#40 - What do you mean - not coming today!!!

#40 - The relief who wasn't.

Madly cleaning the unit, restless sleep all night, down to bare rations in the fridge and pantry.  Such is the way when after 3 glorious weeks in this island paradise of Darnley Island, the time has come to fly home to my bride and offspring.  I have been blessed to have been asked to dinner by the good doctor and his beloved.  Which is a good thing because as of today, the milk for my last 3 weetbix has been expired into it's third day, and starting to resemble yoghurt.  ~~shivers~~ .

If you look at the pic above you will see the main hub of the village.  To the right of the screen with a yellowish roof, is the All Saints church which will host the "Coming of the Light" in 4 days time.  Off the screen but next door to the church is the clinic, but I assure you that the view is just as spectacular from the unit/clinic veranda, as it is from this chopper looking back.  All of my fishing stories have come from that tiny jetty on the right below the big green work sheds.

So I came to work today with the spring in my step, all ready to tidy up loose ends and pick up the "new" nurse from the airport.  My job sheet had no arrival time for him, and so I thought that I would ring the Westwing Airline to get some info....That is when it went pear shaped.
-  "Oh no mate, that bloke <insert nurse's name>isnt flying today, he comes in on the morning flight arriving at 8:30.  Infact Rob, your name is on this list as the one we are picking up on the same flight!"

..."What!!??"   I was expecting the nurse today, there is so much to hand over, patients with complex dressings, and some procedural stuff.  Orrientation of the clinic, where stuff is, policy, procedure, what to do in a black out, resetting the fridges, drug storage procedure, over due immunisations to chase up, penicilling injectoins that are outstanding for June, lots and lots of stuff that I had to learn when I started here, and that I am only just getting my head around now.

So now, at the air strip, on the tarmac, a full clinic handover will have to occur for this poor bloke, as I hand him the car keys, clinic kees, ambulance keys, unit keys, and drug keys, and wish him luck.  I cant help feeling for the poor bloke.  I felt like I fumbled my way through the first week, and I had another nurse here with me in that time. 
So I rang him...he tells me it happens all the time...no to worry, and that he will figure stuff out.   Man I wish I had that level of calmness!  I was so glad it was him and not me.

Needless to say I have kept a pile of cheat sheets for him, and feel that with all the notes I took, he should do well.  The rest of the day was getting around those people who have made my time here so special.  The elders who invited me into their homes and taught me about their language and culture.  I am looking forward to coming back here with family.  The photos just cant do Darnley justice.   As the official last blog for this 6 week adventure, I must say, journaling has been a great way of reliving the experiences I have been fortunate enough to have here. Thank you for taking an interest in my little life on this little group of islands, with a mighty people, and a mighty support and encouragement from my loved ones at home.
Thank you to the health workers and nurses that do such a fabulous job here.  Thank you for David Iliffe from ABC in Toowoomba for seeing a story in my story and following my journey with the support of two interviews.  You can hear the interviews by clicking this link
...
As you are probably aware, I have had God at my side during this trip, and praise him for mapping the tattered wad of loose strings of our lives into the beautiful tapestries that he plans for us.  To step outside your comfort zone and be bold, and have trust is a key component to growth.  If you are a nurse looking to learn, and to cry, and to be angrier than you ever have been, and to love your job more than anything, and to touch the lives of others, and to be touched in ways you never thought possible...
...   ...   ...   ...   Just take that first step, and see where God takes you.


for the last time (this trip)....Yawo !!

#39 - Penultimate Day on Darnley

#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.

#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.

#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.

#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!!

#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!!!!!
 

#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.
 

#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!!

#32 - Got him!!!

#32 - Got him

What does that mean?  "Got him" ?  Tonight it is probably 4 meanings. 

They say that if you come to the Torres for a look, it gets you, and there is a desire to return.  Well I would be lying if I said that I will leave the islands in a week and a half, and not be back.  I will.  This place has got me.  Today perched in my own consult room, seeing person  after person, I had a sense of belonging.  Without knowing it an older man of the community made my day today, when he specifically asked to see me, over and above all other health workers and the other nurse.   Initially I assumed it was a Men's issue, but as he started discussing generic symptoms of his presentation, it was a nice complex medical case.  I was touched that he specifically asked for me.  I feel like I am slowly making headway with some of the older locals here.

