We realise we have been remiss in not posintg our most recent Christmas Letter here… and it is now March 2023. So here is the “letter” ( and the solution:).
Recently, we read that our altered sense of time and inability to recall when events occurred during the past 2 years may be because there are few milestones or unusual events to mark the passage of time. While we certainly have experienced a sense of déjà vu, ennui, and gelangweilt during 2021, we were able to pin down a few things that happened over the past year.
Jeryn and Ted had high hopes of having an extended-family-and-friends wedding late 2021 but as the time drew nearer and it didn’t appear likely that dancing would be permitted indoors by their selected date, they opted to cancel. It was disappointing on so many levels. However, they did buy a house in October and that has been a great project. Jeryn is now just one exam away from being a fully accredited Landscape Architect. Ted was awarded the People’s Choice middle school teacher award in Fort St John, although he says there are several students who would disagree with that designation.
Liam spent time as a support worker for Thompson Community Services, first in Kamloops and then Victoria. He is now studying social work at U of Ottawa, in French for extra challenge and happy to be living in the same city as Rachel again. His guitar was more reluctant than he was to move to Ottawa and only arrived about 2 months after Liam, despite being booked as cargo on the same two flights. Liam was offered a discount code for a future flight — no strings attached.
Rachelle had several transitions during 2021, selling her guinea pigs and her car and moving first to Kamloops and then Vancouver. She worked at three different Canucks Autism day camps in Kamloops. She also helped the contractor rebuild our back deck. On the basis of that experience, she moved to Vancouver to work in construction, learning a variety of skills, and living with first Camara and Otto and then Michele. She is enrolled at Douglas College in Vancouver for January.
Once again, there were no school sports for Thea and although the city soccer league did start up again, the season was limited by poor air-quality conditions because of the forest fires, and she only played one game. She did compensate by skiing at Sun Peaks at least once every weekend it was open from late November to late March. She worked many hours at a newly opened Freshii in Kamloops. Her high school graduation was lovely even if unconventional: parents watched the ceremony on Zoom and then gathered at Riverside Park for photos. The principal and vice-principal visited each graduate’s house to present diplomas and many teachers participated in a congratulatory parade. Thea moved to Edmonton in September to attend U of Alberta, following in her Grandmother’s, Mom’s, Aunts’, and cousin’s footsteps.
Paul continues to do locums near and far, including Williams Lake and Squamish, and several trips to Inuvik. During his recent stint in December, he was able to witness the final sunset of the year having seen the first sun rise of the year when he was there in January. Lori continues to fill in for colleagues, more often at Andreen’s in West Kelowna than Similkameen Pharmacy in Keremeos, and in Fort St John when possible. She became much more comfortable administering vaccines after working for the month of June at one of the community COVID-19 vaccine clinics in Kamloops. She and Paul overlapped there on a couple of days, which is the first time they have worked at the same site. In the autumn, Lori also administered third doses of COVID-19 vaccine in long-term care homes with her classmate and long-time friend, Karen. There were some challenges, but it was a privilege to witness the hard work and compassion of the many healthcare professionals in those settings and to interact with the elderly, including several who were over 100 years old. (one 104-year-old woman still plays the piano!)
In July, we were able to bury Lori’s Dad’s ashes in a ceremony in Pincher Creek and it was good to be able to mark that event with family and friends.
The forest fires in BC this season were devastating for many. We were fortunate to only be on evacuation alert one evening, but dense smoke clouded the city for most of August. Then flooding and mud slides in November affected multiple communities south of Kamloops, again devastating for the residents.
Paul and Lori were grateful to be able to travel in Canada a bit this fall, with short trips to Victoria and Calgary. We hope that 2022 will allow reconnections with more family and friends both near and far.
Silver Linings Ledger Book
This trip was not without it’s challenges but each of these came with a silver lining. Our bags missing the flight from London to Johannesburg meant I had more justification for buying additional ‘Presidential’ shirts at the airport. Difficulties in the road trip to and from Harare and Karanda made me focus on the journey. Glitches following the MOIS upgrade made me realize that local IT staff can troubleshoot many problems.
It seems I have developed somewhat of a reputation at Karanda Mission Hospital (KMH). Readers will know that one of my prime goals was to help staff at KMH free themselves from the multiple accounting registers they were using to track their work as required by the Zimbabwe Ministry of Health. Pictured above is one of the books the lab staff had gone back to using to track semen samples. My good friends in the lab were somewhat embarrassed that they were having to use a ledger book to track this information (side note: I’m not convinced that anyone from the Ministry ever looks at this information). So it was quite satisfying to quickly add a template for this data (and remind them that Zoe in the computer office has the instructions and knows how to do this:)
One of the students visiting from Toronto commented that she heard someone saying, “Here’s a ledger book (the Antenatal one) Dr Mackey doesn’t know about” to which I replied, “Oooh yes I do” (I have a picture:). I had built a flowsheet for the Antenatal Register last time I was at KMH but I am well aware that this would be a bridge too far at this time. But it’s there in case they ever end up reaching that bridge.
There was a noticeable uptick in “data integrity” while I was there. Word on the wards was that they knew I was going around and checking so staff were being a little more attentive to putting in the information. I totally understand the reticence around using the computer. For some elements, staff are having to enter the data on paper and on the computer and thus struggle to see the point. The challenge has been to impress that, if they do the data entry on the computer correctly and diligently, then they can do away with the paper and save time. Of course it is hard to alter cherished and time-honoured habits.
I did a mini presentation to the hospital staff and was truly able to say, “My work here is mostly done”. All the elements are in place for them to record the information they are required to and they are 80-90% there in the data recording. The challenge is (as always) to make the leap and leave the paper behind.
I got great help from the Drs Sean and Nicole Ebert from Vanderhoof and their son Connor in particular. He was able to do his Excel and Visial Basic wizardy so that the raw data coming out could be nicely sorted and packaged for delivery to the ministry. It was also an incredible blessing that Zoe is now employed as IT support at KMH. Whenever the “My computer’s not working” message came to the office I was able to say, “That’s Zoe’s speciality”. It was very reassuring knowing that KMH has Zoe on site to help continue the work.
Amazingly I had never previously been to eat in the “town” of Karanda. As a group we ended up visiting the same establishment twice to enjoy Zacharia’s wife’s cooking (and appreciate the work that goes into preparing sadza, the national dish). Zacharia works in the hospital CSD department and his sister-in-law, Muguti, continues to work in the pharmacy and so immediately asked how Lori was.
