I mentioned the Kimberley Art Contest 2 weeks ago. We bought some of the art at the exhibit, and Vicki brought it home Monday.

This is Turtle Nesting Cycle by "Wossie" Hunter. Wossie is an artist who lives and works in One Arm Point. He was on my Watch on the Leeuwin trip, and showed us this work on his cell phone camera. The Bardi people at OAP have an intimate relationship with the turtles, protecting their nesting beaches, and hunting them in semi-traditional manner (they use outboard motors now) for food. This painting encompasses the entire life cycle of the turtle. It is in our living room, and the longer we look at it, the more we see, and the more we like it. See detail to the right:










"Myalls Bore." This photo is of the longest watering trough in the Southern Hemisphere, which is located just out of town in Derby, near the Prison Boab Tree. It was used during the cattle drives to the jetty, to water the huge herds brought through Derby.






My personal favorite, this little photo is of a Restless Flycatcher, called the "Scissor Grinder" due to its raspy call. This was taken at the jetty we think on the edge of the mudflats...

It wasn't until we got these home that we realized the common theme to them all. We didn't plan it that way: after all, we only had an hour to decide what art in the exhibit spoke to us.

Can you see the common theme?
Hint: look for the evanescent, reflecting the eternal.)

I kept track of one day in the office at DAHS recently. Like the Gibb, it is run on the "British" model of consultation. I have my own room to see patients, with a computer and basic equipment. The staff put the charts in the box on the door and I see the patients in order. There are no appointments. I call my own patients, and do all their vitals. However, at DAHS if I get really busy I can often talk an Aboriginal Health worker into drawing some bloods or finishing the opportunistic screening, which helps.

Here is list of one busy day:

· I start the day with two little kids, 10 months and 4 years, with acute conjunctivitis. We use cholamphenicol eye drops here, a drug that has been virtually banned in the U.S. due to a rare risk of bone marrow damage. However, I looked it up, and its never been associated with eye drops. Here in the Kimberley, bacterial infection is so rampant that we use antibiotics much more aggressively.

· Next is a bearded dude in his 40s who needs refills of his BP meds. I saw him a few months ago and tried to get him to quit smoking with patches. He’s down to 5 a day, and would like to have a go with the Zyban, which I prescribe.

· A 10 month old has nocturnal cough for a month. There is a family history of ?asthma and lots of smoke exposure. We’ll try a short burst of Prednisolone for reactive airways disease.

· A very obese (150+ kg) diabetic comes in with a second attack of ankle gout in a month. I put him on recall to try to get Allopurinol started once we get it settled.

· A young man comes in right behind him ALSO with a sore ankle. I think, “It can’t be two cases of gout in a row!” but it turns out it might be. He was told he had gout before. I’m not so sure on exam what it is, except the spot anterior to his fibula is sore and swollen. We decide to settle it with ibuprofen and see what happens.

· 5 year old brought in by mum who notices “his head stinks”. I smell the fuzzy-grape odor of Pseudomonas. When I take off his cap, his hair is matted with a solid, thick skullcap of dried pus and he is covered in head lice. Mum says this only started last Thursday but nobody believes it. The kid has swollen glands and a little bit of fever. I start oral Augmentin and get the Health Worker to shampoo him in the office and remove as much crud as she can. We will rewash his hair daily this week until he is better.

· A one-eyed old man comes in wanting copies of his records for when he travels. I notice he is very short of breath, and find his COPD is really flared up badly. He hasn’t really noticed it much- he always runs an O2 sat of about 90 and refuses to use home oxygen. I give him his 3rd Prednisolone burst in 3 months and flag the drivers to drag him back to DAHS in 2 weeks.

· 30-something local woman who drinks a lot brings in a huge abcess under her arm. I take 45 minutes to set everything up myself, I&D it to drain the pus out, pack it, start her antibiotics and pain meds and arrange another call back. I get to clean up the mess myself and sanitize the room after each patient, which I tell myself is a good Buddhist exercise in humility and being in the moment.

