Alice is Wonderland
I stepped off the three-hour, climate-controlled flight and
into the hot, still, dry air of Alice Springs. My eyes fell first to the large,
khaki welcome sign that reminded me so much of the one that welcomed me to
Uluru only two years prior. Almost 500km south on the map, my geographically
uneducated eye would, at first glance, know little difference. Red dirt and
dusty green plants surrounded the tiny airport. A slowly-moving baggage
carousel carried the luggage of a hundred weary travellers. And, while I
waited, I peered curiously at the many advertisements. A4 paper sheets spread
news of local events, larger placards advertised the local casino’s $16 Steak
nights. Local tours of nature’s highlights shouted loudly with brightly coloured
writing glaring out over colours of the earth.
I waited in the long queue for one of Alice’s few taxis to
take me home. Ahead of me stood some Aussie travellers, remarking on how it was
cooler than they expected – only 36 degrees Celsius. Behind me, a gaggle of
American girls cheered at making it across the country safely and whooped in
excitement for their desert adventure. Their noise cut through the quiet
reflection on my new location. Soon, my taxi arrived; a safe-haven from the
oppressive chatter more than the welcomed heat. I knew I was in a small town
when my taxi driver mentioned he worked at the hospital – and when, two days
later, I bumped into him after my morning run.
My life here very quickly became settled. The weather that
is, for the most part, unchanging. The rhythm of hot days and cool nights. The
pitter-patter of our weekend rainstorms. The hand-over meetings followed by
lengthy ward-rounds; the teaching sessions and afternoons of ward jobs.
Escaping the mental fatigue with long gym sessions with dedicated housemates.
Cooking dinner and sitting down to an evening of study on our somewhat
unreliable internet connection. Sleeping, then starting it all again.
Here, we walk everywhere. Time unfolding along the same path
we tread day in and day out. To the hospital; to the supermarket; to Thursday
night Trivia at Monte’s. The stretch of the main road tells the same story each
day: no Indian myna birds swoop us here; instead, native birds screech and
chatter as we make our early-morning venture towards the hospital. The dusty
bus shelter welcomes newly discharged patients, sometimes still wrapped in
their hospital-issue green pyjamas, and shade-seeking locals alike. The
hospital seems a hub of activity – people sit in the car park and wander past
to the sports facilities down the road.
Though the warm sunshine is barely felt through the
hospital’s double-glazed windows, it feels like there’s a little more of the
outside inside here than at my home hospital. Here, the floors come in linoleum
blue and red. The walls are peppered with Aboriginal artworks in a
not-entirely-successful effort to make this sterile place feel a little more
welcoming. Families wander in and out. And here, patients actually have
visitors.
Here, patients seem like real people. Where, at home,
patients seem to sink into the sick role, and sometimes revere in it, it is the
reverse here. Many patients refuse to believe that they’re sick. They fight
against the reality of their ailing health. Some fear it. Some just don’t worry
about it. Despite frequent language barriers, we’ve had some good laughs with
many elderly patients – patients who read WHO Weekly and Women’s Day because
they love the pictures, and constantly pester their grandkids to repeat the
translation of our questions because their hearing is failing. Then they hear a
common word – generally something like “poo” – and make emphatic gestures to
suggest the quality of their bowel movements.
I watched as one elderly Aboriginal man sat in the chairs at
the entrance to the ward, determined to be put on an RFDS flight home. As one
of the Aboriginal Liaison Officers translated our concern for his health, I
watched the fear in his eyes. Fear whose cause I can only guess. Stuck inside,
in a cold environment, surrounded by people who don’t speak his language. Fear
at an unknown system. Fear, I guessed, because his face didn’t tell a story of
a life of happiness. Either side of his nose sat deep valleys of sadness – a
face that told of a lifetime frowning. His eyes, opened wide with vigilance,
had no crow’s feet to mark many long-past smiles. Instead, all I could imagine
were great tears of sadness flowing through the crags of his down-turned face
and on to his obviously well-cared-for clothing. His polo shirt and trousers
atop leather lace-ups often polished but losing the fight against central
Australia’s dusty soil. Keeping this man, and the many like him we meet each
week, inside the hospital might help us create a drug regime that will fix his
biomedical health problems, but the damage to his mental health seemed an
extreme trade-off.
Many of our patients are wheeled from their bedrooms to the
long windows at either end of the ward – windows that frame the nature chequered
with modern trappings of cars and the sad stories of discarded beer bottles.
And I can feel the longing for the wide expanses of earth unmarred by these
inane accessories.
At the same time, the beauty of sleeping under the stars
loses some of its lustre when we have particularly cold nights. These nights
are followed by Emergency admissions for pneumonia and exacerbations of lung
diseases. My medical student colleagues in other departments tells stories of
the children who see not the brilliance of the stars in clear night sky, rather
the fear of returning home to a shelter with walls and roof but little safety
from the people with whom they must share that space. My colleagues in surgery
see the unfortunate results of the night’s violence.
And we have to send our patients back to a world that’s less
than perfect. We figure out their health problems and prescribe a number of
drugs – drugs that might be difficult to obtain in some remote settings. We
dish out pills in hospital and see marked improvements – but see the same
patients back a few weeks later because their supplies have run out and the health
problem has again reared its ugly head. Here, we see heart failure and chronic
obstructive pulmonary disease (COPD) in fifty and sixty-year olds – conditions
that are common in our seventy, eighty, and ninety-year old patients at home.
And here, some of our fifty-year olds look older than the ninety-year olds on
whom we did hip replacements at home. It feels like we’re providing a Band-Aid
solution. We’re fixing a biomedical problem that sits inside a much broader,
more complicated picture. And all the tablets in the world won’t solve that.
You hardly have to scratch the surface to see the racism and
inequality in the town – the bouncer at the pub who very obviously rejects any
Aboriginal patrons from the facility, the cars speeding along the streets as
groups of, often young, Aboriginal people walk. The transient hospital staff,
from all corners of the globe, who often live in NT Health-provided
accommodation while the NT Housing for many of our patients is often reported
by Occupational Therapists as having a multitude of faults. The taps don’t
work; the tiles are broken; there is no hot water.
Alice is a wonderland. A place where I constantly wonder at
how so many different worlds could possibly live in parallel, brushing past
each other. Sometimes, there’s friction. Sometimes, it’s as if we were never
there at all. Invisible. I wonder at the story that’s so obviously not being
told. The story that’s been muted to my straining ears. And I wonder if this
place will one day be filled with elderly Aboriginal men who have crow’s feet.
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