Future Focus: Indira Barrow

Our first FutureFocus 2022 recipient to return from her elective is Indira Barrow, final year medical student at the University of Melbourne. 

Indira experienced life as a rural doctor as she completed her elective at Tennant Creek Hospital (TCH) and spent the majority of her elective in the Emergency Department, where she gained valuable experience in patient care, and also had the opportunity to travel with paramedics to patients in need of medical attention.

Meeting the locals

The BOQ Specialist FutureFocus grant afforded me the opportunity to travel to TCH for my final elective as a Medical Student. This was an experience I was excited to undertake, in preparation for my upcoming role as an intern at Alice Springs Hospital next year. Learning about the local culture, history and relevant clinical presentations were key focus areas for me. I spent most of my time in the Emergency Department, in which five beds and two resus bays cater for a population of 3,000. To put this into context, a metropolitan Emergency Department would usually only have one or two beds for this same population. The high acuity of patient care provided a dynamic learning experience, and gave me ample opportunity to practice many procedural skills that I have developed throughout medical school. Dog bites, fractures, wounds (including acute and diabetic foot ulcers), obstetric emergencies, and missed dialysis procedures were among the presentations in the Emergency Department itself, in addition to more common acute symptoms including nausea and vomiting.

Embracing different cultures

Tennant Creek is located about 500km north of Alice Springs, within the Barkly Region that caters to thirteen language groups.  In the first week, a cultural orientation session exposed me to words within the Warumungu language, as well as the kinship system, bush medicine and traditional practices. I learned about common traditional methods of child rearing, which helped me comprehend the types of people I may encounter at the emergency room. For instance, a child's aunty is also referred to as their mother, but a child's uncle is simply referred to as an uncle, and while the grandmother is typically the primary support person during a birth, the child's uncle is the most responsible person (i.e., boss) in a child's life. A baby should never be put to sleep "tummy-up," and oil cannot be cooked at night when a baby is present in the home. These insights enabled me to better communicate with the locals and engage with them to support unique birth plans and educate families about neonatal health issues like Sudden Infant Death Syndrome (SIDS). This experience contextualised many of the patients I will be seeing next year in Alice Springs.

Eye-opening experiences

TCH lacks an operating theatre, therefore, in order to provide obstetric treatment at the crucial stage of birth, expectant mothers are sent to Alice Springs for “sit-down” at roughly 36 weeks gestation. Given this, I was shocked one morning in my first week, when a young mother delivered her baby overnight at TCH ED, although it seemed the veteran doctors weren’t easily surprised by many situations! One patient I’ll not forget was a 31 year old woman who had been vomiting for two days with abdominal discomfort. She had no change of bowel habit, no sick contacts, no new medications and no known past medical history. Unable to hear bowel sounds on her bloated abdomen, I puzzlingly asked again if she was sure she’d opened her bowels that morning. I dipped her urine to discover she was pregnant, and by then I was worried about an ectopic pregnancy, in which the foetus develops in the uterine tubes and poses a potentially fatal risk of rupture to the mother. The ED registrar and I got the shock of our lives when we saw the foetus on the ultrasound take up the whole screen - she was at least 20 weeks pregnant! It was such a fulfilling experience to be with this woman during the initial consultation, the pregnancy confirmation and the ultrasound.

Another memorable experience from my elective took place during one of my night shifts. I accompanied the paramedics on the way to a pick-up, when we were diverted to an overriding Category 1 - a stroke. When we arrived to the front yard of one of the town camp houses, we met the whole family who were sitting out under the stars. Fortunately for the patient, she had experienced a Transient Ischaemic Attack, meaning her symptoms had largely self-resolved. Whilst the paramedics triaged the patient, taking note of her clinical history, I stayed with the family. The patient’s mother, a Warumungu woman, introduced herself to me as a Traditional Owner. She welcomed me on her country, thanked me and the paramedics for our services to the community and invited me to her traditional home, a “humpy” if I was ever in the area again. I felt honoured to have such a meaningful interaction with this woman, who had every right to be indifferent (or worse) towards me, based on my white skin. This is something I will never forget.

Conclusion

The lack of resources and the requirement to transport patients to larger centres are problems that Tennant Creek and other isolated villages deal with. For my internship year, being exposed to the reasoning behind these choices was instructive. Do you transport patients against their will? For someone with a headache but no neurological symptoms, is a $10,000 travel for a CT scan worthwhile? Who gets the one available seat on the aeroplane when the hospital is out of blood units and two patients are crashing and in need of ventilation? It was encouraging to see the doctors handle such a variety of presentations while using such minimal resources. Clinical history and examination are crucial, but without a CT or MRI, would you ever be able to escape the sense that you're missing something? This elective taught me that, despite how unqualified you might feel, you are the best caregiver for this patient at this precise moment.

Alongside cultural and clinical learning experiences, I found time to socialise with the other staff members and students and explore our country. Pool parties, BBQs, rodeos, town parades, stargazing, sunrises and the Devil’s Marbles are just a handful of the experiences I will always treasure, thanks to the support of the BOQ Specialist FutureFocus grant.

Developed exclusively for medical and dental students, each year the BOQ Specialist FutureFocus grants provide students with the opportunity to undertake an elective so that their commitment to helping others can be realised. Applications for our FutureFocus Grant open in May and close in August. 

You can also access funds to help undertake an overseas placement, with our Student Banking Package.