As I knocked off this afternoon, I wandered out onto the reef where Chris and I were fishing on Monday.  The spot where I had a massive fish snaffle my lure.  Chris was there, having been fishing for about 40 minutes, and held up a big potato cod.   "Got him", Chris said, sure that this was the blighter that snapped my line on Monday!  It was a beautiful big fish.  We brought it over to the clinic yard and filleted it.  It was every bit of 10kg.  Just as he started to cut up the fish, a lady was dropped off at the clinic by some random.  She had a huge dog bite from one of the poorly managed dogs on the Island.  It opened up her calf about 9 cm.  This poor girl in her early 30s will have nasty scaring from that dog for the rest of it's life.  It is the second person that I know of that has been bitten by it.  There is no animal control officer here like there is on Saibai.  Even there a dog had to bite 8 people before I was able to put it down.  I really believe that there should be a dog death row.  Annie the permanent RAN told me that last year a vet from Mainland Australia came out and culled half of the dogs on Darnley.  I really think that it is time to do another trip.

Another young bloke came in today with grit in his eyes.  I did an inspection and irrigated his eyes, but he was still troubled.  Sometimes people get a foreign body in their eye, their eye waters, and the particle is gone, but a scratch on their cornea feels like there is something still in their eye.  We have a special eyedrop called florescene which is bright orange.  You pop it in someone's eyes, irrigate to excess out with salty water, and switch of the lights.  Then under a blue light view the eyes, and the orange stain is attracted to damage to the cornea.  It glows bright green under the blue light.  Sometimes when there is still a foreign body in the eye, but too smalll to see, the speck will take up the stain, and declare its presence.  "Got him" I said, to my patient after seeing the Flouro stained shell grit on his right eye.  Removing it was now easy, as I had a target.  A whisp of cotton wool, and a steady hand, and he was on his way home to watch tonight's state of origin League match.  He was happy.  As I opened the door to let him out, a bug flew onto my shirt.  Quicker than lightening, my patient slapped me hard killing the bug, saying "Got him"  and winking with his good eye.

So as the kick of to this historic football game is about to commence, I pause again to reflect on my day, and my time living the Island life.  And as I bite into beautiful reef fish that was still kicking just 2 hours ago, is think to myself....." yep...Torres Strait...youv'e Got me"

#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 !!

#30 - My name is Ted but they call me Tim

#30 What's in a name?

Today was a great day.  A day full of culture lessons, and fishing and reef walking and all the things I cant do if I am on Call and need to be near a phone and clinic.
  It started with a welcome knock on my door at 8am to hand over the oncall phone and drug keys to Annie, the permanent RAN here on Darnley Island.  I was a free agent.  I took a long walk along the shore, up around the south western tip of the island.  Darnley Island or Erub as the locals call it is one of 4 islands formed after the eruption of a volcano.  It has lush red volcanic soil which supports a tropical friut salad, just growing wild in the lush jungle like interior.  On the beaches, which is course sand formed from broken down coral, there are remnants of black lava flows, with boulders of basalt and obsidian littering the rocky coast lines.  The beach might be a sandy beach for a hundred metres or so, then a rocky ledge full of tidal rock pools, then another stretch of sandy beach, then another rocky beach, and so on.  It is truly beautiful.

I met a local man fishing with a bit of string and a home made hook that he'd sharpened.  No reel, or sinker.  He was fishing in a deep gutter between some rocks on the low tide, and demonstrated how he caught his bait first, by putting his line in to a dark cloud of sardines, and pulling randomly in a jerky fashion to snag a sardine.
Once caught he re-hooked the fresh live fish through it's tail and casts it with precision into a deep blue hole.  Within seconds he has a huge fish on the line, which shot up under a rocky oyster encrusted ledge and cut his line to ribbons.  I was amazed.  He told me the fish are very big, and then proceeded to take a hook from his bag which was as large as my hand and almost straightened out.  "tis bastad got away" he told me recalling the event.  It bent his huge hook!!!

