#31 - Core Business...Shame

#31 - The jobs that matter.

Today was one of those turning point days, where the awe of the tropics, and the wonder of a new place, the excitement of emergency practice all fade like a water painting in humidity.  Today working along side Annie, we got down to what has been termed Core Business.  These island clinics run a model of care called the Torres Model.  It is one where the clinics are managed by Islander managers, and health care is coordinated using a team of Indigenous Health Workers and RANs.  As a white nurse in a black community (and I am saying this respectfully) I am considered an outsider.  I am welcomed, and privvy to issues on superficial levels, but the health of the islanders is very much managed by Islanders and their own local health workers.

The scope of practice of a RAN is vastly expansive when compared to the role that the health workers, but I need to constantly be reminded of where I sit in driving health promotional, educational and community programs.  I must be invited, and initiative to be proactive is discouraged.

Yesterday I touched on taboos surrounding Islanders using the names of inlaws.  This is extended into the clinic, where even touching a relative from particular families is forbidden.  On a small island like Erub (Darnley) where everyone is related through marrage or biologically, this forbidden touching is problematic.  If health worker Sally is related to Patient John, then she would not be permitted to use his name, or to do his vital signs, touch him, or even ask certain questions.  It is called "Shame".

Shame also exists in gender relationships.  For example, the Midwife on Thursday Island phoned me on Friday afternoon, and told me that (lets call her Nancy)  ... that Nancy Bloggs is a  pregnan girl who has just been diagnosed with Gestational Diabetes (for those non health people...Gestational Diabetes is a special form of diabetes (high sugar in the blood), that only pregnany women get).   This girl had just this minite been diagnosed, and needed to be called in to be given a Sugar monitor, and education on diet, sugar testing 4 times / day and a host of other stuff.

I called her in on Saturday morning and taught her all the stuff, gave her all the information, a brand new sugar monitoring machine and the consumables that go with it.  She was to return on Monday (yesterday) to show me 48 hours of blood sugar levels, but didnt show.  I spent an hour with her ensuring that she would be fully on board for the health of her baby....but no show!   Today , I sent a female health worker to her place to get her and bring her to the clinic, and to bring her monitor book with 3 days of testing recorded.  She arrived, ...no book.  I asked her if she had been monitoring her sugars, and written them down....No.  not, testing her own sugars, not recording anything!   Frustration of the poor compliance was something of an understatement, so I asked Annie the other nurse to speak with her, and see if she could get Nancy to re-commit to monitoring her sugars.    The reason that Nancy didnt look after her sugar testing was because I am a man, and her diabetes was linked to pregnancy.  for me to discuss any pregnancy related issue is "shame", and so it could be considered "shame" to follow my advice on women's business because I am a man.

Getting my head around these cultural issues is a steep learning curve.  I am a visitor, and this is their health, their way.  To really have an impact here, I need to know more about these social mores and the taboos that disadvantage the patient because I am out of line and didnt know it.

Mens health works the same way.  Most of these islands of the Torres Strait are staffed by predominantly female health workers and white female nurses.  It is shame for a man or a boy to present with a sexually transmissible infection, penile or testicular pain, urinary problems, even constipation.  As men get older and prostate issues start to become a problem, many men will leave it and urine infections to the very last minute to be seen, because the nurse is usually a woman.  One of the concerns I have here is that it takes time to develop a rapport with some of the uncles and other men in the community.  So by the time that they learn that there is a male nurse here, and that they can come to the clinic and see me, Im finished my contract.

Today in a meeting, the health team here decided that I will host a communinal mens BBQ on the beach opposite the clinic, and have a talk about mens health issues, and STIs.  Cook up some Turtle, and fish, SopSop and rice and broach some of the subjects that are Taboo for the female staff.  I am nervous, and not entirely sure how it will go, butI am here for the experience, and have a passion to be involved, and make my time here meaningful and benificial.  Pray for me that it goes well.

Who knows, perhaps I can encourage some blokes up here to get a Men's Shed happening....because we all know Shed Happens!!!

Yawo !!