Sunday, September 30, 2012

Three Years and the Night After

Three weeks ago we celebrated the sixth wedding anniversary of our friends  Marja and Claudio.  We went out to a very nice restaurant and toasted them in glasses of French champagne and Chilean wine-
        "To love - "
        "To a lifetime -"
        "To memories of happy days and happy nights - "
 Claudio leaned back in his chair and looked at his wife and sighed mistily.
        "Six years ago today, Marja, I carried you across the threshold of our first apartment -"
        "After we'd walked up five flights of stairs - "
        "There was no elevator and our apartment was on a narrow landing -"
        "With only a railing over the stairwell, and you had to be very careful not to tip me over the edge as you picked me up and swung me around to get through the door!"
        "And then" Claudio smiled slyly,  "I carried you inside for a night of wild nuptial bliss!"
Marja and Claudio looked at each other fondly and held hands under the table.  But they didn't meet my eyes.  I narrowed mine, and leaned forward.
        "May I ask a question?"
        "Absolutely!"  Claudio waved expansively, and poured himself another glass of wine.
        "DID you have a night of wild nuptial bliss?" I said. "I don't know of a single couple who, in real life, on their actual wedding night, actually did.  A wedding is mostly this huge, stressy, organized-to-the-walls THING, and even if it isn't stressy or messy, the party afterwards is generally pretty epic, and by the time you've escaped from the guests and gotten back to your room, any reasonable person just wants to go to SLEEP.  I reckon that there isn't actually a single wedded couple  - at least, any a couple that isn't required to produce proof of consummation in the morning, or isn't 18 and invincibly horny - who DOES consummate their marriage on their wedding night!"  I sat back and took a deep breath.  "There."  I said.  "A speech."

Marja and Claudio looked at each other.  They looked at me.
        "To answer your question," Claudio said slowly, "We did NOT.  To be honest, I didn't even carry her very far over the threshold."
        "About three steps." Marja giggled.  "Then he fell over. It was two o'clock in the morning when we got upstairs, and it had been a  LONG day!"
        "First I picked her up at her parents house - at noon -"
        "And then we went to the courthouse -"
        "And then the church -"
        "And then we had a party -"
        "A REALLY good party- "
        "And after THAT, lifting her up to carry her across the threshold almost floored me. We sort of OOOZED across, with her feet about an inch above the floor -"
        "And then we went to sleep."  Marja grinned.  "But the day afterward - THAT was another story."

Mr Tabubil and I were married at ten o'clock in the morning, barefoot, on a beach.  We were married out of a small hotel in Titikaveka on the Island of Rarotonga, and after the ceremony, we and our few beloved guests repaired to the hotel's little restaurant for a truly EPIC wedding breakfast.  The weather was tropical hot and  tropical sticky, and when the party floated to a finish, Mr Tabubil and I, drowning in our splendid wedding togs, dribbled upstairs to our room, throwing promises behind us to see everyone again on the beach, in an hour - just enough time for a shower and a change of clothes and the briefest of restorative shut-eyes- that's all -

In our room we barely had the strength to close the door and slip off the dress and the suit before we fell face-down on the bed and fell asleep, his hand on mine, clasped together over our fine new rings.
We woke up three hours later to the sound of laughter and splashing below our window.  We slipped into swimsuits and went down to join our guests and only came out of the water when the sky had turned red and the sun was setting over the reef. 

Upstairs again, we discovered that while we were down in the water, the housekeeper of the hotel had crept up into our room and laid out a wedding tableaux.  Two cane chairs had been dragged over to the window and turned so that they faced the sea.  A small table had been placed laid between them, and laid with my wedding flowers, a candle and a box of matches and a bottle of champagne.  Over the back of the chair she had draped a brand new pareo, in the same shades of blue and purple as the water outside.  The bed had been turned down for sleep, and as a final touch, the housekeeper had gone into the closet and found a lacy little bit of nothing that I had brought with me in my suitcase, and she had smoothed it flat and laid it out across my pillow.
It was perfect.
But this wasn't an evening for romance.  We were new-married in paradise, but we were also in the middle of a one-week window where we had the north American friends that we loved best in the same place as ourselves, so we dried ourselves  off and walked across the road to a little cottage where our Canadian friends were staying, and a rather splendid after-party burst into the black tropical night like a catherine wheel.

We crept home again at three in the morning, and slipped into bed and fell straight asleep.

When we woke the sun was high in the sky, and looking around the room at the untouched wedding tableaux, we felt a terrible remorse.  The housekeeper had spent such time and shown such kindness setting up the perfect nuptial night, and there we were, the unspoken wedding cliché, and all her efforts wasted.

