of the day with a preparation of a feast of island food, whole turtle, dugong, and pigs roasted in a Kupmurrie, or gropund oven. Feasting goes into the night, and then when all are full, dancing starts around midnight, and goes through till daylight with a hypnotic trance like troup of dancers, and singers all chanting melodically to the beat of the Kundu (island drum). I have not been to such a spectacle as yet, but others who have wittnessed and videotaped them, say it is a sight to behold. Now Midday to Dawn...now that is a party. During the men dancing, women come out and spray the men with purfume and douse them with talcum powder, as by morning the dancers, fully clad in warrior costumes with spears, arrows and the characteristic Dhari (head dress) are covered white with powder. It is a mark of respect, and all to honour the life of 1 person. I cant wait to have an opportunity to see it first hand.
Well that is it for another installment, as I criuse to the end of the third week, and my last on the island of Erub.
I love the feedback that you have given me as I blog these journeys of discovery. I am a little humbled at the number of hits, and with just 5 more sleeps before I see my family again, I must admit that staying committed to this daily task has not been easy, but os so rewarding, and with out your great support through email and facebook, I would probably have stopped writing these after Saibai.
Sunday, 19 June 2011
#36 - The All Nighter
#36 - The all Nighter.
One of the amazing experiences of this job, is sensation of climbing into a fresh bed, after a 12 hour night shift. At 9am this morning, I walked up the steps from the clinic to my unit to a nice warm bowl of Baked Beans (comfort food), kicked off my boots, and slunk under the covers my bed in a darkened room. As I lay there reflecting on the last 12 hours, It dawned on me that I love this job.
For many nurses the thought of night shift is an intrusive annoyance that plagues their consciousness leading up to start time. There is for many of us, a sense of dread, or impending doom, which encroaches on ones psyche. But for a RAN you never know when a night shift is going to occur.
Up here when a patient has to be retrieved by medivac, a call is placed with QEMS or the oncall doctor, then we wait.....and wait....and wait.
I had a key community leader in the clinic last night. 830 an emergency call went out from the family blo em (his family), he has pain in his chest!
Now if we were anywhere else (other than remote Australia) the ambulance would come with highly trained paramedics, lights and sirens, and all the bells and whistles. Here, you get Me, and I dont know where any one lives, and there are no street names and houses are not numbered!!!
It is culturally appropriate to phone the on call Health worker, and Pick them up from their home (few islanders drive or have cars), then once you've picked up your human "Navman" you then make your way to the patient's house.
Last night the call came in at 830, but it was not until 850 (20 minutes later) that we arrived at the house!!! The irony was that the people live 3 minutes walk from the health centre!!!!
So I do my assessment, I say "mmmm" with a concerned look on my face, a few times, and we transport "old mate" back to the clinic.
The bloke had a convincing story for having developed a blood clot in his lungs. In the industry, we call this a Pulmonary Embolism (PE), and it can be fatal. These folk have a culture of blame. If someone dies whilst in my care, it is My fault, not the fact that their condition was going to kill them anyway. They tend not to use the words dead or died, they say "Passed away", it's softer, and I like it.
Anyway.....I called the medical officer on call, and rattled off the symptoms. Then that sweet, sweet sound that all isolated nurses want to here...." Yep, I agree with you Rob, It sounds like a PE. I'll talk to QEMS and we'll come and get him" I silently did the happy dance, took clexane orders (clexane is a drug to reduce blood clots), and commenced the paperwork for the medivac. Then the waiting game started. That was at 10pm. The MO rang back at 1030 and tells me that they wont be able to come get him till daylight (no lights on the air strip) and my night shift was set.
By all accounts it was a breeze of a night. But when Annie the other nurse cruised in this morning at 830, 12 hours after I had started this patient's care, she was a sight for sore eyes.
I slept like a log...thank God for air conditioning and a dark room, and no traffic. But as usual, that hung over feeling lingers, and after Tea at Chris and Annie's tonight Im looking forward to my bed again. I feel like I have lost a day somewhere, and I still didnt get to go and do what I wanted to on my day off!!
Oh well. Im loving it, despite the challenges, and cant help but think I am be prepared for a change in career. but we might keep that provocative suggestion under wraps for the time being.
Yawo!!
