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.