Not only have I experienced several figurative silver linings, but there is a literal connection with Tania’s work in wound care while we have been here. There have been some impressive advances in wound care in recent years (necessary because of the increased incidence of diabetes as well as the aging population). Silver is incorporated into some dressings for its antibacterial activity. Unfortunately these dressings are too expensive to purchase in developing countries. So even in wound care, there are great disparities between Canada and Zimbabwe. However, there were many donated dressings stored in various nooks and crannies (and scary shipping containers) that weren’t being used because there was no attached education. Tania organized the supplies and introduced and updated some practice around wound care that will have lasting benefits. She has also left behind an excellent selection of resources that will help to advance wound care at Karanda. I would again like to acknowledge the provision of prescription and non-prescription medication from Health Partners International of Canada (HPIC) and the supplies donated by uniPharm, the Vancouver-based wholesale company that Fort St John Pharmacy uses.
As with previous visits, the premier silver lining associated with all the travel hassles and the heat and the lack of sleep was re-establishing relationships and meeting new people. We are always treated with such grace and gratitude by the staff at KMH (and the people of Zimbabwe). The customs official, noticing how many Zimbabwe visas I now have in my passport asked, “When are you coming back to Zimbabwe?”.
Back in the Groove/Back on the Blog
After a chaotic start to my travels with a 4-hour delay in Vancouver resulting in less than one hour to make a connection to Johannesburg in London (which our bags did not), I (Paul) have returned to the blog. Those who have been avidly following along will recall that this is my third sojourn to Karanda Mission Hospital, now 2 & 1/2 years since Lori, Rachelle and Thea were here. This time I linked up with the team that Dr Ray Markham puts together annually to visit Zimbabwe. It was Ray and his office staff who initially installed the electronic medical record (EMR) Medical Office Information System (MOIS) at Karanda, at the request of their administration. My first visit in 2015 was inspired by a slide presentation I heard Ray give at a conference in Montreal and he had then encouraged me to continue the MOIS install.
I always have some trepidation when encouraging others to embrace computer technology in their work (particularly healthcare) as I am fully aware that it takes immense time and effort for people, especially those on the front lines here who are extremely busy. Thus each time I have returned to Karanda I am curious to see how much training has been retained and which features of the system are still being used given the demands of working here, not the least being the erratic power supply.
Once again the staff of Karanda have excelled. Some may recall that most of our efforts last time were to try and remove the need for the multiple accounting ledgers that were being used to record information, which some staff member then had to trawl through to extract the data required by the Zimbabwe Ministry of Health. Thus it was particularly gratifying to see that each department with MOIS was still “off book” except for the subset that the Ministry requires in a particular ledger (essentially HIV and TB). It was also incredibly gratifying to see the rapid and almost effortless way the staff were then able to extract the data they needed to (in a minute or two versus hours). Well almost effortless as there was a tiny (but extremely annoying) bug because of Canada being “Letter” and Zimbabwe being “A4” for printers. However after a few hours of: “I should remember how I fixed this!!” I did indeed remember.
It was also heartening to see how the staff adapted some of the workflows I had started. In some cases, they figured out that my way wasn’t working and so they came up with a better, simpler way. As usual everyone greeted me very warmly and generously, despite me being the “MOIS doctor”. It has been wonderful reconnecting with people and they are very patiently re-teaching me all the Shona I had forgotten.
Of course there have also been some hiccups. During this visit, we updated MOIS and, as expected, the update “broke” a few of my workarounds. Nothing I wasn’t expecting and the update now gives me the tools to do the local adaptations properly. However it does mean the keyboard grunt work has to be done. I do have the luxury of doing this in the computer room which is air-conditioned, unlike the other hospital departments and wards. As before, MOIS staff back in Prince George have endured my numerous requests and given me solutions.
This time of year is the rainy season and therefore “cooler” than the 40 degrees we all experienced in Oct 2016. However the fans are still required in the day and are missed when the power goes out. It does get a fraction cooler at night and I commented that this time was the first (on one night) that I actually had to pull up the bed cover. The difference in the vegetation is fascinating to see after the rain, with everything that was brown before now green. However the rains have been less than usual and the season appears to have finished early, which does not augur well for the coming dry. Already the water is being turned off at various times.
Because of rising prices, the hospital has even fewer medications available than before. For this trip, Lori arranged a substantial supply of medications through Health Partners International of Canada (HPIC). Something as basic but as essential as acetaminophen was being rationed before our arrival and the various antibiotics in the HPIC boxes were particularly appreciated.
Tania Bell, a wound and ostomy care nurse at Fort St John Pharmacy and Wellness Centre, joined me on this trip. She is very much in demand. As the Canadian Dr Thistle who works at Karanda full-time says of Karanda, ‘Pus Is Us’. Tania has been organizing all the donated dressings, developing simple protocols so nurses know how and when to use them, and teaching the nurses. She has also been adapting some of the wound-cleaning procedures. The staff at uniPharm, the wholesale company in Vancouver that supplies medications to various pharmacies throughout BC, generously donated many supplies such as eye patches, knee braces, etc. that were gratefully received.
Amidst all these challenges to provide the basics it does seem a little irrelevant to be maintaining computers and printers and training people to use software. However the staff continue to be gracious and hard working and receptive to change. Ray always emphasizes capacity building on these trips and that is our goal. I have more “help” from Ray’s team arriving this week to expand the training, which staff have identified they need. I anticipate a productive week.
Mackey Musical Reflections 2018
For our 2018 Christmas letter, we would like to offer you our playlist for the year.
An anthem for the times. “History’s been leaning on me lately”.
Having already used Twin Peaks’ “It’s Been a Year” we had to find a different song with “Year” in the title. This one describes the ups and downs of life well.
It is no secret that Jeryn is a HUGE Hugh fan and that she is very disappointed that he is performing in Toronto a week after her convocation at Guelph in June. Thea has joined the fan club and this was her favourite song from the movie, which her devoted father is learning on the piano.
In October, Lori met some of her friends and Jeryn in Toronto for a fun weekend. This musical was a highlight.
We were fortunate to have Naomi Shore and Lyndsay Walker perform a house concert for us as part of our “first anniversary of living in Kamloops” house warming. One of the songs they sang was “My Peace River” by Miss Quincy. We felt this particular track spoke to our Peace River roots but also our feelings about settling in our new home.