So we stepped into the breach.
Mr Tabubil dragged the chairs around to face each other and lit the candle to blacken the wick and blew it out again, and dropped the spent match on the table.  I wadded the freshly pressed pareo into a ball to crease it, and pulled it straight again, and dragged it across the floor half-way to the bed and left it there.  While Mr Tabubil twisted our bedsheets and pillows into a perfect storm of acrobatic disarray, I took the lacy bit of nothing and wadded it up and shoved it underneath one of the pillows - and considered it, and took it by the corner and dragged it out again and left it hanging artistically half-way down to the floor.

We looked at the chaos and smiled.  We'd said thank you.  In the best possible way - with a tableaux to match her own. 
And Mr Tabubil took my hand and we went down to breakfast.

Happy anniversary, Mr Tabubil.  It's been three wonderful years.  Here's to another three, to match Marja and Claudio's six, and three more after that and three score times three -
Here's to happy days and happy nights -
To love and to a lifetime.

Friday, September 28, 2012

The Dr Tabubil Files: Leaving Cloncurry

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts all about living and working in the Red Centre.  Enjoy!


My time in Cloncurry ended with a bit of a bang. On my second last day, I walked the quarter-kilometer home to my loaner house for lunch, and somewhere in the near distance, there was  an enormous cloud of black smoke  climbing up into the sky.   It was as near as the other side of town, but I could not smell any smoke in the air.  
            A fire clearly, but the wind was blowing in a northerly direction, and I was eastward of the fire -
            I didn’t have the courage to grab my car and drive over to see what was going on.  Bush-fires in Australia are Dangerous.  It’s the triple threat combination of dry air, strong wind, and tall grass.  When the big bush-fires hit, lives can be- and often are - lost.  The worst, and most recent fires have been the Black Saturday fires that took over whole swathes of Victoria in the dry February of 2009.  Those fires took out whole towns, and 174 people died.  
            This one must have been as big as the smoke column promised -within a half hour  I could hear the fire-trucks screaming toward the fire.  But it couldn't be anything too bad - so I finished my lunch  (oh, I will miss those two-hour lunch breaks when I’m back in Brisbane, and  as likely as not, not taking a single break all day, and lunching on a power bar, if I remembered to stash one in a pocket….)  and wandered back to the clinic - where the sharing of information started.  
            There was a huge bushfire right on the edge of town, more or less directly across the highway from the Hospital.  The highway was closed, and traffic was not permitted to leave or enter the town.  You can imagine what this would have been like for the road trains and the Gray Nomads, all on a tight schedule - but you can imagine that it was much worse for us here in town!
            There was a flurry of activity from the Med Super and the GP registrar on call at the Hospital… The Hospital was being evacuated!   And this was news - A major Bushfire threatening a Major Rural Centre - it went out on the television and the radio, and we were headline news all across Australia.  Which might be great for Australia, but was not at all cheering for us.  
            Fortunately, there were not too many inpatients in the hospital to be evacuated, but there are quite a few residents in the nursing home section of the hospital. And what a day they had!  It was the most excitement they had had in years!  Ambulances shuttled everyone across to the newly completed Shire Council Hall, and we settled them all in for the duration.  
            Over the afternoon, the fire crews battled the flames, and eventually, they started to win. 
            The highway was re-opened before dark.  And no-one was injured.
            It was the hoped-for outcome, but it brought home the reality of how quickly things can go wrong out here-  big fires can eat towns, and all you can do is hang on, and hope that you will ride it out! Before the end of the day, the fire was under control and the patients were back in the Hospital (shuttled back again in ambulances).  They had spent about 3 hours total in our makeshift wards and jury-rigged ER, and they talked about it for days - and will probably continue to do so for months! 

Wednesday, September 26, 2012

The Doctor Tabubil Files: The Quamby Rodeo, Part Two

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

Last weekend was the Quamby Rodeo.  Quamby is 45 kilometers north of Cloncurry.  Population 6.  Unless it’s rodeo day.  Then, the population jumps to more than 2,000!
            The Quamby Rodeo kicks off the rodeo season – the next weekend it’s the Cloncurry Merry Muster, and the weekend after it’s the Mt Isa Rodeo, but Quamby is regarded as the best – it’s only one day, but the crowds can get a lot closer to the action. 
            I drove out with four other people, and we arrived just in time for the Greasy Pig event.  I've never seen this before.  It was awful: 100 young men and women running after a poor, terrified wild pig.  Eventually it was caught, and dragged back to the start line by its hind legs.  Not the best start to a rodeo, actually.  Apparently, Quamby is not on the "official" rodeo circuit, so does not need to abide by the regulations pertaining to animal cruelty...
            Yeah.  I got that. 

