A few final notes and then...the end.

The last few days were really a blur - in fact the whole 2 weeks were a bit like that for me!! One of the things that really made me realize what a small world this is was meeting an Austria ex pat who had come to work in Weipa in the 70s. He was in the nursing home section of the hospital with dementia and not a soul in the world. I was asked to speak to him about a "not for resuscitation order and it turned out that when he spoke in German he was actually quite articulate and scored 25/30 on a mini mental quiz (used to assess someone's cognitive function). We arranged his will and he was clear on not wanting anything to prolong his life and had quite a chat at the same time.

{Small world again - Johanna also admitted a grey nomad who lived in the same street in Victoria Point that Michael's parents had before their recent move into a retirement home.}

The last morning on call was quite busy. A lot of kerfuffle about an indigenous lady who was about 20 weeks pregnant (not sure as has not had an ultrasound) who had paranoid schizophrenia and lived with a violent husband. When I admitted her she was hearing voices but really just wanted some respite from a dreadful home situation. All took ages.

The afternoon was just great. One of the nurses showed Michael a great beach/lagoon where we could actually paddle (croc free) and we spent some time playing ball with our friends and the kids. We then drove to Red Beach where we saw our first crocodile !! They look very log like till they move.... Had our last supper at the Thai /pizza place and saw a beautiful green tree frog. Kids all exhausted ... I am a bit that way myself. Spent the last day packing, clearing up and handing in that on call phone. Jumped every time someone's mobile rang for a few days afterwards...

Rather nice to get onto the little plane that connects Weipa to the world. Kids behaved well and had a smooth flight. Flight from Cairns left pretty much right away but still got home about 9pm - travel weary and pleased to see East Brisbane again. Michael dreamt about a cup of coffee and I dreamt about a night's uninterrupted sleep ... actually make that a week of uninterrupted sleep.

Overall, it has been an adventure and I am keen to do some more remote rural locum work. I felt challenged and was definitely out of my comfort zone. Australia is really an amazing place.

Finally, a croc

Johanna's last day at work today! Just the usual stuff, a pregnant paranoid schizophenic domestically abused woman, nothing out of the ordinary.

In the afternoon we went to a beach with a safe paddling lagoon that a local showed us.


After that we headed over the river to Red Beach, not sure why it is named that...


And we saw a crocodile at Red Beach, yay!

And then a Jabiru!

End of the second week

I have not really contributed to the blog for a few days. The alternate on call is quite draining and I feel very tired. I feel as though I am on a cycle of work, sleep, work... I am managing to fit in a run on most mornings except when I am called out late during the night.

Tuesday was a real highlight for me. We went to a small indigenous community Mapoon which has a small clinic. The medical student came along as well. He is great - has a lot of 4 wheel driving experience and loves the far north. The clinic was a really rewarding place to work. Committed, friendly staff who work really really hard. It was not too busy so we had the opportunity to do some real exploring. We drove up to Cullen Pt which is a very basic and beautiful camping spot near an amazing beach. Unbelievable that you cannot swim as it looks so inviting. Lots of large crocs apparently. We then went on to Pennefeather which was even more amazing. It needs a 4 wheel drive and I have to say there were times that my heart was in my mouth when we drove in the soft sand.

It is incredibly beautiful. Completely isolated. The kids had a ball and I have to say that I found it hard to go back to Weipa to work. I just wanted to camp there away from it all.

Work is challenging but interesting. I have learnt a tremendous amount. I cannot believe how much gonorrhoea and chlamydia you see here. It is treated without taking swabs and urine samples - you just treat for both conditions assuming the results will be positive. Have also had a couple of postive syphilis and even a man with leprosy who was seen by infectious diseases in Cairns and sent back with a treatment pack. My hospital skills are improving exponentially and I am becoming adept once again with things I have not done for eight years or so. The nurses are really helpful and I have been grateful for their support. You really have to rely more on your clinical skills here as it is so hard and time consuming to arrange investigations. There is only xray, with bloods getting flown to Cairns at lunchtime so any evening bloods will not be reported till the next afternoon. Makes it tricky to make clinical decisions. Tonight is my final on call. I finish at 2pm Saturday.

There is another indigenous clinic near Weipa and I have spent quite a lot of time there this week. Various allied health professionals including a dietician, diabetes educator and podiatrist fly in on a fortnightly basis. Problems with alcohol are huge despite it being a supposed "dry" community. Diabetes is endemic and unfortunately compliance with treatment is poor. Poor renal function is almost normal in patients over 40. The kids are fantastic. Very unrestrained and happy, cheeky and full of fun. They are just gorgeous. Our kids seem to have adopted some of the unrestrained living that is possible here due to the lack of potential dangers (busy roads etc). Not sure how they will adapt back in the big smoke ...

Yesterday evening we all went down to the local beach to watch the sunset. Not one of the really spectacular ones but pretty gorgeous all the same. This Saturday we plan to go to Red Beach after my on call finishes. May even try to get another fish!! Will head to the local Thai place for dinner with our friends. There are three Thai chefs and judging from our recent take away from there they are really good.

