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!

Western Desert Walytja Palyantjaku Tjutaku (WDNWPT) win the Team Excellence category in the HESTA Primary Health Care Awards

Congratulations to Sarah Brown and her team at Walytja Palyantjaku Tjutaku (making all our familes well) or as it is known – The Purple House – on winning this award.

“Walytja Palyantjaku Tjutaku” means “Making all our familes well” is owned and managed by the members of Kintore (NT) and Kiwirrkurra (WA) communities. It’s aim is to bring respite haemodialysis to remote areas to allow for respite visits back to country and family.

As well as the purple house in Alice Springs they have set up a respite house in Kintore and a mobile dialysis bus is nearly complete.

You can learn more about them at WesternDialysis.com.
The bush garden at the Purple House was also featured on Gardening Australia earlier in the year.

Related Post: Cross Border Health: Renal Disease

Yuwawu, pitja-ya Ngaanyatjarra ngurrakutu. Kulila-ya

A new website at http://www.ngurra.org/ has a brief outline of the Ngaanyatjarra communities (and a few close by) along with a story or two about the community and a traditional story of the country.

Ngaanyatjarra

Take a look around.

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