public toilet map

I love this country!

I was looking for camping grounds in and around Freycinet National Park, in Tasmania, and I stumbled across this website.



Check out the very informative website: The National Public Toilet Map - The Australian Department of Health and Ageing

The name of the website includes the word "continence". THE NATIONAL CONTINENCE MANAGEMENT STRATEGY!!!!!!! They have a strategy for managing continence!!! Can you imagine winning a government seat in a hard-fought battle in your electoral district and being named the minister for continence. It would clearly put Depends(TM) out of business in North America if the government took responsibility for continence. Tee hee hee. I'm going to be giggling about this all evening. This has made my day!!! Clearly, important that people don't lose it in the middle of the bush, but make it to a friendly, neighborhood, government run toilet. In fact, you can plan your trip around Australia based entirely on the location of the toilets. You can bookmark your favorite toilets. And if you can't find one, you can have the website downloaded to your mobile. I love it.

Of course, I laugh now, but after 2 or 3 kids, maybe I'll find it much more serious. Maybe I'll aim to be the named to the ministry of continence. Maybe we need one of these in Canada. After all, wandering around in the +30 degree weather to find a toilet is nothing in comparison to having to drop your drawers to squat when it is minus 40.

The week that was

Paul and I had our first week of work. Work it was. My shifts are truly shifts now. The day time shift is from 8am until 9pm, and the night shift is from 8pm until 9am. You can get out slightly earlier than 9 if handover goes quickly, though it rarely seems to. Last week I started with three days of day-shift, then two days of night shift, and then two nights of Pediatric Emergency Transport Service (PETS) call. It has been interesting, and exhausting.

Day one of work - all I really remember is running around like a chicken with its head cut off, and not know how anything worked, where anything was, or how to do any of the administrative load. Fortunately, none of my patients acted up. My first task was to administer a general anesthetic to the baby coming off of cardiopulmonary bypass (called ECMO when they are on it for extended periods of time). I'm used to the anesthetists doing this, so it was a new experience for me - I couldn't see the baby the whole time, and don't think that I took my eyes off of the patient monitor for two seconds.



Next was figuring out how to do all the paperwork. It was a really good thing that I was only in charge of 3 patients that day...sooooooooo much paperwork. We are incredibly spoiled in Canada. If you want an IV fluid and a drug, you just order them on an order sheet, and the nurses transcribe them to a patient kardex (for example, midazolam 4mcg/kg/min). Here, there are order sheets for every different type of medication or infusion: an order sheet for IV infusions, one for regular drugs, one for frequently given medications, and a different one for one-time infusions. The IV infusions have to be rewritten daily, and you can not just order the drug to be infused. One must order how the drug is to be mixed (for example, 3mg/kg of midazolam = 35mg in 50ml of 5% dextrose-heparin, 1-4mL/hour = 1-4mcg/kg/min). It is all very time consuming!

By day three, I was getting the hang of it. I had to intubate one of my little patients who was not doing very well, and gained a new appreciation for all that the respiratory therapists at in Canada do. They get everything ready, do the taping, make sure that we know what equipment we are using, set up the ventilators. Here, the nurses are amazing, and with their help I'm learning to set everything up for myself. So much to learn! I do love being able to change the settings on the ventilator without getting my hand slapped by the RTs though.

My two nights were relatively quiet. You aren't supposed to sleep over night, because it isn't a 24-hour call but a 13 hour shift. So, when things aren't exciting, they are painfully slow. I circled the rooms many times checking on blood work and ventilator settings, but the nights do drag on.

The last two nights were PETS calls. The first night, blessedly, there were no calls so I got to catch up on a bit of sleep. Last night was a doozie, though. The PETS team is the regional transport service for any child felt to be sick enough to go into a pediatric hospital. They don't need to be sick enough for ICU, just the hospital. Which means that we seem to transport a few not-so-sick kids who, at least in Ottawa, would be transported by regular ambulance service. My phone call at one am was for a cute, but very cranky, 18 month old having an asthma exacerbation. He was stable, so we babysat him while we went from a hospital in Frankston to the other peds hospital in town (Monash). When we got back by cab to the Roayl Children's, there was another call waiting for us. So, out we went again to a hospital called Box Hill, where there was a significantly sicker child. I finally got back home around 10:30 this morning, and crashed.

