Are You Going to Scamander Town?

The remainder of our time in Europe was lovely. When not touring around, Lori, Thea, and I managed to write and record a last-minute entry for the Mackey Family song competition, but alas placed second (again!) to the unfailingly adorable Chicago Mackeys.

Apart from arriving 7 hours later than scheduled in Vancouver and missing a Christmas Eve party, our four days in Vancouver were wonderful. It was super to see Jeryn and Liam, both Lori’s sisters and their families, her Dad, two of her second cousins, and a close friend from pharmacy. We reorganized our belongings, grateful to be able to store stuff at Camara’s. 
It was difficult to board yet another plane but once we touched down in the Australian sunshine, the trip seemed like a good idea. I managed to skip my birthday because Dec 29 evaporated as we crossed the international date line. We recuperated from jet lag by taking advantage of the hospitality of my Dad and Sandra. We were also pleased to catch up with my aunt and uncle, a family friend, and some high school and medical friends while in McCrae and Melbourne.

It has been great to be reminded of the friendliness of small town Australia. As we walked to the beach at McCrae one day, someone stopped to ask if we needed a ride and there have been many welcoming nods and greetings since arriving in Tasmania. The weather has been fractious – alternating hot and cold. The girls did brave the surf with their uncle Adam on a cold day. They were happier posing with the surf boards than paddling on them. Ironically we have all experienced more sunburns and and me and Thea more bug bites in Australia thus far than our whole three months in Africa.

I have been commenting to many about the different preparations required for Australia vs Africa. When doing the medical preparation for Africa my main concern was how to diagnose and manage conditions which I had no experience with. I did a tropical medicine course back in May but, of course, the information was as quickly forgotten as it was obtained. Also, patients don’t present nicely packaged as a disease but with complex undifferentiated symptoms which could declare as any number of diseases which, in Zimbabwe and Uganda, I would have very little experience with or knowledge of. In the end I didn’t do as much “undifferentiated” clinical work and my knowledge gaps weren’t overly exposed.

In contrast my greatest concern about coming to Australia was about relearning and navigating the system. Despite having grown up, trained and worked here, I knew that enough would have changed (or not changed) that I would be, at times, drifting aimlessly in an administrative sea. Into my second week here my expectations have been realized in spades (I already have many stories). The medicine is little different to that in Canada (no I have not had to treat any Tassie Devil attacks) but I have been spending a significant part of my time attending to system and administrative details that do nothing to improve patient care. In fact, my experience of medicine in the last four countries I have worked has only strengthened the notion that the purpose of medical administration and government is to try and impede access to care to either save money or divert it elsewhere. 

That being said, the work is a pleasant change and challenge. Being a newly opened one doctor clinic in a relatively quiet seaside town I am afforded a little extra time to spend with patients and try to start to build charts and care plans with them so that they can have a semblance of continuing care even though they will not be seeing the same doctor. It is extremely unlikely that a doctor would ever move here full time, particularly with the Australian government strangling General Practice (particularly rural General Practice) by freezing the Medicare rebate. I encourage everyone to read Atul Gwande’s latest piece in the New Yorker, and this other in the NYT about the neglect of “incremental” medicine.

http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

https://mobile.nytimes.com/2017/01/19/opinion/sunday/the-conversation-placebo.html?smid=tw-share&_r=0&referer=https://t.co/NtW5fE5ahB

Apart from the challenges of battling the obscuris that is the Australian PBS, other challenges include having to draw my own labs and, gasp, having to do my own ECGs. However I remain thankful that I at least I have the facility to draw bloods and get them tested and have an ECG machine that works and doesn’t print out reports labeled “US State Department”.

Those on FB will have seen that we have been already making the most of our location. We are only 15 mins from Binalong Bay which is the southern end of the Bay of Fires. Not named for the fire-like appearance of the lichen on the rocks but in fact for the fires on shore observed by Captain Furneax as he sailed past as part of Cook’s second voyage. The days have(mostly) been warm enough and long enough for us to head to the beach once I get back from work. We originally thought we would be staying near the clinic in Scamander however our accommodation is 15 mins north in St Helens. It does mean I have to “commute” each day but it does work out better for Lori and the girls as it is only a short walk across the bridge into St Helens which is a larger community and therefore has more going on. Well a bit more: you still can pretty much cross the main street on a Saturday night safely with your eyes closed.

The pace of life here is very different. Everything shuts down at 830pm and most things are closed Sunday afternoon. A reflection of less hectic times. Tasmania is twice the size of Vancouver Island (curse the Mercator projection maps. Southern hemisphere geography is always distorted) but with half the population. A lot of people are here because they want to get away from it all or slow down. Well except when they are driving too fast on the narrow windy roads. The unfortunate victims of this are the many (mostly possum) road kills that present an extra olfactory challenge to the hardy cyclists who are already playing cat and mouse with the aforementioned speeding drivers.

Lori has always harboured a wish to live by the ocean and so was excited about moving to the east coast of Tasmania. Not to swim in the ocean necessarily but she does enjoy listening to the sound of crashing waves. Me, if the water is there, I feel I have to swim in it and, despite the cool (some would argue frigid) temperature of the water, I have been determinedly doing so. 

Already friends and family are queuing up to visit, a luxury we were rarely able to enjoy in Fort St John. We plan to use the weekends to explore as much of Tasmania as we can (you can drive across it in 4 hours) so expect more photos of remote beaches, pristine waterfalls and lofty peaks.