Counting down ...

One week to go - and still a few things I would like to do to assist with the hospital functioning before I go.   But let me have a little rant first ... we at Babinda have 100% ward occupancy ( I hear that is good ) - all with long stay patients.  Cairns "has a responsibility to the community" and has been encouraging us to take as many as possible to help relieve their bed stress ( they don't have the luxury of going on bypass like the Melbourne hospitals ... they "ramp" their patients until the can be seen in the ED ).   Interesting dilemma facing us here in Babinda though - those who I might otherwise be able to admit here as acute care patients can't be as I have no bed for them, and have no bed now for a few days in a row.  Funding here is also dependent on bed occupancy but there is a fine line between what should be done to support the extended Cairns Health Services area and what is expected to be an acute care facility for the local community.  I hope the locals keep a finger on the political pulse, or they will lose their Babinda Hospital like so many other small rural communities around Australia and the facility here will be officially renamed Babinda Nursing Home to reflect the increasingly long-stay care role for the hospital.   The locals and the people working here at Babinda are beautiful people ... don't screw with them, and above all be honest.

 

The local electioneering has taken Cairns Base Hospital as a political baby and run with it ... and running not very carefully either mind you, that baby is going to be dropped in the scramble for votes and in being dropped hurt badly.  The local Cairns newspaper makes interesting reading at the moment with extravagant promises being made without apparent thought to resourcing any new or improved facility.  As usual, might be good for votes as long as the voter never has to use the facility and discover that it does not come up to pre-election promise expectations.  No, this is not unique to Cairns ... you have all heard the same bullshit from your own local politicians in times of ( their own political ) need.  There is even talk here about a "24hr Super Clinic" here in Cairns to "ease" the problems of Cairns Base.  Dunno what the policy makers are smokin' ... the Australian ethos ..er. disease should I say ... is "what does not work anywhere we can make work, I'm sure we can" ... and its been got bad here.  Who is going to be seen at the "Super Clinic" ?  GP level care patients of course ... and yes this might appear to help the numbers in ED by reducing the triage category 4 and 5 patients, but its not them who are causing the "ramping" ... or the 90+ day stay patients bed-blocking the ward beds for acute care patients because there are not enough nursing home beds anywhere in the community or because the small rural hospitals like Babinda are full of long stay care patients and can't take anymore "waiting for placement" patients.   The whole system is constipated.  And who is going to staff the "Super Clinic" ... overseas trained doctors?  ... I am not even going to go there.

 

I speak from experience .. I have been there, done that .. 25 years of GP experience in more places of differing repute that you would care to know about.  Believe me, after hours clinics don't work and are not sustainable long term.  Just tell me how many privately owned 24 hour clinics are currently running in Australia - does anyone even care to know?  As a public health system mutation they are an awful waste of limited health budget resource.   You need to support the local GPs to do their job better, not open up a fancy new clinic down the road from their clinic.  Pay local GPs a retainer to be available after hours?  Actually employ GPs inside the Cairns Base ED ? ... heaven forbid !  If you health policy makers want to talk to me for more on my opinionated opinion you know where to find me.   I have said it for a long time now, but never in such a public forum ... you don't need more doctors you need less patients ... there I've said it for all the world to see.  If you don't understand what I just said there, go sit in the corner with a light ale and a glass of water and have a long think.   For the sake of all the gods you believe in, don't throw potentially good money after bad ... be long term smart, not short term stupid.

 

Well actually that wasn't just a little rant was it ...  oh well, get me onto health care politics, patient advocacy and health service provision equity and you are going to have to pull on the bit real hard to keep me under control.   Lets leave the rest for another time maybe.

 

Today has been a good day .. its amazing how much relief is provided with one gets paid for the job being done.  Today payment for my first three weeks and the airfare reimbursement was deposited to our account and cleared for use today.   I repaid the lines of credit to stop any further interest at credit card rates simply used for family living expenses.  Have enough in reserve from the remainder for our family to live on until I start getting my salary back in Melbourne in a couple of weeks time.  I expect a significant majority of the remaining two week or so's income will be set aside for tax and GST, the smaller of the rest will be set aside for future reserve ... I have been a little isolated from the "world economic crisis" here in Babinda but at least the money earned extra here will be a welcome financial cushion for the family.  I don't want to even think about how much less that "superannuation guarantee" I have been getting as an employee for the last two years is worth.

