Hearing

Today I saw a few people in the morning.  One lady came to pick up meds and the nurse sent her to me for  "woman's check" - good idea, it had been a while.  She also needed some chronic condition checks - she's 44 and had had a heart attack last year.  On asking her if she smoked, she said she'd like some patches, she needed to stop - good move I thought - but I was getting them out for her, and she left!

Another lady had been to Darwin, said she drank too much alcohol there "because of family pressure" - had been feeling unwell last week, probably de-toxing, and had been asked to return for a check up today, so she did!  She often feels stressed because of family issues and she's decided to "stop taking all the responsibility" for everyone.  Good thought!  We reflected on what being part of a family means. I think it's about the right balance.  She was really motivated to work on her health, and said she feels inside that she can get off her medications.  Perhaps she can!  I encouraged her.  She'll see the dietitian next week.  She's already joined the running group.  Yes, the RUNNING group.  I'm not sure that it's cultural to run, but people are running.  

It's so much easier for me to feel like I've connected, when people are motivated to change, to be healthy, to work on things.  But really, work here (or in any health facility) isn't about being easy for the staff, but it's about learning how to communicate in a way that can be heard.

Hearing. While seeing that second lady, she had a text from a family member, advising her of a "hearing ceremony".  This is a ceremony to advise of a death.  It was the death of the lady we sent to Darwin unconscious, on Saturday - she died today in ICU.

Hearing is so important in the communication process.  I'm challenged to listen more - talk less - understand more - and ponder how I can explain things in a "hearable" and understandable way.  Working with the Aboriginal Health Practitioners is a key in this.

After work today, there was a graduation ceremony, for 9 Aboriginal Health Practitioners, and others (school assistants, community workers).  It was great to be there, sitting on a mat.  Lots of people had come from Nhulunbuy and Darwin to be part of it.  The MC was the lady who led the service yesterday.  The graduates were "presented" by their clans - this was like a procession with didgeridoo and clap sticks, singing and dancing to the front area.  One lady (not one of our AHP's) was awarded an honorary doctorate for her contribution to health research over many years, working collaboratively with researchers to ensure cultural appropriateness.  There was a great sense of pride and community involvement, although I think it was hard for the community at this time of funerals and grief. 

  The graduates have yellow gowns

Our Aboriginal Health Practitioner graduates

  Good vantage point!

Walking home it was dusk, and I saw the new moon setting.  I love the new moon!  It's the hope of a coming full moon.  So, can I also hope for better hearing? and better health for the community here?

Sunday

I had an amazing morning bird watching this morning - I was out about 3 hours, just wandering on the track to the wetlands.  It's lovely being out in the early morning.

I was excited to see a pair of green Pygmy geese :

       

 And ESPECIALLY to see an emerald dove - this doesn't to it justice

I came home in time to get to church.  There was a small group present: about 5 Aboriginal women, and a few white families.  It was great to be part of it.  The gathering was led by an old lady.  A couple of people talked about a Bible passage, and we spent a lot of time praying for a very sick lady - turns out it's the unconscious lady we sent to Darwin on Saturday.  She's the daughter of the pastor (he wasn't there).  

It's good to pray, and even to ask for healing.  But how does God answer that?  However the focus of the prayer was for the presence of God to be with the family at this difficult time - I can identify with this, and it seems to make sense of how I understand God.  God is with us in the ups and downs - and certainly for so many people, there aren't many ups in life.

The other aspect of course is our own personal responsibility for our health.  Lifestyle issues.  Management of chronic conditions.  How does God fit into that? And how hard for Aboriginal people, introduced to western diseases, infections and the consequences, and of course unhealthy food.  There are THREE takeaway shops here. And someone said that the people don't naturally think that there's choices to be made.  "Why would they sell us food that is bad for us?"  Good question, yes, a really good question!  

I've had lunch at the home of the registrars; his mum is here, and his dad coming soon - the dad worked with Geoff (my brother-in-law) in Brisbane! Small world.  The mum said I don't look like Linda, but she changed her mind...

Walk last night, round to the far point visible from the veranda. A long way with quite a lot of rock scrambling, and an eye out for crocs. 

Galiwin'ku is on the distant point

There's a mango tree in the garden! It's flowering more & more each day. I didn't realise what it was, when I was here for the week before going to Nhulunbuy 

Big questions for a public holiday

Yesterday was a public holiday, Darwin Show Day.  I was called in to the clinic by Jeremy, one of the registrars I'm supervising while I'm here.  He and his wife Tanya are coming to the end of their first 6 months of GP training.  They're leaving in 2 weeks, when I finish. 

