Making Mistakes

It has been said that “to err is human” yet there are endeavours in which error cannot be accepted. The airline industry is an obvious example, and the nuclear industry is another.  Dose this mean that to be safe we need to remove humans from the equation?  The short answer is ‘Yes’ and that is exactly what has been done in the above examples.  Humans are still involved, but systems have been created that monitor for errors and correct or prevent them.
Now to health care.  In many ways, errors must be avoided because they cause illness or injury, increased length of stay in hospital, or death.  Everyone accepts that errors are bad, but for some reason it is expected, by regulators, managers, the public, and health care practitioners themselves, that health care will be error free. In effect we expect that health care workers are not human! This is patently absurd because it is their humanity that makes them effective.  For all our faults and propensity for making mistakes, humans are still better at caring for other humans than machines are. Granted, there may be some individuals who do feel they have a relationship with ‘Siri’ on their iPhone or iPad, but very few people would actually choose to have nursing or medical care delivered by a machine. The therapeutic relationship is a crucial component of caring.
The expectation of perfection is therefore unrealistic and unreasonable, and in fact is not supported by case law.  The law accepts the concept of ‘reasonableness’ which therefore allows for mistakes.  So why does everyone else, including health care workers themselves, expect perfection? I think it is because mistakes are taboo, and that is dangerous.  Very few health care workers go to work intending to harm someone that day, and if someone is harmed they feel tremendous guilt and self-doubt. We are typically not trained to deal with mistakes, as the unspoken rule is that if you are ‘good enough’ you won’t make any.  So we hide our errors, possibly even from ourselves. If you do report an error and the report is then mishandled by managers who take the easy approach of blaming you for it, you will be far less likely to report any future errors.  What about near misses?  If no harm was caused, forget about anybody reporting it.  This robs the organisation of any chance to prevent future events that might not be near misses.  In many causes, managers only have themselves to blame for this culture of avoidance.  You can’t encourage a person to be honest by beating them every time they tell the truth!
That’s the problem, and it’s a big one.  What can we do about it?  Firstly, we must adopt a no-blame approach to incident reporting.  Mistakes happen all the time in health care, yet very few are reported especially if the patient was not obviously harmed or not aware of the mistake.  Then we must investigate the incident reports to work out what system faults caused the error or allowed it to progress.  In some cases the person is the problem, but that should never be the first or primary conclusion because no-one works in isolation from the systems.  Disciplinary matters have their place, a long way down the priority list.
We need to educate health care workers that mistakes are inevitable and our only hope of preventing them is to work together.  ‘Two minds are better than one’ rings true as cross-checking is a valuable tool to detect and prevent mistakes.  To make this work properly, all participants have to have a voice, and be heard. Part of investigating an incident report should be about how cross-checking failed, and whether the error could have been prevented if someone had spoken up.  If so, what prevented them from doing so? Shifting blame to the person who didn’t speak up is unhelpful, so the focus is on addressing the culture of the workplace so that everyone has the right to speak.
In summary, errors are inevitable in health care, and will remain so because humans are involved in it. Systems need to be created that help fallible humans to detect and prevent them before harm is caused, and these systems cannot be based on blaming the person who made the mistake. System change is driven by incident reporting, and the focus of investigation must be heavily biased towards finding system flaws that facilitated the mistakes. Finally, we all need to stop expecting the impossible s that just perpetuates the problem.

Motivating staff to own up to mistakes

Ever wondered how to motivate staff to report mistakes such as medication errors or minor injuries at work?  I’ve spent time in many workplaces over the years, in agriculture, volunteering, healthcare, and education.  Each workplace has had its differences, and issues, but in every one of them I saw people hiding their errors.  Mostly this was because when they had ‘owned up’ in the past, they were punished for it.  It has happened to me plenty of times in my working life, and often I didn’t report errors if I thought no-one would otherwise know about them.  The problem with this outcome is that the organisation ends up with a low rate of incident reports which might sound like a good thing, but it’s not.  An incident-report rate below expected norms for the relevant industry might mean the company is brilliant at safety and quality, or far more likely it means that the company lacks a safety and quality culture that values incidents as learning opportunities.
How then can a workplace motivate staff to report errors?

