Tropical gardening

It's interesting growing a garden in Tennant Creek. We gave the wet and dry seasons as we are 500km north of the Tropic of Capricorn. During the dry season, plants need regular watering but the temperature is not high, so it's manageable. In the much hotter wet season, it is fortunately also wetter, so use of tap water is minimal. Plants grow like crazy though, what with the perfect combination of warmth and water. Hence our front yard looks lush and green at this time of year. Unfortunately we have very little soil in our yard, so growing food plants is difficult. Because of aggressive termites, we can't use the usual timber planks to make raised garden beds like we did in Oodnadatta. We are currently saving to buy a few Eco posts made of recycled paper, as they are termite proof. They cost about $90 each, do it will be a while yet!!

Report on CRANAplus Conference 2011

Well, I guess it's about time that I posted something about the 2011 conference in Perth.  It was held on October 11-14 and I think it was the best one yet.  As CRANAplus has grown, the conference organising has more and more become a staff responsibility, with a subsequent improvement in the quality and feel of the conference.  The next step may be to use a conference organiser, but we'll see how things go with the current setup.

The conference kicked off on the Tuesday evening with a cocktail event, a combination of opening ceremony and presentation of the inaugural Fellows of CRANAplus, as well as the annual presentation of graduates from relevant postgraduate courses in remote health.  I was privileged to become a CRANAplus Fellow, as well as being recognised for my recently acquired Master of Remote Health Practice - Nurse Practitioner qualification.  So it was two walks to the podium for me!

On Wednesday morning, the conference proper got under way with a keynote address from Professor Colleen Hayward and a smorgamsbord of interersting and informative talks from presenters around Australia.  This continued until lunch time on the Friday, with some very special treats on the way.  A presenter from the Solomon Islands shared some of his work in the Solomon Islands Red Cross, and a group of Rural Health Club students amazed us with their passion for remote health.  The catering along the way was superb, and facilitated many opportunities to chat with colleagues.  One of the highlights of the CRANAplus conferences is the chance to catch us with old friends, and make new ones.  This time was no exception, as I saw people who I hadn't caught up with since last year's conference, and added a lot of new people to my list of contacts.

My own presentation entitled "Dealing with uncertainty in remote and isolated practice" was on Friday morning, and was well received. I have been asked by a number of people if they could use it in presentations of their own, and also if I could present it in other settings in the NT.  No worries, I'm happy to share what I've learned, and if it helps others, so much the better!

Next year, the 30th CRANAplus Conference will be held in Cairns, and I can hardly wait. 

The Nanny State

I used to think government handouts were a good idea.  After all, we pay taxes so the government can do the job of running the country, and it's nice to get some money back.  When I was a farmer in the late 1980s, it was useful to get subsidies to help with drought, bushfires and other natural disasters.  Subsidies help people recover from difficult situations, or to cope with changes in their lives.

So why do I now believe that government handouts are generally a bad thing?  Let's apply a common household situation.  Say the dishes need washing, or the bedroom tidying.  The children are reluctant to do the jobs, and put off complying with parental requests, or their own consciences.  Eventually, a parent does the dishes or tidies the bedroom.  The child learns that he or she does not have to expend the effort to do these tasks as long as they can rely on someone else to do them.  It is the same with government handouts.  Why put aside money to cope with a drought year or two, or plan for dealing with a bushfire, when you can simply expect the government to pay you when things go wrong.  Or why bother trying to find work when Centrelink will pay you not to work?  As long as you are satisfied with the standard of living provided by welfare, why allow yourself to be tied to the routine and discipline of a paying job?  Sure there is a requirement to actively seek work, but in reality if you live in a remote community, you are exempt from the 'looking for work' test, even if there are jobs going begging.

My personal experience of this was in a remote community where for years I tried to hire people to help my wife with the housework.  As her MS progressed, it became more and more difficult for her to cope, and I was far too busy at work to spend much time on housework.  Despite very high levels of unemployment in the community, during a four-year period we hired a local to help us for exactly zero days.  And it wasn't due to lack of trying!  It seemed that it was a source of 'shame' to clean someone's house, yet there was nothing shameful about sitting back and claiming unemployment benefits while a disabled woman struggled for lack of help.

Anyway let's get back on track before I get completely lost.

My current thinking is that government subsidies stifle individual and corporate responsibility.  A farmer who can rely on a handout in drought years is relieved of the responsibiltiy to plan for drought years despite the fact that they are an inevitable part of farming life in many parts of Australia.  A company which relies on government tariffs on cheaper, better imports is relieved of the burden of making competitive products, and hence has less incentive to invest in quality - look at Australian-built cars for example, nearly as bad as American-built cars, and for the same reason.  A mother who can rely on the welfare system, and the generosity of strangers, to feed her children has little incentive to divert resources away from feeding her own smoking, drinking, or obesity.

I do believe that government has a role to play in providing a safety net, but I think the balance has swung so far in that direction that it's now more than a safety net, it's a lifestyle.  If people can live on welfare, then welfare is too generous.  Everyone has a right to adequate food, water and shelter.  Beyond that, everything else must be earned.  Companies don't have the right to any support, as they are supposed to risk-manage their business rather than expect governments to bail them out when they screw up.

One final example that shows how subsidies don't work:

In 2006, the Australian Government introduced a $2000 rebate for conversions of petrol or diesel vehicles to run on cleaner-burning LPG.  Immediately prior to the rebate, a basic conversion for a Falcon station wagon cost around $1600 to $1800.  By mid-2007, a basic conversion for the same vehicle cost around $3500.  This was despite a huge increase in the number of conversions occuring and the number on installers competing for market share.  Therefore, the actual cost to the consumer reduced from an average $1700 to an average $1500, while the rest of the subsidy ($1800) became profit for the installers.  As the amount of the rebate has fallen over the subsequent years (to currently $1250) the average cost of an installation has also fallen so that the actual cost to the consumer is still at around $1700.  It seems that the market value of an LPG conversion is $1700, and all that subsidies achieve is to inflate the price so the consumer still pays the market price.

CRANAplus Conference 2011

This year, the CRANAplus annual conference will be held in Perth.  I submitted a paper "Dealing with uncertainty in clinical practice" which was held in reserve as the organizing committee had more papers than they needed.  This was a good thing, as it wasn't too long ago that CRANAplus struggled to get enough papers to fill the slots at the conference.  I have written and presented papers at the past four conferences, so it was with some relief that I found I could have a rest this year.  Or that was the plan.

Last week I was emailed a request to consider presenting after all.  It seems another speaker had pulled out.  It didn't take more than a few seconds to decide that I felt strongly enough about my topic to go ahead, so it's back on track.  Watch this space, as I jot down some thoughts about the topic, to add to what I've already posted.

Hiking on Fraser Island - Day 5

Day 5

Our last day on the island dawned clear and cool.  We got up early as this was to be the longest walk of the hike, about 24km with our packs.  The planned route took us from Central Station to Basin Lake, then Lake MacKenzie, then along an old tramway to the remains of MacKenzie's Jetty.  From there we could choose whether to walk along the beach or along the forest trail to Kingfisher Bay.  Our booking was for 5:00pm on the ferry, so we had a deadline to meet.

Breakfast consisted of the last of our oatmeal sachets and condensed milk tube, washed down with hot Milo.  By this time, we were getting low on food, but there was enough to allow us morning tea and lunch.  Afternoon tea would have to wait until we got to Kingfisher Bay, so there was an added incentive to keep going.  If we arrived early enough, we could have a proper afternoon tea at the resort!  The tents and sleeping bags were rolled up for the last time this trip, the water bottles topped up and sterilised, and we were on our way just before 7:30am.

