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Society of Rural Physicians of Canada |
| Société de la médecine rurale du Canada |
Let me share a narrative about what it was about.
I arrived in Australia in mid January 1999 in Melbourne. While recovering from jet lag I made the not surprising observation that the Australian bureaucracy is as much unfathomable as our own Canadian one.
I have been dealing with them for over 6 months now, but January 19th was the first time we met face to face. For a Canadian doctor to enter the country as a "temporary resident physician" i.e. foreign locum, one must seek prior approval from the local state medical practitioners board (we would call it the College of Physicians and Surgeons), the department of health, and the department of Immigration. Curriculum Vitaes, a certificate of standing from the Provincial College of Physicians and Surgeons and an application from the employer from a region of "unmet need" a complete physical and chest Xray the visa application, a few months and a few dollars and finally one get the subclass 422 visa. One would think that after all that preliminary paper work the rest would occur quickly. Of course one would be wrong.
Sure enough, on arrival, I got an appointment at the medical practitioner board and the health insurance board. The practitioner board (similar to our College of Physicians and Surgeons), after a brief but frantic moment where there were trying to locate my file, just needed a half hour to check my visa and passport (yes it is I) look at my original diploma (clutched in its frame as carry on all the way from Toronto) a letter from my residency program and another certificate of standing from the Ontario College (in case I had done something in the last 3 months since I sent in the last one). That, another passport picture and the sum of $200 Au, and I am a licensed doctor in Victoria (albeit restricted).
The health insurance board was another story. Unless in high season when the medical schools release another cohort of students, they take appointments only one day a week. I got the lecture about Medicare and pharmacare, loads of manuals and forms and then was told that I need a 3J of course (silly me) that is issued by another branch of the ministry of health. I am still not sure what a 3J is, something about exempting me so that I can bill Medicare because I am serving an "unmet need" (didn't we do that getting the visa?), hence billing and prescribing numbers that came through in the following week.
One of the better commercials shows a dark skin lesion of the nose being excised and a graft taken from the buttock, "unless you want to wear your bum on your nose... slip slop slap"
Are the commercials successful? Well I have seen lots of hats, but there is still plenty of topless young women sunbathing on the Melbourne beaches. I saw someone who was driving the previous day in a sleeveless top and had the sun give her blisters through the car window. The surgery has a dermatoscope that helps in identifying skin lesions, and a liquid N2 sprayer to deal with pre cancerous lesions on Fridays and every Thursday there is a lump and bump theatre at the hospital to deal with excisions of the rest.
Me, I'm wearing SPF 30+ under my hat and getting after the rest of the clan.
No worries
We use software to print the Rx at the surgery here. It makes looking things up in the MIMS (CPS equivalent) less needed (an electronic equivalent is accessible through the program), it probably reduces chemists (pharmacy) errors as well. Considering the complexity of the phamacare system in coverage (stuff can be covered, partly covered, covered for restricted uses, covered for restricted usage AND requiring prior phone authority approval) and the prevalence of packs (drugs are sold in set quantities and they are limited and specified e.g. Penicillin 250 mg Rx quantity = 50 Repeat max =1 unless you get an authority)
This is a 3 doctor town and yet it has avoided becoming just a diagnostic and treatment centre. One of the GP's does hernias, open tubals, appendectomies and Cesars (caesareans). Once in a while I get to be baby doc for a Caesar and we had a retired doc in town assist. Obviously for stat sections we run with a minimum of the surgeon and anaesthetist. If either is out of town we send VBACS out.
I am also getting used to X rays. The hospital doesn't have enough Xray to warrant a tech so the docs do them. One night early into the locum the GP on call asked me to come in to help reduce an elbow. I was thinking radius and wondered about the fuss, until I saw the Xray, it also included the olecranol-ulnar joint. He anaesthetized, I tried to reduce, he eventually did it (I got to bill for it, as the Anaesthetist cannot bill for the procedure) and I got to run to take and develop the rays.
Good practice as over the lunch I was called back to the hospital (I was on call) and I X rayed a boxers # (and set it and re X rayed post reduction - wasn't perfect but it was better and he didn't bother coming in on a previous boxers fracture, so he was wondering about the fuss. My colleagues were also a bit surprised why I bothered) and Xrayed a 1st MT fracture that was undisplaced.
