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Our Medicine Season 2 Episode 2
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00:00aboriginal and torres strait islander viewers are warned that the following
00:04program may contain images and voices of deceased persons
00:25previously on our medicine
00:27so yeah blanching
00:28med student kisha kicked off her rural placement
00:30she's come in with some itchy spots behind her ears
00:34like everything there's risks of course
00:36deadly visions prepared for surgery
00:39and the akiliata team began an adventure
00:47indigenous australians still suffer some of the highest rates of chronic illness and shortest life expectancies in the developed world
00:55as mob coming into these medical spaces we feel like everything's against us
01:00but change is happening is it painful no i've not even seen it across the nation's senior indigenous health professionals
01:07and traditional healers are joining forces with the next generation i know my mob i know my ancestors that keeps
01:15me grounded to create a future of better health for first nations people and all australians there are people that
01:23care a lot of people that care
01:36and our mates having difficulty breathing yeah that's and that's all we've got like no name no nothing
01:44in cairns veteran paramedic george finnamore and trainee rob minikon are on their way to assist a distressed woman who
01:53approached another ambulance crew for help
01:56my colleagues will look after you okay get you out to hospital come and hop on the bed
02:01get out turn down
02:04bit of a step bit of a step yeah just there
02:09okay i'll pop your keys in here so they're safe george and rob's 73 year old patient has been vomiting
02:16and has concerningly low levels of blood oxygen
02:21following a recent operation her respiratory system is compromised rosalyn had a tumor in her throat and she
02:31has removed and has a tracheotomy in place that's a hole in the neck to help breathing
02:40her trachea hasn't got a filter on her so she can't talk
02:45the open tracheotomy could be a source of infection but the first priority is to stabilize her condition
02:53your oxygen drop it down the 92 put this on your arm there
02:59still was having a very difficult time breathing but obviously because she had a tracheotomy we can't
03:03go over her mouth we've got to sort of improvise hold it over your trachea okay
03:11she could go into respiratory arrest where she stops breathing and then her heart stops and then
03:17we have like a cardiac arrest as well all right with stable oxygen ros is out of immediate danger
03:26but patients can be resistant to medical care even when they've made the call out themselves
03:31can i pop this in your ear darling okay thank you i won't do it hard it's all right it's
03:39gonna sit in
03:40this edmonton 142 transporting you're right darling and despite her current challenges patient ros is no
03:51shrinking violet
03:56bumpy yeah just watch the bumps no worries
04:00sorry roslyn i'll take it easy ros is directing me here to tell you
04:07that's okay though we try to please
04:16oh sorry though
04:25i look at how my mentors deliver their care how they interact with patients how they joke with
04:33patients i was telling her that rob was a racing car or rally driver or something and you just have
04:38a
04:39to joke with them you know it works for white fellas it works for black fellas you know it's it's
04:43it's easy to build rapport with anyone
04:47i think that's pretty much done now can i pop this on your nose
04:52just so you can breathe down you don't want it okay
04:57okay one two three at cairns hospital the acute response team is ready to provide ros with full
05:06emergency care um she can't talk her trachea hasn't got a filter on it there's a bit of secretion coming
05:13out of that as well i'd say she'd be on a full treatment of antibiotics intravenously they'd also
05:21put a new filter over that tracheotomy instead of it being exposed so she can go back home
05:28it's good exposure for rob to see it's showing him the different medical conditions we go to
05:37this is the kind of jobs that makes me want to go back and read so i have a better
05:40understanding
05:41of these things everything's a learning curve so it's amazing
05:55all right so we're just getting everything set up yeah everybody's at darwin hospital
05:59a group of first nations patients are prepping for life-changing eye surgery
06:05yeah a little bit anxious just to go through the process but excited for the end result
06:13so right eye and then give me first nations ophthalmologist dr chris ralla baker
06:20has returned to darwin to perform the delicate cataract surgeries why is it taking so long and this
06:26time he will be shadowed by first-year indigenous medical student aiden womb aiden will see the
06:33anaesthetic go around the eye and there'll be some sedation to make the patient feel a little more
