Sunday, May 3, 2009
Community Outreach
Ramingining
Ramingining is an Aboriginal community in the north-central part of Arnhem Land. One of the pediatricians & I set off for the town on last Monday morning for a two-day overnight visit. There was about an hour delay in our flight because of “mechanical difficulties.” When it was finally time to set off, I was terrified to discover that our pilot looked like he was about 19-years-old & our rickety plane was smaller than any I’d been on previously. For some reason, the planes keep getting smaller & smaller—this one looked like a toy plane. It seated four of us—the “teenage” pilot, the pediatrician in the co-pilot seat, & a special education teacher who was coming along. We had to climb over the wing of the plane to enter the plane through a door on the side of the co-pilot seat. I’m convinced I’m going to die every time I get on one of these planes.
Luckily, we made it to the community safely & landed on the dirt airstrip. There was considerable turbulence during the landing because as we descended the air currents, created by uneven warming of the ground, buffeted our plane. Like my visit to Croker Island, we waited on a covered platform to the side of the landing strip until one of the clinic nurses arrived. The community was a short drive from the landing strip. First, we dropped off the schoolteacher at the school & then continued on to the clinic. We made a quick trip to the doctor accommodations, which were a short walk from the clinic. The small cabin was in a ramshackle state, & there was only one double bed & a small twin mattress leaning against the wall for the three of us—apparently, no one had bothered to arrange any accommodation for the pilot . . . We decided to sort out the sleeping situation later, left the pilot in the cabin, & went to the clinic to start seeing patients.
We had a very busy day. I saw about 10 patients over the course of the morning & afternoon & the pediatrician saw at least twice as many. She comes to the community every month & knows most of the children whereas I was considerably slower as I was meeting the children & their families for the first time. Many of the children came for weight checks for poor weight gain. In the process, I discovered that many had other issues like perforated ear drums with frank pus oozing from their ears or crusting skin infections like scabies. I examined a child who I suspect had a tibial fracture. The closest location to obtain an x-ray is Gove Hospital, which is about an hour flight away. We ordered the x-ray nonetheless, but it won't be speedy process. Similarly, I diagnosed a young boy with a urinary tract infection, but he’ll have to fly to Darwin to get an ultrasound of his kidneys & bladder at some point. It forces one to think very carefully about every single test that’s ordered.
We finished at the clinic in the early evening. We discovered that there was another accommodation available in the community where the visiting dentist & his assistant were staying which had two extra beds. We decided the pilot & I would join the dentist & the assistant & the pediatrician would stay alone in the doctor's cabin. The place I ended up staying was also a quick walk from the clinic right across from the tribal council building & art center & next to the community store. I was pleased to find that it was in better upkeep than the other cabin. It consisted of a commons area with TV, seating area, kitchen, & two bedrooms, each with two twin beds & adjoining bathrooms.
The next morning, I was pleasantly surprised to discover the community “alarm clock” which is a town-wide broadcast of 60s & 70s music starting at 8am. We had another busy morning in clinic. I discovered a murmur on a one-month-old. She’ll have to get an echocardiogram, which will need to be arranged at Darwin Hospital. I visited the community store during lunchtime, which I was pleased to find had just received a fresh shipment of vegetables. Otherwise, it was similar to the Croker Island store with a limited selection of processed foods & dry goods all marked up considerably from Darwin prices.
On my way back to the clinic, I spotted a young woman carrying a limp dog by the legs with the dog’s head bobbing along as she hauled the dog. I then saw her deposit the dog on the open hatch of a pickup truck while a man came alongside carrying another limp dog. Fascinated, I approached them & discovered them performing surgery on the first dog—apparently they were veterinarians hired by the government to go to the various communities to spay & neuter the dogs. They give the dogs a shot of ketamine & then under questionably sterile conditions perform the procedure on the back of a pickup truck. They also give the dogs a shot of penicillin in the neck to prevent infection & apparently have low rates of infection. They clip their ears to mark which ones have been spayed or neutered so they can spot them easily on their next visit. Before this program started, the dogs in each community numbered in the many hundreds—almost outnumbering the people! In Ramingining there were still many packs of dogs roaming & lying about but a huge improvement from what it was before the program.
