Tenant Creek Clinic: First Day

My first day in the clinic....
It's all new and pretty...a lovely open round architectural design, painted white and orange...a friendly sunny waiting room and working BP and blood measuring thingies!
All the staff seem friendly and open too...
I spend the day working with a lovely midwife called Sue, mainly to help me get a hang of how to use the computer system, which of course is a completely different one to the PCIS system I used on Groote last year... (It sucks big time, the usual committee designed monstrosity with multiple double entries for everything...sigh.)
Our first pt is an 18 month old boy...who comes accompanied by his 23 yr old mother and 4 other siblings, including a small baby.
They are all filthy. And covered in sores. And dressed in filthy and totally inadequate clothes.
The Mum speaks very little english, and most of what Sue is saying to her seems to go straight over her head. We manage to work out that the 18 month old is overdue for his vaccinations, which is why they are all here.
sue attempts to go through a basic developmental and health check list with mum before we give these.."Do you think your son can hear properly? Does he react to sounds from the other side of the room? Are you feeling at all depressed? Do you feel as if you have enough support with the other children?" the official language in which the protocol questions are written is stilted enough to make them difficult for the average white woman, but for this lass....she answers "Yup" quietly to each question, looking down, but I'm pretty sure she isn't getting much of this at all.
As Sue starts checking our official patient physically, she asks: "Do you brush the kids teeth twice a day?" "Yup." Yeah right. Gawd knows when these kids last saw a bathroom, let alone a toothbrush.
My heart is aching looking at them all. I sit down on the floor and start talking and playing with the other kids while Sue continues to try and communicate with mum and the 18 month old. The older kids are surprisingly eager to interact, and incredibly nimble and quick to work out what do do with the building blocks from the toybox. They smile and show me what they are building, and seem to understand most if not all of what I say, though they don't speak much.
The baby is down on the floor and I lean over and try and get it's attention. And it worries me...the little girl doesn't focus on my face at all, or react to noises either side of her head, and when I offer her my fingers, she doesn't grab them, or cling at all when i wrap her tiny fingers around mine and attempt to pull her up....and she has a weird dry rash over her forehead that may or not be scabies... somethings not right here....
But we are trying to focus on the 18month old and not intimidate the poor mother too much...from her notes I now find that she has avoided a number of bus pick up recalls with various excuses, and when I ask her about the birth and how it went, she manages to communicate that it was "operation" as were all the others...5 caesarians! the poor lass! the baby is only 2 months old....no wonder she looks so flat.....
Its so hard for me to tell whats going on here...I know that it's seen as rude to hold direct eye contact in many aboriginal cultures, and that many women in particular are very shy in dealing with white medical people...but she just sits there dumb, herself quite round and overweight, with well brushed clean hair...whereas her kids are disheveled and uncared for looking to the point that in the white suburban world I normally work in, it would mean a phone call to DOCS and the kids immediately being taken into care.
I don't know what to think. Is this normal here? Or is there something seriously wrong in this mothers world? What can i do? What should I do?

In the end I then help Sue to administer the 4 immunization shots the 18month old is due for, poor mite. 2 in each thigh. And we give the 18 month an iron shot to try and make up for the low HB which was noted a few months ago on his last visit but not treated, and his mother cradles him very caringly as he cries after the needles. We ask her to come back next tuesday, officially so he can get another iron shot, but really also so we can begin to work our way through the problems with the other kids and also have a better look at the baby.

the young mother rounds up the kids with a few soft words, and they jump obediently and follow.

and I sit there totally shell shocked. What the hell did I just see? A Caring competent mother who follows older traditions that I just don't understand that don't value cleanliness....or a totally dysfunctional depressed and overwhelmed mother with severely neglected children?
My head spins and I feel dirty....i wash my hands and wish i could change my clothes...scabies, lice, skin infections....

Luckily our next patient is a clean, educated, English speaking grandmother, who has come in with her two youngest boys, and her two grandchildren. All are clean and sensibly dressed with neatly cut and bushed hair...though the two grandkids have sores on their legs...
It turns out that Grandma has taken them off her son and daughter in law as she didn't think they were being looked after properly, and she's brought them in for a check up.
A bicillin injection and a urine test later, they all go home, and i feel hugely relieved that we could actually do our job here.

It's going to be an interesting 2 months.......