Thursday, 11 August 2011

#56 – Paradise found and lessons abound

#56 – Paradise found and lessons abound

Well this is it weary readers.  Until my Family and I return to the crystal clear waters of the Outer Islands, these blogs will take a break.

In 13 short (but sometimes long) weeks, I have cried, and laughed, and been angry, and been relieved, and been fed gastronomically, spiritually, vocationally, educationally, and socially. I have experienced, disappointment, frustration, elation and humiliation.  I have enjoyed, the culture, the work, the language, the fishing and the solace.

I have grown immeasurably in these three 3 week contracts.  I came to the Torres to get a taste of what outer island nursing was all about and will leave with an insight so unique, so quintessentially different to any other theatre of nursing, that I am left awe struck and inspired.

When in May 2011, I came to the islands for my first taste,  I thought I knew what I was doing.  The experiences and randomness of the Torres carved an indelible scar into my knowledge base, and the cavity that it left will never fill. 

I know that there are nurses young and old reading these posts, who for what ever reason say to them self, “Oh…I could never do what Rob has done”, and to you I say “Rubbish”

There are nurses reading this that will say, “ahhh.  Piece of cake, give me a ticket, this RAN stuff is easy”, and to you I say “Rubbish”.

There are nurses that know me and think that I am confident in what I do and that I am prepared for any eventuality, and to those nurses I say, “Rubbish”.

Let me be brutally and painfully honest.  I was scared, scared that I wouldn’t know enough to function in an isolated area.  I was so stuck in my trauma nurse comfort zone that really only became anxiolytic on a small handful of situations.  You cant prepare for working in an area like the Torres.  It is unique.  You arm yourself with the right attitude, and I came to learn that that attitude was one of humble servant, and scholar.

There wasn’t a day that went passed, where I didn’t ring some expert in TI, or Cairns for advice.  I learned that I didn’t have to have the answers, just the balls to ask the rigt questions.  For me, a nurse educator, this was a huge shock.  I come from a world where I had to have the answers.  I have made a career out of reading everything I can get my hands on, and committing “stuff” to memory in case, in a class room somewhere, I get asked.  Many would say that remembering things is one of my strong points….but all this means nothing when you find yourself in a foreign land, with a world that functions in a different dimension.

So one of the most important pieces of advice I can give you, is ask more questions than you give answers.  It is a hard lesson for me, but one that has served me well in the Torres.
To the people in the three villages that I lived, played and worked, I say big esso. As a nurse having to sit through useless, inane cultural awareness programs that did no more to prepare me for your “way” than reading about knots prepares me to be a sailor; yet you took time to teach me your customs, and your language, and your food, and your perspectives.

You have done more for my concept of closing the gap, than any corporately funded program.  I hope that you have found my blogs about the Ilan way, to have been honest.  Not sugar coated, or inflammatory, but a true reflection of issues that you face daily.

To the family and friends that have dutifully, or even voyeristically logged in every so often to read the next post, I hope that you will understand me when I say “you just wouldn’t understand, unless you were there”.  You may have found these posts entertaining, I am glad you saw it that way.  They were meant to be entertaining.  You might have found them raw, because they were.  You might have found them fanciful, or embellished, but I can assure you that they weren’t. 

What I hope for is that you saw them through my eyes. 
That when I was lonely, you felt that too.
When I was angry or frustrated at injustice or irresponsibility, you felt that. 
That when I was awe inspired by the shear beauty of the region and the people, you felt that too.  I hope that you want to put the Torres on your bucket list.

I hope that by reading my clinical stories you learned a thing or two about medical differences, and conditions, and that you googled them or went to Wikipedia and learned along side me.

I hope that regardless of your faith, you respected that I have mine.  That my God is with me “Emmanuel”, and with these people, and that in the darkest times here, I had my God and my faith as comfort, and strength.  I hope that if it turned just one of you to the bible, or a Christian friend to ask a question or two, you did that without feeling silly.

If you are a nurse and you long to give this a go; do it.  Understand that no one is an expert, no one is really prepared for what happens up here, but remain a scholar, and keep a keen eye for the learning that befalls you and you will have an experience beyond all you most amazing dreams.

For the final time on Yam Island, I sign off, and trust when I pick up this keyboard again, there will be another story, another experience but most importantly, another lesson.

Yam Island…Over and out!

Tuesday, 9 August 2011

#55- when is an STI and STI?

