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10 Oct 2017

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

 The very first patient I attended in this country was during my heaven-sent locum on Kangaroo Island.  She came to me with razor blade cuts on her face arms, legs, and on the remnants of her work clothes with a shredded logo.

 “Good Grief” whatever happened?” I thought she was in some rural gang fight where they massacred each other with razor knives.  The answer?  “The koala wasn't as sedated as we thought it was!”

She was a park ranger capturing some of the overpopulated diseased koalas and treating their chlamydia ophthalmopathy and sterilising the little sweeties to prevent further over population.  I quickly learnt that koalas have two thumbs per limb. Each one with razor blades on the tips.

This first patient was one of the reasons I am still working rural Australia ten years later, and that story has been told countless times to my medical colleagues in Canada.

So here is a collection of rural clinical presentations that urban doctors may never encounter and certainly won’t found in textbooks.

Twenty-one-year-old male, acute STEMI. Why? Black magic. The neighbouring village and their medicine man took umbrage to something this fellow did and the destructive spell was cast. No diabetes, hypertension or dyslipidaemia, just black medicine. Frighteningly powerful. Like voodoo and once the victim believes, the STs elevate and the troponins rise.

“I broke my toe, Doc."

“How did you do it?”

“I kicked a coconut.”

Apparently those coco ‘nuts’ land on the ground like a boat landing on its keel.  Out of the ‘keel’ the root spikes downward but the coconut still looks like a lost footie, still has not formed the ‘sail’ out the top end of the ‘boat’ which will later be the tree.  My advice? Don't kick it.  Australian roots are very stubborn.

“However did you get that deep knife cut into the palm of your hand?”

“I was fishing with my hand reel and I caught a croc. He got my fish, think it was a barra, a big one”.

“You tell my son to stop painting himself with the sap of that bad tree.”

This is a sad example of self-mutilation by unhappy or self-actualising Aboriginal teens.  This tree is found in the wilderness in the Top End and is well known by Aboriginal peoples.  The sap of the tree burns their forearms and ritualistically they will burn their arms similar to the familiar forearm slashes we see in the city.  Lots of keloids.

The babe is 27 weeks, the umbilical venous catheter is too big and so is the neonatal mask, it is four hours until retrieval gets here.

“Congratulations you have had periods now for over a year, how are you managing with the monthlies?  Using pads or tampons?”

The wide-eyed response is: “What are those?” 

Now doctor, how to manage women’s business in the Outback when monthly periods are a matter of shame, to be hidden and not discussed?

Mango season, get ready for the mango rash.  Looks like sulphuric acid burns.  You don’t even need to touch the tree, the spray from the harvest will burn you.

A typical URTI, I percussed the lung fields.  Later I found out: “Don't go to that doctor, she beats up your back!”

“I have been a teacher in the Outback for the past 6 years.  I am depressed.  At first it was easy to make close friendships with the other Kartiyas* here.  But then they left, so I re-invested in establishing new friendships, and now they left.  Now I have stopped trying.  It is hopeless to keep trying.”  Not exactly a job for an SSRI (selective serotonin reuptake inhibitors).

“I ate too much ants... now I got a gut ache.”  I ask you doctor, what is the treatment?  PPIs?  H2 antagonists or a good bowel clean? 

Not in textbooks.  Welcome to rural Australia.

 (*Kartiya = Top End Aboriginal word for us Westerners.)


Published: 10 Oct 2017