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BRANCH news northern territory

I arrived as a new graduate speech pathologist in Alice Springs in February and stepped out into the sweltering air full of flies. I was excited but also somewhat apprehensive, and wondered what this town had in store for me. My interest in rural/remote health began when I was a student – our lecturers had always advocated for rural health and encouraged us to explore options beyond our home city (Sydney). I was interested, but being shy and introverted, the notion of being removed from familiarity also terrified me. I was fortunate to have a variety of placements during my studies both around and away from Sydney. Although many of these placements were neither “rural” nor “remote” (they were just ‘not in Sydney’, which, in my naïve student eyes was the same thing as rural) it did become a kind of catalyst or beginning of a preparation for what was to come. Having learnt that I could survive being away from the city, family and friends, I was open to applying for rural/remote positions when my final year of studies came to an end. I did not however, think that I would really find myself being offered a position at Alice Springs Hospital (ASH). As a result of my lecturers’ efforts, I had a vague idea of what to expect in the rural/ remote setting such as the high ratio of Aboriginal and/or indigenous clients, cultural differences and the need to be a ‘generalist’ due to staff/resource availability. What I did not expect in Alice Springs was: that Aboriginal and/or indigenous patients made up almost 90% of the caseload; the level of impact on patient care and service delivery due to limited access/availability of services and resources in communities; that for many patients English was their second, third or fourth language; that many of these patients rarely had contact with Western culture or medicine; that family and cultural commitments often took priority over medical procedures for many patients; that many patients would Take Own Leave (TOL) even though medically they were a high risk; and that there was quite a different system in place even within the hospital. All of these factors made an interesting contribution to my first foray into the workplace. Suddenly there was more planning and clinical judgement required around assessment and therapy

My experience as a new grad in Alice Springs

Ha Young Lim left her hometown of Sydney to take up a placement at Alice Springs Hospital.

occasional missed referrals to speech pathology. I thought that certain referral pathways (e.g. blanket referrals for stroke/ TIA patients) were standard across hospitals. I have found that depending on who is seeing the patient, referrals can, and have been missed – e.g. stroke/TIA patients not being referred to allied health or placed NBM (as per National Stroke Guidelines); and patients on bed rest being given food and no referrals made to speech pathology despite coughing/ choking episodes. I have thus found myself in needing to approach relevant parties to discuss these issues – a fine balance of best practice and professionalism. I am now almost halfway through my 12 months in Alice Springs. In addition to my development as a clinician, I have visited the amazing Uluru, Kata-Tjuta and King’s Canyon; gotten into bike riding, hiking, camping and the outdoors; learnt to cope with living in a communal setting (nursing quarters); and learnt to cook and clean for myself. The things that surprised me when I first arrived are barely registered now, and I have learnt to work around things I initially considered a barrier. As my manager noted jokingly, I am “still here, and haven’t run away, so it’s a good sign”. Alice Springs has given me an opportunity to grow as a speech pathologist and also as an independent adult by showing me that I should not be afraid of new situations and challenges. I am now looking forward to what the remaining six months brings!

due to language barriers. I found myself working with Aboriginal Liaison Officers for language interpretation and cultural brokerage, when previously I was only just aware of the position existing. There were rarely ‘textbook cases’ and adjustments around assessment and recommendations were frequent to account for cultural sensitivities and differences. Relationships are a key factor in any environment, and I discovered that it was even more so in Alice Springs. The transient nature of Alice Springs means that every few months or even weeks, there are new nurses/doctors/allied health professionals leaving or joining ASH. I was told that often “referrals were based on relationships” and there was an emphasis on “making my presence known” on the wards when I first arrived, to ensure referrals were not being missed. Luckily for me, since I started there has been an increase in referrals on the wards, I am less frequently mistaken for the dietitian or a doctor and hospital staff are reporting increased awareness about speech pathology. Aside from meeting clinical challenges arising from such a transient environment, another challenge to meet was the impact of the physical, social and psychological isolation. It is difficult and draining finding a good friend in someone, only for them to leave 3 months later and for the process to repeat itself over and over again, and this is something I know I will be learning to cope with for the duration of my time here.

There have been some interesting occurrences at times including the

Ha Young Lim (Summer) Graduate Speech Pathologist

Speak Out October 2014

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www.speechpathologyaustralia.org.au