When asked for suggestions for the playlist Rachelle offered this. How she came to be listening to Bobby Vinten is anyone’s guess. We suspect the choice arose because, having graduated from High School, she was adapting to moving out from the Shenton’s and into residence at Northern Lights College with a roommate who “is in the kitchen calling her friend and yelling at her. And also watching a show at 12. I totally don’t want her to shut up so I can actually sleep or anything”. Karma?
El Paso is one of Lori’s dad’s favourite songs (and we suspect it also made an appearance on JVM favourites) so this is in honour of Jerome coming to stay with us in transition from Drayton Valley to Ladner.
Continuing the Mexican theme, Jeryn suggested this in honour of Rachelle’s Mexican boyfriend Pedro.
It’s not that we hate Winnipeg it’s just there are not many songs that feature the prairie capital. Because Paul was doing a locum in Neepawa (the home of Canada’s only estate brewery) in the summer, Paul, Lori and Thea got to visit Winnipeg, notably the impressive Museum of Human Rights. Thea finally got to see some of Canada east of Edmonton but it became apparent that the landscape all looks much the same from east of Edmonton to Winnipeg.
A road show Cirque du Soleil performance in Kamloops was an event we could take our Chinese home stay student Hera to and we would all be equally baffled and amazed.
If we compiled a soundtrack of our lives, we would include Jann Arden’s music. It was a highlight to see her perform in Kamloops.
Mick and Wal are also on the soundtrack of our lives so it was fascinating to hear them workshopping this track while we were on the safari tour in Africa. Paul made a short trip home in November to attend the Melbourne Cup with family and to drive his Dad and Sandra to wineries. lt was a little surreal for Paul to say hi to Mick and Wal and hear the final product at the Merri Creek tavern. You know you are getting on when the artists you follow are selling tea-towels as merch!
Adam came to visit. And did some fishing.
We saw Frank Turner perform in Vancouver and dragged along Lori’s sisters and brother-in-law. A sincere, high energy concert. This is his “traditional” closing track and so a fitting book-end to our 2018 playlist…
For the encore…
What would a Mackey playlist be without some Billy Joel? This one seems the most descriptive. Jeryn “moved out” of her exchange program at RMIT in June and did some travelling before heading to Fort St John and then back to Guelph. Upon graduating in April she’ll be moving back to Fort St John to work with Urban Systems. Oh and to be with Ted. Liam too will be moving out. He has been home with us in transition between UVic and continuing his studies in January at Thompson Rivers University in Kamloops. Rachelle too will be moving. In January she is moving to Saltillo, Mexico, for 6 months, to continue her studies. And to be with Pedro. Thea is moving but just up, not out. In grade 10 at St Ann’s, she enjoyed playing on the senior volleyball team but is not enjoying being the senior flautist in band. “Those grade 9s don’t know anything”. Paul has been moving around a fair bit doing rural locums: Terrace, Barriere, Clearwater, Fort St John, Williams Lake, Salmon Arm, Chase, Ashcroft and, in Manitoba, Neepawa and Thompson. As a result Lori has been moving around less. She had been doing some pharmacy stints in Fort St John, Keremeos and West Kelowna but has been focusing more on her medical editing work for David Mackey and being a m-uber for Thea.
Life moves on.
Mackey 2017 – The Album
Dear avid readers. In case any of you missed us here is an End of Year sampler as it were, artfully created by Lori and Jeryn.
It’s Been A Year
It’s Been a Year
“It’s been a year since you came and went….”
Recently Facebook popped up a “memory” photo of Liam and Lori on the ferry a year ago as we crossed to Victoria to deposit Liam at UVic for his first year. We then turned around and embarked on our own adventure. (“Have a good year Liam. We’re off”). Sending him off to his second year seemed a little less like abandoning him.
The words of one of Lori’s favourite Twin Peak’s songs spring to mind. Lori had asked Naomi to play it at our joint 50th birthday party the year before but Naomi replied, “No. It will just make you cry”. While the lyrics and the tone of the song are sad and wistful, it does resonate a little as we reflect on the year passed and adapt to our new future based in Kamloops.
It was quite startling how quickly we returned to our old routines. Lori was back at work the day after she arrived in Fort St John; similarly, I arrived back one day then started working the next. Lori and the girls were initially couch surfing but, with our house-sitters away on their own holiday we were somewhat strangely house-sitting in our own house. This at least gave us the opportunity to slowly assemble our stuff in preparation for our final move from Fort St John. I’m sure many are wondering which one will be the last encore!
For me (Paul), arriving back in Vancouver in July was a strange experience. Having spent the last 3 weeks in Katherine on my own, I cut a somewhat lonely figure as I wandered the walkways of the airport en route to immigration and the exit. I didn’t have to explain my extended absence or list of purchases to anyone (but, please, I really want to) as immigration is now a computerized formality (and a far more efficient and welcoming process than Johannesburg for example). As I exited the immigration hall where many other travelers were greeted by signs, flowers and loved ones I caught myself thinking, “So that’s it then?” I walked out onto the street, hopped into a cab and felt like I was rebooting a former life.
But not really. Lori and I agree that our perspective on many things has changed over this year. We have both observed that telling our stories to friends (who have been very attentive and understanding:) has helped us process and consolidate the whole experience. When friends ask us, “What was the best….?” we both find ourselves talking about the people we had the pleasure and privilege to meet on our journey, particularly those who are still struggling with the many difficulties we were able to leave behind on the return to the comfort and safety of Canada.
A visit with a friend offered a framework for trying to encapsulate our experiences. His family uses “high-low”. Because of the context in which he asked it reminded me that a high for me was returning to Karanda and seeing how much of what I had done the year before had persisted and in fact progressed. Given the complexity of setting up computerized medical records and some of the work arounds that had to be used to shoehorn the software into the Zimbabwean hospital environment, I had expected that the system usage would have settled back to a lesser equilibrium. However, it was inspiring to see the hard work and dedication of the staff at Karanda persisting at making MOIS work for them (and the patients) and looking for opportunities to expand its usefulness further. It was here that I felt I had been able to contribute something that might have a lasting effect.
A contrasting low was the struggle to provide care and make a meaningful contribution in the government hospital in Nyanga. The hospital had little to no funding to operate and the patients had no money to pay for care. I often repeat the story of only having one bottle of propofol and thus having to choose which patient would get it for his or her operation. Despite this, the very skilled staff there endeavored to provide the best care possible. The low for me was being overwhelmed by the lack of resources and the feeling of not even knowing where to begin to try and improve things.
