An Unapologetic Rant

First a disclaimer. This post is a rant: pure and simple. Why have a blog if you can’t complain every now and then? So, you’ve been warned – read on at your own risk.

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The cover of the Medical Journal of Australia’s recent issue carried the headline “Manna from Country”. It was an issue timed to coincide with NAIDOC week, and is full of good articles relating to Aboriginal and Torres Strait Islander health. 

My problem is with the way that we use grammar when we talk about Indigenous issues. Manna from country, living in community, birthing on country, speaking in language, caring for land… the list goes on. It is as if we neglect to use words like “the”, “my”, “his”, “their” for some reason. Where are the definite articles, pronouns and prepositions? (I had to look that up on Wikipedia). I hear these sorts of sentences all the time. In the hospital: “there’s a great resource about diabetes in language”. In the media: “living on country”. About a patient: “He’s going back to community”. 

Why do we use these awkward sentences when we talk about Indigenous people? Is it because we are trying to talk like Indigenous people do? We use many other Aboriginal English words in this way: whitefella, walkabout, sorry business, big mob, humbug. I haven’t heard any of my Yolŋu patients talking like this. Or perhaps our jilted English harks back to a colonial era, where domineering white people talked to Indigenous people in a simplified way, assuming they wouldn’t understand. Or perhaps this is just the way that everyone talks and we never question it. 

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I think we should question the way we talk. When we say “he’s going back to country”, perhaps we should say “he’s going back to his country”, and indicate ownership through our language. Or when we say “translate this into language”, perhaps we could say “translate this into Yolŋu Matha”, and by naming the language identify its importance. At the very least, we could try to use proper grammar when we talk about Indigenous people. 

I’m glad I got that off my chest. Thanks for reading to here!

My Life as a Travel Agent

travel agent

Do you know any logisticians who want a job? Sometimes I wonder if being a logistics expert would be more helpful than being a doctor in East Arnhem. This week I have been spending most of my time directing traffic, or at least pointing vaguely in a direction and hoping that the drivers will understand.

I spent a long time with a pregnant lady near term explaining why she needed to travel to Darwin. When she very reasonably refused to go by herself, I spent an equally long time trying to arrange for her relative to get there with her. I tried everything for her – hitch hiking with CareFlight, a chartered plane, driving to Gove at short notice. I had to admit defeat as the weekend made it too hard to arrange. The woman graciously travelled alone.

The next day, a young unwell girl was transferred to hospital from one of the homelands that I visit regularly. She arrived at the hospital with her aunt and was admitted, then promptly disappeared for the night. I heard on the grapevine where she ended up, and the next morning it took a few phone calls to find out which house she was in, make a case for her to go back to the hospital, and organise a taxi to take her there.

Today, I saw a boy in a remote homeland who I was worried about. Was it appendicitis? My gut instinct said yes. He looked miserable – hot, tachycardic, dry, uncomfortable. I wanted him in hospital soon and planned a plane to pick him up before we left. His mother was not so sure. “He’s scared of flying,” she said. I pointed out that she would be with him on the plane and he really needed to go. “I’m scared of flying too. Can we go tomorrow in the bush taxi?” I rang back to the office for ideas, and was told a bush taxi had left another homeland and was headed our way, should be there any minute. I looked out the window. There was the bush taxi, about to leave! I waved furiously from outside the clinic, and received a lethargic wave in reply without noticeable deviation of the vehicle’s course. I jogged over, trying not to look too conspicuous running in the relaxed homeland atmosphere. Someone yelled “Wuy, doctor – you looking for someone?” I caught the taxi, and the boy and his mum squeezed into the last seat in the back.

Plane at Gan Gan

Plane at Gan Gan

They left with nothing, so I dropped in later to Emergency with a few bags of clothes sent from home. The boy looked a million dollars…. probably not appendicitis.

I’m not very good at being a travel agent. The logistics of getting around up here are such a challenge. It would be hard for a Yolngu person living in the homelands to negotiate this maze of trips, planes, cars, appointments and deadlines just to receive good healthcare.

Back in NT

plane at yilpara

The Wandering Lintons have returned once again to the Top End. After a year of travelling, locuming, relaxing and growing our family, we found ourselves looking north and moved back to Nhulunbuy about four months ago. I am working both at the local hospital doing GP Obstetrics, and at Laynhapuy Health flying into a number of homeland communities for GP outreach work.

