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 !!

Saturday 30 July 2011

# 48 A - The Stingray Barb

#48 – The Sting Ray Barb.

One of the Island things to do is reef walking, to take a stroll out on a low tide reef exploring tidal pools and rocky crevasses, and explore the intricate fractalism inherent in the coral itself, is relaxing.  I was sitting some rocks yesterday afternoon watching some fellas wade through knee deep water, as clear as Gin, they had spears in hand and were catching flat fish, sole, flounders, sting rays, flat head…I guessed.  As I sat there I wondered how many of these blokes score fish stings.  They are at one with the land and sea, they seem impervious to the sharp jagged coral and shell encrusted rocks as they traverse their patch of bay with a leopard like prowling.  Not one of these blokes wearing shoes, and I made a mental note at that time to look back at the clinic stats to see how many presentations from coral and fish injuries there had been through the health care centre.  With string bags they would occasionally stop, spear and then retrieve some flipping morsel destined no doubt for an island feast that is legendary in these waters.

That was about mid afternoon.  These blokes might go till dusk about 630pm before returning with a full tote.

Fast forward to me sitting in my unit last night, 745pm and the oncall phone rings.  It is one of the health workers. “Uncle Rob, my cousin bala has a sting ray sting, and he is in a lot of pain, can I bring him up”?

I smiled to myself as I reflected on the ponderings I had had just 4 hours prior while watching the stealth hunters at work.  “Waa, bring em come!” I said in my best attempt at Creole.

The young bloke hobbled in his foot was white and shriveled like he had been in the bath too long.  I pointed to his foot, and said “Yu b putem in otwata (hot water)”, he raised his eye brows (the island equivalent of our nodding in the affirmative), “Good boy” I told him.  I knew that this was not the first time a fish sting had happened to him or his family, as bathing a stung limb in the hottest water one can stand is the first line treatment.  I asked when it happened, his reply was 3 hours ago.  I smiled again.  He was one of the blokes I had been watching perched on my rocky observatory.

Drawing up 5 ml of lignocaine (local anesthetic) he started to shiver.  I asked if he was ok and he tells me he is scared of needles.  I smiled again, amused at  the paradox  of a man walking bare foot in sting ray infested waters and a needlephobic.  I was torn between full disclosure of informing him right now that he had a Tetnus booster and an opportunistic Flu needle coming in a few minutes, or not.  For the moment I chose ‘not’.

With a deep breath I inject the ‘local’, he holds still, then clink, my needle hits something hard.  Bugger, there is still barb in the wound.  Out come the forceps and scalpel, I open the wound a few millimeters, and forceps in. A piece of barb is easily removed, and I pull out.  Relieved, and shaking myself.  We get taught principles of surgical wound closure, but I have never had to cut and retrieve a foreign body from a fish sting.  That was a first for me.  Bleeding is a bit of a problem for these injuries, so after 5 good minutes of pressure, I have stopped the flow, applied a pressure dressing, and am preparing his Tetanus and Flu shots.  He’s gonna be sore tonight when that ‘local’ wears off!  I supply him with some strong pain killers and off he hobbles.  I hope to see him this morning at follow up, but it is anyone’s guess.

Friday 29 July 2011

# 47 - Frustration envelops me

# 47 – Frustration envelops me!!

It was a serene setting on Yam Island this morning as I sat on a jetty over turquoise water and wet my line.  A few small fish played with my line and as fishing goes it was pretty lame haul of three small boney fish, but it was definitely a satisfying experience.  I had some recalls this morning too, but as seems to be the way on this island, reliability to return for follow up is not great, so after sitting in the clinic between 9-10 am just tidying up from he last nurse, I decided that enough of my day off had been sacrificed, and I grabbed my reel and headed for the reef.

One of the frustrating things in this place is the value I place on health, is not reciprocated by the majority of Islanders.  So when Islanders are asked to return for follow up it is anyone’s guess if they will show up or not.  Now I am all for freedom of choice, but if you are the parent of small children who need consistent quality health care, ignoring health recalls and follow up appointments treads a fine line between child neglect, and exercising the right to refuse treatment.  I feel a little frustrated by this, and it unsettles me when I see kids that are so sick with infections, that if they were in a metropolitan part of Australia, where there are good services, the child would be flagged as a neglected child, and the parents/carers would be hauled in to explain to authorities why they fail to provide the necessities of life.  Am I being unreasonable here?  Is my expectation that you will be a responsible parent reasonable?  Or am I living in some other fantasy?