 

I will keep in touch ... maybe a couple more posts before I say my final goodbyes to Babinda.

Cairns -> Cooktown and return

The photos are of the trip and some of Cooktown.  A small town that can be walked easily one end to the other.  I stayed at the Seaview at one end of Cooktown right near the wharf.  A nice surprise was that the 07.00am bus back from Cooktown was rescheduled to leave later at 13.30pm .. so I got to sleep in a couple of hours and spend a bit more time around town.  The bus trip was most enjoyable, mostly because I did not have to drive, but also because it permitted the trip down the coast through places otherwise not safe to attempt with a normal road vehicle. 

 

Went through Bloomfield, along the edge of the Daintree, through Cape Tribulation then across the Daintree ferry, down through Mossman and back to Cairns, just over 5hrs trip all in the afternoon.

 

Tomorrow starts my final countdown to returning home.   Looking forward to it.

Its a small world

Yesterday I met Gil at Cairns Central - had a chat over coffee. He is up here for two weeks in the GP clinic at Central. Good to catch up with him and more about the local "goings-on". I am on the bus to Cooktown to stay overnight and then pick up the coast route trip home. Still have not been paid anything by QHS - this would be a disaster if I did not have contingencies already in place but currently managable for another week or so. Can't imagine QHS reimbursing me for the interest on the line of credit though! Will post again with photos Saturday evening.
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The day after the night before ..

No its nothing fancy - I just realised that I promised a brief update last night and neglected to do so, but perhaps all is well as I have extra information to provide as of today.

 

Firstly Babinda Boulders ... forget the romantic tourist image of the swimming hole ( you can hunt that down via the tourist page link on my September post ) ... after a decent night's rain and continuing light rain falling during the day ( Saturday night then Sunday that is ) the quiet clear water was alive and imposing.  A most pleasant place for a short walk ( about 1.2km round trip along the river ) and to take in the sounds, the green and the moist of the tropical rainforest.

 

Josephine Falls will await another time ... I decided to go back into Cairns and stock up on a few days' supplies and wandered the streets for a while.

 

Today's news ? ... the circumstance that led up to this should not be spoken of in this public place other than to say that it was an example of what appears to be not an uncommon experience of medicos trying to work with Queensland Health ... however the outcome has been a direct communication with another locum doctor to arrange an extension of two days cover to a three day break (Thurs, Fri, Sat).   With this, two opportunities have presented themselves ... the first is the ability to work the final ten days straight through without having the Babinda DON to find someone else to cover time off later, and with three days off could arrange a trip to Cooktown where I would be able to then stay overnight.  I have access to a car, but I would dearly love the ability to be a passenger in a trip up the coast road where the recommendation is for 4WD for the river crossings ... car is okay inland but totally dependent on dry crossings for the coastal route.  I am reluctant to risk the integrity of the vehicle entrusted to me ... and it would be nice to see and not drive for a trip.

 

I will do a bit of "web-surfing" to find out what is available.

 

Catch you all again in a day or so when I have the days off planned.

 

ps ... to the media monitors, keep your pens and notepads handy for my experiences summary post when I leave on 5th November ... and yes I will also be providing a report to the locum agency with a "cc" to the DON here and the Medical Admin of Cairns base at the end of my time.

Saturday's 'round trip at the half way mark

Up early this morning to hand over to the doctor covering the weekend for me then head off to Skyrail just north of Cairns. One way trip to the tourist town of Kuranda where I spent three hours walking around town, had lunch and went into the butterfly enclosure. Then a scenic rail trip down the side of the hill to Freshwater where I caught a bus back to where I left the car at Skyrail.

A few stops at various places along the way, including views of the Barron Falls from both sides of the gorge. A most enjoyable excursion through some of the history and natural beauty of the place.

Tomorrow will be a little more casual. A drive to local places, Josephine Falls and Babinda Boulders, then a trip back into Cairns for some shopping and R&R before I start work again tomorrow.