The first part of the walk took us via Wanggoolba Creek, a crystal clear creek that flows past the Central Station campground.  There were various relics of the timber logging days, such as a derelict loading ramp, a glass-topped petrol bowser, an an old engine block.  From Wanggoolba Creek, we ascended a long ridge until we arrived at a breathtaking scene - Basin Lake in the morning sun without a ripple on its surface.  There was no-one else there, so it was peaceful.  We could easily have spent an hour soaking in the beauty of the place, but the remaining 21km of our hike and the ferry deadline spurred us on.

Basin Lake

Lake MacKenzie was only a short walk from Basin Lake, about 35 minutes. This was where we began to see other people by the busload.  Lake MacKenzie has pure white sand and clear blue water, and amazingly looks exactly like on the postcards of Fraser Island.  In fact, I'd say it looks even more beautiful in reality than it does on a postcard or in a photo.  We had planned to spend some time there, but the water proved to be more chilly than expected.  A photo taken by a helpful tourist was enough, before we gladly exited the water and donned our boots again to continue the hike.  After morning tea of course!  It is important to get the priorities right.  Morning tea consisted of our last packets of 2-minute noodles, and some left-over muesli bars.

Laura, Claire & John at Lake MacKenzie

Our hiking map showed that the trail followed around the western and northern shores of Lake MacKenzie, before heading due east for a couple of kilometres.  Only when it met up with the trail to Lake Wabby did it veer back towards the west and MacKenzie's Jetty.  On the other hand, a vehicle track cut due north from Lake MacKenzie, only requiring a 500m detour to the south-east to connect with it.  This track ended up joining with the walking trail we wanted to be on, and saved over 3km of walking.  All we had to do was miss seeing the sign that said "No Pedestrian Traffic" and we were on our way.  At one point we had to scramble off the track as a huge 4WD tour coach took up the whole track, but otherwise we had it to ourselves.

Taking a short-cut via a vehicle track near Lake MacKenzie

The longest section of the day's walk was from where the vehicle track rejoined the walking trail to MacKenzie's Jetty.  It was hotter than previous days too, as the vegetation was shorter and we had more direct sunlight on us.  However, the packs were lighter, we were fitter, and we had become accustomed to walking, so it was a pleasant hike.  Also, the gradient of the trail was gentle as it followed old tramways used in the old days for logging.  This all added up to us making better time than expected, so that we arrived at MacKenzie's Jetty soon after midday.

MacKenzie's Jetty

 At this point, we had a choice about which way to go.  The beach route was shorter, but involved walking through sand, while the longer forest trail was firmly packed but quite a bit longer.  After testing a bit of the beach walk and finding the sand firm near the water's edge, we chose the beach route and set off on the last leg of the hike.  The sand was soft and hard to walk on in only a few places, so it was a good choice.  When we were in sight of the jetty at Kingfisher Bay, we has a ceremony to say farewell to our hiking sticks which had helped us with 5 days of hiking. 

Trekking the final leg to the ferry at Kingfisher Bay

Hiking of Fraser Island - Day 4

Day 4

Day 4 of the 5-day hike dawned fine and clear at Lake Wabby Walkers' Camp.  After breakfast of hot oatmeal porridge, we packed up the camp and stashed the packs in a dingo-proof steel box.  Then it was a short, easy backtrack to the Lake Wabby lookout to view the battle between the lake and the sandblow.

Lake Wabby from the lookout

Only time will tell whether the lake or the sand dune will win in the end.  Perhaps the sand will fill the lake, or perhaps the forest will cover the dune and stabilise it before that happens.  In the meantime, we get to enjoy the interaction between sand, water and forest.  From the lookout it was a further 1km walk to get to the lake, but we decided not to do the extra this time.  We had already been to the lake during our previous trip in 2008, and there were still a lot of kilometres to walk before camp.

From Lake Wabby Walkers' Camp, we followed an old logging road through valleys of huge trees and over ridges towards Pile Valley.  Pile Valley was so named as it was the site of logging for many of the tall straight timber piles used to repair the docks in London after the First World War.  Walking through this area now almost a century after logging ceased, it is breathtaking to see the towering trees.  We can only imagine what it looked like before logging, with fully grown trees several centuries old!

Trees in Pile Valley

We arrived at Central Station Hikers' Camp well before sunset.  This was partly because most of the day's walk had been on old logging roads and tramways, so the gradients were gentle.  The other reason was that we were becoming acclimatised to carrying the packs.  There were times during the day 4 hike that I forgot I had my pack on.  Laura and Claire made the same observation, so we thought we were finally getting used to carrying the weight, and packing the gear so that the packs were well balanced.

At Central Station, we were finally able to have hot showers.  The only problem was that we had not packed any $1 coins, and they were required to get hot water.  Cold showers were not very appealing, but some campers in the main campground were able to change a $5 note for us.  There is something very satisfying about soaking away 4 days of sweat and dirt, and we made the most of the hot water.  While I was in the shower, I noticed blood running down the shower drain.  On investigation, I found a very round, obviously well-fed leech crawling away across the floor.  A trickle of blood flowed from my ankle where it was obvious the critter had been feasting for some time before the hot shower made it time to abandon dinner.  I was amazed that I had not felt a thing, and even when I found the bleeding bite, I still felt no discomfort.  Whatever the anaesthetic in the leech's saliva, it's pretty good stuff!

Our final dinner on the island was similar the the three previous ones.  Rice flavoured with bacon stock cubes and dehydrated soup mix might not sound exciting, but when you have to carry all your food for 5 days you get to enjoy simple tastes that don't weigh much.  Having to carry a gas stove added some extra weight, but I was very impressed with the gas canisters.  I'd packed 2 as I was worried we would run out of gas, but as it turned out, we only used one, and even that had some left after 5 days.  All cooking was done in a stainless steel billy - this weighed a bit more than an aluminium one, but it was far more robust.  Each of us carried our own bowl, lightweight cutlery set, and mug, and this was all we needed for eating.  

Day 5 was to be the longest walk of the trip, so we turned in early at Central Station.  No fires allowed, so nothing to keep us up after the sun set anyway.

Hiking on Fraser Island - Day 3

Day 3.

We awoke early on day 3 because it was time to get ourselves organised enough to set up camp in daylight.  This meant we needed to break camp in the morning, have breakfast, and set off by 0800. The motivator was an ooportunity to detour 6.5km from our trail to see the largest tree on Fraser Island, a giant satinay tree.  An extra 13km hiking might not sound like a great idea, but it was without our packs.  The detour took us 45 minutes out and 50 minutes back, and without the weight of our backpacks, it felt like we were floating down the trail!  The giant satinay was not as big around as the giant tallow-wood, but it was taller - a majestic specimen.

Giant satinay tree in the Valley of the Giants

From the giant satinay, we retraced our steps back to the Great Walk and donned the packs again.  Then it was off towards Lake Wabby.  Each day, we stopped three times during the hike.  Morning tea was after the first 2 hours, at which we ate some muesli bars or dried fruit.  Lunch was taken at the halfway point of the day's hike, so usually occurred about 1230 or 1300.  We tried to vary lunch a bit, and on day 3 we had mountain bread rollups filled with salmon and mild sweet chilli.  Fresh fruit and vegetables were non-starters due to the weight and lack of refrigeration, but this was OK for a week.  Afternoon tea was a welcome halt about 2 hours before we expected to arrive at camp, and consisted of boiled sweets.  By this time of the day, we needed the energy boost of a sugar hit, backed up by a trail bar or muesli bar where possible.

