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.