#55 – When is an STI an STI?

It intrigues me when a person comes in with one problem but leaves with another.  Some years ago a former mentor of mine suggested that when a young bloke presents to a clinic with an insignificant ailment, start digging and you will find the real reason for his presentation.  Well I have spent too many years as a jaded, and at times burnt out ED nurse to really have time to bother with halfwits that want to waste my time by not getting to the point of their consult; that is , until I started to work in remote practice.

The pace is slower.  The world up here is not ruled by the clock like it is down south.  So One of the good things is that as a clinician I can take my time developing a rapport, and getting to thoroughly assess someone before rushing them out the door.  Today a prefect example took place.  A young man in his early 20s presented with an “old football injury”.  I asked all the relevant questions, and assessed what was just a mildly painful soft tissue injury, what we call an STI.  I suggested he could take some panadol or nurofen for his pain, but he declined.  I was puzzled.  First he comes to me for help.  Next he is refusing to take the advice I give.  Then it dawns on me that there was something not right with this picture.  Young fit healthy men don’t take themselves to the doctor until there is something seriously wrong!!

I shut the door to the consult room, and leaned in close and asked him. “is everything ok with your privates mate?”  The look of relief on his face was all the answer I needed.
He started with a story about not being able to pee well.  “No Uncle, it prapa hurts wen I go pisspiss”.  “Ah ha! “…like pissing razor blades”? I asked, and he raised his eyebrows which is Torres gesture for “Yes!”

“Any thing else  Bala” I enquired, and he raised his eyebrows again.  “Waa Uncle, I gad dis sores, and some pus, on there.”  I told him that I needed to have a look at his “there”.  The sight that awaited me was enough to make me wince.  The poor bugger!
This young bull, had sores , and discharge and a whole farm of sexually transmissible infections (what we call STI), and he told me that he had been having symptoms for over a month.  The good news that I gave him was that most of the treatment for STIs are a single oral dose of strong antibiotics, and in some cases a needle.  That is it.  Done.
I ran some pathology samples (urine test, blood test) and swabs, and he was on his way, brown paper bag full of condoms and lube tucked under his arm, with out the limp that he came in with.  So was his presentation an STI, or an STI??  Ill let you be the judge of that.

. * . *. *

Blister packs are packets of pills.  Usually packed for ease and convenience by the pharmacist, a blister pack has the week divided into Monday – Sunday rows of medications separated by ‘breakfast-lunch-dinner-bedtime’ columns.  Many of our elders in the community are on Blister pack, which change from time to time.  We supply them through our clinic, in batches of 2 weeks lots, and use the consult as an opportunity to catch the person for a Blood pressure check, or blood sugar level check when they come up for a refill.  Occasionally after doctors clinic, the meds are changed, and new blister packs need to be issued, dispensed via TI pharmacy, and then supplied to the patient.   Today I did 8 home visits to distribute blister packs.  Going into the homes of the community members really gives me an insight of how these folk live.  In the yards of two people I visited today, the family was butchering freshly killed Turtle.  These magnificent animals are part of the traditional diet of Torres Strait islanders, and to see them out in the open air, with dogs and flies hanging around, and sunlight bearing down, was a little stomach churning.  One home had a huge open wood fire boiling chunks of turtle meat in a concoction of onions, celery, and herbs.  The meat is red like venison or beef, and the fat is green like the colour of a lime.  I casually asked some questions and handed over the medications, and was on my way. 

Later this afternoon, while fishing on the jetty, my oncall phone rang, and it was a mn from one of the families, asking if I could stop at their house on the way home to the clinic.  Curious I finished my bait, and wandered home via the main road.  As I approached the house, I could hear laughter, and music.  I could smell an unusual aroma coming from the fire pit.  One of the young blokes came over to see me with a plastic bag in hand.  He held out the bag, and says, “ good afternoon Uncle, we have some Totol (turtle) meat for you”.  I was honoured, and a little repulsed, but very touched.  I asked how to cook it and was amused to hear that they often cook it with flour, curry powder and soy sauce.  It amused me that such a traditional meat is cooked with flavours that are more at home in a Caucasian kitchen.

Following his advice, I came home and cooked my totol, and am thrilled to say that once I got my head around eating something that was not normally something that I would have associated as food, it was delicious.  I have enough for another meal, so am looking forward to having a crack at using it in one of my own curry recipes.

Well that is it for this post.  Two more days on Yam, and I will be home with my mob, packing for their adventure of a lifetime.  I cant wait.