Jeremy, Tanya, the Aboriginal Health Practitioner on call, and several nurses were looking after an unconscious lady - she was found like this when the family woke.  We presume she had had a big stroke.  Certainly not very well, and had deteriorated while at the clinic.  There wasn't really much for me to add.  But I suggested calling the family in, to talk about the serious nature of things.  Plans were proceeding for her to be taken to Darwin by Careflight.  So about 4 women came in.  They gathered round the bed and prayed for her - mostly in Yolgnu matha, but a few English words here and there.  It seemed like an appropriate response.  I doubt she will return alive.

I found it quite profound, witnessing this trust in God at a time of great difficulty.  Life is hard for Aboriginal people here: much chronic disease, frequent funerals.  And I feel for the Aboriginal Health Practitioners who bear a significant burden in talking to people about hard issues.  It's also draining for the nurses when situations like this are frequent, especially after hours.  

I couldn't help wondering if it was a good thing to transfer her to Darwin.  Wouldn't it be better for her to die with dignity here, at home with family caring for her?  I did raise this at the time; but she needed a CT and a diagnosis.  This kind of scenario happens in any medical context, and I suppose the team and the family have to make the best decision with the information they have - and avoid thinking/ saying, "We should have..." or, "we shouldn't have..."

            The old cemetery

Later in the day we went on a picnic, driving with others to a remote beach.  Two went swimming! I would love to, but feel too afraid of crocs.  They felt confident because of a sandbar a bit of a way out.   It was a beautiful beach, lovely sunset, and great to spend some time with Kylie (the other doctor), her husband, his parents, and a nurse from the homeland health service (run by a different organisation from the clinic).  It was a beautiful drive, on a narrow track through lovely bush.  Not sure I'd find it again!

         Sunset - not yesterday's though

I took Tim to the airport today.  Felt quite sad to see him leave.  He's off to Darwin, then Katherine tomorrow for 2 weeks' obstetrics locum.  It was so good to have him here, and he looked after me so well! Housework, shopping, meals.  And great company!  I'm glad that he knows a bit about life here.

         Fun to walk on the beach together 

        Time to board

       Home! 

         The view from the bed reminds me of Wye River

Nhulunbuy and Wandawuy!

What a "small world" we live in! The pilot who flew me to Nhulunbuy used to be a drug rep, and he remembered visiting us in Leongatha! It was fun to chat about his journey: giving up a career that he wasn't really enjoying, and following his childhood dream of becoming a pilot.  He has young children, so it works for him to be based on Elcho Island, while getting his flying hours up, to move into a larger airline job.

I have the use of a car at Elcho, so drove myself to the "domestic" part of the airstrip. "Just leave it there with the key in the glove box and we'll come and get it, don't worry, it'll be quite safe."  Comparisons are odious....  but, it's great to feel relaxed in this way.
How exciting to begin the descent, and to land! Taxiing in to the "domestic" bit of the Nhulunbuy airport, I could see Cathy, Georgi and Isabel waiting (Andy was on the phones to my mum, telling her that they're expecting another baby!).  Then the pilot opened the window and I could put my hand out and wave!
Isabel has been talking ever since about how "gramma came little pane".  So very dear. It's just so special to spend this time with the family. Tim came "big pane" on Saturday night: Andy, Georgi and I went to meet him.
 Nhulunbuy feels like the big smoke compared to Galiwin'ku (keeping in mind that comparisons are odious..) - great to have other options for exercise (pool, bike), and shops. It's a great place for young families.  Andy and Cathy have some good friends here.

We had a day trip to Wandawuy (pronounced waa-ndaa-woy).  It took about 2 hours to drive there.  It's a homeland, and is the home of the family who adopted Andy and Cathy.  There was a funeral going on! So it felt a bit strange to be showing up for a social visit.  But Andy had checked it out, by saying that his parents were visiting, and everyone said, "you must come."  We took food for a BBQ, which we had by the creek during a lull in the dancing.  The funeral was going on for days, and what was happening was dancing, which tells the stories of the land, animals, people etc, teaching children the culture.  It was so good to watch, and to talk about it with the family.
We met lots of the family, learning the relationship name we call them.  The mother of the family (my sister) gave us names in addition. I'm ngurula (seagull) and Tim is meriel (pied imperial pigeon). Not sure about the seagull idea! At the creek the children caught yabbies and we cooked them on the fire. At one point, a plane flew over, and my "sister" talked about how it was taking a patient to Nhulunbuy.  After coming back from hospital the previous time, my sister had told her how they were praying for her, and she said, "I know, I could hear you."   What a great day - so hard to put it into words!  Better, some pictures perhaps.  Many were taken by the "grandchildren".

                 

 yabbie pots

  just twist the pincers off, then put them straight on the fire - when they turn orange, they're done!