· A break for lunch. I do a few admin things and run home. Vicki has painted the living room this morning. White of course. We sit outside and have avocado and salami sandwiches in the beautiful garden. She enjoys the little water fountain we placed in the pond this weekend.

· After lunch an intoxicated fella has the drip from not using condoms. He tells me his contact, and I have him take a ZAP pack (Zithromycin 1 gram/Amoxycillin 3 grams/Probenecid 1 gram) in front of me. Cultures to the lab and instructions to go and, if not “sin no more”, at least wear protection.

· Pregnant European woman has headaches at 16 weeks. Seen at hospital twice but not happy about explanations. Multifactorial but we sort it out and start exercises and sleep hygiene. She hasn’t started Antenatal Care, and we try to get that organized.

· Middle aged man with previous sinus surgery has congestion and drip for 5 weeks.
An x-ray taken at beginning of month was filed without being seen by the ordering doctor. I apologize for this. He is understanding, I explain my concerns, start antibiotics and urge him to keep his ENT appointment.

· Young guy working “out bush” comes in with men’s business concerns. We discuss that a circumcision won’t solve his sexual dysfunction problems. But reviewing a handout from the Internet and starting some medicine might help a lot. Finally a chance to practice medicine on a 21st century problem, and not an infection from the 1920s or earlier…

More snapshots from an interesting week.

Our local doctors finished up our 6 months of "small group learning" with a visit from the podiatrist. She talked about leg-length discrepancy. Turns out most of the population has one leg 1 cm longer than the other. My left leg is 2.5 cm longer, which probably explains why I've walked like a duck my whole life, and why I am always tripping with that left foot. The nice thing for the docs here is that by having an organized group they get 30 continuing education points from the RACGP. We focused on community resources this first 6 months. We'll take a break and then finish the year reviewing core topics like CHF and asthma.

Early in the week I started breaking out in a red rash on my wrists and ankles and itching at night. I told Vicki in our first month here that we would not get through the year without a visit from scabies sarcoptei. I am surprised it took this long. We lathered each other up with the permethrin cream and she washed all the laundry. We'll do a repeat this week. Die, bugs die!

Vicki's little 8 year old friend has been visiting a lot lately, as its school holidays now. Hannah has never heard of Harry Potter. Not a clue. And she is way behind U.S. kids at reading. It makes us sad. It also is another evidence of how Derby is the End of the Earth (or at least the last stop before Kandiwell, the True End!)

The library here has a very small kids section. And there are very few books with Aboriginal themes or anything culturally appealing. Vicki took Hannah to get books, because only adults with a proven local address (you have to bring in a bill showing you really live there) can have a library card. Kids aren't allowed to have their own card. Hannah took out a DVD on fairies and mermaids. Made in Australia, it features porcelain-white women dressed in pastel wings and glitter, singing songs about flowers and seashells. She loves it. But for a kid with Aboriginal heritage, I wonder what it does for her already confused identity?

I ordered books online from an Australian bookstore, only to get an email back that they were back ordered until the end of August. By the time the Post gets them here, I will be on my way home. I cancelled the order and re-ordered on Amazon.com, and will have my daughters bring them to me when they come next week. They have also promised to bring Harry Potter along.

Last Wednesday I flew out to Kuppingari (up the Gibb River Road) again and saw 17 patients in one day. That isn't much until one considers the flight time lost on each end, and that I do absolutely everything, including all the vital signs, drawing my own bloods, writing up all the slips, dispensing my own meds from the little pharmacy and instructing the patients in everything. I was exhausted when I got back and went right off to bed.

This weekend brought the end of the Boab Festival, which climaxed in a night of bands and drunken revelry, with loud hootin' and hollerin' until all hours of the mornings. The town has been full of locals and tourists, and we've seen the ambulance make a lot of runs. Many of the locals also light campfires in their front yards in the evening which makes the town smokey, and is a bit of a worry as a fire hazard.