I know in my heart of hearts that the children I give antibiotics to wont complete the course.  I know that the Scabies treatment (which is complicated and intensive) wont be carried out properly.  And to confirm all this, I’m walking down one of the roads this morning, off fishing, and as I pass the homes of some of the people and kids I saw yesterday, there are the kids, in the same clothes, with the same bandaids I applied just 24 hours ago.  Big breath!

So I am reading an amazing book called “The Shack”.  A story based on the age old principle that we  all have questions that we want to ask God.  One man is given an opportunity to spend a week end in a shack in the Oregon woods, with God in all of His/Her forms (The triune God of my Christian faith).  Each chapter is a new lesson and a new challenge for Mack the main character, but the writer has me on Mack’s journey too.  Of “judgment” the author quotes Albert Einstein …
“ Whoever undertakes to set himself up as
judge of truth and knowledge,
 is shipwrecked by the laughter of the gods”.

It dawns on me that this reflection I am having on lack of compliance for treatment, is judgment, and that I am not here to judge, but to serve, and to offer what care I can where the people are at.

……………

My night with the boys didn’t eventuate last night.  I wandered down to the hall, and could hear laughter.  As I entered the venue, I could see 70 or so kids sitting on pampas grass mats, with 7-8 Aunties and Akas (old women) sitting around a data projector.  An old movie (Home Alone) was on the big screen and the kids were rolling on the floor wetting them selves with laughter.  Not a man in sight. Not a TV with footy anywhere to be seen. I paid my $2 for “movie night” and sat with the ladies and the kids who all gathered around me while we watched the last 30 mins of the movie.  It was a great evening, and a welcome light relief to the end of my somewhat frustrating week.

It is going on  4pm Saturday 31st July.  And I have just now returned from a walk on the reef.  It is warm crystal clear water, peppered with beautiful shells, and coral. Sun is breaking through the clouds, and my head is feeling clearer.  This really is a beautiful canvas, but like all masterpieces in the greatest of galleries, one gets to take a close up look and sees cracks in the art work.

There is no such thing as picture perfect.

#46 - The Fridge on the blink, and Mite allerts

When in a community like this one, there are a few health themes that crop up n a daily basis.  I have posted on ARF and the Rheumatic Heart Disease that results from these nasty bacteria.  Two other issues that are rife in the Torres and other parts of Indigenous Australia, are Diabetes, and Scabes.

Diabetics are numerous in this community, and when a diabetic gets sick enough, tablets no longer work.  The patient must be commenced on type of a hormone replacement called Insulin.  Insulin transports sugar in the blood into cells of the body, thus bringing down the blood sugar, which when too high, causes blood vessel and nerve disease, leg ulcers, blindness and in extreme cases, kidney failure.  High blood sugar also increases the risk of heart attacks, high blood pressure and strokes .  If you get diabetes and are poorly controlled, you better hope that you die quickly because a non fatal stroke or heart attack can turn you into a full care cripple with next to no quality of life.

Well The Torres has lots of diabetes, more than I have ever seen, and whether I am just more aware of it here, or perhaps this Island has so many diabetics, it is a very hot topic.  We have many type 2 diabetics (the type you get from poor diet and lifestyle choices) who have had to be commenced on Insulin, as their diabetic tablets no longer work.  Thus the medication fridge in my Pharmacy is full of Insulin.  There is Boxes and boxes of it, If I had to guess how many, Id suggest 4 shelves full with 100 or more insulin devices on each shelf, the crisper at the bottom, where we usually store the suppository medications is full of insulin and the milk shelves in the door are jam packed full of insulin!!   So why does it have to be in the fridge; Im glad you asked.  Insulin is a delicate human hormone made of protein similar to egg white.  Heat denatures it, and stops it from working.  It must be kept in the Fridge between 2-8 degrees like vaccines.

Well.  A back order of 100 insulin pens came in from TI pharmacy yesterday, and I packed them into the fridge...stuffed them in the fridge...and in a similar manner to someone sitting on their suit case to get it zipped closed prior to going on holiday.  But I learned another lesson.  If you over stock a fridge, it cant circulate air, and wont maintain it's temperatures.  When I arrived at work this morning and went through my morning routine of checking the emergency gear, immunisation fridge, 1st cup of coffee, and Medication fridge...It is sitting at 18 degrees C!!!!  Note to self, to avoid ruining $30000 worth of product, DONT  OVER  STUFF  THE  FRIDGE!!!