If you are a bloke reading this.  Do your lady (or man) a favour. Go get a confidential check up with your health clinic or GP.  You don’t need to know why you are there.  Just tell the doc, you haven’t had a Grease and Oil change, or pressures checked for a while…and your health care professional will know what to do from there.
Don’t leave it until your exhaust pipe has almost fallen off!!!

Monday, 8 August 2011

#54 - No Exceptions

#54 – NO Exceptions.

If our staffing gets any leaner, I think I will have to close the clinic and go fishing.  The Boss was still not back today, and Lynda our receptionist flew off the island.  There is only two of us now, and I’m a little nervous.

Those that know me would probably think I was fairly confident n my abilities to work independently.  I think I am, but when there are less colleagues with which to bounce things off, then you do second guess yourself.  That is a little unsettling.  A woman came in today with chest pain. Now for those in the game, you would know that chest pain is one of those “bread and butter “ presentations, and that there are strict guidelines to follow, and the assessment and management of chest pain patient’s is mapped out for you.  Well some of this process was challenging today, as there is no Istat machine to look at blood tests here.  The ECG machine was fresh out of the box yesterday and took a heap of time to get functioning and configured (more on that in a minute).  The patient was hypotensive (low blood pressure), so I couldn’t give the chest pain medicine…a tablet called glyceryltrinitrate (or GTN for short).

If GTN is given to someone with low blood pressure then it can make the BP worse.

So what did I have?  … A woman with chest pain needing an ECG to be done, no way to check cardiac markers (blood tests) and no GTN up my sleeve (or under her tongue).  So I explained to get that I would need to take a heart trace.  But being a man, it was ‘too shame’ for me to do that task, so I am stuck.  No, I was annoyed actually.  People come to me for help, yet wont let me do the assessments I needed, or give the treatments required.

Another patient came today complaining that his bum gets sore when he takes a certain medication.  Now I looked up the clever books, Bumpain isn’t listed as a side effect of this drug, so I tell him, that it might be a host of other things.  I tell him that I will have to take a look at his motop to see what is going on.  I just might add that this is not my favorite assessment!!!  Well he refuses, tells me it is not that much of a problem, and flees, muttering something in language under his breath.

Another Aka (grandmother) brinks in a small child, perhaps 3 years old, covered in impetigo (school sores), and weeping oozing sandfly bites.  The kid has a fever , I swab the lesions for microbiology culturing and start the explanation about this awful Group A Streptococcus germ that is suspected in the wounds on the little pumpkin.  First of all I am to learn that pumpkins are not what we call children in the Torres (lost in translation), She thought I was ballsing up ‘pikinini’  which is their word for child.

Second, the treatment, which as you probably have guessed by now, is that nasty big white needle.  I explain that I will need to jab the kid, and she refuses to let me, telling me that she has been a ‘gud gal’ (good girl).  The premise was that she thought that the needle was some sort of punishment, when infact, it is the kindest option.  That took some explaining, but she wasn’t buying it, and they left with a box of bandaids and a prayer.  When I get a call at 2 am on Wednesday morning with a critically ill septic PUMPKIN, I wonder if they will let me treat her with what needs to be done?

Back to my chest pain girl.  I ring the doctor, and the call goes something like this:

“Hi Dr… This is Rob Timmings the CNC on Yam Island.  I have a 30 year old woman with 24 hours of chest pain.  (jargon describing symptoms / vital signs and other information that you don’t need for the story).”

“Um…well no I haven’t given her any GTN Doc, she is too hypotensive”
“Well no, I don’t have an ECG to fax to you doc, she wont let me take one”
“Yes I understand that Doc, but if the patient refuses an assessment what am I to do”
“Ahhh… Good question Doc, um….no I haven’t taken bloods because there is no Istat”
“No Doc, I don’t know why there is no Istat here.”
“well I know that MI (heart attacks) are diagnosed on ECGs and Bloods, but we cant do bloods and she wont let me do an ECG”.
“Sure doc, I will do that.  Thank you ”

So I hang up from a phone call that was mist strange.  I turn to the patient, and say, “the doctor asked me to give you an Aspirin tablet to reduce the clotting in you blood, then you can go now that the pain has settled.  If it should return I need to come back to the clinic, Day or night, and I will need to do this ECG test.

The girl looks at me and says.  “Oh, I cant take Aspirin, it makes me have a rash” !!!

