Locums for a Small World Blog

By Kathryn Starkey, MD, and Molly Evans

We had a few days to kill, so we decided to head south - across the Tasman Sea - to Hobart, the capital city of Tasmania. We were a bit overwhelmed to learn that over 100,000 people call Hobart home; however, we soon realized that Hobart is more like a village than a big city. The old-world city streets, combined with the fact that we were staying in a 100-year-old refurbished horse stable, led us to believe this was no bustling metropolis.

We didn’t completely appreciate the incredible sustainable food and wine production on the island until we had the opportunity to visit Salamanca Place. What we found were a collection of old stone warehouses built by convicts in the 1800’s, all filled to the brim with purveyors of fine foods, local wines, baked goods, artisan cheeses and restaurants. Local fishmongers sold their goods from Victoria dock, which we soon discovered was the center of the waterfront activity.

Every Saturday, the Salamanca Market is in full swing. There are over a 250 stalls that line the streets; each specializes in Tasmanian produce, honey, jams, wool products, wood-fired baked bread, cheeses, wood crafts and every form of the Tasmanian Devil known to the artistic mind. Our first day at the market, we enjoyed an egg and bacon roll with what the locals call, “the lot." The Aussie "Brekkie" sandwich included egg, ¼ lb of ham, grilled tomato, cheese, mushroom and a sauce of your choice all on a massive toasted, buttered roll. Yummy!

Later, we visited the Tassal Salmon Company - a beautiful store filled with farm-raised, fresh and smoked salmon. They conduct cooking demonstrations a few days a week throughout the year. It’s a great way to learn new ways to prepare salmon and enjoy a free lunch, too.

Our visit wouldn’t have been complete without a trip to Hobart’s own distillery and brewery, Lark Distillery. Known for its exceptional barrel-aged, single malt whiskey and its unique Tasmanian Bush Liqueur, Lark isn't alone on the island. There's Cascade Brewery, which is Australia’s oldest continuously operating brewery. Needless to say, we employed a few cold ones to wash back that smoked salmon.

Although we couldn't stay more than a week, the locals reminded us that summer would soon be there, and so, too, another bounty of great food. At the end of December, Hobart plays host to a seven day “Taste Festival” which coincides with the famous Sydney to Hobart Yacht Race.

By far, this has been our favorite place to visit. The locals constantly remind us that Tasmania is “a world apart, but not a world away.” We welcome company to latitude 40-44 degrees south. Cheers!


Dr. Kathy Starkey, an OB/GYN, and her partner, Molly Evans, have chosen locum tenens as a permanent lifestyle. Their adventures have taken them to New Zealand's North and South Islands, the Caymans, Western Australia (twice) and the small Australian state of Tasmania. They're such great storytellers that they appear in our blog often, so watch right here for more amazing tales from Down Under and beyond.

We've been blogging for a year now, and we have so many new subscribers that we thought we'd revisit these five great locum tenens stories that appeared in our
first post. If you've already read them, they're worth another look. Enjoy!

#1 Do you take this animal barb from your common-law husband?

What do you do once you’ve mastered the wind and waves of Australia? You take your thirst for adventure underground – and we’re not talking about the counterculture. It’s time to go caving, or spelunking if you prefer. So, strap on your gear and hit the caves.

"First, do no harm" isn't a bad principle when it comes to anyone who travels, but it seems particularly appropriate for locum tenens. Every day, hoardes of sightseers are running roughshod over some of the world's most fragile places, winning Machu Picchu a spot on the World's Monuments Fund's Watch list. Wildlife on Ecuador's Galapagos Islands is disappearing under beach towels and hotels, thanks to a boom of building and ships that shuttle tourists by the gutful each year. Even Australia's evocatively-named Bay of Fires, once Tasmania's "best-kept secret," has been threatened by a massive, recent influx of visitors.

So what do you do when wanderlust gets the better of you Down Under? Well, we've happily found several eco-friendly wilderness adventures that will scratch your itchy feet and satisfy your curiosity - without destroying Mother Nature.

The Overland Track between Cradle Valley and Lake St. Clair is regarded as one of the best guided walks in the world, and there's no better way to see it than on a walking tour with Cradle Mountain Huts. Take six days to walk the famous track, bunking down in comfortable mountain huts. You can explore alpine plateaus and glacial tarns, temperate rainforests, rivers, waterfalls and sedge land moors, traversing an extraordinary variety of unspoiled landscapes. The pace is leisurely, with a range of optional and more rigorous side trips including an ascent of Mt. Ossa. Take a trip from your desk chair with this spectacular photo gallery.