One of the amazing experiences of this job, is sensation of climbing into a fresh bed, after a 12 hour night shift. At 9am this morning, I walked up the steps from the clinic to my unit to a nice warm bowl of Baked Beans (comfort food), kicked off my boots, and slunk under the covers my bed in a darkened room. As I lay there reflecting on the last 12 hours, It dawned on me that I love this job.
For many nurses the thought of night shift is an intrusive annoyance that plagues their consciousness leading up to start time. There is for many of us, a sense of dread, or impending doom, which encroaches on ones psyche. But for a RAN you never know when a night shift is going to occur.
Up here when a patient has to be retrieved by medivac, a call is placed with QEMS or the oncall doctor, then we wait.....and wait....and wait.
I had a key community leader in the clinic last night. 830 an emergency call went out from the family blo em (his family), he has pain in his chest!
Now if we were anywhere else (other than remote Australia) the ambulance would come with highly trained paramedics, lights and sirens, and all the bells and whistles. Here, you get Me, and I dont know where any one lives, and there are no street names and houses are not numbered!!!
It is culturally appropriate to phone the on call Health worker, and Pick them up from their home (few islanders drive or have cars), then once you've picked up your human "Navman" you then make your way to the patient's house.
Last night the call came in at 830, but it was not until 850 (20 minutes later) that we arrived at the house!!! The irony was that the people live 3 minutes walk from the health centre!!!!
So I do my assessment, I say "mmmm" with a concerned look on my face, a few times, and we transport "old mate" back to the clinic.
The bloke had a convincing story for having developed a blood clot in his lungs. In the industry, we call this a Pulmonary Embolism (PE), and it can be fatal. These folk have a culture of blame. If someone dies whilst in my care, it is My fault, not the fact that their condition was going to kill them anyway. They tend not to use the words dead or died, they say "Passed away", it's softer, and I like it.
Anyway.....I called the medical officer on call, and rattled off the symptoms. Then that sweet, sweet sound that all isolated nurses want to here...." Yep, I agree with you Rob, It sounds like a PE. I'll talk to QEMS and we'll come and get him" I silently did the happy dance, took clexane orders (clexane is a drug to reduce blood clots), and commenced the paperwork for the medivac. Then the waiting game started. That was at 10pm. The MO rang back at 1030 and tells me that they wont be able to come get him till daylight (no lights on the air strip) and my night shift was set.
By all accounts it was a breeze of a night. But when Annie the other nurse cruised in this morning at 830, 12 hours after I had started this patient's care, she was a sight for sore eyes.
I slept like a log...thank God for air conditioning and a dark room, and no traffic. But as usual, that hung over feeling lingers, and after Tea at Chris and Annie's tonight Im looking forward to my bed again. I feel like I have lost a day somewhere, and I still didnt get to go and do what I wanted to on my day off!!
Oh well. Im loving it, despite the challenges, and cant help but think I am be prepared for a change in career. but we might keep that provocative suggestion under wraps for the time being.
Yawo!!
Saturday, 18 June 2011
#35 - Acute Rheumatic Fever
#35 - ARF...the child killer.
Almost completely eliminated in metropolitan Australia, is a disease process known as Acute Rheumatic Fever. It is a immune antibody reaction to a recent infection with common old Strep bacteria. Streptococcus Pyogenes causes Strep Throat, Scarlet fever and skin infections seen in poverty areas where over crowding and poor hygiene and substandard nutrition is evident.
We have all heard of these infections. They are tonsillitis, infected Scabies and Impetigo or school sores. in 10 days or so the body's immune system can set up a reaction which can ultimately cause valve damage in the persons heart of those who develop Acute Rheumatic Fever.
This condition is the biggest killer of aboriginal and Torres Strait Islander children in Australia. It is almost never seen in white kids, or the first world.! Read that last sentence out loud. It is a 3rd world disease, yet still the biggest killer of indigenous children. Across the Torres, health centres are on keen look out for ARF in kids 5-16 years of age. And today, I had personal experience with this disease that by definition , we shouldn't have in our 1st world country.
Two days ago, a 6 year old girl walked into the clinic with a fever of 40. She complained of a vague leg pain in her thigh. Despite her fever she had no other symptoms that were red flags. Urine clear, Chest- clear, ENT - clear. No rash, no lymph nodes, slight belly runs and a dry scab on her knee, otherwise nothing tangible.
She was a bit dehydrated , so I sent her home with her Aka (grand mother), for rehydration.