  1. Adopt a no-blame approach to incidents.  This is critically important, and has to come from the very top of the organisation.  Staff may well be nervous when implementing a no-blame approach and find it hard to trust that it is real.  Leaders and managers must realise that one badly handled incident will set the process back by months or years.  Don’t blame your staff for errors, and don’t knowingly allow any outsiders to blame them either.
  2. Give credit.  Acknowledge the courage of staff who report incidents especially ones which would otherwise be unknown.
  3. Highlight the positive gains that arise from incident reporting as they relate to workplace goals.  Safety and quality is the key, not paperwork.  Celebrating the introduction of a new checklist is not a positive gain in workers eyes if it does not relate to observable benefits in safety or quality.  That’s not to say that such things are un-needed.  Just don’t highlight them as key achievements.
  4. Apply consequences to line managers and senior managers who breach the no-blame approach, and do so transparently.  If workers don’t trust management, the problem won’t get fixed ‘behind closed doors’.
  5. Make incident reports a Key Performance Indicator for the organisation in the domains of worker engagement and safety and quality.  If the rate of incident reports is well below industry norms, critically appraise how they are managed and whether or why there is significant under-reporting.
  6. Educate all staff from the most senior manager to the student on work experience about the crucial role of incident reporting in securing improvements in safety and quality.
  7. Include incident reporting history in performance appraisals and staff development agreements, by linking a strong track record of incident reporting to a commitment to a culture of safety and quality.
None of this is easy, but it is all readily achievable if the organisation takes it seriously.

