"The traditional healers are still elusive but I know who some of them are. It's a gradual process, but there is movement in a good direction for me to know who they are."
Rocky noted that Miriam builds relationships with the people. She said that she sees that they watch her. "They want more black people in the health center. They want less white people. A good elder is Bonnie, a hospital liaison. Bonnie is very important for me. Bonnie is another person I ask about very sensitive issues because she is very knowledgeable about the health system and she is an elder. She started the Coop. She was one of the original circle of women. Marion was the other.
"I remember a patient who came from Queensland with abdominal pain. She had pinpoint pupils every time she came. I sent her to emergency. They gave her naloxone and the pinpoint pupils returned. Bonnie came to me and told me they are using morphine. I sent her back to the hospital. That way, it was easier to understand what was happening with the patient. Bonnie brought me the problem. She knew the patient and her partner. Her abdominal pain was actually narcotic withdrawal. Tramadol was there too. It was lovely to have her as a patient. I remember when she decided to talk to me about the issue. She said, "You cannot help me'. She told me she would go back to Queensland. It was more issues than even I could help. Her husband came once and was very upset with me because I took the medication from the hospital and held it at the hospital. He was so upset because he wanted that morphine. I told her this was not the medication for her (morphine). She was abusing morphine, then going to emergency with acute pain and getting morphine, which relieved her withdrawal symptoms, and then returning when the morphine wore off again."
"I couldn't help that patient because her husband didn't want help. Part of the process was to get help for both. I was walking outside. She went first. He went after. Then I followed. I heard him demanding her to ask for morphine. She told me that the pain was inside her and that it wasn't in her abdomen or her back. It was a deeper pain than I could understand.
"When I arrived at health center I learned about Schedule 8 drugs. One of our doctors is a police officer, too. Some of her patients are methadone patients as a harm reduction program. I don't have the permission to have the schedule 8 medication. I can only prescribe for two weeks. Whenever I get a patient with Schedule 8, I refer to three different doctors. Two are from mainstream and have Schedule 8 permission. One is from health center. Some of patients from the methadone program are not on the program any more. They come only to review or get drugs in an acute setting. They are not in the methadone program any more. They are still trying to get the drugs. I have been consistently sending them to alcohol and drug follow-up with the nurse in Tandera. The number of patients with these same issues are large but they are decreasing for me since I started. Some of the patients looking for drugs, stopped. They started to go to mainstream doctors as their prescriber. They stopped trying to get more drugs from us. I have contact with these two mainstream doctors. Patients say they can't get the medication. Then I call the doctor right away and that doctor says send them right there.
"Patients sometimes go to several different doctors. They are very complex patients. They are not only shopping for medications, but are very addicted patients. They are trying to get more benzo's, more narcotics ". It's easier to send them back to the prescriber. They start not coming back to me.
"Schedule 8 drugs are everything with morphine, oxycodone, fentanyl and the like. I have the right to prescribe for two weeks. There is a pharmacology course for those who want to prescribe for longer. You have to do it and apply for MedCare. You have the right to put your name on the Medicare only for aboriginals. Bairnsdale is the end of the train line from Melbourne. We don't want every addict to come to Bairnsdale to get these drugs.
We finished the discussion by talking more about my pain group in Vermont and her pain patients. More about that discussion will come later. The night was getting late and everyone wanted to go to bed.