essay: Yirrkala

Yirrkala                                                                                            Oct/Nov 2013

 

You’ll be relieved to hear that there won’t be many emails this year.  I’ve worked in this area before so there aren’t too many fresh insights.

Usual easy flights up, with a new Qantas plane complete with sophisticated in-flight entertainment system with so many choices – watched a very good Canadian film/doco “Stories We Tell”.  Stayed on that nice Esplanade in Darwin as usual, started work in Yirrkala straight from Gove airport Monday 2 weeks ago, a bit knackered after two 4AM starts.  I have a nice big flat in a quiet part of Nhulunbuy, about 13k from work, and a big solid Hilux 4-door ute to rattle around in.

Though little has changed working with the Yolgnu, the prevalence and severity of chronic disease (esp diabetes, chronic kidney and heart disease) at all ages still shocks.  Rheumatic heart disease remains a curse.  More shocking still was the gratuitous offer of a grandparent concession at the lovely big Nhulunbuy pool – have been swimming a k after work, as Territory public service hours are 8-4.  It takes a few days to get used to the different approach to health care up here – firstly there’s Communicare, the quite complex non-intuitive software program which facilitates health data extraction but not day-to-day clinical work, though I am used to it after 5 years.  More important though is the huge emphasis on preventitive care and detailed regular health checks on everyone, trying to tackle the enormous burden of chronic disease.  There’s the everyday acute medicine of course, often quite challenging, and there are teams of outreach workers tackling the various chronic diseases.  Much higher levels of smoking than in white Oz add hugely to that burden, and of course grog and violence do too.  There are big innovative projects, like the telehealth retinal photography of diabetic patients being trialled at 3 NT sites including here, coordinated through RVEEH Melbourne, and said to have great immediate educative value in tackling arterial disease.

 

I’ve had to adapt to something unexpected at work.  There’s usually plenty of it so the days have passed quickly on previous jobs.  I picked Yirrkala for my locum this year as it was the busiest of the outstation clinics managed by Miwatj aboriginal health service in Nhulunbuy.  When I arrived I was told I’d be working with a younger doctor at Yiirkala – he’s about to do his college oral exams, and is very keen to see as many patients as possible – so he was sent to Yirrkala.  To give us enough work for the first 3 weeks until his exams, I agreed to concentrate on seeing ‘chronic’ patients, creating/updating care plans etc, which is meaningful work and brings in good money to the clinic, so I was happy to try this d/o labour.  Problem was that one of our drivers went bush, so couldn’t get the chronic patients to the clinic, and also not enough rooms for the doctors and nurses doing a mixture of ‘acutes and chronics’ ie nobody had thought through how to make use of 2 doctors.  So some quick negotiations with Miwatj management and I’m spending weeks two and three across three clinics, plugging holes where doctors away, then just at Yirrkala for the last 2 weeks, when I’ll be driving Rochi to Yirrkala too, early each morning.  Things are generally changing too re locum jobs up here.  I suspect there are more doctors coming to NT now, some long-term, so the nicer places like this are filling up and I doubt there’ll be as many spots for locums in places like Yirrkala.  The local climate is close to ideal, warm to hot but with cooling sea breezes from the Gulf and the Arafura Sea, much easier to bear than the searing heat inland.  A similar example in dentistry – before leaving Melb I had a dental check and one of those expensive crowns was loose, though I hadn’t noticed.  My dentist tried to stick it down but not with great effect since as soon as I got up here I became aware that it was VERY loose.  No chance of seeing a govt dentist – on the road most of the time and not returning calls so I googled and found the one private dentist.  She’s a young Indian, half of a husband and wife team flying in from Qld doing clinics every Fri and Sat, and doing other remote spots as well.  Of course that’s one way of building a practice – coming to under-serviced areas.  She couldn’t help me but was pleasantly reassuring in a Peter Sellers sort of way.