Now you see, this sort of frustration happens in the big city hospitals too, but there is always a colleague that you can bounce off, and when the going gets like wading through mud, then there is often a tag team, to release you.

My hypotensive chest pain patient, came into my care, had no oxygen, no ECG, no bloods taken, no GTN and no Aspirin.  I sent her home, and have to pray that her pain resolves and that this is a non event, and I have to face my nursing students agaqin with a straight face, and tell them, “now when chest pain patient’s come in, this is what you must do!!!”

Then I have to look at all those keen to learn faces, that take my words for gospel, and give them that convincing look, that says…

“No Exceptions!” 

Sunday, 7 August 2011

#53 - Random Weekend

#53 – a weekend of randomness

I love the weekend like most everybody else, but when the prospect of another 48 hours on call hovers you feel a little trapped.  The boss told me that he’d take me fishing on the weekend, and I was looking forward to that, and crayfish spearing under spotlight on the reef, but when he didn’t get off the Friday afternoon plane, I was a little let down.  Saturday morning came, the Saturday morning plane came and went, no boss!  Saturday afternoon plane came and went, no boss.

It was an interesting Saturday, with a pot pourri of presentations, some mundane things, coughs, colds, sore this and sore that.  Then a little island princess came in aged 6.  While fishing with her Bala (brother), she had sustained a fish hook through her finger.  This sucker was in prapa deep.  After performing a ring (digital) block with lignocaine, I used a needle holder to get a good grip of the hook, and pushed it all the way through the finger so it broke through the other side.  Once through, it was a simple matter of using wire cutters to snip the barb off the hook, and retract it back the way it went in.  Praise God for lignocaine anaesthetic.  My knees were jelly while I was doing all this, but this little darling felt nothing.  I was really proud of myself.  I  reviewed her this morning (Sunday) and there is no signs of infection or any pain.  I am mentally High fiving myself.

After this adventure I decided to walk around to some secluded beaches.  On one of the beaches, there were fresh turtle tracks in the sand.  They lead up the beach to a resting spot, no doubt a nest of eggs; and then another set of tracks coming back to the water.  I stayed tight lipped about it, because I know that Turtle eggs are a delicacy, and had anyone known that the nest was there, then there would be a race to the bounty.

Sunday morning started like every other on the islands.  Clear blue day. There were recalls of Saturday’s patients, and a church service.  Now I have blogged on the church services here before, but this morning’s service was different.  During the week, for confidential medical reasons, I cant discuss here, I got to know the pastor of the AOG church on Yam Island.  He is a straight shooter, who preaches the gospel with power from the pulpit.  He delivers the service in creole, which at a slow pace, is ok, but when he gets his blood pressure up and starts going for it; I feel like I am in another country with a language I don’t speak.  It is just so fast.  I have been in churches where people pray in tongues before, but at times there today, I wasn’t sure if it was broken English that I was hearing or prayer in tongues!!  Im all goosebumpy now writing about it.  As usual the music was awesome, loud, colourful and spine tinglingly catchy.

Then Brother Harold stood up to do announcements.  Now I know that in many churches, the parishioners are referred to as brothers and sisters in Christ, but in the islands this is taken to the extreme, and bala, or sissy is the term used, and is a prefix to your name.

So Harold gets up and introduces the children from Sunday school for a musical item.  After some disorganized shuffling, the children sing “Jesus loves me, This I know”.
There is clapping, wailing and whistling, and the kids sit down.  Harold gets up and says “ Now we ‘av another item from some of the Balas. “  he calls out four blokes names, and looks straight at me and calls BalaRob.   All the men who were called, make their way to the front of the church, make a line across the stage, feeling very self conscious, and oh so white, I line up with the blokes.  Wonder what the heck is going on?  I thought.  Then as the thought passes, music starts.  It is an up tempo Negro-spiritual that I am vaguely familiar with, yet, I neither know the words or the tune well. The other 4 blokes start clapping to the beat, Im there with them.  Then they start singing!!  Not in English, but KLY the old language which doesn’t resemble English!  I am feel very uncomfortable now.  I keep clapping with the boys.  To my horror, the 4 men now start actions, which resemble island dancing!!!  I don’t do dancing!!  I am standing in a 5 man line up neither singing nor dancing, with a dumb look on my face clapping like a halfwit.

