Ten questions for Robbo aka @BiteTheDust

I drove off the lands on Boxing Day 2015 and stayed a couple of nights with Bob Gosford. For my sins he forced me to answer his 10 question quiz. The original post is here.

My pet hate listed in the quiz has certainly come to prominence following the 4 Corners investigation into the running of Indigenous Corporations. Please watch the show “Ripped Off” if you have not already seen it.

Ten questions for Robbo aka @BiteTheDust

In July 2015, Robbo was named the Pharmaceutical Society of Australia Pharmacist of the Year for 2015. Robbo has worked for the last ten years as a remote pharmacist in the vast Ngaanyatjarra Lands of Western Australia adjoining the NT and South Australian borders and is a tireless advocate for improvements in Aboriginal health.

Robbo, George and Girl outside Wanarn Clinic
Robbo, George and Girl outside Wanarn Clinic

I had a yarn with my good mate Andrew “Robbo” Roberts aka @BiteTheDust over the Christmas break just before he flew out of the country for a few months.

In July 2015, Robbo was named the Pharmaceutical Society of Australia’s Pharmacist of the Year for 2015. Robbo has worked for the last ten years as a remote pharmacist in the vast Ngaanyatjarra Lands of Western Australia adjoining the NT and South Australian borders and is a tireless advocate for improvements in Aboriginal health.

At the time of his induction he said that his:
”… biggest thanks go to the people of the Ngaanyatjarra Lands for welcoming me on to their lands and into their lives for over 10 years. I hope this award increases the recognition of the need for pharmacists to be working as part of the health care team for our remote Indigenous Australians.”

The Northern Myth: Tell readers about yourself in ten words.

Robbo: A ten word biography? Desert, bush, medication, literacy, best-practice, education … Dingo, four-wheel drive.

TNM: What makes you happy?

R: Coming out of the bush and having someone make me a fresh coffee that I haven’t had to make myself.

TNM: What makes you angry?

R: The sheer waste you see and the blame-shifting by whitefellas buggering up indigenous organisations.

TNM: Cats, dogs, both or neither?

R: Dogs. The less said about cats the better.

TNM: Sunday morning music?

R: I don’t really listen to music much but out bush where I am you get the church going or some locals playing music somewhere in the community. There is always music in the bush.

TNM: Your Desert Island disc?

R: There are a few bits of music that I always associate with certain things that happen in the past, so some of the old seventies songs, a bit of old Skyhooks or pretty much anything by Madness …

TNM: Where do we go when we are dead?

R: In the ground.

TNM: What do you sing in the shower?

R: Nothing. I’m not a singing person.

TNM: When did you last break the law?

R: Yesterday when I did a u-bolt outside your place without putting the indicators on (laughs) and usually every time I come into town because out bush you don’t worry about white lines or indicators.

TNM: Top-loader or front-loader?

R: Top-loader – out bush that’s all there is!

TNM: Most treasured possession?

R: Well I couldn’t count Girl (my Dingo dog) as a possession. Can’t really answer that one …

TNM: Pen or pencil?

R: Pen! I love a fountain pen. I’m left-handed and I’m a shocking writer so at least it makes me try and have hand-writing that is legible.

TNM: What are you reading in non-fiction?

R: Not much at the moment, all my stuff is packed up. The last book I was caught reading was just released about the life and works of the artists from Wanarn Aged Care called The Wanarn Painters of Place and Time: Old Age Travels in the Tjukurrpa made with the assistance of the arts centre from Warakuna. Some great old artists from the lands have ended up at the aged care centre, including Dr. Mary McLean who is now a West Australian Living Treasure. She doesn’t paint anymore but she is a renowned artist who lived in Kalgoorlie for a number of years and moved back out to country to stop at the Wanarn Aged Care facility.

TNM: What about fiction?

R: Yeah, I’ve been churning through a lot of books. I didn’t read much for ages but I’ve been reading some nasty and forgettable crime fiction recently. Not much of any substance for a while.

Remote Pharmacist WA – A conversation between myself and the Pharmacy Guild President

In January 2015 the president of the Pharmacy Guild George Tambassis and his PR man Greg Turnbull came onto the lands to spend 5 days with me on the lands. George and I have known each other since uni (in the same prac. group) but had not seen each other since we graduated. We caught up for the first time in nearly 30 years at an international pharmacy conference in September 2014.

The first few hours were spent in Alice Springs where the now previous CEO tried to tell him I was acting out of scope of practice for reviewing medications on the discharge summary of our patients from hospital and advising the doctor of any problems (actually best practice). This set the tone for 2015.

George and Greg travelled out the hard way in a troopie with me for 924km from Alice Springs in the January heat and spent nearly a week with me.

On their last day on the lands Greg filmed George and I having a conversation. Yes, it is a year old but the discussion is still relevant.