The flow of patients tapered off early that afternoon, so we were able to make an early start for home around 3pm. As we were taking off on the plane, some kind of crank or handle at the base of the plane’s floor behind & between the pilot & co-pilot seats at my feet started spinning wildly in circles. The pediatrician & I let out screams & notified the pilot who grabbed behind him to stop it. I also noticed a red light started flashing on the “dash-board” along with two green lights. The pilot tried to explain the situation over the din of the plane’s engines, but I couldn’t make out what he was saying. I was sure there was something terribly wrong with the plane!
Things were smooth up until we reached Darwin & started descending for landing & this lever/handle contraption started spinning again & ripped up the carpet at our feet, which got jammed up around the lever. I also noticed a burnt smell. I was sure we were going to die. The pilot, while trying the land the plane, reached back with one hand trying to pry the handle out of the carpet. He finally managed to pry the carpet loose, & seemed to “click” the lever into a locked position. I noticed the red light was flashing again. Somehow, we landed safely. Once on the ground, I asked our “teenage” pilot what the heck was going on with this wildly spinning lever & he said something to the effect of: “if there’s only one red light & two green lights then it’s okay,” but if there’s three red lights than you’re basically in serious trouble! He went on about some hydraulic emergency system . . . He ended by saying “the mechanics are going to be busy tonight.” All I have to say is that if on my two remaining charter flights it looks like I’m getting on the same plane, I’m going to refuse to board!
Yirrkala
Yirrkala is a coastal Aboriginal community on the northeastern edge of the NT. It's a short drive from Gove, which I visited last week. The community is in a beautiful location on the sea & is more well maintained compared to other communities I’ve visited. I believe the community benefits from money from the Gove mines, which are on “leased” Aboriginal land. A new clinic was recently built, so the clinic facilities were quite nice. The pediatrician & I split seeing patients through the morning. We had a steady flow of patients, but a slower flow than we’d had at Ramingining. Despite their proximity to the city, I was surprised to find that the people were so lacking in their English speaking abilities—probably the least English fluency of any community I’ve visited. I found myself becoming increasingly frustrated by my inability to communicate with the patients. A few times I asked one of the Aboriginal Health Workers to come into a room to assist with communication, but they are not trained interpreters & it was obvious to me they were not comfortable with this role.
The patient flow tapered off in the afternoon such that I had some downtime to explore the community. I visited the art center, which featured Yirrkala bark art, which is quite distinctive from other Aboriginal art. Some of the artists featured are internationally renown & have pieces hanging in museums & galleries throughout the world. Therefore, much of the art was well out of my price range, but in a dusty, out of the way corner I found some small & therefore more affordable pieces of bark art. I decided to splurge on a small bark with a painting of two intertwined snakes. I then made my requisite visit to the community store, which was similar to other community stores, which little fresh produce & exorbitant prices. I then walked along the shore & watched as a woman & two children fished with plain fishing line standing atop rocks along the sea shore.
Milikapiti
Milikapiti is an Aboriginal community on Melville Island, one of the Tiwi Islands. The other main Tiwi Island is Bathurst Island, where the Tiwi Football Finals took place in March. The community consists of about 500 people. I again had to fly on a small charter plane, but this one was larger the one I took to Ramingining. Two other doctors & a medical student rode along. The plane made two stops at two other Tiwi communities dropping off the other doctors & student before reaching Milikapiti.
I was scheduled to work on my own for the day completing school screenings, which basically involved listening to heart & lungs & deciding if any children needed referral for further tests. The NT has very high rates of rheumatic fever & rheumatic heart disease, so the major question I needed to answer was whether or not I needed to refer children with heart murmurs for echocardiograms. Another doctor had come earlier in the week & completed many of the school exams, so I had to review the ones she hadn’t gotten to & re-listen to a few children about whom she was concerned. Most of the exams were normal, but I agonized over the slightest murmur that I might have otherwise dismissed as a benign murmur in the US because of the known high rates of rheumatic heart disease in the NT. In the end, I only referred one patient for an echocardiogram.