2015 Family Update letter

Here we are again, after a three-year gap. This year I am actually writing a letter! It’s not that there was nothing to say about 2012-2014, just that by the time I got around to writing each year it was halfway into the next year. So I thought I’d just wait a bit longer and try for a 2015 letter. Here goes …
Claire, Laura and John hiking near Cradle Mountain
We ended 2012 and began 2013 with a holiday in Tasmania. Laura, Claire and I hiked the Overland Track from Cradle Mountain to Lake St Clair. This trek was 5 days of hard work and fantastic scenery, and we celebrated the New Year under the stars. Anita was relaxing in Hobart in a respite care facility while we were slogging over the mountains, and Erin visited with her Nana and Opa. Then we all joined up at Hobart Airport for the rest of the Tassie holiday. Evan joined us with his Landcruiser as well, so we got to do some of Tasmania’s excellent 4WDing. The other big events in 2013 were Laura’s 18th birthday, her completing Year 12 with excellent grades, and getting a place at Charles Darwin University to study nursing.
Laura and John driving the Telegraph Track on Cape York
The big trip for 2014 was a return to Cape York. Erin was 2 ½ when we did this trip previously so had no memory of it. Laura drove her Patrol for the trip, which was it’s first major expedition since we completed the rebuild. The waterholes, creek crossings, and scenery were every bit as good as we remembered from the trip in 2008. One extra addition this time was a ferry ride to Thursday Island for Laura and I. This is one part of the world that could do with some more exploring if we get the opportunity!
2015 included some milestones and highlights as well. There was no Big Trip, but lots of smaller ones, some with all of us and some by myself. The travelling kicked off with a cruise for Anita to celebrate our 20th wedding anniversary in 2014. It took that long to arrange everything that we actually had our 21st anniversary during the cruise. It was Anita’s first time out of Australia, and we spent 14 days on “Voyager of the Seas” visiting New Caledonia, Fiji and New Zealand. 
Camping in Flinders Ranges for John’s 50th birthday
Then there was my 50th birthday party in the Flinders Ranges is SA, where we camped for a weekend after driving both the Landcruiser and Patrol nearly 2000km. Laura got to try out her new winch that I’d given her for her 19th birthday, and I got to see all my siblings and a large number of nieces and nephews which was pretty special because it’s rare these days. Another trip to celebrate Anita’s stepfather’s 80th birthday ended abruptly when we hit a cow with the Transit van. After rolling onto its side and spinning a few times, the van was a write-off and we returned home shaken and sore. No-one was hurt, which was pretty amazing as our whole family was on board with some heavy luggage to keep us company during the accident. Fortunately the van was insured, so I must have learnt something from losing our uninsured Landcruiser in 2008 to a drunk driver. Then in October we had another quick trip down south to attend sister Rachel’s wedding in Streaky Bay. Seeing all my siblings twice in one year!! Other trips have been to Darwin, Alice Springs, Melbourne, Cairns, Gold Coast (twice), and Adelaide in connection with work, CRANAplus, or NTES.
Transit van after hitting cow and rolling
We are still living in Tennant Creek but since the last letter in 2011, we have moved. We now live at 6 Gray Court in a solid brick house set in a lush tropical garden. It is spacious and comfortable, and very well suited to caring for Anita. There are 3 large bedrooms including one with an ensuite. The main bathroom contains a big spa bath and the 2 toilets mean that there are no queues when you need to go. The house is shaded on all four sides by verandah, carport or patio, and 2 huge trees screen it from the street as well as shield it from the afternoon sun. The back yard sports a plunge pool, a large BBQ, a wood-fired pizza oven, and a shaded entertainment area. On the side of the house is a large carport leading to a double garage. All of this is set off with a privacy hedge flanked with frangipani trees, and masses of palm trees and jasmine. It’s a far cry from our first home in Tennant Creek! Since moving in, we have planted 3 citrus trees and four passionfruit vines. The vines are doing a great job of covering the patio to make it shady and more comfortable in the heat
Laura’s Patrol and John’s Landcruiser
For transport we still have our 80 series Landcruiser. The ‘new’ engine installed in 2011 is going strong with its turbocharger to give it extra kick. During 2013 I installed a top-mount intercooler that makes it run even better. The other transport option was a Ford Transit van we bought in Melbourne during 2012. It had a hydraulic hoist in the back which made loading Anita and her wheelchair simple and pain-free. Even Erin could load Mum into the van and strap her and the chair into place. Unfortunately that all came to an abrupt end 380km south of Tennant Creek a few months ago so we had to come up with an alternative. Running a second vehicle was expensive, and I wasn’t about to sell my beloved 80 series Landcruiser. Then I found a vehicle-mounted hoist that can lift Anita from her wheelchair into the Landcruiser and back again. So with the hoist and a new lightweight power chair (about 30kg rather than 110kg) and we were mobile again.