Luckily I had the the Diabetes Educator right there this morning, and I could seek her advice.  Liz offered to take an Esky of Insulin back to TI Pharmacy for me on her flight down to Thursday Island.  Relief!  I cleared out the gross over stocking, and made a little space for air to circulate.  The fridge was sitting at 7 degrees 2 hours later, and I was to learn that Insulin is not as delicate as vaccines...so dodged a bullet that time.

My afternoon was interesting, A family came in with a infestation of Norwegian Scabies.  These tiny mites burrow under the skin and lay eggs in their burrow tracts.  When the larvae hatch, they cause intense itching, which results in uncontrollable scratching, which results in open sores, that get infected.  These two little girls 2, and 4 years old were absolutely covered in purulent wounds, and scabies burrows.  I have never seen anything like it.  There would have been at least 50 wounds on each limb, of both children.  The scabies is notorious when the mite affects us it is called Scabies.  When it affects dogs, it is called Mange.  Hence the term "Mangy dog".  Over crowding and poor hygiene is the underlying issue.  One kid with scabies will sleep on the same mat or bed as 2-3 other children, and it is highly contagious.  I am still feeling itchy just thinking about it.  To treat it, the bedding needs to be washed in near boiling water, every member of the house needs to pan themselves with a mite killing cream, and leave it on their body for 8 hours before washing it off.  Then the whole process needs to be repeated in 7 days time.  Now that just kills the bugs.  The next BIG issue is healing the infected wounds left behind after the scratching.  That is where my old mate Penicillin comes in to a staring role.  So as you can imaging, our stocks of penicillin must be big right?  Well Yes, right you are.  BUT, Penicillin syrup (what I use for kids) is the only antibiotic syrup that comes ready made, and as a result , must be refrigerated.

Remember the medication fridge?  Yup...full of insulin.  After diligently repacking the fridge this morning, a task that took more than an hour, I discovered that I had pushed the penicillin syrup to the back, and I wasn't sure exactly in the back of the fridge it was located.  Those poor kids had to wait half an hour for me to get them sorted.  But they did wait, and were so gracious with me, after a "big esso" from the Aka who brought them up the 4 year old went to give me a hug good bye, which I returned, but in view of the presenting problem, resulted in me having to take an iodine shower for half an hour.!!!

I am still itchy!!

Well that is it for this post.  Week one on Yam Island down.  Im off to watch the Broncos with a group of rowdy island boys.  Yawo!!

Thursday 28 July 2011

#45- Knuckling down to business

#45  - The knuckle down

So comes a time when you transition from baby-sitter to parent.  For the last two placements I have been acutely aware that my time on those islands was only a temporary experience.  An understanding that the clinic was looked after by a team of health workers and a nurse with some degree of permanency, and so, the role I played was one of assistant.  I didn’t get involved in the politics or the ordering of stock, or the chronic diseases programs, I was a transient assistant to the team who coordinated that stuff.

Well that changed today.  With the pending adoption of an island , the realization hit me today that I will be a key figure, responsible for the primary health of a whole community in a few short weeks.  Today, was a day of learning a new set of ropes.  I placed my first pharmacy order, I hosted the Chronic Diseases nurse here to complete care plans on the community, the Dietitian and Diabetes Clinical Nurse Consultant came to meet with the island diabetic patients, I arranged treatment plans for venous disease ulcers, and liaised with the Rheumatic Fever nurse in TI to seek a strategic plan for managing the non compliance with penicillin.  Today was full of all that stuff that I have not really had to worry about to date.  It was a great opportunity for me to hone skills that will be needed when Jo and I take a longer term placement on Darnley Island in August.