Today also hits the half way mark of the five weeks I am here. Its strange doing the tourist stuff without company, although its nice to be able to share with you all via this blog. I have started to miss the family too .. looking forward to coming home in just over two weeks.

Quite a few photos taken today, with a small sample attached to this email.

These are of the Skyrail and Barron Falls.

The streets and shops of Kuranda .. and the butterflies.

That one above is of the path along the side of the Barron River at Kuranda .. and the next few are of the Kuranda station and the rail trip back down to the coast.

I will drop you all a small note tomorrow evening.

Ciao.

Settling into a routine ..

The work here has settled into a routine now ... getting to know the staff, the patients and the running of the hospital ... and even some of the local politics (although I am happy to be a casual observer and let those who know the local environment deal with local issues). Being on-call does not feel like 24 hours on-call, the workload is eminiently manageable and meals (prepared at "home") are usually had at approximately the time one would expect the meal to be needed.

Each day I plan an early morning round, a mid afternoon round, see the acute care outpatients as they arrive. Nothing that has presented in the now two weeks I have been here has been not requiring medical attention. It is definitely a culture shift from city surburban general practice where much of what we do is less than inspirational (eg. certificates for yesterday's gastro/URTI/headache).

The lack of strong mobile phone signal in Babinda is of nuisance value, but I am getting to know where in town the signal is best.

I do have this weekend off (Sat, Sun) ... even though a roster was not able to be supplied in advance, the DON here has had her finger on the pulse and providing me with cover for time off as we go - works out well. Saturday is planned to take the Skyrail (just north of Cairns) up to Kuranda, spend a few hours there and then take the Kuranda train to Freshwater station and back via bus to the start-point at Skyrail. Sunday I have not planned for yet ... might check out a few places in Cairns itself, and I must go see Babinda Boulders.

I think it has rained most days since I have been here, but the last two have been a little heavier than most. One of the nurses here this morning said "I wish we had better rain" and after some discussion of what "better rain" is ... sounds like that's wet season flooding she was after. I guess that will happen in March.

Finally, a special *wave* to the media monitors.

Proof its me !

Yep .. that's me .. photo taken Friday in the rainforest.

Today is coming back after a Friday,Saturday weekend off. Saturday was a little more leisurely with a trip into Cairns, a wander around the "tourist district" and along the Esplanade where there was a craft market. I bought a few things as gifts for the family, but don't tell them - I want it to be a surprise.

I then headed up to the Tjapukai Aboriginal Cultural Park, just north of Cairns, where I viewed a history video detailing how the local forest clans were slaughtered for sport and minor misdemeanor, relocated and forced to be fringe dwellers and beggars. The Tjapukai have worked hard recently to recover their cultural stories and language and this centre appears to be one way they are attempting this recovery. I also watched a telling of some of their clan creation stories, followed by a number of traditional songs and dances. One of the women talked about local bush food. It was an intense time of learning and observation.

On the way back home I stopped off at the local seafood market for some fresh local-catch fish for the next three meals, some fresh banana prawns which I cooked chili style to have with some steak last night, and some barramundi fillets for today.

I don't know when my next time off will be, but I will be talking to the local admin about what they can arrange for me in the next week or so. I will also be providing feedback to both Queensland Health and the locum service about how a signed contract accepting a 10 day fortnight has not been honored.

There is still good work and staff at Babinda to keep life interesting so its not a drag to be here - no regrets, just a lesson learned that what might appear to be on offer does not necessarily reflect the reality. More clarity will be demanded for future locums.

Catch you later this week .. won't necessarily post simply to say today is the same as yesterday and the day before, but I will keep a little chatter going on anything that seems worth making a diary note on.

ps .. I am out sitting in the car sending this in, found a spot in town where the 3G net connection is reliably 4/5 bars ... its pouring rain !

Its Friday evening

So today being my first day off work I decided to make it a long one ... and that it was. Woke at 6:30am for a quick check on one patient I had been changing medications for and a pre-8.00am handover to the doctor covering for my time off.

The at 9.00am I headed south to Innisfail, get some cash from the ATM and fill the car with petrol. Then back north along the Palmerston Highway inland to the Wooroonooran National Park. It is World Heritage listed Rainforest, in the Waribara clan country.