Gourmet lunch on the trail

One highlight of the day 3 hike was a short detour to see the Bidjana Sandblow.  This was a desolate windswept sand dune which was advancing gradually into the rainforest, blowing from east to west under the influence of prevailing winds.  It looks destructive, as the sand kills the forest, but it is the mechanism by which the island grows.  A mountain of sand builds up and up as it advances across the island until eventually the forest reclaims the bare ground behind it.  This reduces the effects of the wind and the sand mountain gradually comes to a halt and is finally completely covered with vegetation.  Bidjana Sandblow was only a small example of the phenomenon, but being able to walk up to the leading edge of the dune then climb it, we were able to really appreciate the forces of nature involved.

Bidjana Sandblow advancing into the rainforest

Whle Laura and I were exploring the Bidjana Sandblow, Claire rested with the packs at the turnoff from the Great Walk.  During the rest, she discovered a number of leeches on her legs.  The bites were painless and bled freely due to the leeches' saliva.  Leech spit contains chemicals that act as an anaesthetic and an anticoagulant.  The anaesthetic means that the host is less likely to dislodge the leech than if the bite was painful or annoying like a sandfly or mosquito.  The anticoagulant means that the host's blood clotting is interrupted allowing the leech to drain its fill of blood before the puncture wound stops bleeding.  I only had one leech bite during the 5 days, but I didn't notice it until I was in the shower at the end of day 4.  The leech was fat and round having feasted on my blood for quite some time, perhaps up to 4 hours!  We didn't get any pictures of them attached to us as the moment we found one, there was a powerful instinct to remove it immediately.  It was only afterwards that we thought it would have been interesting to get a photo.  It seems we have evolved to resist having our blood removed and this took precedence over taking photos.

Claire modelling several leech bites

 Our campsite on day 3 was at the Lake Wabby Walkers' Camp.  Finally we had managed to reach camp in daylight, and it was a luxury to set up camp and cook dinner without having to hold a torch. Once again we had the campsite to ourselves.  In fact we had yet to see any other walkers on the trail.  Apart from a few vehicles seen at checkpoints where the walking trial met vehicle tracks, we had not seen anyone for 3 days.  So much for the crowded Great Walk on Fraser Island.  Given that I did not have a sleeping mat, and hence was not particularly comfortable, my snoring would have cleared out the campsite anyway.

Hiking on Fraser Island - Day 2

Day 2.  We awoke at 0700 to find our campsite wet with rain.  It must have been a good sleep, because I never noticed the rain on my hiking tent overnight!  Everything except the tent flies kept dry.  The food was locked in a steel box to keep it away from dingoes and goannas, and we had our packs under our tent flies.

Breakfast was hot oatmeal porridge made from sachets of flavoured oatmeal.  There was water at the campsite, but it was untreated so we used our UV water sanitiser to make it safe to drink.  Previously I have used various purification tablets, and they all have one thing in common - they make the water taste revolting!!  The UV treatment only takes 90 seconds per litre and does not affect the taste of the water at all.  No nauseating chlorine or iodine taste, and no chemical smell.  The UV water sanitiser proved to be one of the best bits of hiking equipment we had.  Having it meant I was able to go without filling my 4L water bladder, which saved 4kg of weight in my pack.

After breakfast, we hit the trail to hike to the Valley of the Giants Walkers' Camp.  Walking along ridges was fine, as was going downhill, but climbing upwards really gave the leg muscles a workout!  We were glad we had left a lot of spare things in the locker at the Roma Street railway station in Brisbane, as every extra kilogram in the packs felt like 10kg after a few hours. 

Flooded walking trail between Lake Garawongera and the Valley of the Giants

An hour or so from Lake Garawongera we came to a swamp, which was flooding the trail.  It seems that the big floods in Queensland had also seen the lakes and swamps of Fraser Island filled up to record levels.  We had to detour around this, or at least we chose to detour rather than wade through the water.  I led the way through thick scrub and got both legs badly scratched for my trouble.  Note to self:  Always wear long hiking pants rather than shorts!  After about half an hour of scrub-bashing, we emerged on the other side of the swamp and back onto the trail.  This section is probably why the Lake Garawongera to Valley of the Giants section was supposed to be closed, as there was no clear detour around the flooding.

As we climbed higher into the interior of the island, the trees became bigger and the rainforest more and more spectacular.  Some of the trail was situated on an old tramway, which had the advantage of being a gentle gradient and hence easy walking.  We were able to relax into the hike and really enjoy the sounds and sights around us.  One highlight was a dingo that followed us for several hours.  We stopped for morning tea at one point and the dingo came within 10 metres of us, obviously looking for food.  Previous visitors have apparently been encouraging the dingos with food so they can get good photos, but this can backfire as it makes the dingoes lose their fear of humans.  Then they can become dangerous.  We got some great photos of this animal without doing anything to attract it, by using the telephoto zoom lens on Laura's camera.

Dingo following us on the trail

Lunch was at Petrie's Camp which was a loggers' camp in the early 1900's when the area was an important source of timber.  Nearly 100 years after logging it was hard to imagine that this thick lush forest was once cut down, except for one thing - none of the trees were really big.  The tallow-woods and satinays take up to 1000 years to reach their full size, so all the trees in this area were still junior.  Not all of the big trees were logged though.  One magnificent specimen in particular remained standing near the end of the day's hike - before it was hit by lightning and lost the top section, it was the largest tree on the island, estimated to be over 1000 years old.  It was getting dark by the time we reached this tree, but we managed some pictures and video of it.  A photo of Claire hugging the massive trunk shows the scale.

Claire giving the Giant Tallow-wood a hug

We camped the night at the Valley of the Giants Walkers' Camp, surrounded by huge trees.  Once again we set up camp in the dark, because we started off in the morning too late.  Dinner was rice, again, but this time flavoured with chicken soup mix.  Rice is a great food for hiking because it is easy to carry and cook, and a small amount is very filling.  On other occasions I have existed for days on plain rice, but this trip was the height of luxury with flavours to make the rice more palatable.  Cooking was done on a gas cooker powered by disposable gas canisters.  Fires were not permitted on Fraser Island, so we had to take gas or liquid fuel for cooking.  We chose the gas canister stove because it was light and compact, and used the same canisters at the $20 gas stoves that you get from the hardware shop.  These canisters are available practically everywhere, and each one is good for several days.

Hiking on Fraser Island - Day 1

In early July 2011, I spent 5 days hiking on Fraser Island accompanied by two of my three daughters.  Laura (15) and Claire (11) donned their backpacks and camping gear for our first major hiking trip together. In April, we hiked two sections of the Larapinta Trail near Alice Springs as a warm-up, but this was our first big hike.  Getting to Fraser Island proved a bit of an adventure in itself - see my blog 'Transport troubles on holiday' for details.  However, once we arrived it was worth the effort, and then some!

Day 1.  We arrived on the island at 0945 on the Kingfisher Bay barge, to be picked up by the Fraser Island Taxi as arranged.  The taxi took us across the island to Eli Creek, which we has selected as our starting point.  The plan was to spend the 5 days hiking back to Kingfisher Bay to catch the barge back to Hervey Bay.  On the way in the taxi, we heard a rumour that the northern section of our planned route was closed to walkers due to flooding.  As it turned out, the track was flooded in places, but there were no signs advising closure of the walking trail, so we went ahead.  Anyway, I'm getting ahead of myself a little.

Eli Creek

Hiking along the beach towards Happy Valley

The northern end of the Fraser Island Great Walk is at Happy Valley village, and our starting point was 6km up the beach at Eli Creek.  This is a beautiful crystal clear freshwater creek flowing out of the sand dunes and across the beach.  Claire had a short swim and said the water was fine, but I thought it a bit chilly so settled for wading in for some photos.  We then loaded up and walked along the beach to Happy Valley to start the Great Walk.  Just on dark, we arrived at Lake Garawongera, but due to flooding we had difficulty finding the walkers' camp.  Not that it was actually hard to find, but the signs were oriented to the trail that was in the lake, and we deviated around the flooded section so missed the turn-off.  After 2 hours with torches heading up the wrong track, we finally found the campsite and set up for the night.  Dinner was rice flavoured with peas, vegetable soup mix, and bacon stock cubes.  After our troubles getting to the island, and then 8 hours of hiking, we were soon out to it in our sleeping bags.  Unfortunately I managed to leave my hiking mat at home, but I found that scooping a small hollow in the sand for my hip enabled me to get comfortable.