I also sat down with the health workers over lunch and learned some language, and some of the complex names that Islanders use for their relatives.  A grand mother is called Aka, but the grandmothers sister (what I would call a Great Aunt) is also referred to as Aka.
Grandfathers and great Uncles are not differentiated either, and called “Athe” (prounounced “ah-tay”).  My father’s oldest brother would be called “Big Daddy” the oldest sister would be called “Big Mumma”  All other brothers and sisters are called Uncles and Aunties respectively.
All my cousins and their children would be called cousin brothers’s or cousin sisters.
The authority to parent may fall on any Uncle or Aunty, and if you were to be growled at by any relative on your mother’s side, you would wear it without argument or back chat.
It is such an intricate system, and I have really enjoyed learning more about it.   Some of the language changes, the closer to PNG you get in the Torres.  On the top Western Islands, where PNG culture is often intermingled with southern Torres Strait culture, some of the words have a PNG influence.  An example of this was this lad that called me Namu yesterday (Big Brother), and Thawii is the word used to refer to an Inlaw, such as a Father inlaw.  My wife would call my sister “Kossir”, and a grandchild is referred to as my “Napa”.

Well that was Central Islands culture lesson one.  The crew here are so happy to teach me, and speak straight creole to me now,  which is great, because it is a really quick way to learn.  A couple of the boys have offered to take me crayfish diving on the weekend, and on Friday night I have been asked to attend a Men’s Group with a feast and fund raising watching Broncos on the big screen.  Whilst footy is not really my thing, a night out immersed in the village life, is just what I need, so I am really looking forward to it.
  There is not much else to report for today, so I will sign off for another day.  Tomorrow, TGIF.  Yawo

Wednesday 27 July 2011

#44 - Camping with a glass half full

#44 – Camping with a half full glass.

I passed a comment in yesterday’s blog that being here for 3 weeks with no TV would be like camping.  Well that would be closer to the truth if there was only luke warm water, the sound of gentle waves lapping at the shore and the constant hum of some blokes generator off in the distance.  Well after a restless night, my reflections have confirmed that I must be camping.

If the ambient temperature was less than 27 degrees, I might have been a little annoyed that my shower rose was not yielding to the scalding temperatures to which I have been come accustomed to at home. But I’m not.  It is rather refreshing.  My glass is half full.

To sit in the silence of the evening devoid of mind rotting television was an adjustment, but also quite novel.  I was able to get into my Bible, and do a bit of other reading.  It represents a departure from my metropolitan life but again, rather refreshing.  You see, my glass is still half full.

Now, I would like to have been able to report that the sounds made by gentle waves was hypnotic and sedative but for that bloody generator.  On retiring to bed last night my glass started to empty a little.  Just 50 metres from my unit there is a generator.  Not just any generator, but a massive one with four engines, that run 24/7 fueled by massive 5000 gallon diesel tanks.  This is no ordinary generator.  This sucker sounds like a Mack Truck with a head cold, coughing and spluttering in its slumber, all the while, snoring it’s big old head off!!   The Island power plant is the generator, sending electricity to some 70 homes, for a 300 strong population, all no doubt enjoying TV with an aerial in relative quiet!!  My glass is not quite half full.

So the decision makers decided to locate the clinic on the airstrip, next to a massive generator.  White noise??  I understand the concept of white noise, but after only one day and one night here on Yam Island, I am wondering when the noise will become white.
I have decided that giving up beer this month was not such a good idea.  The island however is a dry island, meaning that there is no canteen (pub) like the other two islands that I have worked on.  There is nowhere on the island that alcohol can be bought.  Bummer!  It might have been nice to slurp a cold one after the day I have had.  But unless I brought it with me (which I didn’t), or I “get to know some local boys who make their own” (Shhhhh), sobriety will have to pave my perceptions….Did I mention that my glass is getting empty?


 Those issues aside, the Day was ok.  A bit slow for a trauma junkie like me, but I had enough to busy myself with the task of opening and closing every door and cupboard with the express intent of finding the stuff that I might need in a hurry.  The Defibrillator here is an old school Paddles style, of ER fame.  You know the ones that the Doctor pushes onto the chest of the chest and yells " Clear !!!... now get me 10 CCs of Lidocaine (aside: what ever that is), STAT, (aside: what ever that means)".

They are cool and those who know me, know I just want to give them a test run!!!

There is no Oxylog, but then that is not so bad, because there is no one here really "authorized (aside:what ever that means)" to intubate, so nothing ventured , nothing gained.  Bag-Valve-Mask...chest go up chest go down.  Pink is good Blue is bad!  The Emergency retrieval bag, a kit we call a "Thomas Pack"  had stuff in it that expired in 2009, and there is not a pink IV cannula to be found in the place!  I love my 20 G pink.  Needless to say, I have made a few adjustments to my new sandpit.  If I am going to play, I need my toys.