Yesterday , she returned for follow up so I could reassess her. This time she limped into the clinic, was still running a fever, had lost 200grams, was complaining of pain in her knee, and the small dry scab on her knee had become weepy with a golden exudate. This was a Red flag. Fever and Joint pain in a TSI child is a reportable condition. With a phone consult to our amazing nurse practitioner to see I was on the right track, I commenced the ARF protocol which included analgesia, and a nasty injection of penicillin in the backside. This little pickle was so brave, and I really didn't understand just how sick she really was. It was decided that she should be sent to Thursday Island for further investigations and treatment. Flights were organised for today, so she was able to go home to grandmothers and sleep. I would see her in the morning.
This morning comes, this poor child is beside her self in pain. The knee has blown up to 2/3 larger than it was, she cant walk and is carried into the clinic, still has fever despite maximum panadol and Nurofen. I am worried. Kids crash so fast, and 200 km from the nearest doctor or hospital makes me a little edgy.
When that plane came and took her and her dad to TI, I was very relieved. I have spent the rest of the afternoon reading up on and learning about a condition unique to indigenous Australia, and one that when I head south, I will probably go another 25 nursing years and still not see.
These kids need there sores to be managed better. Clean clothes daily, good hand washing and body hygiene, and for goodness sake...1 kid in a bed!!! This little germ is a nasty bugger.
When this child comes home, she can look forward to a painful penicillin injection in her bum every month till her 21st birthday. If tests in TI reveal any heart damage, then she could need monthly injections for up to 40 years!!! This disease attacks heart tissue causing a Congestive Cardiac Failure, and treatment aims to minimise heart disease. It is cruel and barbaric, and I hate giving these kids penicillin injections, but when you look ad 6 year old children as cardiac cripples the likes of an 80 year old man who has survived heart attacks, then one understands the necessity.
I wont bore you with the physiology, (you know I want to) that is what Dr Google is for, but it never ceases to amaze me how fast kids get sick, and what the Torres can throw at my steep learning curve.
Perhaps one day I will need these skills and knowledge again ;)
I will follow up this little girl. The possibility is that she may have to be medivac to Cairns for a heart specialist, but when I listened to her chest, and took her ECG, all was normal at that stage. That said, this disease can be unpredictible. The sad thing for children with ARF is that the treatment of the inflammation of joints and the heart tissue, is a drug called Aspirin. Kids cant have aspirin, so it is a classic Catch 22 situation.
Do I risk killing the kid from aspirin complication called Reyes Syndrome, or do I withhold it and risk fatal heart failure?!!!
The questions are so hard to answer, but perhaps the most difficult issue is that this condition is completely preventable......Cover your sores kids, and STOP picking your scabs!!!!!
Almost completely eliminated in metropolitan Australia, is a disease process known as Acute Rheumatic Fever. It is a immune antibody reaction to a recent infection with common old Strep bacteria. Streptococcus Pyogenes causes Strep Throat, Scarlet fever and skin infections seen in poverty areas where over crowding and poor hygiene and substandard nutrition is evident.
We have all heard of these infections. They are tonsillitis, infected Scabies and Impetigo or school sores. in 10 days or so the body's immune system can set up a reaction which can ultimately cause valve damage in the persons heart of those who develop Acute Rheumatic Fever.
This condition is the biggest killer of aboriginal and Torres Strait Islander children in Australia. It is almost never seen in white kids, or the first world.! Read that last sentence out loud. It is a 3rd world disease, yet still the biggest killer of indigenous children. Across the Torres, health centres are on keen look out for ARF in kids 5-16 years of age. And today, I had personal experience with this disease that by definition , we shouldn't have in our 1st world country.
Two days ago, a 6 year old girl walked into the clinic with a fever of 40. She complained of a vague leg pain in her thigh. Despite her fever she had no other symptoms that were red flags. Urine clear, Chest- clear, ENT - clear. No rash, no lymph nodes, slight belly runs and a dry scab on her knee, otherwise nothing tangible.
She was a bit dehydrated , so I sent her home with her Aka (grand mother), for rehydration.