During this crazy week, which I am to repeat many times over this year, Paul was sweet. I had dinner at night, the bed was made (which was good because he clearly was not going to wake up at the same time as me), the dishes were done...how lucky am I. He has started working on his year-long project to try to make a go of stock trading. Slow going at this point, as he is still at a stage where he is setting goals, reading and finding a relevant computer program. It isn't looking like actual trading will take place for the first several months, but he would be better able to describe that, and I can't seem to get him to contribute to the blog.

I think the major highlight this week, though, was getting a bike. It's a great little hybrid that I got used at a very nice bike shop. The brand is Kumo, which I had never heard of before, but is apparently a Canadian brand, and the exact bike is a Dew. It's got new wheels, new pedals, and a bell! Not that anyone here seems to pay any attention to the bells. There are cyclists everywhere, and they are generally ignored by both the cars and the pedestrians. So, I also have a goof helmet, and a flashing back light, and now I just need a front light. The freedom! I feel like I can get anywhere, and it is so much faster. Also, after 13 hours of work, the last thing I feel like doing is walking home for 35 minutes. Although it isn't far, after my shifts I seriously lack motivation. Tomorrow I'm bicycling down to the beach at St. Kilda's.


Now, I'm on a week off. The benefit of working like crazy. I'm not sure if the week on/week off thing will last, but for now, I'm looking forward to some serious sleep!

Lighter fare

I've been getting requests for blog topics, so am happy to oblige as much as possible. We will begin with Australian oddities.

First, $$$$$$$$$. Everything here is SUPER expensive. At first, we thought it was just apartments, then just drinks, now we realize it is everything. Let me give you some examples.

A banana - $1
An apple - $1
Green peppers - $7/pound
Loaf of bread (not specialty, just the mass produced stuff)- $4
Head of lettuce - $3
Paperback novels (not the nice, bigger trade paperbacks, just the crumby little glossy-covered ones) - $30. That's right, three-zero. Paul nearly choked.
A bar of chocolate - $2. Small bars are $1.20, and Cadbury's bars like Fruit and Nut are $2.50
A movie - $15.50 (per person, and that is at the alternative cinema. No cheapie nights. That said, the concession food is cheaper than in North America)
2-bedroom apartment - anywhere from $300 to $1000...per WEEK. The $300/week apartments aren't nice, so we aren't at the bottom, but we aren't near the top.
Bike helmet - cheapies are over $50
Sneakers - $200 (not the special ones, just a pair of normalish joggers. But if you go to the markets and are willing to buy last year's models, the prices come down to $100).
Cell phone calls - $1 per minute on the cheapest plan we could get

As you can see, the increase in salary here is necessary, because the cost of living to soooo high. Paul and I are easily spending $100 a week on groceries, usually more.

That said, there are a few things we really like about society here and how it functions. First is the fresh food. All of the fruits and veggies are grown in Australia, and so the transportation of food over long miles is less. Also, the farmers here receive no subsidies. None. That means that they have to charge more for the food, but all of the farming is sustainable (at least until the water runs out) and only based on demand. So, we have been okay with paying a bit more for the fresh food.

Second is their water conservation. Years ago, they legislated toilets that had a maximum of 6L per flush, and all of the toilets have the option of a 3 or 6 L flush, depending on what you are trying to flush down. You get the drift. In North America you have to buy specialty water-efficient toilets to get as low as 6L. Of course, you do kind of lose the energy efficiency if you have to flush more than once ;-) People save their shower water to water their plants, and you are not allowed to put a hose on to your grass or garden. There is an ad campaign encouraging showers of less than 4 minutes, rinsing food in standing water rather than running the tap, etc. It all makes a lot of sense, and it is necessary in this desert country. Paul and I are realizing how much we have always taken water for granted.

The counter to that is that they seem to be terrible at energy conservation. On the one hand, every appliance comes with a sticker touting its energy efficiency. On the other, you can pass stores and government buildings on any hot day, and the air outside, around the door is cool with air conditioning.