I met many of the locals today.  Fishing tonight on the jetty, I must have had a sign on my back advertising that I wanted to be asked by 300 people "Have you caught anything?", "No mate I just got here";  " Oh well you will have to come in the morning tide, that is when you catch fish."
..." Um...Yep, thanks!!"  Have you ever cringed from being asked the same question over and over?
I am spray paining in big yellow letters a T-Shirt that says "NO, I haven't caught anything!!"

I wandered back to my unit, Empty bucket in hand, and as I am climbing my stairs, a voice yells out, " Hey my Namu, yu Ketch anything?"  I was torn.  I hated the question , but loved the way he asked it.

Namu, is an old word meaning "Big Brother"  a term of endearment.  A sign that after just 24 hours here, I have gained some acceptance....My Glass is definitely half full!!



Tuesday 26 July 2011

#43 - Ere I Yam Iama.

Wow.  When beauty and spectacular have a love child it is called Yam island. My day started with my alarm clock waking me at 5:30.  Up, shower, pack my stuff into my suit case, ...pick up from Cairns Novatel Oasis, Airport and off.

We boarded the Q400 to Horn...uneventful flight over pristine reef and rain forest...off the tip of cape York and landed on Horn Island.  A wait at the airport for a couple of hours and onto the Westwing leg of the journey.  I sat where I wanted to, She sat where she wanted to, He sat where he wanted to, and they all sat where they wanted to. Suddenly the plane lurched back and rested on a steel pole placed there to brace  the tail , and stop the plane over balancing. The aeronautical equivalent of the Decky, had a wee winge to the pilot, who asked a few of us to shift our weight forward .  Subsequently, I sat behind the pilot, a few islanders come up front with me, and we were good to go.  I had no idea how much of a fine balance those planes are on.

So up to Boigu Island, on to Saibai my old stomping ground, where I shed a tear (I do miss Saibai-you always remember your first you know!).  Then on to Yam (Iama).  With not a cloud in the sky, the water was iridescent, blue/green and fish/sharks could be clearly seen swimming around the coral bommies and reef on our landing.  I made a mental note not to swim at that spot.

I landed and was met by Susie, the nurse who has been posted here for the last 8 weeks.  The air strip is in the Clinic's front yard, so after collecting the bags from the hold, we wandered over to the clinic to meet the boss (Andrew) and some of the health workers (James and Millar).  The hand over went smoothly then the Bomb shell.  Susie is out on the next plane at 9am tomorrow morning!!  This is a 1 nurse island, and from 9 am , I am it.

Now I am a little anxious about this.  On Saibai, I was one of 3 nurses.  On Darnley, Annie the permanent nurse and I were two nurses, with a Doctor on the island also.  But here, it is just me and three health workers.  Now dont get me wrong, or think I am paranoid or anything, but I get the sense, more than anything now, that God is conditioning me.

The afternoon was filled opening and closing cupboards, to familiarize myself with the layout of the clinic and shopping for a few groceries at the iconic Ibis store.  The shopping done, it was time to unpack my stuff in the unit.  At Darnley the unit was up stairs above the clinic.  Well this is the same building on Yam.  Two units on top of the clinic, so it immediately felt familiar.  Same aircon, same kitchen, same bathroom (only functioning).  The TV is much bigger, and I was thrilled until I turned it on.  No aerial !  equals no TV !!!

Are they kidding me?   three weeks of no TV?  I will be on call for three weeks, confined to my unit every night, and I have no TV or DVD player???  So I think I might just have to blog, and pretend I am camping.

This evening on dusk, I went for a walk down to the jetty.  There was half a fresh crushed Crayfish head on the jetty, and I kicked it over the side into the clear water.  Immediately a frenzy of activity as 4 sharks measuring about a metre or more vied for gustatory rights.  This is truly an amazingly beautiful place, and I have been given the honour to nurse it's people for a snapshot in time .

Tomorrow, it is home visits, finding my feet, and meeting new people.  Optimism is high, but not quite as high as my anxiety levels.

Until tomorrow's post...Yawo.