Laura’s Patrol was finally completed just in time for her to go to University in Darwin in early 2014. It is old and noisy and thirsty but she loves it, and has taken it successfully up to Cape York and back, and down to the Flinders Ranges and back. Not to mention several trips to and from Darwin (1000km each way).
Now let’s check out each family member …
John. After 2 and half years relaxing and enjoying being a team member in the Emergency Department, I applied for and won the position of Clinical Nurse Consultant – Emergency Department. Against all the odds I’ve ended up back in management! I took up the new position on Anzac Day 2013, and have found that I am really enjoying the improved quality of life from not doing shift work. The pay is a bit less, but the benefits are worth it. Then in late October 2013 I stepped up to the role of Acting Clinical Nurse Manager for the Hospital while my boss went on leave until mid-February 2014. Over the Christmas/New Year period I got bumped up the ladder even further as Acting General Manager / Director of Nursing for two weeks. 
On July 1st 2015 I stepped across into the Clinical Nurse Educator role for Tennant Creek Hospital. That was another pay cut for me, but I love the job and my quality of life is pretty good. Importantly I have a lot of flexibility if I need to go home to help Anita at short notice, which is something that wasn’t easy when I worked “on the floor” in the Emergency Department. I must be doing something right because I won Employee of the Month in October! Education has been an interest of mine ever since I started postgraduate study in 1997, and started teaching CPR to nurses at Flinders Medical Centre. It is so rewarding to be able to inspire colleagues to improve their knowledge and skills, and create systems that support quality education for Tennant Creek Hospital. It’s probably no surprise then to hear that I am back at University, this time studying Clinical Education. How far I’ll go with it depends on time and money, but for now I love being back in the learning role, finding out new stuff.
Outside of work, I have my “hobbies” to keep me from getting bored. I’m still on the Board of Directors of CRANAplus, having just been elected to another three-year term of office. I did run for President, but it’s probably just as well the members chose the other candidate given how busy I am at work now. Several times a year I do volunteer work as a trainer for CRANAplus, teaching emergency skills to remote health staff or people wanting to go and work out bush. I am also treasurer of the Central Australian Rural Practitioners Association. Finally, to fill up any last gaps in my spare time, I am a volunteer with the NT Emergency Service (our SES). The rationale for that was that it was something completely different from my professional life, and also something I could do with Laura when she is at home. A few months ago I was appointed Unit Officer for the Tennant Creek Volunteer Unit which means I am responsible for keeping the unit ready to respond to emergencies. 
Health wise, I finally have my blood pressure under control, mostly … well sort of … oh all right, a bit. Losing 30kg would help so if anyone can give me a dose of cholera that might do the trick. Laura’s dog Jess needs regular exercise, so most days I take her for a walk with one of more of the girls. Cycling is another form of exercise I enjoy, but right now it’s too hot to be at all enjoyable, or safe. Bring on the cooler weather!
Anita. What can I say? Nothing has changed except she is much less mobile than when I last wrote. She can still stand up with assistance, but no more walking or moving herself other than in her electric wheelchair. Her right hand is almost completely paralysed now, and the left hand is getting weaker. Despite all this, she’s still the cheerful friendly person everybody loves. Getting out and about was a lot easier with the accessible van, so Anita was able to enjoy the Tassie holiday along with the rest of us. Having Laura as a driver has also been a big help in making outings possible, as I don’t have to be available every time. Now that we’re back to using the Landcruiser, and Laura is away at University for much of the year, trips for Anita are a little more challenging but at least they are still possible. In September/October Anita spent several weeks in hospital having a physiotherapy workup among other things. She and I were sent over to St Vincent’s Hospital in Melbourne for 2 weeks, where she had a couple of procedures to reduce the spasticity in her legs. This worked a treat, so we can now do stand transfers again after about a year of having to use the hoist all the time. Now we are waiting to see if we can get some funding to purchase a new wheelchair which has a standing function so Anita can spend some time on her feet. Anyone got a spare $40,000 that they can’t find a use for? The physio says it is really good for her bones, circulation and lungs if she can stand several times a day. For now, I’m her standing machine, so she can only stand when I’m available. 