I completed the school screening by the early afternoon. Then, one of the community nurses took me on a tour of the town. We visited the community farm, which was started by one the nurse’s husband & employed some of the local Aboriginal people. It was an impressive operation with mango trees, bananas, sweet potatoes, pineapples, citrus trees, hydroponic green house, & nursery with local plants for mine re-planting. Overall, I found Milikapiti to be the most well organized community I’ve visited. I also visited the art center, &, of course, walked away with another piece of art, this time a beautiful print.
Ramingining is an Aboriginal community in the north-central part of Arnhem Land. One of the pediatricians & I set off for the town on last Monday morning for a two-day overnight visit. There was about an hour delay in our flight because of “mechanical difficulties.” When it was finally time to set off, I was terrified to discover that our pilot looked like he was about 19-years-old & our rickety plane was smaller than any I’d been on previously. For some reason, the planes keep getting smaller & smaller—this one looked like a toy plane. It seated four of us—the “teenage” pilot, the pediatrician in the co-pilot seat, & a special education teacher who was coming along. We had to climb over the wing of the plane to enter the plane through a door on the side of the co-pilot seat. I’m convinced I’m going to die every time I get on one of these planes.
Luckily, we made it to the community safely & landed on the dirt airstrip. There was considerable turbulence during the landing because as we descended the air currents, created by uneven warming of the ground, buffeted our plane. Like my visit to Croker Island, we waited on a covered platform to the side of the landing strip until one of the clinic nurses arrived. The community was a short drive from the landing strip. First, we dropped off the schoolteacher at the school & then continued on to the clinic. We made a quick trip to the doctor accommodations, which were a short walk from the clinic. The small cabin was in a ramshackle state, & there was only one double bed & a small twin mattress leaning against the wall for the three of us—apparently, no one had bothered to arrange any accommodation for the pilot . . . We decided to sort out the sleeping situation later, left the pilot in the cabin, & went to the clinic to start seeing patients.
We had a very busy day. I saw about 10 patients over the course of the morning & afternoon & the pediatrician saw at least twice as many. She comes to the community every month & knows most of the children whereas I was considerably slower as I was meeting the children & their families for the first time. Many of the children came for weight checks for poor weight gain. In the process, I discovered that many had other issues like perforated ear drums with frank pus oozing from their ears or crusting skin infections like scabies. I examined a child who I suspect had a tibial fracture. The closest location to obtain an x-ray is Gove Hospital, which is about an hour flight away. We ordered the x-ray nonetheless, but it won't be speedy process. Similarly, I diagnosed a young boy with a urinary tract infection, but he’ll have to fly to Darwin to get an ultrasound of his kidneys & bladder at some point. It forces one to think very carefully about every single test that’s ordered.
We finished at the clinic in the early evening. We discovered that there was another accommodation available in the community where the visiting dentist & his assistant were staying which had two extra beds. We decided the pilot & I would join the dentist & the assistant & the pediatrician would stay alone in the doctor's cabin. The place I ended up staying was also a quick walk from the clinic right across from the tribal council building & art center & next to the community store. I was pleased to find that it was in better upkeep than the other cabin. It consisted of a commons area with TV, seating area, kitchen, & two bedrooms, each with two twin beds & adjoining bathrooms.
The next morning, I was pleasantly surprised to discover the community “alarm clock” which is a town-wide broadcast of 60s & 70s music starting at 8am. We had another busy morning in clinic. I discovered a murmur on a one-month-old. She’ll have to get an echocardiogram, which will need to be arranged at Darwin Hospital. I visited the community store during lunchtime, which I was pleased to find had just received a fresh shipment of vegetables. Otherwise, it was similar to the Croker Island store with a limited selection of processed foods & dry goods all marked up considerably from Darwin prices.