Don't take this as a sign that in Orbost we are expected of being able to do everything. I arranged for a referral to an orthopod of a # base of the 1st MT yesterday. It was unstable in a local doc's hands so he sent it acutely to the surgeon at the next town for pinning. Unfortunately for the kid the general surgeon said eh! and did a closed reduction but it was obviously falling apart when we re Xrayed here later.
As a variant to the ever present 'veek n dizzy' there is an illness of muscle and joint pain, tiredness, and a rash that would qualify as the flu if it wasn't caused by a arbo virus. There is also a similar Barmah Forest virus that is also transmitted by mosquitoes.
Both illnesses have a broad spectrum of presentation. After a week of incubation you get muscle and joint pains, tiredness, and sometimes a rash. Many are sub clinical and you can find people with blood work showing previous infection (IgG antibodies and negative IgM) without any significant history. There is the other end of the spectrum where they manifest as "a nasty bit of work." People can literally be disabled for months, but neither is not felt to cause permanent injury.
If you get bit by a tick one has to think about the rare Q fever (This ricketsial illness is treatable with tetracycline). The chart in Casualty divides venomous snakes into those that cause muscle damage (rhabdomyolysis) and those that just cause the usual pain, nerve gas like symptoms and so on. For poisonous spiders the major one in Orbost is the red back with a splotch of red on the top of the abdomen.
On the other hand the locals tell me that Victoria doesn't have as much shark and croc problems as the rest of Australia. This would be reassuring if you weren't already worrying about the bugs and snakes!
To be fair though, there are only 10 deaths due to snake bite a year, and only one unprovoked, in all of Australia, so there is more anxiety than substance here. I chuckle with the irony of it all when they ask me how worried I get about bears in Canada.
About 88% of the land in East Gippsland is crown land with large tracks as wilderness park lands. Much of East Gippsland is relatively untouched due to mountainous terrain and distance from urban centres. The peaks and plateaux rise about 1500 m above sea level, and actually get snow in the winter. Eucalyptus forests ("gums") predominate in the dryer rain shadow areas. There are probably 600 species of these trees, including bushes that often line country roads. In Canada portions of these bushes are sold at amazing prices in stores for dry flower arrangements. Here the oils that they give off so fills the air that it turns distant mountain peaks blue (hence the apt named Blue Mountains).
In the rain drenched slopes and gullies you find rainforests. These are delightful walks and exhibit a huge variety of flora and fauna. Here you can find Sassafras, Tree Fern, Kanooka, Lilly Pilly and the usual tangle of vine and dense fern. Especially beautiful (and rare) are the rain forest orchids that grow ontop of living and fallen trees.
With major fires finishing off most woodland near Melbourne in the late 30's, logging operations transferred to Gippsland. This lead to a boom for a while, but people tend to cut trees quicker than they grow. Currently the lumber industry is in a bit of trouble with "greenies" providing protest, good timber becoming more and more difficult to access, and some lands having been turned into parkland.
Other industry includes farmland. Orbost lies near the Snowy River estuary. Much cattle graze the fertile Snowy River flood plane. The season is tropical with climate suitable for many crops. In the back yard we have apple, lemon, apricot and nectarine trees. We have been regularly enjoying home grown lemonade and apple crisp! Next door there are passion fruit vines, but not one of the Hutten-Czapski's have taken a passion to the fruit.
Further South we get to the sea. Rivers that enter the ocean here tend to have their estuaries silted off and so form a series of brackish or freshwater lakes divided by sand dunes. These attract many shorebirds and provide miles (many more than the 90 miles advertised) and miles of pristine beaches with few or any people. Some of the most interesting shorebirds are the little penguins. These 30 cm birds prefer to roost on isolated rocky islands. They spend their day in the ocean swimming and return to the rookery emerging from the surf at dusk to walk, or rather waddle up. How they find the right nest seems amazing as there are hundreds if not thousands of similar nests a foot or two apart.