I’ve never seen so many hot cowboys in my life - devastating young men, every way I looked. Tight jeans, button down shirts, and the ever-present Akubra hat.  The faint smell of sweat as they brush past  you, the side-long glance as they see a woman for the first time in weeks, and the crunch of gravel under their boots as they move to lock eyes with the bulls and the broncos.  The motes of red dust that cling to your skin and your eyelashes, and make films over trees and animals lends a surreal quality to the day.  Little children shriek with laughter as they gather handfuls of the red earth and fling it in the air. 
            I wore my own new Akubra hat and blended right in!  Not really – I’m clearly a city girl. I got upset when my hat blew off and got dirt on it.

 The mutton buster was delightful.  This event is for the babies - tiny bronco-riders-in-training, their hats cut to fit the brim of their safety helmets, their eyes as terrified as the eyes of the sheep, as their fathers hold them on the animals back, all the one way from one side of the arena to the next (it's only 4 meters wide!).  And the crowd roars in encouragement!   

Mutton busters mutton busting:

I kept myself busy photographing as much as possible. I was camped by the fence snapping photos of the men as they were flung off the broncos when there was a quiet, "Excuse me, please," from behind me. I turned to find an impossibly gorgeous horse breathing over my shoulder, red dun in color, and an intricate lead over its shoulder as the cowboy side-stepped it to the gait. It's impossible not to romanticize the life on a station when everything is in technicolor and softened by gatherings of people who haven't met for months.

A young jackaroo waits for his turn in the ring.

Rodeo fans waiting on the fence.

But what I loved about it was that I finally understand what my patients mean when they say they muster.  There was bull riding, bronco riding, and cow roping.  And I get it now.  When they tell me that the old leg wound is hurting from rubbing on the stirrup, I know why.  I know why they get rolled by cattle and thrown by horses.  I know why they are covered in dust when they walk into my rooms.

Jackaroos tangle with bull-calfs.

A jackaroo gets a grip.

Horses are broken.

And so are riders.

The jackaroo bites the dust.  And if he's unlucky, I might have a new patient tomorrow.

Monday, September 24, 2012

The Dr Tabubil Files: The Quamby Rodeo, Part One

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

Hey Tabubilgirl -

Quamby rodeo was brilliant. I've never seen so many good looking cowboys in my life. I'm back now and blowing red dust out of my nose.   Here are a few photos - amazing, eh?

A jillaroo  chases down a bull-calf.

A young man tries a bull.

A jackaroo wrestles with a bull-calf.

A rider tries his luck on a horse.

The horse comes off best.

Friday, September 21, 2012

The Dr Tabubil Files: The Royal Flying Doctor Service

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  This post is written by me - Tabubilgirl.  Enjoy!

Dear Dr Tabubil

I just learned something  fantastic.  Did you know that the Royal Flying Doctor Service started out right where you are in Cloncurry? 
I am so going full-out fan-girl on you right now, for being there.  You lucky doctor, you!

-A highly excited Tabubilgirl.

I find it very hard to write sensibly about the flying doctor, so - in advance - I ask you to please excuse all of the hyperbole that has crept into this post.  (Except where it is simply an accurate and measured description of an organization that is, by all objective measures, entirely deserving of everything I throw at it.)
            The Flying Doctor is, at its roots, an air ambulance for a very big continent.  Australia is a massive country.  Across the interior of it, human habitation is scarce, and  scattered.  We have cattle stations larger in area than many european countries, and in all of that space, there might be no more than a couple of dozen working jackaroos (cowboys) and a family or two in a homestead somewhere along a creek.  For most of Australia's settled history (and for all of the history before that) when you were sick, you were sick where you were, and you lived or died on your own out in the loneliness.  All the medicine you had was the knowledge of hygiene or basic nursing in your own head.  
In the nineteen-teens and twenties, a Reverend John Flynn (Flynn of the Inland, he is better known today - the label taken from a famous 1932 hagiography by writer Ion Idriess ) worked the territories as a superintendent for the Australian Inland Mission.  Out there, he found himself horrified by the things that he saw. Women and babies died in childbirth in remote, water-less huts.  Children died of treatable diseases.  Men grew crooked when broken limbs weren't set - or were set wrong.  He  told  often the story of a ten year old child, who had pulled his sick mother  - in a wooden BOX for the god's sakes - for ten days across arid desert to get her to somewhere that might have medical help, dragging his baby brothers and sisters along with him.

