Arriving back in Hobart, from my last working trip in Jeddah (Saudi Arabia), in mid- 1994, I had, at last, paid off my two large mortgages, in full. The family were all well. Dan was 30, Zoe 28, Tara 24, Tabitha 21, and Alicia 18.
Beach Road Medical Centre was chugging along well, with Anita at the helm. We were Bulk billing all patients and this was greatly appreciated. The “grown up kids” were all happy and contributing , pretty much independently, to their own futures, and developing their own talents, mostly, in all the right ways!
I resumed work at Beach Road Medical Centre for a few days a week.
Since the mid 1980’s four local businessman, and I, owned Dockside Fitness Centre. Dockside had a about 3,500 members and was a thriving, up to date Centre with all the latest equipment, trends , gizmos and 29 aerobics instructors.
A wide range of sportsmen and women trained there and it’s waterfront location was superb.We transferred the business to The Hobart Aquatic Centre after eleven years and then sold it to the City Council. We developed and opened Club Salamanca Executive Health and Corporate Fitness Centre in Hobart which provided personalised assessments and fitness training programs combined with a multi -disciplinary rehabilitation facility for Corporate and other clients.
My business Colleagues were an Ex-Tasmanian AFL player and Liberal Member for Denison, an Australian Team Cricketer (and wicket keeper),a Criminal Lawyer and a Consultant Anaesthetist.
What a diverse mob.We all got on famously well and I guarded my 15% business interest proudly.
After 18 years in the ‘game’ I sold my share to my mate Bob, because other interesting opportunities presented themselves.
Having worked in, and provided Medical Services to, the Military and their families of the richest Country in the world .I received a phone call from The Northern Territory Town of Katherine.They had been experiencing difficulties in getting a locum for three months to relieve their regular doctors who needed a break.
SO THIS WAS MY FIRST OPPORTUNITY TO WORK FOR, AND WITH, THE POOREST PEOPLE IN AUSTRALIA, OUR INDIGENOUS PEOPLES.
It must have been, and still is, very hard, for the average Australian , to comprehend the plight of our First Australians in 1950 or in 2020.
They have indeed lived here for 60000 +years, in what is factually, their own Country, and it has taken dozens of, largely fruitless reviews ,statements ,white and green papers,parliamentary investigations,recommendations and votes etc ,etc, to even scratch the surface of what the heck is going on in this space.
Yes, there are zillions of interest groups who want their fifty cents worth of input into trying to resolve, for all time, a seemingly too difficult problem, about rights and responsibilities.It appears so far that never the twain will meet and agree.
The educational, social , medical, legal, equality of opportunity and all of the other social determinants of health and living rights, appear to have been left to groups of opportunistic, connected white fellow lawyers and corrupt Land Council blokes, to decide when it comes down to “fact finding” and workable decision making. Regrettably there is overt and covert nepotistic tribalism, amongst some influential groups of Elders and decision makers.Personal interests often strip away the hope of many of the genuine needy, and greedily pushes many deeper into a swamp of even greater poverty. Nimby excuses in these situations can indicate cover-up, however.
I don’t have an answer,only further questions.
What I did have , was an opportunity to see ,for myself,a bit of what was going on, initially in Katherine NT. So I went there for Oct/Nov/Dec 1994, the three months in 40 degrees C heat and 95- 100% humidity that precedes,and accompanies the ”big wet”. Gees! This place was hotter than Saudi Arabia and far more humid…flies, moths, butterflies, geckos,big lizards,hairy spiders and , thank heavens, mangoes for the picking every where.
This was my first time ever working in Remote Aboriginal Lands on a ‘fly -in fly- out,” or “drive- in, drive -out basis” doing clinical, administrative and emergency retrieval work servicing a number of Top End Communities.
Staying a few nights in Kalkaringi, Lajumana, Duck River, Noogar, or Mataranka, with stopovers in Victoria River Dam,Timber Creek or Pine Creek, meant travelling hundreds of km daily either by car or on Aero-Medical flights in a Nomad , Cessna or other small aircraft,usually without radar and often in thunder and lightening Top End storms.The best plane for retrieval flights at this time was the twin engine King Air…big, smooth and comfy.
Whether by day, or by night, retrieving Emergencies from remote areas and taking them to Katherine Hospital or Darwin Hospital ,though often tiring, was always professionally rewarding.
Our Pilots and Retrieval Flight Nurses were awesome, helpful and so very reassuring and experienced. Most of the time they seemed to do all of the hard work.Thanks a bundle guys!
I was disappointed when my three months passed by , oh so quickly, yet oh so happily.
I left Katherine with a great many new thoughts about Medicine and a need to go and work in Remote Indigenous Australia a lot more in the not too distant future.
Sometimes things seem to work out in many different ways to reach a purpose and we are often ignorant of that reason or, indeed, that purpose.
I decided to go to an Annual Royal Flying Doctor Conference at Broken Hill , some weeks after completing my Katherine Locum, and took Anita.
On the first day I met a number of Flying Doctors from Perth, Broken Hill ,Queensland and South Australia .They all seemed a very happy, experienced mob. I was drawn into and fascinated by their day to day tales and vignettes.
The next morning, I left the Hotel with Anita and suddenly found that I was unable to use my legs to walk across the road. I was totally numb from the waist downwards, could still sit on a toilet, do my ablutions and have a good pee. After standing still for a few minutes the numbness was reduced sufficiently to allow me to cross the road.
Over the course of the next few days I experienced recurrences of the numbness,and whilst not panicking, managed to finish the Conference and flew back to Hobart a few days later.
NOW HERE’S THE THING:-
Sixteen years previously, when driving from Hobart to Bridgewater, to take a morning Clinic at the Community Centre,my car hit an icy road patch and spun around at least three times, finishing up looking backwards towards Hobart.Now that was a bit disturbing but I carried on, did the Clinic , drove back to Hobart,put an ice pack on a couple of bruises and never gave it another thought.
Some days later I developed severe Rt sided C6 nerve root Neuropathic persistent arm pain. A fortnight later Neurosurgeon Graham Duffy relieved the pain,after all other treatments had failed, by performing a C5-6 Anterior Cervical Fusion operation.
Everything went really well and for many years I had full use of my neck, painlessly and played all sorts of sport,including Tennis,cricket and Rugby.
In Broken Hill I recalled how I had left Riyadh in Saudia Arabia in 1991, having sustained nerve root damage to my neck after a tennis ” service injury” during the first Gulf War. That had also required nerve pressure release Neurosurgically in Sydney some weeks later.
So what had happened in Broken Hill which had causing loss of the use of both of my legs episodically whenever I was walking?
Some weeks after the incident, my good friend and Hobart Rheumatology Specialist,Hilton Francis, diagnosed my condition as severe spinal canal stenosis whereby Osteoarthritis had caused significant traumatic pressure on four out of the five lumbar spine nerves centrally as they left the spine to travel down into the legs. This required a three and a half hour spinal operation to release the pressure on the nerves, a so- called four level Laminectomy using a 22 cm scar.Mr Fred Binns was my meticulous surgeon.
Although I had many naysayers write off my surgical, urological and orthopaedic stability future, I managed, after 10 days , to painlessly walk up and down 120 stairs in the Hospital, got into my car the next day for my discharge and illegally drive home. I think that this is an example of my trying to justify the”Law of pure Cussedness”.
This was the beginning of a totally new era. I was now , for all intents and purposes, totally uninsurable in the event of anything, accident or otherwise, happening to any related area of my spine, top to bottom.
Having left the Hospital, there was a question of what rehabilitation program I should follow , when, where, for how long and who should manage it and why?
There had to be answers to this conundrum,and there were.
I saw Fred two weeks later.He was smoking his favourite curly pipe.I asked him whether I might get problems during the next few years.He was understandably evasive, blew a big puff of sweetish smelling smoke from his pipe,coughed and mumbled…”Good luck mate,I’m hoping I won’t see for another 20 years.
Fred was right, he didn’t see me again.He died about five years later and I’ve never had to go back to see his successor.
Vale dear Fred Binns.
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After three months in Katherine, and after Surgery for my Lumbar Spinal Canal Stenosis, my work travels took me to Walungurru (Kintore) NT in The Central Western Desert for an initial six week locum in an Aboriginal Controlled Community. The details of that experience are written elsewhere under the title ”Walungurru”(Kintore).
I later returned to Kintore for a two year period , starting in January 1997 and ending in early November 1998, a rotating job share with another doctor.
Thereafter I returned to Kintore, intermittently, until my last working visit there in 2012. The details and vignettes relating to all of my times in Kintore are written under the Walungurru Kintore) stories,to assist continuity.
I visited 56 Indigenous Communities in Central Australia during the period Oct 1994 and February 2017,as a Remote Medical Practitioner.
Some visits were as a Royal Australian Flying Doctor, retrieving seriously ill patients from an area of 400,000 sq km, mainly in NT, but also including part of the APL lands in South Australia,and the NT,WA,& QLD adjacent border Country.
I lived, and worked, in Alice Springs, employed as a District Medical Officer and Specialist Public Health Physician, in 1999 and early 2000 . It was here that I spent a great deal of time working as a fly- in, fly -out, or drive -in, drive- out doctor visiting very Remote Communities.
In 2000-2001 I lived in Yulara (Ayres Rock) for nearly two years, employed by the Royal Australian Flying Doctor Service as the Resident Doctor.This post was shared with a colleague and we worked for 21 days and nights straight each, and then returned after another 21 days.These were extremely hard working,challenging but stimulating times, representing the RFDS and treating travellers and visitors from all over the world.
RFDS Yulara, was often described, by International visitors as “The World’s window to Australia’s Flying Doctor Service”.
I enjoyed excellent accommodation, wonderfully happy , friendly and well qualified working colleagues, a privileged, once in a lifetime job, and the very best of Senior “bosses”, based in Adelaide and Melbourne.Go,Go, you good thing!
THE FOLLOWING IS A COMPLETE LIST OF ALL OF THE REMOTE COMMUNITIES, THAT I VISITED ,AND WORKED IN, DURING THE PERIOD OCTOBER 1994 TO FEBRUARY 2017. THE TERRITORY HEALTH SERVICES OUTLETS MAP IDENTIFIES THE SITE OF EACH COMMUNITY.
1 ALICE SPRINGS URBAN.
Alice Springs, Hermannsburg, Haast,s Bluff, Papunya, Mt Leibig, Nirripi, Walugnurru, Yuendumu, Laramba, Mount Allan, Willorwa, Sterling, Ti-Tree, Pmara Jutuma, Tara, Utopia, Ampilatwatja, Bonya, Hart’s Range, Alcoota, Santa Teresa, Amoogdana, Wallace Rockhole, Titjikala(Maryvale), Areyonga, King’s Canyon.
2.ALICE SPRINGS RURAL.
Finke, Mt Ebenezer, Imampa, Mutajulu(Ayer’s Rock), Yulara, Docker River, Curtain Springs.
3.WESTERN AUSTRALIA.
Kiwirrkura.
4.BARKLY DISTRICT.
McLaren Creek, Ali Curung, Murray Downs, Canteen Creek, Epenarra, Tennant Creek.
5.KATHERINE.
Lajamanu, Kalkarindji, Daguragu, Yarralin, Victoria River Dam, Timber Creek, Pine Creek, Wurli Wurlinjang, Matarahka , Ngukurr(Roper River), Hodgson Downs, Borraloola, Urapunga, Bulman.
6.DARWIN URBAN AND RURAL.
Jabiru.
7.SOUTH AUSTRALIA .
Amata, Fregon, Indulkana, Mimili, Ernabella.
8.QUEENSLAND.
Mount Isa, Lake Nash.
I HEREBY MAKE A STATEMENT WITH REGARD TO PERSONS WHOSE NAMES I MAY HAVE CONSIDERED MENTIONING IN MY TEXT,OR WHO MAY HAVE BEEN INVOLVED IN MY VIGNETTES.
WHERE AND WHEN I HAVE RECALLED STORIES OF ACTUAL EVENTS THAT HAVE HAPPENED OUT BUSH, OR IN VERY REMOTE COMMUNITIES, INVOLVING PERSONS WHO HAVE BEEN CLIENTS OR PATIENTS, I HAVE RECORDED THE EVENTS AS THEY ACTUALLY HAPPENED BUT CHANGED THE NAME OF THE PERSON OR PERSONS INVOLVED TO DIFFERENT NAMES SO AS TO BE ETHICALLY AND MEDICALLY SENSITIVE AND JOURNALISTICALLY CORRECT .
WHEN DISCUSSING OTHER MATTERS, WHERE A PERSON’S NAME IS NEEDED TO COMPLETE FACTUALITY, PERSON TO PERSON, AND NOT A SECRET DISCUSSION OR DIALOGUE, RATHER THAN DISCUSSING CONFIDENTIAL MEDICAL MATTERS I MAY HAVE INCLUDED THEIR NAME ,”IN GOOD FAITH AND WITHOUT PREJUDICE” TO FACILITATE VERIFICATION SHOULD THAT EVER BE NECESSARY. AT TIMES I HAVE OMITTED THE NAME OF THE COMMUNITY IN WHICH THE EVENT OCCURRED SO AS TO DE -IDENTIFY THE PERSONS INVOLVED.THE FACTS REMAIN,THEY HAPPENED.
This section deals with events, that I felt may be of interest to recall , and, which happened in one or other of many different Communities.
At times I would have been acting as a regular locum tenens doctor,in familiar surroundings out bush , or as a District Medical Officer employed with Remote Health based in Alice Springs. As a DMO I was frequently on call as the Doctor responding to requests to attend and effect Emergency evacuations from Remote Communities,through the Royal Flying Doctor Service based at Alice Springs Airport.When urgent ,or Code 1, requests for evacuation ,were confirmed ,the doctor on call was required to drive to the Airport,and ,together with the Pilot and Flight nurse, make sure that everything was in order to take off from Alice Springs within 45 minutes of the initial request.Occasionally this was not possible because the RFDS plane was already in another Community.Sometimes a possible Code 1 request was downgraded to a Code 2 request ,in which case an asap was enacted. Whatever the situation, the RFDS doctor on call took over the management of the seriously ill person ,using their own clinical judgement together with back up from Hospital Specialists and continuous ongoing contact with the Clinic, in which the sick person was based, and the person making the original request.
There were frequently occasions where a person could be driven from a remote Community in a Community Ambulance to Alice Springs for assessment and treatment. These occasions would require some certainty with regard accompanying Medical /Nursing Staff and their ability to manage a possibly increasingly serious issue when travelling through unfavourable country in unfavourable conditions.The responsibilities placed upon Doctors and Nurses ,in these circumstances can impact horrendously on their lives ,if things go wrong, AND THEY DO. The vehicle driver is often an Aboriginal Health worker and the implications for them ,if things go wrong, can become serious cultural issues.
On a number of occasions ,in a number of Communities it has been impossible to get an RFDS evacuation flight to come out from Alice Springs or Darwin, because of severe storms, and,in addition, having badly flooded bush roads preventing us from attempting an Ambulance evac. There are then serious management problems especially if the storms continue for 24 hours or more.
Included in this section are also a number of events which occurred when I was the RFDS Doctor at Yulara Clinic( Ayer’s
Rock ) in 2000-2001.
THE FAMOUS FINKE DESERT RACE.
On the long weekend of the Queen’s June birthday ,the Finke Desert Race takes place. It is an off road, multi- terrain two day race for motor bikes, cars, buggies and quad bikes and goes through desert country. It starts just west of Alice Springs and winds it’s way to Aputula (Finke), an Aboriginal Community in the Northern Territory 229 km distant. After spending the night at Finke the competitors turn their vehicles around and race back, the same distance, to Alice again.
The Annual Finke race, first run in 1976, has a reputation of being one of the most arduous off road courses in one of the world’s most remote places . About 500 riders and 140 drivers usually start and the winner on each day takes about one hour and fifty minutes to reach the finishing line.
In the late 1990’s I was the Medical Officer, on call with the RFDS and Remote Health, whose job, on two race days, was to retrieve injured competitors, who had been involved in crashes.They had been initially triaged and assessed by the on- site Race Medical Team, and, where necessary, put in an Ambulance and taken to a small Airstrip for evacuation to Alice Springs Emergency Dept. There were seven injured motor cyclists / race car drivers evacuated over the two days. One had a head injury, two sustained ankle fractures, one a nasty wrist fracture, one a fractured fibula(lower leg), one a fractured collarbone and finally one with 3 broken ribs. A veritable potpourri of Orthopaedic work for the Emergency Dept to manage.
There were a number of interesting social and verbal interactions between the injured, both before and during the flights back to Alice Springs.
These were very macho blokes who, initially ,collectively and almost competitively, declined any strong pain medication but, as preparations progressed towards the actual flights, all of them,again collectively, wisely reviewed their pain needs.
