On the island

landed on Wednesday evening, and the first sign that I'm now in a different world was the airport! Barbed wire surrounding a runway with a basic office, and the new addition of a roof overe the baggage area so you don't get soaked waiting for your luggage! I spent the first 2 nights at the "young doctors house" where the juniors and the medical students get to hang out, and the finally ( after some juggling around of who was supposed to go where, claimed one of the flats behind the medical centre as my own little cave for the next month. A fifties motel room throwback within a nice metal cage...against hurricanes? Angry natives? Beer shortage riots? Who knows....but it has fans, air conditioning that I turnoff most of the time and a decent size flat screen tv that gets ABC, SBS and imparja... I'm supposed to be working in the mining town clinic, which sees mainly white people, but the last 2 days I ended up being sent over to the neighbouring town which is indigenous land and off limit for your average tourist, which was truly delightfully chaotic and homey... The first afternoon I walked in to a young man who had threatened to hang himself earlier in the day going off his nut,being held down by a bunch of staff while others fiddled with drug bottles trying to get something into him to sedate him.... I felt right at home, just like an arvo in Wyong, different skin colors is all.... The next day I got pointed to a cubicle and a desk with a computer and told to "just see patients!" So I click on my first patient and wander into the waiting room trying to work out how to actually pronounce their name properly? It was an interesting day...the challenge of trying to bridge the gap of culture and language to work out what was actually wrong with the people I saw....and what I could actually do to help them... You call up each persons medical file when they sit down at your desk-which is a great help as it gives you cues about whatever chronic diseases they have, what vaccinations, health checks or things might be due such as bicillin injections for rheumatic heart disease... The first guy came in for a dressing on a cut on his hand, and left with an antipsychotic depo injection, the above mentioned bicillin and a tube of eucalyptus heat rub for his sore back. And that pretty much set the tone for the day. Each person came in with a wide rambling shopping list of symptoms, often including some for the kid who came in with Mum. the kids were wild, distracting, delightful, and once I had worked out that I could deal with them by putting them on my knee and getting them to help take their mums temperature etc, also a great gateway to help get their mother to relax and open up to me a bit more.... it was quite daunting at first to be suddenly set free to actually diagnose, treat, dispense medications and send a patient on their way without ever even consulting a doctor. While I do trust my own clinical judgement, and all of this is done following the beautifully clear step by step guidelines of the holy CARPA manual, 7 years of having it hammered into my head that nurses just can't do this no matter how much they might know, and living in the twilight of holding out the medications to the doc to write up, and getting them to sign the chart you have already filled out for them (including the dose they didn't actually know themselves), it was a weird experience indeed. But good.