Serious stuff

After a random picture, I suppose I’d better say a bit about work, hadn’t I?

The RAH is a tired hospital. All except the ED which was new about 4 years ago. And already the department is not big enough. Everything comes through the ED, which means that we see all patients admitted to the hospital. That includes transfers in from other hospitals (I can see the sense in that one, given the quality of a couple of things recently), GP referrals (“Please see and sort out” type thing), walk in patients, ambulance arrivals etc. And when the other hospitals in Adelaide get too full (fairly often), we get their patients too. We never close.

Obviously it is also the middle of winter too (difficult to believe with temperatures of 30.4ºC today – the hottest August day on record). Which means that there is currently a (geniune) ‘flu epidemic as well as the usual excess of patients you get in the winter. And no beds in the hospital (same old, same old).

One of the attractions of coming to Aus to do a year was the lack of the 4-hour targets and the fact that patients stay longer in the department. Which really takes me right back to starting to do Emergency Medicine – trolley waits are genuinely 24 hours for some patients. No matter how much the 4 hour targets have caused problems for some patients and doctors, particularly in some departments, there have been benefits. It’s very strange to come back into work the next day to the same people you left the evening before.

There are a lot more doctors in the department than in my experience in the UK, although a lot of them are on study leave for the exams currently. The shifts are 8 hours with 2 consultants on from 8am to midnight (3 until 4pm). That’s because it is just too busy for one. And it means that there is senior input into nearly all the patients – again very difficult to achieve with staffing in the UK in my experience. There’s a small ward area in the dept with Exactly the same clientele and problems as at home – I did say somethings were incredibly the same.

So where do I fit in – I’m on the consultant rota, so supervising as well as seeing patients / sorting problems. Like any new department it takes a long time to fit in – not just to get used to the staff and the way of working, but also for people to get used to you and I’m sure I’ll still be meeting new nursing staff for months to come. That’s one of the stresses.

And what about the patients? We see huge numbers of people with drug and alcohol / psychiatric problems – far more than Britain because there is no system of getting people evaluated in police stations. I don’t like how keen they are on physical restraint here, although that is being worked on.

Then there are the usual little old ladies, arrogant *****s and general mix. There is a large amount of private medicine here, but again if there is any problem that cannot be dealt with by them, we pick up the pieces. But it does make the attitudes of some people difficult. So does the fact that there seem to be a number of fairly chauvinistic (and racist) men. Or maybe it’s just me. I don’t know.

Maybe you are picking up that I’ve had a couple of difficult shifts. That’s life of course – but it’s always slightly harder when you’re new to a place. But that’s why I came, to get out my comfort zone. And the bosses here are fairly supportive (when there are 15 of them, there are always going to be some who are less so, some more) – it’s not a bad place to work. It just takes time. (as long as it doesn’t take a year like it did in Addenbrookes, I don’t mind).

Boring bit over, Let’s have another nice piccie.

Things to see and do in Adelaide (part 1)

The cactus house

Time to tell you a little bit more about what I’ve seen so far, although I’ve barely been outside the confines of Adelaide.

. To be honest, most of the places of immediate interest are on North Terrace or the road parallel to the south. By immediate interest, I mean the RAH. Plus the botanic gardens which are right next to work – fine, but look at the plants, don’t look up as all you can see are the residential wing (a tower block worthy of Long Henry Row in Sheffield), the heli pad – on a tower block and ... Well you get the idea. On the other side of work is the uni, then the art gallery and the museum. And for those of you interested, the Adelaide oval is behind.

Actually I’m really impressed by the botanic garden. Mainly cos they’ve got ‘erbs. It’s obviously split into areas of different fauna. There’s a mallee (small eucalyptus bush) area – which is the native scrub. South Aus has a very dry, mediterranean climate. The eucalypts are beautiful – silvery grey trunks, and the air at times definitely clears the sinuses. And there are nasturtiums growing wild (instead of poking their heads up and immediately getting eaten as happens in my garden), and geranium hedges.

So the botanic gardens also has a mediterranean garden, with plants from all over the world (South Africa, Chile etc) as well as the obvious. There’s a beautiful walk called the Murdoch walk (no prizes for guessing which international corporation is currently paying for the upkeep) which has 100+ year old fig trees which are huge.

