Darwin is the main city in the Northern Territory state of Australia and its surrounding area has a large population of indigenous people. The diverse population was one of the main reasons I chose this location for my elective. I was also keen to have a placement in paediatrics, as at my university we don't get our paediatric placement until final year and it's a specialty I am interested in.

Meeting the locals

I was placed with the community paediatrics department in Darwin, which provides outreach paediatric services to many remote Aboriginal communities. As a result, I had the opportunity to go on outreach trips to indigenous communities with the team. Some of these communities are very remote and require small aircraft to reach them.

Once you arrive at the community, a typical day includes firstly being introduced to the local healthcare team, such as the administrative staff, nurses and Aboriginal healthcare workers. The clinic would then start as soon as the first children arrived. I had the opportunity to examine the patients, talk to their families and discuss with the doctors their diagnosis, investigations and management plan. I was also able to sit in with other health workers, including specialist nurses.

New experiences

I saw many disease presentations which are not as common in the UK paediatric population, such as rheumatic heart disease (RHD). On one of my outreach trips I saw patients who were on four weekly benzathine penicillin G injections as secondary prophylaxis for RHD. Some of the children were on the injections for more than 10 years, so education and an understanding of the disease was of paramount importance to ensure compliance to the treatment. The children would be seen by a doctor to assess their heart and then they would see the rheumatic disease co-ordinator for more education on RHD. This included a short video in the local language on the importance of diagnosing acute rheumatic fever early, and also adhering to the prophylactic treatment. For example, we saw a teenage girl who had damage to two of her heart valves due to RHD and required counselling for a double valve replacement.

As well as RHD, failure to thrive and behavioural problems such as attention deficit hyperactivity disorder (ADHD) were common presentations at the clinic.

My elective: Darwin

Hannah Pennicott

My elective: Darwin