Flynn changed all that. 

In 1928, Flynn recognized that two hot new inventions, the radio and the airplane, had the potential to do something entirely unprecedented in Australia. He set up a network of radios across the bush, and brought in a fleet of spanking new airplanes to act as an air ambulance service across the inland territories.  
            It was a rough and ready sort of set up.  The radios were primitive, pedal-powered sets  and the planes were boxy little biplanes that landed on rough airstrips hacked out of the scrub.  But it made a difference.
            How it made a difference. 
            The airplanes got people to doctors and the radios opened up the world to the people who lived out there all alone with the great big horizon. Particularly for the women, who spent much of their lives alone in the bush with a pack of kids while their husbands were out for weeks at a time with the cattle,  the radio was a world-opener.  The radio gave them companionship,  and in time, it led to the School of the Air, a radio-correspondence school (still going strong, although making more use of the internet today than the radio) for children on remote stations, who up till then, hadn't had much in the way of education except irregularly delivered correspondence courses, or what education their entirely-too-busy mother could provide when not providing everything else.
The Reverend Flynn wasn't particularly keen on a genuinely inclusive mandate for the Flying Doctor - in its early days he circulated opinions about Australia's aboriginal population that shocked even the other leaders of the Inland Mission (which is not particularly remembered today for its history of Christian attitudes toward the non-white Australians under its dominion.  So that's saying something.)
            However, the Flying Doctor grew past its founders and and throve. Today, doctors fly out of 22 bases across Australia, flying circuits through the stations and townships of the outback, running regular clinics and inoculations, and getting people to hospitals when they need it.  Their airplanes land in paddocks, on country roads, and on dry riverbeds. Their right of passage is absolute. 
            Flying Doctor airplanes have set the standard for rural carriers all over the world - they are equipped with  specially sprung undercarriages for landing on every sort of terrain, their cabins are equipped with advanced pressurization capacity (they can limit the pressurization to 2000 feet to protect patients with heart and brain injuries) and their engines have extended air range for long-haul outback flights.
            The Royal Flying Doctor Service is one of Australia's greatest civil and logistical achievements, and I will take on anyone who chooses to argue otherwise.  With water-pistols at ten paces, if you please. When Australians see the RFDS, we see a net of lifelines - strings of compassion and communication stretching out over our continent.  It symbolizes the best of what we aspire to - an absolute, unselfish cooperation and an appreciation for our fellow men and women. 
            I ran into a flying doctor airplane at an airshow a couple of years back.  We were permitted to look through the plane, and when we'd prodded and gawked our fill, the pilots closed the airshow with a fly-past over the airstrip.  

Here's a flying doctor plane, on its way out to the airstrip. 

And the interior of the same plane - as good a set-up as in any ER, but with seat-belts and altitude controls! 

It was a good way to end a show, with a look at the best human face of aviation, something way beyond acrobatics and big engines and formation flying. When you look at the RFDS, you think - we do all right.  And when you see one of their planes throttling low, fifty feet above the airstrip, you get lumps in your throat and just about stand up and salute.