Australians like to speak with as few syllables as possible, though sometimes the abbreviated form isn't actually shorter. Everything is shortened with "ie", or just cut off altogether. Residents in the hospital are resies, registrars are regs, tutorials are "toots", Australians are Aussies, Tasmania is Tassie. Bickie is a biscuit (no cookies), prezzie is a present, brekkie is breakfast, footy is football (they have their own version that is a mix of American football, soccer, and rugby), mozzie is mosquito, barbie is bar-b-que (obviously), cardie is a cardigan. The list goes on. Needless to say, Jenny is easy for them. The most readily apparent strange saying is "How you going?" whic gets slurred together a bit to sound like, "Hayagowen?" It doesn't look all that strange when written, so you will just have to take my word for it. Whenever asked, and people ask frequently because they genuinely care, I still have to resist the temptation to raise an eyebrow at the grammar. Of course, we aren't much better. We ask, "How are you doing", which is regularly shortened in normal conversation to "Ha-ya doin'?" and don't bat an eye. We haven't really heard much "How ya goin' mate?", and have only heard "G'day" a couple of times.

Whenever you apologize for something, the standard response is "no worries", and flip-flops are thongs. Everyone seems to own a pair of thongs. Paul got a blister between his toes trying them, and he hasn't put them back on since. The other day one of the registrars fed one of the babies, and said "I was feeling clucky", to indicate motherly.

There is a park called Batman Park, and a street named Batman road. Apparently someone with the last name Batman was an early settler, and Melbourne was almost called Batmania.

We have seen the stuff called Vegemite, but are a bit afraid to try it. They do have cream-cheese spread in a jar, and it looks tempting. Can't find molasses, and although they have giant sections of baked beans, it is all in tomato sauce or bar-b-que sauce. The bar-b-que sauce, by the way, is gross. They don't have vegetable shortening, and I can't even find lard, though they have this stuff called copha that is coconut shortening. I'm a bit frightened to cook with it. The gummy bears and jellies are WAY better than in North America - they actually have flavor. The chocolate cooking squares and chocolate chips suck - less flavor. One little treat we have found is Turkish Bread. I don't know if it is actually Turkish, but it is a really yummy. Especially toasted with butter. Mmmm.

Overall, though, people here are people, and they are very kind. We've been invited for beers, and on trips with our building superintendents. We have had no problems getting around, and are loving our time here. We are settling in to as much of a routine as my crazy schedule will allow (I just finished 3 12-hour days in a row, and tonight I go in to work from 8pm til 9am for 4 nights in a row.) We miss home, but I'm now going to start planning our first trip, to Tasmania, so there is lots to look forward to.

Bushfires

This has been a week of tragedy. Victoria is undergoing one of the worst human and natural disasters ever. As many of you know from the media, there have been bushfires throughout the state of Victoria since last weekend.



Many of the fires were felt to have been deliberately set by arsonists; evil people who feel unexplainable exhilaration watching huge fires envelope land, homes, cars, and the people in them. With the dry weather over the last two months, any fire spreads so rapidly that people and animals often don't have the ability to outrun them, even in vehicles.



Over 7000 people are now homeless. The stories are horrible. A father and mother each had a child. The father ran back in to get the last child and flames engulfed the home. A mother and father and their son in a wheelchair couldn't make it out of their house. Two teenage girls died trying to save their horses. A father carried a charred little two-year-old out of their burning house. She was burned over 90% of her body and didn't survive. The rest of the family died, and the father is still in critical condition. I don't know if he would want to live. Then there are the animals. Cattle burned where they stood, barn animals trapped in buildings, and the forest animals who had nowhere to go. That some of these could have been started by other humans is unthinkable. Also despicable are the looters and scam artists who are setting up false websites and appeals to collect money for themselves.



Then there are the stories that warm your heart. They make you realize why, even when human hands cause destruction and loot the remains, we grieve when tragedy befalls other humans. A husband and wife ran out of the bush fire and got separated. Each thought that the other was dead until meeting up in one of the refugee camps that have been set up. Their reunion was broadcast all over the news, and brought tears to my eyes. Firefighters are working on 12 hour shifts, and have been going around the clock for days. A firefighter saved a koala from the fires. Australians have donated over $1 million dollars an hour in the last day to help victims of the fires. When the military asked people to donate one shipping container of donated goods to help victims set up housing, 14 were donated. Today, on my walk to work, a cavalcade of about 20 South Australian (the next province over) forestry vehicles came down the road. Cars stopped to honk at them and wave. Indonesia and Papua New Guinea, not exactly the world's richest countried, donated $2 million for the rescues and rebuilding.

