essay: Maningrida 2016

Maningrida in 2016


This might be Maningrida Only; it’s my 8th year and there can’t be much new to say, but you know I’ll try.  Easy flights via Darwin, and the usual tedious difficulties getting my phone SIM changed to Telstra.  The first one was faulty, causing ages of sorting out on a Telstra chat line.  Woolies was open late and I could get another one and go to the back of the chat line queue again; then getting emails by hotspot sorted out at Maningrida – the 3 (!)Telstra chat liners were all inexpert so again time consuming and expensive by hotspot.
Maningrida is quite a large dispersed settlement of about 2500 mostly full blood indigenes on the east bank of the Liverpool River estuary, NE of Kakadu.  I have a fine little 2br brick bungalow on the road from the airstrip, but it’s about 2km from the clinic, so need a lift there and back – would arrive drenched in sweat otherwise.  Everyone welcoming and friendly last Monday, with 2 other docs (soon just one), and the first hour getting remote phone refresher training in PCIS, the software which I’ve used once before, in the Tiwis.  Quite a large clinic with lots of RAN’s and other health workers, some visiting from Darwin.  The patients have the usual mix of chronic severe diseases, with diabetes and chronic heart and renal disease predominating; scabies and other skin infections also very common.
First week as a locum is always more testing; time and effort to sort out the IT, home and work.  Then even in what seem to be friendly places like this, there’s a need for the locum to come up to speed quickly – eg with the software, so different from down south.  Other staff are happy to answer questions but of course everyone is busy and you have to swim not sink.  There are always a lot of local rules/customs/habits to learn – both the indigenous ones and the local procedures for the job, which vary from place to place.  Locums  don’t get a car here, so I cadged one to get to the shop one night before closing time 5pm.
There are 2 stores, much the same, a footy ground, a nice arts centre somewhere apparently, and the usual PO, police station shire office etc.  Plenty of crocodiles in the estuary I’m told, and one has to carry a cudgel and learn to say “shah” ( ‘piss off’ in local language) loudly to the hordes of dogs, many of whom are ‘cheeky’ – a euphemism for running at you with teeth bared and making a lot of noise.  I noticed crosses and one fresh grave in front gardens; it’s a local custom to bury relatives in the (small) front yard.  The body can be under a tarp for weeks while distant relatives arrive; someone sits close by to keep the dogs away.  Roads are quite often blocked off for ceremonies, so you find another way.  Once again, the impression is of being in a totally different poor third world country.
Finished reading Magda Szubanski’s Reckoning and enjoyed it a lot; she writes well with a very clear and accessible style – a page-turner as one reviewer said. She has had a life of anxiety and self-doubt, really tortures herself, feeling much better when she finally came out; lots of sadness, particularly the dreadful accounts of Poland’s modern history, involving her family, chronicled in detail.
Thursday mornings are patient-free for housekeeping, education etc; but I had what seemed like quite severe food poisoning; think it was a morsel of cheese left in the fridge, w seemed fine!  Went back to work for the afternoon after resting a few hours but by home time had quite severe belly ache again, which sort of responded to Mylanta and Zantac.  Went to bed with enforced fasting, so quite impressive wt loss I think.  They say there’s quite a lot of campylobacter about, a common cause. Anyway a lot better now.
We have a clinic meeting at 8am each morning, and as usual my dodgy hearing struggles with meetings; but v impressed with health centre involvement in the community, this week in a careers day at the local school (primary and secondary).  Finished the week with a bit of drama – had to fly out a 4yo who managed to amputate half a finger with a sharp knife. Lots of screaming and weeping by the family, took a while to settle down.
It’s Saturday and I started with a walk along the estuary in the relative cool at about 7.30 am, then finding my way around the town; carrying my big cudgel, which was very useful.  I think I saw one croc, but it was far out in the estuary, and saw no obvious tracks on the beach.  The latter is strewn with all the detritus of town life – a bit sad but as in other such communities a clean environment isn’t a value or priority – though the town itself is better than many.  Lots of big hawks diving and swooping –  rather nice as I am reading the little novel A Kestrel for a Knave (the film was Kes) about a boy in a poor rough coalmining town of Northern England, who trains a kestrel.  Back past the Darwin barge landing, then up through the town past the ‘bottom’ store to home, which is halfway between ‘top’ and ”bottom’ stores. Lots of big old mango trees, some with very low hanging fruit, but all sadly immature in late Sept.  Food is of course expensive, shipped by barge; but I found a gi-normous pineapple for $2, and opened it for lunch – a perfect one!  From Darwin Woolies I brought with me ‘Moccona with a (large)hint of caramel’; it was on special, you’ll be surprised to learn.  I am a caramel lover, and it’s not that bad if you have to drink instant coffee; w I seem to be drinking a lot of, missing the little machine from Coles.
I was very sad to see in today’s Age online that Dr Bill Williams has died at only 57.  Only the good……  I used to know him in antinuclear activism days; he was probably more radical than I, ten years younger with lots of energy, a man in a hurry.  He had an impressive career, and a fine obituary.
This is not a ‘dry’ town, and I saw lots of slabs being carried off as I walked around town early today.  There has just (4.30 pm) been a big dramatic alcohol fuelled brawl in front of the house directly across the road; I kept a low profile, but think I might close the gate.  It could be a long night!  That’s it for week one.  Cheers and love, Rod