A Pharmacy Student Placement Out Bush

Over the last nearly ten years I have had a large number of students visit me out bush. They came from a mere week to a month or more. Unfortunately they never have time away from me, sharing my house and my working hours. I try to get them to write an article,or their university does. And sometimes they do it! Here is one of their stories. Some slight editing so patients from past years cannot be identified.

A Pharmacy Student Placement Out Bush

Outback, remote, arid, red dirt, abandoned Fords, Landcruisers and Jag left to mark the passing of time. Vast landscape that remains changeless despite the impact of bush fires, adaptation of people and spirit. Somewhere in miles of red dirt, we travel the connecting roads from Jameson to Kiwirrikurra, 750kms, many parts across the Sandy Blight.

Bore on the Sandy Blight Road
Bore on the Sandy Blight Road

Robbo drives with ease of experience along sandy bush tracks, visited by him only two weeks prior, he warns me of impending corrugations, found along this now dry twelve hour drive. The long range tanks filled with diesel at $2.80 a litre will theoretically make the distance, a rogue pot hole threatens to undo the chassis.

I am relaxed during the drive despite the potential chance of danger, a remote possibility the wind might change southerly. The bush fire as our neighbour taints a smokey horizon creating a spectacular sunset, a burning flame of a sun that dips slowly in the sky as a full moon of the same colour meets it, a change of guard from day to night.

Robbo is well versed in outback travel and spending just a week with him its obvious that his knowledge has a practical side, combined with a teasing humour that puts me at ease. On the other hand, do I really have a choice!

I talk a lot at first, when Robbo asks me about my experience so far. One week at Jameson. A small community of under 200 people, I am not sure yet if I am getting what I want out of the journey. It’s always dangerous to invite expectation, it takes time for people to trust you, to share themselves and to gain respect. I feel like an alien, white skin dominated by black, the foreign tongue of Ngaanyatjarra in my ears, and a complexity of issues witnessed from a distance.

The challenges faced in terms of medications and health outcomes are intertwined with family tensions, living conditions, a shifting of culture and language barriers, to name a few.

The challenges faced in terms of medications and health outcomes are intertwined with family tensions, living conditions, a shifting of culture and language barriers, to name a few.

Robbo’s interventions are equally social as medical. Over the course of the week I have observed him warmly embracing a young man who climbed the water tower whilst he was away in an attempt to commit suicide. Ensuring timely medication infusions for a patient with an auto immune disease, giving a lift to Warburton for a fortnightly monoclonal antibody treatment 125km away. A discussion with the grandmother who looks after her grandson’s phenytoin medication. She wishes to go out country with the ladies, who will be responsible that the dose is not misplaced or forgotten.

These experiences and many so far had consolidated my understanding that being a pharmacist and achieving concordance is about relationship building. Coupled with many additional challenges, management of chronic disease, seizures, mental health, boils, scabies and lice to name a few, management of aboriginal health requires management on many fronts.

Robbo’s experience and relationship with the people enabled him to address some of the social issues, whilst ensuring other aspects of pharmacy also ran smoothly. Remoteness requires a timely and adequate supply of stock, making available to other health professionals useful tools and multi-tasking with a nurse or doctor at a distance.

Apart from personality and experience, I also witnessed the use of many resources and tools whilst working with the Aboriginal people. Just now I noted on Robbo’s blog a series based around alcohol with a theme to reshaping drinking habits and misconceptions over alcohol in Aboriginal communities. Pharmacists in a remote setting must also be teachers and use these valuable resources as tools.

In the end I would say I learnt many things from those around me as well as the location and the people themselves. I think its important for us newly fledglings that we are green and so looking to the guidance of experienced people and adopting and adapting there methods, as well a being guided by resources and tools will enable me to fashion my practise. Watching it in action is for me the best way to learn.

Summing up my lessons would be:
1) Don’t judge a book by its cover
2) Humour is a tool
3) Be genuine
4) Write down dosages and calculations,
5) How to pack metformin into dosette boxes
6) Get the client to demonstrate how they will take their medications
7) Use your mirrors when backing out of driveways or avoid reversing all together
8) Life and people are complex understanding good management in this context takes time and experience
9) Being in remote Australia requires multiskilling, working closely with nurses and doctors
10) Systems are useful to avoid errors
11) The joy of quality research and tools in order to avoid reinventing the wheel and wasting time.
12) It’s better to drive of the road then scare your student by fishtailing!

George Tambassis, Pharmacy Guild President interviews Robbo

If you follow the blog you would know the Pharmacy Guild President, George Tambassis, came and visited me a few weeks ago and he wrote this piece on The Challenges of Bush Pharmacy

As well as that piece George also interviewed me. See the agonising the seven and a half minutes below.

George Tambassis, Pharmacy Guild President interviews Robbo

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