Yesterday , she returned for follow up so I could reassess her. This time she limped into the clinic, was still running a fever, had lost 200grams, was complaining of pain in her knee, and the small dry scab on her knee had become weepy with a golden exudate. This was a Red flag. Fever and Joint pain in a TSI child is a reportable condition. With a phone consult to our amazing nurse practitioner to see I was on the right track, I commenced the ARF protocol which included analgesia, and a nasty injection of penicillin in the backside. This little pickle was so brave, and I really didn't understand just how sick she really was. It was decided that she should be sent to Thursday Island for further investigations and treatment. Flights were organised for today, so she was able to go home to grandmothers and sleep. I would see her in the morning.
This morning comes, this poor child is beside her self in pain. The knee has blown up to 2/3 larger than it was, she cant walk and is carried into the clinic, still has fever despite maximum panadol and Nurofen. I am worried. Kids crash so fast, and 200 km from the nearest doctor or hospital makes me a little edgy.
When that plane came and took her and her dad to TI, I was very relieved. I have spent the rest of the afternoon reading up on and learning about a condition unique to indigenous Australia, and one that when I head south, I will probably go another 25 nursing years and still not see.
These kids need there sores to be managed better. Clean clothes daily, good hand washing and body hygiene, and for goodness sake...1 kid in a bed!!! This little germ is a nasty bugger.
When this child comes home, she can look forward to a painful penicillin injection in her bum every month till her 21st birthday. If tests in TI reveal any heart damage, then she could need monthly injections for up to 40 years!!! This disease attacks heart tissue causing a Congestive Cardiac Failure, and treatment aims to minimise heart disease. It is cruel and barbaric, and I hate giving these kids penicillin injections, but when you look ad 6 year old children as cardiac cripples the likes of an 80 year old man who has survived heart attacks, then one understands the necessity.
I wont bore you with the physiology, (you know I want to) that is what Dr Google is for, but it never ceases to amaze me how fast kids get sick, and what the Torres can throw at my steep learning curve.
Perhaps one day I will need these skills and knowledge again ;)
I will follow up this little girl. The possibility is that she may have to be medivac to Cairns for a heart specialist, but when I listened to her chest, and took her ECG, all was normal at that stage. That said, this disease can be unpredictible. The sad thing for children with ARF is that the treatment of the inflammation of joints and the heart tissue, is a drug called Aspirin. Kids cant have aspirin, so it is a classic Catch 22 situation.
Do I risk killing the kid from aspirin complication called Reyes Syndrome, or do I withhold it and risk fatal heart failure?!!!
The questions are so hard to answer, but perhaps the most difficult issue is that this condition is completely preventable......Cover your sores kids, and STOP picking your scabs!!!!!
Friday, 17 June 2011
#34 - Puripuri. Black Magic in the Islands
#34- Puripuri
Today's post is the subtext of a conversation I have been having with some colleagues, and Islanders over the last few days. It is a topic that I do not fully grasp, nor can I discount the claims that are made. I will state two things:
The first is that the following post is sensitive, and of a cultural and spiritual nature,
second, that the comments I make are heresay, and personal stories from many colleagues in the Torres, and whilst, with my Christian faith, I struggle to understand these stories, I neither refute them, or accept them as fact.
Puripuri, Mai , or Black magic (sorcery) is practiced across the Torres and PNG in many many communities. The central focus is a Puripuri man who is a local villager, is believed by many to have powers to place curses on people and objects, eg rocks, places, plants and trees. For a person to go to or touch those items, may cause a curse to be attached to that person. If a family member is wronged by someone, Puripuri curses can be placed on that person, and the result can be sickness or the death of the cursed individual. It is believed that breaking cultural taboos may cause curses or spells cast by puripuri men that have long since deceased, to affect that person, members of their families or their future descendants.
The practice of this is quiet, yet widely practiced in the islands. To walk along a street on the island, you might notice yard decorations, or statures, a\that at first resemble garden ornaments, but are actually blessed items that protect the house or it's occupants from bad puripuri. Occasionally a vehicle or a home could be seen with water bottles dotted around it, as a method to protect the driver or home owner from bad puripuri. It is believed that a Shaman or puripuri man can mind speak to others and place thoughts, and guide actions on others.
It is understood that puripuri can be good or bad. Good puripuri curses are placed to attract successful fishing, hunting or harvest. Good puripuri men can be sought to offer the lifting of a curse causing sickness. These good puripuri men or medicine men, may also prepare poultices, concoctions or prescribe local naturally found plants, animals as medicine or potions.
