"TB or not TB"? That is the question.

I wonder if tuberculosis was around in Hamlets day?  It certainly is around in the Northern Territory, as is Leprosy and Syphilis.  Yip, sometimes it feels like I'm in a third world country.

Here all aboriginal people get routinely screened for TB, as do people who have visited countries with high incidents of TB, all immigrants and those people working with high risk populations such as health workers, prison staff, police, homeless shelters etc.  So, I fronted up to be screened as you do fully confident I wasn’t likely to come back with a positive result having had my BCG vaccine when I started my nursing training some 19 years ago.  What they didn’t tell me when I had by BCG is, that it’s really only effective in preventing TB for half of the population who have had it. 

To my total shock I was in the half of the population it didn't help as my mantoux test showed a substantial positive result.  Positive meaning, I have been in contact with someone with active TB and need to have a chest x-ray to see if I have any lesions and to provide a baseline x-ray for future comparison.  Fortunately I have no current lesions and no symptoms of active TB.  Therefore, I officially have been given the diagnosis of “probable latent TB”.

So what is the risk of me actually getting ‘active TB’ or Infectious TB Disease as it's also known as?  Well, they have a software program here that calculates the risk. The doctor puts in all the information like my age, where I was born, countries I’ve visited, my health status, whether I smoke and drink and a few other bits and pieces of information into the program and it gives out a percentage of risk.  If the percentage is on the higher side then treatment is strongly recommended but is only forced (by law) if active TB is present. Treatment being 9 months of antibiotics for latent TB.  Of course, this doesn’t stop you from being reinfected in the future.  My percentage was less than 5% so I was therefore given the choice of treatment now, or just wait and, if I get symptoms in the future start treatment then.  Chances are I could spend my life with latent TB and never actually develop active TB.  However, if the risk changes later in life due to age, having COPD, being immune-suppressed (i.e: having chemo), suddenly becoming an alcoholic or whatever, then I will need to commence treatment.  In case you haven’t already guessed, I chose to wait until I have symptoms. So it will therefore be annual chest x-rays and reporting any symptoms such as night sweats or fevers, productive or persistent cough or blood from my cough or loss of weight  (can only dream about that one).  All seems surreal currently.

Now, as I have only been in the country a month and the test does not show recent contact but only from 3 months ago or prior, then it's seems I contracted this in New Zealand. The country that doesn’t screen for TB routinely, that doesn’t often BCG routinely and that has LOTS of immigrants now residing there. So actually, I feel safer here in the Northern Territory where they take TB seriously verses at home, in New Zealand where we largely ignore the fact that we likely have people with active TB living amongst us. 

The best prevention for TB is not a BCG injection, but rather early detection and treatment. It’s something we don’t do well in New Zealand.  So all you people who have been in contact with me, don’t stress, I’m not contagious..........but are you?  I did after all, get it from someone. 

Go and ask your GP for a mantoux test and watch as he says, "We don't do that routinely" or "You'll need to pay for that as it's not covered in our funding".

It was only a few years ago we had an outbreak in the very City I lived:


http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10651417

In New Zealand we also now have drug resistant TB:

https://www.mja.com.au/journal/2011/194/11/extensively-drug-resistant-tuberculosis-new-zealand-s-first-case-and-challenges

So maybe it's time we woke up and started taking TB seriously in New Zealand too!

NT prisons described as third world

The World Today By Lindy Kerin

April 24, 2012

The Prison Officers Association has described conditions in Northern Territory jails as third world, saying overcrowding has reached crisis point, which is putting enormous pressure on prison staff.

Mr Goldflam says overcrowding is so bad that in some cases prisoners are being housed in police watch-houses to cope with the overflow.

"It's a remedy which has to be used at the moment just to manage the crisis," he said.

"But as a long-term solution, it's completely inadequate and I don't think anybody would suggest otherwise.

Watch-houses aren't built to imprison people, they're just built to hold people who are in police custody during investigations and while people are in the process of having their bail situation sorted out.

The figures fluctuate from day to day, but over the Easter weekend, here in Alice Springs, we had the situation where there were a number of people being held on remand who could not be sent to the jail because there was no room for them.

These are people who haven't been found guilty of anything but can't get bail. And then there was another group of people who are actually serving their short sentences, but serving their entire sentence in the watch-house."