Pictures from Boab Festival at Mowanjun, and Xavier & my trip birdwatching...

Boab Festival Week

"Have you been drinking?" the Shire worker asked the Aboriginal man and woman who walked into the Civic Center just in front of us. "You can't come in if you've been drinking."
The woman turned away, but the man said, "No, I haven't been..."
"Yes I think you have!" said the man, "You can't come in." Reluctantly, (but also clearly inebriated) he turned away also.

A woman worker appeared from the left, and pulled us aside.
"Come in", she said. "There's no charge tonite. Please sign in, and here are your three free drink tickets. Enjoy the show and the buffet."

What is wrong with this picture?

We had been excited to attend last weeks Boab Festival Kimberley Art Competition, in no small part because we hoped to purchase a painting by the Aboriginal man who was our guide on the Leeuwin trip. And I think we were stunned and shocked as the above scenario unfolded.

Yet we believe it is symptomatic of what is happening in Australia today.

The big national news here (notwithstanding scares about terrorist doctors) has been the Howard government's "intervention" in the Northern Territory to rescue Aboriginal children from child sexual abuse. After 8 years of doing nothing, with the election looming, Mr. Howard has sent Federal Troops into small communities in the N.T. to take control of the communities. And this week, there has been a firestorm in nearby Halls Creek, Western Australia, where a dozen men and teenagers have been arrested for having sex with underage (<16) girls as young as 11. (We have seen many family members from Halls Creek visiting Derby relatives this week as a result.)

This has been a brilliant political move- after all, who can oppose stamping out child sexual abuse?- but some say it is a cover for abrogation of Aboriginal land rights, and to take the focus away from the current government's lack of progress in improving the lot of Aboriginal children.

What is immediately apparent to us is that the policy is inherently racist. There is no equal push to detect and treat child sexual abuse in European communities. In fact, the diversion of social workers and resources to Aboriginal communities might be giving a free pass to non-Aboriginal child abusers. It is easy to go into a remote community with the Army and look like something is being done- but whether there will be a sustained push to improve the conditions that predispose to child abuse and neglect is another story.

The original report (that so embarrassed the government that they HAD to do something) said that "rivers of grog" were a major factor leading to child sexual abuse in Aboriginal communities. And the Government has indeed declared Communities "grog-free zones", which their soldiers will enforce (causing the heaviest drinkers to relocate to nearby towns and cities).

But the problem is deeper than that. The son of the Premier of Victoria this weekend was drink driving and wrapped his car around a utility pole, putting his best friend in the ICU with head and facial injuries. This is not the first time this teenager has been in trouble over alcohol. He will receive a small fine only, and some points on his license. His father has been quoted as saying, "I really don't think he has a problem with alcohol."

It really all comes back to accepting responsibility and consequences.

Which brings me to several conclusions.
1) As we've said before, the average Australian (90% of whom live in the big cities) has no clue about conditions of poverty and despair in Aboriginal communities.
2) But if they do have an opinion, what we hear is that its the fault of "drunken Aboriginal people on the dole".
3) Yet ALL of Australia tolerates levels of drinking that are far higher then we are used to, and with even fewer consequences than we see in the (overlawyered) U.S. (not to mention Scandinavia or New Zealand)
4) If you are drinking, what happens to you depends on who you are are and the color of your skin.

One of my students this week mentioned how shocked and guilty she feels about the situation here in her own country. But she feels inhibited about speaking out, afraid she'll be perceived as racist.

In our discussion, I pointed out that the Government should and could intervene in a non-racist way. No matter what color you are:
1) Children should be made to go to school, with truant officers and consequences for parents who don't educate their children.
2) Any child at risk of abuse should have a family investigation, and support and intervention as needed
3) Welfare should be a temporary situation, with training and job placement an expected outcome in a short term of several years. (If only Nixon could go to China, then only Clinton could declare "welfare should not be a way of life".)
4) Dole payments should be vouchered, like Food Stamps, so they can not be spent for alcohol, gambling or tobacco.
5) Alcohol intervention programs should be funded and available to all who need them.
6) All communities should be encouraged to pursue economic development with equal resourcing.

