Tuesday, June 9, 2009

Country feedback

It's the beginning of week 3 of my GP term and, as predicted, I'm bored.

I'm on my rural placement in far western NSW with another student from my uni. We thought we were going to Broken Hill, but we've actually done one week in Wilcannia, and just started a two-week placement in Menindee. They're both very small towns.

Wilcannia was an eye-opener. It's a really depressing place. It used to be a thriving riverside town - the beautiful old sandstone buildings are a reminder of that time. But now it has one shop (a supermarket where, for example, broccoli costs $13 a kilo), one pub, and one club - and a raft of social, cultural, and health problems. There is a large indigenous population.

The hospital is very nice (another gorgeous sandstone building), and our accommodation was better than expected. But we couldn't go out at night, and felt very isolated. Even walking to the supermarket at 4pm on a Wednesday meant encountering groups of drunk men walking the streets.

It's a frustrating place. I have a lot of respect for the people who are trying to make it better, but I don't know how they can handle it. Small steps, I suppose. Health has improved in recent years with the implementation of a chronic disease monitoring program, and an early childhood program. Change is coming - slowly. But there's just so much that needs to be done - not just in healthcare. It's a place that many people have tried to fix over the years, but the list of failures is long.

One night we put our names down for ambulance/ED callout, and were woken at 1am. There was a brawl - one man had been glassed and he was in the ED, very aggressive and not allowing anyone to examine him. It was obvious that he hadn't just been drinking. Drugs are having more and more of an impact on the community. The perpetrator was there too - he'd broken his arm.

I was given the task of examining a woman who'd come in after having the crap beaten out of her by her drunk partner. I'd never examined an assault victim before (I'm sure it'll be all-too-common next year though), and I was pleased that I stayed calm and got a good history and did a good examination. In the ED we have to phone the on-call doctor at the RFDS base in Broken Hill, and she was happy with my assessment. Thankfully, the woman was not too seriously injured (no broken bones).

We found it hard to learn much about general practice because the doctors weren't there every day. One day, the RFDS doctor couldn't land due to fog, so we ran his clinic and called him to sign off on what we were doing. Sounds interesting, but it wasn't too challenging and we weren't getting feedback on our performance, so it didn't feel worthwhile. The clinic staff were very grateful for our help though. The worst thing we saw was a child's infected scalp still crawling with lice. (I just typed that and then scratched my head - happens every time I think about lice.)

We arrived in Menindee this morning, and the healthcare setup is more of the same - except there are even fewer doctors here, and fewer patients coming to the ED. Today dragged like you wouldn't believe - and I'm here for 11 days. Thankfully this town is more functional than Wilcannia (two shops, two pubs!), and we feel safe walking around. But it's cold and windy and rainy, and we've already had enough.

The aim for the next two weeks is to knock over all of my uni assignments so that I can relax when I get back to Sydney. It'll be good to do my urban placement with one GP who I can build a relationship with over the three weeks, and hopefully learn from.

PS. We were quite amused to see that Wilcannia Hospital made the news while we were there! Thanks to Yay for letting me know...

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