Have you ever seen a group of kids on stage, doing a song or dance routine, which requires coordination?  There is always that one kid that isn’t singing, or doing the wrong words, or isn’t dancing in time.  They turn left, the kid turns right….You know that Kid.   Well today in front of a congregation enthusiastically singing a gospel song in a language I don’t understand, I was that Kid!.

If ever I have prayed for the rapture, it was right then!  In 2 painful minutes, the song was over, and I could crawl back to my seat.  I realize that when I get in front of my class room, or my Toastmasters friends, or even my own church, I have prepared, and know what I am doing there.  Today, nope, I was way out of my comfort zone.

The afternoon was much more productive.  I went fishing with a local lad who showed me how to catch bait fish by foul hooking them, then catch dinner by using the still live bait fish to catch the big white fish under the jetty.  Trevally, and Queenfish were on the bite, and in just under 10 minutes I had dinner.  A 700gram Queenie.  Yummo, lime, chilli and ginger marinade, fish, on a bed of coconut brown rice.  It doesn’t get better than that!

I have 5 more sleeps left on Yam.  I do hope that the boss arrives home from Thursday Island tomorrow, but that is anyone’s guess.  I am in wind down mode.  I am ready for my holiday back home, and with my family.  It has been a hard two weeks away from them this trip, but the light is at the end of the tunnel, and I cant wait to bring them up to share this island paradise. 

In just 6 days, this dream will finish and a new one will begin!

Friday, 5 August 2011

#52 - Iama week 2 down

#52 - Iama week two down.
wow what a week, filled with new challenges, new experiences, and fishing.   It is Friday night.  I am just getting ready to put my pen down for the night, but I thought that Id pop on the blogger and air my reflections.
I went down to the jetty tonight and caught that big fish.  as I lifted it from the water, it flicked and snapped my line again.  But not before I snapped a couple of photos.  Some sort of shark, and a timely reminder not o swim at the jetty.  My line is rated to 100 lb which is 45 kg.  Now that is a big fish in anyones language.

The health centre manager has been away for the week, and it has been a laid back relaxing week.  after that mammoth 26 hour shift on Wednesday, I slept fir almost as long, and working today felt like some strange time warp, where Id lost a day.  I unpacked boxes that arrived on the SeaSwift barge.  Again, it was like christmas, as each new box had something better than the rest.  The real jackpot was a ventilator. An Oxylog3000plus arrived in all it's glory.  When the nurses unit has no TV, or lighting in the bedroom, and the clinic doesnt even have an Istat, I cant begin to think why a sophisticated ICU ventilator is needed in a remote clinic, with no doctor to intubate!!  but Im not complaining, just making a social commentary.  We scores a brand new 12 lead ECG machine that takes spirometry also.  Dont get me started on that one.

Tonight I was to be a movie night down at church too.  But it was pouring rain when I went to go, so  I aborted that mission.  I have a few jobs around the unit, so I might just do those, and have an early night.

I have 1 week to go on Yam.  The time has gone quick.  I feel so much more confident with ordering stock, and pharmacy items.  More confidence with contact tracing and STI checks. The core business  stuff that justifies the existence of these clinics is becoming clearer to me, and I really like the model of care.  I cant wait to have my family up here with me, so in 7 days, the big packing starts.  It will be another Island, and another set of circumstances, but I will have my support systems with me and God willing, they  will love it as much as I do.

Wednesday, 3 August 2011

# 51 - The Long one

#51 - The long one.

My plan, after my fishing disaster was to fortify my line, and have another crack at that monster that got away on Tuesday morning.  But for some reason I slept in and only woke in just enough tome to shower, dress and run down stairs to work.  That sleep was perhaps the best that I have had in ages.  Little did I know that I would need that rest in my reserve tank.   The day was huge.

Locals here are getting to know me, I hear them coming to the window and ask the receptionist "That new white nurse, can I see Em?"  I put up a sign down at the IBIS store advertising Flu shots, and there has been a steady stream of people coming for a shot, and a chat.  It is nice to get to know the folks.  As I am seen more and more out and about after hours, people are gradually opening up, and discussing stuff that they wouldn't have just a week ago.  Being new in any community is not easy.  Making the effort can be tough when the way that you communicate is different by values, customs, culture, and language, to the people with whom you are trying to communicate with.  But slowly I'm getting there.

