It looks like I will have to grow wings here soon, as the Royal Flying Doctor Service locums "no showed" for this month, leaving the two RFDS docs here very stressed. This means they have no time to help with our remote clinics, leaving it all to DAHS doctors. Last Wedsneday I went back to Imintji, and next week I have two flights, Yulumbu and Dodnun, and then a flight the week after next as well. It is really starting to heat up here- it was over 100F several times in the last week. The tin box airframe of the planes becomes a furnace sitting in the sun on the red dirt strips while we do our clinics, and I sweat from the heat on takeoff and then freeze when we hit 9000 feet and it cools off. I sat on the porch at Imintji store eating my lunch, and a willi willi blew around the corner, dust flying and pulling the trees sideways. The clouds, absent for the last 5 months have returned and the humidity is ramping up as well.

The Imintji trip did have a bit of happy news, in that the patient we organized to see the psychiatrist was actually hospitalized, and started on meds. An adult in the community who has known her for her entire lifetime, has given her a job with lots of structure. Getting up in the morning for meaningful, daily work; quitting ganga and taking some medication has had a wonderful effect. So while mental health is a real problem for remote communities, it's nice to see that some community caring can make such a difference.

The RCS students have been more focused on tutorials, and getting all their assignments done. E-logging of cases is due by the end of the month, so suddenly the computer records of the cases they have seen has become more important. They also wish we could cover everything in the next month before exams. We have been focusing on Paeds and GP this week, and will review some O&G in the next 2 weeks.

Yesterday in the clinic we saw a gentleman who desired some medicine for a rotton tooth. Turns out he is a heavy drinker. Thursday was "payday" when the Centrelink (welfare) payments are made. Typically there will be 50 people at Woolies waiting for the "bottle shop" to open to buy grog. This gent had consumed 4 "casks"- these are also called "balloons" for the silvery linings of the 2 liter wine boxes, seen blowing around town the next day. After 8 liters of wine he was not running on all cylinders, but we were amazed that he could even walk.

I have been talking with my students about social attitudes towards drinking, and asking them to reflect on how these affect health care. We found some great international comparative statistics on the Wikipedia, which I've abstracted into the table below. I'll paste in the quote from the Wiki page, and let you, dear reader, reflect and draw your own conclusions...

From: http://en.wikipedia.org/wiki/Recommended_maximum_intake_of_alcoholic_beverages

This article summarizes the recommended maximum intake (or 'safe limits') of alcohol as recommended by the health agencies of various governments. These recommendations are highly varied, reflecting the fact that they tend to be more political than scientific in nature. The recommendations are distinct from legal restrictions that may apply in those countries. Therefore, consumers need not follow the recommendations of the country in which they happen to live and are free to choose those of another country.

Here's my table:

Country	Drinks per day	Drinks per week	Std Drink size (g)	Max per day (g)	Max per week (g)	Rec OR Calc'd g/w	Legal BAC
Australia	6	28	10	60	280	280	0.05
Italy				40		280	0.05
Japan	2		19.75	39.5		276.5	0.03
Portugal				37		259	0.05
Denmark					252	252	0.05
New Zealand	3	21	10	30	210	210	0.08
Ireland		21	10		210	210	0.03
Spain	3		10	30		210	0.02
Hong Kong	4	21	1 glass wine/pint beer)			210	N/A
Netherlands	3		9.9	29.7		207.9	0.05
USA	4	14	14	56	196	196	0.08
Canada	2	14	13.6	27.2	190	190	0.08
UK	4	21	8	32	168	168	0.08
Switzerland	2		12	24		168	0.05
Austria				24		168	0.05
Czech Republic				24		168	0
Finland		15	11		165	165	0.05
Sweden				20		140	0.02

For a further exercise, check out the international recommendations for permissible alcohol intake in pregnant women. I can't believe that some countries still believe it's ok to drink while you're pregnant!
http://www.icap.org/PolicyIssues/DrinkingGuidelines/PregnancyTable/tabid/254/Default.aspx