It's not always sunny in Gunbalanya

The vibe in Gunbalanya is changing as the transition from dry to wet season has begun. Temperatures peak in the high 30's and the humidity is between 50-70%. In the afternoon dark clouds roll across the escarpment and fat drops of water fall from the sky cooling us down and flooding the streets. I was becoming accustomed to the the sight of a willy-willy (small twister of dust or ash) moving across the flats each day but now with the onset of the wet I see sheets of rain sweep across the plains and through the town. The clinic is quiet during the downpours but I’ve been told that with the rains come a number of infectious diseases so we’re bracing for business!

The Donga (aka Chateau Fitzcartney)

The medicine here in Gunbalanya is incredibly interesting and intellectually challenging. This is because the Aboriginal people in Arnhem Land have extremely poor health and are socially disadvantaged.  Overcrowding, poor hygiene, unemployment, malnutrition, illiteracy and lack of education are all big issues that affect this community. It makes working as a doctor here an excellent and unique learning opportunity but is also confronting at times. I'm not sure whether I could do this permanently but I am enjoying this three month stint. Here are a couple of examples that may help to demonstrate what I’m talking about. I've also included some random Gunbalanya photos to distract you if hearing about health inequality is not what you were after. 

Food in Arnhem Land is expensive and not fresh
so I'm slowly learning how to bake my own bread.

Acute rheumatic fever is rare in most developed countries and almost non-existent in non-Indigenous Australians. For non-Indigenous Australians this disease declined dramatically during the 20^th century due to improved living conditions and better access to health services. However, for Aboriginal and Torres Straight Islander people today, rates of acute rheumatic fever are among the highest in the world. It is a life-threatening illness that can damage heart valves leading to rheumatic heart disease. Acute rheumatic fever is a disease I have never seen in Melbourne and am unlikely to come across again once I leave Arnhem Land. But here in Gunbalanya, 10% of the community have had acute rheumatic fever and as a result have developed rheumatic heart disease.

Acute rheumatic fever comes from a bacteria (Group A Streptococcus). Children, often between the ages of 5-14 years, get this bacteria from pharyngeal infections. These children are at high risk of developing these throat infections due to overcrowding, poor hygiene and passive smoking (80% of the population here smoke cigarettes). These infections persist and can develop into a serious bacterial infection that travels into the blood. This provokes an immune reaction where the body produces antibodies (too many in fact) and they start to congregate on heart valves and can also block up the kidneys (causing potentially lethal glomerulonephritis). This might be too much medical jargon for some or an over simplified explanation for others, but the point is that this serious disease affects one in ten here, is preventable with public health measures and totally treatable if people have access to and comply with medical intervention. The high prevalence of acute rheumatic fever has also led researchers to consider the possibility that the bacteria may also be via skin sores. Skin sores occur here due to scratching of itchy skin caused by head lice or scabies mites (conditions affecting more than 50% of the school children here).    

Oenpelli police station (yes, just the truck!)

As I learnt from being an OT, you can gain a huge amount of information and insight into the lives of your patients by doing home visits! In Gunbalanya, I learnt that you can also experience significant cultural shock by visiting patients and their families. Last week I arrived at an elderly man's house, jumped out of my troupie (literally jumped out of the clinic 4WD as it is so high off the ground!) and entered a dusty yard full of dogs. I counted 7 in total but was unsure if 3 were dead or alive as they didn’t seem to be moving or breathing. My learnt defence strategy is to call out “Shaa” and surprisingly, the dogs seem to leave you alone. The man’s children called me into the 2 bedroom house and here I found another 4 dogs and 5 or so people spread out on mattresses on the living room floor. There is no furniture in this home, only mattresses, two cupboards and a flat-screen TV. The people and their dogs were watching a movie and directed me into the bedroom to see the “Old Man”. On the way I remembered I needed to go to the kitchen for some water and I was shown to a room with two sinks and a shelf. No oven, no hotplates, no fridge and no appliances. I turned to the sink and had the fright of my life. An enormous buffalo leg lay in front of me with a big, bloody meat cleaver beside it! The family had been slowly eating the meat, cooking it on the campfire at night, but most of the leg was still intact with the hair, hoof and skin of the lower leg poking into the middle of the room. I took a deep breath, dodged the leg and filled up a cup of water for the old man to drink. The old man is a respected elder and dearly loved by his large family. He has a wide smile and a quick sense of humour that help you see past his frail frame and poor prognosis. I am learning a lot about the Aboriginal culture and traditions from visiting him and appreciate the value they place on family and caring for their elders.

Sunset across the billabong

After four weeks in the NT I can’t wait for Ed to come and visit tomorrow! I'm looking forward to introducing him to the people here (especially Sophie and Simon) and showing him some beautiful sites of Arnhem Land and Kakadu National Park. It is a really special place to be and I feel privileged to be working here.  

For more information on Acute Rheumatic Fever and Rheumatic Heart Disease see http://www.rhdaustralia.org.au/. 