Walking a bit further, and I met another bloke.  He introduced himself as Ted but said everyone here calls me Tim.  I enquired of him why this is the case, suggesting that despite being named Robert, a few people call me Timmo.  Tim told me that in his culture he, and anyone else in his family is forbidden from calling an inlaw by their name.  He said when My sister married a Man, that man's father (Tim's sisters Father-in-law)   His name is also Ted.  So the younger man could no longer say the word Ted, despite the fact that Tim's real name was Ted, he was no longer allowed to use it....so gets Tim.....Are you following??   He said that not only does this affect him, but all his brothers and sisters and their children too.  It is Taboo to call your inlaws by their name, but more than that, is taboo to use your own name if that is the same as an inlaw.  They would address their inlaws as Uncle / Aunty or just Friend.  Should he slip up, and utter the name of that who he cant utter, then a penalty is imposed, which means that Tim would have to present a substantial gift to Ted senior.

After going for my walk, Annie's husband Chris the plumber/handyman, who had finished inspecting the leaking roof down stairs in the clinic, asked me to run my shower.  I turned on the shower, which is directly above the child health/immunisation room...that had the leaky roof....Are you following this??
Within seconds he yells up to me to shut off the water.  The s-bend trap under my shower has cracked and is running straight into the clinic ceiling.  No more showers for me!!!  My hygiene needs will now be met by going down to the clinic shower.  A bit of inconvenience, but you do what you must.  A work order will be completed but it is probably not going to get fixed in this financial year!!!

This afternoon, it was Fishing off the reef in deep water.  All the thrill of rock fishing with little of the dangers involved.  We rugged up the lines on 100lb braid, and lures that were 9 inches long.  I have never fished with a rod that had such heavy gear on it, but Chris assured me that it was necessary.  First cast, and BANG, a massive Potato Cod came out of nowhere and hit my line like a Mack Truck.  It was all I could do to stand up straight, as the rod bent in two and the braid was being peeled of the screaming reel.  I slowly tightened the spool, and attempted to lock up the line, but just couldn't hold it.  after what seemed like minutes but was probably only a matter of 30 sec or so, there was a bit of give and I was able to start winding the reel, and take back some of what Moby Dick has claimed.  what a fight.  It was like trying to tow in a couple of bags of cement.  I kept winding, and slowly making ground, when suddenly, SNAP...my line was limp, and the resistance was gone. The braid had been cut on the sharp coral.

This was the biggest fish I never caught!!  Had I landed this monster I think it would have easily been as big as an ironing table, only twice as wide.  I saw it actually take the lure from 10 feet away!!!
That was my fishing story.  One cast, one lure, one fish escaped, one-nil to the ocean.

  After fishing Chris took me exploring 4WD style.  We went to the top of the island with magnificent views of the southern beaches, and the other Eastern Torres Strait Islands of Mer (Murray), Ugar(Stephen), and Yorke.  Outstanding views.
We picked some coconuts, and bananas, and explored another beach before coming back.  This was the best day in the Straits so far.  I love the clinical work, and the people, but I had forgotten what it felt like to have a guilt free day off.

Tomorrow afternoon...some Octopus fishing, and Im going to have a crack at making SopSop...and island vegetarian dish made with sweet potato, pumpkin and fresh coconut cream.

Yawo !!

# 29 - Sunday Bells - No man is an Island

#29 - Sunday Bells

No man is an Iland, intire of it selfe; every man
is a peece of the Continent, a part of the maine; if a
Clod bee washed away by the Sea, Europe is the lesse,
as well as if a Promontorie were, as well as if a Mannorof thy friends or of thine owne were; any mans deathdiminishes me, because I am involved in Mankinde; And
therefore never send to know for whom the bell tolls;
It tolls for thee." 

The prose quoted is John Donne's Meditation no. 17 from "Devotions upon Emergent Occasions" (1624):  and made famous in 1940 by Ernest Hemingway. in his book "For whom the bell tolls"

With all good intentions to attend the island church service this morning, it was not to be.  I received my first call out at 8, then 9, 1030 and 1130.  Having just returned from my 5th call on my day off (at 330pm) , I missed the opportunity to attend the service this morning, but was reminded, nay taunted by the church bell ringing to call the people to church.  I was ring for me, but Me couldn't get there because there were people to see.

What is it with these folk and boils?  I have never seen so many boils.  A small girl presented with multiple boils, 7 presentations in the last 12 months  for boils on her motop (you sit on your motop usually!!).  Normally when you come at children with needles and scalpels, the kids will start crying and carrying on...not this princess.  "been there done that"  she knew the drill.  It is sad really.