2016, experienced a cold foggy, frosty and dusty start to that race. 17 riders and spectators were treated track- side ,of which 12 were transferred to Alice Springs Hospital.
FATAL VEHICLE CRASHES ARE EXTREMELY RARE DURING THE ANNUAL FINKE DESERT RACE. WHAT ABOUT ON THE NORTHERN TERRITORY ROADS? LET’S TAKE A REALITY CHECK ON THE FIGURES FOR THE PERIOD 2011-2020.
During this period there was a total of 352 fatal road crashes on NT roads of which 163( 40%) were alcohol related.
90 involved not wearing a seat belt.
113 were speed related.
27 were fatigue related .
287 involved male drivers, of which 206 were Aboriginal.
298 were on rural and 113 on urban roads.
Strangely enough 25 were lying on the road when they were killed.
WHAT KIND OF ROAD CRASHES DO YOU GET CALLED TO ATTEND TO, WHEN WORKING AS A DOCTOR IN VERY REMOTE COMMUNITIES ? DOES IT TAKE LONG TO GET THERE OR DO THEY USUALLY HAPPEN NEAR HOME BASE?
Road crashes on main roads in the NT are often very different than in Remote Areas.You are rarely the first person to arrive because there is probably passing traffic and so immediate help may be available.
Many people die in the first ‘Golden Hour, after a crash, from significant injuries. Some of these people may not die if there is a person on the scene immediately who can apply basic life- saving First Aid principles.
Others, who stop at the scene, can apply these principles to make the area safe, contact an Ambulance and Police and generally be available in many ways. Getting to an Emergency Department at an Accredited Hospital ,in the best possible condition, is the next goal.
In remote areas, where rural roads are dirt or not sealed, presents a whole bunch of new problems. The road may be sandy, muddy and slippery, especially in areas where there are lots of corners to negotiate. Speeding home,often with some alcohol still in the system, from last drinks before leaving Town, is common . Fatigue, from a long drive, combined with poor head lights and night driving, is the recipe for a disaster waiting to happen.
THEN IT HAPPENS,SUDDENLY, WITHOUT WARNING, AND AT SPEED!!
In the next few pages, I will relate SIX scenarios where car crashes occurred in Remote areas, far from any hospital and where official Ambulance help was unavailable. They are in no special order, and the names of persons involved and their Communities, have been changed .
1. WAS WALLY LUCKY ENOUGH,OR UNLUCKY ENOUGH,TO HAVE BEEN PICKED UP, ON THE SIDE OF A REMOTE ROAD, BY A YOUNG FEMALE STRANGER DRIVING A POSH TOYOTA LAND CRUISER?
Wally was a well known, 74 year old local Community Elder, who painted highly collectable Aboriginal Art.
His car, driven by a family member, had broken down, 150 km from his Community, on a dirt road, at 2 pm in the afternoon.The driver managed to flag down a passing Toyota Landcruiser within 30 minutes.
The Toyota driver, a young female social worker, was going to Wally’s Community, albeit for the first time, and stopped to help. Wally had a lift home, and that was OK. Well, it was only OK, for the first 40 km, then her vehicle experienced the big, bad out of control wobbles.
The social worker was not used to Remote roads. Her wheels spun, slid in the sand on a 45 degree corner, flipped in the air and left her and Wally upside down inside of a crashed Landcruiser.
A satellite connected phone, an essential in Government vehicles out bush, was available and the uninjured social worker was able to contact us briefly, stating her predicament!
Within 10 minutes a Health worker and I left, in the Clinic Ambulance and arrived after an hour and 20 minutes and 110 km later.
Wally was furious,in pain and uncomfortable, at still being upside down, on the road side, on the inside of the ,now frightened,young woman’s Toyota. After hearing the sad story, of what happened, we managed to extricate Wally, assess and examine him, and transfer him to our Clinic Ambulance. He was given a Morphine injection for a compound fracture of his right Collar bone. Compound means that the bone was fractured with a chunk poking out through the skin of his neck and upper chest.
Another vehicle took the social worker back to Wally’s Community and sorted out her accommodation.
By the time the health worker and I arrived at Wally’s house,news had swept through the Community and Wally’s family were already calling for the person who was driving the Landcruiser, to undergo payback. Wally’s well known grandson, was already brandishing a spear.a nulla nulla and a boomerang. I don’t think he realised that the social worker was a woman, but,of course, he had to display as much theatre as possible so as to appear culturally strong and be seen to be doing the right thing for the family.
I knew the agitated grandson well and was able to briefly pull him aside to prevent a melee and unpleasant repercussions . I talked to the social worker privately, at length, explained the cultural situation and managed,through her Government bosses ,to get an order for her to be flown out of town the same evening so as to defuse the matter.
Wally’s x-ray confirmed that the fracture was “compound.” He was flown for an Orthopaedic surgical opinion the following day and his collar bone underwent surgical repair the next day. Six weeks later he was able to start painting again.
2.YOUNG FELLAS’ TAKE ADVANTAGE OF “BORROWING” THE CLINIC AMBULANCE FOR A JOY RIDE INTO TOWN.
When I worked in Saudi Arabia, you could leave your car keys in your car, with the doors and windows unlocked, and come back later and they would still be there. After living there a while you realise that they were still there because ,if someone nicked them and were caught,they may well lose the hand that stole the keys, on a fine Friday morning in ”Chop Chop” square at the orders of the Saudi Arabian executioner. That seemed to work ,as a preventive measure over there, but is, thank heavens, not the law in Australia. If that were so, I would have expected,statistically, to have come across lots of single handed 16-40 year old persons in Australia, during my many years in Medical Practice.
In very Remote communities an available vehicle is an important asset. Now, kids have no assets, and are unlikely to have access to a vehicle unless some white fella doctor(like me), forgets to remove the keys from a vehicle, that he has been using all morning.
“LEAD US NOT INTO TEMPTATION, BUT DELIVER US FROM EVIL” is not a well followed biblical instruction when faced with an Ambulance full of fuel. and three sixteen/seventeen year old boys looking for a big joy ride.
Someone had seen the Ambulance leave town,speeding away towards Alice Springs,lights flashing and bells ringing.
CEO Steve(not his real name) and I hopped into his 4 wheel drive, and the race began to follow and witness the eventual fate of the Clinic Ambulance. Old fashioned Hollywood films about Cops and Robber chases would probably have paid for excerpts of scenes from our next couple of hours in the desert . We realised that they had a bigger, stronger vehicle and that,knowing kids on a joy ride, they would take the only road to town and drive like the clappers.
We would take the same road and act rather more cautiously !
140 km into the chase ,Steve noticed a deep pattern in the dirt road made by a vehicle travelling without back tyres and continuing to travel on the wheel rims. This continued for 5 km and then,around a wide corner and in deep sand, we found the Ambulance. Yes, the rear tyres had burst at different times and the kids had kept driving .Then the tyres rolled off separately ,and the kids had kept driving! Then they drove for about 5 km on the wheel rims ,until they dropped off ,and finally ,after travelling for a further 200 metres, the axles separated and fell off ,leaving only the front wheels available to move. But they couldn’t and they didn’t .
We had arrived about 50 minutes after the kids had abandoned the vehicle. They were uninjured, only 3 km outside of the nearest Community, and had somehow managed to scam a lift into the Community’s main drag.
At this stage of my tale, it would not surprise me, if you felt just a tad sorry for them.
Within minutes,and long before Steve and I had arrived at the drag, the three kids had stolen another Troopy from the Local Clinic. Somehow they managed to get to Alice Springs, dump the vehicle in the Creek and seek solace and respite in a neighbouring Camp.
This is not a ‘happy ever after’ story. Our Ambulance had been worth A$50,000 in the morning and was towed away for scrap in the late afternoon. A second Community Ambulance had been stolen and dumped in the Creek after being deliberately damaged.
POSTSCRIPT:-
Police investigations revealed that these young rascals were never residents of the Community in which CEO Steve and I were currently working. They had arrived from another Community near Kalgoorlie (inside the West Australian border), had stolen a vehicle there, driven it across into NT and had been camping out bush for four days, before grabbing our Ambulance, and racing off towards Alice Springs. Police investigations were long, complex and hampered, due to Police Forces from different States being involved.
3.COUNTRY ROADS,TAKE ME HOME,TO THE PLACE,I BELONG,TAKE ME HOME COUNTRY ROADS TAKE ME HOME.
JOHN DENVER’S 1971 SONG EXPRESSES WHAT EDDIE MIGHT HAVE BEEN FEELING ON A SUNDAY IN 2002.
Eddie (not his real name) was in his early thirties. He was the Senior Aboriginal Health worker in an Aboriginal Controlled Community a few hundred km N/W of Tennant Creek.He had a happy marriage ,a wife from a highly respected Tribal Group,two little girls and a sporting history of being one of the best Footy players in the local competition. In short, he had everything going for him.
One Sunday night,in 2002 ,he was driving back home,later than usual, when he crashed his newly purchased, second hand, big blue Holden Sedan. His 57 year old father was in the passenger seat , and they were approaching a windy desert plain.
A large pile of sand had accumulated over most of the narrow remote road, and an area in front of the car was also covered for a distance of approx 50 metres. In a strange twist of fate, his mother had been killed within 200 metres of this area when she was a passenger in another car crash 2 years previously.
I was the Doctor in Eddies Community at the time . I had worked there a number of times and spent a lot of time each weekday with Eddie, mentoring him . At the weekend I’d watch him play Footy at the Oval .His wife worked , as a proud Clinic cleaner, on most mornings.
I was very sad when I received a call from the local Police asking me to take the Ambulance 70 km to the scene of the accident. When I arrived I noticed that, Eddie and his dad, had been thrown about twenty metres away from the Holden and had been dead for at least 3 hours. A number of 4 litre wine casks had been propelled from the car boot onto the road side. It took a number of hours to safely clear the road, put Eddie and his dad in zip- lock bags and return them to their family in the Community. A sad ,sad day and night indeed, and further sad days at work and in the days leading up to, and following their funerals.
POSTSCRIPT:-
I had taken many photos of the results of the crash.This was necessary to help answer, routinely asked questions, and provide evidence to the Coroner for his report.
The Coroner’s conclusions indicated that sand, road conditions, speed, fatigue and alcohol consumption were all involved .and that father and son were possibly distracted by recalling the mother’s death at the time .Vale Eddie and his Dad Will.
4. MY WORST DAY EVER IN A VERY REMOTE COMMUNITY. A TERRIBLE ACCIDENT.THE NURSES WERE IN ALICE, STUDYING.THERE WAS JUST ONE SENIOR, ABORIGINAL HEALTH WORKER, AND I, AVAILABLE TO COPE.
It was Saturday morning in the late 1990’s. I was working, again, in one of Australia’s most remote Aboriginal Communities. I knew almost all of the locals and was familiar with where everything was in the Clinic. My female Aboriginal health worker knew everyone and had a fairly good knowledge of managing most things that happen out bush.
I had finished breakfast and ,without warning, a middle aged Aboriginal man rushed into my kitchen shouting hysterically, ”Come quick Doc,come to the clinic, there’s been a terrible accident, just out of town, and kids were in the car!”
Within two minutes I was at the Clinic. More than 100 people were wailing and screaming and streaming towards the open Clinic door. Three were carrying children in their arms, under blankets.
This is a time to be clear headed ,in charge, grab a couple of willing, capable helpers and immediately try to triage the kids. Someone who had been to the Accident, and could reasonably relate what had happened, where it happened, who was in the car and what has happened to them, would tell me, as I triaged the kids in the Clinic.
There was no resident police presence in the Community,and the Chairman of the Council had already phoned the nearest Police station ,some 250 km away, requesting that someone fly in asap ,if possible.
The three children were age 2 months, 2 years and 4 years. My fear was that one, or more of them, may have serious injuries which were beyond my capacity to deal effectively with, and may not survive the timelines of obtaining an RFDS Evacuation flight to Alice Springs.
I understood that Rob,(not his real name),the driver of the car, had been thrown out of it, as it rolled over four times . He died immediately. His wife, Andrea(not her real name) in the front passenger seat, was thrown out of the car , and was clinging to her 2 month old son. His wife’s sister, Winnie, was still jammed in the vehicle in the seat behind the driver. The other two children had been retrieved from the back seats and rushed to the Clinic. Finally a thirty two year old man had jumped, unharmed from the back seat, after the crash, and had fled the scene. he cause of the crash was thought to have been the bursting of two worn rear tyres at a speed of about 90 km/hour within the 5 km boundary of the Community.
I rapidly triaged the three kids, then slowly, thoroughly and painstakingly re-examined them.
I could not find ANY clinical evidence of ANY injury whatsoever to ANY of the three children. I WAS AMAZED.
My Senior health worker and I decided to review them, once more, and if we still found no injuries, their immediate families would monitor them carefully in another Clinic room for a couple of hours. Luckily all went well, and as planned.
Rob’s Aboriginal wife was, literally, carried into the Clinic by two strong locals and placed onto our examining couch. She had severe chest and lower abdominal pain but was able to talk clearly and recall events. She had not been knocked unconscious and had no evidence of ANY head injury whatsoever. Significantly, her pulse rate was raised and her blood pressure was down a bit, the result of shock and some blood loss????In the chest, abdomen or hip/pelvic region.
After a thorough examination we performed an ECG, put in an IV line with fluids, took appropriate blood and oxygen saturation tests, applied a special oxygen mask and supply, and BP monitors and gave her some strong iv pain medicine.She had, at least, four fractured ribs,a punctured lung on the Rt side and a smaller less significant punctured lung on the left side. Her Rt pelvic pubic ramus bone had been compound fractured and, (as yet undiagnosed), the main artery to her left kidney had been twisted ( requiring surgery the next day). I put in a special chest drain a little later to prevent the Rt lung collapsing and compromising her breathing any further.
About 20 minutes after initially attending to Andrea ,when she first arrived, there was a screeching of tyres outside of the Clinic .The Troopy vehicle stopped, and a local man carried in the other young woman whom they had managed to extricate from Rob’s car. The man left the Clinic, without saying a word, having placed her on the floor in front of me. She was terrified, couldn’t speak or breathe.She touched my arm as I bent over to assess her and died within 30 seconds.
Having reassessed Andrea again, I was able to contact the Alice Springs Emergency Department . I explained the whole situation and asked for an Emergency Code 1 evacuation in view of the extreme nature of Andrea’s injuries. I asked if a Consultant Anaesthetist could be brought out to look after her breathing and other difficulties.
This was one of those busy ,busy retrieval days for the RFDS. I was advised that the earliest time of arrival would be in three and a half hours and, yes, a Consultant Anaesthetist would come as well.
SO THAT WAS IT, WAS IT? NO, IT CERTAINLY WASN’T!
I was thanking, and congratulating, my Senior Female Health worker, for the calm and skilful way that she had helped me manage Andrea. Andrea was ,considering all things, fairly comfortable ,seemingly pain free and sleepy. She was aware that she would be travelling into Alice by RFDS plane, for special additional assessments and treatment, and that the plane should be here in a couple of hours.
SO THAT WAS IT, WAS IT? NO IT CERTAINLY WASN’T!
Another flurry of folks, all looking anxious, burst through the Clinic door. The run- away thirty two year old Aboriginal man, Josh, had been found 20 minutes ago .The mob was very angry with him. They had decided that he was partly responsible for the car crashing because he had a financial interest in the bottles of Bundaberg rum and stash of hash revealed in the car boot when the lid flipped open.
In a sudden impulsive, panicky gesture, he allegedly drank half a small cupful of car battery acid ,ran away again, and ,upon further retrieval was dragged into the Clinic and dumped heavily on the floor.
I confess to not having had to treat such a problem before. What I did know was that drinking a quantity of Alkaline matter (like Draino) would rip your guts apart within a minute or two and cause an incredibly painful pre-death period.
Car battery acid contains only 35% sulphuric acid mixed with water. Pure 100% sulphuric acid is deadly vicious and you couldn’t buy it anyway. Drinking a small amount of car battery acid can cause extensive damage to the mouth, throat ,gullet and stomach for several weeks after swallowing it and maybe death in a month or so.
My immediate thought was to dilute it as much as possible but how ? I grabbed a litre of full cream milk from the fridge , got a couple of Josh’s big friends to sit him in a chair, holding his head and neck tightly, whilst I would pull his mouth open and shovel in as much full cream as I could without impairing his breathing. He probably managed a pint in the stomach and the rest on the floor. He was the only one of his mob who was not amused . After a couple of minutes he stood up, had a noisy projectile vomit of full cream and flecks of blood. Josh swore, disapprovingly, in his native language, opened the door and ran away again.
Some hungry local dogs nudged the Clinic door open, again, and licked the floor clean.
I was told that Josh, later, underwent serious traditional payback by aggrieved family members and was excommunicated from the Community.
