"This man had complaints for at least the past 10 years. Not acute. He was hearing voices, and the voice was telling him to do something dangerous for himself and for others. I was concerned about that. He has alcohol issues too. I contact the nurse from Tendara, the coordinator of Tendara Alcohol and Drugs. They also have a counselor. In that stage, I contact him and I start to work with the staff in the Tandara House. We start to work with this patient. He and I went to the clinical mental health triage because we thought it was an urgent matter to assess this patient. The clinician assessed him. He had an assessment by the end of the week. The patient was concerned about the very intense voice. He had fast speech and was aggressive. We started with olanzapine 2.5 mg and the voices decreased at that stage. [That's a very low dose by U.S. standards!) He gets a follow-up every day either by the nurse, the aboriginal health worker, me, or the mental Health clinician."
We were impressed with the community based support. Both Rocky and I commented that we had nothing like this in our practices to support us with our risky patients.
Miriam continued, "Sometimes here the patients are in jail because of their mental health problems. The police don't know what to do. They're worried about safety and they are scared. Once we had a fight in the community. They don't want to go there because they know it's two families fighting. They don't want to get involved. They went to us to get the training.
"I started to do home visits on Thursday and Friday. Some patients don't like it because they want to have their party. I went to one home. "Look doctor. I already had four beers.' Some of them are alcohol but they drink as a community event. It's specific houses. They put out high levels of sound. They are very nice. They say, "Don't come here Thursday or Friday.'"
Rocky pointed out that Miriam had instances of working with elders in the community that had gone well. He knew that from his previous visit to consult to the physicians. Miriam added to that:
"When I arrived here, I didn't understand the concept of elders. With time, I understand. I went to some meetings they had and the elders are there. I was invited to a meeting with the governor. Uncle Albert was there. Elders were there. I asked about some of the elders looking young. Marion, an elder, told me about some of the families who have these specific people as a role to be taking care of the community. Sometimes Marion brings the case and tells me what the patient needs. I listen to her. When I come to the patient, I take the issue to the patient. Marion is an aboriginal health worker too. Uncle Albert is another elder. He told me whenever I need something, call him. He explained to me the relationship among the families and within the families. Some elders bring the patient. They are taking care of the community."
Are there instances where you've been able to connect patients with their traditional healers?
"They are not open. That is the first time. With your consultation I have more contact with Marion because of my background with her. I had contact with Elaine, another elder. She was very strong in the bush medicine. She invited me once to go but I didn't have the real opportunity to go there. Death is very common here. Since I arrived here, every month I have one death. First month was Linda T. I had seen her at the hospital. She had aspergillosis and a big cavity. She came to me and was so nice. She told me that you have a lot of work. She knew she was at the end of her life. Last week we had another funeral. Every month someone has died usually of chronic disease complications. They have grief. They have been missing some important people in the community.