06:41comfortable anaesthetist dr chris bradshaw is providing some medicinal relief for the anxious
06:48patients well some chilling air drugs coming from me there there are medications mixed into that sedation
06:57that reduce anxiety we've done that hard hard eileen you can relax now the eyes very mum
07:02dr bradshaw is excellent with his sedation he's just a whole approach it's a really culturally safe
07:07approach that he takes people feel very at ease by the time they get in here is your eye comfortable
07:12yeah thank you you're welcome
07:18after successful surgery to remove a cataract from his left eye uncle leonard has returned to have the
07:25other side done i'm 73 years old and i'm getting my eyes back oh my god it's incredible you know
07:32these young folks don't know what they're handling out but leonard's operation has gone off plan
07:40he ate this morning so he won't actually have any sedation he'll be fully awake but he's very
07:46comfortable with that and he's quite happy to go ahead with the surgery unsedated the most important
07:52thing is is relax and i'll i'll talk him through things as we go
07:57you're chris i am yeah how are you yeah you might hear me talking to aiden here is that that's
08:03your
08:03junior yes yes he's here cool oh that's perfect i'm gonna get started now
08:12aiden will be able to see the actual cataract being removed and the lens being injected
08:16you let me know if you're uncomfortable or feel any pain you shouldn't it's a wonderful
08:20anesthetic that dr bradshaw has done dr chris is conducting the surgery through a two millimeter
08:28incision breaking up the cloudy old lens so he can insert a new one
08:35very tight
08:39when you're operating it's already a very big thing for these people to come up to the hospital and have
08:44something in in their eye if you have a bad outcome it's very difficult
08:49to regain that trust you've got to get it right and you've got to get it right the first time
09:00what's that pink thing
09:03it's heartbeat
09:06his heart rate is um dangerously low
09:13a resting heart rate below 40 beats per minute
09:16can lead to brain damage or cardiac collapse
09:21we've got adrenaline in the bags do we peter yep
09:29if the heart rate doesn't climb the outcome could be fatal
09:45dr chris's patient is in mortal danger heart rate 36
09:53okay 73 year old leonard is fully awake and his pacemaker should be keeping his heartbeat stable
09:59but underneath the test dr bradshaw has discovered a problem
10:04it's a technical issue with the pacemaker
10:09okay give me the green please that's not my dream don't worry about the panel yep
10:13his heart rate was in the 30s and his pacemaker should kick in at a heart rate of about 50.
10:21chris i've just got to put a magnet on can i just talk to him yes
10:25can i fall back is that okay uh give me two seconds yeah i'll just wait till you're ready
10:30chris get above this iris i don't want to catch it because you're going to pulse it
10:38before they can address leonard's low heart rate dr chris must carefully remove the tools from his eye
10:44as any slight wrong movement could cause irreversible damage
10:51you can talk to him now leonard uh whereabouts is your page my boy okay
11:00is that you will feel it i called for a magnet is it there leonard yeah well i've got to
11:08put a
11:08magnet on put the magnet over the pacemaker yeah i can't i can't get it you're good i wasn't quite
11:15sure what would happen but i knew if it does work it would restart his heart at a satisfactory rate
11:29uh it's 77 88. wonderful thank you chris all part of discernment oh yeah thank you wonderful thank
11:40you there he's made a work in there yes working at the moment yes i bet a magnet in my
11:47pocket yes
11:50michael's saying so everyone's different anyone who tells the old cataract surgery is
11:54saying they've got no idea what they're talking about ready for the uh my cold when you're ready
11:59there peter thank you lovely lock it in with leonard's heart rate stabilized dr chris can finally relax
12:07and continue the operation i've never had a pacemaker malfunction during surgery dr bradshaw was able to
12:16put a magnet on the pacemaker and reset it and the pulse came back up so a very difficult complex
12:23case but we got there safely and we'll have a good outcome all right you got there thank you so
12:31much
12:32pleasure you put us all through our paces he was very very lucky that he was in hospital having his
12:40cataract surgery done and being monitored if he was at home and if he stood up with a heart rate
12:46of 36 he
12:47probably would have lost consciousness and it would have probably been a very bad outcome all right
12:52well that's as hard as it gets yeah all right pretty wild
12:59things don't always go the way that you want them to go and eight out of nine cases