At this point let me emphasize that these are good policies for the U.S. as well. Certainly we could add health-care equality to the list as a specific U.S. problem. And we have our own share of racism in places like Hurricane Katrina/New Orleans/ South Side Chicago and many other cities...

Yet amidst all this social distress in the Kimberley, there are real moments of beauty. We sat in the outdoor movies last Friday, with about a million local kids under a spectacular dark starry sky, watching Spiderman 3. There were at least 4 brilliant shooting stars during the picture. And early Sunday a student and I went birdwatching, enjoying a dozen brolgas, and a flock of huge white pelicans in the local lakes.

Derby, Western Australia, often makes me feel like when I was a kid with a friend down the block, who gets into trouble a lot. Sometimes he is mean to me, and he is always in the Principal's office; but on occasion, often enough to tantalize, he can be a really sweet kid, who has so much potential, if only he could just change his attitude, and come right...

The full moon shone brightly over the beach and its breaking waves, as the taxi headlights showed the silvery reflections of the crew's life jackets. My flight from the Medical Coordinators' meeting in Fremantle had been 40 minutes late, and then I had been stranded at the airport for another hour waiting for a taxi on a busy Friday night in Broome. The special beach pickup had been arranged by another RCS faculty member, and I had not wanted to inconvenience the ships crew. So it was with relief that I stumbled out of the cab with my single bag and walked down onto the sand. We wrapped the bag in plastic and waded into the sea. Just as I reached the zodiac, a huge wave came in and all hopes for a dry pickup vanished in a wall of water. Laughing, we hurled ourselves into the boat, and headed the mile across the sea to the Leeuwin. The wet arrival was compensated by my first view of the ship at anchor, masts lit from below, riding the moonlit sea.

We signed up to join the Leeuwin cruise at the suggestion of a friend in the RCS. Leeuwin is a Tall Ship, its major mission is educating young people. It's a member of the Australian Sail Training Association. The idea is to put diverse young people together on a Tall Ship for leadership training. From the ASTA website:

Sail training is an outdoor adventure activity for young people. Its purpose is not to teach young people how to sail. It is principally to help them learn about themselves, to discover hidden strengths and talents, to understand the value of others and of working as one of a team. It requires an individual to confront many demanding challenges, both physical and emotional. It is an activity that inspires and develops self-confidence and responsibility, an understanding and acceptance of others whatever their social or cultural background, and a willingness to take a calculated risk. For many it can be a life-changing experience.

Our particular voyage, Broome Leaders, included 29 teenagers, aged 13 to 19, and 5 adults plus ships crew. The kids were from various Kimberley communities: Broome, Derby, Mowanjun, Halls Creek, One-Armed Point, Mandurah, and one from Kalgoorlie. They were about half of European and half of Aboriginal descent. We were bound for Sunday Island, at the mouth of the King Sound (see map).

The Bardi people, the traditional owners of the Dampier Peninsula and many of the islands of the Buccaneer Archipelago gave permission for the trip. Wossie, a Bardi man in my Watch, was our guide.


The first day out we spent literally "learning the ropes". We were divided into 4 "Watches" which worked as teams. Watches set and furl sails together, and take rotating shifts running the ship. You can bet that taking the 0400 to 0800 nightwatch on a sailing ship was a novelty for many of these teenagers. Add that to 35 people sharing 4 toilets, bunk rooms with 4 to 6 in a cabin, and a small deck with no place to hide and you have an intimate experience.

We also learned to climb rigging, with safety harnesses. And there was the ultimate challenge: climb to the top of the 33 meter mast and read the plaque at the top. The climb is steep, and near the top the rope ladder so narrow that I can barely fit my toe into the rung. The tip of the mast is swaying back and forth in the ocean swell, and the narrow ladder twists- suddenly I understand the meaning of the phrase "twisting slowly in the wind".

