I have been in Alice Springs for over 6 months and it already defines my life a little. The beauty and the people. I have been playing quite a lot of music and the town tolerates my rough attempts at Leonard Cohen or Ryan Adams. Kate and Jacko’s lives are filled with music. Wendy, Kate and Richard have played a lot. Ross puts together most of the town’s musical events. Vath, a GP from Darwin who now lives in Adelaide, walked the Larapinta Trail last week and stopped by to sing at the Water Tank Cafe with us. She got a ‘kitchen cheer’ which is an indication that you are doing OK.
It is hard to describe the clarity of view in this place, in colour or in black and white. It is as though the sky has been lifted off. Like you have no top to your skull. You feel like you can see forever and you pretty much can. Vath told me that when she was lying down at night out west of Alice she thought the stars were a cloud glowing. The dark bits of sky stand out, not the stars that sparkle in a confluent mass. Hard to describe if you didn’t see it.
I am already quite angry about how hard it is to recruit staff to Alice Springs, despite working for an extraordinary Aboriginal organisation that has developed the model of community control here in Australia. I’m not alone, but people who have been here a while just smile and get on with the job. It has been and remains their struggle. Locals say they are ‘spinifex people’, a bit sharp, but very resilient. JL, one of the wonderful senior Congress people I work with now, said it to me in 1993 in Darwin to explain away some of the edge in his voice as he advocated for Central Australian health care. It doesn’t take long to discover the shared experience of being south of the legendary Berrimah line – an imaginary line now marked with traffic lights and road trains just south of Darwin. It immediately unites all Territorians living in the bush and the other towns in the NT. It is very hard to believe that people can’t see things the way we do; and they are oh so clear to us!
Central Australia is an ideal opportunity for learning to be an excellent health practitioner and Congress is deeply committed to providing training for all health professionals. Congress has been nominated as “GP Training Post of the Year” for 2017 and we hope this might come off this year; we are often in the short list!
But we have 300 people in Alice on dialysis and a heap of premature morbidity. Fifty percent of the Central Australian population of 40,000 is Aboriginal. Infectious disease walks tall and strong. Wander around the wards and notice the difference in who is there. It is not at all like a hospital in Towoomba or Armidale. You’ve got to come here, let your eyes adjust, to get a clear view. It’s like they see the stars and we see the dark bits.
While not giving up on trying to change things so that Alice Springs is not the only remote town in Australia where GPs cannot do their 6 months rural training, I want to share with you the sorts of jobs that I think need doing here. I am hoping I might pique your interest if you are a health professional, and your support if you are not. Copy and send a link to this page if you know someone who might be interested.
First, I believe that working for a mature Aboriginal community controlled organisation and joining their struggle to achieve health parity with other Australians is a very honourable use of medical, nursing and other health skills. We are 350 or so people and more than 200 of us are Aboriginal. It means working as an equal with people of different backgrounds and languages; who know their community and its needs intimately. It means taking direction from the Board about priorities and strategies that matter to the community. It means being trusted by the community in a way that is humbling but demands responsibility.
Second, Congress is devolving to smaller clinics, with smaller teams (e.g Sadadeen). There are now 10 clinics and there will soon be eleven. This provides a more traditional primary care environment with massively increased continuity of care and accountability compared to our larger service centre at the Gap. Each clinic knows how they are performing: how many long-acting bicillin injections to protect children with rheumatic heart disease have not been given; how many children have been screened for anaemia; and what treatment is being given. The five remote clinics have always worked like this but the organisation is embracing this approach across all our services. The results look very promising. So we have jobs for nurses, Aboriginal health practitioners and general practitioners that involve working as part of a smaller team in a larger organisation. It is more like mainstream general practice but on steroids – the steroid element is the diverse team, the range and degree of medical need and the resources to address these problems. It makes most people glow to work like this.
Third, Congress has two ‘gender protected’ clinics; one for men – Ingkintja, and one for women – Alukura. Alukura is the bigger service with a visiting obstetrician and a midwifery group practice getting underway. There is a lot of general practice to do here and we are looking for a female GP who is very interested in working with a team of GPs, nurses, Aboriginal health practitioners, midwives and an obstetrician. There are jobs for midwives and Aboriginal health practitioners too, especially in the remote clinics but also in the midwifery group practice. It is a spectacular service and will develop your skills dramatically. Ingkintja is the men’s clinic. The men, as I have described, do it tough around here. It is a wonderful experience to hear their stories and successes, trusting in you to do your best for them. It is a place to come and take care of your body and soul and wash your clothes. A male GP who is interested in making a difference in this domain will help a great deal, to assist the registrars and Aboriginal health practitioners and assist in making these services available in all our remote settings.
Fourth, for the time being, is a role for an enquiring and caring doctor who is interested in palliative and aged care. Major decisions also arise in people with end-stage renal failure as we saw with Dr G who so tragically died recently in the Top End. We have 100 people in aged care, a dozen or so in palliative care and over 200 on dialysis. We have programs supporting people at home and also during dialysis. We have Aboriginal health practitioners, nurses and doctors working in the area but without leadership. Who should we recommend for palliative care, dialysis or even a renal transplant? How is the family involved? Are advanced directives or family meetings the best solution to find a way forward for people in different settings? I would love someone interested in this area to come and live here, work with us and see if we can make a difference together.
The last thing to say is that you can work in a very remote setting as much as you would like. Congress has a splendid team of remote doctors, nurses, Aboriginal health practitioners and support staff. Most staff live in the community and fly home for breaks (apart from holiday). We have some people on 8 week cycles at Mutitjulu (discussed elsewhere) or 4 week rotations at Santa Teresa, and we have doctors working 2 days a week at Utju and supporting Ntaria. You can drive to Amoonguna each day from Alice. There is no doubt that this experience is unique and splendid, with all the challenges you might expect. Some emergencies to deal with, some trouble sleeping when the brumbies stampede through town, some ceremony and discovery of what is pure Australia. It is just another aspect of working with Congress, meeting the same objectives with the same meaningful governance.
I have put links in to the pages where you can contact us if this captures your imagination. I hope you will feel safe to get in touch and find out a bit more. There is always some spontaneity in what makes life good.
Medicine at the Deep End 