The Territory Government will commit $20 million in next month's budget to help solve some of the problems.

It will include funds for 189 more prison beds and a new, 800-bed prison that is expected to be finished by 2014, but Mr Goldflam says immediate action is needed.

"What we need to do, both in the immediate term and as a long-term strategic approach is find ways of avoiding sending people to prison," he said.

"We've got almost five times the rate of imprisonment in the Territory from the rest of the country, it's completely unsustainable."

For the full news story and audio click here:

http://www.abc.net.au/news/2012-04-23/nt-prisons-described-as-third-world/3967114?section=nt

Rabbit-Proof-Fence

Well, this last week I've actually been quite home sick.  I knew it would happen eventually, though I suspect because the kids and my husband are on school holidays back in New Zealand and I'm over here working played a huge part in it.  But then when my daughter got sick and admitted to hospital after vomiting for 3 days, I had my big cry baby moment and felt so helpless. They kept her is for 24 hours to hydrate her and run a few tests.  My husband stayed in the hospital and the other two kids stayed at their grandmothers house.  Now they think it was just a bad case of gastroenteritis.  Poor wee thing is back home but still not well.  Sucks getting sick in the school holidays. Talk about being ripped off.


Anyway, last night I watched a really good Australian movie (yes they do exist).  I actually watched the whole movie on you tube in parts.  Not the most conventional way, but a friend was talking to me about it and I felt I needed to see it to really understand some of the history behind the issues I'm seeing today.  Most of you have probably seen it as it's been out a few years now.  But it's called Rabbit- Proof- Fence and it's based on a true story about three half caste aboriginal girls who are stolen by the Government (white man) and how they found their way home to their mother.  It is basically the story of the STOLEN GENERATION.  Part of the dark, sad side of Australia's history that was still happening in the early 80's. Where babies and children born of Aboriginal woman with white fathers (often a product of rape) were taken by the Government from their mothers to be raised as 'white' in missionary schools and then passed off as domestic servants (girls) or farm hands and labourers (boys) to the white people..... as slaves.


I won't say too much about the movie but this clip says alot about that history for those who don't already know.

Research finds alcohol policy an 'abject failure'

 on ABC 1 NT News

April 16, 2012 13:23:00

A survey of Darwin's homeless population, the so-called 'long grassers', has found about half drink almost every day and the median weekly quantity for men is nearly 91 drinks. A long-term Northern Territory alcohol reform advocate, Doctor John Boffa, says the research by the Larrakia Nation Aboriginal Corporation shows alcohol policy in the Darwin region has been an 'abject failure'.

Larrakia Nation Aboriginal Corporation's chief executive Ilana Eldridge says the long grassers are almost all Aboriginal people. "They live wherever they can," she said.

"There are large numbers, we estimate around 2,000 people on any given night sleeping rough in Darwin."

The research found many will drink as much as they can lay their hands on.

"People are drinking to get terribly drunk, they become unconscious, they'll sleep it off and then they'll start looking for alcohol again," she said.

Ms Eldridge says previous work by the Larrakia Nation Aboriginal Corporation found four in every five Aboriginal people living on the streets in Darwin showed symptoms of post traumatic stress disorder.

But she says there are not any services to help them deal with traumatic events and she believes people are drinking to self-medicate.

"This Government sees this drinking and this homelessness through the prism of antisocial behaviour rather than seeing if for what it is, which is a deep trauma," she said.

Click here to listen to the News item that featured on tonights ABC News.  It again highlights some of what I have been saying.

http://www.abc.net.au/news/2012-04-16/research-finds-alcohol-policy-an-abject-failure/3952914

I found this below video on you tube also which gives you an idea of how 'long-grassers' live.  Often many don't even have tents. They also don't as a result wash or shower so combined with the heat, they do sadly, smell bad.  If they need to be admitted to hospital the nurse has to try and coach them into showering, for the other patients benefit, as much as their own.

On patrol

I just came home from another busy night where over 40 people were brought in for Protective Custody.  When so many people are brought in you have to ask, are these alcohol restrictions making any difference?