I was talking with my wife just last night,  about how I am not just home sick this trip, but for the first time I am lonely.  As a social person, I need people around me, that is what energises me.  But here, I am in a unit by myself, ontop of the clinic, away from the village, and when the shift is over, and the sun goes down, and I am sitting in the unit just waiting for the phone to ring, it feels pretty lonely.  That is the hardest bit about this trip, this time.  So I was saying to my bride, that I am looking forward to today (Wednesday), because there is a two day doctor clinic. That meant that I would have another human in the unit next to me, with whom I could share a meal and an evening of conversation.  With a really good night sleep under my belt, and a spring in my step, i had a cracker of a day.  More interesting primary health things to follow up.  It was a day full of STI (sexually transmissible infection) followups, testing and counseling.  Some Flu shots, lots of pharmacy supply and a team meeting with the other Outer Island nurses via telephone conference.  The Dr flew in from nearby Warraber (Sue Island) just after lunch, and after exchanging pleasantries, we retired to the mountains of work that we had 4 hours to wade through.

It is coming close to knockoff time near 5pm and i ask the doctor if she would like to share a meal (left over curry), she accepted, our plans were set.  This would be a night where I had some company  !!
Then a man came in with chest pain...

I went through the routine, thankful that I had spent half an hour fixing my ECG machine.  Assessment, ECG, GTN, Aspirin, Vital signs (NO oxygen!!   you know how I feel about oxygen) 18 g IV cannula, bloods collected & spun, and discussed it with the doc in the next room.  This guy had a medical history that reads like a Harrisons Internal Medicine Textbook, so with his history, and risk factors, we just couldn't ignore the symptoms.  Most clinics have an Istat machine.  This is a small hand held electronic machine that you put a blood sample into, and it will give you a series of blood test readings.

One important blood test is a protein in the blood that is released from damaged heart tissue during a heart attack.  It is called Troponin.  Ideally we would have performed a Troponin level on the patient, but Yam Clinic has not got a machine, so we were required to call the Thursday Island hospital and arrange for transfer.  It is going on to 630pm.  an hour and a half after closing time.  Irene the doctor informs me that the patient will be transferred, and as she is telling me this, I have Retrieval services Queensland on the phone telling me the same thing, only their news is not good.  They cant get here til morning light!!!  I was asked to nurse the patient on the monitor until they arrive.

There go my evening plans - of all the nights on Yam to score an all nighter, it had to be one where I actually had some company.  So right now it is 230 am, by clinic is clean, restocked, and my patient is snoring.  The light flickering of a flouro down the corridor is sending Morse code messages to the island spirits., The immunisation fridge is droning on maintaining my cold chain between 2 and 8 degrees., my patient doesn't need obs till 4 am, and it is time to check my facebook.  My friend Brian is doing his first night as a newly registered nurse, and we have been texting on an off for a couple of hours.  I sit here in the clinic at the computer , slower than dial up internet of the 90s, and reflect that in the face of all adversity, I have company.  A world of online insomniacs, friends and colleagues that are away from their beds tonight also, and a blog to write. 

Best case scenario is that the helicopter will be here around 8am, assuming handover on the air strip is swift, I should be able to knock off and catch some zzz at 9 am (just over 6 hours away).  At that time I would have completed a shift that was 25 hours in duration.  This is a special job, with unique challenges, and the more that I reflect on it the more I realise that (even with out sleeping)
... I am still......Living the dream.

Tuesday, 2 August 2011

#5- - The half Ton and Escapees

# 50 – The half Ton and the Escapees

If you thought by the title of today’s blog, that I would be telling some fishing story, you would be right.  The title however refers to the fact that this is entry number 50, half of 100 (or a ton).  But since you mentioned fishing, so will I.  I have, as yet had very little luck fishing on the Yam Island jetty, where, legend has it, that great numbers of large “white fish” or trevally are caught.  With mile complaint to some locals, about my plight, I was informed that if I want to catch big fish there, I should go at 6 am before the dawn.

So, this morning, armed with the mental picture of fish wearing wrist watches so they would know the time, I took my line, and pilchards, and one hook down to the jetty to do battle with the promised monsters.  First cast, and my line is taken, and taken , and taken.  This fish decided to head to New Zealand with my only hook, and had both the strength and stamina to do it. 