Laura. In October 2013 Laura turned 18, and it was great to have some of her relatives from SA come up for the party. Since then she has successfully completed two years of her three year Bachelor of Nursing. Two of her clinical placements have been at Tennant Creek Hospital where she is very popular with the staff. During holiday breaks, Laura works at the hospital as a Patient Services Officer, and her computer skills are in high demand. We has senior staff arguing recently over who was allowed to ask Laura to do things, as everyone claims they need her skills! Laura has turned into an amazing manager of resources and makes decisions with a maturity I wish I had when I was 20.
Probably the biggest highlight of 2012-2015 for Laura was her trip to Nepal in late 2013. She was trying to get to Mount Everest Base Camp, just over 5 ½ km above sea level. She didn’t quite make it due to bad weather but it was a fabulous experience all the same. She was on this trek as both a personal challenge and as a fundraiser for shade sails at the Tennant Creek Primary School. A close second in the highlights list was a trip to New Zealand in late 2014 with her Uncle Sam and cousins Katelyn, Genevieve and Nicola. Laura was amazed by the variety of adventure experiences on offer compared to Australia, and of course the scenery was spectacular to a girl from the desert.
Claire. Claire turned 15 this year and has just completed Year 10. She brought home a bagful of awards from the Tennant Creek High School awards night, having now won Student of the Year for her year level four times in a row. She enjoys maths and design, and is good at science subjects. She is looking forward to studying some of her subjects in 2016 via the NT Open Education College (NTOEC) as she needs excellent grades to get into veterinary medicine. Tennant Creek High School is not up to the task. To help with her future plans, Claire is hoping to get work with the local vet as an assistant in 2016 via a school-based initiative.
During 2013 Claire joined the Army Cadets and went on a few camps and other adventures, but chose not to continue with this in 2014. She now has two after-school jobs (down from three) so rakes in a few dollars which she is learning to manage wisely. In fact she has just returned from a holiday to Melbourne which she funded herself!
Claire now has three pets. The little dogs Parker and Sophie have been with us for 13 and 6 years respectively, while George is almost 4 years old. George is one of a double litter of 14 kittens born in our yard to two stray cats. I managed to get rid of the mothers and 13 of the kittens, but Claire wanted to keep one. I reluctantly agreed and now George is a contented member of the family. I’m not as contented as he is because I get hay fever symptoms if he gets too close to me. He is cuddly though!
Erin. Our ‘tjuta bug’ is growing up fast. She had her tenth birthday a couple of weeks ago. She is an avid YouTuber so I have to keep the computer password-protected to stop her spending 24 hours a day staring at the screen. Unfortunately she has discovered that the TV, the iPads and the iPhones can all connect and download YouTube clips! On the same thread of computer-based activity, Erin loves Minecraft and plays it any chance she gets. She says she likes Tennant Creek because she has friends to play with and she likes growing up because she can now buy presents for people. If she did a little less screen time and a bit more helping around the house she might have more pocket money, but so far that argument hasn’t worked. 
Erin is a very clever girl who picks up things with amazing speed. Unfortunately the local primary school is just a day-care centre and not even a good one of those. We are rapidly approaching the point where we will need to sort out some proper education for Erin before Tennant Creek ruins her future. Laura and Claire had the advantage of Alice Springs School of the Air to set them up as independent learners, but Erin has only ever had the sad debacle of Tennant Creek education.
Roger. Anita’s father, the girls’ Grandpa, came back to live with us in March 2013, in the lead-up to his first hip replacement. With family support and being able to relax, the operation and rehabilitation went well. He had the other hip replaced in November 2013, so now sets off the buzzer at the airport like Titanium Man. The move to Tennant Creek was intended to be temporary until Roger was back on his feet and able to look after himself. However, in moving him from Adelaide we found piles of unpaid bills of which he was blissfully unaware. During the post hip replacement rehabilitation process it became apparent that the problem was dementia, so we decided to make Roger a permanent addition to the household. The situation is not without its problems, but overall it has been good for both Roger and Anita for him to live with us. Four adults and two children in a three-bedroom house is hardly ideal, but none of the alternatives were acceptable so we’re making the best of it. I call it the “Gray Court Nursing Home” which is funny, for now.
Well, that’s it for now. The story of our lives is way more complex than these few pages, but I hope you have seen a glimpse of our family. To all our far-flung friends and relatives, we hope your 2016 is full of visions realised and dreams coming true. May your sad days be short ones and your happy days long.
John Wright
Tennant Creek NT
December 2015
View on dog walk at sunset near Tennant Creek