On my way back to the clinic, I spotted a young woman carrying a limp dog by the legs with the dog’s head bobbing along as she hauled the dog. I then saw her deposit the dog on the open hatch of a pickup truck while a man came alongside carrying another limp dog. Fascinated, I approached them & discovered them performing surgery on the first dog—apparently they were veterinarians hired by the government to go to the various communities to spay & neuter the dogs. They give the dogs a shot of ketamine & then under questionably sterile conditions perform the procedure on the back of a pickup truck. They also give the dogs a shot of penicillin in the neck to prevent infection & apparently have low rates of infection. They clip their ears to mark which ones have been spayed or neutered so they can spot them easily on their next visit. Before this program started, the dogs in each community numbered in the many hundreds—almost outnumbering the people! In Ramingining there were still many packs of dogs roaming & lying about but a huge improvement from what it was before the program.
The flow of patients tapered off early that afternoon, so we were able to make an early start for home around 3pm. As we were taking off on the plane, some kind of crank or handle at the base of the plane’s floor behind & between the pilot & co-pilot seats at my feet started spinning wildly in circles. The pediatrician & I let out screams & notified the pilot who grabbed behind him to stop it. I also noticed a red light started flashing on the “dash-board” along with two green lights. The pilot tried to explain the situation over the din of the plane’s engines, but I couldn’t make out what he was saying. I was sure there was something terribly wrong with the plane!
Things were smooth up until we reached Darwin & started descending for landing & this lever/handle contraption started spinning again & ripped up the carpet at our feet, which got jammed up around the lever. I also noticed a burnt smell. I was sure we were going to die. The pilot, while trying the land the plane, reached back with one hand trying to pry the handle out of the carpet. He finally managed to pry the carpet loose, & seemed to “click” the lever into a locked position. I noticed the red light was flashing again. Somehow, we landed safely. Once on the ground, I asked our “teenage” pilot what the heck was going on with this wildly spinning lever & he said something to the effect of: “if there’s only one red light & two green lights then it’s okay,” but if there’s three red lights than you’re basically in serious trouble! He went on about some hydraulic emergency system . . . He ended by saying “the mechanics are going to be busy tonight.” All I have to say is that if on my two remaining charter flights it looks like I’m getting on the same plane, I’m going to refuse to board!
Yirrkala
Yirrkala is a coastal Aboriginal community on the northeastern edge of the NT. It's a short drive from Gove, which I visited last week. The community is in a beautiful location on the sea & is more well maintained compared to other communities I’ve visited. I believe the community benefits from money from the Gove mines, which are on “leased” Aboriginal land. A new clinic was recently built, so the clinic facilities were quite nice. The pediatrician & I split seeing patients through the morning. We had a steady flow of patients, but a slower flow than we’d had at Ramingining. Despite their proximity to the city, I was surprised to find that the people were so lacking in their English speaking abilities—probably the least English fluency of any community I’ve visited. I found myself becoming increasingly frustrated by my inability to communicate with the patients. A few times I asked one of the Aboriginal Health Workers to come into a room to assist with communication, but they are not trained interpreters & it was obvious to me they were not comfortable with this role.
The patient flow tapered off in the afternoon such that I had some downtime to explore the community. I visited the art center, which featured Yirrkala bark art, which is quite distinctive from other Aboriginal art. Some of the artists featured are internationally renown & have pieces hanging in museums & galleries throughout the world. Therefore, much of the art was well out of my price range, but in a dusty, out of the way corner I found some small & therefore more affordable pieces of bark art. I decided to splurge on a small bark with a painting of two intertwined snakes. I then made my requisite visit to the community store, which was similar to other community stores, which little fresh produce & exorbitant prices. I then walked along the shore & watched as a woman & two children fished with plain fishing line standing atop rocks along the sea shore.
Milikapiti
Milikapiti is an Aboriginal community on Melville Island, one of the Tiwi Islands. The other main Tiwi Island is Bathurst Island, where the Tiwi Football Finals took place in March. The community consists of about 500 people. I again had to fly on a small charter plane, but this one was larger the one I took to Ramingining. Two other doctors & a medical student rode along. The plane made two stops at two other Tiwi communities dropping off the other doctors & student before reaching Milikapiti.