One of the most startling things is that on these islands, there is a strong Christian following, which stems from the arrival in the 1800s of the London Missionary Society, bringing the Gospel to what was then a warrior based society on the islands. Yet intermingled with their christian practices, and faith that has islanders believing in God and Jesus and the message of the Gospel, these black magic beliefs are also entrenched in the culture. On nearby Murray Island there was recently an SBS special that records the local Bishop discussing Mai (puripuri) which to me is strange. To hear a Christian leader discussing how he might use black magic to cause the death of another person is something I struggle to comprehend.
http://tradmed.atsiphj.com.au/index.php?option=com_content&view=article&id=70:black-magic-in-torres-strait&catid=42:resources&Itemid=60
In our health centre, the occasional presentation of an islander with a condition resistant to treatment, night go away to see the island medicine man, have their curse lifted, and return to the clinic to get "conventional" medicine to "finish off the healing". The remarkable thing is that the patient miraculously does get better. Staff that I am and have worked with discuss this phenomenon quite openly, and I find it intriguing to say the least.
I was out in the car with a health worker yesterday, and enquired as to why the patch of land on the other side of the airstrip was uninhabited. It has magnificent views of the coral reefs and further islands, and would be an idyllic spot for a village. The health worker told me that that was a bad place where bad things happened and bad spirits live, and to go there would bring sickness. This is a working example of bad Puripuri, and just how effective it is. She wouldn't elaborate any further, but I could see that even talking about it was making her feel very uncomfortable. One young bloke I asked about black magic, mentioned that it (curses) are contagious like diseases. If you talk to the wrong people or drink with the wrong people, then you can be affected.
Certain clothes, artifacts, weapons, masks and objects are used in black magic ceremonies, including puripuri which can be used as part of island feasting, initiation ceremonies and other traditional gatherings. The practice is covert. It is just under the surface of what looks like a happy culture, and community, yet mention puripuri, and any islander will be able to share a personal story of the practice of black magic, either good or bad. One bloke commented ..."it is all around us, and it is real, like a tree, you can touch it!"
Today was another of those Wow moment days, where I learn yet another lesson about this amazing rich culture. I love this education, and I am ever thankful to the locals who take time to teach me their language and ways. I am not ready to put on a grass skirt and learn to dance just yet, but who knows. Perhaps a puripuri man might just get in my head and influence me in that regard!!
Tomorrow I am on call again, and will hang around the unit and clinic. I have a few patients to review, and a sick little 6 year old girl to fly out. The wont come and get her tonight, so we do IV antibiotics on her till the morning, and fly her to down Thursday Island at Midday. So Im hoping for a quiet day...You will no doubt, be informed either way as I continue my blogs
.....from .....over the top.
Today's post is the subtext of a conversation I have been having with some colleagues, and Islanders over the last few days. It is a topic that I do not fully grasp, nor can I discount the claims that are made. I will state two things:
The first is that the following post is sensitive, and of a cultural and spiritual nature,
second, that the comments I make are heresay, and personal stories from many colleagues in the Torres, and whilst, with my Christian faith, I struggle to understand these stories, I neither refute them, or accept them as fact.
Puripuri, Mai , or Black magic (sorcery) is practiced across the Torres and PNG in many many communities. The central focus is a Puripuri man who is a local villager, is believed by many to have powers to place curses on people and objects, eg rocks, places, plants and trees. For a person to go to or touch those items, may cause a curse to be attached to that person. If a family member is wronged by someone, Puripuri curses can be placed on that person, and the result can be sickness or the death of the cursed individual. It is believed that breaking cultural taboos may cause curses or spells cast by puripuri men that have long since deceased, to affect that person, members of their families or their future descendants.
The practice of this is quiet, yet widely practiced in the islands. To walk along a street on the island, you might notice yard decorations, or statures, a\that at first resemble garden ornaments, but are actually blessed items that protect the house or it's occupants from bad puripuri. Occasionally a vehicle or a home could be seen with water bottles dotted around it, as a method to protect the driver or home owner from bad puripuri. It is believed that a Shaman or puripuri man can mind speak to others and place thoughts, and guide actions on others.
It is understood that puripuri can be good or bad. Good puripuri curses are placed to attract successful fishing, hunting or harvest. Good puripuri men can be sought to offer the lifting of a curse causing sickness. These good puripuri men or medicine men, may also prepare poultices, concoctions or prescribe local naturally found plants, animals as medicine or potions.
