By Doctor Louise Burns – ACRRM Registrar 

I started working at Mulungu Aboriginal Health Service this year not really knowing what I was in for. It didn’t take me long to appreciate the complexity and unique challenges of Indigenous Health and working within an AMS. But with these challenges came a sense of satisfaction and fulfilment that I had not experienced in any other area of medicine. To be able to work and learn in this space as a registrar is a unique and rewarding opportunity. 

Yesterday I referred three patients up to the ED. A young man with acute rheumatic fever, an older patient in urinary retention with a persisting breast abscess and a patient with diabetes presenting with a random BGL of 19.0 and a heart rate of 117.  She looked as crook as a dog and a file check uncovered a HbA1C of 12.0 done in January. 

In my first week, I managed “heartburn” that ended up being a STEMI, diagnosed and arranged management for end-stage renal failure, treated scabies and syphilis, identified acute liver failure, diagnosed an ectopic pregnancy, discovered an acute abdomen from a likely ruptured large ovarian complex cyst / malignancy, had that difficult conversation with a patient with newly diagnosed metastatic breast cancer, dealt with acute and chronic mental illness and, to round out the week, a few chronic suppurative otitis media found in a routine health assessment. These diagnoses always come with context and there is often a complex interplay between physical and psychological trauma, alcohol and drug use and extreme poverty.  One complex, acute problem often comes hand in hand with another and there is always an entrée of chronic issues to consider before the main. 

Every week, I put together a long case to discuss with my mentor/supervisor Dr Louis Peachey.  It is rare for the case to have less than ten issues and is almost always upwards of 10-15 pages long. Our hour long sessions often go for two or three as our discussions extend beyond the case and into the broader complexities of population health. 
 
But with all of this brain stimulating clinical complexity, the most rewarding part has been advocating for, guiding and walking beside my patients as they traverse a healthcare system that's often culturally unsafe and inappropriate. It’s the look of gratitude that comes with giving a family a skin kit and towels so that everyone in the house has one. It’s learning to put judgement and indifference aside to treat the person in front of me. It’s the realisation that much of what we do is deeply rooted in wider social and cultural contexts, and for us as doctors, it is the precipice of where science becomes medicine. 

I have come to admire the strength and resilience of our First Nations peoples; strength and resilience built on sturdy foundations of family and community and an ancient spiritual symbiosis with the land that we are so fortunate to share. 

I think I've found my forever home in Indigenous Health.