I was scheduled to work on my own for the day completing school screenings, which basically involved listening to heart & lungs & deciding if any children needed referral for further tests. The NT has very high rates of rheumatic fever & rheumatic heart disease, so the major question I needed to answer was whether or not I needed to refer children with heart murmurs for echocardiograms. Another doctor had come earlier in the week & completed many of the school exams, so I had to review the ones she hadn’t gotten to & re-listen to a few children about whom she was concerned. Most of the exams were normal, but I agonized over the slightest murmur that I might have otherwise dismissed as a benign murmur in the US because of the known high rates of rheumatic heart disease in the NT. In the end, I only referred one patient for an echocardiogram.
I completed the school screening by the early afternoon. Then, one of the community nurses took me on a tour of the town. We visited the community farm, which was started by one the nurse’s husband & employed some of the local Aboriginal people. It was an impressive operation with mango trees, bananas, sweet potatoes, pineapples, citrus trees, hydroponic green house, & nursery with local plants for mine re-planting. Overall, I found Milikapiti to be the most well organized community I’ve visited. I also visited the art center, &, of course, walked away with another piece of art, this time a beautiful print.
Thursday, April 23, 2009
Pediatrics
Last week I made the switch from ID to pediatrics. There are three pediatrics units at RDH on the 5th, 6th, & 7th floors. The 5th floor consists of all general pediatrics admissions. The 6th floor encompasses the well-baby nursery, the special care nursery, & NICU. The 7th floor is the isolation ward for children with potentially contagious conditions like diarrhea or respiratory infections. There's no children's ICU, rather any children who require ICU level care go to the general ICU & are managed jointly by the pediatricians & ICU doctors.
The schedule on pediatrics is similar to the medicine schedule starting every morning with an 8am handover from the overnight registrar to the day teams. Every other Tuesday, there's an ID meeting after handover to go over any interesting ID cases with the ID team. On Wednesday there's a journal club after handover. On Thursday morning there's radiology meeting. There are also teaching conferences at noon with registrar teaching on Wednesdays, psychosocial rounds on Thursdays, & Grand Rounds on Fridays.
The workload is split among three pediatrics registrars, with an RMO assisting, who are each responsible for the units during the day. Often, another registrar or two handle emergency department admissions, transfers, & outside calls. There's a scheduled evening handover every day at 4pm during which the day teams hand-off to the evening registrar & RMO. The evening team then hands-off to the night registrar who comes on at 10pm & holds down the fort managing all admissions & cross-cover until the am handover the next day.
My first week on peds, I joined the 7th floor team. As I said earlier, this unit is the isolation ward composed of patients admitted with diarrhea or respiratory issues that could potentially be contagious. The vast majority of children admitted to the ward are Aboriginal & have severe malnutrition in addition to diarrhea & dehydration. It is estimated that up to 20% of children in the NT meet the WHO criteria for malnutrition, which by WHO definition constitutes a "health crisis." Because these children are already compromised by malnutrition & poor living conditions, they are especially vulnerable to diarrheal illness. It's not uncommon for the children to be infected with multiple organisms at once: giardia, rotavirus, salmonella, & cryptosporidium being the most common as well as other parasites like strongyloides. They often come in with severe electrolyte abnormalities with dangerously low potassium, sodium, calcium, & magnesium levels & acidosis. Many of the children also have other vitamin & micronutrient deficiencies as well as iron deficiency. We have to monitor them very closely, constantly adjusting their fluid & electrolyte replacement.
In addition to my time on the 7th floor ward, I've been on another outreach trip. One of the pediatrics consultants & I flew to the town of Gove, also known by its Aboriginal name Nhulunbuy, for a one-day clinic. Gove is at the very north-east edge of the NT. Historically, the Aboriginal communities of Nhulunbuy & Yirrkala were located there. The town of Gove was primarily built up around aluminum mining & a large ALCOA aluminum plant. The clinic was held in the hospital & the vast majority of the patients were non-Aboriginal children of parents in some way affiliated with the mines & ALCOA. These children had primarily "western" complaints with the vast majority being evaluated to developmental issues. In contrast, next week I'll return to the neighboring community of Yirrkala, which is an Aboriginal community. Next week, I will also be going to another Aboriginal community in the midst of East Arnhem, the vast region of the NT between Kakadu & the eastern border of the NT. It will be my first overnight trip to a community!