SO THAT WAS IT, WAS IT?NO IT CERTAINLY WASN’T!
Andrea was successfully flown back to Alice Springs, arriving at dusk, and taken by Ambulance to Intensive care.
I trod my weary way, back to the Doctor’s house, also arriving at dusk.
Within minutes a forty two year old local resident, Ned, appeared from nowhere, accompanied by his wife.
He was bleeding profusely from the outside of his right thigh. We removed his blood soaked jeans and hosed him down with a powerful garden hose sprinkler. His bulky thigh muscle had been traditionally speared down to the bone. I didn’t need to review his medical or Police records to conclude that Ned was another financial investor in the illegal Bundy and Hash stash that had arrived in Town at around 9 am.
At the end of the day, all Ned got was a loss of face, a shaming , a spearing, a financial loss, the loss of a pair of jeans , a huge compression bandage to stop the bleeding ,a packed thigh muscle, a big dose of penicillin in his left gluteus muscles and an anti -tetanus booster. After two days of repacking the muscle I would need to stitch it inside with absorb-able sutures before closing the big skin wound. He would always have a big scar there. Other Aboriginals would always recognise it as, “Something done to him, because of something bad that he done to some other person.”
Vale Rob and Winnie.(Not their real name).
5.MATT HAD ARRIVED IN TOWN ,LATE AT NIGHT AND DEMANDED THE USE OF A VEHICLE TO TAKE HIM HOME TO HIS OWN COMMUNITY.HE WAS AS DRUNK AS A SKUNK AND AS ANGRY AS A CUT SNAKE. WHAT HAPPENED?
In the same Community, as Rod’s terrible accident in the late 1990’s, things just happened .”Expect the unexpected Doc” and you’ll be right, I often recalled.
Matt was a little Aboriginal man ,full of fire and brimstone, and with the lowest possible level of tolerance to anything other than his own selfish whims. His father, a gentle soul, and mother, a kindly loving wife and mother, had had a number of children. They had all been successful as artists. Matt lived in another Community, some 170 km away, and his behaviour seemed to run ,in parallel, with the amount of grog that he had consumed on any particular day or night. “Some days were diamonds and some days were stones!” as Neil Diamond would have sung in the 1970’s.
Earlier in the evening Matt had persuaded a gullible local politician ,who was currently doing a “shaking of hands and pressing of flesh thing, “in a number of Central Australian Communities , to give him a lift back from the last place, he had visited and into our Town. Having dumped Matt at midnight and settled in somewhere comfortable, the aspiring member had not realised that Matt was using him to return home.
At 6 am Matt hammered on the door of the CEO’s house, demanding the use of HIS vehicle to drive him home. The CEO was used to humbugging and told Matt where he could stick the idea. Matt ,still not sober, came to my house with the same request and received the same answers. He took offence. He smashed all of the lights on the doctor’s Troopie, made huge dents in the vehicle’s doors, smashed all of the windows and did about $25000 worth of damage in 15 minutes.
He proceeded, in a major huff, to the house where the aspiring politician was staying, flushed him out and chased him up the street wielding a boomerang and a mulga wood nulla nulla. The politician was far too fit and nimble for the persistently pissed Matt.
The early morning noise soon drew the attention of a group of Elders and young fellas. There was an instant recognition of Matt and a fear that his behaviour was very disturbing.
Within a very few minutes, the Elders had thrown a huge net over him, and, as he struggled ,the net tightened so that he was totally unable to move. He was eventually allowed to sober up, and, still netted, put in the back of a Troopie and delivered back to his own Community before lunch. Matt scarcely revisited that Community during the next three years ,and then only when sober, to visit his mother, or to sell a few of his artworks.
6. NEVER PLAY BLIND MAN’S BUFF, WHEN SOMEONE IS DRIVING A CAR. IT COULD BE THE LAST GAME YOU PLAY!
At the end of a long Sports weekend, in a Remote Community, about 250 km West of Alice Springs, in the late 1990’s, seven people, 3 children under 12 years and four Adults ,were travelling West, in the evening,back to their own Community. It had been a happy, joyful weekend. Winners and losers had been shared across many Communities .
Morey, the sober driver of an elderly Sedan, and Vinnie , his not so sober passenger -seat mate, were travelling along a familiar remote road at an average speed of about 80 km/hour.
The other passengers were Tina, Vinnie’s wife, their 6 year old daughter , Sheri- lee, two teen aged boys, Marlene , an aunt , and Jeannie, grandmother of the two boys.
THIS STORY IS TRUE BUT THE NAMES OF THOSE INVOLVED HAVE BEEN CHANGED TO PRESERVE THEIR ANONYMITY.
There was nothing odd about the journey, everyone had been playing simple travel games, and thoroughly enjoying themselves.
Vinnie suggested they play another game because the kids kept saying …” Are we there yet, are we there yet?”It was agreed that they played ”I spy , with my little eye,something beginning with ….xxx abcd!” This game is pretty much played, universally, during long car journeys.
Vinnie was a pushy leader of the pack. He had a reputation of not staying sober whenever there was grog around. Tonight he was still into the whisky whilst still in the passenger seat .Nobody would dream of telling him to stop drinking because it would provoke his anger.
After a few more games and a few more drinks, Vinnie became verbally abusive toward Morey, the sober driver. A bit of pushing and shoving occurred between the two of them .Suddenly, Vinnie shouted out to Morey ,”We’re going to play “Blind man’s buff” now Morey.”
Vinnie shoved both of his hands over Morey’s eyes ,taunting him, as he shouted ,”We can’t play “I spy” any longer Morey, ‘cos you can’t see, so you’ll have to play blind man’s buff.”
Within seconds,Morey lost control of his vehicle, and crashed into a group of trees with a deafening THUD!
It would have taken nearly 2 hours for anyone, who had any knowledge,of crash management, to arrive on the scene.The Golden hour would have passed. Those, who would have had, serious life threatening injuries,would have already died.
Vinnie’s wife Tina was dead, so was their six year old daughter.
The two teenagers both suffered non-life threatening arm fractures, and , later were evacuated to Alice Springs Hospital. Marlene had treatable minor injuries , but Jeannie’s Rt hip and her Rt lower leg received compound fractures requiring life saving Orthopaedic Surgery the following day. Jeannie’s injury took many months to heal enough to provide 30% residual usage and life long painful disability. Jeannie was 63 years old, and had long standing Type 2 diabetes. The diabetes exacerbated her disablement and delayed recovery . Morey, was concussed for a few hours and it took a week or two for his memory of the crash to come back,though patchily. He sustained multiple bruises and minor hand fractures. It was never clear how many of the seven were wearing functioning seat belts.
There were Police, Coronal and Insurance inquiries into the causes of, mechanisms involved, and passenger deaths and injuries incurred . In addition, the families of the dead and injured passengers, and the shared vehicle owners, needed to discuss, individually and collectively, what Payback and other Traditional Cultural requirements had to be sorted out and honoured.
Recalling exactly what has happened, in accidents like this, and in these circumstances, can often be confusing, unreliable and inaccurate. A concussed person, like Morey, with even minor memory problems will be challenged about his recall. Vinney is an aggressive man. The two young teenagers would be fearful of disagreeing with whatever he has said in his statements. Vinnie had been, and was, drinking spirits. Aboriginal teenagers, with limited and imprecise use of English, or their own Traditional language, when it involves complex matters, cannot reasonably ,be expected to have absolutely, accurate recall. Jeannie was very seriously injured and would have remembered little or nothing about the crash.
The legal investigations, and evidence collecting ramifications, take many months to establish. It is accepted as a norm that “proceedings”are always perilously slow.
When events such as these, occur in remote Communities, there are rumours , truths , half- truths and downright lies,leaked through to all of the families who have any association with anyone touched by the tragedy. Speculation and suspicion increasingly disrupts residents minds, and the resulting restiveness becomes overwhelming, unless resolved.
Payback, directed at the guilty party , or parties, is commonly an early, swift, effective Traditional cultural method of dealing with the issues, but needs required consent( vide supra) and certainty of evidence. If it is applied inappropriately, then escalation and long term consequences become the order of the day.
Initially, Morey, as the driver of the vehicle, was firm favourite to receive any due punishment. He had no way of avoiding it.
Vinnie’s wife and daughter were already dead. Vinnie was the “first born” to his father, from a first wife some 25 years previously and his father’s second wife was Jeannie. Jeannie was very seriously injured and disabled for life.
It took some weeks before the truth came out….Vinnie was the villain, and the accident happened because Vinnie covered over Morey’s eyes, thus preventing him from seeing the road and controlling the car. Morey was not to be punished.
The Elder’s family were not the only ones demanding payback. Tina’s, Morey’s , Marlene’s, and the two teenagers.
Payback had to be performed at different times and different places according to the availability and convenience of each family. Vinnie’s father performed it on behalf of himself, the rest of his family and his current wife Jeannie.
I am not privy to the total physical and mental consequences of Vinnie’s injuries, but, having met him three years later, I can assure the reader that they were very substantial , disabling and disfiguring.
POST SCRIPT:- I wonder what the guesstimated costs would amount to, if they were all tallied up, in such a way as to include every possible $A spent on this accident, from day 1 to the end of all ongoing physical, mental, other treatments, disability care and relevant pensions for all of the victims?
PPS:-Payback is still practised, in the 2020’s, in much the same way, as it was in the1990’s , and for much the same reasons.
END OF SIX OF THE VEHICLE ACCIDENT SCENARIOS,THAT I WITNESSED IN REMOTE CENTRAL AUSTRALIA
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WHAT SPECIES OF SNAKES DO YOU GET IN THE CENTRAL AUSTRALIAN/ALICE SPRINGS REGION?
ARE ANY OF THEM DANGEROUS ? WHAT SHOULD I DO IF I SAW ONE, OR IF MY MATE GOT BITTEN BY ONE?
Among the many species of snake found in the Central Australia Region of the Northern Territory are the common harmless Children’s Python and the highly venomous Desert Death Adder. Various other snakes that can bite you include the Brown snake, the King Brown(mulga),the Curl Brown and the Yellow- faced Whip. Australia ,in general ,has got a load of snakes, but only about 3 to 20 persons per 100,000 get bitten annually ,and only one or two actually die as a result of the bite.
Snakes like living around peoples’ gardens ,especially where there’s a load of rubbish, long grass , little birds, mice ,tiny mammals ,frogs and sometimes a little fish, if you’ve got a pond. They don’t being humbugged by people wearing boots thongs or no thongs, and they try to keep out of your way. They don’t like being poked around by a blunt stick or being scared, ‘cos that’s when they are likely to have a go at you. In fact, half of the very few people who die from snake bite in Australia, are bitten around the home. If you ever did see one, you probably wouldn’t know what sort it was anyway, so the best thing to do is to phone the local snake removal expert and pass the problem onto them.
YEAH! But what about if the bugger bites me, or my mate, or my kid Doc?
OK, just remember these SEVEN little things to do :-
1.DON’T PANIC, and tell the others not to, either,
2. STAY CALM AND TELL THEM NOT TO MOVE AROUND AT ALL ,
3.PHONE 000 FOR AN AMBULANCE ,AND ANSWER THEIR QUESTIONS,
4. APPLY AN IMMOBILISATION PRESSURE BANDAGE TO THE BITTEN AREA,
5. IF THE BITE IS ON A LIMB,WRAP THE BANDAGE FIRMLY AROUND THE LIMB,
FROM THE TOES, (OR FINGERS) ALL THE WAY UP TO THE TOP, OVERLAPPING IT ON THE WAY,
6.DON’T WASH THE VENOM AWAY(It may be needed to identify what sort of snake it came from).
7. DON’T SUCK IT OUT OR CUT THE SKIN,(That could drive the venom into your blood stream),
What is snake antivenom? When is it used and why?
Snake antivenom is a very expensive (approx A$ 2000 a shot) injection medicine. It can only be given by a Doctor or a Vet (for bitten animals) to someone, who has been bitten by a venomous snake, and who is getting, or has got, dangerous symptoms and signs of envenomation. The bitten person’s blood and urine can be tested, quickly and accurately, to indicate which of the three antivenoms should be given. In remote Central Australia the anti- venom is strictly only made available to larger population Centres, such as Alice Springs,Tennant Creek and Yulara, because of it’s cost, short shelf – life span, and rareness of using it clinically.
What are the commonest symptoms of mild envenomation?
Usually, pain at the site of the bite, redness, swelling, and bleeding, accompanied by a rapid heart rate ,nausea and sweating.
IN THE NEXT SECTION, I RECALL FIVE SNAKE- BITE RELATED, AND TREATMENT EXPERIENCES. THESE OCCURRED IN WALUNGURRU, YULARA (AYRES ROCK), AND THE BARKLY REGION, (SOUTH OF TENNANT CREEK). THE NAMES OF VICTIMS INVOLVED HAVE BEEN CHANGED, WHERE APPROPRIATE, ETHICALLY, TO PROTECT ANONYMITY.
1. DID A KING BROWN (MULGA) SNAKE, REALLY CRAWL UP ANDREW’S TROUSER LEG LATE AT NIGHT WHEN HE WAS SLEEPING AND BITE HIM? OR WAS IT JUST A NIGHTMARE? A TRUE TALE FROM WALUNGURRU (KINTORE).
On a hot summer’s night in late 1998, Andrew, (not his real name), was fast asleep under his blanket,outside of his wooden house in Kintore. It was his common, under the stars, practice. His wife and two small sons were asleep inside. At around 2 am Andrew leapt out of bed, rubbed his left knee and shouted to his wife to wake up. He thought that a snake might have bitten him, just below the knee, where his navy shorts wasn’t covering.
When his wife had a look at the knee, she couldn’t see any marks suggestive of a bite, but Andrew was rubbing it and said it was ”sore.”
They took a torch and had a good look around the pillow and ground blanket area. They checked around the house, in the grass, under the car and in the bushes .The dogs hadn’t been barking, at all, so they decided to stay up for a little while longer before settling back to sleep.
Andrew was restless , because of the kids being close by if there was a snake around. He kept rubbing his “sore knee”, unconvinced by his wife’s suggestion that it ”really doesn’t seem to be anything much Andrew.” Finally ,he took out his dirty pocket knife, scraped the blade all around, and over, the sore area, until it was bleeding, washed it with bucket water, grunted, and wandered around his house for a few minutes.
His family, and neighbours, were now all wide awake and the dogs started barking. As soon as dogs start barking, at night in a Community, it is an open slather for every dog, within earshot, to join in collectively.That’s what they like to do !
Andrew told the neighbours what had happened and they insisted on getting the Doctor. It was 3 am and I drove down to the house , had a good look around, and couldn’t any snake tracks . Andrew and his wife came to the Clinic, and I had a good look at the knee with strong lights and a magnifying glass.
His scraping and scratching had had the same effect as if someone had rubbed the top skin away with thick sandpaper.
Any possible bite marks would have been completely obliterated. I cleaned up the wound and gave him Penicillin and an anti-tetanus booster. Washing, sucking and cutting in the area of a bite,is against ALL First Aid recommendations.
It was now 3-30 am, Andrew had no symptoms of envenomation. We didn’t stock venom detection kits. I took some blood and urine, and put it away in the fridge for the Mail plane to take to the Pathology lab in Alice Springs for testing the next day. At 4 am Andrew still had no symptoms of envenomation, he was very tired and insisted on going home. I agreed to come to his house at 8-30 am to see if he was OK, but told him that, if he felt any symptoms of envenomation, he must call me and I would see him immediately. I would arrange for an RFDS evac, if he wasn’t well, because we were 600 km from the nearest Hospital where antivenom injections were available, if needed .
So did you sleep Doc?
Not even for 15 minutes!That’s what happens in medicine sometimes when you’re not quite sure of things. Anyway, off I went to Andrews place, sharp at 8-30 am. There was nobody there, the neighbours didn’t know when he had left (with wife and kids), which way he went or where he was going. Neighbours out bush never let anyone know where their neighbours have gone ‘cos that’s the way they protect each other.
OMG.OMG! Is Andrew sick,confused? What’s going on? Is it a shame job? Does he feel awful, because he woke everyone, and their dogs, up last night, and realised that he’d made a stupid mistake?
I muddled through the Clinic, reassured by my professional support system, of Ineke and Tania ,that he’s probably OK and just nicked off for a few days of R and R.
The mail plane arrived ,collected Andrew’s blood and urine, dropped and collected other goods, and flew back to Alice Springs, as it always did on Mondays and Fridays,
It was Friday. I slept a lot over the weekend.It’s interesting that, when the Community know that you are having a hard time, looking after and looking out for their interests, they do tend to look after you and stop people from humbugging you unnecessarily. It’s a double edged sword, really, they want to keep you and you want to stay.