There’s also a big emphasis on Linnaean classification, so part is planted in families (which I think’s really interesting having done a bit of biology at A-Level), and an interest in economic plants. Which are ‘erbs – there’s a museum and a garden which I can walk around thinking “my one of those would be flowering now”. Anyway, it’ll be good during the summer when you guys are drowning in rain again (and I’ll be complaining about the heat) to see what I’ve missed. And I’ve got loads of ideas for my garden back home.

Anyway I cycled to Henley beach last week which is along the river (about 6miles there). Very pleasant in a managed environment sort of way. A much more pleasant ride than the Anzac highway which goes to Glenelg. Starting by the convention centre, the river is dammed to make a small lake, then is really a trickle after that. Like all city rivers it runs through a bit of an industrial area – then you turn the corner and are cycling through a cemy. No warning, no walls, just graves in a completely unexpected sort of way. Then it’s park until the final “wetlands” where the river is a bit wider and there are fields. But I did see pelicans, and a cockatoo (for anyone brought up watching Play School!) And again, the flowers are beautiful.

The beach at Henley is wilder than at Glenelg. There are managed dunes, then the sand which is so white that at first, with a steel-blue sky behind, it looked like snow. I didn’t really explore much as it was getting fairly late, but definitely worth a proper visit.

The only place out of the city I’ve seen so far is Maclaren Vale, which is about 45 minutes south of the city. It’s not far – just that the speed limit is 40mph for so far, and in fact you have to get right out of the city before they let you do 65! Maclaren vale itself is fairly small – it has a visitor’s centre (where one of the wineries has cleverly got itself installed), a sweet factory outlet shop and that’s about it. There’s a “tourist drive” around the hills surrounding, which again takes you round the wineries. Didn’t see any kangaroos, but a koala loped across the road in front of the car (brake!!!). I was intending to drive on and stay a bit longer, but it started raining so there wasn’t much point.

The economic garden (Note to self- look at the size of the silvery-grey wormwood. Think I might have some drastic pruning to do when I get back)

OK this is freaky...

Australians really do have garage sales (“1 asbestos garage, free to a good home...” Unfortunately none that I walked past seemed to be selling the car when I needed it), the skirts on school dresses really are that short, and I’ve been called a Good Neighbour. And I’m not even living in a suburb of Melbourne.

Actually it’s funny how coming from outside you can see how daft things really are. Apparently here, instead of being “Registered Blind”, you are “Legally Blind”. So does that mean that you can be illegally blind too??

And so amny things have different names. Particularly vegetables. What’s “witlof” mean? Answers on a postcard to...

And then bank accounts. I have a Current account, with a Cheque book and a Debit card. So what do I have to tell people that it is to get the EFTPOS transaction to go through. Not a current account (they don’t have those), not a cheque account or a debit card. No, it’s a Credit card. That just does not make sense – and it was a while before I could get any money out of the hole in the wall because they just used to spit my card back.

Anyway, so far I can report that we really do have the cream of Aussie TV back home. Weekday TV is dependant on the Simpsons / Futurama and all the channel 5 American stuff. And the weekends are music vids, films “to be arranged” and the AFL. And er... that’s it.

In the mornings, all channels show news and then Richard and Judy equivalents. Well, when I say “News”, it’s just Local. It’s so parochial that I can find out more about what’s happening in Adelaide on the national news than I can find out whats happening in Peterborough by watching Look East. I’m so hungry for international news, which entirely seems to be served by recordings of news programmes from France, Greece, Russia and the Philippines. My Russian is just not good enough.

Then there are the commercial. Either the ad breaks – and they manage to fit 4 (yes, four) into the half hour that Neighbours is being shown. Or there’s the Infomercials (as opposed to Advertainment) when two talking heads sit round for quarter of an hour discussing exactly why you should go to St Elsewhere’s if you have a heart attack instead of just calling 000 and going to the public hospital because there are it doesn’t have private rooms, and they don’t REALLY care about you. And just how good Standard Commercial property insurance is because you can talk to them on the phone in an emergency.

Well, talking of Neighbours (which I wasn’t), I’ve jumped forward 6 months and, you know what, IT DOESN’T REALLY MATTER. So, no spoilers here, except that they still don’t have any medical advisors on the staff, and that the music has got even worse. Oh, and apparently if you are a private patient, you can pay for your GP to look after you in hospital, so maybe having Karl being the only doc in Erinsborough isn’t so far fetched. (Or maybe it is).

