Our Supplies Have Arrived. Well Sort Of.

Our roads have been shut off a lot of the time, particularly for trucks since before the Queensland floods. Our food deliveries usually come in from Perth. However with the rains the road to the east has been open a little more often and we have had one or two road trains come from Alice Springs to deliver food once or perhaps twice since Christmas.

Over the weekend with the roads open to the west a backlog of trucks (albeit with only a maximum of two trailers allowed) started to roll into various communities. This is my community on Sunday evening. Three trucks waiting to unload supplies before moving onto the next community and one truck being unloaded in the yard behind the community shop.

Some carried loads for exploration crews in the area and some contained refrigerated items that had been packed in January when the roads opened. Only to be closed again before the trucks could get through. Our bok choy and celery weren’t much chop and the yogurt arrived three weeks out of date. we have a dry goods truck packed for six weeks still waiting to get out.

But that’s life out remote. Only a few out here have whinged about it.

We were looking forward to the chill truck coming out again next week with fresh food but the three trucks in the picture and the truck being unloaded all became bogged on the same stretch of dirt road heading back to Laverton. It could be a while again before the next truck.

We had a similar problem in 2008

Practical Pharmacy: Stock Control

Lately I seem to have become a bit of a file linker and server. But many of the smaller specialised newsletters I find worthwhile and wish to share either don’t have a home on the web or are only put up quite some time later. The Victorian Residential Aged Care Coronial Communique is a case in point.

Another specialised newsletter is the HAI Africa Practical Pharmacy Newsletter. Again the current edition is not on the web. Previous editions can be found here. Click on the picture to download the current issue 7MB)

click on picture for newsletter

This newsletter is designed to help train indigenous workers in Africa about all things pharmacy. The current edition focuses on the basic building block of logistics. Stock Control.

It covers everything from ordering to stock management and expired drug disposal. In remote Australia we can receive medications regularly by plane and no cost but many of these principles we still use in our clinics.

A Visitor’s View of Remote Australia

Last week John Rovers, a North American academic, was let loose for a few days in remote Australia. Here is his story.

Lots of pharmacists drive 4WD vehicles to work and around town. Presumably, driving one of these trucks will come in handy if you ever get stuck. But let’s face it, 99.9% of the time, the most challenging off road experience for a pharmacist is driving up his driveway in Manly when it has leaves on it.

four_wheel_driveBut last week, I had the chance to find out just how remote ‘remote’ actually is and when driving one of those gigantic Toyota Landcruisers with the roo bar, 4 different kinds of radios and the air intake at roof level actually makes sense. Trust me, your Porsche Cayenne would last less than a week out there and your little RAV 4 would have rattled to death by lunch time.

I spent 5 days studying drug distribution logistics on the remote Ngaanyatjarra lands of Western Australia. Remote in this case means:

    (a) 10 hours west of Alice Springs or 10 hours east of Kalgoorlie
    (b) 5 hours off the nearest bitumen road
    (c) needing 4WD low range – WHILE YOU ARE STILL ACTUALLY ON THE ROAD
    (d) heavy traffic is seeing a dozen camels in the middle of the road.

Getting stuck on the Ngaanyatjarra lands is quite a bit different than getting stuck in traffic at the Gabba after a game lets out.

I found this to be a challenging environment. Every flat surface is covered in a thin film of red dust and if you wipe it off, it will be back by tomorrow. It’s not every pharmacist who receives a request from a nurse to come over to the nurse’s house and kill a brown snake on the front porch.

snake2

Keeping a healthy diet is tough when a bag of 3 carrots costs $5 – assuming carrots are even available this week.

And yet I found this to be a place where health care workers come voluntarily and where they give every effort against long odds to improve the fairly fragile health of Australia’s indigenous people. It’s hard work but they do it without complaint and they do it well.

No doubt to a few, it’s the Australian equivalent of joining the French Foreign Legion and leaving an unpleasant or painful past behind.

But the professionals I met really do seem to enjoy their work and my hat’s off to them. I doubt they get much credit for taking on what must be the hardest jobs in health care. Good on ya! Every one of ya mugs!

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Remote Pharmacy – A Review from a Remote Nurse

This was written for me some time ago by Melissa, a Remote Area Nurse I worked with in 2008.

Working in a remote area as a health professional is a very challenging role. Unlike working in an urban or rural hospital situation, where there are a multitude of doctors, nurses, allied health professionals and pharmacists available 24 hours a day, remote health clinics rarely have a variety of health professionals, let alone the ones which are essential. Having a pharmacist located within the region is not only rare, but is highly valuable and appreciated.

There are many times when having a pharmacist nearby is a definite advantage. Questions over medication interactions, brand names, etc can easily be sorted by pharmacist who is only a phone call away and is well familiar with the medications commonly utilised in the area. Pharmacists are a fount of knowledge about medications, drug interactions, and side effects. This is not only helpful for doctors, so that they do not prescribe medications which interact, but also for nurses who may need help with understanding certain medications, interactions and side effects.

Having a pharmacist as a part of the remote health team helped immensely in streamlining patients medications when they have been discharged from hospital. Commonly, patients are discharged from hospital without any consultation with Medical and/or Nursing staff, with patients discharged on new or altered medications, which may not be readily available in the remote clinic. Having a pharmacist who is actively involved in helping with patient discharges means that any new or altered dose medications a patient may require can be ordered and, hopefully, arrive prior to the patient returning to the community. The pharmacist can also help to organise new remote scripts when patients’ medications have been changed by a hospital or specialist.

Transportation of medical supplies and medications in remote areas is not merely a matter of placing an order and it arriving in a day or two. It takes time to get medications and medical supplies transported out, mostly by airplane, and having a remote health pharmacist has certainly helped with this. Whilst it is impossible to know exactly how much medication a clinic will use in a given month, the pharmacist can be instrumental in helping to calculate average usage and to assess what minimum level of medication stock should be kept in a clinic.

When a medication inadvertently does run out before the next order is due/arrives, having a pharmacist nearby is handy. By calling the pharmacist who has a general idea of what clinics have what medications and the levels of medication in each clinic, the pharmacist can organise to have emergency supplies transferred from another clinic to the clinic in need. This can also be useful for medications whose expiration date is coming up. Because the pharmacist has knowledge about which clinics and patients use certain medications, close to expiration date medications and vaccines can be transferred to where they are most likely to be used in order to help prevent wastage.

A remote health pharmacist can also spend time with individual patients and explain their individual medications, changes to their medications, and how to use medication devices such as dosette boxes and insulin pens. Whilst nursing and medical staff aim to explain the medication prescribed to the individual, often they do not have the time or the expertise of knowledge which a pharmacist has. Having a pharmacist travel from remote clinic to remote clinic means that patients who require extra explanations can have a visit booked with the pharmacist for that express purpose.

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