Monday 25 July 2011

#42 - Phase 3 - Yam Island - The Hat Trick

The Hat trick.
Devoid of hats, or even tricky-ness for that matter , today marks day one of phase three for my Torres sojourn sans family.  I have done the packing and the good byes with my kin, and as this is the first post from this third adventure, I thought Id avoid the details of how that last few days, save to say that it has been some how easier to go this time.  The last two trips were for my own selfish reasons.  For me, my Saibai and Darnley trips were to touch real patients again.  But this trip has a whole new context.  Having made the family decision to leave Toowoomba till 2012, and experience the Torres as a family, this third trip is one that will cement what cultural, and clinical orientation I need, to enable me to be a leader for my family.

For Jo and the kids, the Torres will be an amazingly wonderful, but at the same time, scary and foreign experience.  They will look for me for some stability, and direction, and this last lone trip to Yam Island, should allow me more time, immersed in the culture of the region, to be that support to my bride and offspring.

Iama or Yam Island is located in the centre of the “Islands”. It is a coral cay half way between the tip of Cape York, and the southern shores of PNG’s Western province.  Whilst the common language is Torres Creole, and English, there exists a third ancient language called KLY (Kalaw Lagaw Ya).  I look forward to learning more about this.  I look forward to getting into the community as I have on Saibai in May, and Erub in June.  Something that I missed on my two previous trips is the legendary Island feasts.  I will be on Yam Island for the celebrations of 1st August (next week) and so I look forward to blogging this.  I sit here in the airport again, TV in the corner, coffee on my table, and an add has just come on TV about the census on 9th August.  It dawns on me that I will not be home in Meringandan West when the country takes that snap shot of the population.  I will be a Torres Strait resident and recorded as such for the rest of history.  It is kind of cool.

For now.  The boarding call has just been made.  I gaze over at the cattle lined up at Brisbane Airport Qantas gate 18, and ponder the next 2 hours sitting next to a person unknown, and wondering if I will be able to read my book or whether conversation will flow.  Will channel 6 (the comedy channel) be functioning, and will I hear the same old jokes, or will I watch mindless reruns of some inane sit-com, and chuckle along with the canned laughter.

Must away….a hat trick awaits.

OK…Here in Cairns, I am over, crying babies .   The flight, though devoid of any meaningful conversation, book reading or comedy channel listening, was pleasant enough, save for that screaming baby.  I was polite, I introduced myself, I nursed the baby when the mum wanted to get something out of her MummyBag.  I even suggested that she feed the baby during the descent to help the little darling with his ears. The final act of chivalry came when I wrote a word on the back of a serviette.  That word…”Demazin”

So here I am in Cairns.  My northward legs are tomorrow, so for now, Ill have a bite to eat, check out the night markets, and catch an early night.

Friday 15 July 2011

#41- the next chapter

#41- the next chapter.

It has been three weeks since my last journal entry. In that time I've covered 2 weeks relief as a nurse educator at Rockhampton Hospital. A nice slide back into my usual job. I've also taken that time to explore Greatkeppel Island with my bride and kids. Beaching the boat on the north side was mo fun, but great snorkeling with rays, turtles, and dolphins was definitely a highlight. When stranded on the beach we had to wait til high tide to recluse the boat, and so blessed to meet Rosie and Doug who made us comfortable and offered us a meal in their boat. Good chat, good people, good food, and new friends.

I've been back in Toowoomba for one week. I have another to go before I tackle my 3rd Torres Strait Island. I leave next Monday for the coral cay called Yam Island. The locals call it Iama and it is one of the central islands. 100km or so to the tip of cape York.
As I have done previously, I will try to keep a daily diary of events, lessons learned, and of my reflections. It will be another tough 3 weeks away from my loved ones but the optimism in this trip is that on my return to the mainland in August, I pack up family, and take them up to the outer islands for a few months with me as I go first to Yorke, then return to Darnley where I was in June 2011.

I lay here in bed, it is Saturday morning, cold and rainy outside. And it feels a million lightyears away from the warm azure waters of the tip of Australia. There is an optimism, and a wave of excitement as I contemplate sharing the culture with my people. We have been watching the "RAN" series from SBS TV - a six episode drama that journals a remote area nurse's live workin on an outer island. The series was filmed entirely on Yorke Island, and for the kids to see the exact place where they will gobfor 5 weeks over September is awesome. The sea, the coral, the culture, the language. The kids have started to learn Creole. And listen to island music. They are both scared of what to expect, as is Jo, but we will do it as a family, and it will be such a great thing to give them (us) that experience.

So 1 week left for me here. Yam for 3 weeks, then the family adventure starts.
... Livin the dream...

Friday 24 June 2011

#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 !!