June 27, 2005

so i'm just coming off my first day shadowing in melbourne...hardly know where to begin, so i guess i'll just dive in and see where i wind up.

i'm working with something called "north yarra community health" which is affiliated with at least 4 different clinics in the 'bad part' of town in melbourne...the money supporting these clinics comes entirely from the government. i got to visit 3 of the 4 clinics today, and it seems as tho they each have a specific purpose:

1) collingwood - biggest facility, probably 4 general practitioners working here at any one time (plus nurses, podiatrists, physiotherapists (aka physical therapists), etc. seems to see the widest spectrum of patients (everything from sore throats to migraines to bipolar disorder to ectopic pregnancies, etc etc).

2) fitzroy - medium sized facility, probably 3 general practitioners working at any one time (plus nurses, podiatrists, and dentists all under the same roof). nearly every patient i saw here was a current or former heroin user on methadone. there was one exception (an older gent with lower esophageal cancer), but for the most part this clinic is for heroin users with drug habits more or less under control who are dealing with the socio-emotional aspects of recovering from addiction.

3) smith st. - tiny facility, maybe 1 or 2 general practitioners. this is for heroin addicts with addictions that are not under control. from what i hear (i only stopped by, but didn't see any patients here), these patients are the most difficult to manage.

today i shadowed dr. barbara hoare at collingwood in the morning and then dr. dave jacka at fitzroy in the afternoon. the most striking difference i noticed with my previous icm was the amount of time spent with each patient. the patient dictated the length of each visit, with some going visits lasting 5 minutes and others lasting up to 60 minutes. dr. jacka's attitude is that it is more efficient to tackle all of the patient's issues in one go, rather than spreading them over several visits.

i think i'll leave it there for now...i'm still trying to piece together the insurance puzzle here. there is universal coverage, but it's not quite as simple as that...

other notes:

1) first two things you see when leaving the melbourne airport: holiday inn and mcdonald's...you almost doubt that you've left the US!

2) except for the fact that everyone drives on the left side of the street...still trying to wrap my head around that one and not get myself run over.

3) the store you see on most every corner in downtown melbourne: 7-11! bizarre.

4) kangaroo meat...yes, i tried it. basically hard to distinguish from beef...really just a tourist dish cuz authentic ozzies don't eat it much by all accounts. and nobody drinks fosters (supposedly australian for beer) either...it's all victorian bitters and xxxx here.

5) cricket...i think i actually understand the rules now! but ozzie rules football is a whole other story...

translations:

repeat = refill
one off = one time only
capuscin = green pepper (to distinguish from table pepper)

so many more, but i'm too tired to remember them now...

tomorrow: off to one of the jails in melbourne to do drug treatment sessions there with dr. jacka...that should be interesting to say the least :)