A researcher (Seligman)  did experiments electrocuting dogs in the 1960s, coined the term "Learned Helplessness"  where, knowing that there is no escape from an inevitable painful stimulus (in the dogs case it was an electric shock, the dogs subjected to the shocks stopped reacting, or even bracing themselves to the coming shock.  Some of these children are so used to having boils incised and drained, or painful LA Bicillin injections injections in their motop, that they hardly flinch.  There is in effect a form of learned helplessness.

So what is the answer?  The wider Torres medical and nursing community would suggest that these recurrent conditions are multifaceted.  Caused by substandard hygiene, over crowding (sometimes 3-6 kids in one bed), poor nutrition (Vit C , zinc, iron in the diet).  What ever the causes, these conditions are fairly isolated to these communities, and I am a little flawed as to why more awareness, and funding is not being thrown at this continuing problem.  Is it in the too hard box??  Has our federal health department received a dose of it's own learned helplessness?  Look I am not meaning to get political here, and nor is this a political issue, but as a White boy taking a look at a snapshot of a few indigenous communities in the Torres, in 2011.  These sorts of problems read like medical journal observations from the 60's and 70's.

For whom does the bell toll??

On a lighter note, my colleague Annie's  husband, Chris just returned from fishing off that reef ledge out the front of the clinic just now.  He has 100 pound line (45kg ish) on his lure and something just hit his rod and shredded the line like limp spaghetti .  His wire trace was snapped and a metal swivel was straightened!!!  I have decided not to go snorkling there tomorrow, but dead keen to see if I can lose a few lures.  The locals go down to the jetty on high tide and with a fresh hook, flick it through vast schools of sardines; foul hook them, and use them immediately as "injured, distressed live bait"  Trevelly and spanish Mackrell  love them.
I think that sounds like great fun...catch your bait, and then recast out to deep water to catch you dinner.
Hopefully by this time tomorrow afternoon (Queensland Birthday), I will be able to report a seafood feast.

Until tomorrow. Yawo!

#28 - Odd jobs and Odd creatures

#28 - We are living in a weird and wonderful place.

Today (Saturday) is my first day off.  Though work this week, has not been particularly taxing- save for the Cold Chain Breech yesterday; it is still nice to occupy my time my way. 

My morning started by dropping off Ben another nurse off at the airstrip.  The end of his contract had come, and he heads off on a marathon trek today from Darnley Island - Horn Island - Cairns - Sydney - Adelaide. He wont get home until about 8 pm tonight, so I loaded him up with  a breakfast of half a wild grown PawPaw & two Strong cups of coffee, and in return he left me some lovely fresh Mackerel.  Yummo...for tonight we eat fish.  Ben if you are reading this, thank you, and it was a pleasure meeting and working with you....Now Mop my floor!!!  (in joke).

A couple of other odd jobs this morning.  A young lady with a new diagnosis of Gestational Diabetes which is a form of diabetes one gets only when pregnant; needed to have this news shared with her this morning.  She was a little upset at the thought of having to test her own blood sugars (by pricking her finger) 4 times each day, and change her diet from CocaCola, Nuttella and Nutrigrain to fresh health fruit and veges, but with some gentle persuasion she'll come round.  I will do some followup education and counselling with her on Monday morning to see how she is going.  Another first for me.  Ive never had to break this news before, but the maternity team in Thursday Island, has a fabulous set of resources to use for teaching new Mums to be about the evils of diabetes.
  If you have been following the blog, you will recall that a huge rock wall was hand built around the coral shelf in front of the clinic (and my accommodation).  This Fish trap is one of those things that I have been watching for the last few days, and as the Luna cycle creeps towards full moon, the tides have gradually been getting higher highs, and lower lows.
On the bottom of the low today the rocky fish trap was almost completely devoid of water save for multiple rock pools , gullies and sandy shallow ponds.  After a few call outs and odd jobs, I decided to venture out to the shelf and explore the pools.

Do you remember loving to do that as a kid.  You'd don thongs (jandalls in my case) or an old pair of sandshoes and explore all the cracks and crevasses left behind by a retreating tide?  Well I had a ball!!
I saw creatures in that water that I have never seen before.  Crabs that look like mossy shells, long snake like fish with a mouth of a million needle like teeth.  A beautiful spotted eagle ray, and even caught some footage of a small squid playing around my feet and the rocks.  It was so relaxing to paddle, in relative safety litterally a stones throw from the clinic.  The water was about 27 degrees, and crystal clear!!   After about an hour I looked back to the clinic to see a patient waving from my front door.  My fun was over for the minute....or was it.