After the damage of Cyclone Larry, a tourist venture called the Mamu Rainforest Canopy Walkway was built involving construction through and above the rainforest on the steep slopes down into a river gorge. The total length of the walk to the end and back is about 2.4 kilometers. It takes a trip through the treetops of a regrowing rainforest ... I read in the information provided that it will take up to 30 years for the rainforest to return to its normal condition after the Cyclone damage. With the canopy half destroyed, the trees that struggled under the shade of the canopy have burst into life with new light reaching down to the forest floor.

The traveling up inland out of the rainforest into cattle country via Millaa Millaa and then to Atherton. A quick stop for lunch ( falafel and a bottle of water ) then further up into the inland dry country where potatoes, cane, macadamia trees, bananas all seem to do well enough, but a lot of irrigation is obvious. You can see the dryness of the local bush around Mareeba ... I took a westerly detour to the Mareeba Wetlands ... a fascinating oasis in the middle of dry bush lands.

Then up to a small town Mt Molloy .. and heading east again, crossed back across the range back into rainforest. Steep gradients down from the tablelands to the coast resulted in a rather slow trip behind a B-Double ( I think that's what they are called ) full of cane for processing.

I did take a look at Port Douglas ... high class tourist town - I can see international tourists coming here, never leaving for the whole of their stay, and naively thinking that is representative of far north Queensland. I did not stay, just came, saw and left ... no thought of conquering !

Then southwards along the coast road back into Cairns in time to pick up a few supplies that I can't get locally. Arrived back home at about 6.30pm and just under 400km traveled.

Tomorrow I will likely take a little less intensely and head just north of Cairns to the Aboriginal Display and Skyroad.

( I have emailed quite a few photos with this entry, but I will take a few out of my post and leave them in the online album for you to look at .. if you can find it )

Catch you again soon !

The first week continues ...

Okay ... just letting you know that I am eating well, really ... that's a picture of my lunch. Food here is fresh, not a great variety, but I buy what I need every couple of days. I was told that the best food in town was either at the Thai restaurant in town (Fri-Mon), or the Bowls Club on Friday nights. I indulged and tried some of the Thai as takeaway .. the usual test of Tom Yum and Chicken green curry ... if this is the best in town then it truely is a sad state of affairs. Yes, I am spoiled rotten with having found a few very good Thai food places near home in Melbourne - the Thai food here was of good wholesome home-cooking style, but nothing that could reasonably be called restaurant quality food.

Tuesday - hot weather with no cloud cover, but the humidity felt less so more like the Melbourne hot summer day I am familiar with. The airconditioning in the hospital and accommodation is crucial though. Interestingly the hotter, drier weather brought out the ants. Some at work, tiny ... smaller than I have ever seen,

and these "green ants" around the lower structure of the house I am staying in. I found this interesting website while editing this post.


The cane mill "railway line" near the house that runs across the main street is used frequently. The narrow gauge line is for the sugar cane being moved from one section in the cane mill to another ... the engines pull out a very long line of cane "trucks" out of the mill until the line is clear of the redirection point and then the engines push the cane back again. A photo of this.

I am still completing the medication reviews at the "acute stay" end of the hospital - reducing a number of excess medications and rationalising others. Particularly ceasing some of the ones like cholesterol lowering agents in some of the older patients with liver dysfunction. Neither needed for the "long term risk reduction" as what it would have been for them twenty years younger nor as safe with the unhappy livers.

Today had a Melbourne man who was at the end of a ten day fishing trip who came in with a "boat propeller injury" ... I dreaded what I might see on arrival, but fortunately the propeller was in fact stationary at the time of the injury. Still a significant laceration though - didn't know propeller blades were so sharp.

Another thing I am beginning to see as a common pattern is the sun damaged skin, in almost everyone local ... young adults who work in the plantations are very tanned, and the older adults all have multiple patches of sun damage, and the elderly who have live local for the whole of their lives have skin that has an appearance somewhat less than human-like.