The personal highs for me were many and almost impossible to choose between. The one that sticks, though, was the unexpected opportunity to visit the Bungle Bungles. It had always been a place that I had seen pictures of but I had thought I would never visit because of its remoteness. It was cousin David pointing out, “But Kununurra is only 5 hours from Katherine” that provided me the opportunity and the impetus. I comment that the Bungle Bungles is one of those places, like Uluru and the Grand Canyon, that, while spectacular in photos, are mind-blowing in person.
I must add that I also find myself thinking wistfully of my regular swims at Edith Falls and the Bay of Fires. As we recently stood in Paul Lake amongst the mud and reeds Thea was moved to comment, “Well it’s not quite Binnalong Bay”.
For Lori, working with the pharmacy staff in Karanda was a high, especially as they were able to transition off paper and onto computer while we were there. The dedication, enthusiasm and good humour of the pharmacy staff (despite the heat!) was inspiring. As was the lovely thank you letter they gave us. A low for Lori came in Uganda as the pangs of homesickness coloured the juxtaposition of living so close to poverty while in the presence of such incredible natural beauty and warm, friendly people.
In case you hadn’t noticed Lori really liked Tasmania especially being able to entertain our many visitors and to show them all the places that had quickly become our favourites.
Thea says her highs were building the mud hut, snorkeling at the Barrier Reef, visiting the Harry Potter Experience (of course) and going to the twenty one pilots concert in Melbourne with Uncle Simon and cousin Katie. Both Thea and Rachelle felt that building the hut was one of the few times they were able to contribute in a substantial way.
Additional highlights for Rachelle were the Kenyan Safari (we don’t think it was the listening to Mick Thomas sing part:), especially the baby lion cub and the small plane flight from Entebbe to Bwindi along Lake Victoria and over the lush Uganda countryside. She found it disquieting sticking out so much while we were in Nyanga and Karanda and some of the negative attention that afforded.
While we felt we were intellectually prepared for the experience, the struggle to volunteer in a meaningful way in the face of so much need in so many places was disheartening at times. Sometimes the infrastructure was so poor that we couldn’t even take the easy option and financially contribute. In Harare we tried to buy a very overpriced local soccer team jersey for Jeryn’s boyfriend, Ted. However, the store couldn’t get their debit machine to work and cash was so hard to come by that we couldn’t afford to part with that much.
In Bwindi, Lori observed that banking and micro-finance is what the community appeared to need the most. There were many who were entrepreneurially struggling to advance their lives and those around them but were being held back by the lack of a financial structure to realise those dreams. It did seem counter-intuitive that, in the face of the struggle to find shelter, food, clean water and sanitation that finance would seem the solution. However, as it was pointed out to us, if you don’t have anything to provide as collateral for a loan then you are trapped.
In Zimbabwe it was more dire. It is estimated that more than 90% of the economy is now underground or bartering. If commerce is not happening then there is no taxation and therefore government wages can’t be paid or infrastructure attended to and so the system spirals further downwards. Corruption and ineptitude and the upper levels of government and administration contribute to the collapse further.
The success (and safety) of our year away owed so much to the incredible generosity of friends both in Canada and Australia, but also those acquired on our travels. We really were very fortunate in that we were never knowingly at risk and that we remained in good health throughout. It both gladdens (and saddens) us when we hear from the many incredible people we had the privilege to meet and work with while away. The generosity has continued on our return. Our summer seemed to come full circle when Lori and I stayed at Coral and Ted’s at the end of the summer as that is where she and the girls first landed back in FSJ. Thanks to Laurie and Stephen for allowing us to consolidate our accumulating boxes in their garage, which made moving day much more straightforward. Thanks to John and Janine who looked after our house so well while we were away and shared its space and their moose meat when we got back. Thanks to Robert and Rhonda for hosting Lori. Thanks to all those who have fed us, who have listened to our stories, and who have helped us pack up and move. It was gratifying for both us to be able to jump back in with work and friends over the summer and we are both relieved that we have been “replaced” in Fort St John and that our patients are getting looked after. It also gives me great joy that the BC North Model Railroad Club has taken over the care of the train at the clinic. Thanks also to Monica in Kamloops for all her help with house-hunting. A special thanks to the piano lifters who ensured the baby made the transition safely!
What lies ahead? As I (Paul) write, Thea and I are mostly settled into the house in Kamloops though there are many boxes (mostly of books it appears!) to sort through. Lori is finishing off her stint in FSJ and will be joining us soon. Liam has made it back to UVic to start his 2nd year of Creative Writing. Jeryn is back in Guelph to start her 3rd year of Landscape Architecture. Rachelle has moved in with (very accomodating) friends in FSJ to embark on the family experiment of her completing grade 12 in FSJ. Thea started grade 9 at St Ann’s here in Kamloops. Soon after she arrives here, Lori heads further south to the pharmacy in Keremeos for a week. Come the end of September I start my itinerant career with a locum stint in Terrace. It will definitely be a transition for us, especially having been in such close quarters for a year. While it was special to be back together as a family (and with good friends) in FSJ over the summer, we have both commented that the move still feels the right thing to do at the right time and we hope to be able to contribute to more communities in this way.
And I find myself strangely looking forward to a winter…….
PS Wishing Twin Peaks a highly successful tour in Australia. Check out their dates here..www.twinpeaks.ca
As many of you are aware, Lori, Rachelle and Anthea have made it back to Canada and have left me here in Katherine to batch it for the last three weeks. As I write this (and hope to complete this) I will be in my last week here.
It has been a strange transition to being alone after being in each other’s back pockets for nine months. The unit seems strangely large, empty and quiet. It’s probably telling that I have heard barely two sentences from Rachelle and Anthea since they have been back with their friends. Anthea’s comments have mostly been limited to exhortations to shave off the beard that I have allowed to grow in their absence.
Working in Katherine has required its own degree of adaptation. To improve patient safety in the ER they have created a new position of ER Senior who is present in the ER during the day and then on call overnight. Due mostly to my grey hair I think, I have been doing many of these shifts and on-call as well as anesthesia on-call. Even though I initially trained in Australia I have not worked very much here and certainly not at all in the Top End. Thus, my level of “experience” is low in this environment. Adding to this is that the spectrum of disease here is quite different not only to Canada but to the rest of Australia. As I have been wont to say, “I know lots about frostbite but not so much about snakebite”. I thought I was intellectually prepared for many of the health challenges in the Northern Territory but the realities of diagnosing Rheumatic Fever and Post Streptococcal Glomerulonephritis and admitting so many children with dehydration from Rotavirus in a country as wealthy as Australia was nonetheless startling and disheartening.