Campsite at Lake Garawongera Walkers' Camp

Harts Range Races

Over the long weekend at the end of July, the Harts Range Amateur Race Club hold their annual race day at their race course near Harts Range on the Plenty Highway.  It is a family weekend, with events and entertainment for children and adults.  Catering is a mix of BYO and a canteen kitchen usually operated by volunteers from the Ioslated Childrens Parents Association (ICPA). 

For the past 3 years, I have been catering coordinator for ICPA for the Harts Range weekend.  This involves organising the required permit to operate the kitchen and sell food, ordering all the necessary supplies, arranging a roster of people to do the cooking and serving on the weekend, and then overseeing the operation of the kitchen.  The first year was very stressful, as I had no idea what I was doing and no idea what I needed to know.  This third year was much better, despite the usual crop of setbacks.  Most of the orders arrived without a hitch, except we received 20 loaves of bread instead of the 20 cartons of bread I ordered (that was 240 loaves!!)  Fortunately we were able to contact a latecomer who could collect the other 220 loaves from Alice Springs for us.  Everything else arrived as ordered.

The weather was quite warm.  It was not so hot as to be uncomfortable in the open, but certainly warm enough to prompt people to want lots of cold drinks.  For the first time that I have been involved, we sold all of the drinks we had available, which was both good and bad.  Good because we had no leftovers to dispose of, and bad because we could have sold more if we had them!  Ice blocks and bags of ice we also quick sellers, and we ran out of them too.

Staffing the kitchen is always a problem.  This year was better in that a team of volunteers took the morning shifts out of my hands and ran the kitchen from opening at 8am until 1pm.  Then I took over, assisted by two of my girls and another volunteer, until 8pm.  The occasional hour or three from other volunteers allowed us to take short breaks , but it was still a long day in the heat of the kitchen.

Once again I was unable to see much of the activity on the racetrack and in the rodeo arena.  When the events were on, I was in the kitchen, and after the kitchen closed the girls and I collapsed on our swags until morning.  Maybe one year I'll go for the fun of it!!  The best thing about this year's effort is that we were able to raise a lot of money for ICPA, so they can continue to advocate for bush kids to get quality education and appropriate support to make the most of the educational opportunities that come their way.

Maybe we will tackle the coordinating role again next year.  Time will tell, as it depends on whether we are still in the NT this time next year.  It's been a good experience, but don't ask me too much about what goes on at the Harts Range Races.  I can only tell you about the kitchen, for everything else you'll have to talk to someone who actually gets to see the races!!

Transport troubles on holiday

During our recent school holidays, I took two of my daughters on a hiking holiday to Fraser Island.  When we were there in 2008 with the 4WD and camper trailer, we said we should return to do the Great Walk.  Then we could see the sights we missed that were inaccessible to vehicles.  The trip was planned 6 months in advance, and in February I booked and paid for all the transport that would be required.

The plan was to drive from Tennant Creek to Adelaide, do some work on the car, then start the Fraser Island trip.  Flights were arranged between Adelaide and Brisbane, using Virgin Blue due to the cheap price.  This would connect with the Tilt Train from Brisbane to Maryborough West, and a coach to Hervey Bay.  A good night's rest at the Palms Tourist Park would have us ready bright and early to catch the Fast Cat ferry to Fraser Island, and the Frasert Island Taxi from our landing at Kingfisher Bay to the start of our hike at Eli Creek on the eastern coast of the island.  Permits, fares, tickets and bookings were double checked and carefully recorded - for once I was not relying on luck to make everything come together.

On June 31st, we awoke at 4am  (after 3 hours sleep) and a friend drove us to Adelaide Airport to catch the 6am flight to Brisbane.  That was when the plan unravelled.  Our flight had been cancelled during the evening, yet we were not informed despite having given several forms of contact details to the airline.  No reason was given for the cancellation.  We had to change to a later flight, leaving at 8:50am, which meant we would miss our train from Brisbane.

Due to the lack of sleep, I wasn't functioning too well, but somehow thought to ring Queensland Rail at 8am EST and change our tickets.  I also rang the caravan park to advise that we would be arriving late, but only got a grumpy caretaker who wasn't in the office and who couldn't help me.  I needed to ring back later, which would have to be while we were in Brisbane.  We arrived in Brisbane about 20 minutes after our original train had departed and had to then wait 2 1/2 hours for the next train.  Despite our exhaustion, we had to work out what hiking supplies to buy as we would now be arriving in Hervey Bay too late to go shopping as originally planned.  Using our iPhones, we navigated our way to a Woolworths store and stocked up on the food we would need, and obtained some first aid supplies from a pharmacy.  So far so good.

We found the platform for our train, locked our spare clothes and excess baggage in a locker for 6 days, and settled into our seats for the trip up to Hervey Bay.  About half an hour out of Brisbane, I finally remembered to ring the caravan park about our late arrival, only to be told abruptly that there was no late check-in and if we weren't there by 6pm we were out of luck!  Since our coach was arriving in Hervey Bay at 10pm, it seemed rather unlikely that we would make it.  To add to the stress, my phone was almost flat by this time so I put it in flight mode to conserve battery while we were out of range of mobile coverage.  Unfortunately, this meant that I missed the return call from the caravan park office to suggest a solution to our dilemma.

We arrived in Hervey Bay just after 10pm and the coach delivered us to the front entrance of the Palms Tourist Park.  All was quiet.  No response to the door bell.  No answer on the mobile number. Great!  $100 down the drain, paid for a room we could not use.  The next hour was spent trudging around Hervey Bay looking for accommodation with late check-in, without success.  Finally, a concerned local Googled on his iPhone for hotels in the area with 24-hour check-in.  There was one, called Peppers Resort, about a half-hour walk from our location.  Just after midnight, we finally checked in to our room which cost us an extra $220, to get a few hours sleep.  We needed to be at Urangan Boat Harbour at 6:30am to catch the Fast Cat to Fraser Island.

Next morning, still very tired, we loaded up our backpacks and hiked to Urangan Boat Harbour.  There we found that the Fast Cat service had stopped operating two years previously.  Hmmmm, how come I purchased tickets online in February 2011??  It seems that the company still had a ferry leaving at 6:45am, but not from Urangan Boat Harbour, but from River Heads about 30 minutes down the coast.  That's 30 minutes driving.  Our tickets clearly said Urangan Boat Harbour, but we were supposed to know to go to River Heads without having to be told.  One positive result of the stuff-up was that while waiting for the bus to take us to River Heads, we had time for a proper breakfast in a very nice cafe on the harbour.  A quick call to the Fraser Island Taxi enabled us to change our booking to suit our later arrival, so it seemed we were finally getting back on track.

Finally we boarded the Kingfisher Bay ferry for the trip to Fraser Island, and our tiredness began to be replaced by excitement.  As the island came into view, we were eager to start the hike we had planned for so long.  During the hour and a half 4WD taxi ride from Kingfisher Bay to Eli Creek, we chatted with the driver, who told us that the Great Walk was closed at the northern section due to flooding.  Just marvellous!!  We had travelled thousands of kilometres and endured a string of stuff-ups due to Virgin Blue's abysmal customer service for the express purpose of doing the Great Walk.  No way, this is not happening!!  We had permits for the walk, and no-one had bothered to contact us about the closure, so we were doing it anyway.

