Speak Out
October 2014
21
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
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
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!
Ha Young Lim (Summer)
Graduate Speech Pathologist
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.