Those that know me know I love a good wound, or boil to lance.  Well today This bloke had a doozy.  A 4x5cm carbuncle with about 6 heads in it.   !!!

• Scalpel ...check.
• Lignocaine ...check.
• Lots and lots of gauze...check.
• Goggles ...(yep, you read right) ......check.
• Antibiotics......check.
• Good strong arm (and stomach)......check!!

Hold tight mate....Im going in!!! 
Well that was as much excitement as looking in rock pools.  It is amazing to see what can come out of some folk.  I am sure he is a kilo lighter!!  In all seriousness, this was nasty, and he was starting to feel systemically unwell.  The big risk with these lesions is that they can become cellulitic and cause complications like septicaemia (Blood poisoning).  As aggressive as my poetically licenced description may sound, this bloke will be feeling much better today because of his abscess drainage.  I feel satisfied.  A job well done, and he was very thankful.

On completing this task, I met Annie, the permanent nurse, who had just been picked up from the airstrip by Chris her hubby.  I look forward to learning the ropes a bit more from Annie, and hearing her take on Life a a permanent RAN (Remote Area Nurse).

The afternoon has been quite civilized.  I might have another paddle in my rock pools , or catch a few zzzz on the couch, with the breeze blowing through the coconut trees.

Tomorrow... On call again, but will attend the church service (which is just next door), and we will see what comes through the clinic door.

 It is almost the end of week one of three on Darnley.  There is so much about this island that I could enjoy more if I had Jo and the kids with me.  Amy would love playing with the island kids, Ben would have a ball in those rock ponds, and fishing off the wharf, and I could walk hand in hand with my bride for endless miles down unspoiled beaches, sucking the island breeze into my lungs and feel recharged by His creation.

#27 - An Ode to the Cold Chain

Ode to the Cold Chain
All stop thee for the charter of the skies which brings forth great wonders from down south,
low, it is with sad regret that this morning my chin did drop , and agape was my mouth.
for upon the winged stead which adorned us with its delivery just last night
was a grail of polystyrene, which held sacred contents, needing refrigeration,
Yet with nay haste was it brought forth unto the clinic, and its contents, delegate and costly vaccines, perished under the might of the Torres heat.

Woe to us that discovered such foul and foetid breech, and was made fast to have to report the potential loss of a multitude of treasures.  Yet with orchestrated precision, such err was thwarted by some quick cognition and the hand of God.

....   Oh what a load of rubbish...Here is the drill.  Vaccines must stay between 2 and 8 degrees from the time that they leave the supply department in Brisvagus, to the time that they are in our hands.  They arrive by a chartered plane, via Cairns, Thursday Island and then on up to the verious clinics that store them prior to administration.  Each Esky is packed a special way with a digital thermometer that records the minimum and maximum temperature of the contents of the esky (the vaccines).  Well last night at 5pm, the charter flight delivered the vaccines.  They got picked up at the airstrip, and then...somehow, the esky was left in the boot of the car!!   Now those in the know will tell you that this represented a massive Cold Chain procedure breech.  On arrival of the vaccines here, they should have been immediately packed into a specialised vaccine fridge.

This morning I enquired as to whether the Vaccines had arrived as yet, and some folks swallowed hard....whoops.  The Esky containing thousands of dollars of medication was still in the boot!!!
It was 10 am before this was discovered.  I thecked the contents of the box, and assessed the Min/Max thermometer.....DAMN!!!   4-10 degrees....breech!!!  Protocol has it that I had to phone through to Brisbane and Thursday Island Public Health Unit and report the breech.   They were very good about it, and directed me to the next procedure.  The Vaccines needed to be quarantined with a DO NOT USE sign until further notice.

Thank fully God was smiling at us, the phone soon rang, and the good news was that because the vaccines hadnt got warmer than 10 degrees, there were still viable.  Lesson learned!

The thing that I love about the Torres is that every day is a new challenge, and a new thing to learn.  In my silo that is the Toowoomba based educator job; there exists a sence that you know what you need to know.  But you step out of your comfort zone, and into a completely different field, and realise that you are just a sterile Agar plate waiting to be colonized with new and exotic knowledge.  I love these experiences.