Fearful of snapping my line, as has previously happened fishing at Darnley Island last month; I decided to use nylon cord that has a massive breaking strain.  In my mind, it made sense that if I could just hang on tight, once hooked, it would just be a tug of war.  Surely no fish will snap 100lb (45kg) line  !!!   Attached to my whippy-snipper thick cord, I attached a big ball sinker the size of a 20c piece, a heavy duty swivel that looked more like a rock climbing shackle, a wire trace with a 25 kg breaking strain, and my only hook.  A big hook!  Looking at the maths, the weakest link in the chain would be the wire trace, which is rated to snap at 25kg.  I felt confident that anything that took my bait, would be mine, that all I had to do was wear it out, then drag it in.

Well plans were thwarted.  This first cast, and the fish that took it nearly ripped my arm off.  I let him run, and run, and run.  At first sign that the line stopped running, I wound him in, and wound him in, and in , and in.  I was getting excited at this point.  I was about to catch my first monster fish.  Just hang on and keep winding.

In a few minutes, he was up near the jetty, I had only 50 feet of line or so left.  Suddenly he took off again, reclaiming a couple hundred feet of ocean between us.  “Right you mongrel”, I thought, “Im putting a stop to this”!  I slowed the line down and wound him in.  Things were going great until with no warning, he tried a third run, and that’s when the line fell slack.   Dejected, and confused, I wound in my line to see if it was one of my knots that had let go.  What awaited me was nothing short of freaky.  My hook was straightened out!!!  Ive never seen anything like it.

I found a rock and bent the hook back into a hook shape, only with more of a curve, re-baited and cast again.  Within 30 seconds, I was on again.  I am sure it was the same fish, because he behaved the same way.  This was war.  Man vs Fish.  With a sudden jerk, my line was slack again.  I reeled in, and discovered that he had shredded my wire trace, it was a tangle of wires that had unraveled, and frayed.  Twenty five kilo breaking strain wire, and it was snapped like a cheap nylon fishing line.  Tomorrow morning, with two wire traces, and two hooks; I will fight this big fish, and when I land him, I reckon I will have to make the biggest curry and share him around the village.  The big escapee.
From a clinical point of view, it was an interesting day.  More womens business today, a newly pregnant patient, and dome sexual health screening on a few people, some contact tracing which is needed when a sexually transmissible disease presents.  We need to contact all the partners and offer them testing and treatment.  Sensitive business, and I am not yet fully informed on the process, but I did my best and will continue to learn in that regard.

A young woman came in tonight with a severe throat infection.  Her tonsils were touching one another.  She was sicker than she thought, and with glands up and a stiff neck, a puffy face and joint pains, I thought I might have been dealing with meningitis or Glomerulonephritis (a severe kidney infection).  Both of these conditions are emergencies.  I told her that we will need to treat her with some antibiotics, and when I mentioned that one of those treatments involved a needle in the bum, she started to cry and said she needed to phone a family member for moral support.  I told her that was fine, and if she steps outside to make her call, I could ring the duty doctor in Thursday Island to discuss the management of her more fully.  Well, orders given, and I went to get her; gone!  She was my second escapee for the day…if you count my fish this morning.

I was so annoyed, you do all you can for these kids and they “bend the bars apart with their little bekker, and …Voom!”  (Monty Python 1969).  Half an our later she comes back with her entourage and takes it …lying down.

APSGN or Acute poststreptococcal Glomerulonephritis, is a very dangerous inflammation of the kidneys that occurs after a strep throat illness like tonsillitis.  If the infection is bad it can destroy the kidneys and cause permanent renal failure, the likes of which mean, that the patient will require kidney dialysis, for the rest of their days. The alternative treatment is a kidney transplant.  Torres Straight Islanders and Aboriginees are at particular risk, and we must be vigilant.  One of the hall mark symptoms is a puffy face and swelling on the body (oedema), the patient retains fluid, and reports a massive weight gain quickly.  When urine is tested, the result shows large amounts of blood and protine in the urine.  This poor chicken had all those symptoms.  Ill review her for the next few days, but I am confident that by returning to the clinic for her medicine she has saved her own life, literally.  The sad paradox is, she will have no idea how important that one shot will be.

This game is like a knife edge.  One wrong judgement, one wrong call, and the case can go pear shaped very quickly.  God was on her shoulders (an mine) today.
I love this game!!!

Monday, 1 August 2011

#49 - Shame Shame Shame

#49 – Shame Shame Shame !!!

They say (who ever “They” are?) …They say that things come in threes.  Well the proverb may well be true in today’s blog..  The health centre at Yam Island is managed by three health workers and a nurse.  Normally in that mix of staff there is a representative of both genders.  But while I am the nurse here, the usual gender mix is not there, for Yam has three male health workers, and me, a Murse.