Working here has tested my knowledge and skills, probably more so than working in Uganda and Zimbabwe. Part of the reason for that is that, in Uganda and Zimbabwe, I was very clearly the less experienced with a certain limited skill set that I was offering. In Katherine, the lines were less clear. I found it a significant challenge to be “supervisor” for many who have far more on the ground and local experience than me. Likely adding to this is 20 years of working in Rural Canada which means working predominantly solo and only having to be responsible for myself. While I have supervised Family Practice Residents the training and work structure is significantly different enough to make the supervision required different enough.
I have somewhat paradoxically found it less disquieting to be on call for and attend major life threatening anesthesia emergencies than to be the senior on call for the ER. I think this is in part because, in the anesthesia position, my role is very defined and I have a certain area of expertise for which I am responsible. In the ER position I am also responsible for a lot of other people and it’s not a role I have had a lot of experience with.
That being said, it has been an incredibly valuable experience for me working in an ER staffed with several doctors. Sometimes we would be tripping over each other as physical space is limited, but the opportunity to bounce ideas off colleagues and have someone else have a second look has been invaluable. I think the patients benefit from this as well.
As the gap year draws to a close there are many things to reflect on. It is hard to distill what I have learned into a few words. When setting up this final job in Katherine I did joke that, what working in Africa did teach me is that, as a family, we do need our separate time (especially Rachelle and Thea) and thus going to work in an even more remote community in the Northern Territory would not have been wise. As it was, they were probably not here in Katherine long enough to get their own space.
What this year did give me was an opportunity to work with Lori. In FSJ, while we would chat back and forth about work things, we were always working in our own work environment. In Zimbabwe and Uganda we had the opportunity to work on things together and to troubleshoot issues. It made it all the more worthwhile making small contributions to projects she was working on.
Outside from work we all very much benefited from Lori’s approachability and social awareness. It definitely helps that she is very good at remembering names and effortlessly covers for me when I don’t. Truth be told, as per these three weeks, I don’t really mind my own company and could easily be a hermit if given half the chance. However, Lori was always out there meeting people and finding out ways to engage, be that the Basket Weaving and Gorilla Mask Making in Uganda, the Dingo Lady in Tassie, or Aboriginal painting in Katherine. It was great to go to an art exhibition here in Katherine (OK so I did go out occasionally once she had left) and recognize one of the artists who had “taught” Lori and the girls and so we were able to have a chat.
A final solo highlight, and possibly the greatest highlight of the whole trip for me (big statement I know) was a visit to Purnululu National Park and the Bungle Bungles in Western Australia. I had thought that I would not ever get there but cousin David remarked to Lori, “Why doesn’t he just drive there from Katherine?” So I managed to link together 3 days off, drove the 500km to Kununurra, did a tour flight over, down to and a walk amongst the Bungle Bungles then drove the 500km back the next day (stopping about 30 times to take pictures of Boab trees). Breathtaking, remarkable, stunning. The words (and the photos) just can’t do it justice. It is one of those places that you read about and see pictures of but to stand there amongst them was overwhelming.
That’s about enough from me. Here are some thoughts Lori penned before heading home. We had hoped that Rachelle and Thea might also share some profound insights on what they had learned from the year….
I knew it was unrealistic but I had hoped the extended togetherness these past 10 months would knit the four of us closer together. I had imagined that our communication would improve and any irritating habits and mannerisms would wear away. Alas the travel and often extreme conditions just seemed to accentuate any pre-existing issues. Paul and I have completed enough flights to Australia and back with small children and their inconvenient luggage that travelling with two teenagers does not tax our teamwork. I gained even more appreciation for his organizational ability when all his hours of booking flights, visas, accommodation, and transport were realized. He invariably gets asked directions in a foreign city (in fact it’s sort of a badge of honour!). Even being confronted by immigration officials in Johannesburg demanding full birth certificates for Rachelle and Thea didn’t overly fluster him as he had scanned copies on our home computer that were available on the cloud.
It was enlightening to observe his respect for all patients and other healthcare professionals he came in contact with, regardless of their age, disability, social status, and language or cultural barriers. He managed to brainstorm ways to contribute, even if it was as simple as taking inventory in an OR, fixing an ECG machine, or playing ukulele for a group song. He took every opportunity to learn about the local medical concerns, operational systems, and history. There were days I was less motivated to be a tourist but his enthusiasm kept me going. He dealt with the irritation of whatever parasite he picked up in Europe and the pain from his vertebral disc injury stoically. I am so grateful I approached him in that hospital cafeteria so many years ago – it has made my life very interesting.
Understandably Rachelle and Thea did not get along better on the road than at home as they often had to share a bedroom and share the laptop for schoolwork. Probably their one uniting emotion was their frequent annoyances with Paul and me. OK the time I told the guy trying to sell skin products in an airport that I actually prefer if they are tested on animals probably did warrant some embarrassment on Rachelle’s part.
Rachelle was always willing to pose for a photo though and certainly expanded the range of foods she was willing to eat. Thea was a good sport about most things but it was clear that both girls desperately missed their friends and just hanging around others their own age. It was gratifying to see them both become a bit more outgoing and comfortable talking to people we met and wonderful to watch their interactions with the young children at the Redemption Song Foundation soup kitchen. Many of our friends also have teenage children and it was fun to get to know them a little one-on-one as individuals rather than the earlier random whirlwind toddlers or tweens. Our friends’ kids were uniformly welcoming to our girls and we are impressed with the maturity, keen sense of humour, and high emotional quotient of the current generation we met. The girls have been keeping in touch with several new acquaintances via snap chat and Instagram and I hope these connections can persist over time and they can get meet up in person again in the future. It was heartwarming to spend some extended time with the cousins and in-laws and to tour around the Margaret River area with Paul’s Dad and Sandra and for Paul to take the train with them.
For me personally I don’t think I became more attuned to issues of poverty, disease, and malnutrition, because I had a high level of awareness and concern. However, the scale of the problems in Zimbabwe and Uganda are certainly more real to me and I almost feel less optimistic than I was before. Obviously actually witnessing poverty and meeting numerous patients with chronic illnesses affects one deeply and at times I just felt overwhelmed and hence impotent. I did try to learn what I could about HIV, malaria, and TB and I also had time to read several books on the history of South Africa and Zimbabwe and about effective volunteering and aid programs. I do think I will buy even fewer clothes than I did before and have a higher threshold for discarding them. Despite ample time, I did not learn to operate our camera better but I did learn a few photo editing techniques and acquired a few more chords on the ukulele. I was pleased to have many CE lessons to review for CCCEP and some other editing work to do as well.