Well, it’s my second weekend here and Grand Final weekend; good luck to my Footscray friends.  Last Sunday morning there was another brawl, this time in the other house directly opposite – lots of shouting and screaming, thumps and bangs.  This house has a powerful sound system which periodically blasts the neighbourhood.  Droves of locals and dogs arrived rapidly from all around, about 200 outside my house for a while.  It was very angry, so I decided to call the local police – was uncertain of the potential for violence – but no answer so I called the police in Darwin who said they’d contact the local copper on call.  After a while someone turned on the ghetto blaster, which seemed to defuse things a little and the arguments moved further down the street.  After about 20 minutes a police car drove through, then after another ten minutes the cavalry – a few more police wagons, and the crowd gradually dispersed.  The doof doof went on for another half hour.
Later I walked about half a km to the airport – said to be a nice bush walk out there, but not really, just very hot and too much rubbish.  More drunken fighting at a house on the way back, with an older woman beating up an old man.  It’s a few years since I’ve been in a community with alcohol readily available, and the difference seems quite significant.
There’s a big art centre right at the airport, for the dealers flying in and out I guess; it’s a big hangar-like building, and part of it is a sound studio; open only on weekdays so I booked a viewing after work one night (now have a Hilux ute to take home after work, which is nice). It’s a slick commercial operation, with very expensive art work, in similar styles to Yirrkala – hundreds of painted totems.  The circular woven mats and basketry were perhaps more distinctive, but again very expensive; or perhaps more reflective of the labour involved – after all we’re not really a third world country, though it seems so up here; but you do wonder who is making the money.
During the week we had a roadshow type visit by a delegation of senior Top End health bureaucrats, to present the grand business plan; quite a good emphasis on training local people, this part presented by an aboriginal bureaucrat.  The COO was Peter K, a morbidly obese Greek Australian, who lovingly presented a prolonged summary – a bit eye-glazing overall, though good that they were seeking feedback from the front line.  I was pleased to be called away to the emergency room.  The carrot was a BBQ lunch.
I’ve been the only doc here for a few days and it’s a busy clinic, said to be the busiest in the Top End outside Darwin.
At long last I started reading AB Facey’s “A Fortunate Life” and finished it in 2 nights.  It’s a small (~50,000 word) autobiography of an uneducated Australian who grew up under very difficult circumstances in the early 1900s and fought at Gallipoli.  Told in simple words by a straight-talking knock-about type, it’s a lovely little book and a great window on interesting times now long past; makes our own lives seem a bit of a doddle, fortunate indeed.
One of the nurses reported a large croc seen from her house down beside the estuary.  That got everyone telling croc stories; the standout was about an ex-nurse manager here who was fishing from a creek and dropped her lure.  Reached down to retrieve it and was grasped about arm and shoulder and pulled in by a croc who’d clearly been waiting for his chance.  A quick-thinking (and brave!) local man jumped onto the croc’s back and poked it in the eye, whereupon it let go the nurse and retreated, thank goodness.  She was left with big scars, and presumably about as enthusiastic about more fishing as I am.  I can’t think of too many nurses I’d do that for – sorry girls.  There are also buffalo and pigs, the latter in large numbers around the town at night, I’m told; the big ones have large fangs and can be fierce.
Our clinic manager Christine had a birthday party at her house last night, and I took along a few pizzas, which were rather good.  Friday night each week the local take-away stays open after 5pm and makes pile of pizzas.  It’s a well run clinic here with a pleasant bunch of workers, so a bit of socialising was rather good too.  There are ‘ceremonies’ this weekend so the road in and out of town is completely closed.  Hundreds of people filed past my house last night, with some chanting and percussion, but all peaceful.  I’ll be at my own ceremony on the couch, watching the action at the MCG.
Cheers and love from moi
Just a quick one at mid-term; it has all been said before.  It’s pizza night after a busy Friday, and I’ve just consumed a fine garlic prawns pizza with large succulent prawns – a good way to mark the end of each week.  Last Saturday I watched the Grand Final – one for the ages; both teams fought so hard until the Doggies, with impressive all-on-field tenacity, wore down Sydney in the last 15 min.  Fantastic to see the joy among the fans; the impression was of unity across the western suburbs en masse.  Melb/Syd rivalry clearly involved too, with unimpressive booing of the Swans at big moments – the unlovely side of footy crowds.  The massive build-up and rah-rah around ‘big football’ also a bit cringe-worthy, not unlike reality TV, but that’s an educated viewpoint, and it’s not our day.  The Doggies President is Peter Gordon of Slater & Gordon, and vice pres Susan Alberti another very wealthy business person.  It’s a huge money game now of course, a bit at odds with the battlers’ image.  Though again, it’s a bit like sport up here; one doesn’t begrudge the money spent in the west as it brings joy, resources and a leg-up to underprivileged people.
Another brief note on the grog here, and the doof doof across the road is revving up.  The grog arrives by barge once a fortnight, and of course everyone stocks up.  Walking down to the estuary early one weekend, I came upon a long queue outside a non-descript shed, and people walking away with XXXX cartons.  It’s called ‘The Line of Shame’ apparently.  The CEO of Malabam, the local health funding management corp, told me he’d lined up once but wouldn’t again – felt ashamed.
So this is probably my last remote locum.  It’s a well run clinic, and everyone friendly, but  I’m feeling the isolation more than I used to.  What has changed is my deteriorating hearing.  I miss quite a lot at the important daily 8am meetings.  It’s a big busy complex health centre, doing lots out in the community, with a changing parade of staff faces, most of whom know each other.  The locum is here primarily as an extra pair of doctor hands, and I still do that stuff well and enjoy the challenges – it’s one to one and hearing isn’t a problem; but one feels detached from everything else.  This is compounded by unfamiliarity with computer systems, with the organisation of remote care generally, and of course with the patients themselves – they are mostly well known to the permanent staff.  So the boredom at weekends is compounded by an increased feeling of isolation at work.  Having said all that, this week was better – everything improves with familiarity!
And tomorrow night I’m having dinner with the other doctor working here, so social life has been OK.  I always do quite a lot of teaching too, which I enjoy.  Love from moi
It’s my fifth and last week coming up, and it’s worth reflecting on how my coping at work improves over the course of the locum, especially if I am to do it again:

  1. Routine use of software improves; so a refresher before arriving would be good. Other IT problems (ie at home) probably just have to be solved though working it out with Telstra first might help. “Data Plus” was the pre-paid contract that was best for my phone in a remote spot.
  2. I do everything possible at meetings to maximise my hearing. Participating as much as I can makes me feel more connected, as does offering my experience, and teaching.
  3. Understanding local practices and procedures is better after the first 1-2 weeks 4. Even a little bit of social life reduces the sense of isolation.

Last Monday 10/10 at 5.30 am I took a very distressed call from Rochi, as Lulu died in her arms, almost certainly from a bowel perforation from crunching up a bone.  It was very hard to hear Rochi so distraught, and not be there.  Eve went straight across and both families have been wonderful in their support, with Maria and Donna flying down to be with Rochi over the week.

I messaged Martin for his birthday one week too early (!) but learned that he is having a hip replacement on 8 November.  I wrote a ‘tribute to Lulu’ after it crystallised in my head while sleeping – interesting how that happens.  Past week at work has been more of the same challenging clinical work, which of course includes simple things I don’t usually do, like dispensing from the little pharmacy, and taking blood samples for pathology tests.  I gave a presentation on back pain, and listened to a talk on the current  NT syphilis ‘epidemic’, which seems to have started around Alice Springs.  It continues to be quite common around Maningrida, along with a number of cases of TB – increasing the sense of being in a totally different, poor, third world country.  In my last week visited the nursing home not far from the clinic, on the shore of the estuary; a finely designed structure with a large open common area, without walls, overlooking the water.  Saw one old lady who appeared about to die from sepsis ?pneumonia, but she rapidly and dramatically improved after one dose of IV antibiotics; and I had told a large group of her relatives that I thought she was on the way out.  So that’s it for Maningrida Sept/Oct 2016.