One of the most startling things is that on these islands, there is a strong Christian following, which stems from the arrival in the 1800s of the London Missionary Society, bringing the Gospel to what was then a warrior based society on the islands. Yet intermingled with their christian practices, and faith that has islanders believing in God and Jesus and the message of the Gospel, these black magic beliefs are also entrenched in the culture. On nearby Murray Island there was recently an SBS special that records the local Bishop discussing Mai (puripuri) which to me is strange. To hear a Christian leader discussing how he might use black magic to cause the death of another person is something I struggle to comprehend.
http://tradmed.atsiphj.com.au/index.php?option=com_content&view=article&id=70:black-magic-in-torres-strait&catid=42:resources&Itemid=60
In our health centre, the occasional presentation of an islander with a condition resistant to treatment, night go away to see the island medicine man, have their curse lifted, and return to the clinic to get "conventional" medicine to "finish off the healing". The remarkable thing is that the patient miraculously does get better. Staff that I am and have worked with discuss this phenomenon quite openly, and I find it intriguing to say the least.
I was out in the car with a health worker yesterday, and enquired as to why the patch of land on the other side of the airstrip was uninhabited. It has magnificent views of the coral reefs and further islands, and would be an idyllic spot for a village. The health worker told me that that was a bad place where bad things happened and bad spirits live, and to go there would bring sickness. This is a working example of bad Puripuri, and just how effective it is. She wouldn't elaborate any further, but I could see that even talking about it was making her feel very uncomfortable. One young bloke I asked about black magic, mentioned that it (curses) are contagious like diseases. If you talk to the wrong people or drink with the wrong people, then you can be affected.
Certain clothes, artifacts, weapons, masks and objects are used in black magic ceremonies, including puripuri which can be used as part of island feasting, initiation ceremonies and other traditional gatherings. The practice is covert. It is just under the surface of what looks like a happy culture, and community, yet mention puripuri, and any islander will be able to share a personal story of the practice of black magic, either good or bad. One bloke commented ..."it is all around us, and it is real, like a tree, you can touch it!"
Today was another of those Wow moment days, where I learn yet another lesson about this amazing rich culture. I love this education, and I am ever thankful to the locals who take time to teach me their language and ways. I am not ready to put on a grass skirt and learn to dance just yet, but who knows. Perhaps a puripuri man might just get in my head and influence me in that regard!!
Tomorrow I am on call again, and will hang around the unit and clinic. I have a few patients to review, and a sick little 6 year old girl to fly out. The wont come and get her tonight, so we do IV antibiotics on her till the morning, and fly her to down Thursday Island at Midday. So Im hoping for a quiet day...You will no doubt, be informed either way as I continue my blogs
.....from .....over the top.
Thursday, 16 June 2011
#33 - The Stabbing and the lesson
#33 - The stabbing.
Just when you think is is safe to knock off...ring ring!! Help us help us there is a man here who has been stabbed! The phone call came through from a home just 300 m from the clinic. On these islands the Nurses are the ambulance. We have a white Toyota Troopy with a stretcher in the back, but no emergency gear. It's got the Red cherry lights on top but no siren, and its got a two way radio, but no one else on the island is on the same channel!!
So off I go in the ambulance, with Lizzy one of our health workers, and arrive at the house. There is a woman out front on the deck, pointing inside. I go in, gloves on, combine ready, and here is the bloke covered in blood, holding his arm. Face washer over what I was expecting to be a near amputation from all the blood!!!
I open up the face cloth slowly in case it spurts me in the eye, and .....WHAT. a cut that is only a centimeter long!! Let down...big time.
So I walk him to the car. as he climbs in to the vehicle, a woman climbs in the other door. I say to the bloke...why is she coming and who is she..." oh that is my girl friend, , she is the one who stabbed me"
What!!! So I again ask if He is ok with her coming up to the clinic too. He replies ..."Yes she has to, she has stabbed her self too!!!!" Oh, the plot thickens. Can this get any crazier, I think.
So we get back to the clinic, Annies takes the woman into one room, I take the bloke into another. Annie and I meet in the corridor between the "lovers" and get our story straight..
Annie tells me, "Your patient, was caught by my patient texting girls on his phone!" It is a strange dynamic. It is like Male and female nurse have taken sides, and I feel somewhat accused. "well that is no excuse to stab my client" I reply, as though this was a court room drama. "What did she say she stabbed him with ?" I asked Annie, to which she retorts, "she didnt say, she just produced this!"