Wednesday - a little overcast. Ward rounds are starting to come easier with getting to know the patients and their individual needs. Today also introduces the administrative paperwork of the ward - signing off on discharge diagnoses and treatments for the coding that will be used to determine some of the funding for the hospital. Of the 22 beds, 15.3 are funded as acute care beds ... interesting, as it really is defacto nursing home care for the majority of the occupancy. We have 20 patients in at the moment ( yes the other two currently empty beds are for my genuine short stay, acute care patients - and I have used these as such a number of times already ) and a category review of all of those 20 patients this morning with our ANUM ( yeah .. you can look that up too - hint : it's a role descriptor abbreviation ) revealed, as I expected, that only two of those are classified as acute care patients, and even then they are the longer end of the acute care, eg. one with COPD recovering from pneumonia - thats a two week acute care episode if all goes well.

Did my second clothes wash today ... have 5 days work clothes supply, and two days casual clothes, so need to keep ahead - twice a week seems to work nicely. There is a good set and forget washing machine, and a hanging line under the house for drying - even with the humidity anything out of the washing machine dries in a few hours.

Today I started planning what I might do on my weekend off ... found a good website with local road tour maps here ... will do the Reef to Rainforest - about 260kms round trip Gordonvale, Etherton, Mereeba Wetlands, Mt Molloy, Port Douglas and back along the coast to Cairns, probably Friday. Haven't decided about Saturday yet.

Oh by the way, in case if you haven't found it already, just at the bottom of each of my blog posts there is a "Comments" .. click on that link and you can make a comment or leave me a message ... I have this blog set up to email me when a comment is posted and a copy of your comment gets sent to my mobile phone, so even if I don't have easy net access I get your message fairly promptly. You can choose to post anonymously so you don't have to set up a gmail account, and there is a security number you need to copy from a distorted picture - this is implemented to discourage random automated spam for the usual unpleasantries.

Will probably post next on Friday after my first day off ... see you all then.

Today is Monday

The weekend was an interesting experience. The usual catching up on the ward patients with a few adjustments in management. Reduce medications, rationalise polypharmacy, prescribe evening therapeutic brandy. A few "out-patient" presentations, including someone who had to be referred on to Cairns Base. Saturday had a lady with a fish-hook imbedded in her toe. The standard push-through and cut off the barb was not going to work, the tip of the hook was in contact with bone, so "forwards" was not a viable direction to travel. The Flying Doctor manual had the solution, not a technique I had seen used before - shield the barb of the hook with the tip of an injection needle and then the "traction/rotation" extraction.

I also saw man with a cut finger (about a one week old injury ) who developed cellulitus. The local pharmacy being closed Sunday and with him having not enough petrol to travel far, I decided to give an intravenous antibiotic that would last 24 hours. This was Sunday morning. By Sunday evening he was feeling unwell, had fevers and while with us had "rigors" ( yeah, go look it up - but not a good thing to have ) ... easy decision, not something that I was comfortable attempting to manage locally anymore. This is in itself was actually not the reason why I tell you about this man though. It was because I got stonewalled by the Cairns Base ED doctor-on-duty. Reminds me of the days I was an "admitting officer" at Dandenong - it saddens me that decisions are made still based on workload and rationing of resources. I won't say much more because this is a public place, but needless to say I shared the nursing staff frustration.

Last night we also had someone in with a tick for removal. Long time since I had to deal with this. Patient and doctor survived the process. The tick did not.

Otherwise the weekend was a relatively casual time .. enough spare even to watch most of the NRL final .. until I couldn't bare watching anymore. It wasn't that Melbourne was losing, I can appreciate a good match who ever is winning or losing, but to have a game so one-sided ... no not a good spectacle at all - well except for the enthused Manley supporters who would have just been seeing their warriors slaughter the opposition.

Oh .. more photos ...

This one is of the hill behind the hospital - that rainforest on the back doorstep.

This one is of the welcome sign painted on a Silo near the Babinda railway station on the main road in ( Bruce Highway, which you can see on the Google map )

... and the other two of the local sugar mill not far from where I am staying. The smell down wind was quite pleasant, warm syrupy - not overpowering at all.

Today I got a semblance of a roster ... well, actually just notification of cover for the weekend. A locum who is currently in Weipa will be flying into Cairns and travelling down to cover me, if all goes to plan I will be off from 08:00 am Friday to 12:00 midday Sunday. Now I can plan a bit of local sight seeing.