13:03would seem like they're quite routine but then you get the odd case where if if something can go wrong
13:07everything goes wrong both chris and the anesthetist that did a great job at not letting that
13:13affect the outcome and the safety of the patient it's pretty exceptional how they can consider
13:18those variables but still focus on the patient and make sure that they can do the best work
13:22and it's just a very slow slow slow push
13:39that okay for you yeah yeah but you'll have to come back and see us next week and we'll check
13:44it again
13:46on palm island where 90 percent of the population is first nations colonization has left a legacy of
13:54chronic illness like rheumatic heart disease it was eradicated in the mainland long ago but yet
14:04we still suffer in this day and age compounding the problem there is widespread distrust of the
14:12the mainstream health system stemming from the island's traumatic history
14:20palm island was the traditional home of the mun borough people but from 1918 everything changed
14:30that year the queensland government began to forcibly relocate first nations people from across the state
14:37on to the island today's palm islanders are descendants of those relocated peoples plus the original
14:47inhabitants a population that traces its origins to over 50 different tribal groups
14:57my name's stanley palmer is i'm a proud descendant of the warungoo tribe here in north queensland my
15:04grandfather and his siblings were one of the ones that got sent from mission beach area all the way to
15:11palmer
15:11island under government policies which lasted for over five decades people like stanley's elders lived in
15:21harsh prison camp like conditions and was systematically deprived of adequate food and proper medical treatment
15:32it was a tough life being told what to do where to go every day by a superintendent listen to
15:41a bell
15:42that's ringing ringing ringing and we are still living with that transgenerational trauma
15:48even though some of us didn't go through that but our parents our grandparents went through that
16:01in response to the harsh conditions the people created a new identity
16:08the word bulgaman means many tribe one people so back when people were brought here to live
16:17you know stolen generation days people come together and created bulgaman as one mob living on palm island
16:27although the dark days of forced relocation are over
16:31the bulgaman people now suffer from some of the poorest health outcomes in the country
16:37and many are reluctant to use government-run health facilities
16:45however after decades of downward spiraling health trends
16:50in 2021 the community took control of the local primary health care center
16:56renaming it the bulgaman healing service and things began to dramatically change
17:04just in the blue chair there you pop your bags here
17:08getting a flu vaccine today yeah yeah bulgaman healing service is an aboriginal medical service
17:15where community run it's more welcoming for community come in and you say you're a bit nervous from needles
17:22yeah yeah yeah yeah all right big d press in and ready following a self-determined health care model
17:32which began in redfern in 1971 bulgaman healing service is one of 146 aboriginal community-controlled
17:41health services across the country which follow the same model of comprehensive and culturally safe health care
17:50all right it's more of a friendly setting it's more family orientated
17:58so we're just checking the hemoglobin it can indicate the iron levels
18:06we have that holistic approach we have night clinics here pediatricians physiotherapists
18:13dietitians all making an impact together we have our community members working in here as
18:20receptionists health workers like myself do you want to come through things community trust is on the rise
18:28all right ready since 2021 patient numbers have tripled from 1 000 per year to over 3 000
18:35all done thank you thank you it's early days but it looks like the trend of health outcomes on the
18:43island may be improving
18:49that same information knowledge that's been handed down to us it needs to be passed on to the next
18:55generation we can turn the transgenerational trauma to a transgenerational strength
19:13with just six weeks before her exams today fourth year medical student keisha kalyan will be facing one
19:21of her fears and then you're like i've done it once before my friend like technically i have done
19:26it before today i'm learning how to take bloods
19:32patient raymond needs regular tests to monitor his peripheral vascular disease
19:38but in the past getting a blood sample has not been easy with his vein he's got like jelly veins
19:45so
19:45when you put the needle in the vein just sunk sometimes it will move if you're too soft like
19:50even if you come inside with it would just move the thing you guys should go to turn and like
19:53give