The schedule on pediatrics is similar to the medicine schedule starting every morning with an 8am handover from the overnight registrar to the day teams. Every other Tuesday, there's an ID meeting after handover to go over any interesting ID cases with the ID team. On Wednesday there's a journal club after handover. On Thursday morning there's radiology meeting. There are also teaching conferences at noon with registrar teaching on Wednesdays, psychosocial rounds on Thursdays, & Grand Rounds on Fridays.
The workload is split among three pediatrics registrars, with an RMO assisting, who are each responsible for the units during the day. Often, another registrar or two handle emergency department admissions, transfers, & outside calls. There's a scheduled evening handover every day at 4pm during which the day teams hand-off to the evening registrar & RMO. The evening team then hands-off to the night registrar who comes on at 10pm & holds down the fort managing all admissions & cross-cover until the am handover the next day.
My first week on peds, I joined the 7th floor team. As I said earlier, this unit is the isolation ward composed of patients admitted with diarrhea or respiratory issues that could potentially be contagious. The vast majority of children admitted to the ward are Aboriginal & have severe malnutrition in addition to diarrhea & dehydration. It is estimated that up to 20% of children in the NT meet the WHO criteria for malnutrition, which by WHO definition constitutes a "health crisis." Because these children are already compromised by malnutrition & poor living conditions, they are especially vulnerable to diarrheal illness. It's not uncommon for the children to be infected with multiple organisms at once: giardia, rotavirus, salmonella, & cryptosporidium being the most common as well as other parasites like strongyloides. They often come in with severe electrolyte abnormalities with dangerously low potassium, sodium, calcium, & magnesium levels & acidosis. Many of the children also have other vitamin & micronutrient deficiencies as well as iron deficiency. We have to monitor them very closely, constantly adjusting their fluid & electrolyte replacement.
In addition to my time on the 7th floor ward, I've been on another outreach trip. One of the pediatrics consultants & I flew to the town of Gove, also known by its Aboriginal name Nhulunbuy, for a one-day clinic. Gove is at the very north-east edge of the NT. Historically, the Aboriginal communities of Nhulunbuy & Yirrkala were located there. The town of Gove was primarily built up around aluminum mining & a large ALCOA aluminum plant. The clinic was held in the hospital & the vast majority of the patients were non-Aboriginal children of parents in some way affiliated with the mines & ALCOA. These children had primarily "western" complaints with the vast majority being evaluated to developmental issues. In contrast, next week I'll return to the neighboring community of Yirrkala, which is an Aboriginal community. Next week, I will also be going to another Aboriginal community in the midst of East Arnhem, the vast region of the NT between Kakadu & the eastern border of the NT. It will be my first overnight trip to a community!
Thursday, April 9, 2009
Croker Island Clinic
Today the Medical Outreach Registrar took me along on a trip to one of the remote Aboriginal community clinics on Croker Island. The day started off at the small charter plane hangar at the airport, an event that’s becoming all too common on this trip to Oz. There were two DMOs (District Medical Officers), a pediatrics consultant, a medical student, & a nutritionist on our flight. The pilot let me ride up front in the co-pilot seat (for the 2nd time).
Croker Island is about a 50-minute flight from Darwin off the coast of the NT. I listened to my ipod on the flight to block out the deafening sound of the plane’s engines. We landed on a dirt airstrip. The registrar, the nutritionist, one of the DMOs, & I disembarked while the rest of the group continued on to another remote community. There was a covered platform next to the dirt landing strip where one of the clinic nurses was waiting for us. There wasn’t enough room in the truck for all of us, so the nutritionist & I waited on the platform while the first group drove into the community, which is about a 15-minute trip on the other side of the island from the airstrip.