If we've seen it once, we've seen it a million times; doctors who locum Down Under get caught up in the grips of a grueling affliction known as fear and loathing of packing. Despite months of planning, these doctors and their families preparing for locum assignments are left staring at their suitcases for untold amounts of time, unsure about what to take and what not to take. Symptoms include melancholy; fear of exorbitant airport charges for overstuffed luggage; fear of not having their Aquafresh toothpaste in Refreshing Ice Mint flavor, and more. They become morose, ill-humored, broken or really "pack the sad," as they say Down Under. Dr. Kathryn Starkey, a veteran locum for Global Medical, and her partner, Molly Evans, have experienced the effects of this disorder first-hand and have offered up a fine solution: The Starkey & Evans Definitive Guide to Packing for a Locum Adventure Down Under.

On January 4, 2010, Dr. Kathryn Starkey and Molly Evans left Australia and headed for their 5th locum assignment, this time on the South Island of New Zealand. In a previous issue of Hemispheres, the ladies told of an upcoming trip to Margaret River - including a the possibility of a tree climb. We asked for an update, and we got it. Just prior to their departure for NZ, they sent this:
                                    
Dear All,

Before we head to New Zealand, we wanted to tell you about an area the Aussies call "our little secret." The Margaret River, in the southwest corner of Australia, is a beautiful, unspoiled world of history, nature and a spirit of all that is important in life...family, friends, food and wine. It features the Gloucester Tree, the highest working fire lookout in the world. Ignoring our age, we climbed its 153 rungs (actually reinforcement bars) to a height of a 20-story building (>200 feet) to the lookout platform. American litigators would have a heyday with this liability prone public amusement. Still in the climbing mood, we ventured to the coastline, driving through majestic Karri and Jarrah tree forests and climbed the Cape Leeuwin lighthouse, built in 1885. It is Australia's tallest at 56 meters (184 feet) high - there are 186 steps - and still supplies a nightly safety beam of one million candlelight power via the 1000-watt halogen bulb and original prism glass. This overlooks the meeting of the Indian and Southern Oceans which clearly is visible in the water and can be seen over 25 nautical miles away.

Our last adventure (before enjoying the wine tasting and a lovely long lunch) was exploring a series of 100 underground caves along a coastal ridge. It was definitely a lost primeval world with crystalline beauty. Back on terra firma, we found the Brown Hill, Voyager, and Brookland Valley wineries - with fabulous Cabernet Sauvignon Merlot blends, Shiraz and Chardonnay. You may not be able to find any wine from this region at home, but we recommend it highly!
 
As we do our final packing, we find it quite bittersweet. We have enjoyed living and meeting new friends in Western Australia.

It may be summer Down Under, but Aussies celebrate the season much like anyone who enjoys a white winter holiday, with a couple of notable exceptions - primarily an event called Carols by Candlelight.
It began one night in 1937 when an elderly woman was sitting alone in bed on Christmas Eve. Her only light was a candle, but it was enough to illuminate her expression as she sang "Away in a Manger" along with her radio. A passerby named Norman Banks was strolling along historic St. Kilda Road in Melbourne and caught sight of her. It made him wonder how many people spend the holiday alone, which inspired him to create the first public gathering of people to sing carols by candlelight. A pioneering radio broadcaster who'd just completed a late night shift, Banks' sight of the woman that night led him to create the most treasured Aussie tradition.

Historically, it's said that Cornish Miners in Moonta, South Australia, would gather on Christmas Eve to sing carols lit with candles stuck to the brims of their safety hats. Perhaps it was the early start of the Carols tradition, but it took one lonely woman in a window to inspire one man of action to spread the tradition.

The very next Christmas following Bates' inspiration, nearly 10,000 people congregated at Alexandra Gardens to sing carols with a choir and the Fire Brigade Band. Following World War II, Carols had become so popular that the event was moved to the neighboring park of King's Domain. The number of carolers grew and grew, so in 1959, the newly constructed Sidney Myer Music Bowl became a permanent venue for the gathering of over 30,000 people. Most towns across the OZ nation hold a Carols concert; over 100,000 people gather in Sydney, and many major Carols events are televised to millions of viewers - who sing along at home. Carols of the Domain, as it's called in Sydney, has also helped raise millions of dollars for the Salvation Army Oasis Appeal for Homeless Youth.
 
Beyond Carols, two other traditions Down Under are noteworthy: advertising is not permitted to be broadcast on television or radio on Christmas day, and get this: postage for Christmas cards cost less; senders are simply required to write "Christmas card only" on the envelope to get the lower-priced stamps. It has to be said: those are first-class holiday traditions.

We finally realized our dream to travel to the Red Center of Australia known as Uluru-Kata Tjuta! These 600 million year old monolithic rock formations hold both a magical and spiritual connection for indigenous people and tourists around the world (see more here).