Wednesday, September 19, 2012

The Dr Tabubil Files: Odd Fellas

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

Small towns have large shares of characters.
            Driving to the hospital one morning I drove past what is probably the oddest thing I have every seen. There was an old man in an Akubra walking a bull on a leash.  A pet bull.  The bull’s name is Toolabuc… and he’s registered as a dog in the shire of Cloncurry. He’s well trained. Every day he goes for walkies down the whole length of the town.  He was rescued from a future of hamburgers as a newborn calf.  He was hand-reared, and now weighs 770 kilograms.  And walks on a leash. He knows the way to the Post Office Hotel, where his owner will have a glass of rum (or five) before it’s time to turn around and go home.   His owner's watering hole is next door to the home of one of the GPs.  It’s not a happy relationship.
            There’s a man in town that everyone knows quite well. Apparently, he is filled with ideas on how to improve the town.  His plan, they say, is to turn Cloncurry into the Las Vegas of North West Queensland (imagine that!) He wants to start by turning the local motel/caravan park into a legalized brothel.  Not that rooms 10 and 11 don’t make up the unofficial town brothel anyway.  He is so dedicated to his cause that he ran for shire council to get his ideas approved.  He couldn’t understand why he only got two votes (one was his own).  
            “Everyone in town promised they’d vote for me!”  
            I think his dreams of legal prostitution in this tiny country town will have a wait a while he comforts himself with the key to Room 11… 
            Speaking of the caravan park, on one of my strolls down the town’s one main road (which is also the main road across the continent.  Yes, the town evolved around a little country road, and when the little country road got upgraded to a highway, the planners didn’t run a diversion, just plowed right on through) on a Sunday afternoon (and I can walk it in less than an hour, notwithstanding the windburn from passing road trains), I overheard the afternoon’s entertainment entertaining the Gray Nomads in the caravan park.  There was a rather insipid but enthusiastic man-and-woman duo singing popular American country songs interspersed with jokes a la Australiana:
            “I always like to ask travelers if they have nicknames for their wives.  I asked this one bloke from Alice.
            'Yeaaaah, he said.  "I call my missus Harvey Norman.'
            'Harvey Norman!' I says.  'What for?'
            'What for?' He says.  '12 months innerest free!'
            (Note: Harvey Norman is the name of a large national chain that sells furniture and electrical appliances.  We enjoy a very high level of humor out here.  I’d rather go and watch the under-twenties slow dancing in the pub.)
            I walked past the Oasis again yesterday night at Happy Hour.  There was a wizened old man playing mournful songs on his accordion while caravaners drank wine coolers and made small talk.  It was not inspiring.

(editor's note:  This sounds lovely!  A convivial evening in the country in the caravan park?  Can I come along too? What’s not inspiring about that?
            Reply from Dr Tabubil:  There is absolutely no way this is inspiring.  It was one of the LEAST inspiring things I have ever heard.  He was a sad old man, so tired out that the accordion almost hid him from view.  It was like he didn’t even have the energy to play a faster song. It was like the moment in the war movie  - the night before the big battle where everyone is sitting around a campfire looking depressed and a wounded solider plays on a mouth organ and the orchestra leaves him alone because you know everyone is going to die tomorrow and silence and a bad mouth-organ is sadder than music.  So please don’t try to make it inspiring, okay?
            Ed note: Okay.)

Monday, September 17, 2012

The Dr Tabubil Files: The Road to Isa

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

After three weeks in Cloncurry, I hit a wall.  It’s lonely out here.  It's a tiny town, with very few social opportunities besides the pub, and there's nothing much around but scrub - for hundreds of miles in every direction. I was given a shire council car when I arrived, but it's a compact European make and totally unsuitable for driving outside city limits.  Ten months ago, the doctor in my position drove up to Isa and back.  She came home late at night, which for city folk is a huge danger:  there are cows out here in cattle country - black cows that wander onto the roads at night, where the bitumen is warm through retaining the heat of the day.  All that you can see of them are their eyes, usually at the moment that they fly through your windscreen. 
            This doctor missed the cows, but she hit a large kangaroo. Kangaroos cause a significant number of accidents on Australian roads - in fact, they're probably the one thing that actually scares country people.  They can bash up your car pretty good - particularly if you're in a small-ish sedan, but the real danger is if they go through the windscreen: they come through and they keep kicking.  In this particular case, the doctor was uninjured, but the car was in the shop for 10 weeks.
            As a consequence of the accident, I have the car, but I'm not allowed to drive out of town in it - just in case.  You can imagine how frustrating this can be.  So when I hit this wall, I begged and I pleaded (I might even have groveled a little) to be allowed to drive to Mt Isa  - 120 kilometers to the east, for a few hours change of place.  I had a real reason to go - a friend  was flying in to visit her sister, who lives there, and we really wanted to catch up.
            My begging and pleading paid off, with restrictions: I could go, but I could do no driving between 5pm and 9am to avoid the ‘roos and the cows.  I was more than happy to comply, especially when the Powers That Be suggested that I stay in Isa overnight and drive back the next day, even offering to re-schedule my patients for the morning so that I could drive back in daylight and in safety! 
            The drive was beautiful.  The road is well travelled, and has recently undergone some major improvements, most notably the addition of real overtaking lanes every 20 to 30 kilometers.  This has been a major useful change to the road - particularly in the places where caravans (carrying hordes of Australian Grey Nomads)  and road-trains with two or three trailers behind them, slow down to struggle up the shallow hills. 