 

Nhulunbuy is unchanged, a pleasant small town and regional centre for East Arnhem Land clustered around ‘Mt’ Nhulun.  It could have been much reduced from last year, but the huge alumina plant (on the tip of the Gove Peninsula) is still running – it was slated to close when I was here last year.  World prices and the cost of power have made it barely viable, and negotiations continue about piping gas there (?from Timor Gap).  I think currently it comes by boatload from WA.  They have adapted by increasing export shipments of raw bauxite from the mine (near Yirrkala), so the ‘world’s longest conveyor belt’, a great covered structure running 30k from the mine to the jetty at the plant, still cranks up any time day or night.  As you may remember this is accompanied by an ear-splitting air raid siren, followed by howling from all the local pooches.  It happened 3 times last night.  I now know that blackouts are more likely on Sat nights; was sitting having  dinner in front of the (very parochial ) ABC news last week when everything faded to black – power returned after about 45 mins, from a power station that burns diesel.  I had a small torch, and now I have a lantern.  I’m spending weekends quietly with bike-rides and walks along the lovely beach spots around Nhulunbuy – sadly can’t dive in because of crocs and stingers, though the Yolgnu seem less concerned than we are.  They are quite friendly to us generally, and most speak some English, though there’s an uneducated lot from the more remote areas who can be quite stony-faced, less so as they get used to you.  I had an odd little episode the other night – was cooking dinner and there was a knock at the door, by a gaunt sixtyish Yolgnu woman.  I couldn’t understand her well (had been swimming and not wearing the ear-horns) but she definitely asked “Where is your wife?” and “Are you working at Yirrkala”?  She tried to push past me to come in but I gently stopped her, said I had to go back to the cooking and said goodnight.  Thinking about it after, I wondered if she was ‘casing the joint’, ascertaining that it was empty in the daytime.  I chatted to the local police next day, and they reassured me that break-ins are rare up here; but it was enough to make me take my iPad and camera to work with me each day.

Rochi’s arriving in 10 days to do 2 weeks of volunteering at the wonderful Yirrkala arts centre, probably one of the best indigenous art galleries in the country, run by ex Sydney barrister Will Stubbs in that isolated spot.  So that will be fun for us both.  Cheers and love, Rod

 

Hi, brief final communication from Gove.  I’ve been up here 4 weeks, Rochi 1 week, and we return to rescue Lulu next Saturday.  We’ve just come back from a Sunday morning drive to Crocodile Creek, a pretty beach within sight of the huge alumina plant on the very tip of the Gove peninsula, then a look at Gunyangara, a little settlement with a one doc health centre where I’ve done several days work.  It has been fun showing Rochi the sights around Nhulunbuy, mainly the lovely beaches, great for a morning or afternoon walk when the heat isn’t too much.  Rochi was a little anxious about crocodiles at first, and I of course reassured her.  “Don’t be silly!” etc.  Then by somebody’s law Rochi came across some obvious croc tracks on the beach, and at some point later a helpful young fisherman who was keen to tell us about all the crocs he’d seen ‘near here’.  Excellent.

Volunteering at the Yirrkala Arts Centre ( a big enterprise with about 25 employees, resident artists and other vols) Rochi has had similar frustrations to mine.  The director Will Stubbs has been up here 20 years is very hooked into (incl married into) the Yolgnu community, and is so determinedly ‘laid back’ that he hasn’t thought much about what someone with her skills and experience could do to help for 2 weeks.  A pity, so Rochi is coming and going and occupying her time in other ways.

My strategy of filling spots at other clinics where there wasn’t a doctor was successful, and gave me some work to do until the young doc at Yirrkala did his exams.  Now on the 2 days a week that he’s at Yirrkala he’s having the same  frustrations that I had trying to find useful work, as I  am based in the ‘doctor’s room’, but it’s still unsatisfactory for both of us.  It has been a wasteful piece of poor manpower planning, when you consider that docs are expensive workers, and I’ve written a short case study about it for the Menzies School of Public Health.

It made me think about why I come up here – it’s partly for a change of course, but it’s also about wanting to be useful in an area of great need.  When that latter need is frustrated, it does take the shine off the experience, and shall change the way I do this in future.

This weekend we had fine barramundi meals at the Arnhem Club (one of those sign-in clubs that are everywhere in the outback) in a nice outdoor setting overlooking the beach; then last night another nice meal at the Gove Golf Club, with a family we’d been put in touch with by Drew Potter – Evan’s parents are Drew and Teena’s friends and Teena’s cousins, and the mum is sister to a fine glass artist who Martin Haskett works with – small world again!

We are back home for a week next Sat nt, then a 2 week break in Hervey Bay, before returning to work in early December.  Cheers and love, Rod and Rochi

 

 

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