As it turned out, no closure signs were in place, so we did the walk.  Yes the trail was flooded in places, but that added to the challenge and interest.  We were delighted with the 5 days we spent on Fraser Island, and walked a total of 98km with our backpacks.  Thanks to Virgin Blue, who we will never fly with again, it started off much more stressful and more expensive than it should have, but even so, it was worth it all.  Would we go again?  Definitely!!  Maybe better planning next time, with a backup plan in case things go wrong.  But this was our first hiking trip, so we learned from it.

Now where shall we go next? ...

Dealing with uncertainty

I have recently become interested in the concept of uncertainty, particularly as it relates to remote clinical practice.  Uncertainty is a normal part of human existence, and very often it is an uncomfortable part.  People tend to try to minimise uncertainty, to reduce the discomfort it causes.  This occurs in a number of ways, and these have consequences for the safety and quality of clinical practice.

• Avoidance is a common technique.  It involves manipulating the environment to eliminate or at least reduce the amount of uncertainty.  For example, a nurse who lacks confidence in dealing with children will avoid working in paediatrics, as this reduces the uncertainty he or she feels in this setting.  In a remote setting, this nurse may have no choice but to deal with children, and attempts to avoid doing so will have consequences for the health care team.
• Denial is also common.  Uncertainty can be denied by simply ignoring the fact that it exists, and seeing all issues as black and white.  For example, if a patient is labelled as a drunk, there is no uncertainty about inconvenient differential diagnoses such as subarachnoid haemorrhage or hypoglycaemia.  The consequences for denial are obvious, and mostly stem from corrupting the evidence base for quality clinical practice.  If you ignore relevant alternatives, you do reduce uncertainty, but also increase the risk of being wrong.  Being wrong in clinical practice is typically detrimental to patients.
• Logic can be used to try to reduce uncertainty.  Evidence is collected and weighed, and used to make a decision about a course of action.  The more comprehensive this process, the more valid the outcomes.  However, it requires time and effort, both of which can be in short supply at times.  There will always be another possibility that 'should have been considered', and the weighing of evidence is itself fraught with bias and uncertainty.  Logic and reasoning are valuable tools, and should certainly be used, but they do not eliminate uncertainty.  I'm not sure they even reduce it!
• Dogma is another all-too-common approach to uncertainty.  For millenia, humans have sought explanations for things they do not understand, and religion has evolved to meet this need.  By attributing the unknown, and often also the known, to an omnipotent omnipresent diety, uncertainty is eliminated by stating that it is 'God's will' or the 'will of Allah' or whatever.  Uncertainty then becomes evidence of a lack of faith, so the 'faithful' strenuously pretend to be certain of what they claim to believe.  Unfortunately, this does nothing to actually reduce uncertainty, and in fact makes it worse by pushing it underground.  In clinical practice, dogma is detrimental to safety and quality, as it absolves practitioners from responsibility for decisions - after all everything is 'in God's hands'.
• Probably the least common approach to dealing with uncertainty is acceptance.  By accepting that uncertainty is normal and expected, practitioners can allow for the fact that they will make mistakes sometimes.  Reducing mistakes is part of professional development, but it is unreasonable to expect that they can be eliminated.  

I think the reality for most practitioners is that they use a bit of everything.  A dash of avoidance, a hint of denial, a cup of logic, a pinch of religion, and top up with acceptance.  The important thing is to be reflective and know what your coping mechanisms are.  This allows the practitioner to assess whether their approach contributes to or detracts from safety and quality.

Thinking by proxy

At my workplace we have recently implemented the Modified Early Warning Score (MEWS) to assist clinicians to decide if their patients are unwell or not.  On the surface of it, you would think this is a great idea, especially as it empowers junior staff to call senior staff to review patients they are concerned about.  Given my interest in the role or rational thinking in healthcare, my view is less positive.

I have no problem with the MEWS being used as a tool to quantify your concern about a patient, even though there are times when you are concerned despite the observations appearing OK (and hence the MEWS is OK).  What I have serious doubts about is staff using MEWS to decide whether they should be concerned!!  If you need a score on a sheet of paper to decide if your patient is unwell, you probably should find another line of work.

Using the MEWS in the Emergency Department makes no sense.  It merely adds another task to the list, with little likelihood of impacting on patient outcomes.  This is especially true when there are no policies in place to govern the use of MEWS in this setting.  Say a patient has a MEWS of 8, so what?  We will already be implementing emergency care to deal with whatever the problem is, so what are we adding to the equation?  If the MEWS is supposed to guide the level of response such as Triage Category, them I'm getting really worried.  Allocating triage categories and directing ED resources is a specialised skill, and should not be done by inexperienced staff, so I can't see how using MEWS is going to improve anything in the ED.

However, because someone higher up the food chain than the frontline staff has decided that MEWS is the best thing since sliced bread, it seems that it is here to stay.  Its use is even being audited, which is quite funny is a sad way.  Since it has no bearing on patient outcomes in the ED, auditing its use is a waste of resources.  If we're going to audit it at all, we should audit its efficacy not just whether it is being used!!

Distance Education

Most of my education has been by one form or other of distance education.  My first 2 years of schooling were Grade 1 and Grade 2 at Meadows Primary School, then just as I was starting Grade 3, we moved out bush.  Our farm was 20km from the nearest bus stop, and the school was a 1 1/4 hour bus ride from that bus stop.  Rather than spend such a huge chunk of time sitting on a bus each school day, I was introduced to the South Australian Correspondence School (now SA Open Access College) and began my lifelong love affair with distance learning.  Every fortnight I would receive a package from the Correspondence School, which I would complete in 2 or 3 days then have the rest of the fortnight off.  Compared to the boredom and lack of intellectual stimulation of the classroom environment, it was Utopia!  It wasn't until Year 11 that I had to spend more than a week to complete each fortnight's package, and my grade sheets showed A's across the board.

I left school at the end of Year 11 to start work as a farm labourer, shearer, grain handler, truck driver, and fence fixer.  The plan was to get together enough resources to acquire my own land and become a farmer.  I was given the opportunity to do some cereal sharefarming in the mid 1980's which was to be my foot in the door.  Unfortunately both crops I was involved in financing failed, and I saw the writing on the wall.  Now what to do?  I decided to go back to school and complete Year 12, then go to university.  Year 12 was a culture shock, as I was 21 in a crowd of 17-year-olds, and had not set foot in a classroom since early 1974.  However, my independent study skills learned from the Correspondence School helped me to do well and complete Year 12 with a 96% grade.

Then came four years at university trying to find out what I wanted to do.  A year of Electronic and Electrical Engineering, a year of Mechanical Engineering, and two years of Surveying left me still confused what I was going to do.  During all of this, I was a volunteer Ambulance Officer, and in my second year of Surveying I starting going out with the daughter of a GP.  I spend many hours with this GP (and the daughter of course!!) discussing health care etc, and she suggested I should try medicine as a career.  So I applied, but was knocked back as a bad risk due to three uncompleted degrees already.  The Dean of the School of Medicine at Adelaide University suggested I acquire a nursing degree, then if I achieved high grades he would give me a place in medical school.

Three years later I graduated with a Bachelor of Nursing with the highest grade point average of my class over the three years.  Much of what I learned during my nursing degree was self-directed as I quickly found the lectures and tutorials were pitched at the lowest common denominator and were unbelievably boring.  So I spent much of the three years teaching myself from textbooks and journal articles, just like I used to do with the Correspondence School.  It worked for me, as I achieved a high enough grade (High Distinction average) to go to medical school.  Unfortunately for entering medical school, but fortunately for my life in general, I married Anita shortly after graduation and decided to stick with nursing for the time being as I was sick of being a penniless student.