Did you ever find out what happen to Andrew?
At midday on Monday morning, I had a phone call from a Regional Perth Hospital which specialised in Snake venom identification. A cheerful Pathologist ,talked to me after identifying myself.He said ”Oh, Doc, i ‘ve just had a report on your patient Andrew from Kintore. Yeah, he’s positive for King Brown Mulga snake venom on his blood tests.Thought i’d give you an early call about it ! The words “Thanks mate ” nearly caught in my craw, as I prepared to take on all of the implications of my call.
So he was right, he was bitten…by a King Brown,WOW! I wonder where he went? I wonder if he got there ? I wonder if he is still alive? Maybe he collapsed in the desert? Gee have I stuffed up here?
I reviewed all of Andrews Medical notes, to justify that, I had done all of the right things at all of the right times and, that he had chosen to go away after being totally informed about his condition and its’ possible ramifications.
I spent the whole of the afternoon on the phone talking to all of my Community contacts within 500 km of the Clinic. None of them had seen or knew of anyone who had seen or been in contact with Andrew. At about 5 pm, and after having suffered disappointment after disappointment, I leaving the Clinic, when a call came from an Alice Springs Aboriginal Social worker.
”Hi Doc, just to let you know, that we’ve found Andrew and his family in Woolworth’s, in Alice Springs. Yeah he’s been OK. He hasn’t needed to go to the Hospital at all, and will be coming back to Kintore with his shopping tomorrow.”
Aboriginal Social Workers are just brilliant when tracing Remote people who come to town for R and R.
I passed by,and stopped at Andrew’s house, the next day. He greeted me, in a very friendly way , as if nothing had happened .I chanced to notice that he was wearing a new pair of long Jeans that evening!
It is important to note that, even though Andrew had King Brown Mulga Snake venom in his blood, it must have been in amounts which were insufficient to require the use of Anti-venom vaccine treatment,which can have it’s own serious side effects.
POSTSCRIPT:-
There are a number of little titbits in this story, cultural, medical, social, psychological et al. The reader might chose to identify with those that might have affected them , had they been in the situation of Andrew, his wife ,their children,their neighbours, the doctor, the nurses , the Aboriginal Social worker or even the Community dogs !
2. SHIR-LEE LIVED NEAR THE DREAMTIME DEVILS MARBLES SACRED SITE. BUT IT WASN’T THE RAINBOW SERPENT THAT HAD BITTEN HER,WHEN SHE TOLD HER OWN DREAMTIME STORY TO THE RFDS DOCTOR ON CALL.
The Devils Marbles are a group of, huge, cluster formation boulders situated 500 km north of Alice Springs in the Barkly Tableland Region. It is a Sacred site, for many Aboriginal Tribal groups, and is therefore of great spiritual and cultural significance. It is a “must see” feature for tourists, passing through the Region, and is millions of years old.
There are two stories told about their origin. The UNTRUE story is, that the boulders represent the fossilised eggs of the Rainbow Serpent which the serpent left there in mythical times. The TRUE story, accepted by the local Aboriginal people, is that they occurred when an Aboriginal man was cutting his hair to make a Traditional Aboriginal man’s hairbelt. He dropped lots of piles of his long hair onto the ground and they apparently kept growing to form the
widespread Devil’s Marbles.
SO WHAT HAPPENED TO SHIR-LEE? (not her real name)
Shir-Lee was a 15 year old Aboriginal girl who lived in the Barkly Tablelands with her Aunt and a couple of her “cousins”. She had been living in Alice Springs, for most of her childhood, in unfortunate family circumstances. The move had been with the best of intentions and with agreements within the family. Sadly, a common occurrence.
At 9 pm one evening, Shirl-Lee went to see her aunt who was watching TV. She told her Aunt that she had been walking barefoot at the side of the house,having woken up and couldn’t get back to sleep. She said that she had felt a sudden pain on the top of her right foot and that it was now bleeding.
Her Aunt, ever alert to an occasional odd snake around the property,and knowing that bits of dropped food attracted snake-loving mice, took a long look at the foot and noticed two red marks, a few mm apart, that were bleeding.
Concerned about the marks and the bleeding ,her aunt phoned the Alice Springs Hospital and asked to speak to the Doctor on call for Remote Health. She was able to talk with a Senior doctor experienced in such calls. She reiterated Shirl-Lee’s account of what had happened, and told the doctor what she had found on her niece’s right foot.
The doctor asked to speak with Shirl-Lee,who confirmed what had happened.She said that she felt unwell but couldn’t say specifically what other snake bite related symptoms were causing her problems.
The doctor recommended that a Remote nurse,currently about 60 km away ,visit Shirl-Lee within an hour and make a report on her findings ,to the RFDS doctor.Normally ,in Remote Australia ,anyone with an established snake bite, should be evacuated to an Accredited Hospital ,for assessment, observation, testing for envenomation, and, where indicated treatment with Antivenom (Antivenene) medication .
The Remote Nurse, having arrived, confirmed the story with the evidence of possible snake fang bites ,and bleeding on Shir-Lees right foot. Again there were no specific symptoms of envenomation. The nurse spoke to the RFDS doctor on call, and, it was agreed that a snake bite had happened without envenomation and that the safest action was to bring Shirl-Lee back to Alice Springs for observation even though this would involve a night flight after a Remote Ambulance arrival at the aunt’s house and a 40 minute trip to a suitable Airstrip.
A night flight, for Emergency evacuations ,was available and arrangements were made to collect Shirl-Lee,estimated time of arrival approx 2 am. The Flight crew arrived at Alice Springs Airport,prepared the plane, and were ready to depart at 12-25 am.
At midnight, an urgent call was received, from the Ambulance Paramedics, who had arrived at Aunt’s Remote house.The Ambos were told that Shirl-Lee was fast asleep and wasn’t coming with them. Fearing that she may have, indeed, been seriously envenomated, they woke her up to talk to her and examine her.
Shirl-Lee was furious.She shouted and screamed at her Aunt and the Ambos and burst into sobbing and crying.
What, the heck, had happened
It transpired that, Shir-Lee had been desperately unhappy for weeks ,after living with her Aunt and the other kids.
She was bored out of her mind, she missed the few real peer friends that she had had in Alice Springs, and had been waiting for an opportunity ” to run away, or somehow get the hell, out of here.” Shirl-Lee wasn’t stupid and waited for a getaway opportunity,
She somehow knew, that people who had had a snake bite out bush, always got evacuated, so she faked her own snake bite. She had taken a needle,from her Aunt’s sewing box, pricked two small adjacent areas on the top of her right foot, waited till the spots had bled , and raced off to her Aunt for confirmation of a possible snake bite.
The Paramedics relayed the confession back to the RFDS Flight nurse and Pilot, the flight was immediately cancelled . A few days later the incident was reviewed by the appropriate division of the Children’s’ Department. They would have started off a further review of how best to deal with poor Shirl-Lees waning childhood.
THE ROYAL FLYING DOCTOR SERVICE MEDICAL CENTRE, YULARA.
ULURU (AYERS ROCK), IN CENTRAL AUSTRALIA, IS A MAGNET FOR 400,000 THOUSAND TOURISTS ANNUALLY, FROM ALL OVER THE WORLD. YULARA IS THE NEARBY TOWN OF 1000 + RESIDENTS, CLOSE TO THE LOCAL AIRPORT, AND IS WHERE THE MAJORITY OF TOURISTS ARE ACCOMMODATED IN 2-7 STAR LUXURY.THE RFDS PROVIDED EXCELLENT GENERAL MEDICAL, NURSING,ANCILLARY HEALTH, PARAMEDIC AND EMERGENCY FACILITIES THERE, FROM THE LATE 1980’S FOR ABOUT 25 YEARS.THE PARAMEDIC SERVICE INCLUDED FULLY OPERATIONAL ROAD AMBULANCES. I WAS,ONE OF THE TWO MEDICAL OFFICERS THERE IN 2000-2001.
THE NEXT TWO SNAKE BITE TALES OCCURRED AT YULARA MEDICAL CENTRE.
3. Yulara is a fabulous place to walk off a heavy evening dinner before “hitting the hay.” Its’ paths are extensive, neatly trimmed , bordered by sweet smelling tropical plants and flowers and dimly lit. A veritable paradise, and an hour’s stroll in which I allowed my cobwebs to be blown away, most evenings after work.
We had five Emergency beds in the Medical Centre Casualty.
FREDDO THE FRENCHMAN, AND HIS WIFE, ARRIVE AT THE RFDS MEDICAL CENTRE, WITH A “FOOT FORMIDABLE.”
It was 10-30 pm. We had had an Obstetric Emergency evacuated to Alice Springs at lunchtime, a couple of fractures to x-ray and treat ,intermingled with a sick child with croup and a non-cardiac Chest pain to sort out. I had just closed the doors and Tim, my “full of all knowledge” male nurse, was instructing the night cleaner about various jobs that needed to be done in the Centre.There was a light knock on the door,followed by a heavier knock on the door,followed by a purposeful, flurry of closed fist knuckle- hammering.
I slowly opened the door to an angle of about 20 degrees, eyeballed an agitated 40 + year old smart little man wearing a Paris tee shirt, tiny shorts and thongs. I simply said.”Yes?” and received an immediate reply, of “My wife has a sore foot!”
Recalling the Truism that,”Manners maketh the man,” I backed away from a smart arsed, glib, English response, having recognised,from his voice, that he was a Frenchman. We’ll call him Freddo the Frog (not his real name).Freddo spoke tolerable English.He summoned his barefooted, thong-less wife from the shadows,and shoved her sore foot close to my face saying,”There is her sore foot Doctor.”
I realised,immediately, that this sore foot wasn’t a sprain, or a stubbed toe.The red spots of blood , the swelling , and two fang marks were the result of stepping on a snake which had turned around and bitten her on the ankle.
My ever- alert male Nurse,Tim,having noticed what was happening, popped her onto an Emergency bed and implemented the official treatment regime for snake bite, and removed the Snake venom detection kit from the fridge.
Freddo was flabbergasted when given the diagnosis. His wife was even more flabbergasted, because she understood very little English, and every bit of information, and instruction, had to be relayed through Freddo, translated by him into French, and then given to his wife again in French. How much important info was lost, or misinterpreted, was impossible to judge. Obtaining a suitable and willing interpreter, in Yulara, at 11 pm onward throughout the night was not feasible.
Tim was able to set up venom detection tests on the patient’s blood and urine specimens and read the results at around midnight. Yes they were positive for Brown snake envenomation and she had mild symptoms from the envenomation….pain at the bite site , swelling , bleeding from the bite, redness of the surrounding skin, nausea and sweating. This lady had to be fully and carefully monitored.
At this stage these are the problems and alternatives:-
1.The husband and wife holidaymakers are French.
2.The wife has a moderately severe Brown snake bite with no way,at present, of telling whether it will get worse.
3.Their individual and collective knowledge and understanding of her problems are very limited because of language difficulties.
4.Their understanding difficulties limit there choices about what might be in their, total, best interests.
5.We are unaware what their original holiday plans were ,if this issue had not have happened, or, having had it happen, what alternative choices can be offered to them, eg travel, accommodation etc?
6.What financial obligations they face now that their plans will need to be reviewed? What does their Insurance cover?
7.Who do they need to contact, why, how, and when?
There are clearly other questions, with, or without, answers.
Most of these problems and alternatives, have a bearing on what we decide clinically should be their management in their and our situation.We have only two staff, until we are, belatedly relieved, at 8 am tomorrow morning.
We decided that, at this stage, there were no sound clinical reasons to dive in and give Brown snake antivenom injections , because, of themselves, they can produce serious side effects that we may find impossible to manage ,given the present situations.For example ,how do you give a good account of what the complications might be and how do they then agree, or not with the treatment?
So what did we do?
We spoke, to the Alice Springs Hospital Emergency night Physician- on- call, asking for an extended Management plan.
Freddo and his wife understood that their problem was shared elsewhere with a major Hospital.
We monitored his wife for a further two hours and it became obvious that an RFDS evacuation from Yulara to Alice was the correct move .She would be carefully monitored during the flight, travelling with an experienced Doctor and Flight Nurse. She arrived in Alice at 4 am , was further monitored and later given Antivenom (antivenene).She required minor plastic surgery for some loss of skin around the actual bite, recovered and was well enough to continue holidaying in a number of other tourist spots after another week.
VIVE FREDDO(and his wife) ET VIVE LA FRANCE!
4. AN AMERICAN ”PIT-BULL- IN- YULARA,” FINDS SOMETHING ELSE TO GET HIS TEETH INTO AFTER SUNDAY LUNCH, BUT GETS ROASTED HIMSELF AFTER A HEATED BUSH ENCOUNTER.
In mid 2000 Dyson,a long term resident of Yulara (near Uluru), owned an American Pit- bull Terrier, purchased long before the days when importation of Pit-bulls was banned in Australia.
Both Dyson and Tyson,his pit-bull, were the epitome of fitness, neither carried an ounce of extra fat and both were incredibly strong. In fact, to the uninitiated or myopic, they could have been mistaken for a couple.
I,m told that pit-bull Terriers are very friendly, and like to have their tummies rubbed when the are lying on a couch,but I’ve never been game enough to challenge that information practically.
Dyson and Tyson were incredibly good mates, and, with no wife and kids to compete with ,Tyson had Dyson’s attention 24/7…… except at 3 pm on this particular hot summer afternoon!
Dyson had been jogging along the gritty footpaths that zig- zag the Community. Tyson was doing his usual manic running , racing, jumping, stopping and standing still performance. Tyson’s game was to suddenly reappear, just when you thought that he had bolted away to Uluru. It was unusual for Dyson to need to call him and shout for him to”come to heel”, but he had to, today.
Dyson could hear Tyson barking, excitedly, persistently and continuously in the middle of a clump of thick bush. Suddenly the excited barking mollified into a dark silence,then Dyson heard whimpering from his stricken dog.Tyson only had enough strength to drag himself out of the bushes and into his master’s outstretched arms.
I was in my house when Dyson called for Emergency support. There was palpable panic and desperation in his voice. Within 45 minutes I had examined the crest fallen Tyson, contacted a Veterinarian mate in Hobart, and was given instructions as to how to initially properly assess a dog with snake bite, apply first aid principles, and work out an algorithmic treatment plan.
Tyson had been bitten on his upper thigh.We could offer him some essential initial treatments after assessing him.
His leg was already swelling and the bite marks bleeding a little.He was weak,trembling and twitching and drouling from his mouth.His back legs were already weak and he had started to get diarrhoea.
The Central Australian brown snake does hang around Yulara a bit because there are mice, birds, and enticing food scraps dropped around by little litterers.
Arriving back in Hobart, from my last working trip in Jeddah (Saudi Arabia), in mid- 1994, I had, at last, paid off my two large mortgages, in full. The family were all well. Dan was 30, Zoe 28, Tara 24, Tabitha 21, and Alicia 18.
Beach Road Medical Centre was chugging along well, with Anita at the helm. We were Bulk billing all patients and this was greatly appreciated. The “grown up kids” were all happy and contributing , pretty much independently, to their own futures, and developing their own talents, mostly, in all the right ways!
I resumed work at Beach Road Medical Centre for a few days a week.
Since the mid 1980’s four local businessman, and I, owned Dockside Fitness Centre. Dockside had a about 3,500 members and was a thriving, up to date Centre with all the latest equipment, trends , gizmos and 29 aerobics instructors.
A wide range of sportsmen and women trained there and it’s waterfront location was superb.We transferred the business to The Hobart Aquatic Centre after eleven years and then sold it to the City Council. We developed and opened Club Salamanca Executive Health and Corporate Fitness Centre in Hobart which provided personalised assessments and fitness training programs combined with a multi -disciplinary rehabilitation facility for Corporate and other clients.
My business Colleagues were an Ex-Tasmanian AFL player and Liberal Member for Denison, an Australian Team Cricketer (and wicket keeper),a Criminal Lawyer and a Consultant Anaesthetist.
What a diverse mob.We all got on famously well and I guarded my 15% business interest proudly.
After 18 years in the ‘game’ I sold my share to my mate Bob, because other interesting opportunities presented themselves.
Having worked in, and provided Medical Services to, the Military and their families of the richest Country in the world .I received a phone call from The Northern Territory Town of Katherine.They had been experiencing difficulties in getting a locum for three months to relieve their regular doctors who needed a break.
SO THIS WAS MY FIRST OPPORTUNITY TO WORK FOR, AND WITH, THE POOREST PEOPLE IN AUSTRALIA, OUR INDIGENOUS PEOPLES.
It must have been, and still is, very hard, for the average Australian , to comprehend the plight of our First Australians in 1950 or in 2020.
