Alice - Greetings from the Red Centre

Wet, wet, wet!
I’ve been in Alice exactly one week and it has rained every single day. In fact, we’ve had so much rain that the usually dry Todd river is full and overflowing. This created such a stir that half the town was down by the river edge to witness such a rare event. The Todd river, completely dry 99% of the time, is home to many Aboriginal families. Usually their makeshift shelters and campfires are easily spotted along the river bed, with children running around their bush lounge room. So the flood means that they have had to pack up their belongings and move to one of the town camps to stay with relatives. While this migration happens most years you will appreciate that it is very disruptive to family life and puts great stress on the already crowded housing situation.

Orientation
I have not actually begun any real clinical work yet – instead I have been subjected to four painful days of orientation. Typical of most orientations, it contained vast amounts of useless information (burying the occasional gems), loads of paperwork, odd characters and a long time just waiting around. However, of much greater interest and value was the day of ‘cultural orientation’. As you probably know, I worked and lived in a Yolnu community in Arnhem Land in 2005, and there are many similarities between the ‘Top-end mob’ up there and the ‘Desert mob’ here in Alice. However, there are also many differences and the clinical aids and approach that worked in the Top-end may be inappropriate, confusing or even downright derogatory down here. Over the next few months I’ll introduce you to some of the locals I meet and share with you the cultural discoveries (and inevitable blunders) that I make.

Alice Springs Hospital
Alice Springs Hospital (ASH) is a very unique place. Despite having only 165 beds, it services an area the size of Victoria and NSW combined! Greetings from the Alice! The next closest major hospital is in Adelaide (~800km south). This means that ASH must be able to deal with pretty well anything that comes through the door.

As the Director of Remote Services commented:

“I have three RFDS (Royal Flying Doctors Service) planes to cover an area the size of Europe!”

A big ask indeed! It also means that, unlike any comparable Australian hospital, ASH has a fully functional Intensive Care Unit (ICU) including three full-time ICU Specialists.

Naturally, ASH has a huge focus on Aboriginal health. Aboriginal peoples comprise around 50% of the local population but constitute more than 80% of the hospital’s workload. Apart from Aboriginal health generally, the hospital is particularly renowned for its Paediatric and Renal (kidney) units. The renal ward is full of young patients with end-stage renal failure. This is usually a diagnosis seen in older diabetics. However, while diabetes is common here in Alice a minority of Aboriginal patients live long enough for its renal complications. Instead, the causes of renal failure in these young patients can be traced to childhood.

One cause is maternal malnutrition (an issue that has been pretty well rectified now). The other cause is the childhood infectious disease burden. In the days before antibiotics, patients with severe infections (e.g. osteomyelitis) would often die not of the infection, but of the renal damage it caused. Here in the Alice, chronic infection is normal among Aboriginal kids. This includes scabies (~50% carrier rate) and bacterial skin infections as well as respiratory tract infections. Such an infectious load puts a large burden on young kidneys and resulting in people in their 20s with end-stage renal failure. [For the medics among you, the typical renal biopsies show scanty large glomeruli consistent with the timing of such an infectious insult].

Plans
I start work on Monday – at the Central Australian Aboriginal Congress (or just Congress for short). It was the first Aboriginal controlled organisation in the NT and was established soon after the Australian government granted full citizenship to Aboriginal peoples (in the late 1960s). It now offers not only GP-style medical assistance to the Aboriginal population, but also legal, public health, advocacy and other health and social services. I’ll be the first resident doctor to ever work there – so it’ll be a time of discovery all round! More on this next letter.

Feel free to write or email me, and pass this on to whomever may be interested.

Till next time, cau!