My next educational endeavour was two years later when I was working is a busy metropolitan ED, and began a graduate program for Emergency Nursing.  This was almost entirely by distance education, and left me with a graduate certificate in Emergency Nursing.

Then after yet another change in my career, I ended up working as a Remote Area Nurse in Oodnadatta SA.  It didn't take me long to realise that I knew almost nothing that I needed to know to be effective, so it was back to distance education to fill the gaps.  I enrolled in the Master of Remote Health Practice and completed it over 3 years, then the Master of Remote Health Management over two more years.  The possibility of becoming a Remote Nurse Practitioner became achievable in 2010, so I then completed a bridging course to convert my first Masters to a Master of Remote Health (Nurse Practitioner).

What's next?  Well right now I'm refreshing my ALS certification via an online unit with CRANAplus, and in the next few months it is possible that I'll have the opportunity to start a PhD program.  So the love affair with learning, and in particular distance education, continues.  I am thrilled that my children have had the opportunity to do some of their schooling via Alice Springs School of the Air, as it has exposed them to the self-discipline, challenges and rewards of distance education.  If the skills they acquire through this form of learning are as useful to their lives as they have been in mine, then they will be fortunate indeed.

Making a difference

One of the things that makes work worthwhile is the opportunity to make a difference.  In my experience, this is a factor which is often underestimated, or perhaps undervalued, by managers.  It goes part of the way to explain why throwing money at remote health jobs does little to resolve the chronic shortage of personnel.  In fact, in some ways throwing increased money at remote staff has the effect of attracting mercenaries who are only 'in it for the money'.

So if it's not the money, and let's face it, the salary package for a Remote Area Nurse is among the best you can get in the profession, then what is it that keeps people in the field?  Well, my opinion is based on my experience as a Remote Area Nurse, as a remote Health Centre Manager, and as a manager of volunteers.  I think it depends to a large extent on the ability to make a difference, and to see and feel that you are doing so.  For many nurses, life is one of boredom and drudgery, doing the same work over and over again in a never-ending cycle until their backs pack up or they burn out physically and emotionally.  For a few, the rewards that come from helping a patient to find the road to health and follow it make up for all the failures.  It's all very well to patronise struggling nurses and tell them to 'focus on the successes and let the rest slide by'.  Unfortunately that ignores the reality of human nature, where we feel deeply our failures and they erode our confidence underneath the veneer of professional cheerfulness.  Making a difference to people is what makes the difference to us.  This is true of many endeavours, but I think it is most relevant when caring is part of the job description.

During my time in the SA Country Fire Service, I came to realise that most volunteers were giving their time and energy to the organisation because they could make a difference, and that met a need within themselves for their lives to mean something.  This was true even, or perhaps especially, of those who professed to believe religious dogma which was supposed to meet this need.  I used to think it was about the need to belong, and maybe in some ways that's a frequent starting point.  Now I think it is more about making a difference, and being recognised for doing so, that keeps people doing things that others find amazing.  Whether it is fighting fires in your own time, or living and working in a remote community away from family and friends, it is the opportunity to make a difference, and the recognition for doing so that is a potent driver for people sticking with it.

What this means for remote health is that if managers want to be serious about attracting and retaining good staff in the field, they need to stop their senseless bickering and bitchiness about little things that don't make a difference.  They need to focus on making it possible for staff to make a difference.  In Aboriginal communities, this means making a real effort, not the usual token gesture, to include Aboriginal Health Workers as part of the team.  Remote Area Nurses are hampered in their drive to make a difference if they don't have the tools and support they need, and a big part of this is the Aboriginal Health Workers.  Any RAN who doesn't see this needs to do themselves a favour and get the hell out of Aboriginal health ASAP.

To stop the soul-destroying revolving door of acute health care, the health system needs to be reformed to put more money into prevention than it does into cure.  Most of the work in remote Health Centres is acute care arising from preventable causes, yet bugger all is spent on prevention.  Managers tend to express their awareness of this stupidity by blaming the Remote Area Nurses for neglecting prevention, when it is the almost total lack of support and funding for prevention activities that stops it from happening.  You can't make a difference when the cards are stacked against you, and when your own employer is doing the stacking and then blaming you for it, it is not long before no amount of money will compensate for the disillusionment.

So what's the solution?  Give remote health professionals the tools they nned and the support they need to do what most of them are there for, to make a difference.  If you can't do that, or don't know how, then do everyone a favour and get out of remote health and give the job to someone who can.  Either that, or stop pretending that we are in the business of Primary Health Care and rename the health centres "Remote Band-Aid Stations".  Then we can keep wasting time and money and dedicated staff for another 50 years!

Bush Orders - bringing competition to remote areas

One of my long-held beliefs is that people who live in rural and remote areas need to support their local businesses, or risk losing them.  After all, city-based people are not going to drive to the middle of nowhere for the privilege of paying higher prices for a restricted range of lower quality goods.  So if those of us who live outside the cities don't pay up, country businesses will go belly-up.  I'm OK with that, because as far as I'm concerned, the country life is worth the extra expense, especially when you often get to save money in other ways so it balances out.

However, there is a limit.  In Tennant Creek, the sole local supermarket has a captive market which they shamelessly milk for all it's worth.  A regular fortnight's shopping at Tennant Creek will cost me at least $800, and that leaves quite a few items that I can't get at all until I go shopping in Alice Springs.  A comparable shopping trolley full in Alice Springs costs around $500, and includes everything I need.  The quality of fruit and vegetables is highly variable, ranging from OK to inedible, and staples like milk powder and bread are nearly twice the price that they are in Alice Springs.  There have apparently been a number of attempts to start up a bakery in Tennant Creek, but each time the supermarket conducts a price war until the bakery goes broke.  Then the price of bread goes through the roof again.

This is where Bush Orders comes in.  I am a Woolworths customer, so can only talk about their service, but I know Coles do it as well.  Every fortnight I fax a list of what I need to Woolworths in Alice Springs.  The Bush Orders team do the shopping for me, for a $20 fee (which is being scrapped soon) and pack it into boxes.  Meat and bakery items are frozen, fruit and dairy goods chilled, and the rest packed as general goods.  Most times it takes 6 boxes to pack my order (2 frozen, 2 chilled and 2 general).  I then pay $6 per box to have them freighted to Tennant Creek where they are held at the freight depot for me to collect at my convenience.  I could get them delivered to my door, but since I work nights, it's better if I collect them myself.  Then when I get home, it's like Christmas!  Everyone is keen to see what came in the boxes.  I'm caught up in it too, even though I placed the order, because the Bush Orders team usually throw in some freebies as well.

So for me, the benefits of Bush Orders are:

• Avoiding the extortion of a monopoly business
• Ordering groceries eliminates impulse shopping, as all purchases are planned
• I can still buy specials, by referring to the specials catalogue online that applies to Alice Springs
• It saves me having to drive to Alice Springs to buy the items that are not available in Tennant Creek
• I save the cost of the $20 shopping fee just in the bread, and more than recoup the $48 freight on everything else. On top of that, I save over $200 by not having to drive to Alice Springs.

Disadvantages are:

• It is hard to explore new items that we might like to try, so this has to wait until we travel to a Woolworths store. I can browse Woolworths online, but not the Alice Springs store.
• I have to keep money available in my account for up to 3 weeks as it seems to take that long for Woolworths to deduct the payment.  If I change to using a credit card for these purchases, that will eliminate this delay.
• We end up with a mountain of boxes that need to be disposed of.
• I like impulse shopping!!  Not that it's good for me.