Catch you all again in a few days.

ps. The photos are all stored online in my photo album found ... here

The first Friday Night

Yesterday ( typing this Saturday around midday ) evening a man was brought in by ambulance suffering an acute anterior myocardial infarct. Stabilise while on the ambulance trolley, await the two person crew's arrival, transfer to Cairns to be met on the way by ambulance intensivists along the way ( its about a 57 km trip via road from Babinda to Cairns ) with the plan to thrombolise the patient on the trip to Cairns. This is definitely not a level two facility and worlds apart from the experiences and resources one gets to take for granted in a Melbourne eastern suburbs private hospital ED.

Last night at about 1:30 am a 16 year old drunk, involved in a fight, presented for clean up and repair of full thickness lip lacerations. Not a bad repair I thought, but arranged for him to have his stitches out at Cairns Base in five days for a wound check and make sure my repair was in fact satisfactory.

Young woman brought in late afternoon with gastro, but not holding down fluids so I used one of my two acute care beds to look after her overnight ... nothing in itself unusual but her mother asked whether or not this was leptospirosis. Last time I dealt with leptospirosis was back in Shepparton with the goat herders and meatworkers. Apparently the rats piss on the bananas in the plantations and plantation workers are at higher risk of getting leptospirosis. That's my reading for the evening.

This is the house I am staying in while at Babinda. Upstairs living areas, down stairs "office space" and under the house a laundry - I am washing clothes right now, three days worth. I figure its prudent to wash every 2-3 days to keep ahead on clothes. Indoors at the hospital is relatively cool, and the house is air-conditioned, but outside the warmth and humidity is something that is not an experience had too often in Melbourne, but commonplace here. Its not yet summer or wet season.

The "green-ness" is quite intense. This is my view from the back door of the house. It's almost at the edge of rainforest, as you can see.

These are few shots from inside the house. Very nice facilities, three bedrooms so would suit the family coming up if I came back at a time that would suit this happening. Walking distance to the main street .. well walking distance to anything in town really. I just stocked up on fresh vegetables today, and this morning the shopping strip has street stalls all along ... home made cakes, BBQ, local vegetables, plants and crafts. I was a nice feel to be walking down the street.

Final picture is a view of my welcoming committee on the hospital entry steps if I need to go into the hospital after dark.

Yep - cane toads, and lots of them. Nothing I saw that was bigger than a frog, but literally dozens of them on open ground around the hospital and car park. They get much bigger than this.

Okay - that is today's chat. I will probably send to my blog this evening when I go back into the hospital for a ward round, and check up on my one acute care patient who I am hoping will be well enough to go home this evening.

Ciaou.

First Day

What more can I say other than an interesting experience. There is a need to rapidly change expectations and adjust to limitations in resources. I still have not been given a roster and have consequently no information about when I get my first day of not working. This is a 24 hour on-call position, my first night on is happening has I type this in preparation for going to bed.

The hospital is a defacto nursing home with the majority of inpatients being long-stay waiting for placement. A few "walk-in" patients and a couple of ambulance arrivals to assess and manage as my acute care work-load for the day.

Today has been overcast and oppressively humid, light rain on and off all day. Sleeping is not a problem though, I have the luxury of airconditioning.

A few photos to share from today ... the first was taken the night of my arrival, the welcoming party of one, peering at me from the lounge room wall. The others are views of the hospital from the outside and one of the main street in town.

Good night - will keep in touch.

( these entries will be made as emails ready to send when I get access to network connections ... even in the house some rooms have mobile signals and some don't - the signal is clearly not local but has to travel along the valley either up from Innisfail or down from Cairns. )

I have safely arrived.

Arrived in Cairns at about 4:20pm. It took a little while to get my bag, find the car left for me and fill up with petrol in Cairns town. Internet access in Babinda has not been established yet, although I am not convinced that I will find anything in town other than a weak signal 3G connection. If this is the case, blogging will be intermittent. This entry is via mobile-phone email.

Early start tomorrow to catch the nurse's ward hand-over at morning shift change. I am thinking it will be a once only event.

Good(early)night - will speak to you again soon.
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