The first half of our trip certainly took me out of my comfort zone; I was often physically uncomfortable and emotionally stretched. I cried the first time I heard the nurses singing at Karanda, because it was so achingly beautiful in the midst of so much deprivation and disease.
I decided I feel ‘at home’ when I know where to get groceries and do laundry. We recently listened to an interview with a British writer Geoff Dyer and he had a great comment about how he likes to travel but he likes to be settled in one place for a while and have his own kettle and tea pot each morning (he said it more eloquently and humourously). I definitely prefer being based in a spot and doing trips from there versus constantly being on the move as we were in Europe. When we arrived in Katherine I was ridiculously pleased to unpack the coffee press and glasses and beach towels we had mailed from St Helens before we left Tasmania.
The experiences I enjoyed the most were not the ones that were strictly esthetic – looking at paintings or wildlife or taking in scenic vistas while hiking. The most enjoyable experiences had at least some element of interacting with another person, e.g. meeting an artist while at an art show in Harare, chatting to fellow hikers while hiking the Cape to Cape, visiting with friends while watching the sun set.
Can I work a full day again?
Why do my least favourite underwear not wear out?
Things I wish I hadn’t packed: jeans – too hot for Africa and Australia and too cold for Europe (could not fit another layer underneath), ready sarcasm, .
Things I was surprisingly happy I packed: Canada pins to give away, plastic toothbrush cover, Wizard card game.
[In case anyone was following along here are the final results of the 10 month long Wizard Tournament: Paul: 4740, Thea: 4640, Rachelle: 3510, Lori: 2910 (she would much rather play scrabble)]
Things I wish I had packed: nail brush (especially for after building the mud hut).
Things I did that I wouldn’t have thought I could: drive along the Great Ocean Road and in Melbourne without a crash; hike almost 60 km of the WA coast, carrying all my gear for 2 of the 4 days;
Things I thought I would be better at than I was: teaching pharmacology to nursing students; bouncing on giant inflatable water toys; helping with homework
Nonetheless the four of us will have many shared jokes and sayings and I’m sure the experiences will percolate through our consciousness and affect us positively over the years to come. A telling book end to the whole experience and an illustration of how imbalanced the world still is was our departure from Katherine to Darwin. On the Bhodi Bus Rachelle, Thea and I were very much the visible minority on board.
Waterfalls and Water-fails
Waterfalls and Water-fails.
The Northern Territory has a plethora of beautiful waterfalls that change dramatically in volume from the wet to dry season. We spent 2 days in Litchfield National Park, enjoying the various waterfalls and pools and marveling at the cathedral, tree piping and magnetic termite mounds, the latter resembling haphazard tombstones. Mataranka, an hour south of Katherine, has relaxing thermal pools, and Edith Falls, 60 km north of Katherine, provides a stunning setting for swimming at the upper and lower falls. It is strange for us that the water temperature at the waterfalls is so pleasant for swimming when we are used to braving much colder water when swimming outdoors, e.g. Horseshoe Lake in Jasper. Indeed, the outdoor pool in Katherine is almost uncomfortably warm for swimming laps. The Katherine Hot Springs have replaced Binalong Bay as our excursion once Paul’s work day is over. It is great being able to walk to the springs and the water there is friendlier than the ocean. However, we have to share the springs with many more people and the scenery, while pleasant, is not take-your-breath-away like Binalong. However Nitmiluk Gorge is only 30km away and we have enjoyed a sunrise cruise along the Katherine River as well as a hike along part of the rim.
The girls and I booked a cultural experience one morning in Katherine. Trying our hand at painting under the direction of Manuel, an Indigenous artist, we gained a much greater appreciation for the skills and techniques involved. Our efforts at lighting a fire the traditional way were ineffective whereas Manuel started a fire in less than a minute. We also failed at throwing a spear with a woomera. Although Manuel’s parents had come from Arnhem Land, he has never been there himself and it seems very unfair that the girls and I have. The interesting morning ended with the girls cuddling wallaby joeys that had been rescued by the couple who organize the cultural experience. The girls also spent a morning doing some weaving at an Aboriginal-run art gallery. Whereas when we did weaving in Uganda we used purchased raffia, Dorothea taught the girls using pandanas leaves she had dried and dyed in the traditional way. It is reassuring to see that some of the Aboriginal traditions and languages are persisting but distressing to see that, as in Canada, Aboriginals rank lower than the general population in measures of health, education, and income. In his book The Great Race David Hill describes the separate expeditions by the Frenchman Nicolas Baudin and the Englishman Matthew Flinders to map the entire coast of Australia. Baudin was incredibly prescient for stating to King, a governor of the English colony, “To my way of thinking, I have never been able to conceive that there was justice or even fairness of the part of Europeans in seizing in the name of their governments, a land seen for the first time, when it is inhabited by men who have not always deserved the title of savages or cannibals that has freely been given them; whereas they were still only children of nature and just as civilized as your Scotch Highlanders, or our Breton peasants, etc., who, if they do not eat their fellow-man, are just as objectionable.” In 1802 he predicted that assimilation would not work and the marginalization that is present today confirms it. I don’t have any answers but we have at least tried to support the Aboriginal-owned businesses while we have been in Katherine.
War memorials in Australian towns and cities are well maintained and visited. However, in the Northern Territory, there are many actual sites pertaining to WWll. We did not get to the war museum in Darwin but did go to the Bombing of Darwin experience on Stokes Wharf, which gives a very vivid representation of Feb 19, 1942 – the day Darwin was first bombed. Well vivid for everyone except Lori who didn’t realise her VR goggles weren’t working except right at the end. Darwin was bombed on 64 occasions and even inland sites such as Katherine were bombed. En route between Darwin and Katherine there are several WWll air strips. The war cemetery at Adelaide River an hour north of Katherine is the fourth largest in Australia. We were moved viewing the grave of the sole Canadian soldier buried there as well as those of other soldiers and civilians killed during WWll. Katherine itself was basically taken over by the military in WWll and the hospital moved and expanded to over 800 beds. The site of the officer’s mess hall later became a family home and is now a National Trust site. There continues to be a Royal Australian Air Force (RAAF) base near Katherine, named after Archie Tindal, the first RAAF member killed on the Australian mainland by the Japanese in WWll. We often hear the F/A-18 Hornet jets training overhead and the Air Force members are distinctive in their blue camouflage when they are running errands in town. My great uncle Wilfred Schrempp was posted to Australia as a communications technician in WWll. I am keen to find out where exactly he was stationed as no relative still living seems to know for certain (I have to request his records in writing from the office in Ottawa so will do that when we return.)