Territory Day fireworks over Cape Wirrawuy,

Territory Day fireworks over Cape Wirrawuy,


I’m starting to feel outnumbered by the Wandering Linton girls – there’s three of them! Their life here revolves around the pool, friends, kinder, chooks, church, and usual generalised chaos.

at Marcus and Esther's wedding

at Marcus and Esther’s wedding

We enjoyed a recent visit to Victoria for a family wedding, despite having to visit the nearest op shop for woolen jumpers to deal with the cold shock.

After a long hiatus on this blog I’m hoping to write a bit more frequently. I’ve been thinking a lot about language and communication, so expect some ramblings about that. The dry season here is exceedingly pleasant, so hopefully we can share some photos from the stunning place we live in.

Thanks for stopping by.

Isabel Joy Linton

Things have been quiet on the Wandering Lintons blog for a while. There have been some big changes involving one very small person – introducing Isabel Joy!

born on 14th June 2012 – weighing 3565g

Our wanderings have taken us right around the world and now back to our roots in Leongatha. It’s lovely getting to know Isabel and work out what life is like as a family of four. We’ve been very grateful for so many people who have cooked for us, helped out and given in such generous ways.

Looking forward to more wandering!

Sampling the Stereotypes

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Coffee, croissants, baguette, strawberry jam. It was a very Parisian breakfast, and I couldn’t help but smile at the way our whirlwind tour of UK and France has covered a good number of stereotypes. We had steak and guinness pie in England, haggis/neeps/tatties in Scotland and potatoes in Ireland. We visited castles, drank warm English ales and cold Irish Guinness (some of us),  rode the Tube in London, the Metro in Paris, got stuck in traffic on the M1 and  listened to Irish music in a pub called “Duffy’s”. We got the impression that all English people lived in 16th century thatched cottages and all Irish people lived in castles

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Haggis

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More importantly than doing all these stereotypical things has been visiting a number of very special friends from times past. We have really enjoyed making connections with people again, sometimes after more than 20 years. We have been glad of so much warm hospitality wherever we have stayed. Thank you so much to the Wellers, the Jones, the Youngs, the Sniders, the Irvines, the Calcrafts, the Suttons and Ruth.
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Our trip has taken us from London, up the east side of the UK to Edinburgh, to the beautiful Lake District, to Dublin then up to Newry in North Ireland and finally to Paris. We’ve travelled without hiring a single taxi, which I think is a fair achievement given we had 3 bags, a toddler, a pusher (aka “buggy” in UK), a backpack and a pregnant tummy in tow.
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I’ve been keeping track of things that are great and should be imported to Australia:
– postcodes that are specific to a small area. Very helpful – just type it into the GPS and away you go. Or as one person told me, send a letter to them like this: Name, Postcode, England. Brilliant!
– number plates that tell where and when the car was registered. I don’t know why, I just think that is good.
– French bread.
– French cheese
– French shops that are not supermarkets selling bread and cheese
– Speed limit of 70mph (or about 115kph) on all motorways
– Good quality cheese in English supermarkets
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I’ve also kept a list of things that I like about Australia compared to this part of the world
– Fish and chips. Sorry England, you may have invented it, but we perfected it.
– Coffee. The best coffee I had in London was from a cafe run by Australians. Although Zappi’s Bike Shop Cafe in Oxford was good. (Thanks Cam)
– Kids being welcome in restaurants. Seemed not the go in Paris
– Cold beer
– Weather – no, it is not a “scorcher” of a day when the temperature gets out of the teens.

The Mystery of the Wandering Bear

It happened near Van Gogh’s Sunflowers. Jaded and jetlagged after arriving in London at 5 AM, we were stumbling around Trafalgar Square and the London National Gallery waiting to be able to check into our hotel. It would be a stretch for any two year old to remain interested in countless artworks, no matter how significant. Her complaints changed though at the Van Gogh – from “I want to go home” to “I want my teddy…”

We looked under the pusher where we expected to find Teddy. No luck. In the bag? Not there. We looked at each other briefly and it didn’t take long for panic to set in. Anyone who knows our daughter will attest to the importance of Douglas Teddy. “Let’s retrace our steps” we decided. Back through the rooms of artwork, with happy artlovers wondering why we were speeding around the rooms with not even a cursory glance at the paintings. No Teddy at the lost property spot. No sign of him anywhere around the expanse of Trafalgar Square. Stumped, I asked our daughter if she had thrown him somewhere. “Yes Daddy,” she replied helpfully, “I threw him by his ear. Onto a bench.” This was a helpful lead, but did not lead to Teddy.