People aren't allowed to drink grog or be drunk in a public place which means for those people who are homeless basically whenever they drink they are committing an offence. Then after they commit three offences they get a ban.  If they then break the ban they get arrested, then they break it again and are this time in breach of bail, and so on, and so forth.  What a crazy dumb arse system that is clearly not working. 

This video was taken in Katherine a couple of years ago but reflects just what it's like being a policeman here.  This is in the day time so you can imagine how bad it can be at night.

Easter Monday Drive

Today I had the day off and decided to go for a wee drive around town and take a few photos so you get the idea as to what Katherine looks like.  I'm no photographer, so be kind!!

On the way into Katherine from Darwin.

Notice the Police Wagon to the right.  They all have a cage on the back so as to let air through. But it does mean people look like animals in a cage when you see a group in there being taken to the cells or Court House.

Katherine Vistor Information Centre - a very busy place now we are coming into the toursit (dry) season.

Just a few of the common birds

Front Entrance of the Hospital

Katherine's Main Road - The Stuart Highway, which runs from Darwin through Alice Springs right to the bottom of Sth Australia

Katherine's BIG mall - lol

Fine Dining :)

The Golden Arches right opposite the Katherine Court House to the right

The main bottle store in Katherine

Spot the bats!

The last four photos are of the newer style of house built around here since 1998, when Cyclone Les came through and flooded Katherine wiping out most of the town. While we have many floods in New Zealand we don't have rivers that are full of crocodiles and snakes.  Erkkkkk!

So these days people are now building their houses higher and often on top of the carport.  It’s uncommon to find someone who has a car garage here as these just become huge ovens in this heat.  Small garden sheds are about all you see.



Happy Easter

Good Friday has been and gone and I have just got in from work. It's 4.30am here in the Northern Territory and there is a beautiful Full Moon out.

Now when we hear 'full moon' as nurses we think BUSY!  Usually speaking for whatever reason (myth or reality) hospital beds would fill up quickly on those nights.  So I went to work at the police cells expecting much the same given the fact it was a public holiday also.

However, the cells had only one person in them all night.  A person who was actually brought in the day before.  So not one person was brought in for protective custody or arrested.  Why???  Well, that is easy to answer.  There was NO alcohol for sale today.  Yes, it's as simple as that!  Amazing!!  There is definitely a case for prohibition!!

As the alcohol restrictions in Katherine mean people can only purchase one bottle of wine a day, (though most people get around that by visiting different outlets, as they don't keep a record) they consume the alcohol when they get it.  And consume it they do.  Bottle stores open at 2pm and the first people are brought in at around 4pm.  In Katherine you don't have to be drunk to be brought in, as just consuming alcohol in a public place is an offence.  Though those people usually get bailed straight away and will often go straight back out drinking only to be brought back again the same night.

Policing in Katherine, as the Senior Sergent explained, is all about assault (generally domestic) and alcohol. Take away the alcohol and there is no real crime, other than petty stealing.  As they don't have the criminal or gang element like in New Zealand, crime is very different.  They break into cars for coins and leave the stereo.  There just are no gangs as such here to on-sell stuff to and as aborigine's don't value possessions they have no need to do burglaries or robberies.

But they do drink!!  For many currently in the Katherine area they have just received their royalties from the gold mines here, in which they get around $1.5m to give out to 600 or so people.  Some people get a lot more and some a lot less. It means they have heaps of money to buy cars, and have a constant stream of alcohol until the money runs out. Then they can't afford the cars and they are left on the side of the road ruined.  Possessions just don't matter to them so it's 'easy come, easy go'.

Anyway, happy Easter everyone!! Off to bed now :)

My Clinic

A few photos of my clinic which I'm very proud of.  I have started working in it now and done two nights.  Both very quiet but I thoroughly enjoyed them!

Largely out of view because of the fax/printer is the medical couch.  The blue bag on the floor is the emergercy bag with oxygen etc.  The red/yellow button on the wall is the duress alarm  If I push that police come running with guns in hand.

Black triangle in the top corner is the camera - always recording.  You can just see to the right of the photo the police watch house desk where someone always sits watching the camera screens and checking on the prisioners. Opposite that (a hard right in the photo) are the cells.

Trolley on wheels is my locked dressing and drug trolley (actually, everything is locked regardless).  Blue curtains are disposable.  Boxes on the floor aren't meant to be there - just awaiting the bins to arrive.