They have indeed lived here for 60000 +years, in what is factually, their own Country, and it has taken dozens of, largely fruitless reviews ,statements ,white and green papers,parliamentary investigations,recommendations and votes etc ,etc, to even scratch the surface of what the heck is going on in this space.
Yes, there are zillions of interest groups who want their fifty cents worth of input into trying to resolve, for all time, a seemingly too difficult problem, about rights and responsibilities.It appears so far that never the twain will meet and agree.
The educational, social , medical, legal, equality of opportunity and all of the other social determinants of health and living rights, appear to have been left to groups of opportunistic, connected white fellow lawyers and corrupt Land Council blokes, to decide when it comes down to “fact finding” and workable decision making. Regrettably there is overt and covert nepotistic tribalism, amongst some influential groups of Elders and decision makers.Personal interests often strip away the hope of many of the genuine needy, and greedily pushes many deeper into a swamp of even greater poverty. Nimby excuses in these situations can indicate cover-up, however.
I don’t have an answer,only further questions.
What I did have , was an opportunity to see ,for myself,a bit of what was going on, initially in Katherine NT. So I went there for Oct/Nov/Dec 1994, the three months in 40 degrees C heat and 95- 100% humidity that precedes,and accompanies the ”big wet”. Gees! This place was hotter than Saudi Arabia and far more humid…flies, moths, butterflies, geckos,big lizards,hairy spiders and , thank heavens, mangoes for the picking every where.
This was my first time ever working in Remote Aboriginal Lands on a ‘fly -in fly- out,” or “drive- in, drive -out basis” doing clinical, administrative and emergency retrieval work servicing a number of Top End Communities.
Staying a few nights in Kalkaringi, Lajumana, Duck River, Noogar, or Mataranka, with stopovers in Victoria River Dam,Timber Creek or Pine Creek, meant travelling hundreds of km daily either by car or on Aero-Medical flights in a Nomad , Cessna or other small aircraft,usually without radar and often in thunder and lightening Top End storms.The best plane for retrieval flights at this time was the twin engine King Air…big, smooth and comfy.
Whether by day, or by night, retrieving Emergencies from remote areas and taking them to Katherine Hospital or Darwin Hospital ,though often tiring, was always professionally rewarding.
Our Pilots and Retrieval Flight Nurses were awesome, helpful and so very reassuring and experienced. Most of the time they seemed to do all of the hard work.Thanks a bundle guys!
I was disappointed when my three months passed by , oh so quickly, yet oh so happily.
I left Katherine with a great many new thoughts about Medicine and a need to go and work in Remote Indigenous Australia a lot more in the not too distant future.
Sometimes things seem to work out in many different ways to reach a purpose and we are often ignorant of that reason or, indeed, that purpose.
I decided to go to an Annual Royal Flying Doctor Conference at Broken Hill , some weeks after completing my Katherine Locum, and took Anita.
On the first day I met a number of Flying Doctors from Perth, Broken Hill ,Queensland and South Australia .They all seemed a very happy, experienced mob. I was drawn into and fascinated by their day to day tales and vignettes.
The next morning, I left the Hotel with Anita and suddenly found that I was unable to use my legs to walk across the road. I was totally numb from the waist downwards, could still sit on a toilet, do my ablutions and have a good pee. After standing still for a few minutes the numbness was reduced sufficiently to allow me to cross the road.
Over the course of the next few days I experienced recurrences of the numbness,and whilst not panicking, managed to finish the Conference and flew back to Hobart a few days later.
NOW HERE’S THE THING:-
Sixteen years previously, when driving from Hobart to Bridgewater, to take a morning Clinic at the Community Centre,my car hit an icy road patch and spun around at least three times, finishing up looking backwards towards Hobart.Now that was a bit disturbing but I carried on, did the Clinic , drove back to Hobart,put an ice pack on a couple of bruises and never gave it another thought.
Some days later I developed severe Rt sided C6 nerve root Neuropathic persistent arm pain. A fortnight later Neurosurgeon Graham Duffy relieved the pain,after all other treatments had failed, by performing a C5-6 Anterior Cervical Fusion operation.
Everything went really well and for many years I had full use of my neck, painlessly and played all sorts of sport,including Tennis,cricket and Rugby.
In Broken Hill I recalled how I had left Riyadh in Saudia Arabia in 1991, having sustained nerve root damage to my neck after a tennis ” service injury” during the first Gulf War. That had also required nerve pressure release Neurosurgically in Sydney some weeks later.
So what had happened in Broken Hill which had causing loss of the use of both of my legs episodically whenever I was walking?
Some weeks after the incident, my good friend and Hobart Rheumatology Specialist,Hilton Francis, diagnosed my condition as severe spinal canal stenosis whereby Osteoarthritis had caused significant traumatic pressure on four out of the five lumbar spine nerves centrally as they left the spine to travel down into the legs. This required a three and a half hour spinal operation to release the pressure on the nerves, a so- called four level Laminectomy using a 22 cm scar.Mr Fred Binns was my meticulous surgeon.
Although I had many naysayers write off my surgical, urological and orthopaedic stability future, I managed, after 10 days , to painlessly walk up and down 120 stairs in the Hospital, got into my car the next day for my discharge and illegally drive home. I think that this is an example of my trying to justify the”Law of pure Cussedness”.
This was the beginning of a totally new era. I was now , for all intents and purposes, totally uninsurable in the event of anything, accident or otherwise, happening to any related area of my spine, top to bottom.
Having left the Hospital, there was a question of what rehabilitation program I should follow , when, where, for how long and who should manage it and why?
There had to be answers to this conundrum,and there were.
I saw Fred two weeks later.He was smoking his favourite curly pipe.I asked him whether I might get problems during the next few years.He was understandably evasive, blew a big puff of sweetish smelling smoke from his pipe,coughed and mumbled…”Good luck mate,I’m hoping I won’t see for another 20 years.
Fred was right, he didn’t see me again.He died about five years later and I’ve never had to go back to see his successor.
Vale dear Fred Binns.
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After three months in Katherine, and after Surgery for my Lumbar Spinal Canal Stenosis, my work travels took me to Walungurru (Kintore) NT in The Central Western Desert for an initial six week locum in an Aboriginal Controlled Community. The details of that experience are written elsewhere under the title ”Walungurru”(Kintore).
I later returned to Kintore for a two year period , starting in January 1997 and ending in early November 1998, a rotating job share with another doctor.
Thereafter I returned to Kintore, intermittently, until my last working visit there in 2012. The details and vignettes relating to all of my times in Kintore are written under the Walungurru Kintore) stories,to assist continuity.
I visited 56 Indigenous Communities in Central Australia during the period Oct 1994 and February 2017,as a Remote Medical Practitioner.
Some visits were as a Royal Australian Flying Doctor, retrieving seriously ill patients from an area of 400,000 sq km, mainly in NT, but also including part of the APL lands in South Australia,and the NT,WA,& QLD adjacent border Country.
I lived, and worked, in Alice Springs, employed as a District Medical Officer and Specialist Public Health Physician, in 1999 and early 2000 . It was here that I spent a great deal of time working as a fly- in, fly -out, or drive -in, drive- out doctor visiting very Remote Communities.
In 2000-2001 I lived in Yulara (Ayres Rock) for nearly two years, employed by the Royal Australian Flying Doctor Service as the Resident Doctor.This post was shared with a colleague and we worked for 21 days and nights straight each, and then returned after another 21 days.These were extremely hard working,challenging but stimulating times, representing the RFDS and treating travellers and visitors from all over the world.
RFDS Yulara, was often described, by International visitors as “The World’s window to Australia’s Flying Doctor Service”.
I enjoyed excellent accommodation, wonderfully happy , friendly and well qualified working colleagues, a privileged, once in a lifetime job, and the very best of Senior “bosses”, based in Adelaide and Melbourne.Go,Go, you good thing!
THE FOLLOWING IS A COMPLETE LIST OF ALL OF THE REMOTE COMMUNITIES, THAT I VISITED ,AND WORKED IN, DURING THE PERIOD OCTOBER 1994 TO FEBRUARY 2017. THE TERRITORY HEALTH SERVICES OUTLETS MAP IDENTIFIES THE SITE OF EACH COMMUNITY.
1 ALICE SPRINGS URBAN.
Alice Springs, Hermannsburg, Haast,s Bluff, Papunya, Mt Leibig, Nirripi, Walugnurru, Yuendumu, Laramba, Mount Allan, Willorwa, Sterling, Ti-Tree, Pmara Jutuma, Tara, Utopia, Ampilatwatja, Bonya, Hart’s Range, Alcoota, Santa Teresa, Amoogdana, Wallace Rockhole, Titjikala(Maryvale), Areyonga, King’s Canyon.
2.ALICE SPRINGS RURAL.
Finke, Mt Ebenezer, Imampa, Mutajulu(Ayer’s Rock), Yulara, Docker River, Curtain Springs.
3.WESTERN AUSTRALIA.
Kiwirrkura.
4.BARKLY DISTRICT.
McLaren Creek, Ali Curung, Murray Downs, Canteen Creek, Epenarra, Tennant Creek.
5.KATHERINE.
Lajamanu, Kalkarindji, Daguragu, Yarralin, Victoria River Dam, Timber Creek, Pine Creek, Wurli Wurlinjang, Matarahka , Ngukurr(Roper River), Hodgson Downs, Borraloola, Urapunga, Bulman.
6.DARWIN URBAN AND RURAL.
Jabiru.
7.SOUTH AUSTRALIA .
Amata, Fregon, Indulkana, Mimili, Ernabella.
8.QUEENSLAND.
Mount Isa, Lake Nash.
I HEREBY MAKE A STATEMENT WITH REGARD TO PERSONS WHOSE NAMES I MAY HAVE CONSIDERED MENTIONING IN MY TEXT,OR WHO MAY HAVE BEEN INVOLVED IN MY VIGNETTES.

WHERE AND WHEN I HAVE RECALLED STORIES OF ACTUAL EVENTS THAT HAVE HAPPENED OUT BUSH, OR IN VERY REMOTE COMMUNITIES, INVOLVING PERSONS WHO HAVE BEEN CLIENTS OR PATIENTS, I HAVE RECORDED THE EVENTS AS THEY ACTUALLY HAPPENED BUT CHANGED THE NAME OF THE PERSON OR PERSONS INVOLVED TO DIFFERENT NAMES SO AS TO BE ETHICALLY AND MEDICALLY SENSITIVE AND JOURNALISTICALLY CORRECT .
WHEN DISCUSSING OTHER MATTERS, WHERE A PERSON’S NAME IS NEEDED TO COMPLETE FACTUALITY, PERSON TO PERSON, AND NOT A SECRET DISCUSSION OR DIALOGUE, RATHER THAN DISCUSSING CONFIDENTIAL MEDICAL MATTERS I MAY HAVE INCLUDED THEIR NAME ,”IN GOOD FAITH AND WITHOUT PREJUDICE” TO FACILITATE VERIFICATION SHOULD THAT EVER BE NECESSARY. AT TIMES I HAVE OMITTED THE NAME OF THE COMMUNITY IN WHICH THE EVENT OCCURRED SO AS TO DE -IDENTIFY THE PERSONS INVOLVED.THE FACTS REMAIN,THEY HAPPENED.
This section deals with events, that I felt may be of interest to recall , and, which happened in one or other of many different Communities.
At times I would have been acting as a regular locum tenens doctor,in familiar surroundings out bush , or as a District Medical Officer employed with Remote Health based in Alice Springs. As a DMO I was frequently on call as the Doctor responding to requests to attend and effect Emergency evacuations from Remote Communities,through the Royal Flying Doctor Service based at Alice Springs Airport.When urgent ,or Code 1, requests for evacuation ,were confirmed ,the doctor on call was required to drive to the Airport,and ,together with the Pilot and Flight nurse, make sure that everything was in order to take off from Alice Springs within 45 minutes of the initial request.Occasionally this was not possible because the RFDS plane was already in another Community.Sometimes a possible Code 1 request was downgraded to a Code 2 request ,in which case an asap was enacted. Whatever the situation, the RFDS doctor on call took over the management of the seriously ill person ,using their own clinical judgement together with back up from Hospital Specialists and continuous ongoing contact with the Clinic, in which the sick person was based, and the person making the original request.
There were frequently occasions where a person could be driven from a remote Community in a Community Ambulance to Alice Springs for assessment and treatment. These occasions would require some certainty with regard accompanying Medical /Nursing Staff and their ability to manage a possibly increasingly serious issue when travelling through unfavourable country in unfavourable conditions.The responsibilities placed upon Doctors and Nurses ,in these circumstances can impact horrendously on their lives ,if things go wrong, AND THEY DO. The vehicle driver is often an Aboriginal Health worker and the implications for them ,if things go wrong, can become serious cultural issues.
On a number of occasions ,in a number of Communities it has been impossible to get an RFDS evacuation flight to come out from Alice Springs or Darwin, because of severe storms, and,in addition, having badly flooded bush roads preventing us from attempting an Ambulance evac. There are then serious management problems especially if the storms continue for 24 hours or more.
Included in this section are also a number of events which occurred when I was the RFDS Doctor at Yulara Clinic( Ayer’s
Rock ) in 2000-2001.
THE FAMOUS FINKE DESERT RACE.
On the long weekend of the Queen’s June birthday ,the Finke Desert Race takes place. It is an off road, multi- terrain two day race for motor bikes, cars, buggies and quad bikes and goes through desert country. It starts just west of Alice Springs and winds it’s way to Aputula (Finke), an Aboriginal Community in the Northern Territory 229 km distant. After spending the night at Finke the competitors turn their vehicles around and race back, the same distance, to Alice again.
The Annual Finke race, first run in 1976, has a reputation of being one of the most arduous off road courses in one of the world’s most remote places . About 500 riders and 140 drivers usually start and the winner on each day takes about one hour and fifty minutes to reach the finishing line.
In the late 1990’s I was the Medical Officer, on call with the RFDS and Remote Health, whose job, on two race days, was to retrieve injured competitors, who had been involved in crashes.They had been initially triaged and assessed by the on- site Race Medical Team, and, where necessary, put in an Ambulance and taken to a small Airstrip for evacuation to Alice Springs Emergency Dept. There were seven injured motor cyclists / race car drivers evacuated over the two days. One had a head injury, two sustained ankle fractures, one a nasty wrist fracture, one a fractured fibula(lower leg), one a fractured collarbone and finally one with 3 broken ribs. A veritable potpourri of Orthopaedic work for the Emergency Dept to manage.
There were a number of interesting social and verbal interactions between the injured, both before and during the flights back to Alice Springs.
These were very macho blokes who, initially ,collectively and almost competitively, declined any strong pain medication but, as preparations progressed towards the actual flights, all of them,again collectively, wisely reviewed their pain needs.
2016, experienced a cold foggy, frosty and dusty start to that race. 17 riders and spectators were treated track- side ,of which 12 were transferred to Alice Springs Hospital.
FATAL VEHICLE CRASHES ARE EXTREMELY RARE DURING THE ANNUAL FINKE DESERT RACE. WHAT ABOUT ON THE NORTHERN TERRITORY ROADS? LET’S TAKE A REALITY CHECK ON THE FIGURES FOR THE PERIOD 2011-2020.
During this period there was a total of 352 fatal road crashes on NT roads of which 163( 40%) were alcohol related.
90 involved not wearing a seat belt.
113 were speed related.
27 were fatigue related .
287 involved male drivers, of which 206 were Aboriginal.
298 were on rural and 113 on urban roads.
Strangely enough 25 were lying on the road when they were killed.
WHAT KIND OF ROAD CRASHES DO YOU GET CALLED TO ATTEND TO, WHEN WORKING AS A DOCTOR IN VERY REMOTE COMMUNITIES ? DOES IT TAKE LONG TO GET THERE OR DO THEY USUALLY HAPPEN NEAR HOME BASE?
Road crashes on main roads in the NT are often very different than in Remote Areas.You are rarely the first person to arrive because there is probably passing traffic and so immediate help may be available.
Many people die in the first ‘Golden Hour, after a crash, from significant injuries. Some of these people may not die if there is a person on the scene immediately who can apply basic life- saving First Aid principles.
Others, who stop at the scene, can apply these principles to make the area safe, contact an Ambulance and Police and generally be available in many ways. Getting to an Emergency Department at an Accredited Hospital ,in the best possible condition, is the next goal.
In remote areas, where rural roads are dirt or not sealed, presents a whole bunch of new problems. The road may be sandy, muddy and slippery, especially in areas where there are lots of corners to negotiate. Speeding home,often with some alcohol still in the system, from last drinks before leaving Town, is common . Fatigue, from a long drive, combined with poor head lights and night driving, is the recipe for a disaster waiting to happen.
THEN IT HAPPENS,SUDDENLY, WITHOUT WARNING, AND AT SPEED!!