Andy with brother Peter and 2 of his girls

My sister  ("yapa") said to me, "Yapa, sit here"

so it seemed the right thing to do!  Cathy did a lot of the food preparation

Tim with my "brother-in-law", whom I call dhuway, and Tim calls wawa (brother)

We had an overnight camp at Rainbow Cliffs, which was fun. Just 20 mins from town, and a lovely bush spot, with a beautiful beach - bit of the shine off it due to the fear of unseen crocodiles.

we didn't catch any fish...

Comparisons

"Comparisons are odious" my Nan used to say. How wise! Making a comparison implies a judgement, something is better, or more favorable, or desirable. It may justify the person making the comparison, or release them from understanding the full, complex story. And comparisons are made through our grid, with our own biased or rose-coloured glasses.
Hence, I must be careful in comparing Elcho Island with Wadeye, or with mainstream Australia.
There are statistics about Indigenous health, rates of illnesses, social factors, lots of things. But they don't tell the full story! But they are important facts. Going a level deeper though, the "why" question  is impossible to answer glibly.  I strongly believe that a big part of it is Our Fault.  Invasion; introducing infections, alcohol, smoking, white flour, sugar; destroying culture; misguided (well-intentioned) missions and governments making policies without listening (governments are still doing this) - on it goes. So I don't think "they should ... they shouldn't ... " (eg, they shouldn't smoke, they should exercise...)
The onus is on us as health care workers to explain appropriately, and work with people. I saw someone today who had some thyroid problems. He started over active, had radio-iodine and became under active - quite a common scenario, but difficult to explain. I think I could do a better job if I have another chance!  He came with an Aboriginal Health Practitioner, so I might try to explain it to her a bit better.
Back to comparisons. Certainly there are positives about things here, compared to Wadeye.  It feels much safer - no high fences, locked gates, stealing.  More community harmony, and stronger culture. Similar follow-up challenges (following up results, check ups etc)
Comparing the physical environment - well, there is special beauty everywhere, and I like to be open to seeing it. But, it only goes so far in making a comparison.

House bits

The house I'm in is upstairs. Downstairs is mostly open to the weather. The laundry is there - open to the the red dirt...  (I cleaned it after this. Probably need to use it sometime!)

Top of the stairs

Out walking after work:

Just growing by the path;

Planes come & go all the time

  

Galiwin'ku!

Well. Here I am in Galiwin'ku. It's a community on Elcho Island, and I'm here filling in for a GP who left today. There's so much in my mind to talk about! Perhaps some background to it all, then some snippets of impressions.
Tim and I will be in Nhulunbuy next week, visiting Andy, Cathy and the girls. I was asked to come a week early and fill in, because the GP leaving was a bit sudden.  I'll be back after the week in Nhulunbuy, and I'm hoping that Tim will be able to come too, for a week - then he goes to Katherine Hospital for a 2 week obstetrics locum, and I finish 3 weeks here.  We meet up in Darwin, then off to Wadeye for 5 weeks!
Travelling here went well and I had an afternoon and overnight in Darwin - time for a swim in the sea, in safe waters, no crocs - and I didn't meet the 3 foot (harmless) queen fish either, which was good, but I had to overcome the fear of meeting it, and keep swimming...

• Fun to meet a dentist and dental nurse, at Darwin airport - on the same plane, but they got off at Maningrida. Coming to Elcho Island next week. 
• What a beautiful place this is! Here's the sunset view from the veranda

And a visiting boat in the bay - friends of Andy & Cathy working in Nhulunbuy, sailing to Darwin for holidays

(That's the mainland in the distance)

• There are many Aboriginal Health Practitioners working at the clinic. This makes a huge difference to how things happen. It's great to work with them. 
• The clinic buildings are old, and a bit higgeldy-piggeldy, but seem appropriate for the context
• There's talk of a new clinic to be built. I sincerely hope it's right for the community - I mean, a place where they feel comfortable
• Lovely to see a patient with diabetes who had a heart attack this year, and has since started to turn things around - going to the gym, has lost a lot of weight
• Everyone talks about taking a stick to be prepared for the "cheeky dogs" but I haven't encountered any. However I'll be careful
• I was driven around the community today, a bit of orientation. That included the barge landing 

• A new patient record software to learn! It has strengths and weaknesses, compared to the one at Wadeye. It's a challenge! 
• The clinic here is run by Miwatj, which is an Aboriginal Community Controlled Health Service.  This makes a big difference to the relationship with the community, and also to staff pride in it
• No grog permits here at all! Not for anyone! The police searched all the luggage off the plane, and were at the barge landing. Apparently each community sets up the rules around this. 
• It's great to walk after work - there's about an hour before it's dark

I'm missing Tim! Will be good to be together in Nhulunbuy next week.