Mapoon and Penefather

Johanna had to spend Tuesday at the Mapoon clinic and we all went along. Mapoon is an extremely small settlement about 80km north of Weipa. This makes it about 120km short of the tip of Australia (click on the map to enlarge it).The trip is along a well maintained dirt road through scrub which is very similar to that of the Northern Territory.


After dropping Johanna at the clinic we drove a short distance to a very beautiful point where the kids and I spent a great few hours. This was what we thought the Cape would look like with tropical vegetation and blue seas.


On the way home we took a side trip to Penefather (everyone seems to pronounce this penny-feather). It is " probably the place where, in 1606, the Dutch yacht Duyfken, commanded by Willem Janszoon, after a voyage from the Dutch East Indies, made the first authenticated landing on Australian soil by a European."

It was incredible, pure white sand, crystal clear water and our first clear view straight across the gulf. The water was extremely inviting and because it was so clear and visibility was good we considered ignoring the no swimming rule but eventually decided to just dangle the kids at the waters edge.

A terrible turn of events

Today I heard a horrible scream from Eva. I know my kid's various wails and screams and recognised this as resulting from something terrible.

I found Eva on the toilet floor sobbing horribly with tears running down sad face.

What happened I asked, scanning her for blood and missing teeth.

She held her hand up and managed to say with all the anguish of her heart.

"Buttercup fell into the toilet!"

Buttercup* is now clean and recovering.
(*trademark Pixar)



Other than that, it was a relatively quiet day.

Weekend at Weipa

It does feel like we have been here for ages. Friday was the least busy day I have had and I was not on call. Just the clinics at the hospital. I was on call on Saturday but finished ward round /hospital work by mid day and did not get called once overnight! Checked to make sure that I had not missed any calls... Went out to the local pub with my fellow GP, The DoN (our former neighbour) her family and some of the nursing staff at the hospital. Kids had a ball - I could have done with some alcohol. No drinking as I am technically on call all the time.

I did see one interesting case - a woman who came in with what appeared to be a cellulitis yesterday and came up in weird blisters today. You cannot order blood tests on the weekend or late Friday so i treated her with antibiotics initially. When the blisters started - some about 5cm in diameter I emailed a photo to Cairns Base Hospital. After some persuasive phone calls by my collegue a surgical registrar looked at it and it turned out to be toxic epidermal necrolysis. She has been shipped out to Cairns ICU. Yes, I will be looking this up in more detail too....!

The family gave me a Cook's tour of Weipa today as I have not really seen that much aside from the hospital and the clinics. Had a lovely time at the beach and the boat ramp. The bakery here makes great bread and the best finger buns that I have had anywhere.

The other doctor working here took us out fishing in the afternoon and we had a ball. We got advice from the nursing staff who have hourly tide charts in their lockers and know exactly when and where to fish.

Back to the grind tomorrow.

Johanna's first day off!

Johanna had a day off today.














We went to the beach - even here the bauxite lies in piles.














We went fishing in the afternoon and Johanna caught a barramundi with her first cast. The picture does not do it justice. Michael caught a stonefish. The children were suitably impressed and horrified.

A nice day

Took the kids to a lovely little area to admire the views. The girls enjoyed the mud. They told me it was good for the skin.

Jonathan loves the 4WD.

Work at the hospital

I find it hard to believe it is already Thursday. I start work early with a ward round and then it is clinic work +/- on call at casualty. I am on call alternate days. The days and nights sort of blur into each other and I am having trouble processing the day before I find myself in the middle of the next one. Life is very different here. So many hard things. I am grateful for my collegues - my fellow locum and his greater emergency experience and a great medical student who is keen to commit his life to remote work.

I spent one of my afternoons in A and E sewing up a beautiful young indigenous woman who had been assaulted by her partner with a broken bottle and then dragged along the ground. Her hand was torn open and you could see her extensor tendons and she was covered with lacerations. With phone assistance from one of the plastic surgeons I managed to get all the bits together and admitted her. It took me a few hours. Sadly, she is not wanting to obtain a restraining order and has since been discharged. This is apparently normal here.

I love the local clinics where you drive to an indigenous clinic and see anyone who walks in. The nurses here work very hard and are amazing. Patients wait for ages but never complain and just go away and come back the next day if we have to leave. The children are totally gorgeous and I would happily come back to do these clinics several times a year. Could happily give A and E a miss though! It is all so underresourced compared to the city.

I found this morning very hard. We have this cheeky little boy from a remote community on the ward for "fattening". He is 19 months and 8.5kg and these children are admitted for intensive feeding for 3 weeks or so. He is eating well but I had to put a nasogastric tube down while one of the nurses and my collegue pinned him down. It was heartbreaking. I really hope he does well.

The only radiology available is xray and if you want it reported you have to ring Townsville or Cairns where they can get the xray up on the screen. I seem to ring them all the time! Everyone is very helpful.