The Road to Isa

The road meanders through low red hills,  covered with bush grass and spinefex, and scattered gum and bloodwood trees. It is pure desert out here.   Straight out of the movies.  The only things missing are the saguaro cactuses - you know, the ones that look like fingers - tall and skinny and cinema-shorthand for Hot and Dry and Empty.   
On the way up to Isa I stopped at every single stopping bay, often just a fifty meter stretch of dirt along the side of the road, to look out at the bush.   Occasionally, there are stretches of sidewalk, that start randomly, run for five meters, or fifty meters, and stop again, just as randomly.  I’m not sure who uses them.  Nobody seems to know why they were built.
            It’s a pity none of these stopping areas touched on a creek – I would have loved to photograph the creeks here, but the traffic runs so fast and fierce that it’s far too dangerous to stop on the roads. They have quintessential bush names like Dingo Creek and Gum Creek, but there are a few wilder names - such as Salmon Gorge Creek.  It’s probably the most unassuming creek around. Flay and dry and lots and lots of nothing.  No gorge anywhere. All the creeks out here are all bone dry.  They range from 3 to 20 meters across, flat beds of red sand and not a spec of water.  There are empty creek beds everywhere across this country.  The country does flood in the wet season (in fact, one of the nurses at the hospital hitches a ride to work on the family’s helicopter when the roads are flooded) but right now it’s simply impossible to imagine what they would look like full.
            Although it's the dry season right now, there is still a little water in the Chinaman Creek Dam.  One day last week I drove up to the dam and stomped about (dodging black flies, rural Australian style, all the way) taking photographs, to show you what this country looks like in the wet.  They say that there are snakes out here.  I haven't seen any  - it's winter and it's too cold.  But I saw a snake's slither track once.  Does that count?
The biggest culture shock I've experienced out here in the Red Center isn't the desert stretching out all around us, with its hundreds of miles of nothing there but kangaroos, ta ta lizards, and cows, but the lifestyle of the country folk.  There’s a little bit of everything out here.  The ones I love the most are the young men and women who work out the stations.  I get a secret little thrill and tingle down my spine when they say, “I’m a Jillaroo at Devoncourt" or “I’m the Jackaroo at Fort Constantine Station”.  Maybe it’s because I didn’t grow up here in Australia - where our cowboys are known for fair dinkum drovers, where the jackaroos and jillaroos muster cattle by the hundreds of thousands, and horses by the hundreds (as working horses for the mustering of the cattle) across thousands of square kilometers of Australia, and drive them across the country to cattle-yards for transport on road trains to the slaughter house in the city, over a thousand kilometers away.  It's something that I’ve never been exposed to before, nor ever understood – until now, out here!
            And then we’ve got the truckies - the modern-day drovers, whose sole purpose of occupation is transporting goods back and forth across the millions of miles of road in this country.  Out here, road trains go from the East Coast (Brisbane or Townsville), through Emerald or Charters Towers, then they roar down the main road of Cloncurry and pause for a rest at the Road Runner Road House or the Coyote Inn and plow on through to Isa, where they stop for the night before  dropping down onto the endless plains across to Alice and even further beyond that, Perth.  

The Road Runner Roadhouse in Cloncurry. 

 There are a lot of drugs out here among the truckies, and there are regular drug screens by trucking companies and rail companies.  At a barbeque I overheard one manager of a train company- who is an ex-truckie himself -say, “I bring my guys in for drug screens all the time.  It’s the speed.  I know the signs.  I’ve been on it so many times myself.”  He used to do a round trip from Toowoomba to Perth in 8 days.  That’s over 6000 kilometers of straight road where there’s nothing to break the monotony of empty horizon except kangaroos waiting to be hit.  Truckies swallow amphetamines like candy.  It keeps them awake and gets them home faster for an extra day with their children before they are on the road again.  

And the road goes on - all the way to Perth.

The distances that my patients travel as matter of course - without even thinking about it - are huge.  People from the further stations can travel almost two hundred kilometers of dirt roads before they even meet bitumen.   
            One jackaroo I saw – he had been rolled on by a cow during a muster, and wounded, and had come in to town so that I could change the dressing on the wound for him.
            “Right.  I said.  I’ll need to see you again the day after tomorrow."
            He blinked twice, but said nothing. Just nodded stoically.
            “Erm.” I said. “How far away are you again?”
            “Four hours, each way.”  He said. He had come 150 km, on an ungraded dirt road that most of the time was a cattle track, just to see the doctor.  And didn’t think that it was anything special.
            Right.  So the nurses taught him to clean his leg and change his own dressing.  I saw him two weeks later – which is still really soon for a trip like that.

Friday, September 14, 2012

The Dr Tabubil Files: The Absence of Nightlife in a Small Town

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!
Driving into town from Mount Isa, Cloncurry begins when you pass the first pub and the lawn bowls club.