Blessedly, very few children seem to have been burned to the extent that they needed hospital. Only two ended up in the Children's Hospital. This is a particular blessing because there seem to be so many very sick children from other causes. Certainly, Australia is bearing a terrible brunt from the changes in world climate. We can only pray for rain, and for the people who are homeless, healing, still dying and mourning.

Paul and I have both started work now. He is trying to get himself out of bed a a decent enough hour to get some work done. I'm trying to get enough sleep with daily 12 hour shifts. I'll write more about the hospital later, but for now I'm off to sleep.

First week at work!

I was happy to start work, but the title of this blog sounds more interesting than it actually was. I have yet to see a patient. Four days of orientation that were necessary to understand the workings of the huge hospital (10 floors!!).

The first day was a general orientation for all newbies to the Royal Children's Hospital. It was useful to get a tour of the building, and learn a bit about the system here. The two hours of sessions on how to recognize a sick child and how to order IV fluids became a bit tedious, but I really appreciated the chance to meet some other international visitors to the hospital.

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It seems that most people come from either Germany or the UK, and they come with reams of experience. I've been feeling that I'm getting old without ever having had a full time staff position. Nope. Here, I am green as green can be. The registrars (what they call residents) from other countries come over after years of training in their field. One woman also doing PICU has had a couple of years of NICU training, and is now on her fourth year of PICU training. I met a guy from Australia who is starting his training in ENT surgery. He has already done 6 years after medical school - 4 years of surgery, one year of general internship, and a year of finding himself. I think that the major difference, though, is that the training in Europe and Australia/New Zealand involves fewer hours per week, and the pay is better. This seems to give less of a sense of, "if I can just get through these next few years...", and more of a sense of, "why would I want to ever stop training?" I am hoping that I'll be able to learn a bunch from everyone's collective years of training.

The next three days were an introduction to the PICU. It seems like a fantastic unit. It isn't particularly new (the RCH must be about 50 to 60 years old)but the standards of care are high, the staff are excellent, the fellows (again, called Registrars here) are smart as whips, and the nursing staff seem keen and very experienced. There is a degree of respect given to the nurses here that I have not always encountered. Our handbook specifically tells us that we are to call the staff intensivist any time a nurse thinks that we should. We have been told on numerous occasions that, if we don't know how to do something, the nurses probably do. I am impressed to see this acknowledged so clearly by the staff, and get a sense that there is a real professionalism and cooperation amongst the team.

I will miss the respiratory therapists. In Canada and the States, if a child has an issue with breathing, the physician works with a member of the health team called a Respiratory Therapist. They know everything about the mechanics and physiology of breathing and problems with breathing, they run the ventilators, they help with mobilizing secretions through physiotherapy, they assess and administer medication for asthmatics...they are generally REALLY important. Here, the registrars and nurses do the jobs together. I am going to miss the RTs. Fortunately, they have these wonderful people called, simply, technologists. They know how all of the medical machines in the hospital work, which means not just that they understand the nuts and bolts, but they have been trained in the physiology behind human machine interactions. This is particularly relevant for ventilators. I, for one, am really glad that they are around.

The paper work required at the hospital is feeling a bit overwhelming. I thought that we would have more paperwork in Canada, being north of the biggest litigators in the world. Not so. For each child there is a written note, a typed note, an update entry into the discharge summary and an update on the handover sheet to complete...every day. Actually, twice a day because the day and night shift have to do it. Perhaps it will feel like a bit less when I'm actually doing it.

For now, I'm on off days while I wait for my 7 day stretch of 13-hour shifts to start. Now is Sunday, and this weekend Melbourne had the hottest day ever on record for the state of Victoria. The mercury reached 46.5 degrees celcius. This didn't affect Paul and I particularly, as we closed all of the windows and blinds, turned on all of the fans, and spent the day chilling out. It was over for us by midnight. But, unfortunately, not everyone has fared so well. The news continues to report fires still burning, and shows pictures of devastation from fires across the State of Victoria. About 80 people have ended up in hospitals across the city with burns. I suspect that there will be a few in the pediatric ICU when I arrive on Tuesday morning. Many more have lost their homes and livelihoods. It is not surprising, given the dry weather over the last 8 weeks. The first rains came last night, and there were only a few millimeters in total. The trees have been dropping leaves like maples in a Canadian fall, but without the vibrant colors. The grass is brown and plants are, for the most part, wilted. I've never wished so fervently for rain.

pictures!

