I'm going to talk about work because it really dominates my Maningrida life. This is just my personal experience. Nothing I say here reflects the opinions of Malala or the NT Department of Health.
After the senior doctor quit with very little notice in August I had been sharing the role of senior doctor with my colleague and friend Mel for a few months but by November a new senior doctor had been recruited. Keith seems lovely and has lots of ideas about how we might do things better. Time will tell how these changes might play out as we head towards the final transition from an NT health clinic to a community-run aboriginal health clinic on February 1. I'm very happy to hand over that extra administrative load and responsibility but it was a satisfying experience to take it on for a while. Having a bit more say in the day to day running of things provided a fresh perspective on the complexities and challenges of providing healthcare at a more systemic level. I felt really supported particularly by Mel. We have different strengths and made a good team!
The medical team is really strong. We have got to know our other relatively recent recruit Brooke and she has been a wonderful addition to our team. The lovely and so very capable Kerry came back from a period of extended leave and I was happy to have her back both in the workplace and encouraging me to run! We have also been lucky to have a really genial registrar Alpesh who brought some new skills to the team with his background in opthalmology and has provided a lesson in resilience as he negotiated the (covid-driven) GP exam delays and complications while supporting his family in Darwin. We have regular visits from Penny a mature GP with a long connection to Maningrida and strengths in Women's health. We're also now supported administratively by Alistair who is checking results, radiology reports and discharge summaries remotely in Melbourne. Alistair was away from his family for several months in the middle of the year and came to us to do a couple of periods of locum work. We were fortunate that he was happy to work from home and ease the rather huge administrative load when he returned to Melbourne. The nursing team is also strong and of course I have my favourites but all these remote nurses continue to impress me with the breadth of their knowledge, skills and experience. We made a bit more effort to connect outside work a few times and it certainly made work a happier place for me. Here we are on the beach having sunset drinks with the kids exploring the beach at low tide and Luca drinking from one of several natural springs on the beach while the adults were sipping our drinks and de-fragging.
The work is incredibly satisfying. I love working with aboriginal people who inspire me with their strength, perseverance and resilience. They marry their incredibly complex social and cultural lives with our western medicine as best they can and usually in their 4th language (or more!). While sometimes it feels challenging it is such a great feeling when a patient makes progress in their diabetes management or improves their puffer use so they present less for their lung disease. Most patients really want to engage with their healthcare and will wait many hours for a medical review, will sit outside time and again waiting for visiting specialists or allied health and will line up to pick up their medications. Of course there are people who don't engage with their health and finding more advanced disease is interesting too. I love the whole spectrum of care such that we have emergencies in our resuscitation bays, we see mental health clients in extremis, complex obstetric patients, we manage palliative care and paediatrics doing home visits and school clinics. We have more close interactions with specialists and this year the increase in telehealth and case conferencing means more time seeing that specialist management so I'm learning so much all the time.
Case highlights:
- Palliative care of multiple patients. I love the relationship with the patient and family, the home visits and the culture. Being up close and personal with anyone at the end of life is a privilege but to have that intimacy around funeral rites is very special. Nurse Kerry has been working on improving our Palliative Care and Advance Care Planning and her efforts to engage at a grassroots level and with cultural sensitivity are inspiring.
- I took on the volatile substance abuse portfolio for the last 4-5 months and therefore became involved with the at-risk kids meetings which has given me a whole new perspective on the challenges faced by some kids in the community. It gets pretty raw sometimes but it is real and I will carry some moments with these kids who are both strong and incredibly fragile, with me forever.
- Management of a 28 week baby for a few hours including managing hypoglycaemia and placing an umbilical line with a paediatrician on speaker phone. Adrenaline rush of the cutest kind.
- Another obstetric emergency with a woman labouring at about 34 weeks with a baby in transverse lie and cord presenting (membranes were intact!). She made it safely to Darwin.
- Negotiating with a family around the need for a patient to go to Darwin for inpatient psychiatric assessment and management. The cultural beliefs around mental health are amazing and often include black magic and stories of what we would think of as spirits or ghosts. This case was no exception. And why would you send your loved one to a hospital far away if you had an entirely different explanation for their symptoms? The reluctance of the family was totally reasonable and the way in which we managed to negotiate a solution that we all found acceptable was satisfying.
- We had a few box jellyfish stings this year. I can't say these are a highlight as they are so painful for the patient but I'd never seen them before. Thankfully no deaths but a couple of kids were admitted with skin infections in the healing phase. I have one picture of a sting healing quite nicely.
Comments