This week end I am on call.  Ben the other relieving nurse flies home to Adelaide tomorrow.  Annie the permanent nurse (who has been on Thursday Island at some training) will return to work on Tuesday.
I bit of reef walking, and a spot of fishing, and perhaps even a swim might be on the cards this week end.  But one thing is for sure, It will be another weekend of new and amazing experiences, upon which I build my perspectives, and knowledge.

Youve got to love the Torres!
Yawo !

# 26 - Flushots at the IBIS, and umbrellas in my drink!

#26 - The Dawning of a new day.  One where i take up the opportunistic health sword once again and hit the local shops...well ... shop and offer Flu Vaccinations.  I met Susie, an RN staying on the island.  Susie is originally from East Germany and tells an interesting saga of her youth.  In chatting she revealed yesterday that she is currently undertaking the QH immunisation nursing course, and that she requires another hour of clinical observation prior to her workshop next week.  Well, those that know me, know i can spot a learning opportunity at 1000 paces, so what a great opportunity to get out and conduct my first ever FluVax clinic.

I endorsed as an immunisation nurse in 2007 but being stuck in an office job, there was little opportunities to practice the skills, and actually apply the clinical knowledge.  This was going to be a Win:Win:Win day. 

At 9Am we went through the protocols and packed the esky the way that Donna, SueS and Theresa would be proud (those that know D, SS and T know who I am talking about!!). We packed up 40 Flu Vaccinations, our safety , emergency and anaphylaxis gear.  Sourced our HMP, Standing order, Immunisation handbook, PCCM, Cold chain record book, Letter to the Queen, and every other document that we thought we might need, packed the toyota, and armed with a huge banner we set up a makeshift clinic outside the IBIS convenience store on Darnley Island.

In minutes we had islanders coming from all angles, and with a nice litte system of documentation, and screening interviews we had worked out, soon had more than two dozen sharps under our belt.  Susie then had to catch a flight off to the mainland, so I dropped her, Mala her daughter and Dr Juerg her hubby off at the air strip just in time to catch the most amazing footage (on my iPhone camera), of the tiny 6 seater Barrier aircraft landing in windy conditions...."Go the Barf bag ", I thought, but didn't articulate!!

Waved the family off for their 2 week break...the island is now Doctorless for a fortnight.  So it was back to the clinic to grab Lucy our Centre manager and Health worker extraordinaire, to complete the vaccination task with me. 

Phase Two:  Im Mohamed wont come to the mountain, take the mountain to Mohamed!!  Some of the adults that would miss out on the opportunistic vaccinations on offer at the shop, were the school teachers and teacher aides.  So Lucy and I took the vaccination esky to the school.  I got to meet some of the folk, and between the library and the staff room, soon exhausted our supply of 40 vaccinations.  That is so great.  40 people that might have otherwise contracted the flu this season.  I love this public/primary health stuff.

I returned to the clinic to a mountain of VIVAS documentation , charting and nice feedback about some complex dressings I consulted on over the last couple of days,  healing really well.  The communication between nurses and health workers here is encouraging.  These folk are fun loving, and I am having a great time learning their culture, and language.

Today was a great day.  I feel like I have done a good job, that I am well received, and the sense of optimism today is high.  I am not on call tonight, so I might slurp a rum or two tonight, because for the next 4 days, I am taking call.

Addit: 1800hrs

Im looking out at a group of 30 or so young blokes playing touch footy on a rustic patch of grass on the foreshore of an  incredible Coral cove.  It is surreal, foreign, raw, but oh so comfortable.  I can see myself living this island life long term....especially when the texts from my friends and family 3000 km south speak of 3 degree temperatures and frozen washing on the line.  Im drinking a coconut drink, with rum & pineapple juice, in a light T and shorts, taking in the Darnley Island preparation for State of Origin next Wednesday night....Where is my twizel stick, and cocktail umbrella??  And should I peel another prawn?

Living the dream!!

#25 - Fish Traps at Dawn

#25 - Fish traps at dawn. 


At breakfast today I sat on my front balcony looking at the fish traps.  Ancient man made rock formations that are put in a bay to catch fish. The tide comes in bringing fish, then when the tide goes out, some fish get caught behind the rock wall that dams off a section of the bay during low tide. Men and boys wade out into the shallow waters, corner the fish and spear them. Efficient!!! 