Enter, the cultural ramifications of having cousins, and uncles (as health centre staff) caring for patients who are related via blood line, island adoption or marriage, and you have a complicated set of social mores that come into play in the day to day running of a clinic in a small island community.  Up to this point the presentation of a patient for a cough, cold, sores, or a myriad of other innocuous presentations, has not been complicated, the senior health worker usually sees the patient, speaking creole, elicits the main presenting problem, then relays that to the nurse for collaborative management.

I have so far dodged the need to see women with an issue of a more “personal/private” nature, because I have always worked in an environment that other female staff work, and I tend to do the embarrassing boy stuff, and she deals with the secret women’s business.  But all that changed this morning.  Not once but 3 times in the space of an hour.
As I said, these things come in threes right? ! 

Normally in a community such as this, a male nurse, relative or male health worker would not have anything to do with women’s business.  In the Islands they call it ‘Shame’.  A woman would say “It would be too shame for me to come to boy nurse”  The truth is that most island women would rather treat their own bodies the best way that they know how and sadly, allow themselves to get quite sick before they present at an all male clinic. 

My first was a 19 year old breastfeeding mother with a blocked milk duct.  She waqs in a lot of discomfort, and had a hard palpable lump near her nipple.  I could tell that she was uncomfortable with having to let me look at it and assess her, but I went about my business as matter of factly as I could and pulled in the female receptionist just ho have a chaperone.

No sooner had I wiped the sweat of my brow after that uncomfortable adventure then another young woman presented with an itch, and a discharge.  Way out of my comfort zone and wishing the world would open and swallow me, I assessed and asked the most embarrassing of questions about transmissible diseases, and contacts she had had with other partners, swabs were taken.  Urine tests were collected and medication for a host of afflictions were supplied.  The most nerve wracking experience, and again, you could see that the poor girl was distressed.  At this point I am ready to decompensate.  I pull my self together and the positive self talk starts.  “Robert, you’ve done it, you have crossed the dark line into the Oestrogen abyss, and nothing they can throw at you will be as bad as that”.

Well, Nope.  I was wrong.  One of the health workers came and told me that there is a 9 year old girl to see.  “what is wrong?” I asked casually, now battle hardened and bullet proof.  “I don’t know”, said the health worker, “…it’s shame”.

‘Are you kidding me!!’, I thought, surely this cant be that bad.  I entered the room, where there is a mother and a girl sitting on her lap, looking frightened.  “Good morning”, I said as cheerfully and up beat as possible.  I introduced myself and asked what the reason for the visit was.   The woman replied “Its my daughter, she has a worm”.  Ok.  I explained that where there was one worm there was probably more and that with a single dose of worm medicine, we can clear it all up.  Intestinal worms can some times be seen in faeces or at the anus in advanced parasitic disease.  It is not uncommon to have them collected in a jar and presented to the clinic.

But No.  It wasn’t going to be that simple was it?  The woman explained to me that the worm was not like others.  It was like a larvae of something.  The mother told me that she thinks that there was a second one, because her daughter is very itchy.  And to make matters worse, (and this is where I almost fell off my chair),

……the worm was in the front, not the back!!!   This poor princess has something hatching in her v…, in her V……, in her Vvvvery most intimate spot, and I am way out of my depth.  

Reluctantly I explain to the woman that I will need to take a look.  I allow the mother to assist her daughter to disrobe, and what awaited me behind the curtain, is the stuff of some tropical disease journal.  She had sores everywhere. With one in particular that was becoming cellulitic.  Suffice to say a phone call was made to the on call doctor on TI, I had no idea what I was looking at, but I knew that antibiotics were going to play a staring role.  The doc was great, she reassured me that my description was not unusual, and that the critical issue was to treat the cellulitis of the perineum aggressively.  So with a BIG penicillin needle in the bum, and a course of Fluclox, treatment commenced.  I gave mum some antiseptic soap, and some hygiene advice, and asked her to come on Wednesday to our fly in medical clinic, where a female doctor can do a more thorough examination.

So this place never ceases to amaze me what waits lurking behind the curtain, or revealed each new day.  More than ever I feel like a student again, and with each new experience, and each new triumph, comes a sense of awe, and satisfaction, that really sends the message home to me that I really am …living the dream.

Im off for a Betadine shower !!