#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 !!

# 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.

# 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 31^st 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!!

#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

#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!!

#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.