As the second trainee to fill the post I was able to enjoy a relative lack of the inevitable teething problems when the post began. By the time I arrived the role of the trainee was more firmly established and was a valued part of the various mental health services of Central Australia (which include the Alice Springs Urban Community Mental Health Team, the Inpatient Unit in Alice Springs Hospital, the Barkly Region Community Mental Health Team and the Remote Mental Health Team). I was able to be involved in the fine tuning of the job description of the senior registrar post so as to optimise its value as a training experience. This meant gradually shifting the registrar’s clinical role more toward the remote psychiatry work, which is the area of work most unlike that of any trainee’s likely experience, and most full of opportunity to learn and grow as a clinician. It involves having to pioneer new ways of working clinically in the cross-cultural setting of traditional and semi-traditional Aboriginal society.
This dissertation is born out of the steep learning curve that accompanied my attempts to work in this difficult but rewarding environment. It focuses on the clinical aspects of the work especially those aspects that demand a different approach by the clinician to adapt to the setting. History taking, mental state examination, diagnosis, management, professional boundaries and the way one works with colleagues all need to be approached in a modified way. Such a dissertation lends itself to a descriptive and qualitative method, as it is only through reflection on one’s clinical experiences, supplemented with personal communications with colleagues and review of the scanty literature, that new modes of working can be fully explored.
This dissertation does not cover the service delivery or systems issues surrounding the senior registrar post, areas that were covered fully by my predecessor. Nor does it purport to be the only way for psychiatric practice to be carried out in remote Aboriginal communities, but rather suggestions drawn from careful appraisal of my own experiences to form groundwork for future clinical work and research.