After spending 5 weeks in the Mt Isa region and pondering what to write I find myself about to leave for Mossman and still haven't written a blog entry.
My Mt Isa experience was broken into two parts with a brief sojourn at Doomadgee, a remote indigenous community about 600km north of Mt Isa, about an hour's flight from Mt Isa. Twelve days of Christmas ... well almost, it was 11 days in total including being in the community over Christmas.
Once again the medical details have to be kept blurred as in small communities things I say here can be easily linked to the people concerned ... confidentiality must be maintained where at all possible.
However given this document is in the public domain I will take the liberty to comment on it in my blog, with particular reference to one specific component of the "health" section.
COAG target : Need to improve our dental hygiene and care as it can lead to chronic disease.
"12 Develop an improved Oral Health Care Plan for the community."
"12.1 Identify and implement strategies to increase frequency of dental service visits to community."
"12.2 Build on current teeth brushing health promotion campaign in the school."
"Health Outputs"
"Increase of visiting dental services to monthly by January 2011."
"Enhancements to teeth brushing health promotion campaign identified by December 2010."
You can be fairly confident (if you can actually understand the bureaucratic drivel) that neither of these two targets have been met.
The dental condition of the locals at Doomadgee is appalling and once a month visit is going to be chaos management at best. Currently it is a visit once every three months and in late December 2010 while I was at Doomadgee I admitted a local to hospital with a very severe dental infection. He had tried to get to see the dentist in November 2010 when they were last in the community could not be fitted in. Next visit expected was February 2011.
The community needs a dental hygienist on an ongoing basis not a dentist who visits rarely and all they will be doing is extracting irretrievable teeth in advanced dental disease.
This is third world medicine in your own back yard ... it is shameful.
Would I go back to Mt Isa ?
Possibly yes, but the work place dynamics of the ED were not to my liking - a systemic problem that seems to be part of the development of the public emergency department. I prefer to be "on the floor" working with my peers and with those I am mentoring, not hovering at a safe distance so I can have an "overview" supervisor role.
I would like to return to Doomadgee or even Mornington Island in a dry season ... being at Doomadgee was a challenging experience and provides opportunity for personal growth in addition to attempting to provide good medicine.
Finally I can only re-iterate my disgust with the government's requirement to have overseas trained doctors ( or rather "international medical graduates" IMGs) bonded to the rural community for up to ten years. They are supposed to be in a supervised position and many are token supervised only ... they are alone and supported only by telephone consultation for the majority of the time. These IMGs bring in not only a very different medical mind to that of the Australian training, but a different culture, and a different purpose for being in their bonded position.
If we must have IMGs to top up our medical resources ( not going anywhere near the immoral nature of taking away trained medico's from their own needy community where they were trained !! ) put them in genuine supervised positions in URBAN practice ( and no not the private hospital ED night shifts where also they are token supervised ). Then the Australian trained doctors who cannot practice without a provider number should, as a condition of holding onto their suburban provider number, be required to provide "national service" to the community ... 12 months of rural practice that can be given in one block or over time, say 3 month every 4 years. This will potentially provide better medical care to the rural community and may even increase the numbers of doctors staying in the rural community, when those working in suburbia discover the joys, challenges and rewards of rural medicine.
All it takes is the political will to make it happen ... restrict provider number access and make holding provider numbers conditional. Not popular but its not like the current political agenda has been popular with the profession either !
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