Of course this is Australia. Here you are doing hairpins at about 30 kph and the road is posted as being 100 kph and the line in the middle of the road is always dotted regardless of the twists! You drive along the left side of the road, the edges (shoulders) are inevitably soft, and I don't think that they believe in guard rails. I suppose this is survival of the fittest, any tourist or local willing to go full out gets himself, and his car, buried at sea!
On the other hand, lack of guard rails makes the scenery much more intimate. The scenery is spectacular with shining white lighthouses, towering limestone cliffs, and monuments of rock carved by the sea. The attachment is a picture of 12 of these monoliths called the 12 apostles. The flora of the region is a bonsai forest of salt tolerant species, that hides the local bandicoots and other wildlife. Seabirds, however are much easier to spot here and we saw both hunters and hunted.
To round up our trip we went to the Grampians, which is a mountainous area. We did a number of hikes, including one down to a delightful waterfall at which three of the more childlike Hutten Czapski's, couldn't resist swimming in it's pool. That was Heather Benjamin and myself of course.
On the way home to Orbost we stopped by Ballarat where we saw the 100th annual begonia festival. It was quite a carnival with parade, midway and many other exhibits. Any excuse to throw a party! There was a floral carpet, easily 20 m by 20 m which depicted, in flowers, the history of the Begonia Festival.
Benjamin's enjoyment of the festival was limited by an encounter with a swing on the playground. His infamous tooth ran into the chain chipping a good hunk of enamel off. Luckily nothing worse happened, and we made it home safely.
Canberra pop about 300,000 is that famous political compromise of being neither Melbourne nor Sydney, but rather in the middle of the bush. Because it was planned to be that way it has rather strange street geometry's and newcomers invariably get lost... a lot. The street plan is a series of circles that radiate like ripples from where the pebble landed, right on Capital Hill.
While the city was planned in the 1910's, things such as wars and depressions and whatnot actually delayed a permanent Parliament House until 1988, so it isn't what Canadians would expect. It's done on a majestic scale and some photos are attached.
We enjoyed our selves by making a bee line for Questicon, the science and technology museum. While waiting for it to open we wandered to the next field where a car rally was being held. Normally we would show no interest in such a thing but seeing Rolls Royce after Rolls Royce pull up we had to investigate. As it turns up the Rolls Royce Club of Australia dogged our steps throughout our stay there.
After we had exhibited there long enough we made it to an island on the man made lake where we listened to a 52 bell carillon recital and picnicked. It was one of those, you know you must be in a capital when things.
That evening we retired to a Caravan Park. I am not sure on how it is in Canada, but here in Aussie you can pitch a tent, or pull your Caravan (Mobile Home, RV) into a Caravan park, or rent an on site Caravan, or on site Cabin. We took the cabin as it had an en-suite. You supply the linens, they supply the crockery, and you can move in for as long as you like.
On the way back on Sunday I thought that we would take a quick tour of Parliament. No such thing, while tours do go every 30 minutes, It didn't quite occur to me until I was on the tour that the tour lasts much longer than that.
Past an airport like bomb gun and knife checking equipment we were let into the great hall. As it happened they were setting up a dinner for the Rolls Royce Club, the very same people who were following us all day (even if they did keep changing cars you would think that they would pick a less conspicuous surveillance vehicle).
A bit surprising to have a private function but since big state dinners are few and far between a private person can rent the hall for a function. There has been one wedding (there has to be a minimum 350 people guest list), several Debutante balls, and many corporate Christmas parties.
Adelaide was a city that feels like a nice country town. I heard that it's population is 0.5 million, but due to the fact that the downtown core is a mile square surrounded by a kilometre wide green area it doesn't have the congestion of the cities that I know.
We did some city things, saw a movie (The Matrix - cityscape shot in Sydney) went to the zoo and so on. Mostly we spent time visiting old friends from Kingston days. These two Australian barristers were doing their masters in law while I was going to medical school. We exchanged Christmas cards and all that for years, and we finally made it down to visit.
On our return trip we travelled through hundreds of miles of vineyards along the Murray river. We then travelled the great alpine road through bright and saw exotic autumn colours, and then the mountains where the kids forced me to stop so they could have a snowball fight!