Another week gone by here in Western Australia, and although it is SPRING here and patients are coming in with allergic rhinitis and asthma flares (more from the dust now that the Dry season has hit its stride) it still mentally feels like FALL to me, as I see things starting to wind down. We have made our plane reservations to return to the U.S. and there are only 84 days left. (It was good that we made them when we did two weeks ago- as the trans-Pacific legs were already starting to fill up. School (summer) holidays and Christmas coincide in Australia, and essentially the entire country will shut down in December, I am told.

The good news is that I have hired my own replacement for DAHS and the RCS. In checking references for another doctor we were trying to hire, one of the referees wondered if I "knew of any good jobs working in Aboriginal Health" in the Kimberley. One thing led to another and it appears we have hired a young British woman to take my place here. We are very hopeful she will arrive by end of October so I may train her for a month before we leave.

My students are starting to feel the pressure, as exams begin the last week of October for them, with finals in Perth in mid-November. We are working to fill in the gaps of any subjects they feel they might have missed, which at this point they have decided is "all of them!". Procrastination is a universal attribute, although it was not enough to prevent two of them from spending a week with the Orthopaedic specialist in Kununnura. That left me with one 5th year, and a 6th year student last week.


Last Tuesday the flight rotations took me back to Yulumbu for the first time since April. The small community, very remote, in the Tablelands area of the Kimberley did not look much better, but with water now, they had cleaned up the community room we use for visits. Many people are traveling this time of year, before the rains return and lock them into their communities for 5 months. So instead of 20 kids and 10 adults, there were only about 6-7 very old (that means 50-60 years old) people, a few teenagers and smaller kids in the community. We did "diabetes clinic" for most of the adults, talking about diet and exercise and the importance of taking tablets. One of the innovations I have instituted here is an integrated care plan summary, called a GPMP (GP Management Plan). Setting up these flowsheets has made it much easier to keep track of labs, meds and observations in patients charts. Using the flowsheets really helps in remote clinics, where the doctors and patients rotate around so frequently.
.
One old lady in Yulumbu showed me her new wheelchair with pride. She had fallen into the fire and suffered a bad burn on the leg, but while in the hospital, was fitted with a chair with tires that are wide- they look like a mountain bike tire. This allows her to wheel her chair all over the dirt tracks in the community and get around for socialization. She was quite happy with it.

We also admired the two large King Brown snakes the boys in the community had dispatched the day before. They were hanging in a tree- to what purpose I'm not sure I understand. But they were quite impressive.


The rest of the week was the usual mix of teaching and practice, with the added visit of Mr. Jim McGinty, WA Health Minister, who dedicated the new wing of the local hospital. This despite the fact that the landscaping has been bare red dirt now for 8 months, which the patients and visitors have been tracking in all over the new floors and rooms. We contrasted this delay to the new community school in Jarlmadangah, where the elders put in a sod playing field around the school, at great community expense. They were quite proud of that foresight, which has protected their new school building from the current ubiquitous dust and soon-to-be sticky mud (come Wet season).
Central planning for the hospital has also provided it with new rooms and equipment, but serious personnel shortages. Two weeks ago the entire Kimberley region, from Broome to Wyndham had no surgeon on call for 5 days. This meant that any orthopedics fractures, appendicitis, serious trauma, etc all had to go directly to Perth (at least 10 hours transfer time) without surgical consultation. Derby still has no staff Ob/Gyn, despite being a regional birth center with >240 births a year and rising- something much applauded at the dedication. And the current hospital staff is overworked, and stretched thin with night call and ED responsibilities. My sense is that the community is pleased to have the hospital still here in Derby, and happy that it wasn't downsized in favor of a larger facility in Broome (220 km away). .


Vicki and I have enjoyed a couple of weekends at home. We are both still swimming every day- she notched 100 25m laps today- and enjoying the tropical garden in our backyard before it gets too unbearably hot. It has been over 100F here twice this last week, but so far the humidity has stayed in the lower ranges. However, we can feel it heating up, and have had to use the air-con some days just to get the bedroom cool enough to sleep. I'm hoping to make one more sight seeing trip, to Windjana Gorge, before the buildup gets too far along. We had planted tomatoes, which have come on full, and my papayas and mangos are starting to really grow quickly. The ripening of fruit in the spring here also contributes to the mix-up of my Northern Hemisphere mind thinking it is fall here in the South