Overall then, Bush Orders allows us to enjoy the services, range and quality available from a major regional supermarket for a relatively minor fee.  While I would like to support local business, I cannot support extortion.  I understand that businesses need to make a profit, but they need to understand that we live in a global economy and if they can't compete, they're out.  If that means no local supermarket, so be it.  The reality of course is that there will always be a supermarket here, and if a second one opens, competition will bring prices down to a fair level.  The supermarket pay their staff a pittance and don't open long hours, and freight is very competitive, so that doesn't justify the high prices.  Therefore I refuse to accept them.  Long live Bush Orders!!

Banking on frustration

I received a call from a bank while sleeping in preparation for night shift.  It seemed a reasonable call.  Let's start at the beginning...   Some time ago I completed an application for a new credit card which would facilitate Bush Orders from our chosen supermarket.  As part of the application, I naturally had to provide financial data to support my request.  And this is where it started to get surreal.

Carefully following the instructions received by phone, and rechecked to make sure I had missed nothing, I gave up some of my sleep after night shift to cycle to work and fax off the necessary documents.  These included the expected things, such as recent payslips to verify my salary.  No problems so far. 

About two hours later, I was woken by another phone call thanking me for the documents, and requesting that I now fax across a copy of my most recent bank statement!!  It seems that this was needed to verify my salary.  OK, so why did they want my payslips??  If they weren't proof of my salary, then want was the point of asking for them?  And why didn't they ask for the bank statement at the outset?  Of course the mindless drone that had the unfortunate job of ringing me didn't know the answers - not surprising as probably no-one in the bank knows!  Anyway, eventually I simmered down enough to get up, get the bank statement, blank out all the details they had no right to see, and cycle back to work to fax it off.  Whew!  Now it's done, just wait for a call to confirm or deny the application.

A week later, another drone rings to ask if I have received a letter asking for 100 points of ID.  Of course I haven't yet received any such mail, so I ask the drone how this works.  Seems I have to front up at the service counter at the nearest branch of the supermarket in question with 100 points of ID in order for my application to proceed.  I mention that this store is situated 507km away and I'm not planning a trip there anytime soon.  "No worries" says the drone.  "It's all explained in the letter, and you'll have 14 days to sort it out".  Well, the letter turned up a couple of days later, and it turns out the 14 days begins when the letter is typed, and 13 of them had passed before I received it.  OK, so I'd better get on the phone, because I'm working night shift again, and couldn't get to the store even if I wanted to.  Another drone takes the call - they must have an endless supply of these creatures!  She assures me that there's no problem and hangs up on me before I've even explained the situation.  Hmmm, I can see this is going to end well!!

Several days later, another drone (yes a different one again) rings me up (yes, waking me again) to ask if I have had a chance to complete the 100 points of ID.  Not wanting to spoil his obviously exciting day, I patiently explained that it is over 1000km round trip to get to the store, so there will be some delay.  He doesn't sound too sure about this, apparently he has been told that 98% of the Australian population live within 50km of one of the stores in question.  Therefore I am mistaken as no-one could possibly live 500km from a store!  He assures me that he will make a note on my application that it will be about a month before I can provide the 100 points of ID.  His final parting shot is that "we can't keep the application open for long".  My response is along the lines of, "Well that's your loss then because I'm not making a special trip of over 1000km just to do some paperwork. You'll just have to wait".  "Have a nice day, sir" says the drone before hanging up, having just ruined my sleep and ensured that I'll have anything but a nice day.

Finally, while sleeping in preparation this night shift that I'm on right now, I get a phone call from the bank.  Guess what, it's another drone!!  How many do they have?  So what do they want now?  Well, it seems that reading the customer's file is not one of their skills, because this drone launched into a spiel about needing to get 100 points of ID blah blah blah ...  So here we go for the fourth time, trying to explain to someone with the IQ of a pet rock why I haven't dropped everything and spent 2 days and several hundred dollars to dash to Alice Springs to present my ID at the store.  By this time I am starting to have serious reservations about doing business with this bank!!  I get through my explanation, then the drone asks sweetly "What would you like me to do".  Suppressing the urge to tell her where to shove my application, I beg her to mark my file DO NOT DISTURB and wait for me to get to the store, which will now be in two weeks or so.  She says to have a nice day, so I thank her for ruining my sleep and please just leave me alone.

So that's where it's at.  Maybe I'll eventually get the card.  I don't really care, as I certainly don't need it.  But it has been an interesting experience, and has reminded me why I bank with a credit union.

Redbank Gorge

One of my favourite places near Alice Springs is Redbank Gorge, about 220km west of Alice Springs in the West MacDonnell Ranges. The road is sealed except for the entry into the gorge carpark, which is about 8km of rutted dirt track. It can be accessed by normal car most of the time, but you'd have to take it very easy. A 4WD is a better option.

Once at the carpark, there is a strenuous 1.2km walk along the creek bed to get to the gorge. If you like clambering over rocks and wading through deep sand, then you'll enjoy the walk. Otherwise, just keep plugging away at it, as the gorge at the end is well worth the effort. Because the gorge is so narrow, it gets little sunlight, so the water tends to be chilly. This is OK as you have to work hard to swim through the gorge and this keeps you warm. Also, some flotation is a good idea. I'd recommend something like a small car inner tube, or a floatie ring, as anything big like an air mattress won't fit through.

At several points through the gorge, you have to climb over rocks worn smooth by millenia of water flowing over them. This can be tricky, and I would suggest always having someone with you in the gorge. It's not a tourist spot, so if you get injured, you may have quite a wait for someone to come along and find you. Most visitors to Redbank Gorge stop at the entrance and take photos there before leaving. I'd say only about a third of them attempt the swim through, and maybe 5% make it all the way through. There used to be a chain in the rock about 3/4 of the way through, but it was washed away in 2010, and I don;t know if it's been replaced. You can still get through (I have done it since the chain vanished) but it's difficult and most tourists give up at this point.

If taking a camera, make sure it's waterproof, or in a waterproof case.

Finally, keep an eye out for snakes in the water. I've seen one in the six times I've been to the gorge, and due to the cold it was very sluggish and easily avoided. Just make sure you see it first!

Registration inspection looming

I received my registration renewal notice via email recently for the Landcruiser.  Don't know how much it is because I can't open it!  And yes, I elected to have renewals sent to me via email not post.  Whatever the cost, I know it's due for a roadworthy inspection, so once again it's time to check everything over.

• Brakes have been replaced, so no worries there.
• All light bulbs working for once (though a couple will inevitably pack up just as the inspector looks at them as usual!).
• No oil leaks, as all previous leaks have been repaired and no new ones have appeared.
• All new steering joints, so steering is tight.
• New universal joints on the driveshafts.
• All suspension bushes replaced.
• New coolant hoses and fan belts.
• Headlights aimed properly.
• Seats and seatbelts in good condition.
• No rust in the bodywork.  Now what that has to do with road-worthiness is anybody's guess, but I know from bitter experience that some inspectors think it does.  I used to have a Falcon wagon which I kept in top mechanical condition, but it had a small rust spot over the rear wheel arch.  I was informed that I could not re-register the vehicle without having the spot repaired by cutting and welding, and would need re-inspection before painting.  Since this would cost more than the vehicle was worth, I didn't bother.  The infuriating thing is that the spot was there the previous year, exactly the same (and I mean exactly, as I had treated it with rust preventer) and there was no hint of a problem.  I wasted $240 putting in a new windscreen before inspection, and ended up having to scrap the vehicle.  My question is if nonstructural rust is such a major issue, why was it passed the previous year, and why do they pass rusted vehicles in much much worse shape owned by people with darker complexion than me?  I'll leave you to decide your own answer to that.
• Wipers work, horn works, windscreen washer works, all indicators and other lights work.
• Handbrake - well there we may have a problem.  I have completely replaced the handbrake system with new components, and it is still absolutely woeful.  It is the one thing I don't like about the 80 series Landcruiser.  Even brand new, the handbrake just barely passes the NT road-worthiness inspection.  My only hope is to adjust it right up till it has almost seized, have the inspection done, then back it off before driving home.  There's no point taking it to a brake specialist, as it is already new and still doesn't work.  They will simply adjust it up until it almost seizes, and charge me $500 for 5 minutes work with a screwdriver.

