The Centre of it all: the road ahead

West of UtjuTime to put some cards on the table so people can feel my aspirations, knock the edges off and gather shape. I came with some ideas about what I might achieve, and I presented them to the clinic staff. I feel a little at risk sharing my ideas early on but I want to take people with me if the innovations might be helpful.

My themes are simple but derived from my reading and experience both within and outside medicine. First, I want us (Congress) to be the best in the world at some things, and if we are already, for that to get known. We need to do things well to have an impact in health. I have chosen dealing with people with multiple health problems or co-morbidities as a genuine opportunity for Congress to  stand out. A search on the internet (“GooGoo”) finds a number of papers and an Australian literature review confirming that no one really knows how to deal with patients like this, that is, many of our mob. If we just treat each separate condition according to the guidelines our patients will have no life other than health care. We amplify the patients’ burden of disease as they either soak up all sorts of outpatient visits and investigations or just turn away and get on with their already multi-dimensional and complex lives. How to compromise on patient effort and give some real benefit? How to feel it all from the other perspective?

Second, I want to change the idea of team to a dynamic concept; the team that suits the person we are with at that moment. It will vary a great deal depending on the personality, experience, the conditions, the person’s family and other supports. We need also need to vary our role; offer different knowledge and skills to different people at different times. It is maximising the relevance of the resources we have to hand at each encounter. I learned it at Palmerston Super Clinic from Chris Harnden and Sue Chambers. It requires preparation and focus. Patients then vote with their feet.

Third, I want to see if we can consult more effectively with multiple people at the same time and with the same sort of conditions (known as shared medical appointments). Will people like that? Will it impinge on their privacy? I think it will allow them to discuss what is going on and why. How did she get a better reading than me? What does it mean if your kidneys are not working as well as they might? What can we do that makes a difference? It is definitely a foreign concept in Australian medical practice but many of us have seen it work in special circumstances.

Finally, health care for chronic disease means very little to many people in the community; there is no experience of benefit from all of our interventions, except perhaps in late stages. It has to be accepted on trust and requires considerable health literacy. Congress carries a lot of trust; it belongs to and works for our patients and community. We can gain further trust in two key ways: an ongoing satisfying relationship with individual patients and effective management of acute illness. Both are palpable and offer clear value.

I think I did OK. It was a big audience for a GP and a lot more Aboriginal people than I usually speak to in such a setting. Some Aboriginal health practitioners, general practitioners, nurses, interpreters, receptionists, Aboriginal liaison officers, podiatrists, dieticians and drivers. A number of people drop past my room after this. I made a few friends. I hear some concerns and some ideas from a variety of people. Glen, the interpreter tells me about his after hours efforts to get a new opportunity out of town for kids who are niggling the police or courts. I promise to go out with Tony the bus driver. I confess I haven’t done that yet but I know my reputation will depend on it. But first I’ve got to meet the people working and living in our remote townships.

2017 Scooter at Uluru

The Centre of it all: meeting

I started work. Well, I have been in a wash of information and glimpses of what is to come. Fortunately Samarra started on the same day and will be a key part of the team I am ostensibly leading. And Teena, another key team member, was there too. Both have been in Alice for a very long time and seemed to know everyone. Teena has done most jobs in Congress and is the local Wikipedia; she takes (great) care of the remote teams. We are to oversee the 3 town clinics and 5 bush clinics . Mutijulu is the furthest out at Uluru (“the rock”). We also have doctors at Alukra (women), Ingkintja (men), Headspace and in a variety of teams for the frail aged, disabled and people with kidney disease.

My introduction to the workplace and town is spread over five days, organised by Victoria. She is youthful, helpful and sharp; if in doubt, “Look it up on GooGoo!” Despite training from 12 grandchildren I have yet another vocabulary to learn here. A sort of international creole. Everyone is friendly, smiling, laughing. Its still raining so we can talk about the grass which is growing tall like spear grass in the very wet north. Not just snakes that I have to prepare for but moths, mosquitoes, locusts and, to the horror of many, mice.

I am clearly working for a mature and Aboriginal organisation. My boss Tracey is Aboriginal, as is her boss, the CEO. I am introduced to people passing by, or some just come into the room. My impression is that there is joy in the place, lots of energy. Commitment is obvious with concern for the Mutijulu community which has been flooded and now has an influx of people involved in ceremony that outnumbers the local inhabitants. Maria, the new clinic manager is having to swim against a lot of currents to keep things operational. She is the long distance type.

I have a phone and a car and a desk and a computer. I have brought my tools of the trade and have rescued them from boxes of guitar and microphone leads. I put them into empty draws in my desk. Stake my claim on reality. I have to learn to use Communicare, the health record system. I used it in the late 90s at Bagot in Darwin for a while but it has developed a great deal. No one seems to know exactly how to use it for everything, and some of the remote clinics had their own installation before joining Congress and the alignment is taking time. I know I can help with this.

This organisation is definitely a 21st century operation in a place of wonder and ancient ways. Aboriginal culture, mixed with Central Australian religious influences and business best practice; as a result a young Aboriginal man named Jonah fixes all my IT concerns. I get an email asking for feedback. What can I say?

“Blown away”?

There are some other cultural influences. Eric from South Africa runs the business department and is a very active and influential character. He knows how much Medicare each clinic claimed last week. I sense he has changed many things. Chipo from Zimbabwe manages risk. She is a force, managing accreditation, incident reporting and work health and safety. And Bipin, who runs CQI (continuous quality improvement) gets the data people need. In the clinics there are doctors from Australia, New Zealand, Belgium, Sri Lanka, China, Britain, Myanmar and Zaire. Many working here for more than 10 years and one over 20. I am the oldest though.

I am meeting an old place that has always been threaded with colour. I’ve got to choose my depth of field and focus. Best find a few people to help me with that.