In the next few pages, I will relate SIX scenarios where car crashes occurred in Remote areas, far from any hospital and where official Ambulance help was unavailable. They are in no special order, and the names of persons involved and their Communities, have been changed .
1. WAS WALLY LUCKY ENOUGH,OR UNLUCKY ENOUGH,TO HAVE BEEN PICKED UP, ON THE SIDE OF A REMOTE ROAD, BY A YOUNG FEMALE STRANGER DRIVING A POSH TOYOTA LAND CRUISER?
Wally was a well known, 74 year old local Community Elder, who painted highly collectable Aboriginal Art.
His car, driven by a family member, had broken down, 150 km from his Community, on a dirt road, at 2 pm in the afternoon.The driver managed to flag down a passing Toyota Landcruiser within 30 minutes.
The Toyota driver, a young female social worker, was going to Wally’s Community, albeit for the first time, and stopped to help. Wally had a lift home, and that was OK. Well, it was only OK, for the first 40 km, then her vehicle experienced the big, bad out of control wobbles.
The social worker was not used to Remote roads. Her wheels spun, slid in the sand on a 45 degree corner, flipped in the air and left her and Wally upside down inside of a crashed Landcruiser.
A satellite connected phone, an essential in Government vehicles out bush, was available and the uninjured social worker was able to contact us briefly, stating her predicament!
Within 10 minutes a Health worker and I left, in the Clinic Ambulance and arrived after an hour and 20 minutes and 110 km later.
Wally was furious,in pain and uncomfortable, at still being upside down, on the road side, on the inside of the ,now frightened,young woman’s Toyota. After hearing the sad story, of what happened, we managed to extricate Wally, assess and examine him, and transfer him to our Clinic Ambulance. He was given a Morphine injection for a compound fracture of his right Collar bone. Compound means that the bone was fractured with a chunk poking out through the skin of his neck and upper chest.
Another vehicle took the social worker back to Wally’s Community and sorted out her accommodation.
By the time the health worker and I arrived at Wally’s house,news had swept through the Community and Wally’s family were already calling for the person who was driving the Landcruiser, to undergo payback. Wally’s well known grandson, was already brandishing a spear.a nulla nulla and a boomerang. I don’t think he realised that the social worker was a woman, but,of course, he had to display as much theatre as possible so as to appear culturally strong and be seen to be doing the right thing for the family.
I knew the agitated grandson well and was able to briefly pull him aside to prevent a melee and unpleasant repercussions . I talked to the social worker privately, at length, explained the cultural situation and managed,through her Government bosses ,to get an order for her to be flown out of town the same evening so as to defuse the matter.
Wally’s x-ray confirmed that the fracture was “compound.” He was flown for an Orthopaedic surgical opinion the following day and his collar bone underwent surgical repair the next day. Six weeks later he was able to start painting again.
2.YOUNG FELLAS’ TAKE ADVANTAGE OF “BORROWING” THE CLINIC AMBULANCE FOR A JOY RIDE INTO TOWN.
When I worked in Saudi Arabia, you could leave your car keys in your car, with the doors and windows unlocked, and come back later and they would still be there. After living there a while you realise that they were still there because ,if someone nicked them and were caught,they may well lose the hand that stole the keys, on a fine Friday morning in ”Chop Chop” square at the orders of the Saudi Arabian executioner. That seemed to work ,as a preventive measure over there, but is, thank heavens, not the law in Australia. If that were so, I would have expected,statistically, to have come across lots of single handed 16-40 year old persons in Australia, during my many years in Medical Practice.
In very Remote communities an available vehicle is an important asset. Now, kids have no assets, and are unlikely to have access to a vehicle unless some white fella doctor(like me), forgets to remove the keys from a vehicle, that he has been using all morning.
“LEAD US NOT INTO TEMPTATION, BUT DELIVER US FROM EVIL” is not a well followed biblical instruction when faced with an Ambulance full of fuel. and three sixteen/seventeen year old boys looking for a big joy ride.
Someone had seen the Ambulance leave town,speeding away towards Alice Springs,lights flashing and bells ringing.
CEO Steve(not his real name) and I hopped into his 4 wheel drive, and the race began to follow and witness the eventual fate of the Clinic Ambulance. Old fashioned Hollywood films about Cops and Robber chases would probably have paid for excerpts of scenes from our next couple of hours in the desert . We realised that they had a bigger, stronger vehicle and that,knowing kids on a joy ride, they would take the only road to town and drive like the clappers.
We would take the same road and act rather more cautiously !
140 km into the chase ,Steve noticed a deep pattern in the dirt road made by a vehicle travelling without back tyres and continuing to travel on the wheel rims. This continued for 5 km and then,around a wide corner and in deep sand, we found the Ambulance. Yes, the rear tyres had burst at different times and the kids had kept driving .Then the tyres rolled off separately ,and the kids had kept driving! Then they drove for about 5 km on the wheel rims ,until they dropped off ,and finally ,after travelling for a further 200 metres, the axles separated and fell off ,leaving only the front wheels available to move. But they couldn’t and they didn’t .
We had arrived about 50 minutes after the kids had abandoned the vehicle. They were uninjured, only 3 km outside of the nearest Community, and had somehow managed to scam a lift into the Community’s main drag.
At this stage of my tale, it would not surprise me, if you felt just a tad sorry for them.
Within minutes,and long before Steve and I had arrived at the drag, the three kids had stolen another Troopy from the Local Clinic. Somehow they managed to get to Alice Springs, dump the vehicle in the Creek and seek solace and respite in a neighbouring Camp.
This is not a ‘happy ever after’ story. Our Ambulance had been worth A$50,000 in the morning and was towed away for scrap in the late afternoon. A second Community Ambulance had been stolen and dumped in the Creek after being deliberately damaged.
POSTSCRIPT:-
Police investigations revealed that these young rascals were never residents of the Community in which CEO Steve and I were currently working. They had arrived from another Community near Kalgoorlie (inside the West Australian border), had stolen a vehicle there, driven it across into NT and had been camping out bush for four days, before grabbing our Ambulance, and racing off towards Alice Springs. Police investigations were long, complex and hampered, due to Police Forces from different States being involved.
3.COUNTRY ROADS,TAKE ME HOME,TO THE PLACE,I BELONG,TAKE ME HOME COUNTRY ROADS TAKE ME HOME.
JOHN DENVER’S 1971 SONG EXPRESSES WHAT EDDIE MIGHT HAVE BEEN FEELING ON A SUNDAY IN 2002.
Eddie (not his real name) was in his early thirties. He was the Senior Aboriginal Health worker in an Aboriginal Controlled Community a few hundred km N/W of Tennant Creek.He had a happy marriage ,a wife from a highly respected Tribal Group,two little girls and a sporting history of being one of the best Footy players in the local competition. In short, he had everything going for him.
One Sunday night,in 2002 ,he was driving back home,later than usual, when he crashed his newly purchased, second hand, big blue Holden Sedan. His 57 year old father was in the passenger seat , and they were approaching a windy desert plain.
A large pile of sand had accumulated over most of the narrow remote road, and an area in front of the car was also covered for a distance of approx 50 metres. In a strange twist of fate, his mother had been killed within 200 metres of this area when she was a passenger in another car crash 2 years previously.
I was the Doctor in Eddies Community at the time . I had worked there a number of times and spent a lot of time each weekday with Eddie, mentoring him . At the weekend I’d watch him play Footy at the Oval .His wife worked , as a proud Clinic cleaner, on most mornings.
I was very sad when I received a call from the local Police asking me to take the Ambulance 70 km to the scene of the accident. When I arrived I noticed that, Eddie and his dad, had been thrown about twenty metres away from the Holden and had been dead for at least 3 hours. A number of 4 litre wine casks had been propelled from the car boot onto the road side. It took a number of hours to safely clear the road, put Eddie and his dad in zip- lock bags and return them to their family in the Community. A sad ,sad day and night indeed, and further sad days at work and in the days leading up to, and following their funerals.
POSTSCRIPT:-
I had taken many photos of the results of the crash.This was necessary to help answer, routinely asked questions, and provide evidence to the Coroner for his report.
The Coroner’s conclusions indicated that sand, road conditions, speed, fatigue and alcohol consumption were all involved .and that father and son were possibly distracted by recalling the mother’s death at the time .Vale Eddie and his Dad Will.
4. MY WORST DAY EVER IN A VERY REMOTE COMMUNITY. A TERRIBLE ACCIDENT.THE NURSES WERE IN ALICE, STUDYING.THERE WAS JUST ONE SENIOR, ABORIGINAL HEALTH WORKER, AND I, AVAILABLE TO COPE.
It was Saturday morning in the late 1990’s. I was working, again, in one of Australia’s most remote Aboriginal Communities. I knew almost all of the locals and was familiar with where everything was in the Clinic. My female Aboriginal health worker knew everyone and had a fairly good knowledge of managing most things that happen out bush.
I had finished breakfast and ,without warning, a middle aged Aboriginal man rushed into my kitchen shouting hysterically, ”Come quick Doc,come to the clinic, there’s been a terrible accident, just out of town, and kids were in the car!”
Within two minutes I was at the Clinic. More than 100 people were wailing and screaming and streaming towards the open Clinic door. Three were carrying children in their arms, under blankets.
This is a time to be clear headed ,in charge, grab a couple of willing, capable helpers and immediately try to triage the kids. Someone who had been to the Accident, and could reasonably relate what had happened, where it happened, who was in the car and what has happened to them, would tell me, as I triaged the kids in the Clinic.
There was no resident police presence in the Community,and the Chairman of the Council had already phoned the nearest Police station ,some 250 km away, requesting that someone fly in asap ,if possible.
The three children were age 2 months, 2 years and 4 years. My fear was that one, or more of them, may have serious injuries which were beyond my capacity to deal effectively with, and may not survive the timelines of obtaining an RFDS Evacuation flight to Alice Springs.
I understood that Rob,(not his real name),the driver of the car, had been thrown out of it, as it rolled over four times . He died immediately. His wife, Andrea(not her real name) in the front passenger seat, was thrown out of the car , and was clinging to her 2 month old son. His wife’s sister, Winnie, was still jammed in the vehicle in the seat behind the driver. The other two children had been retrieved from the back seats and rushed to the Clinic. Finally a thirty two year old man had jumped, unharmed from the back seat, after the crash, and had fled the scene. he cause of the crash was thought to have been the bursting of two worn rear tyres at a speed of about 90 km/hour within the 5 km boundary of the Community.
I rapidly triaged the three kids, then slowly, thoroughly and painstakingly re-examined them.
I could not find ANY clinical evidence of ANY injury whatsoever to ANY of the three children. I WAS AMAZED.
My Senior health worker and I decided to review them, once more, and if we still found no injuries, their immediate families would monitor them carefully in another Clinic room for a couple of hours. Luckily all went well, and as planned.
Rob’s Aboriginal wife was, literally, carried into the Clinic by two strong locals and placed onto our examining couch. She had severe chest and lower abdominal pain but was able to talk clearly and recall events. She had not been knocked unconscious and had no evidence of ANY head injury whatsoever. Significantly, her pulse rate was raised and her blood pressure was down a bit, the result of shock and some blood loss????In the chest, abdomen or hip/pelvic region.
After a thorough examination we performed an ECG, put in an IV line with fluids, took appropriate blood and oxygen saturation tests, applied a special oxygen mask and supply, and BP monitors and gave her some strong iv pain medicine.She had, at least, four fractured ribs,a punctured lung on the Rt side and a smaller less significant punctured lung on the left side. Her Rt pelvic pubic ramus bone had been compound fractured and, (as yet undiagnosed), the main artery to her left kidney had been twisted ( requiring surgery the next day). I put in a special chest drain a little later to prevent the Rt lung collapsing and compromising her breathing any further.
About 20 minutes after initially attending to Andrea ,when she first arrived, there was a screeching of tyres outside of the Clinic .The Troopy vehicle stopped, and a local man carried in the other young woman whom they had managed to extricate from Rob’s car. The man left the Clinic, without saying a word, having placed her on the floor in front of me. She was terrified, couldn’t speak or breathe.She touched my arm as I bent over to assess her and died within 30 seconds.
Having reassessed Andrea again, I was able to contact the Alice Springs Emergency Department . I explained the whole situation and asked for an Emergency Code 1 evacuation in view of the extreme nature of Andrea’s injuries. I asked if a Consultant Anaesthetist could be brought out to look after her breathing and other difficulties.
This was one of those busy ,busy retrieval days for the RFDS. I was advised that the earliest time of arrival would be in three and a half hours and, yes, a Consultant Anaesthetist would come as well.
SO THAT WAS IT, WAS IT? NO, IT CERTAINLY WASN’T!
I was thanking, and congratulating, my Senior Female Health worker, for the calm and skilful way that she had helped me manage Andrea. Andrea was ,considering all things, fairly comfortable ,seemingly pain free and sleepy. She was aware that she would be travelling into Alice by RFDS plane, for special additional assessments and treatment, and that the plane should be here in a couple of hours.
SO THAT WAS IT, WAS IT? NO IT CERTAINLY WASN’T!
Another flurry of folks, all looking anxious, burst through the Clinic door. The run- away thirty two year old Aboriginal man, Josh, had been found 20 minutes ago .The mob was very angry with him. They had decided that he was partly responsible for the car crashing because he had a financial interest in the bottles of Bundaberg rum and stash of hash revealed in the car boot when the lid flipped open.
In a sudden impulsive, panicky gesture, he allegedly drank half a small cupful of car battery acid ,ran away again, and ,upon further retrieval was dragged into the Clinic and dumped heavily on the floor.
I confess to not having had to treat such a problem before. What I did know was that drinking a quantity of Alkaline matter (like Draino) would rip your guts apart within a minute or two and cause an incredibly painful pre-death period.
Car battery acid contains only 35% sulphuric acid mixed with water. Pure 100% sulphuric acid is deadly vicious and you couldn’t buy it anyway. Drinking a small amount of car battery acid can cause extensive damage to the mouth, throat ,gullet and stomach for several weeks after swallowing it and maybe death in a month or so.
My immediate thought was to dilute it as much as possible but how ? I grabbed a litre of full cream milk from the fridge , got a couple of Josh’s big friends to sit him in a chair, holding his head and neck tightly, whilst I would pull his mouth open and shovel in as much full cream as I could without impairing his breathing. He probably managed a pint in the stomach and the rest on the floor. He was the only one of his mob who was not amused . After a couple of minutes he stood up, had a noisy projectile vomit of full cream and flecks of blood. Josh swore, disapprovingly, in his native language, opened the door and ran away again.
Some hungry local dogs nudged the Clinic door open, again, and licked the floor clean.
I was told that Josh, later, underwent serious traditional payback by aggrieved family members and was excommunicated from the Community.
SO THAT WAS IT, WAS IT?NO IT CERTAINLY WASN’T!
Andrea was successfully flown back to Alice Springs, arriving at dusk, and taken by Ambulance to Intensive care.
I trod my weary way, back to the Doctor’s house, also arriving at dusk.
Within minutes a forty two year old local resident, Ned, appeared from nowhere, accompanied by his wife.
He was bleeding profusely from the outside of his right thigh. We removed his blood soaked jeans and hosed him down with a powerful garden hose sprinkler. His bulky thigh muscle had been traditionally speared down to the bone. I didn’t need to review his medical or Police records to conclude that Ned was another financial investor in the illegal Bundy and Hash stash that had arrived in Town at around 9 am.
At the end of the day, all Ned got was a loss of face, a shaming , a spearing, a financial loss, the loss of a pair of jeans , a huge compression bandage to stop the bleeding ,a packed thigh muscle, a big dose of penicillin in his left gluteus muscles and an anti -tetanus booster. After two days of repacking the muscle I would need to stitch it inside with absorb-able sutures before closing the big skin wound. He would always have a big scar there. Other Aboriginals would always recognise it as, “Something done to him, because of something bad that he done to some other person.”
Vale Rob and Winnie.(Not their real name).
5.MATT HAD ARRIVED IN TOWN ,LATE AT NIGHT AND DEMANDED THE USE OF A VEHICLE TO TAKE HIM HOME TO HIS OWN COMMUNITY.HE WAS AS DRUNK AS A SKUNK AND AS ANGRY AS A CUT SNAKE. WHAT HAPPENED?
In the same Community, as Rod’s terrible accident in the late 1990’s, things just happened .”Expect the unexpected Doc” and you’ll be right, I often recalled.
Matt was a little Aboriginal man ,full of fire and brimstone, and with the lowest possible level of tolerance to anything other than his own selfish whims. His father, a gentle soul, and mother, a kindly loving wife and mother, had had a number of children. They had all been successful as artists. Matt lived in another Community, some 170 km away, and his behaviour seemed to run ,in parallel, with the amount of grog that he had consumed on any particular day or night. “Some days were diamonds and some days were stones!” as Neil Diamond would have sung in the 1970’s.