Anyway, I guess I'm just about ready for the inspection, so like all drivers of older vehicles, I'll go in with my fingers crossed and hope the inspector is not having a bad day.

Cookbook clinical practice

For many years I have been dismissive of the trend towards what I call "cookbook practice".  This is clinical practice in which all the decisions are pre-set, and the clinician just fills in the blanks and follows the resulting algorithm for treatment or referral.  My objection was based on the idea that clinical judgement is an expected skill/attribute exhibited by practitioners, and they should not have to be spoon-fed.

Recently, I have begun to have my thinking modified by some new data (well, 'new' to me anyway!).  Safety and quality in healthcare has been expensively studied over the years, and it has been found that having clinical guidelines in place significantly reduces the incidence of adverse events.  This may suggest that even good practitioners can benefit from having robust well-founded clinical guidelines to help with decision-making.  I'm still not completely comfortable with the idea, as I worry that guideline-based practice actually reduces the need for clinical judgement.  Maybe clinical guidelines work because practitioners need help making good decisions?  What if we looked at improving their decision-making, and their critical thinking?  Would that not achieve the same or better results?

In some ways, it seems analogous to the issue of young drivers on the roads.  This group are horribly over-represented in road crash statistics, so it seems logical that something needs to be done.  Is it more training and guidance for a longer period of time that is required, or is it more effort into creating drivers who think actively about what they are doing and learn good attitudes and habits?  If having L-plates for 2 years proves to be safer, what about 3 years?  If the restrictions of provisional drivers licences make young drivers safer, what's wrong with applying those restrictions to all drivers.  After all, if we did not allow anyone to drive until they were 21, the road crash data for 16-20 year olds would improve dramatically!

I think the answer is the have reasonable guidelines, then teach people how to think properly.  Some sort of attitude test if you like.  If you don't pass, you don't get a licence until you grow up a bit more.  I know some 16 year olds who are more mature than some 46 year olds, and much safer drivers as a result.  Likewise with clinical practice, I think it should be mandatory to pass some sort of critical thinking test before you are allowed near patients.  How that would look in practice, I'm still thinking about.  Watch this space ...

Losing weight

Yesterday I had the dubious pleasure of having an appointment to discuss my blood pressure control.  I spoke with a Registered Nurse, a renal specialist, and a dietician.  It seems that I have reached a plateau in my use of medications, currently at 4 tablets per day.  Now the focus is on shifting the lard from my midriff.  Easier said than done! 

About a year ago, I weighed 112kg and decided I was sick of being unfit and obese.  So I cut out eating bread, not because bread is a bad food, but because I tended to put bad stuff on it.  This was pretty successful, and in 3 months I lost 12kg and kept it off.  Over the next 6 months, I started eating bread again, but less than before and trying to choose healthier fillings.  The weight stayed around 100-102kg, which is where it is today.  The frustrating thing is that it doesn't seem to matter what I do now, I can't crack the 100kg barrier!  I even tried the bread thing again, but no luck this time.

Seems like portion control and physical activity is the way ahead.  So now that I have my new bicyle (see previous posts) I'm riding at least 16km daily.  Portion control is hard, but I'm trying an idea of using smaller plates to fool the eyes.  Time will tell if I can smash through the 100kg barrier and head to my goal of 90kg.  I know that if I can start getting the weight off again, then I will be motivated to keep doing whatever it was that made it happen.  Well, I think I know that anyway.  Here's to seeing what the scales say at the end of June, my next deadline.

Critical thinking presentation

I recently accepted an invitation to speak to a group of staff at TCH about critical thinking in clinical practice. The attached file is the one I used for the presentation. ...  Well, that was the plan anyway.  Seems the file didn't attach!  Maybe this will work instead:  Try this link

Holidays are coming!

I have an app on my iPhone that tells me that we go on holidays in 38 days.  In the Northern Territory we get 4 weeks school holidays in the middle of the year, so this is when our family tries to go on a big trip.

This year the plan is to go to Adelaide, then Brisbane and Fraser Island, back to Adelaide, then off to visit my siblings on Eyre Peninsula before returning home. We have four weeks to fit it all in, so part of the fun starts now with the planning.  There is a long list of people we'd like to catch up with, and we also have to fit in some essential tasks like fitting the new engine into the Landcruiser and getting it tuned correctly.

One of my concerns is security, as recently a Tennant Creek resident returned home from holidays to find his home wrecked and ransacked.  There's not a great deal you can do, except lock everything up and try to make it look as if you're still around.  We have insurance, but that wouldn't make up for losing the things which are dear to us.  Two of our bikes were stolen a few weeks ago, as I have posted about, and that was bad enough.  Anyway, I guess we just have to cope with the concern, otherwise the only solution is to never go anywhere.  If that was the solution, we'd be better off not owning anything!

So the holiday planning is coming along well.  There are so many things to arrange that this year I'm doing something new, I'm using a checklist to make sure I remember everything.  Maybe I'm just getting older, but it does detract a little from my enjoyment of a holiday when I forget something important!

Sleepover

Claire is having her first friend's sleepover for a long time, maybe 2 years or more.  The girls had fun dancing to the Wii, playing various console games, making a campfire in the backyard, making soup over the fire, playing hide-and-seek, eating home-made pizza, and generally having a lot of fun. Now at 1:40 am they are having their showers and getting ready for bed.  Might be a sleep-in in the morning!

Rational thinking

For a long time, I have highly valued rational thinking.  At school I was strongly attracted to the rational disciplines - mathematics, science, chemistry, biology, physics and so on.  Conversely, I was repelled by the fuzziness and subjectivity of humanities and the arts, in which the same piece of work can get different (sometimes vastly different) marks from different teachers.

When I dabbled in religion for a while, mostly to try to find some sense of belonging, I was likewise repelled by the almost total lack of logic and rational thinking.  Despite vehement assurances to the contrary, I finally realised that to accept religion I would have to reject rational thinking, so I did the only same thing I could do, I rejected religion.

Somewhere along the way, I was misled by a very common myth about rational thinking.  I assumed that there was such a thing as an autonomous rational mind, and this meant that two people applying rational thought to the same data set would arrive at the same rational conclusion.  After all, is that not true of the pure sciences such as mathematics - there is one right answer and a million wrong ones?  Well, yes and no.  While there may well be only one right answer in an absolute sense, in the real world there may be more than one rational answer.  Let's use the example of my wife choosing a dress to wear to a formal event.  It is likely that in her wardrobe, she has only one dress that really meets the criteria for the event, but if she doesn't like it, the rational choice is for me to agree with her wearing what objectively is 'second best'.  That is not because everything is relative, as I reject that premise, but because priorities and external factors do affect rational decision-making.  If someone holds a gun to your head and demands that you agree that two plus two equals five, is it rational to disagree with him?

So I guess the point is that I grappling with the implications of rational thought being inevitably coloured by subjectivity.  Firstly, I will have to be more accepting of people whose conclusions do not agree with mine about a particular situation.  Secondly, I will need to seek more external validation of my conclusions, so that I can benefit more from the wisdom of others, rather than relying on my own rational thinking.  Finally, I will need to spend more time examining my assumptions and biases, looking more deeply than I have previously to find the real reasons for accepting one idea over another.

And for the hot potato question - have I changed my mind about religion?  Absolutely not.  My problem is not that religion uses a different rational thinking than I do, it is that it is not rational at all.