And that is where I learned my lesson. The colour drained from my face and I felt a wave of nausea, as Annie produced a kitchen knife which had been surrendered by the woman, still wild, and fuming and homicidal with my patient. I went into the home of a domestic violence case, with the assailant still there, and still armed with a knife, and transported them both back to the clinic and put my colleagues at risk.
It is a Hard pill to swallow. This woman was fuelled up on PNG Gunja, grog, and jealousy, and was still armed with a kitchen knife, and without any regard for my own safely, I foolishly found myself in a situation which could have ended in a tragic headline!!!
In my education on emergency practice, I harp on the fundamental First aid principle of DRSABCD
Danger
Response
Send for help
Airway
Breathing
Compressions
Defibrillation
Number one principle of all medical aid situations is scene safety, and there is not too many people that could disagree that I failed in this point.
So this gets me thinking. Despite best intentions to follow rules, and regulations, and policies and procedures, the human factor allows mistakes to happen. One small slip up with no adverse outcome, but when thinking of what could have gone wrong, it makes my blood run cold, and cuts me down to the extent, that I realise, I am only human.
To all those I teach, and mentor. To all those I have chastised for being irresponsible. To all those that hold me on a high pedestal...know this. I make mistakes.
But also let me share this wisdom...Make every mistake a new one.
Yawo!!
Just when you think is is safe to knock off...ring ring!! Help us help us there is a man here who has been stabbed! The phone call came through from a home just 300 m from the clinic. On these islands the Nurses are the ambulance. We have a white Toyota Troopy with a stretcher in the back, but no emergency gear. It's got the Red cherry lights on top but no siren, and its got a two way radio, but no one else on the island is on the same channel!!
So off I go in the ambulance, with Lizzy one of our health workers, and arrive at the house. There is a woman out front on the deck, pointing inside. I go in, gloves on, combine ready, and here is the bloke covered in blood, holding his arm. Face washer over what I was expecting to be a near amputation from all the blood!!!
I open up the face cloth slowly in case it spurts me in the eye, and .....WHAT. a cut that is only a centimeter long!! Let down...big time.
So I walk him to the car. as he climbs in to the vehicle, a woman climbs in the other door. I say to the bloke...why is she coming and who is she..." oh that is my girl friend, , she is the one who stabbed me"
What!!! So I again ask if He is ok with her coming up to the clinic too. He replies ..."Yes she has to, she has stabbed her self too!!!!" Oh, the plot thickens. Can this get any crazier, I think.
So we get back to the clinic, Annies takes the woman into one room, I take the bloke into another. Annie and I meet in the corridor between the "lovers" and get our story straight..
Annie tells me, "Your patient, was caught by my patient texting girls on his phone!" It is a strange dynamic. It is like Male and female nurse have taken sides, and I feel somewhat accused. "well that is no excuse to stab my client" I reply, as though this was a court room drama. "What did she say she stabbed him with ?" I asked Annie, to which she retorts, "she didnt say, she just produced this!"
And that is where I learned my lesson. The colour drained from my face and I felt a wave of nausea, as Annie produced a kitchen knife which had been surrendered by the woman, still wild, and fuming and homicidal with my patient. I went into the home of a domestic violence case, with the assailant still there, and still armed with a knife, and transported them both back to the clinic and put my colleagues at risk.
It is a Hard pill to swallow. This woman was fuelled up on PNG Gunja, grog, and jealousy, and was still armed with a kitchen knife, and without any regard for my own safely, I foolishly found myself in a situation which could have ended in a tragic headline!!!
In my education on emergency practice, I harp on the fundamental First aid principle of DRSABCD
Danger
Response
Send for help
Airway
Breathing
Compressions
Defibrillation
Number one principle of all medical aid situations is scene safety, and there is not too many people that could disagree that I failed in this point.
So this gets me thinking. Despite best intentions to follow rules, and regulations, and policies and procedures, the human factor allows mistakes to happen. One small slip up with no adverse outcome, but when thinking of what could have gone wrong, it makes my blood run cold, and cuts me down to the extent, that I realise, I am only human.
To all those I teach, and mentor. To all those I have chastised for being irresponsible. To all those that hold me on a high pedestal...know this. I make mistakes.
But also let me share this wisdom...Make every mistake a new one.
Yawo!!
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