Paul and I wandered over to the local footy oval on a Friday night – still 25 degrees at 7:30 pm. The games were free-flowing and exciting to watch. While the teams were not very mixed racially, we were pleased to see that no team had obviously inferior gear on contrast to our experience of watching soccer in Zimbabwe. It was fascinating to hear the Indigenous players conversing in their own language.
In just over 5 months in Australia we have been to mass in 11 different churches ranging from cathedrals in Bunbury and Darwin to a corrugated iron church in Adelaide River. People have been very friendly, twice we have doubled the congregation, and one priest even congratulated Paul and I on our anniversary (apparently I look like one of the teachers at one of the schools).
We have delved into the Australian music scene a bit. Our friend Sue introduced us to the music of an undefinable band The Northern Folk (her nephew from Albury is one of the members). It is an 11-piece group with sassy sax, brash brass, and exquisite harmonies (thenorthernfolk.com.au). When we were in Echuca, we listened to some songs of Isaiah Firebrace, a teen from Moama who won the 8th season of the X Factor Australia in 2016 and was Australia’s contestant in the Eurovision 2017 competition. No that is not a typo. Australians have been so engaged with the Eurovision contests that their country was given a spot. Isaiah has an appealing look and sound and we hope this is just the start of an exciting career as he could be a mentor for other Aboriginal youth (His father is Yorta Yorta and his mother Gunditjmara). While we missed out on a Jimmy Barnes concert in Launceston and did not manage to see Mick Thomas perform on Australian soil, we were very happy to hear Colin Hay (from Men at Work), Debra Conway, Joe Camilleri, and Mental as Anything perform in Darwin. The concert was sponsored by APIA and we were a little chagrined to learn it is the Australian Pensioners Insurance Agency. That was a reality check we didn’t need. On that same trip up to Darwin Lori discovered a new way to gracefully enter the water (not).
Next on the music agenda is listening to the new album from My Friend the Chocolate Cake (www.MFTCC.com). Thea is still heavily into KPop (Korean Pop), which Rachelle does not appreciate. Since the girls went to the twenty one pilots concert in Melbourne we have been listening to more of their music; this group and Ed Sheeren are two artists we all enjoy. While I remain unashamedly mired in the 80s, I do think Ed Sheeren has almost single-handedly redeemed the current decade’s musical contribution. Shania Twain, and other country music, is popular here in the Northern Territory. On a home music scene, I have not progressed much on the ukulele. However, we are thrilled that Thea has been able to continue with flute lessons from the amazing teacher in Launceston via Skype.
While we arrived too late for the fresh mango season, I am loving the frozen and dried mango we buy at the weekly Saturday market. I am a bit like Bubba and the shrimp: mango chicken, mango muffins, mango pork, mango on my cereal, and I had an amazing tropic burger at the Lazy Lizard Tavern – mango, feta cheese, beef patty, and rocket lettuce. Most innovative, tastiest burger I have eaten in years. Then just when I thought I had tried all permutations and variations of mango, I discovered mango and macadamia nut popsicles – sensational.
In some respects, Katherine has a similar vibe to FSJ – a relatively young demographic, a certain pride in being at the extreme of climate, and an agricultural/ranching community in the surrounding area. We toured the Katherine School of the Air one day, which meets the educational needs of students on remote cattle stations and islands of the Northern Territory as well as children of Northern Territory families travelling or working overseas. Coincidentally one of the teachers at the school had spent 4 summers working on ranches near my home town of Pincher Creek. Paul teases me about how I strive to find someone that I know in common with any new person I meet but this instance seemed particularly unlikely.
Paul’s back and leg pain are gradually resolving, although the day shift followed by three 10-hour night shifts was very tiring for him. He feels he is too old to do night shifts and was relieved that he wasn’t scheduled for any others when the latest roster came out. He no longer needs his walking stick, is able to walk more fluidly, and finds that he simply gets tingling and a mild ache in his leg when standing. He is finding the Katherine ER staff excellent to work with and appreciates having other docs around to bounce thoughts off and that transferring a patient out tends to involve a laconic discussion with an agreeable specialist in Darwin rather than the sales pitch that he often has to make when trying to convince reluctant specialists in Vancouver, Prince George, or Edmonton to accept a patient.
Thea is relieved to be finished her distance education courses through SD 60. This option worked well for her and she had very supportive teachers. She plans to fill in the rest of her days putting together two videos pertaining to our trip. Rachelle had more difficulty completing courses because hers were more content-heavy and she learns better as part of a group (and not with her parents as teachers!). Schoolwork aside, she kept us entertained along the way with her handstands in freaky places (I usually couldn’t watch) and her canny imitations of accents, particularly the ones on Tasmanian TV commercials. They have coped remarkably well with living out of a suitcase, although they are very fed up with their current clothes despite a few additions and deletions along the way (often inadvertent on Thea’s part: two hosts have graciously forwarded items of clothing she left behind to Katherine.)
The girls and I have only I week to go in our gap year because we are heading back to Canada a bit sooner than Paul; he is staying on until the end of June. We are pleased to have a final visitor, a long-term friend who is flying up from Adelaide. We are all looking forward to being “home” even though we are actually home-less. As well we are all looking forward to catching up with friends and family as we try to reset ourselves back to a routine in the northern hemisphere.
Back Out in the Outback
Back Out in the Outback
We made the most of our remaining days in Cairns. I walked through its beautiful botanical gardens with two other spouses from the conference. The girls and I really enjoyed Hartley’s Crocodile Experience and learned the difference between salties and freshies while Paul attended his last day of the conference and participated on a panel about anesthesia procedures in rural settings. Our flight to Darwin was our last within Australia (I took a total of 14 domestic flights over the 4 months) and almost our last car rented (in 4 months we drove a total of 10 unfamiliar cars). It was HOT and still humid, although the dry season had officially begun! It is so different to the dry heat I was familiar with from living in Echuca and the dense vegetation is so different as well. Rather than eucalypt, one smells frangipanni and other tropical flowers. With their fronds lifted overhead on their branches, the pandanus trees look to me as though they are cheerleaders.