First full day in the Darnley clinic today. If I could just stop looking out the window in awe of His creation, I might just get some work done! But seriously, I'm sure the novelty will wear off soon. I saw a potpourri of presentations today. The doctor flew off to Stephen Island this morning, so some interesting stuff fell in my lap. A small boy with a mashed toe needed his nail removed... You've got to love local anaesthetic, but selling him the idea that it would take two injections was not so easy... Two health workers, an Aunty, and some sound proof walls, and it was all over but for the shouting!!!  Another bloke with a sinus 18mths post cabbage.  For those uninitiated to the jargon, a cabbage is actually a Coronary Artery Bypass Graft abbreviated CABG.  A sinus is a wound that develops in the old suture line that starts out looking like a boil then erupts and leaves a deep crater . The resulting cavity (sinus) needs to be packed. We will send him to TI for an ultrasound to determine how deep it is, and to where it leads. 

The usual dressings, pathology specimens and health checks punctuated the remainder of the day.  I must say, the pace here is very sedate when compared with Saibai. Whilst I love the interaction and learning I am experiencing talking to the health workers here, I feel that I am at a loose end when there is little to do. The computer system is currently undergoing maintenance so I can't access my emails. 

I have decided to pack an esky full of fluvax and perform a door to door immunization service tomorrow.  This will get me out and about, I'll meet a few locals, and some of the teachers, jab them with gusto, and make my own fun!!

I'm on call tonight, so whilst I don't want to see any one suffer, a nice juicy trauma would be nice... But shhhhh , I didn't say that out loud.  Until I'm called, I'll just do some fishing, sip my coconut and enjoy the views.

24- poles apart- Darnley island day 1

#24. Poles apart. Darnley day1

A magnificent morning flight to Darnley island. I met Sandy the traveling midwife who hops around doing antenatal visits with women local to the various islands of the Torres.  An amazing woman with what she calls the "best job in the world".

We briefly land on York Island where in 2006 the SBS series RAN - Remote Area Nurse, was filmed, then off in to the azure and turquoise wilderness of coral and sand to Darnley Island called Erub by it's locals.  First impressions was that this is what was meant by the person who first coined the term Paradise!!!

Imagine the picture perfect tropical island, surrounded by blue/green water and coral outcrops, banana and coconut palms,  mango and pawpaw trees, white salt like sand, housed dotted among the mangroves, rocky fish traps, and water so clear that you can see the ocean floor as thought there was no water.  This place is magic... Just call me Robinson!!!

Then we landed. I met Ben (the relief nurse I'm replacing) who drove me and my gear the 15 min track over the hilly volcanic terrain that is this amazing island. Ben took me to the clinic and my accommodation a 2 bedroom town house on top of the modern clinic. The view from my front verandah is nothing short if billion dollar ocean views. The ocean is across the road from the place, ocean breezes fill my unit with a fresh salty aroma as I type this blog, and I swear I can hear whales whistling outside my front door. 
This place is truly beautiful beyond description.

The clinic is run by a crack unit of health workers, who triage the patients into three categories. A health worker pile, a nurse pile and a doctor pile. The doctor resides on the island and frequently trips to other islands in the eastern region by chopper. Unless a life threatening emergency exists, the doctor only works office hours, and nurses carry the oncall pager like Saibai. emergencies are few and far between here. I'm not sure why that us, but for the obvious fact that Darnley is too far from PNG for nationals to cross with emergencies, and the general health of Darnley islanders is very well monitored by a well oiled primary health care model that benefits from a resident doctor. Saibai in contrast is so frantically busy and only gets a doctor for a couple of days a month, it is hard to get a primary health (core business) model up and running. 

In that regard from a frantically busy, swamp/mangrove boarder frontier island to a slow paced, primary care, coral white sand beach island.... The two could not be more different.  They are Poles apart!!!

In my room I unpacked my bags to find that when my bride jokingly jumped in my bag on sunday night saying "I'm coming with you", that she squashed my shampoo bottle, my jocks and socks took the hit and now smell like palmolive 2 in 1.  Not impressed honey!!!

So I'm off to admire my sunset, eat some crackers and dip admiring my ocean view, then when I'm up to it, I will wash my smalls !!!