Cars vs Cows

A couple of weeks ago we had a trip to Adelaide suddenly terminated.  We hit a large cow on the Stuart Highway in the Transit van. The end of the story – the van was written off, we’re all OK, the cow is dead.
I’ve seen plenty of people who have experienced a collision with a bovine road user.  The cow usually ends up dead, but all too often so do the humans involved.  We were lucky.  Part of the luck was due to my years of country driving, and the rest was physics and timing.
Just before the collision I took evasive action and very nearly avoided the cow altogether.  Unfortunately for both of us, she also took evasive action – in the same direction as me!  Bang, flip, spin.  All over in less than 2 seconds.  End of cow, end of trip, end of wheelchair accessible vehicle.  Most importantly though, NOT the end of us.

 Once the insurance stuff is sorted out, we’ll need to work out how to transport Anita from A to B. Will we go for another vehicle?  Use the trailer and Cruiser? Stay home?  I’m not sure yet, but I’d say running a second vehicle is something I’m keen to avoid if possible.   Watch this space …

Anger Management

I am interested to see how different people deal with feeling angry.  Here’s some of what I’ve seen:

  • Ignore or deny the feeling.  I know at least one person who simply does not show anger, no matter what the provocation.  It’s difficult to believe that they don’t feel angry at times, as I know they are exposed to injustice and unfairness.  However, they never show it.  I can’t help wondering how healthy this is!!
  • Lash out at others.  Many of the people I see professionally are either the recipients or perpetrators of this response.  Feelings of anger are dealt with by physically assaulting another person.  Sometimes this is the person who precipitated the anger, but often it’s just the next available target such as spouse or children.
  • Lash out at things.  These are the people who come to the ED with hand fractures from punching a wall, or lacerations from kicking a glass window or door.  It’s probably safer for other people, but can be life-threatening or fatal for the angry person.
  • Lash out at themselves.  Some people cut themselves or stab themselves to “let out the bad spirits” when they feel angry.
  • Drink the problem away.  Alcohol complicates things, almost never helps, as it acts as a dis-inhibitor.  People who would normally cope well with anger feelings tend to cope less well when intoxicated with alcohol.  The grog doesn’t make normally placid people into monsters, but rather it unmasks the monster that is normally well-controlled by civilised behaviour.
  • Become withdrawn.  Some people, especially those who feel unable to do anything about the situation that causes them to feel angry, withdraw into themselves.  I suspect that these are the same ones who lose it when they get drunk.
  • Express their feelings in words.  Swearing and raised voices may be habitual, but can also be an expression of anger.  The angry feelings are defused by the outburst and dissipate, until the next event that precipitates angry feelings.  The damage from this coping technique comes from what is said and to whom, as in the classic ‘career-limiting move’ where the angry outburst is directed at the boss, or the relationship-straining effect of yelling at your spouse.  Some people have a safe place to express their anger, such as a ‘yelling tree’ or a workout at the gym with a punching bag.
  • Grumbling.  This is related to swearing and yelling, but more low-key.  It can be seen in people who always seem to be complaining about something or other.  Sometimes it is due to other feelings, but unresolved anger can lead to chronic whingeing.  It is hard to be positive about life when you’re angry.
  • Any combination of some or all of the above.  
So, I hear you asking, how do I cope with anger?  Well, let’s see …  I don’t ignore it.  I never lash out at others, after seeing my parents violence when I was growing up and deciding that such behaviour is despicable.  I don’t lash out at things any more, as I’ve come to realise that I have to pay to replace them which means I have less resources to do enjoyable things.  I never lash out at myself because, well, I just don’t.  I never drink alcohol or use any of the other popular escape substances. I do become withdrawn especially when I’m at work or somewhere else that expressing negative feelings is detrimental.  My main coping mechanism is swearing, which works really well for me but probably less well for those around me.  They do tend to recognise that it’s a short storm, it’s never physical, rarely malicious, and there are no grudges held onto afterwards.  I have been called a ‘grumpy old man’ but of course that’s not me … much.
Anger is one of those things that scares a lot of people, including me sometimes.  It often means the person is out of control, and when dealing with an angry person I try to empathise and help them regain control.  One thing I learned as a child was that anger can be a powerful tool if used appropriately.  When I was being beaten with a stick by my father, I would use anger to make it pain-free.  Then when I was old enough, I used anger to give me the courage to stand up to him for the bully that he was.  Anger must be kept under control though.  It’s a bit like fire.  A good servant if properly trained, but a very poor master.  

Organising a disabled-friendly holiday

I thought I’d better do some preliminary planning for the Tasmania trip in December-January.  After all, the year is rushing past so fast I’m liable to miss most of it!

Previous family holidays have been camper-trailer based, which gave us a great deal of freedom to go where we wanted.  Best of all, it allowed us to make use of the 4WD to explore interesting tracks.  This year, we will not be able to use the 4WD / camper trailer combination because Anita needs her electric wheelchair all the time now.  We have a wheelchair accessible van, but it has no towbar so can’t tow the camper trailer.  So what to do?  Tasmania is the destination, and the Internet is the key.