Yes, we took and wore our fly netting and made it around the 10K trail walking, and at times, dragging our feet! We also enjoyed an evening dinner in the desert - where all light was extinguished and constellations burst forth. Perhaps you know the stars are different down under. The "Southern Cross" is the most famous. A camel ride was top on my list and followed by time in the swimming pools at the resort. One million wild camels now run wild in the bush. We learned more about the Aboriginal culture and bought a desert dot painting, our second. The Aboriginals have lived here for over 10,000 years! (See more art, and buy your own here and here).

Written by Carville Tolson, MD

G'day, y'all!

There's an interesting greeting—it reminds me of where I am and where I'm from.
 
Anyway, I've been here in Australia 'beyond the black stump' (far out in the bush) for a month now. It really is a nice place. Not flashy or fancy, mind you, but it's a real nice place. Quiet, too...for the most part. It's a long way from anything, to be sure—that MUST have something to do with the quietness.

Clinic practice is good. One has to be a bit innovative at times because we don't have all the medicines in stock, which are sometimes indicated or required. But that doesn't happen very often, and we can get them in about a week or less.

One man has COAD (that's COPD or chronic obstructive pulmonary disease in the States) and he was barely holding his own with his current treatments. I don't consider that I'm a high-powered doc, but I knew a medicine which could help, and though it had already prescribed, I learned that he wasn't taking it. Compliance is a big problem among Aboriginals (and elsewhere), and usually GP's here just shrug their shoulders and say, "Well, what can you do?" I wasn't satisfied with that.

I explained to this man how I had seen amazing benefits with the use of Spiriva for my patients with the same problems back in the USA. I explained that it may not help much in the first few days or even in the first week, but that long-term it would probably help a lot. Don't you know, he started to use it every day and two weeks later he looked much better and admitted he felt better! I guess us GP blokes from the USA can do some good after all.

Compliance issues were introduced as a factor in deciding on the treatment plan. When kids come in with head sores, usually I would just tell them to wash the head daily, give an oral antibiotic, perhaps a cream, and have them come back to check them in a week. But not so, I quickly learned (from the GP who was soon to leave) that parents seldom give oral meds to their kids beyond the first day or two; mandatory washing of the hair is unlikely to happen at all; and parents forget to come back in a week.

So, the best way to treat this is to give the kid an injection of LA Bacillin, which is a long-acting antibiotic, but which also is no fun to get. And yep! It goes in the bum. With my mobility problems, I rely on the parents to catch the little kids, and into the butt it goes!! This is NOT the part that I enjoy - giving shots to kids. But the medicine works!! The next time they come in, though, the child stands in a corner and eyes me suspiciously, even if he or she isn't the patient. But they do warm up to me (it seems) when they hear that brother or sister or cousin is going to get a shot. Then they come right over to me...and help with holding down the next "victim" for his shot. They're such a big help. Of course, all the children present get an "icy popsicle" treat—which is pretty much like frozen Gatorade.

Of the patients who come in, 90% (+) wear no shoes. A young boy, about 5 years of age, had injured his foot which had the potential to get infected, but it only needed a Band-Aid to cover it. When I told his mum and dad that he needed to wear shoes for the next week you would have thought I was giving him a shot! He cried and cried and cried. Okay, so GP docs from the USA can be terribly mean.

Right now the weather is very mild. It does get down to 40 or 45 degrees Fahrenheit, but that's only at night. During the daytime, it gets up to 75 or 80. So, you can see it's really great.

About 10 days ago, the temporary nurse working here offered to take me out on a road trip. We went up to see Devil's Marbles and The Policeman's Waterhole. It was a great day. Weather was perfect. I rode with my window down most of the way. We each took hundreds of pictures—thank you digital technology.

We traveled 600-700 km (375-430 mi) that day. No big deal, but remember, the roads were all dirt roads. At the start I thought, "How primitive this is." After we had finished making the circuit (12+ hrs), coming through a mountain range toward the end, crossing several dry creek beds, passing through narrow openings in the rocks, riding on washboard-textured roads, averaging 20-30 km/hr (15-20 mph) over 160 km (100 mi), and then coming back to the part of the road where we had started, I then realized how GREAT the starting road really was! It was like a grand highway. I just needed a bit of a better perspective, is all.

At the end, a lady looked at me and said, "You look tired." No kidding. "And your hair is red on the left." What?!!! Sure enough, I looked in the mirror and it was. When I washed my hair, there was red muddy water from all the dust. I hadn't realized I had been exposed to that much dust. Hmmm. Wonder if it helps the hair? Might be therapeutic.

I'm really glad to be working here. The people are good people and they have needs. I try to teach them about preventive measures, how to keep from getting sick, and how to treat some problems simply. I've purchased some vitamins and give these to them with good success. They appreciate what is done. It makes me glad to be here.

Dr. Carville Tolson is a GP from North Carolina, USA, who's taken a few locum assignments with Global Medical. He's enjoying his experience in Australia's Northern Territory so much he may never return to the states!