# 23 - happy Queensland Day from the top of Queensland

#23 - Queensland day 6 June- from the top of Queensland.

Happy Queensland day. It was on 6 June 1859 that Queen Victoria signed the Letters Patent authorising Queensland's separation from NSW.  This day, 6 June, is known as Queensland Day, and if not for Queen Victoria's signature, we might all be doomed to an eternity wearing blue jerseys. 

I've come to the opinion that at 4am there are two types of people. The morning people and the grumpy prickly "don't talk to me people".  I'm a morning people, my bus driver was also a morning people too, and that made for an entertaining trip to meet the airport connection coach. The other people on the bus are in the second category. "Good morning"... Nothing!  "where are you traveling to today"... Nothing. Umm. Driver, can you turn the heat up, it's a little cold back here!!!

Bus drivers, hairdressers and taxi drivers.  They are really the experts in social observation. If you want to know what to do about global warming, or conflict in the middle east, or carbon tax or any other government policy, just ask your bus driver, hairdresser or taxi driver. 

Let's just say, I am now fully informed, and know what is best for the country and international diplomacy.  To the other halfwits  on the bus, a big raspberry to you.  Lighten up!!!

So after the dream run to the airport, the next pearl is that my automatic booking failed ... "see a customer service officer"
As it turns out QH had booked my flights but not followed through with ticketing. So I had no ticket!!!???

The CSO could not explain how that worked, but with a few frantic calls to supervisors and some mad ass typing, I miraculously had my boarding pass , a newspaper and a cappuccino and was seated at my gate waiting for the call. One discovers their ability to neoligise (make up words) when one is tired. I spilled my coffee on the newspaper, soaking the number puzzle I'd started.  From this day forward I shall call that situation a 'sudokucino'.... Or a bloody nuisance. 
Time passed, social observations, and comedic content fill my mind, and I settle into my seat on the first leg of my Darnley trip, with an air of optimism, and a reflection that this is about as far from nursing as it gets.  In three short hours I will be at the gateway resort, on Horn Island no doubt uploading this blog to the web. For tomorrow, the language of Miriam Mer, of the Eastern Torres group of islands will be an unfamiliar brogue that my ear must acclimatize to. 
Happy Queensland Day everyone, it is so special to be able to say that from .... Beyond the tip , or ... Over the top.

Blog 22 - Here We go again

Blog 22.  Catch 22.  Ahh the irony.

Sitting at my desk here in Meringandan, I have packed once again, and prepared myself for another 3 weeks away from home..again. Ive had a great week at home, and am excited about what the next 3 weeks in the Torres will throw at me.

My return to "my life" was not without incident.  On the first night of my homeward journey, one of four mud crabs that I was transporting home, escaped in the Horn Island Motel.  My blood ran cold when in the morning , as I was packing to take my final leg of the trip home, I went to zip up the bag holding my crabs, and the head count was only three.  The blighter was discovered under the bed, cornered and angry.  Getting this cross crustacean back in the bag with his mates proved to be a comedy of errors.  None the less, we got there and commenced our two flight trip home.

My home coming was great.  Jo and the kids drove to Brisbane , fighting through Brisbane traffic to collect me from Qantas. I was armed with hand weaved baskets, frozen Lobster tails, live mud crabs, carvings and a Kundu.

It was fantastic to sit with my people and share the 200+ photos of Saibai.  To hold my family, to smell my own pillow, to just Be.  And it dawned on me during my reflections of my time on Saibai, that whilst I have a heart for this job, and the islanders that I was privileged to serve, the old adage of "Home is where the Heart is" rings true.

So is is with mixed feelings that I prepare to do it all again tomorrow.  Part of me is "game on for the adventure" but the larger part of me is really wanting to stay home, and get on with life.  How privileged I am to have choice, when so many dont.  So Ill suck it up, and get on with it.

This time tomorrow night I may be in the very motel room that I was last Saturday night when my crab escaped, and come Tuesday, a new clinic, on a new island, with a new language, and a different set of rules.

Darnley Island in the Eastern group of Torres Strait Islands is the destination, and I pray that the stories and experiences are at least half as colourful as Saibai.

When next I blog, Ill be in shorts, and a t-shirt and talking to you from the tropics.
Here we go again.