The area around the airstrip is a floodplain filled with sundry wildlife including all varieties of birds, wild horses, & crocs. The community consists of about 300-400 people & is nestled over the island’s coast. The clinic building is spacious & new because it was recently rebuilt after the original was destroyed by a cyclone a couple years ago. The community, consisting of the tribal council building, a school, homes in various stages of disrepair, & a small store, spread out before the clinic, which sits atop a hill overlooking it all.
The patients slowly trickled in over the course of the day. Patients aren’t given scheduled appointments. A nurse simply rides through the town in the ambulance announcing that the doctors are here & makes a special effort to encourage patients with issues to come to clinic. I saw a few patients along with the other registrar, & then broke away to see a few pediatric patients on my own.
I saw a pair of brothers, one with a recent asthma exacerbation & the other with recurrent boils on his hands & feet, which had previously cultured out staph & group A strep, which luckily were sensitive to most antibiotics. I prescribed flucloxacillin for the skin infection. I then saw a 19-year-old first-time mother with her seven-day-old baby. The mom had a bad case of mastitis of her right breast, which engorged, painful, & woody hard, but the baby was doing well & almost back to birth weight & managing okay feeding off the unaffected breast. I prescribed the mom a course of antibiotics (dicloxacillin) & asked the community nurse to check the baby’s weight again in a few days.
At the end of the day, after all the patients had been seen, I took a walk through the community. Families were sitting underneath the shade of trees in front of their homes while children ran about & dogs slept on porches. It only took a few minutes to make a round about the entire community. I visited the store, which had a meager selection of foods all of which were priced about 60% more than what they’d cost in the city. I was warned to take a stick along to keep the dogs away, but the dogs didn’t pay me any interest in the afternoon heat.
Above is a picture of the clinic as seen looking up from the community.
Tuesday, April 7, 2009
Kakadu Adventure
Kakadu is Australia’s largest national park, covering over 4 million acres, & is designated a World Heritage Area. It’s a vast place of beautiful landscapes & diverse wildlife. We set off in the early morning on the two-&-half hour drive on the Arnhem Highway eastwards out of Darwin. We reached the Jabiru area of the park by mid-morning & made a quick stop at Aurora & checked in to our cabin.
We then made our way to the small Jabiru airstrip for a scenic flight. This time of the year a flight is the only way to see two of the park’s main attractions, Jim Jim Falls & Twin Falls, because much of the park floods during the Wet season making the roads to the falls impassable. A flight is also the best way to get a full appreciation of Kakadu’s expansive landscape escarpments, ravines, & flood plains. The plane was tiny, seating only six passengers. To give us the best view possible, the pilot tried to fly as low to the ground as possible, so the plane was constantly buffeted by winds. Then, to give each passenger a view of the waterfalls, he made two corkscrew turns around each waterfall, wing tip down in alternating directions so both sides of the plane could get an equal view. Unfortunately, for the weak-stomached, like myself, this is a recipe for sickness. Amazingly, I managed to keep it together during the circling around the falls though I was sweating bullets & am sure I looked green. Despite my best efforts, I lost it about five minutes before we landed.
Even though I got sick, if I had it to do over again, I’d take the flight because there is no other way to see the waterfalls in their full strength & Wet-season swell. Even in the Dry, the falls are only accessible by four-wheel-drive & often not until June & by that time, they’ve often slowed to a trickle. However, in the Dry two magical plunge pools, perfect for swimming, remain at the base of the falls. I’m hoping I have the chance to make it back out to Kakadu in May before I return & make it to the waterfalls.
We then made our way northeast towards Ubirr. The ranger at the Visitor Center warned us that the road to Ubirr was closed to non-4WD vehicles due to flooding. However, we decided to venture out & assess the situation ourselves. About halfway there, we came to the first flooded portion of the road, which was submerged under about 20cm of floodwater across approximately 15 meters of road. We contemplated the situation for a bit & decided to brave it with our little Toyota Corolla. Luckily we made it. There was only one other flooded area a short distance further covering about the same depth & distance of road, which we also easily forged. Ubirr Rock is one of Kakadu’s famous Aboriginal art sites. There are reportedly over 5,000 art sites throughout Kakadu dating back as far as 50,000 years; however, only a few are open to visitors. We climbed about 820 ft. to the top of Ubirr Rock, which was dotted with art sites throughout the climb. We remained at the top until the spectacular sunset over the flood plains.