We can get to Tasmania via the Spirit of Tasmania ferry service from Melbourne to Devonport, so that part is easy.  The thorny bit is accommodation.  We need to be able to stay in Tasmania for four weeks in wheelchair-accessible venues.  Hotels are generally out, as we would need 2 or 3 rooms and that makes the trip unaffordable.  Via a Google search, I found a site that lists accessible short-stay accommodation throughout Tasmania.  It looks like we will be able to rent a cottage near Devonport for 2 weeks, then one on the east coast for a week, and a third cottage for the final week near Hobart.  The only fly in the ointment is that I’ll need to book soon to ensure our place, and there are a lot of bills due at the moment.  Hooray for overtime!

The other bit that needs organising is respite care for Anita during the week that Laura, Claire and I want to walk the Overland Track.  She needs assistance with her activities of daily living for 6 days, and it looks hopeful that the Carer Respite Centre will be able to help with this.  It will be either residential respite care in a facility in or near Devonport, or it may be respite care provided in our rented cottage for the week.

Having a disabled spouse makes holiday planning essential.  We used to just pack up the camping gear and head off on holidays.  Now it takes a lot more organising, and is considerably more expensive.  Still, I’m grateful that we can still have family holidays.  It won’t be too long before Laura heads off to university, then family holidays for all of us together will probably become a thing of the past.

Getting value for money in remote areas

Some time ago, I wrote about using Bush Orders to do grocery shopping.  This is how we avoid being ripped off by price-gouging remote area stores, as we pay normal supermarket prices for our groceries in a regional centre, then pay freight to get it to our home.  This compares very favourably with prices in our local supermarket, and vastly improves the range and quality of goods we can access.

In general, I support the concept “buy local”.  I’m even prepared to pay a premium to support a local store.  However, I am not prepared to support businesses who use a captive market to price-gouge, and often provide abysmal customer service as well.  It seems I am not alone in this.  A recent survey reported in CHOICE magazine found that NT has the highest per capita use of online shopping in Australia, and that’s despite a significant portion of the NT population having little or no access to online services.  No longer can NT businesses sit back and treat their customers with contempt while charging them a large premium for goods.  We will simply order them online, and when this proves to be a positive experience, as it almost always does, we are unlikely ever to go back to the local business.

In my case, I can choose whether to buy a part for my 4WD locally and pay 2 1/2 times more for it, or order it online and wait a week for it to arrive.  In rare cases, I’ll pay the extra because I can’t wait, but mostly (about 98% of the time) I will take the online option.  If the local business kept their mark-up to even 50% compared to city prices, I would but it from them every time.  But a 150% mark-up is stupid!  Especially when their customer service is surly, unhelpful and often downright hostile.  Even for basic food items that I can’t do without, I will wait a week to get them via freight from Alice Springs than buy them locally, mainly because the local supermarket charges between 200-400% more for many items.  Sure some items are as cheap as elesewhere, but they tend to be the junk food lines rather than the healthy foods.  Fruit and vegetables here are expensive and highly variable in quality, sometimes barely edible.  Yet the same items bought via Bush Orders from Woolworths in Alice Springs are fresh, excellent quality, and usually less than half the price even allowing for freight.

It’s not all doom and gloom though.  I recently bought a tyre for the Transit van.  After days of searching online, I found 3 tyres that would do the job.  All were around $240, with between $30 and $100 freight to get the tyre to Tennant Creek.  I then went to the local tyre outlet to check what they had.  The pleasant helpful person on the front desk checked the computer and found the size I needed in a well-known brand for $250 including fitting and balancing, and it was in stock!  So here’s one business that managed to get it right:

  • Good customer service
  • Competitive price
  • Quality goods

So guess where my first stop for all my future tyre needs in Tennant Creek will be?  Yep, the local tyre outlet.  They could have charged another $100 for the tyre, and probably got away with it once, but this would have meant that all future tyres would be bought either online or while on a trip elsewhere.  By giving me value for money, they have ensured that I will support this particular local business.  And that’s probably worth more to them in the long run than a quick $100 once-off.