Anyway, time for another piccie.



BTW, I've now found some vaguely intelligent TV. It just entails running backwards and forwards to adjust the aerial every 5 minutes. I thought rabbit's ears aerials were only seen in 1960s American cartoons

These were the piccies sent to me by Julianne back in May.

Saturday 11th Aug

Blimey, been here nearly month. Time for another installment.

General impressions?

Like Ireland really (for those who have been there). Some things are very different, some things incredibly similar. So the first week were spent doing all the tedious tasks like sorting out insurance, health insurance (which is a visa condition, although I’d still rather be in a public hospital as we end up sorting out everything that the private system can’t. Like home, really), broadband and mobile phone.

I’ve got a bike now, and it’s about 10-15 minutes cycle to work. In the daytime it’s across the parklands, including right across the race course and what looks like part of a formula one track (I think it’s used for a rally later in the year). Sadly, considering how flat Adelaide is, there don’t seem to be that many cyclists and I didn’t manage to find a second-hand bike. So I’ve got a mountain bike far better than what I have at home. Even Cash Converters, which seems to be a big thing here, only sells bike that are in the A$1000s range. A bit more upmarket than home.

I also spent a day working the street looking for a car. Incredibly (for a country that won’t let you take home a doggy bag from a restaurant in case you eat it and get food poisoning), SA doesn’t have any MOT on cars. So there are some real wrecks on the road. Then again, the cars don’t rust, so they probably do last longer. It’s also impossible to tell how old a car is by looking at the no. plate. On the whole second hand cars seem v expensive.

Anyway, I picked up a trevved up Mitubishi Lancer which had 25% off for (once the visa bill came through) just over £4000, complete with spoiler and fat-boy exhaust. It’s actually a good time to move to a new country – right in the middle of the winter sales. So I’ve got wheels and I can now explore properly.

Although I did cycle to Glenelg on the day after picking up the bike – about 10 miles down an urban dual carriageway. Anyway, that’s the nearest beach, although the weather wasn’t warm enough to sit still for long. Glenelg has a “heritage tramway” that you can ride for about 300 yards for free. OK, on Sundays there’s one old tram! But it’s quite cute and I imagine that there’s quite a buzz in the summer cos I think it’s pretty popular, and the beach is a decent size.

So the cycling’s good for me. So I keep telling myself.

The weather has warmed up, particularly in the evenings and it’s like April now. Including the rain. I thought I was coming over here to escape that. Or maybe it just always seems to be raining because it does when I’m cycling home from a late shift at 1 am. The flowers are gorgeous already, the blossom is out (which does look strange as some of the trees still have brown leaves on), and the birds are, well, loud.

Anyway, more about what actually I’ve been doing next time.

A nice piccie of the RAH

So what is Adelaide like?

Having spent most of the last week, and probably the next few weeks too, walking around the centre of time looking for a mobile phone, bank account, rent deposit etc, I’m getting to know the main couple of streets. The centre is 1 mile square, surrounded by parklands, with all the streets on a very imaginative grid. The main shops are on one street which is round the corner from the hospital, with a few familiar names (Body Shop, erm, that’s about it actually).

The house is in suburbia-central. Many of the houses seem to be bungalows of a variety of ages. The older buildings are a strange mixture of Wild West Frontier and Victorian Station Building. Particularly the race –course, part of which looks like you could stand and wait for the 20 past 12 Flying Scotsman service, while the other half looks like, well, Doncaster race-course.

Anyway, the house was built in the 70s, kitchen, lounge-diner, 2 bed, utility room, small yard. That’s the estate agent bit out of the way. It’s quite nice, and the really great thing was arriving to find that the Landlady (Jules) had left sheets, bread, milk, loo-roll, soap and, most importantly, tea-bags. Which was really sweet of her. More than my tenants get (which was a torn-off scrap of paper saying “stopcock”, pointing to how to turn the water on).

Actually, the rental agent was quite amused when I saw her on Monday with a list of questions – where are the stopcock, the meters and the boiler. Although to be fair, I wouldn’t have found the boiler as it’s on the wall in the yard. The biggest drawback to the house – the boiler isn’t connected to any radiators. Nor is there double glazing. So while the days aren’t much different temperature-wise to how June was in Britain, the evenings are cold. Very cold. And there’s no loft space in the house so the ceilings are very high. The Aussies are complaining about the cold too, to be fair.