19:54it a little like buss oh indigenous health worker salel will assist but keisha is only allowed two
20:02attempts before she must hand off to someone else thanks for having to run so you're going to squeeze the
20:11butterfly together i don't like needles and i hate getting my bloods taken so i'm really worried about
20:21missing all right you're ready
20:30nothing so just stop for a second have a little feel so you're just to the right of it so
20:37yeah
20:38turn it to your left a little bit how could you really be doctor yeah yeah i'm helping you
20:43telling me what to do that rob nah she knows everything i'm gonna land a lot off of it
20:49raymond's jelly veins are very hard to locate
20:54i'm like ah like feel really really really bad for stabbing them with a needle
21:03any flashback no all good all right let me just try and find it for you that somebody helps oh
21:09good
21:12do you want to anchor that for me oh the tape or what just holding your hand and then you
21:16can
21:17keep that still and you can swap that over keisha's stumbled at the first hurdle but there's still
21:25technical work to be done if she can hold her nerves keep pushing oh push i've got to get used
21:31to using
21:31this and just be mindful of your needle not moving yep you gotta release the tube and release the 20k
21:43yeah and then put your belly
21:49yeah get the baking when we do that that's it okay all done all right cheers
22:02i thought i would be better at it
22:07if she can't master this skill it will be difficult for her to pass the year
22:12you just get used to it okay just gotta keep going on yeah oh you're
22:17percent i think i'm psyching myself out a bit i need to get better
22:28hey april do you want to come through my name's keisha i'm one of the student doctors here nice to
22:34meet you
22:37having survived her earlier failed attempt to take a blood sample medical student keisha is not giving
22:44up okay i've got like massive empathy for if i take blood from someone and they i miss and i
22:50have to
22:51do it again i hate when that happens to me so i don't want to do that to someone else
22:56this time she'll be assisted by aboriginal health worker leon who's been taking bloods for over 12
23:02months which side would you go leon i find it more comfortable on this side all right let's go
23:08you just have a feel can't feel anything swap over okay don't have a feel i don't know if i
23:16can
23:16even for a seasoned veteran like leon finding a good vein can be a challenge
23:25there's one but we could have a look on this side yeah i might have a look on that side
23:29yeah
23:31you should just clean the whole area yeah and then if you want to tighten it like that hey no
23:39you just feel right here my fingers yeah all right let go a little sharp scratch
23:50oh yeah it's slowly coming now so i just hold it here hey
24:01you know we tried last time and i didn't get it but this time i did i was glad that
24:08i didn't have to
24:09do poker more than once take the needle out mm-hmm solid thank yous i'm really grateful to leon
24:22for helping me today and teaching me with the bloods okay that gives me strength and confidence for my
24:28practical exams you're done yes thanks i have a good teacher yeah the best
24:40around 300 kilometers southwest of ala springs the achiliada healing center has brought workers and
24:47their families to collect and experience a different kind of medicine following traditional protocols
24:54brings spiritual health and safety and strengthens mental health
25:00when you're traveling or anywhere you're going like to other places doesn't matter where you're
25:06traveling or wherever you're going respect the land tell them where you're coming from
25:11and introduce yourself to the country and to the ancestors are there
25:20have a look at the hills and towards the creek and you just sing out hi my name is chris
25:26i'm just visiting your country i'm just visiting your country i come from agenda being a pajaga
25:33mara langan jilling project mara chending gel marina known
25:39where physical mileageic merenden and and and country land and and and more at you know
25:48color after when you welcome yourself so you just come grab a little bit of water
25:55and just let the ancestors know that you are here visiting yeah
26:03worda my name liana i come from ala springs from jay creek
26:16or that my name is declin and i'm from town from jay creek
26:26hello my name jaylen and i'm from ala springs
27:06and george and rob are on the case
27:08so you've got two bones here and i think you might have hurt one of them
27:13while in broome keisha is thrown into the deep end do you want to run the consult i'm like not
27:19really confident in myself but i have to do it because it's going to be my job one day
27:24and on palm island dr rob blackley deals with a painful infection this is the worst part
27:30oh
27:31oh
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