I was about to give up hope when I saw my ever ingenious wife in an animated conversation with a man in a fluoro yellow jacket picking up rubbish. Yes, he had seen Teddy, and he thought his colleague across the square might have picked him up. We sprinted past Nelson’s column to find him. “Oh, that was your Teddy,” he said, “I gave him to that lady.” He waved a complex series of hand actions to another yellow-jacketed lady, who smiled as she realised what it was about. She retrieved the long lost Teddy from her office and handed him back with a grin and a stern warning not to lose him again.

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Teddy finders at Trafalgar Square

Our daughter seemed unperturbed, oblivious to the near loss of her favourite stuffed toy in one of the world’s biggest cities. We decided that from now on we would keep a close eye on Teddy’s escape attempts.

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Reunited at last

The Care Plan – super or superfluous?

image For GPs in Australia, an increasing amount of time is spent managing patients with chronic health problems using tools called care plans. There are GP Management Plans, Team Care Arrangements, Health Checks, Mental Health Care Plans, Asthma Management Plans, Diabetes Annual Cycle of Care and others. Most of these involve filling out a lengthy document outlining the patient’s health issues, medications, progress and goals. Often these plans are produced collaboratively between the practice nurse and the doctor. At the end of the process, the patient is offered a copy of the plan and a significant sum of money is paid by Medicare to the doctor. But is this process effective in achieving improved outcomes for people with chronic diseases? Is this process working for Aboriginal people particularly?

I shudder at the thought of how many trees were required to print the number of care plans I’ve produced over the last 4 years. However, I have been able to work in a number of different settings around Australia where this approach to chronic disease management has been used. I have worked in 3 mainstream GP clinics, 5 Aboriginal medical centres and 4 hospitals and I think this range of experience has given me some insight into how the system of care plans works to improve health outcomes. Unfortunately, my experience is that most of the time these documents we produce are not really that helpful for the patients we serve.

My experience of health checks or care plans has been varied. In some clinics, the bulk of the work is done by the organised practice nurse, and my role is to sign off on the document and discuss issues that have come up. Other times, a patient is brought in for a health check and it is up to the doctor to complete the whole document. The vast majority of these checks and plans have been initiated by the doctor or health service, and not the patient. It also seems that most of them are done for patients who already have frequent contact with a health service. Working in Aboriginal health, I’ve found myself often in the frustrating situation of having to do a health check and tick boxes for a patient that I’ve been seeing regularly, and all the questions and discussions that have to be had seem repetitive. Quite often patients are keen to leave and don’t see the point. I offer to print out the document and wonder what percentage end in the bin.

To try and make the process more medically satisfying, I try to ask each person what their own goals for their health are. It’s then a matter of balancing their goals with the medically recommended goals. Which is the most important goal- to get that HbA1c below 7, or to stop feeling tired all the time? Even when I’ve tried hard though to ask patients about their goals and help them set a path to improved health, the whole process feels unsatisfying and I wonder if the patient walks away wondering if the whole thing was worthwhile. I can’t help but feel that is some settings these care plans and health checks are simply revenue raising for the health service to continue.

Despite my cynicism, I would love to know if on a population level the effort of doing health checks and care plans is achieving something. There’s a strong case made for the efficacy of preventative health assessments by NACCHO in the “Evidence base…” document.

So, is the system working well for Australians? Is it working well for Indigenous Australians? How could it be better? Personally, I find it inefficient that as a doctor I’m paid a significant amount of money to produce a document of questionable benefit to the patient I’m seeing, and that this is a requirement to access funding to provide care that is already happening. Perhaps it’s time to move to a capitation model like the UK?

I would love to hear your views in the comments. Have you got ideas about how the system could improve? Are you a doctor who has done care plans or health assessments? Any suggestions about how they can work better, especially for Indigenous people? Have a rant in the comments.