The week's end ...

Friday night passed without incident.  The previous two Friday nights oncall were punctuated by alcohol fuelled presentations but not last night - it was a pleasant surprise to wake in the morning having had a full night sleep.

 

Mixed feelings are the state of the moment ... looking forward to coming home to my family, but feeling a little sad now that I am so close to leaving.  Four more full days counting today and I will be flying back home.  I found myself trawling the Babinda real estate display window this week and this morning looked at their property listings online.  Nothing planned - just found it an interesting observation that I did this.

 

What have I been doing in my spare time ? ... well not a lot of time spare, but what I have had spare I have split between reading, some television ( SBS and ABC 1 mostly ) and a game I had installed on my laptop.  I would have been doing a bit more locally on days oncall if the mobile telephone reception was more reliable, but its not so I am a little limited.

 

I brought with me to Babinda three items to read, Samuel Griffith's translation of Sun Tzu's The Art of War ( thank you Rowan ), Terry Pratchett "The Colour of Magic"and a D&A report, "A Raw Deal ?".   While I was in Cooktown I also bought a book "The Savage Frontier" by Rodney Liddell.  I have not finished this book yet, but my first impressions is that it would make a powerful resource for clear thinking exercises for year 12 English.  The author claims to be writing so "the truth can finally be told".  I would contest that claim, but am prepared, at least at this stage to continue reading.  You may be interested for yourself looking at the link and website of the author here.

 

I have taken out my suitcase and started to pack some items so its not a last minute pack.   My flight from Cairns is about midday Wednesday so I will need to leave Babinda before 09.00am to be sure I am at the airport in plenty of time.  Admin will be arranging my replacement to arrive Tuesday evening or at least by 08.00am Wednesday for hand-over.

 

Thank you all for sharing my journey with me.   I will post a "summary" probably Wednesday as I leave, although I have not yet decided whether or not to also post my "recommendations" here in this public place or just email them to admin locally.

 

Catch you again soon.

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.
Sent via BlackBerry® from Telstra

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.