I’d better mention work, I suppose. This week has been spent filling in forms, pretty much. Monday I went in, met Sue who is the secretary / mother hen of the department, and had a quick tour of the dept. I then went into town to buy a ball of string to make sure I can find my way out when I venture into the dept alone.

The day after I had to see the Medical Board. They are in North Adelaide, which is kind of annexe to the city centre. Deoendant on buses, I arrived early so went for a coffee (something they are very big on here). I found a café run by Italian-Australians with a sign-writer scrolling
“Welcome to Café Vagabonde. You are now one of the Family”.
I left before becoming assimilated.

The Medical Board interview was quick, although they didn’t like one of the bits of paper from the GMC. Apparently if I hadn’t opened the envelope it would have been OK, although if I hadn’t opened it, how would I know what it was? She couldn’t answer that one. Anyway, I had to phone them that evening so lets hope it worked. Otherwise I’m not starting work on Monday.

I spent yesterday at the departmental teaching and today chasing the IT department, although I still haven’t managed to get on line properly either at work, or home – where I’m waiting for the phones to be connected so I can sort out broadband.

Today I got shown where the Malaysian and Asian doctors go for lunch – as I said, there has to be an upside to being so close to town. Evenings and weekends, being close to town is definitely not a good thing for an Emergency Dept (ED).

And my challenge for the rest of the week / weekend is to find transport so that I don’t have to get a taxi home at midnight when I finish a late shift.

Sunday 1800 ish. I think

Made it.

After 3, no make that 4, weeks where I’ve been so busy I’ve not had much time to really think about being anxious or excited.

Left Peterborough on Monday after 4 days camping out in a strangely echoing house, desperately trying to resist putting a big sign saying “PLEASE LOOK AFTER THIS HOUSE” on the front door. Oh, and I got the job to come back to. Minor worry that was, the interview.

Anyway. Terrorists threat notwithstanding, there were no problems getting to Heathrow aside from what you’d expect at 6o’clock on a Thursday pm. No queue to speak at in passport control either, and a completely eventless flight. No TV, but that didn’t matter as I slept most of it. Then 4 hours to kill in KL airport, which has a very strange, large fishbowl-affair filled with trees in the middle. And a handy hotel with showers. But very slow internet connection on the free terminals so I really didn’t know if anyone was meeting me. The second flight was notable for a working TV which didn’t improve the selection of films though, even if they were available before Aussie release date. Oh, and ice cream for pud, even if it wasn’t proper chocolateon the Magnum.

Immigration was no problem, guess they really must be desperate for medical staff. I finally got to check emails at Adelaide, no reply so I’d to find my way into town. After coffee, of course.

So I got a taxi to the hospital, booked into the accommodation where I was expected, paid the deposit on the house and booked out of the hospital. Shortest stay ever which was probably a good thing – I’ve been in similar but not quite as bad as that. Not exactly a des res. Heating was like a sauna and there wasn’t no pillow on the bed – which was a complete blindside. And welcome to the Emergency Department – there was a drunk being chucked out at 0830 when I arrived. Still at least they have security staff to chuck people out.

I walked into town which was bizarrely quiet for a Saturday morning. The letting agents will not accept credit cards for rent, so I have to find A$1740 bond and A$ 580 rent. Obviously I’m too asleep to remember that I’ve changed the PIN on the account with the money in so that’s that card resting peacefully in the great ATM in the sky, which leaves me to try and take it off the credit card. 4 attempts and 3 cash machines later I’m laden to the eyebrows with A$50 notes, trying to be polite to the beggars and drunks hanging around the cash machines hopefully. Aaarrgh.

So to the house, which I’ll describe later when I’m a little more awake. Spent an hour yesterday in the shopping centre opposite the house, which really does have everything you could want including a greengrocer. There are some differences I’ve noticed immediately. Food’s definitely not cheap. Actually, nothing is cheap, and it’s quite hard not to look for immediately familiar brands, but to go for local stuff which hasn’t been shipped half-way around the world. And when I asked for paracetamol in the pharmacy I got offered 100. Do I look that bad?