Locums for a Small World Blog

My locum adventures 'beyond the black stump'

Posted by Saralynn White

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 surethat 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" treatwhich 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 picturesthank 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!

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