The Cloncurry Lawn Bowls Club
Cloncurry's pubs are very important to the social (and cultural even!) life out here.  There are 4 main drinking holes in town.  The most popular is the Leichardt (Named for the 19th Century explorer Ludwig Leichardt). One of the big draws of the Liechardt is it’s restaurant – they serve quite an adequate steak (we’re in steak country after all, although the Wagon Wheel has the BEST steak in town).  But the pubs aren't really about the food.  Next door to the restaurant, the Leichhardt has a pub, that turns into at disco after 10 pm. The place really fills up after midnight with a hundred sexually active young men and women.  The dance floor is packed and the crush at the bar is three people deep. (Which is very deep for a little town!)

The Leichardt Hotel

Alcohol isn’t cheap out here – it costs to have it shipped in - but the booze flows all night long. What else is there to do for sexed-up young people in a little town in the middle of the bush one hundred and thirty kilometers from Isa and a thousand kilometers from the coast?  There’s a lawn-bowls club, but that is for the over-60 crowd. There is a cinema.  It’s open-air, where you bring your own chairs, but it’s been closed for a few years now.  

The Cloncurry Cinema

And the young people have money to burn.  So they drink. And they shag. And they come to see me the morning after. The ladies dress up in their smallest, slinkiest dresses (not high heels though – this is the Australia's Red Center!  High heels'd get too darned dusty.) and the gents refuse to put in any effort: they wander into the pub wearing shorts and thongs (note to North American readers - thongs are what you would call flip-flops.  You wear 'em on your feet) - a costume that's the perfect recipe for being denied admission to any pub in Brisbane. 
            One night I was sitting at a bar, nursing a drink and chatting with work colleagues, when a rather unsteady gentleman moseyed up next to me to order a Bundy and Coke (that’s Bundaberg Rum and coca cola for the uninitiated).  He seemed inordinately pleased with his wallet, holding it out and catching my eye like he was begging me to comment.
            “Nice wallet,” I obliged. 
            “Yeah,” he slurred.  “It’s like green and sh**t.”
            And there ended his chances for further conversation.  
            The incidence of sexually transmitted infections out here really is spectacular.  Currently, the Mt Isa medical is fielding a Syphilis epidemic. In Australia -  in 2012!  At our clinic it is standard practice to offer an STI screen along with every Pap smear (regardless of the age of the woman).  And we offer a full STI screen at every doctors visit for every patient – of any age and gender.  Our standard tests are Chlamydia and Gonorrhea swabs, and we always encourage HIV, Hepatitis C and a Syphilis serology along with them.  This we do even for backpackers from overseas, who are passing through and who don’t have medicare (editor's Note: Medicare is Australia's national health care system.) and have to pay the full costs of the tests.  If you’re interested, it costs $488 dollars to be screened for those five infections.  Only three of them are easily treated.  So play sensible, okay?
            And then there are the backpackers.  Cloncurry is a major destination on the working-holiday track.  Kids come through all the time, and most of them pick up work in the pubs, where the fun is.
            And this is my medical conversation, about a week after every single one of them arrives: 
            "Hi Doctor.  I've come to inquire about what sort of birth control you offer here in Cloncurry."
            "Well, we've got condoms. And the pill. And the IUD. Condoms are good."
            "Ah - I think that the pill sounds exactly like the sort of thing I'm wanting."
            "You work in a pub, right?"
            "I do."
            "You party a lot?"
            "Indeed I do."
            "We'll start with the condoms, then." 

Wednesday, September 12, 2012

The Dr Tabubil Files: The Grey Nomads

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

Hey Tabubilgirl -

So i had some patients in with me (gray nomads) that i needed by boss to review for me.  As they left they made some comment that i didn't catch.
            Anyway, later on i called my boss about another patient, and he goes, "you've got fans in Port Maquarie.  They think you're sh**t hot!"
            I have fans in port Macquarie.

The Gray Nomads are the retired men and women who close up their houses and spend months out of every year on the road in caravans and camper-vans, exploring Australia.  As the baby boomers age, the pastime is becoming increasingly popular, and brings with it into the outback the ailments and illnesses of the elderly, at a scale that really hasn’t been appreciated out here before.  Most grey nomads usually present with the influenza and want some antibiotics, but occasionally we do get one with cardiac failure - such as the dear old soul who, when she thought about it, “was supposed to get that echocardiogram before setting off on this 4 month journey across the outback.”
Oh dear.
            There was also the elderly gentleman who arrived at the clinic delirious with the flu: so incoherent and muzzy that he managed to drive his car and caravan right into the back parking lot (reserved for the clinic staff), ignoring the multiple signs marked “Do Not Enter.”  Our car park has a long, narrow entrance, leading to a very small lot at the back.  It's big enough for about seven cars, if they’re very friendly with each other, but it is definitely not large enough for a trailer.  We noticed his arrival when we heard a loud bang.  The building shook.  I, of course, thought that the nearest mine was blasting that day, but they don't blast that close, do they?! Turns out not -  the gentleman had backed into a supporting post for the building. 
            It was a close call, and once everyone had panicked and moved their cars out of his way in a real big hurry, he managed to find his way out. I thought that I had done a few10-point turns in my day! He topped my record by far.