Helicopter is the only way to travel

"Arnhem Highway" - the red dirt section is in Arnhem Land,
that leads to the East Alligator River crossing (low tide)
and onto the bitumen into Kakadu National Park
on the right (just below the smoke)

Gunbalanya Health Clinic has three doctors working currently and one of them is Sophie; a GP registrar who has just finished her final exams. Sophie is a fabulous doctor who has been very generous in helping me settle into work at the clinic and life in Gunbalanya. On day one she asked me if I was interested in playing for a mixed touch football team that night. Turns out the pilots in Jabiru have a touch team but struggle to find girls who want to play. Keen to make friends, I of course said yes, and that evening we climbed into the 4WD ute and drove back through Arnhem Land, across the East Alligator River and into Jabiru for touch.   

Simon, Sophie and me

This journey may seem simple enough however there is no bridge across the East Alligator River. Even at low tide you need to drive through shallow water to get to the other side. When the wet season comes the river will flood and there will be no way to drive back to Kakadu- our only option will be to fly. Now the East Alligator River is inappropriately named. It doesn’t contain alligators at all; it is actually home to large numbers of salt water crocodiles. It’s different to Darwin where you look out to the ocean and imagine the hundreds of crocs swimming out there. When you drive through the East Alligator River you can see the crocs all around you. They are terrifying! You can see pairs of eyes, snouts, a flick of a tail or a giant splash as they swim or run into the water. There’s always a sigh of relief when you get to the other side.    

Pelicans

I feel like once we cross the river I am closer to normality. On Mondays I have my regular touch game in a team full of super-fit pilots. Touch reminds me of my high school days at St. Leo's and the finely manicured grounds in Jabiru may not be the MCG but they do make me feel more at home. Sophie’s husband Simon is in the touch team, lives in Jabiru and is a helicopter pilot. If we have a late game or the tide is high we often stay at his place before heading back to work in the morning. On Wednesday afternoon Simon came to visit Gunbalanya. Sophie and I went to the airport to pick him up and he was in the middle of removing the doors from his helicopter. He put them in the back of the ute and asked us if we were interested in a flight. Interested? I’d practically jumped in the chopper before he’d finished the sentence.    

Wild brumbies

For about an hour we choppered around west Arnhem Land and north-east Kakadu. It was honestly one of the best things I’ve done in my life. It was early evening, the sun was low and the light was beautiful. We were open to the elements with the doors off and had an uninterrupted view of our surrounds. The temperature was a balmy 30 degrees and the wind was perfect for flying. We flew over dramatic orange and black sandstone cliffs painted with Aboriginal rock art. We saw wild brumbies, dingoes, boars, crocodiles and hundreds of birds like pelicans, jabirus, brolgas, magpie geese, whistling kites and eagles. The photos will not do the scenery or the exhilarating experience of flying in a helicopter justice. But trust me, it was amazing!       

Boar

Oenpelli

Welcome to Gunbalanya

"Gunbalanya". Note the smoke in the background- it's hot and dry
at the moment so fires burn easily. Some fires start spontaneously
but others are lit intentionally by the Aboriginal people to make
turtle hunting easier in the coming wet season. 

My first week in Oenpelli has been eye-opening to say the least. Firstly, everyone here refers to Oenpelli by it’s Aboriginal name; Gunbalanya. It’s a small Aboriginal community with a population of anywhere from 900 - 1500 people depending on the time of year. Located in Arnhem Land it is mandatory that any non-Aboriginal person visiting requires a permit to be allowed on these traditional lands. Therefore the population is predominantly Aboriginal with a few non-Aboriginal health workers, police, teachers and council employees. On day one I was told that any non-Aboriginal person living here could be classified as being “a missionary, a mercenary or a madman”. I’m not sure which one of these I am?

Lieutenant Macartney

Certainly, the flight over here was a highlight. I flew in a 2-seater, single-engine aeroplane that was smaller than our old Tarago van. I was effectively the co-pilot, wearing headphones and being careful not to push the pedals or controls in front of me. The flight was amazingly scenic. We flew over Kakadu and into Arnhem Land with the border being a dramatic, rocky escarpment and the East Alligator River. I learnt that locals and pilots alike love to entertain with dazzling facts on the area. The truth is never a barrier as long as these facts or stories are delivered with conviction! For this reason I did my own research and now know that Arnhem Land is just bigger than Tasmania or double the size of Switzerland. Air travel is therefore essential for getting around and access to services like healthcare can be extremely difficult.

After arriving in Gunbalanya, I was given a tour of the entire town (duration = 5 minutes) and then went to the clinic for a meet-and-greet. Cyclone proofing of buildings in the NT means that architecturally, my clinic looks more like a prison than a health centre. Plus the fine film of red dust coating the town gives everything a rustic (or rather dirty) look. I also got to check out my donga; a dark blue, Colorbond cabin on the edge of town which will be my home for the next 3 months. It did seem ridiculous to live in a dark coloured, uninsulated, steel box during the hottest months of the year. However, my basic abode is surprisingly liveable. I have air conditioners and fans that keep it cool, a water purifier that hopefully protects me from the waste coming from the uranium mine across the river and a number of pets. As with most outback places in Australia, small frogs tend to enjoy the cool of the bathroom and the pond that is my toilet, and friendly lizards visit daily to keep the insects at bay. I'm happy to share my surrounds with these creatures as long as other more dangerous wildlife stays away!  