A wheelchair-accessible vehicle for our family

Well, I’d better write a few lines before I start getting obituaries!!  It’s been a busy couple of months recently.
Laura and I flew to Melbourne in early February to pick up a Ford Transit van with a wheelchair lifter.  This vehicle makes it much easier to move Anita about – even 6-year-old Erin can load Mum into the van and connect her chair to the tie-downs.  The lifter is a hydraulic Tieman unit, and can easily cope with the 150kg weight of Anita and electric power chair.  The tie-down system is a great concept by Qstraint, using self-retracting straps like a normal seat belt.  You just hold down a red button and pull out the strap, then hook the end to a secure point on the chair (in our case the seat anchors).  This is done on all 4 corners, then the straps automatically ratchet up tight.  So simple!

Wheelchair Lifter

2001 Ford Transit

All we need now is for Laura to get her P-plates, then Anita won’t be dependent on me having time to drive her around.

Weighing up the costs and benefits of treatment

A couple of weeks ago, Anita saw a rehabilitation consultant in relation to her MS.  This was instigated following an assessment for an Extended Aged Care in the Home (EACH) package.  My question at the time was, “What benefit will Anita (or anyone else) derive from this consultation?”  Apart from the obvious financial benefit to the provider, it seems that there was no benefit, so I’m struggling to see how it can be justified.  Now it seems that Anita needs to spend a week in hospital to be ‘fully assessed’ to see what else the rehabilitation team can offer!!  What else they can offer???  They haven’t offered anything yet, nor can I see any circumstances in which they will ever have anything to offer.  We are on a one-way street with MS, and rehabilitation is unrealistic.  There is talk of trying a foot orthotic to improve Anita’s ability to get into the shower.  But what about the fact that she cannot lift her leg?  
This all seems reminiscent of our trials of medication for her MS.  Anita has primary progressive MS for which there is no proven treatment, yet she was put on a trial of interferon beta 1a (Avonex) then glatiramer (Copaxone).  Both treatments are expensive, and don’t work for her type of MS.  My concerns about the risk vs benefit analysis fell on deaf ears.  I was concerned that there was no way to monitor the benefit of treatment, as it is measured by the number and duration of relapses, of which Anita has zero.  In then end, we pulled the plug on medication treatment as it was causing significant adverse effects for no benefit.  In other words, the risk vs benefit analysis showed that the risks were too high.  Similarly, the cost/benefit analysis showed that the money spent was not worth it.
So now we are looking at a week in hospital.  For what?  No-one seems to know.  We are expects to make a decision without having any information about possible benefits.  I know the risks – hospital acquired infections and loss of autonomy as an inpatient spring to mind.  And the costs – cost of admission for a week, cost of two 1000km drives to get to hospital and back home again, disruption to family life.  Obviously I need some benefits to outweigh these risks and costs, but it seems there are no benefits.  I cannot accept a ‘let’s try it and see’ approach, as I’m the one who has to drive 2000km to make this happen.  I don’t want to deny Anita a chance to get some help, but you’d think a specialist would be able to suggest what benefits might be possible.  The attitude seems to be, “Oh well, at least it’s a holiday for Anita, and she’ll be a public patient so it won’t cost you anything”.  Yeah right, that’s because it doesn’t cost anything to drive 2000km.  And anyone who thinks staying in hospital is a holiday has never done it themselves.  At the very least, this whole thing is unethical.  Also, I think that it is unprofessional for a healthcare practitioner to counsel a patient to undertake a course of action which fails the risk vs benefit analysis.

2011 Christmas Letter finally published

Well, I have finally got my act together and completed the 14th edition of the Wright family Christmas Letter.  I began it in 1998 as a way of updating friends and family about happenings in our family, and initially planned for it to be a 3-4 times a year newsletter.  Unfortunately, I never found the time to write so often, so it has become an annual tradition.  This year, I didn’t even make it in the right year!  Never mind, all is now done, so without further ado, let me present the 2011 edition.

Click here for the Christmas Letter