Here is the link to our Picasa pictures. I'm still figuring the darned thing out, so I may need to resend a link each time I upload new pics. I'll keep you posted.

Australia January

Melting, I'm melting!

(Written January 31...we now have an internet connection!!!)
The last four days have been miserable; the worst heat wave in Melbourne in about a century. The temperature was regularly 42 to 45 degrees Celsius, and the worst part was the breeze. Melbourne frequently has a breeze; it’s been one of our favorite things about the city. Now it is hot air. I’ve never felt anything like it. The wind blows and it feels like being under a hair dryer. It provides absolutely no relief. We get up in the morning in sweat, shower, and before we’ve toweled off, we have another layer of sweat starting. Stand in front of the fan to get it off, and then try to apply sunscreen. It is unbelievably difficult to get sunscreen to absorb into sweaty skin. Sound pleasant? Paul and I are starting to wonder if negative 40 degrees is better.

Public transport was in shambles. The trains are really only equipped to deal with up to 35 degrees. So, there were trains breaking down, and people sweltering, fainting, etc. Paul and I rode in one tram that kept having to wait for the one in front, that seemed to break down at each stop. We sat in the tram in what must have been 46 degrees, with no breeze, no air conditioning, a hundred other bodies, and sweat running down everywhere. Pleasant, I know. The transport company gave the whole city a free day of transport to apologize for the lack of reliability.

Melbourne Offers Free Travel as Heat Wave Buckles Rail Tracks

I felt most badly for the tennis players, actually. The Australian Open was on during the last two weeks, and the poor players must have been dying. They finally closed the roof of the stadium, but not until players had been trying to survive 46 degrees. Inhumane. One of the players described it as being like an out of body experience. I can only imagine.

After 48 hours of this, we decided to get an air conditioner. We didn’t want to buy a particularly expensive one, because we figured that our apartment would be pretty comfortable most of the time, and we’d just need it for the really hot days. So, we braved the 45o heat, and walked to several electronics shops, and found the cheapest one out there - $680. It was a floor model, so wasn’t in perfect shape, but we figured it was our best bet. There were no used ones for sale – everyone was buying. Even the window models started at $600. Things here are soooo expensive. So, we got the machine (without a box, but the guy at the store bubble-wrapped it for us) and then got it into the trunk of a cab, and brought it home. Paul did all of the heavy lifting, even less pleasant in the heat, and we got it up the stairs and unwrapped it, and it didn’t have all the parts. Sigh. So, we called the store, and they said, “oops” and sent a guy over with them. By the time we realized that they didn’t all fit, and we were still missing a part, the guy was gone. So, Paul got onto a tram and went back to the store, got the extra part, and some duct tape to try to make it work. Two hours later, he was back and had the malfitting parts duct taped in, and we thought we were finally up and running. Of course, as luck would have it, the thing was not working well. The hosing seemed to be giving off as much heat as the air conditioning was fixing. It didn’t touch the living room, so we moved it to the bed room, where it did help a bit overnight, but kept us awake. Every hour it would start dumping all of the accumulated water out a little nozzle. Apparently it was supposed to be attached to a hose that also didn’t come with the unit, and the hose going out the window wasn’t its escape point. We traded bucket duty all night. Although the machine was supposed to be 13,000BTU and able to completely cool a 25 square meter room, our little 9 square meter room remained about 30 degrees. Needless to say, the next day we packed the pile of junk back in its bubble wrap, along with the mismatching parts, got ourselves another cab, and in 42 degree weather hauled it back to the store. We hadn’t really wanted to spend that much on an air conditioner anyway, so we were glad to have the money back, though weren’t sure how we were going to sleep that night.
Last night, we treated ourselves to an air conditioned movie. It was beautiful. For two hours, we weren’t sticky. The movie was even better. Gran Torino was another memorable Clint Eastwood; well worth the money, but bring tissues. When we got out, there was this wind blowing…it was cool. Finally, the heat wave had broken. It’s been about a day since then, and we are waiting for the apartment to completely cool off, but are thinking that we might actually be able to use the covers tonight.

I start work tomorrow with orientation for the next four days, and then full steam ahead. My vacation has been wonderful, and I’m going to miss the lack of structure that went with the last month, but it will be good to get back in to some work, and especially to start putting money into the bank account.