Download Jameson to Docker River

Jameson to Docker River
Jessica Driver, Final Year MBBS student (2010)
“How long?? I look at the pilot. Even he was shocked. After sixteen years of flying for the
RFDS he had become acutely aware of how long was too long.
“I told you, 3 days.” The doctor looked back at the Troopy ambulance clearly wishing he was
already in it, rather than being interrogated by a pilot.
“Where’s the ECG traces?” The nurse was starting to get in on it as the patient struggled
with the pilot and I to get on the already lowered stretcher.
The doctor turned toward his rescuer, the Troop carrier, and over his shoulder called “The
nurse did them. They’re in the bloody file.” A veritable dust storm flew backwards into us as
the Troopy pulled off to get back into town. The patient’s daughter muttered something in
Pitjantjatjara and held her father’s hand as he was raised into the plane.
“Sit up here darl,” the nurse patted a chair near the head of the stretcher for the
granddaughter, Maurice.
“He’s no good. He’s real sick this time. He don’t speak English either” she looked
understandably concerned. “Maybe they’ll listen this time. I told them doctors in Alice he
was sick. They don’t listen though.”
Julie, the flight nurse handed over the patients file as the plane ascended and began the
500km journey back to Alice Springs Hospital. Her lips pursed, brow furrowed I knew I was
going to be unpleasantly surprised at what I found inside. Looking at the ECG monitor it was
clear to see ectopic beats bouncing irregularly across the screen. The patient looked awful.
He was coughing, wet and productive, and each time knocked a whole heap of get and go
out of him.
The notes were comprehensive for what they were. Three days ago MH, the patient, had
presented to the 300 strong town’s clinic with a bad cough and feeling “no good” according
to his granddaughter. He had a fever of 39.5, and O2 sats of 93%. With the cough, fever and
lack of oxygen in his blood the doctor had called it as a ‘chest infection’. At home, we call it
pneumonia in 67 year old patient with a BMI of 33, and the typical features that accompany
it –diabetes, high blood pressure, cholesterol, central obesity, and angina. All poorly
controlled. Along with his smoking history and subsequent emphysema, his poor medication
compliance (at one stage he was given blister packs for daily dosing and had taken 4 days
worth in one morning), crowded living conditions and the fact he simply looked awful, he
would have been admitted to hospital. Or at the very least given antibiotics. This, however,
did not happen. In the notes the remote area nurse (RAN) had written that he had suggested
the patient should be flown out as he appeared significantly unwell compared to what he
was usually like. He had seemed ‘miserably ill’.
The next entry was the following day. Maurice had driven around to the RAN’s house (it was
a Saturday, and the clinic was closed) and told him he had to come and see her grandfather.
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Immediately the nurse brought him into the clinic and when reading his sats of 83% called
the doctor. The doctor recommended MH to take a double dose of his salbutamol and come
back if he felt worse, and they would call the RFDS on Monday morning if he wasn’t any
better. According to Maurice he had felt worse but refused to come back to the clinic
because the RAN had gone out of town for the day, and he believed the doctor wouldn’t do
anything anyway.
Monday morning came and at some stage someone had finally decided to do an ECG. Which
was dated for the following day. I stared at the ECG. Now I will be the first to admit when it
comes to ECG’s they might as well be in Braile for all I can understand. But this I did! This
one was similar to one we had looked at in Year A- back when I was enthusiastic and eager
as a teenage boy at a year 10 formal! ST elevations and massive Q waves danced throughout
the entirety of the antero-inferior chest leads, accompanied by a severe left bundle branch
block. The poor bloke had had a massive heart attack, and an unfortunate infection on top of
it.
Again he coughed, this time somewhat weaker but still producing sputum. Julie looked into
the emesis (spew) bag she had given him to expel into, and looked across at me. “Pink.
Frothy… Text book.” He was in cardiac failure. After having a blockage in his heart for so
many days without treatment his already strained heart had packed its bags and given up on
him.
I never was able to follow up on MH and Maurice as I left for Victoria before they had even
been moved out of the ED. MH was the last in a long line of patients to be seen when they
arrived, many of them white, forcing him further down the list.
What I did find out was that before the temporary doctor had arrived into their community
the RAN had sent MH and Maurice into Alice Springs on the “Bush Bus” some weeks back.
He had been deteriorating and the RAN felt he seriously needed a medical review. They
travelled 6 hours each way on the bus, plus a few nights in town, only to return feeling
disregarded and quite simply like no one really cared. The RAN had made several follow up
phone calls, many to personal friends and colleagues whom he knew were likely to show MH
the care he deserved and arranged for MH to return to Alice Springs to see a good doctor,
bulk billed. MH refused to go. He hated being away from his family, from his country and
didn’t understand why this time would be different. He didn’t consent to further treatment
outside of the community.
So why is there such a gap in healthcare here? Where can you lay the blame? The RAN was
doing more than his job, he was making his own life difficult for this man, like he would for
anyone in his community. The doctor was doing far less than his job, he was simply there for
the break from the city lifestyle for a couple of weeks, and to get some good money. The
patient felt the system had failed him, was useless to him. He was very poorly compliant on
his medications. He was sick from the food and cigarettes in the overpriced, never fresh
store which was stocked and staffed by people who had previously lived their whole lives in
Sydney. The ED staff had seen a sweaty, overweight Aboriginal man, a smoker who never
took his medication, didn’t speak English, was from the bush and wouldn’t come back to
Alice for his doctors’ appointment.
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Who’s to blame? Where does it start? How do we end it?
After coming back from up north I had less answers than before I left Victoria. I was so… so…
philosophical about it all. I had answers. Yes they were big, but they were achievable. I was
an idiot. What kind of concept can you have of such a huge problem before you sit down and
talk with the people involved? And still I am miles away from really understanding.
The people who live the life, who actually experience it as a patient, as a carer, as a family
member, as a community- these are the people that most need to be heard rather than told.
Then, and only then, are we ever going to have a fragment of chance of closing any kind of
gap.
This is where I was for a month all up- between Jameson WA, Alice Springs and Docker River,
NT (just). The place is magnificent and barely grazed by livestock, so it is truly Australian
landscape. And I was lucky enough to be shown a lot of the scared sites and told stories
about them, and the best bit… I got to eat honey ants! Yummo! Not good if you don’t have a
sweet tooth though!
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The Standard Ambulance for Remote Areas- toughest bloody things alive!
Huh? Where?
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Now THAT’S a road trip! En route to Docker River from Alice Springs with the Centre for
Disease Control
Docker River Health Clinic where we went to vaccinate everyone we could find for porker flu
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Random Camel Survivor. I think he might be a pet now. A week before we arrived 2000
camels were culled from a chopper. Air conditioners, water tanks, piping and houses were all
being destroyed as the camels went nuts looking for water in the community.
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