Monday, September 10, 2012

The Dr Tabubil Files: The Mines, the Miners and Bulk Billing

My sister, the estimable Dr Tabubil, is spending ten weeks on a rural clinical rotation in Cloncurry, a small pastoral town in the Queensland Outback.  It's a fantastic place, and together we have collaborated on a series of guest posts  all about living and working in the Red Centre.  Enjoy!

The patients here in Cloncurry are typical for a small town in cattle grazing country, with a high and regular flow of tourists (Grey Nomads and Backpackers) coming through. I have my regulars, who are already disappointed I’m only there for 10 weeks (yay!) and I see a fair amount of the transient population - the workers from the more remote stations, and the men and women who work in the mines nearby.
            The countryside around Cloncurry seems to be littered with mines.  The mother load around Cloncurry is copper.  Just recently, though the Great Australian Mine has just found a rich body of Gold that will yield some spectacular kilo loads per tonne and keep the mines in cash for a long time - even if (or when) the copper runs out.  These miners are young men and a few women who, once finished with school ( at 16 if they drop out, 17 or 18 if they graduate) sign a contract with the mines for a very large starting salary - AUD $80 000 a year.
            Occasionally it can be frustrating when these young miners ask for a little too much.  Occasionally they'll present to the clinic with a medical complaint, and expect to be bulk billed (Bulk billing is what happens when you are on medicare, our national health-care scheme, and the whole bill is taken care of by the medicare plan.)
            Apart from that, I  LOVE bulk billing.  This generally applies to people on a pension, or under the age of 16, or  people who have a DVA Veterans card or some other sort of concession, but up here we have some reasonable discretion about when and how to use it – like if they have come in on a recall for results, or it was a hellish day and the patient waited for 2 hours for us to be free.  Or, in my case, when I stumbled upon a patient’s recent personal tragedy, and made her cry, by saying, in a really bright voice - “Are there any preexisting conditions in your family?” 
            And she burst into tears and said “My brother is in a full body traction cast!  He fell off of a quad-bike last week!!”  and cried and cried and cried.
            I felt so awful. I spent 15 minutes just sitting there and holding her hand and listening while she told me all about it.  It was so sad.  I definitely bulk billed that one. 

People come from all over to work in the mines - from all over Australia, from all over the world.  I love my job – I meet so many people.  My favorite part of a consult is the moment when I say:
            "Hello – who are you? And where are you from?" 
            Because I get a story.  People will come up to the mines for six months, or for a year, for two years, on a sabbatical from an academic job, because they're on the run from a spouse or some other family situation, and they'll make enough money to go home for a while, and then they'll come back again.  Again and again and again.  The outback seems to get into your blood.

And then there are patients from the really wealthy cattle families.  One family in particular is the tenth richest family in Queensland.  Based out of Cloncurry, they own a full third of Queensland's grazing country.  Their trip in for a checkup is racked with hardship – do they fly their private plane to town, or drive up in their Bentley?
Bulk billing is fantastic – I really got into the swing of it, until the boss had to come and tell that I needed to ease back a little.
            "Dr Tabubil - we appreciate that you're being a compassionate doctor, but  – this is Cloncurry. Not Brisbane.  If they look like they can afford it – charge them.  If they look like they can’t afford it – charge them anyway.  Chances are their private jet is waiting for them at the airport to take them back to the muster, which is why they look like they've been rolled on by a horse and they smell like the back end of a stable.  They are working millionaires."
            Of course, there are people here in town who really can’t afford it.  But the reception staff knows who they are and they probably have a concession card anyway.

Even so,  when some eighteen year old kid comes in  after I’ve seen him throwing bills on the bar the previous night in the pub and looks at me and says -
            "SO, can ya, like, bulk bill?" 
            Well, when that eighteen year old is making 80 000 dollars a year, I generally sigh, and smile sweetly, and say “Oh, NO, I’m sooo sorry.  It’s just not applicable.”