O-Week in Darwin

This year, as part as my medical residency, I am going to work as a doctor in Oenpelli, West Arnhem Land, Northern Territory. This is an optional rotation that I applied for. I could have stayed in Melbourne, enjoying all the fabulous benefits of living in Fitzroy and working at the tertiary hospital that is the Royal Melbourne. But instead I elected to journey to the Top End and work in an Aboriginal Health Centre for the hottest and wettest time of the year. Friends and family have asked for regular updates, photos and stories from the trip and I’ve decided that a blog is the way to go (despite never having written or even read a blog before). The next three months will be all about trying new things and stepping out of my comfort zone- so blogging is my first example.

Week one has been spent in Darwin completing orientation week. The trip was off to a great start thanks to the friendly Qantas baggage staff. The man in charge kindly explained that I had obviously brought too much luggage and would need to pay a fee. He exclaimed- “you have two bags and can only have one”. I answered “I could have put it all in one but then I couldn’t have lifted it- I thought two was a smarter decision”. He agreed but said that I couldn’t lift it because together my bags were 9kg over the limit (and would thus still incur a fine). I saw his point but explained that I was moving to Arnhem Land for 3 months and that I had to take all my clothes, toiletries and most of my food. He was impressed then by my packing and my solo adventure and found a way for me to take all my luggage fee-free. Legend!

"Cock-a-doodle-doom" was the title for this front
page news story featured in The Territorian.

I arrived at the airport and caught my first of many taxis. My drivers have been from places like East Africa, the Phillipines, Sri Lanka and Samoa, which seems pretty typical for the Darwin population. When visiting the local Rapid Creek markets you could have been forgiven for thinking you were in a tropical Asian country. There were stalls of Asian style vegetables, tropical juice stands and bubble teas, massage spruikers on the street and a large selection of sun burnt Aussies with poorly considered tattoos and Bintang singlets. The food was outstanding- one morning I had a traditional Sri Lankan breakfast of an egg hopper with chicken and green bean curry. Delicious!

I’ve needed taxis here as Darwin is incredibly spread out. For a city of 100,000 people (similar to Ballarat), it can take 30 minutes in a car to get from the suburbs to the city. And walking or cycling is not a good option due to extreme heat. In the build up to the wet season the humidity and temperature are high (e.g. 90% and 34‘C). Sweating is the norm here and I’ve learnt to just focus on the skin benefits of my healthy glow. I’m also appreciating the ultra chilled glassware that you’re beverages are served in at all cafes and restaurants. 

Drinks at the Darwin Sailing Boat Club

Orientation was at times quite bland including sessions on medicare and computer data entry but, as I’m learning, Territorians are very keen to educate you on why the NT is the best place in Australia to live and work while at the same time warning you of the extreme dangers and risks involve being here. Orientation was mostly about crocodiles with every presentation containing photos, newspaper clippings, horror stories and tales of heroism. They did everything to warn us of the dangers of the saltwater crocodile (turns out I’ve already swum with freshwater crocs on Saturday in one of the National Parks). The message was weakened slightly though after they recommended drinks at the NT water-ski club where they regularly ski in an area where 250 crocs have been removed this year alone! We also heard about snakes, buffaloes, camels, leeches, mould, cheeky dogs, dingoes, irukandji and box jelly fish. However perhaps the most emphatically delivered warning was also the most surprising- “don’t have sex in the Northern Territory, whatever you do!”. This was followed by horrendous statistics on the rates of sexually transmitted infections in the NT.

Wangi Falls, Litchfield National Park

The highlights for the week were obviously not in the classroom. My good friend, and culinary expert, Emma Schimann acted as a wonderful tour guide and successfully showed us the best Darwin has to offer in terms of fine food and cultural attractions. Pop-up Italian food on the ocean foreshore, the Darwin deck-chair cinema, Hanuman restaurant (an unusual yet seamless fusion of Thai and Indian), the NT art gallery/ museum and stunning Litchfield National Park. As mentioned earlier, here we swam in beautiful rock pools, under 20 metre high waterfalls and walked through monsoon forests. Absolutely beautiful and only slightly terrifying at the same time. 

I am now travelling along the Arnhem Highway in a vintage mini-bus that is towing a trailer containing only my luggage. It’ll take 4 hours to get to Jabiru in Kakadu National Park. At the bus stop I’ll be met by the pilot of my private charter plane. I will then fly over some spectacular scenery (hopefully) to Oenpelli in West Arnhem Land- home for the next three months. I’m becoming apprehensive as I travel further from civilisation and all my usual comforts. I’m also excited and looking forward to whatever this experience has in store. Here we go!