Each day began at 0630 with music playing throughout the ship. We had morning yoga and exercises. An educational director led both games and informational sessions. We spent a fair amount of time on deck just enjoying the sunshine and the wind. The kids were especially good at spotting wildlife- sea snakes, dolphins, whales, a couple of hammerhead sharks, turtles and schools of tuna. I was amazed by the flying fish- which actually do appear to fly 10-15 meters over the waves.

Night watches were spectacular, with the soft hum of the ships engines, and slap of sail and water against the hull, the huge starry sky overhead. We enjoyed moonrises and sunsets. An unlisted aspect of the voyage was being outside most of the time, working with nature to sail the ship, living the rhythms of the sky and sea.

Dawn of the third day and we were at anchor off Sunday Island. In 1899, several "beachcombers" encouraged members of the Bardi tribe to settle in a mission on the island. This isolated community lived a mostly traditional lifestyle with limited interaction with mainland people until the late 1940s, and was finally closed in the 1960s. The children were forced to move to Derby for schooling, and the elders ended up in One Arm Point. Later many of the younger people moved from Derby back to One Arm Point, but today there are still many family connections between the One Arm Point mob and the Aboriginal communities here in Derby.

We launched the dories from Leeuwin and landed on a beach on the Northern part of the island. This area has rock formations unlike an I have ever seen. It is a conglomerate of small quartz crystals, like coarse rock salt, and very sharp to slide over or sit upon. The tides there are huge. Vicki and I climbed to the top of the rocks and spent an hour or so watching sea turtles feeding just offshore on the reef. Around the corner standing waves were forming as the ocean rushed into King Sound. Despite the tide rising at a rate of about a meter an hour it didn't seem to bother the turtles any. We all had a short swim, with "croc watchers" posted on the rocks around our beach. We took turns being the most seaward "bait" swimmer. I did a bit of swimming with goggles- the tropical fish were abundant.

After lunch we took the dories around and climbed into the central valley of the island to view the ruins of the mission. While it is a special place to the local people, it is also a sad one. The valley is essentially rock- so hard and with so little soil that even septic tanks could not be built. Everything has gone to ruin except a few tin shacks. Its a sad legacy after 100 years.

Earlier one of the boys from One Armed Point spent an hour telling me about learning to hunt turtles, dugong and fish with his grandfather. He clearly was skilled and enjoyed living the traditional lifestyle, as much as is possible in the modern world. Cape Leveque and One Armed Point communities now survive with tourist campgrounds and operate boat charters as a way of earning a living.

We found the young people to be a study in contrasts. One one hand, some of the Broome kids were very worldly, and some of the Aboriginal kids had met Michael Jordon and were fans of the latest hip hop songs. Yet they were simultaneously naive and much less mature than the teens we are used to. At age 17 to 19 many are "just starting to think about what career I might want to have" as one young lady put it. One girl from a remote community confessed to Vicki that she "wanted to be an astronaut". Another told me her plan was to become a mechanic and work in NASCAR. Many of the Aboriginal kids are clearly caught between two worlds, with no good options in either the White world or their own homelands.

We spent Tuesday sailing back from Sunday Island, around the Lacepede Islands, a group of formerly-guano encrusted sand spits that the United States briefly tried to claim from Australia at one time. This bit of trivia led to the quip that, "as usual, the United States wants everyone else's shit", to which we could only smile. Tuesday night we had a Ship's Opera, complete with musical acts, acrobatics, humorous skits and songs. I presented a short lesson on "How to Talk Like a Pirate", complete with red bandanna and eye patch.

We were all pretty tired by debarkation Wednesday morning, but there was also a sense of accomplishment. As the Voyage Certificates were passed out, each person said a bit about what they learned on the trip. We had begun the trip with an interest to see the coast, the wildlife, and the beautiful Archipelago. But we will remember the journey most of all for the young people we met. We wish them well, and hope we contributed some small thing to their life's voyage.

Click the picture below for more photos:
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Leeuwin