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/.