A Doctor's Dream by Buddhi Lokuge

Author:Buddhi Lokuge
Language: eng
Format: epub
Publisher: Allen & Unwin
Published: 2014-07-24T16:00:00+00:00

17

ISLAND HOPPING

The first two days at Umbakumba on Groote Eylandt started awkwardly. I was there to do simple skin checks; the nurses had to perform ear, eye, blood and urine checks. When the children arrived for school screening, they moved efficiently between stations but it seemed like I was always standing in the way.

When I spoke to Tanya that night I noted dully that I had been asked to go to the Milingimbi healthy skin day the following week so I would only be home for the weekend. And I would have to spend those two days preparing for the next steering committee meeting.

‘Why don’t you change the meetings to every six months?’ she suggested.

Lawrence had been pushing for more reporting but as it was I was spending every waking moment on the scabies program, including keeping Sam in the loop with painstaking detail, often several times a week. Changes happened slowly so extra reporting for the steering committee would only replicate the reports I was already producing and I had been clear that I would begin by implementing existing treatment protocols better, not by trialling new ones so we were not waiting on new protocols.

I had convened a medical working group of experts from Northern Territory Health and Miwatj in order to update the clinical guide for scabies and crusted scabies treatment protocols, with the aim—in part—of introducing ivermectin. This update would become part of the Central Australian Rural Practitioners Association remote medical practitioner’s Standard Treatment Manual but that, too, was a long-term project that could take months or even years.

Tanya reminded me that despite decades of work on scabies nobody had eliminated scabies as a public health issue in remote communities. So since it had only been a couple of months since we had decided to create our own program with One Disease she thought I could afford to take the pressure off myself to have solved the problem already.

Some of the scabies programs that had been run previously may have worked had they not ended before they had the chance to look at ways to adapt and deliver better outcomes. Most of them had no room to pivot and become more relevant to the context. They had an action focus, imposing by doing, rather than a reflection focus, learning by doing. A reflective focus means admitting that we don’t know everything and we may make mistakes but we are committed to learning. We brought a reflective focus to the table but it meant we were swimming against a riptide. A humble program run by people determined to learn how to do something truly valuable for communities in the area of scabies, even if that meant taking ten years to treat ten people, was much harder to pitch to donors. If I couldn’t provide Sam with enough impressive-looking ‘evidence’ to keep the steering committee supportive and convince donors to get onboard for the long term the program would fail, just like those before it.

When I finally spoke, my tone was lifeless.

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