While Cairns seems mostly about tourism plus some sugar cane production, Darwin appears much more a working city – fruit growing, uranium mining, LNG, military (Australia, US, and occasionally other countries), with some local tourism as well as tourism to Kakadu National Park and points beyond. There are no old buildings in Darwin because 80% of the structures were wiped out by Cyclone Tracy in 1974. The present architecture incorporates a lot of primary colours, well suited to the climate. Compared to Melbourne, the people are much more likely to greet you and much more likely to wear white than black. I can’t pin the vibe down. There is a cosmopolitan element rubbing up against a frontier element – high heels/dress shoes vs bare feet/Blundstones. Similar to Tasmania, the TV ads in the Northern Territory aren’t known for their subtlety.
It is striking how heterogeneous the population is, especially compared to the homogeneity of Tasmania where the local Aboriginal population was exterminated and fewer immigrants flow in. Darwin is home to Chinese (most recently dating back to gold mine days but there is evidence Chinese and certainly Indonesians arrived before European explorers), Indians, Filipinos, Vietnamese, etc. The percentage of the population that is Indigenous is much greater in the Northern Territory. It is distressing to see how marginalized they are. In Darwin, it almost appears that there are two parallel societies, somewhat reminiscent of our brief exposure to South Africa without the underlying threat of violence. While some individuals must cross between the two societies, it disheartening to see the wonderful Aboriginal designs appropriated for all manner of gifts being sold in stores that do not directly employ Aboriginals (and I have naively purchased such gifts both in Canada and in Australia).
We took a 2-day tour from Darwin, spending the first day in Kakadu. We saw many species of birds on a cruise that traversed part of the South Alligator River, named by a cartographer who had been working in the Americas and assumed the animals he was seeing were alligators, when of course they were crocodiles. On the second day, visiting Arnhem Land (an Aboriginal land that also warrants a name change as it is named for one of the Dutch explorer ships, which was named after the town in the Netherlands) was a highlight for all four of us. I even enjoyed wading through the water and climbing up to see some rock art (but was relieved not to acquire a leech although Paul was not so fortunate). We were interested to hear from our guide that more Aboriginals in the Northern Territory have retained their languages and spiritual traditions compared to those in other states of Australia. It was also refreshing to visit Injalak Arts Centre (http://injalak.com ) in Gunbalanya that directly benefits the many artists who work there in different media, including print-making, and provides an opportunity for collaboration with textile workers in Cambodia.
I had not read enough to understand the wet and dry season in the Top End versus the usual seasons elsewhere. Lushness is still present as the wet season winds down and seeing the acres of lilies in the waterways in Kakadu and Arnhemland was like a scene from Voyage of the Dawn Treader. It is difficult to imagine the many waterways in Kakadu drying up. The dry season is aptly named: 7 months with virtually no rain. The consistency of the weather is a bit disconcerting to people who have experienced three seasons in one day in FSJ.
The 320 km drive from Darwin to Katherine was eerily similar to travelling in Zimbabwe – relatively flat, red-soil terrain interrupted by numerous large termite mounds and areas being burned off. However, the flora is much more diverse and the highway is much better maintained compared to Zim. The speed limit is 130 km/hr and when the large road trains (a semi pulling three or even four trailers) pass, one’s ear drums note the change in air pressure. There are few curves in the road, another stark contrast with Tasmania. The population density of marsupials is lower than in Tasmania and thus the road kill rate is much lower, with butterflies the most common casualty we witnessed.
Katherine began as an outpost for the Australian overland telegraph route, has a population of over 6000, with fruit and vegetable production and some cattle ranching on surrounding properties, and gold mining, and it is the nearest base to explore the Nitmiluk Park/Katherine Gorge. Katherine had its own catastrophe in 1998 when much greater than normal flooding of the Katherine River required many people to evacuate and a great deal of reclamation afterwards.
Our unit in Katherine feels very spacious, with three bedrooms and two bathrooms. Rather than herons outside our window as we had in Zimbabwe, here there are whistling and black kites and red-tailed cockatoos. We live less than 1 km from the free local hot springs, which are only tepid compared to Liard Hot Springs but when the ambient air temperature is 30 degrees at 5 pm, tepid is fine. A pop-up café sets up near the springs each morning and has become our ‘local’, especially for Rachelle and Thea as there is free Wifi there. There are some trails along the river for running and cycling. The town has a 50 m outdoor swimming pool. It is funny to us Canadians that the pool is not open for lane swimming in the early morning hours in the dry season because it is too cold out (i.e. 20 degrees at 6 am). Tourism is ramping up in the dry season, with tourists of many nationalities driving Land Rovers and stocking up on supplies in town.
We are getting quite a few mosquito bites so I purchased some insect repellent that is 80% DEET just because it was available. Rather frightening when the directions read: Avoid contact with eyes, mouth, cell phones, spectacle frames, other plastics, painted surfaces, vinyl seat covers, and synthetic fabrics.’ ‘Dispose of empty container by wrapping in paper, placing in plastic bag and putting in garbage.’ Sounds like the stuff should come with HAZMAT training; I didn’t anticipate that wearing repellent was going to be one of the most dangerous undertakings of the trip.
At the time of posting Paul has completed his first two weeks at work. We were worried that Paul’s disc problem would preclude him from working as planned but he is coping so far although the 10-hr evening shifts are going to be a challenge. His mum’s expression of her leg “tiring out” from her back problems seems the most descriptive. The hospital is reasonably well staffed, with medical students and residents rotating through. He is appreciating the opportunity to work in an emergency department with other medical staff on duty as it helps the exchange of ideas, which in turns enhances the patient’s care and helps mitigate that feeling of being overwhelmed. It also helps that the NT emergency transfer service, CareFlight is very efficient and appears well resourced so that the truly sick patient who needs transfer to Darwin achieves that transfer quickly. There are the challenges of providing care where the underlying issues are the social determinants of health or lack of community supports; however, these problems present with their own local flavor peculiar to the Northern Territory and, in particular, the at-risk Aboriginal population. The hospital serves a resident population of about 19,000 (of which 85% are Aboriginal) as well as the 500,000 visitors per annum. These “Grey Nomads” (as they are semi-affectionately referred to in Australia) obviously present their own health challenges when they have need for emergency care. All these elements are part of the learning curve, as well as adapting back to shift work from the regular hours of East Coast Tasmania. Everyone has been gracious and kind as he hobbles about with his hiking stick shortened to function as a cane, even the one patient who exclaimed, “You’re not House so don’t go poking me with that thing!”