Earlier in the evening Matt had persuaded a gullible local politician ,who was currently doing a “shaking of hands and pressing of flesh thing, “in a number of Central Australian Communities , to give him a lift back from the last place, he had visited and into our Town. Having dumped Matt at midnight and settled in somewhere comfortable, the aspiring member had not realised that Matt was using him to return home.
At 6 am Matt hammered on the door of the CEO’s house, demanding the use of HIS vehicle to drive him home. The CEO was used to humbugging and told Matt where he could stick the idea. Matt ,still not sober, came to my house with the same request and received the same answers. He took offence. He smashed all of the lights on the doctor’s Troopie, made huge dents in the vehicle’s doors, smashed all of the windows and did about $25000 worth of damage in 15 minutes.
He proceeded, in a major huff, to the house where the aspiring politician was staying, flushed him out and chased him up the street wielding a boomerang and a mulga wood nulla nulla. The politician was far too fit and nimble for the persistently pissed Matt.
The early morning noise soon drew the attention of a group of Elders and young fellas. There was an instant recognition of Matt and a fear that his behaviour was very disturbing.
Within a very few minutes, the Elders had thrown a huge net over him, and, as he struggled ,the net tightened so that he was totally unable to move. He was eventually allowed to sober up, and, still netted, put in the back of a Troopie and delivered back to his own Community before lunch. Matt scarcely revisited that Community during the next three years ,and then only when sober, to visit his mother, or to sell a few of his artworks.
6. NEVER PLAY BLIND MAN’S BUFF, WHEN SOMEONE IS DRIVING A CAR. IT COULD BE THE LAST GAME YOU PLAY!
At the end of a long Sports weekend, in a Remote Community, about 250 km West of Alice Springs, in the late 1990’s, seven people, 3 children under 12 years and four Adults ,were travelling West, in the evening,back to their own Community. It had been a happy, joyful weekend. Winners and losers had been shared across many Communities .
Morey, the sober driver of an elderly Sedan, and Vinnie , his not so sober passenger -seat mate, were travelling along a familiar remote road at an average speed of about 80 km/hour.
The other passengers were Tina, Vinnie’s wife, their 6 year old daughter , Sheri- lee, two teen aged boys, Marlene , an aunt , and Jeannie, grandmother of the two boys.
THIS STORY IS TRUE BUT THE NAMES OF THOSE INVOLVED HAVE BEEN CHANGED TO PRESERVE THEIR ANONYMITY.
There was nothing odd about the journey, everyone had been playing simple travel games, and thoroughly enjoying themselves.
Vinnie suggested they play another game because the kids kept saying …” Are we there yet, are we there yet?”It was agreed that they played ”I spy , with my little eye,something beginning with ….xxx abcd!” This game is pretty much played, universally, during long car journeys.
Vinnie was a pushy leader of the pack. He had a reputation of not staying sober whenever there was grog around. Tonight he was still into the whisky whilst still in the passenger seat .Nobody would dream of telling him to stop drinking because it would provoke his anger.
After a few more games and a few more drinks, Vinnie became verbally abusive toward Morey, the sober driver. A bit of pushing and shoving occurred between the two of them .Suddenly, Vinnie shouted out to Morey ,”We’re going to play “Blind man’s buff” now Morey.”
Vinnie shoved both of his hands over Morey’s eyes ,taunting him, as he shouted ,”We can’t play “I spy” any longer Morey, ‘cos you can’t see, so you’ll have to play blind man’s buff.”
Within seconds,Morey lost control of his vehicle, and crashed into a group of trees with a deafening THUD!
It would have taken nearly 2 hours for anyone, who had any knowledge,of crash management, to arrive on the scene.The Golden hour would have passed. Those, who would have had, serious life threatening injuries,would have already died.
Vinnie’s wife Tina was dead, so was their six year old daughter.
The two teenagers both suffered non-life threatening arm fractures, and , later were evacuated to Alice Springs Hospital. Marlene had treatable minor injuries , but Jeannie’s Rt hip and her Rt lower leg received compound fractures requiring life saving Orthopaedic Surgery the following day. Jeannie’s injury took many months to heal enough to provide 30% residual usage and life long painful disability. Jeannie was 63 years old, and had long standing Type 2 diabetes. The diabetes exacerbated her disablement and delayed recovery . Morey, was concussed for a few hours and it took a week or two for his memory of the crash to come back,though patchily. He sustained multiple bruises and minor hand fractures. It was never clear how many of the seven were wearing functioning seat belts.
There were Police, Coronal and Insurance inquiries into the causes of, mechanisms involved, and passenger deaths and injuries incurred . In addition, the families of the dead and injured passengers, and the shared vehicle owners, needed to discuss, individually and collectively, what Payback and other Traditional Cultural requirements had to be sorted out and honoured.
Recalling exactly what has happened, in accidents like this, and in these circumstances, can often be confusing, unreliable and inaccurate. A concussed person, like Morey, with even minor memory problems will be challenged about his recall. Vinney is an aggressive man. The two young teenagers would be fearful of disagreeing with whatever he has said in his statements. Vinnie had been, and was, drinking spirits. Aboriginal teenagers, with limited and imprecise use of English, or their own Traditional language, when it involves complex matters, cannot reasonably ,be expected to have absolutely, accurate recall. Jeannie was very seriously injured and would have remembered little or nothing about the crash.
The legal investigations, and evidence collecting ramifications, take many months to establish. It is accepted as a norm that “proceedings”are always perilously slow.
When events such as these, occur in remote Communities, there are rumours , truths , half- truths and downright lies,leaked through to all of the families who have any association with anyone touched by the tragedy. Speculation and suspicion increasingly disrupts residents minds, and the resulting restiveness becomes overwhelming, unless resolved.
Payback, directed at the guilty party , or parties, is commonly an early, swift, effective Traditional cultural method of dealing with the issues, but needs required consent( vide supra) and certainty of evidence. If it is applied inappropriately, then escalation and long term consequences become the order of the day.
Initially, Morey, as the driver of the vehicle, was firm favourite to receive any due punishment. He had no way of avoiding it.
Vinnie’s wife and daughter were already dead. Vinnie was the “first born” to his father, from a first wife some 25 years previously and his father’s second wife was Jeannie. Jeannie was very seriously injured and disabled for life.
It took some weeks before the truth came out….Vinnie was the villain, and the accident happened because Vinnie covered over Morey’s eyes, thus preventing him from seeing the road and controlling the car. Morey was not to be punished.
The Elder’s family were not the only ones demanding payback. Tina’s, Morey’s , Marlene’s, and the two teenagers.
Payback had to be performed at different times and different places according to the availability and convenience of each family. Vinnie’s father performed it on behalf of himself, the rest of his family and his current wife Jeannie.
I am not privy to the total physical and mental consequences of Vinnie’s injuries, but, having met him three years later, I can assure the reader that they were very substantial , disabling and disfiguring.
POST SCRIPT:- I wonder what the guesstimated costs would amount to, if they were all tallied up, in such a way as to include every possible $A spent on this accident, from day 1 to the end of all ongoing physical, mental, other treatments, disability care and relevant pensions for all of the victims?
PPS:-Payback is still practised, in the 2020’s, in much the same way, as it was in the1990’s , and for much the same reasons.
END OF SIX OF THE VEHICLE ACCIDENT SCENARIOS,THAT I WITNESSED IN REMOTE CENTRAL AUSTRALIA
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WHAT SPECIES OF SNAKES DO YOU GET IN THE CENTRAL AUSTRALIAN/ALICE SPRINGS REGION?
ARE ANY OF THEM DANGEROUS ? WHAT SHOULD I DO IF I SAW ONE, OR IF MY MATE GOT BITTEN BY ONE?
Among the many species of snake found in the Central Australia Region of the Northern Territory are the common harmless Children’s Python and the highly venomous Desert Death Adder. Various other snakes that can bite you include the Brown snake, the King Brown(mulga),the Curl Brown and the Yellow- faced Whip. Australia ,in general ,has got a load of snakes, but only about 3 to 20 persons per 100,000 get bitten annually ,and only one or two actually die as a result of the bite.
Snakes like living around peoples’ gardens ,especially where there’s a load of rubbish, long grass , little birds, mice ,tiny mammals ,frogs and sometimes a little fish, if you’ve got a pond. They don’t being humbugged by people wearing boots thongs or no thongs, and they try to keep out of your way. They don’t like being poked around by a blunt stick or being scared, ‘cos that’s when they are likely to have a go at you. In fact, half of the very few people who die from snake bite in Australia, are bitten around the home. If you ever did see one, you probably wouldn’t know what sort it was anyway, so the best thing to do is to phone the local snake removal expert and pass the problem onto them.
YEAH! But what about if the bugger bites me, or my mate, or my kid Doc?
OK, just remember these SEVEN little things to do :-
1.DON’T PANIC, and tell the others not to, either,
2. STAY CALM AND TELL THEM NOT TO MOVE AROUND AT ALL ,
3.PHONE 000 FOR AN AMBULANCE ,AND ANSWER THEIR QUESTIONS,
4. APPLY AN IMMOBILISATION PRESSURE BANDAGE TO THE BITTEN AREA,
5. IF THE BITE IS ON A LIMB,WRAP THE BANDAGE FIRMLY AROUND THE LIMB,
FROM THE TOES, (OR FINGERS) ALL THE WAY UP TO THE TOP, OVERLAPPING IT ON THE WAY,
6.DON’T WASH THE VENOM AWAY(It may be needed to identify what sort of snake it came from).
7. DON’T SUCK IT OUT OR CUT THE SKIN,(That could drive the venom into your blood stream),
What is snake antivenom? When is it used and why?
Snake antivenom is a very expensive (approx A$ 2000 a shot) injection medicine. It can only be given by a Doctor or a Vet (for bitten animals) to someone, who has been bitten by a venomous snake, and who is getting, or has got, dangerous symptoms and signs of envenomation. The bitten person’s blood and urine can be tested, quickly and accurately, to indicate which of the three antivenoms should be given. In remote Central Australia the anti- venom is strictly only made available to larger population Centres, such as Alice Springs,Tennant Creek and Yulara, because of it’s cost, short shelf – life span, and rareness of using it clinically.
What are the commonest symptoms of mild envenomation?
Usually, pain at the site of the bite, redness, swelling, and bleeding, accompanied by a rapid heart rate ,nausea and sweating.
IN THE NEXT SECTION, I RECALL FIVE SNAKE- BITE RELATED, AND TREATMENT EXPERIENCES. THESE OCCURRED IN WALUNGURRU, YULARA (AYRES ROCK), AND THE BARKLY REGION, (SOUTH OF TENNANT CREEK). THE NAMES OF VICTIMS INVOLVED HAVE BEEN CHANGED, WHERE APPROPRIATE, ETHICALLY, TO PROTECT ANONYMITY.
1. DID A KING BROWN (MULGA) SNAKE, REALLY CRAWL UP ANDREW’S TROUSER LEG LATE AT NIGHT WHEN HE WAS SLEEPING AND BITE HIM? OR WAS IT JUST A NIGHTMARE? A TRUE TALE FROM WALUNGURRU (KINTORE).
On a hot summer’s night in late 1998, Andrew, (not his real name), was fast asleep under his blanket,outside of his wooden house in Kintore. It was his common, under the stars, practice. His wife and two small sons were asleep inside. At around 2 am Andrew leapt out of bed, rubbed his left knee and shouted to his wife to wake up. He thought that a snake might have bitten him, just below the knee, where his navy shorts wasn’t covering.
When his wife had a look at the knee, she couldn’t see any marks suggestive of a bite, but Andrew was rubbing it and said it was ”sore.”
They took a torch and had a good look around the pillow and ground blanket area. They checked around the house, in the grass, under the car and in the bushes .The dogs hadn’t been barking, at all, so they decided to stay up for a little while longer before settling back to sleep.
Andrew was restless , because of the kids being close by if there was a snake around. He kept rubbing his “sore knee”, unconvinced by his wife’s suggestion that it ”really doesn’t seem to be anything much Andrew.” Finally ,he took out his dirty pocket knife, scraped the blade all around, and over, the sore area, until it was bleeding, washed it with bucket water, grunted, and wandered around his house for a few minutes.
His family, and neighbours, were now all wide awake and the dogs started barking. As soon as dogs start barking, at night in a Community, it is an open slather for every dog, within earshot, to join in collectively.That’s what they like to do !
Andrew told the neighbours what had happened and they insisted on getting the Doctor. It was 3 am and I drove down to the house , had a good look around, and couldn’t any snake tracks . Andrew and his wife came to the Clinic, and I had a good look at the knee with strong lights and a magnifying glass.
His scraping and scratching had had the same effect as if someone had rubbed the top skin away with thick sandpaper.
Any possible bite marks would have been completely obliterated. I cleaned up the wound and gave him Penicillin and an anti-tetanus booster. Washing, sucking and cutting in the area of a bite,is against ALL First Aid recommendations.
It was now 3-30 am, Andrew had no symptoms of envenomation. We didn’t stock venom detection kits. I took some blood and urine, and put it away in the fridge for the Mail plane to take to the Pathology lab in Alice Springs for testing the next day. At 4 am Andrew still had no symptoms of envenomation, he was very tired and insisted on going home. I agreed to come to his house at 8-30 am to see if he was OK, but told him that, if he felt any symptoms of envenomation, he must call me and I would see him immediately. I would arrange for an RFDS evac, if he wasn’t well, because we were 600 km from the nearest Hospital where antivenom injections were available, if needed .
So did you sleep Doc?
Not even for 15 minutes!That’s what happens in medicine sometimes when you’re not quite sure of things. Anyway, off I went to Andrews place, sharp at 8-30 am. There was nobody there, the neighbours didn’t know when he had left (with wife and kids), which way he went or where he was going. Neighbours out bush never let anyone know where their neighbours have gone ‘cos that’s the way they protect each other.
OMG.OMG! Is Andrew sick,confused? What’s going on? Is it a shame job? Does he feel awful, because he woke everyone, and their dogs, up last night, and realised that he’d made a stupid mistake?
I muddled through the Clinic, reassured by my professional support system, of Ineke and Tania ,that he’s probably OK and just nicked off for a few days of R and R.
The mail plane arrived ,collected Andrew’s blood and urine, dropped and collected other goods, and flew back to Alice Springs, as it always did on Mondays and Fridays,
It was Friday. I slept a lot over the weekend.It’s interesting that, when the Community know that you are having a hard time, looking after and looking out for their interests, they do tend to look after you and stop people from humbugging you unnecessarily. It’s a double edged sword, really, they want to keep you and you want to stay.
Did you ever find out what happen to Andrew?
At midday on Monday morning, I had a phone call from a Regional Perth Hospital which specialised in Snake venom identification. A cheerful Pathologist ,talked to me after identifying myself.He said ”Oh, Doc, i ‘ve just had a report on your patient Andrew from Kintore. Yeah, he’s positive for King Brown Mulga snake venom on his blood tests.Thought i’d give you an early call about it ! The words “Thanks mate ” nearly caught in my craw, as I prepared to take on all of the implications of my call.
So he was right, he was bitten…by a King Brown,WOW! I wonder where he went? I wonder if he got there ? I wonder if he is still alive? Maybe he collapsed in the desert? Gee have I stuffed up here?
I reviewed all of Andrews Medical notes, to justify that, I had done all of the right things at all of the right times and, that he had chosen to go away after being totally informed about his condition and its’ possible ramifications.
I spent the whole of the afternoon on the phone talking to all of my Community contacts within 500 km of the Clinic. None of them had seen or knew of anyone who had seen or been in contact with Andrew. At about 5 pm, and after having suffered disappointment after disappointment, I leaving the Clinic, when a call came from an Alice Springs Aboriginal Social worker.
”Hi Doc, just to let you know, that we’ve found Andrew and his family in Woolworth’s, in Alice Springs. Yeah he’s been OK. He hasn’t needed to go to the Hospital at all, and will be coming back to Kintore with his shopping tomorrow.”
Aboriginal Social Workers are just brilliant when tracing Remote people who come to town for R and R.
I passed by,and stopped at Andrew’s house, the next day. He greeted me, in a very friendly way , as if nothing had happened .I chanced to notice that he was wearing a new pair of long Jeans that evening!
It is important to note that, even though Andrew had King Brown Mulga Snake venom in his blood, it must have been in amounts which were insufficient to require the use of Anti-venom vaccine treatment,which can have it’s own serious side effects.
POSTSCRIPT:-
There are a number of little titbits in this story, cultural, medical, social, psychological et al. The reader might chose to identify with those that might have affected them , had they been in the situation of Andrew, his wife ,their children,their neighbours, the doctor, the nurses , the Aboriginal Social worker or even the Community dogs !