The second day, we woke at the crack of dawn for the Yellow Water cruise. The Yellow Water Billabong is a lake south of Jabiru near the center of the Park that is surrounded by freshwater mangroves, water lilies, & countless varieties of birds including sea eagles, magpies, kites, kingfishers, jacanas, & many more. During the Wet, the billabong floods to join with Alligator River. The cruise started at sunrise at the billabong & wound along down Alligator River. In addition to all the birds, there were several large saltwater crocodiles that swam alongside our boat.
Following the cruise, we visited the Aboriginal Cultural Center, which took us through the history & lifestyle of the Bininj Aborigines & Dreamtime creation myths. Then, we took two bushwalks ending the day at Nourlangie Rock, which is often considered the best of the Aboriginal art sites. During the walk, I came a across a wallaby! It stood about five feet away from me just looking at me. Then, it suddenly bounded away on its powerful legs.
Friday, April 3, 2009
Sunday, March 29, 2009
Tiwi Island Footy
Last weekend I had a unique Australian cultural experience--attending the Tiwi Island Football Finals. The Tiwi Islands are located off the coast of Darwin. One can get there by ferry or by taking a 20 minute flight. The islands were proclaimed an Aboriginal Reserve in 1912, & the vast majority of the inhabitants are indigenous. For tourists, there's no overnight accommodation--just day trips to the islands.
Every March, the Tiwi Islands host the Football Grand Finals, which attracts thousands of visitors for the day. A large contingent from the hospital goes every year, & I decided to join them. The first thing I did after I got off the plane, was visit one of the local Aboriginal Art Galleries, where the local artists proudly displayed their art. I decided to splurge & purchased two beautiful works.
The crowd slowly gathered around the football oval. The game was fantastic! It was Australian rules football, which is sort of something of a hybrid between soccer & rugby. The game is played on a large oval shaped grass field. There are 18 players on each team & the goal is to score a goal by kicking the ball between the middle two goal posts. Players can kick, "handball," & run with the ball. There's some weird rule about bouncing the ball on the ground periodically & players should not get caught holding the ball. The game is played in four quarters that are about a half hour long, so the entire game lasted slightly more than two hours. It was a very hot day & the game is extremely physically demanding. I was exhausted just spectating in the heat.
The locals really take their footy seriously. It was wonderful to see the indigenous people in their element so happy & proud to have all us visitors their to see them at the their best. The best footy players are Aboriginal & the vast majority of the players last Sunday, if not all, were indigenous. Then, to top off what was a wonderful day, on the flight back to Darwin, the pilot let me sit up front with him in the co-pilot seat!
Every March, the Tiwi Islands host the Football Grand Finals, which attracts thousands of visitors for the day. A large contingent from the hospital goes every year, & I decided to join them. The first thing I did after I got off the plane, was visit one of the local Aboriginal Art Galleries, where the local artists proudly displayed their art. I decided to splurge & purchased two beautiful works.
The crowd slowly gathered around the football oval. The game was fantastic! It was Australian rules football, which is sort of something of a hybrid between soccer & rugby. The game is played on a large oval shaped grass field. There are 18 players on each team & the goal is to score a goal by kicking the ball between the middle two goal posts. Players can kick, "handball," & run with the ball. There's some weird rule about bouncing the ball on the ground periodically & players should not get caught holding the ball. The game is played in four quarters that are about a half hour long, so the entire game lasted slightly more than two hours. It was a very hot day & the game is extremely physically demanding. I was exhausted just spectating in the heat.
The locals really take their footy seriously. It was wonderful to see the indigenous people in their element so happy & proud to have all us visitors their to see them at the their best. The best footy players are Aboriginal & the vast majority of the players last Sunday, if not all, were indigenous. Then, to top off what was a wonderful day, on the flight back to Darwin, the pilot let me sit up front with him in the co-pilot seat!
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