I have Sunday off so hope to see a bit more of Weipa! I am still doing a run each morning but I have to go with a torch so do not really get to see that much! The highlight of the hospital is the super coffee machine which makes the only good coffee in town - Michael is jealous ...It makes a rang of goodies including lattees cappacinos and chocolate latte. I am having a daily chocolate latte fix.

Michael's birthday was fun - usual pressies inthe morning and then I worked all day. Went to the bowling club pm where there is a playground for the kids. The food was great and we all enjoyed ourselves. Had birthday cake at home. Yum.

Kids on the beach

I took the kids to the beach this morning. There is much concern about being eaten by a crocodile. We were told that a kid was running on the tidal flats on Monday and tripped over something. When our friend (The DoN) ran out to help she saw that he had tripped over a small croc. The kids have taken this story to heart.

Routine

It is day five and a routine is forming.

We have noted that we have a traditional household arrangement at the moment though the gender roles are reversed.

Johanna works at an intense job and has a long day while Michael stays at home with the kids and takes care of the house. Johanna spends her day using high level skills and interacting with adults. When she gets home she needs time to process her thoughts and often thinks of what she has on the next day.

Michael tries to keep the kids entertained and is lucky to speak to any adults during day. He is relieved when Johanna gets home.

We both agree that our prior division of these duties is much preferred by both of us.

Coffee

Today I found a cafe that sells coffee. It was probably the worst coffee I have ever had in my life.

Johanna's first day at work

Well, today was my first day at work. I did a short run am to get a better idea of the layout of the town and had a long chat to the life guard at the pool who was welcoming and very friendly. It took 2 years for the pool to be built which is the way things are here. The hospital was daunting - just not knowing where things are or how they work. Must say though that everyone was very helpful and made me very welcome. There were 2 other doctors on the ward round and one medical student. Nearly all the inpatients are indiginous. There were two who could have been discharged but you have to wait to have two people heading the same way before chartering a plane to take them home so they just stay another night. There was one woman there who is a well known indiginous artist who is quite a character. I had never heard of her but she has apparently done a lot of the murals in Cairns and has been invited to art exhibitions in London and New York. One of the drs headed off on holidays so now it is just two of us - a bloke from Mornington Peninsula in Victoria and me.

I did a morning clinic at a nearby indiginous community called Napranum. We had to drive this huge 4 wheel drive which I find a bit daunting but the medical student has spend a lot of time in the outback and offered to drive me which was a relief. The clinic was amazing. Full of committed and very hardworking staff who are under resourced but never complain and are permanently friendly and helpful. There are no appts so you just start working through the files and do what you can and leave in time to do a pm clinic back in Weipa. Those not seen just come back to the next clinic. You do see pathology that I have not really seen much before. Have had two patients with septic arthritis, one with osteomyelitis and woman with a pebble in her ear ! We thought we would have to send her to Cairns but I had this moment of inspiration and used a nasal suction tube cut down to get it out.

The pm clinic is the same. More white patients who work for Rio Tinto but again no compaints despite long waits. I am provided with lunch but unfortunately, the nursing staff are not so I felt pretty awful eating my cooked meal with staff who were having toast... I am on call tomorrow - I take it in turns with the other GP.

Managed to make a cake for Michael's birthday with no measuring cups, scales or sifter. Smells good so hope it tastes ok ! The barge with supplies came in today so the entire town converges of woolworths for the week's supply of fresh food. A pretty basic basket of groceries for one week cost Michael $437 !!! Living up here is not cheap. Not sure how those on welfare manage.
The kids seem happy and end the day covered in red dirt.

Tomorrow, I head to a more remote clinic in the afternoon and then do the on call. I have no doubt that Weipa will start to look like the big smoke after going to the more remote indiginous communities.

Mandatory tourist photos

The car, the house, some local images

Day One - quite tiring

Up at 4.15am and to the airport for a 7am flight. Off the plane at Cairns at 9.25am. Taxi into an excellent kid’s playground on the Esplanade – anything rather than spend three hours at the airport. Back to the airport and onto the Weipa plane at 1.20pm arriving at 2.40pm. Picked up by our friend ‘The DoN’ in a big eight seater 4WD which is to be ours. Driven to the new house, which looks like any other new home anywhere in a bald estate. Back into the 4WD for a tour of the town. The river and sea are beautiful . Everything close to the soil is red. The town is basic, outback standard. The hospital is brand new . We drive along a stretch of beach – the unofficial road between the pub and the supermarket. The camp ground is full of new arrivals for the cooler holiday season. The kids start to seriously fall apart from exhaustion. We order pizza (in a Thai restaurant) and play down by the river while waiting. Wonder Boy gets completely covered in red dust. We find a dead snake, which Lara declares to be cool.
Back to the house, some food and bed. We are very tired.
Johanna starts work at 7.45am tomorrow.

Time away

We are flying out on Sunday 20 June 2010 and returning on Sunday 4 July 2010.