2. SHIR-LEE LIVED NEAR THE DREAMTIME DEVILS MARBLES SACRED SITE. BUT IT WASN’T THE RAINBOW SERPENT THAT HAD BITTEN HER,WHEN SHE TOLD HER OWN DREAMTIME STORY TO THE RFDS DOCTOR ON CALL.
The Devils Marbles are a group of, huge, cluster formation boulders situated 500 km north of Alice Springs in the Barkly Tableland Region. It is a Sacred site, for many Aboriginal Tribal groups, and is therefore of great spiritual and cultural significance. It is a “must see” feature for tourists, passing through the Region, and is millions of years old.
There are two stories told about their origin. The UNTRUE story is, that the boulders represent the fossilised eggs of the Rainbow Serpent which the serpent left there in mythical times. The TRUE story, accepted by the local Aboriginal people, is that they occurred when an Aboriginal man was cutting his hair to make a Traditional Aboriginal man’s hairbelt. He dropped lots of piles of his long hair onto the ground and they apparently kept growing to form the
widespread Devil’s Marbles.
SO WHAT HAPPENED TO SHIR-LEE? (not her real name)
Shir-Lee was a 15 year old Aboriginal girl who lived in the Barkly Tablelands with her Aunt and a couple of her “cousins”. She had been living in Alice Springs, for most of her childhood, in unfortunate family circumstances. The move had been with the best of intentions and with agreements within the family. Sadly, a common occurrence.
At 9 pm one evening, Shirl-Lee went to see her aunt who was watching TV. She told her Aunt that she had been walking barefoot at the side of the house,having woken up and couldn’t get back to sleep. She said that she had felt a sudden pain on the top of her right foot and that it was now bleeding.
Her Aunt, ever alert to an occasional odd snake around the property, and knowing that bits of dropped food attracted snake-loving mice, took a long look at the foot and noticed two red marks, a few mm apart, that were bleeding.
Concerned about the marks and the bleeding ,her aunt phoned the Alice Springs Hospital and asked to speak to the Doctor on call for Remote Health. She was able to talk with a Senior doctor experienced in such calls. She reiterated Shirl-Lee’s account of what had happened, and told the doctor what she had found on her niece’s right foot.
The doctor asked to speak with Shirl-Lee, who confirmed what had happened. She said that she felt unwell but couldn’t say specifically what other snake bite related symptoms were causing her problems.
The doctor recommended that a Remote nurse, currently about 60 km away ,visit Shirl-Lee within an hour and make a report on her findings ,to the RFDS doctor. ,in Remote Australia ,anyone with an established snake bite, should be evacuated to an Accredited Hospital ,for assessment, observation, testing for envenomation, and, where indicated treatment with Antivenom (Antivenene) medication .
The Remote Nurse, having arrived, confirmed the story with the evidence of possible snake fang bites ,and bleeding on Shir-Lees right foot. Again there were no specific symptoms of envenomation. The nurse spoke to the RFDS doctor on call, and, it was agreed that a snake bite had happened without envenomation and that the safest action was to bring Shirl-Lee back to Alice Springs for observation even though this would involve a night flight after a Remote Ambulance arrival at the aunt’s house and a 40 minute trip to a suitable Airstrip.
A night flight, for Emergency evacuations ,was available and arrangements were made to collect Shirl-Lee, estimated time of arrival approx 2 am. The Flight crew arrived at Alice Springs Airport, the plane, and were ready to depart at 12-25 am.
At midnight, an urgent call was received, from the Ambulance Paramedics, who had arrived at Aunt’s Remote house. The Ambos were told that Shirl-Lee was fast asleep and wasn’t coming with them. Fearing that she may have, indeed, been seriously envenomated, they woke her up to talk to her and examine her.
Shirl-Lee was furious.She shouted and screamed at her Aunt and the Ambos and burst into sobbing and crying.
What, the heck, had happened
It transpired that, Shir-Lee had been desperately unhappy for weeks ,after living with her Aunt and the other kids.
She was bored out of her mind, she missed the few real peer friends that she had had in Alice Springs, and had been waiting for an opportunity ” to run away, or somehow get the hell, out of here.” Shirl-Lee wasn’t stupid and waited for a getaway opportunity,
She somehow knew, that people who had had a snake bite out bush, always got evacuated, so she faked her own snake bite. She had taken a needle,from her Aunt’s sewing box, pricked two small adjacent areas on the top of her right foot, waited till the spots had bled , and raced off to her Aunt for confirmation of a possible snake bite.
The Paramedics relayed the confession back to the RFDS Flight nurse and Pilot, the flight was immediately cancelled . A few days later the incident was reviewed by the appropriate division of the Children’s’ Department. They would have started off a further review of how best to deal with poor Shirl-Lees waning childhood.
THE ROYAL FLYING DOCTOR SERVICE MEDICAL CENTRE, YULARA.
ULURU (AYERS ROCK), IN CENTRAL AUSTRALIA, IS A MAGNET FOR 400,000 THOUSAND TOURISTS ANNUALLY, FROM ALL OVER THE WORLD. YULARA IS THE NEARBY TOWN OF 1000 + RESIDENTS, CLOSE TO THE LOCAL AIRPORT, AND IS WHERE THE MAJORITY OF TOURISTS ARE ACCOMMODATED IN 2-7 STAR LUXURY.THE RFDS PROVIDED EXCELLENT GENERAL MEDICAL, NURSING,ANCILLARY HEALTH, PARAMEDIC AND EMERGENCY FACILITIES THERE, FROM THE LATE 1980’S FOR ABOUT 25 YEARS.THE PARAMEDIC SERVICE INCLUDED FULLY OPERATIONAL ROAD AMBULANCES. I WAS,ONE OF THE TWO MEDICAL OFFICERS THERE IN 2000-2001.
THE NEXT TWO SNAKE BITE TALES OCCURRED AT YULARA MEDICAL CENTRE.
3. Yulara is a fabulous place to walk off a heavy evening dinner before “hitting the hay.” Its’ paths are extensive, neatly trimmed , bordered by sweet smelling tropical plants and flowers and dimly lit. A veritable paradise, and an hour’s stroll in which I allowed my cobwebs to be blown away, most evenings after work.
We had five Emergency beds in the Medical Centre Casualty.
FREDDO THE FRENCHMAN, AND HIS WIFE, ARRIVE AT THE RFDS MEDICAL CENTRE, WITH A “FOOT FORMIDABLE.”
It was 10-30 pm. We had had an Obstetric Emergency, evacuated to Alice Springs at lunchtime, a couple of fractures to x-ray and treat ,intermingled with a sick child with croup and a non-cardiac Chest pain to sort out. I had just closed the doors and Tim, my “full of all knowledge” male nurse, was instructing the night cleaner about various jobs that needed to be done in the Centre.There was a light knock on the door,followed by a heavier knock on the door,followed by a purposeful, flurry of closed fist knuckle- hammering.
I slowly opened the door to an angle of about 20 degrees, eyeballed an agitated 40 + year old smart little man wearing a Paris tee shirt, tiny shorts and thongs. I simply said.”Yes?” and received an immediate reply, of “My wife has a sore foot!”
Recalling the Truism that,”Manners maketh the man,” I backed away from a smart arsed, glib, English response, having recognised,from his voice, that he was a Frenchman. We’ll call him Freddo the Frog (not his real name).Freddo spoke tolerable English.He summoned his barefooted, thong-less wife from the shadows,and shoved her sore foot close to my face saying,”There is her sore foot Doctor.”
I realised,immediately, that this sore foot wasn’t a sprain, or a stubbed toe.The red spots of blood , the swelling , and two fang marks were the result of stepping on a snake which had turned around and bitten her on the ankle.
My ever- alert male Nurse,Tim,having noticed what was happening, popped her onto an Emergency bed and implemented the official treatment regime for snake bite, and removed the Snake venom detection kit from the fridge.
Freddo was flabbergasted when given the diagnosis. His wife was even more flabbergasted, because she understood very little English, and every bit of information, and instruction, had to be relayed through Freddo, translated by him into French, and then given to his wife again in French. How much important info was lost, or misinterpreted, was impossible to judge. Obtaining a suitable and willing interpreter, in Yulara, at 11 pm onward throughout the night was not feasible.
Tim was able to set up venom detection tests on the patient’s blood and urine specimens and read the results at around midnight. Yes they were positive for Brown snake envenomation and she had mild symptoms from the envenomation….pain at the bite site , swelling , bleeding from the bite, redness of the surrounding skin, nausea and sweating. This lady had to be fully and carefully monitored.
At this stage these are the problems and alternatives:-
1.The husband and wife holidaymakers are French.
2.The wife has a moderately severe Brown snake bite with no way,at present, of telling whether it will get worse.
3.Their individual and collective knowledge and understanding of her problems are very limited because of language difficulties.
4.Their understanding difficulties limit there choices about what might be in their, total, best interests.
5.We are unaware what their original holiday plans were ,if this issue had not have happened, or, having had it happen, what alternative choices can be offered to them, eg travel, accommodation etc?
6.What financial obligations they face now that their plans will need to be reviewed? What does their Insurance cover?
7.Who do they need to contact, why, how, and when?
There are clearly other questions, with, or without, answers.
Most of these problems and alternatives, have a bearing on what we decide clinically should be their management in their and our situation.We have only two staff, until we are, belatedly relieved, at 8 am tomorrow morning.
We decided that, at this stage, there were no sound clinical reasons to dive in and give Brown snake antivenom injections , because, of themselves, they can produce serious side effects that we may find impossible to manage ,given the present situations.For example ,how do you give a good account of what the complications might be and how do they then agree, or not with the treatment?
So what did we do?
We spoke, to the Alice Springs Hospital Emergency night Physician- on- call, asking for an extended Management plan.
Freddo and his wife understood that their problem was shared elsewhere with a major Hospital.
We monitored his wife for a further two hours and it became obvious that an RFDS evacuation from Yulara to Alice was the correct move .She would be carefully monitored during the flight, travelling with an experienced Doctor and Flight Nurse. She arrived in Alice at 4 am , was further monitored and later given Antivenom (antivenene).She required minor plastic surgery for some loss of skin around the actual bite, recovered and was well enough to continue holidaying in a number of other tourist spots after another week.
VIVE FREDDO(and his wife) ET VIVE LA FRANCE!
4. AN AMERICAN ”PIT-BULL IN YULARA,” FINDS SOMETHING ELSE TO GET HIS TEETH INTO AFTER SUNDAY LUNCH, BUT GETS ROASTED HIMSELF AFTER A HEATED BUSH ENCOUNTER.
In mid 2000 Dyson,a long term resident of Yulara (near Uluru), owned an American Pit- bull Terrier, purchased long before the days when importation of Pit-bulls was banned in Australia.
Both Dyson and Tyson, his pit-bull, were the epitome of fitness, neither carried an ounce of extra fat and both were incredibly strong. In fact, to the uninitiated or myopic, they could have been mistaken for a couple.
I’m told that pit-bull Terriers are very friendly, and like to have their tummies rubbed when the are lying on a couch,but I’d never been game enough to challenge that information practically.
Dyson and Tyson were incredibly good mates, and, with no wife and kids to compete with ,Tyson had Dyson’s attention 24/7…… except at 3 pm on this particular hot summer afternoon!
Dyson had been jogging along the gritty footpaths that zig- zag the Community. Tyson was doing his usual manic running , racing, jumping, stopping and standing still performances. Tyson’s game was to suddenly reappear, just when you thought that he had bolted away to Uluru. It was unusual for Dyson to need to call him and shout for him to”come to heel”, but he had to, today.
Dyson could hear Tyson barking, excitedly, persistently and continuously in the middle of a clump of thick bush. Suddenly the excited barking mollified into a dark silence, then Dyson heard whimpering from his stricken, bitten dog. Tyson only had enough strength to drag himself out of the bushes and into his master’s outstretched arms.
I was in my house when Dyson called for Emergency support. There was palpable panic and desperation in his voice. Within 45 minutes, I had examined the crest fallen Tyson, contacted a Veterinarian mate in Hobart, and was given instructions as to how to initially properly assess a dog with snake bite, apply first aid principles, and work out an algorithmic treatment plan.
Tyson had been bitten on his Rt upper thigh. We could offer him some essential initial treatments after assessing him.
His leg was already swelling and the bite marks bleeding a little. He was weak, trembling and twitching, and drooling from his mouth. His back legs were already weak and he had started to get diarrhoea.
The Central Australian Brown snake does hang around Yulara a bit because there are lots of houses, gardens, restaurants, mice, birds, and enticing food scraps dropped around by little litterers.
My ever ready Male Nurse, Tim, arrived at the Clinic and we shaved Tyson’s “good” leg to expose a small vein.We drew some blood to test for which type of snake venom was in the bite , put in a paediatric intravenous line, gave him some strong iv pain medication and some important fluid replacements in the drip line.
We placed a rectal thermometer in his bottom. I had been told that if a snake bitten dog’s temperature rises above 40 degrees Centigrade it could indicate imminent death.
Basically the assessment process and the treatment , of snake bite and envenomation, is pretty similar in humans and dogs.
We detected Brown snake venom in the detection kit . In a couple of hours Dyson took his dog back to his own house, which, fortunately, was just around the corner from me.The pain had improved , his temperature was only raised a little,he hadn’t yet had a pee and was still very dopey and unable to move. Dyson would keep a close eye on him and phone me if he was worried.
SO WHAT DID WE DO NOW?
The only reasonable treatment for Tyson, at this stage would be for him to receive a dose /for weight Brown Snake antivenom injection. Relying on his own ability to clear venom from his body,would require careful and constant nursing in an approved Dog hospital for a number of days, by experienced professionals. Some dogs get better in a few days, if the venom dose has been small. Many will last for a week or so, experience lots of pain and problems, and experience a drawn out death.
Tyson weighed 70 lbs, was worth, maybe $5000-8000 and, as Dyson’s best mate,was priceless.He should be treated if possible. His antivenom injection alone would cost over $2000, if made very urgently available, which is hardly feasible in extremely Remote Central Australia.
The RFDS Yulara Medical Centre held Two doses of Brown snake antivenom in the refrigerator, for urgent use , by the Medical Team for seriously envenomated patients.The medication is expensive, has a short shelf life and has to be replaced every 9-12 months because it gets out of date. When it goes out of date for human use , it can still be used for treating animals for a month or so, despite it starting to go off.
Tim and I checked our Human antivenom supply .
One ampule would have to be changed in about 3 months, but the other one had run out about 2 weeks ago and needed replacement. The planets ,or whatever, had conveniently aligned in Tyson’s favour. That same evening Tyson had his life saving injection. Within 24 hours he had turned the corner and within a further 3 days he was walking the zig- zag paths of Yulara, albeit slowly and cautiously.
I did visit Tyson at home once. and tested the theory that American Pit-bulls liked their tummies rubbed when they are lying on a couch. I can confirm that for Tyson and I it was true!
5. RED BACK SPIDERS ARE COMMON IN PERTH, BRISBANE AND ALICE SPRINGS. SOME HAVE BROWN OR BLACK BACKS RATHER THAN RED.THEY CAN ALL CAUSE VERY PAINFUL BITES.SOME CALL THEM ”BLACK WIDOW SPIDERS!”
I have included some information, about these nasty little critters, because, when I was in Alice Springs in July 2001, a local man received a world record number of bites in a painful encounter with one or more of them.
A bite from a Redback spider usually causes intense localised pain and swelling within 5 minutes, followed by sweating and a bit later, nausea , headache, lethargy and possibly vomiting. The pain from the venom can last for a few hours and may even recur persistently for 2 to 5 days. It often requires strong medication and sedation for relief. Since the introduction of Red back spider antivenom injection treatment, there have been no fatalities recorded in Australia. Prior to the antivenom, a fatality was very rare and it was mainly introduced to relieve the shocking pain associated with the venom.
In July 2001 Darren, a twenty five year old local man gained world fame on radio, TV and in the Newspapers, when he received 20 Red back spider bites! The Courier Mail headline, 11 July 2001,read:-
“Darren’s arse gets the attention of angry Arachnid. Horrid Bites to his posterior”.
Darren had gone to bed one night and had woken up with significant pains in his posterior. An uninvited Red back spider had settled into bed with him, got aroused and angry, and speared him with a continuum of 20 bites during the ensuing onslaught. So severe was the strength, and persistence of the pain, that Darren was taken to the Alice Springs Hospital Emergency Department, loaded up with Antivenom and other medications, and admitted to the Intensive Care Unit. During the next few days he needed 16 doses of Antivenom to help neutralise the venom and keep him virtually pain free. This was a World record .The previous world record holder had needed a mere 8 doses!
THE MORAL OF THIS STORY IS, TO BE CAREFUL WHO HOPS AROUND WITH YOU IN BED IN” A TOWN LIKE ALICE.”
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