Part 1 – a visual Patient Journey Map that follows

Part 1 – a visual Patient Journey Map that follows the journey of Billy Jakamarra and his wife Jessica. Patient Journey Mapping – Part 1. Billy Jakamarra is a 37-year-old Luritja man who lives in the community of Imanpa. He speaks Luritja, Pitjantjatjarra and Southern Arrernte (Pertame). He is the eldest son of Jupurrula (who is the senior law-man) and Napanangka who live in Papunya with Billy’s brothers and sisters. It is coming up to Christmas time and the men in Papunya are getting ready start “bush camp” in 4 weeks’ time. This means that Billy will have to return to Papunya and take part in the 2-week bush camp and ceremonies. Billy’s family is expected to stay at Papunya with his mother and sisters. While Billy is considered to be healthy by the community and his family, however he does have type 2 Diabetes which is diet controlled and a heart murmur from birth, which has not been assessed for more than 20 years. Billy is married to Jessica who is 35 years old, and they have 3 children Gabe 12 yrs., Daniel 10 yrs. and Trephina 5 yrs. old. Jessica is from a local family. At home, the family speak 4 languages Luritja, Pertame, Pitjantjatjarra and some English. They live in a 3-bedroom house with Jessica’s mother Lorraine who helps with the children when Billy and Jessica are at work. Billy works with the local council and gets paid Community Development Employment Program (CDEP – work for the dole) which equates to $520 a fortnight. Jessica is an Aboriginal Education Worker with the local school and earns $1200 per fortnight. Lorraine is on an aged pension and receives $420 per fortnight. Imanpa is a small community of 177 residents and is located 7 kilometres off the Lasseter Highway and lies 160 kilometres east of Uluru and 200 kilometres southwest of Alice Springs. The main language is Pitjantjatjarra and Southern Luritja. They have a community store, Primary Health Care Centre run by Central Australian Health Services and a school. The community is run by the Imanpa Council. No fuel is provided but is available at the Erldunda Roadhouse 73 kilometres away. There is also no aerodrome. On the weekends Billy, Jessica, Lorraine, and the kids go out to the family outstation (the block), which is located 10 kilometres away, where they go hunting kangaroos, goannas and gathering bush foods and medicines. It is a long weekend with a public holiday on the Monday and the family decides to go out to the ‘block’ in their Toyota Landcruiser on Friday afternoon. At the block there is a tin shed, drop toilet water tanks, a quad bike and 2 dirt bikes. They spend the afternoon setting up camp, collecting firewood so that they can cook up a good healthy meal. In the morning at about 9.00 am they decide to go for a ride on the bikes hoping to shoot a few kangaroos and track some goannas. Gabe spots a kangaroo in the distance and Billy takes off, on the quad bike, to chase them. Travelling at a speed of 80 kms per hour, Billy hits a large hole in the middle of the track and is flung into the air landing on the road. Billy has a loss of consciousness for approximately 2 minutes. His right leg and right arm are clearly deformed. Gabe stays with Billy while Daniel rides back to the camp to tell his mother about the accident. At 10 am Jessica and Lorraine find Billy and Gabe a further 5 kilometres away. Jessica stays with Billy while Lorraine drives back to the local clinic to get the nurse and community ambulance. There is no mobile phone service on the block. The nurse arrives in the community ambulance about 1 hour later post the incident. Billy is now conscious and in significant pain. The nurse administered some analgesia and splinted the limbs and loaded the Billy into the ambulance and driven back to the local clinic. The nurse rings the on-call doctor, who organises an emergency evacuation with the Royal Flying Doctor Service (RFDS). The nearest airstrip is 160 kilometres away at Uluru, so a halfway meet is arranged with the Ambulance service at the Ayers Rock Resort. At 1pm, the nurse drives Billy in the ambulance with the on-call doctor and Jessica. At around 2pm they meet halfway, and Billy is transferred over to the Ambulance service then transported the rest of the way to the Ayers Rock Airport. RFDS is waiting for them when they arrive after loading Billy on board, they continue to Alice Springs airport. Jessica is with Billy in the clinic ambulance, but when they hand over to the Ambulance service there is no room, so the nurse drives her back to the community (80 kilometres away). The family have now returned to community with Lorraine and are waiting for Jessica. They then pack the car up again and head into Alice Springs which is 200 kilometres away. It has been 6 hours since the accident and they need to re-fuel at Erldunda if they want to make it to Alice Springs before night-time. The flight from Yulara airport to Alice Springs airport takes 1 hour and arrives at 4 pm. During the flight Billy’s pain increases significantly, and his consciousness fluctuates. Billy is then transported via Ambulance from the Airport to the Hospital which takes 20 minutes. On assessment in the Emergency Department, the Doctors send Billy for a CT scan and X-rays to see the extent of his injuries. what injuries he may have. From the x-rays and scan the doctors find that Billy has a Closed fracture of his right tibia, a closed fracture of his right ulna and a haematoma on the frontal lobe of the brain with no bleeding. Billy is in a conscious state and opens his eyes and nods when asked questions. The on-call Surgeon calls the Royal Adelaide Hospital (RAH) to speak with the Surgeon about transferring Billy to Adelaide for surgery to on his closed fractures to his right arm and leg. The on-call surgeon performs a neurological exam which indicates that Billy does not have a head injury but needs to be transferred for surgery as there is no Orthopaedic Surgeons at the Alice Springs Hospital. A back slab was placed on his right arm and right leg. Another patient requires immediate evacuation so it has been decided that Billy will be transferred to the Royal Adelaide Hospital as well. It takes a further 1 hour to organise the RFDS and transportation to the airport. Billy has now been in the Alice Springs Hospital for 4 hours and Jessica and his family arrive in Alice Springs at 6 pm. They drive straight to the hospital and spend time with Billy in the ED. At 8.30 pm Billy is then taken back out to the Alice Springs airport to be transported by RFDS to Adelaide. Jessica is unable to go as there is no room and she will need to come back on Tuesday (Monday is a public holiday) to arrange a bus ticket by the Patient Assistance Travel Scheme. The RFDS flight takes 3 hours. South Australian Ambulance Service picks up Billy and the RFDS Doctor gives them a handover. During the flight Billy’s observations remained stable and he was placed on oxygen and given sedation during the flight. The following set of clinical observations are taken by the paramedics on the way to the hospital: • Glascow Coma Scale: 11 (3 – open to verbal stimulus; 4 – conversing but disorientated and confused; 4 – withdraws to pain) – was GCS 15 prior to sedation • Pupils: 3 PEARL + • Heart Rate: 130 bpm • Respiratory rate: 20 per minute • Blood Pressure: 90 / 60 • Temperature: 35.8 ⁰C • O² Saturation: 94% (oxygen 2L/min) • 2 x IV cannula insitu • Right radial pulse: present • Right pedal pulse: not visible but located on top of foot, colour good with good blood return, foot feels warm. • Visual observation of the patient is an Indigenous male Billy eventually arrives at the RAH at 12.30 am on Sunday morning. The paramedics hand over the patient in the resuscitation room. Billy is admitted to the surgical ward as he is conscious and in a lot of pain. By 6.30 am he is prepped and taken in for surgery. The surgery goes well as they were able to fix both closed fractures on his right arm and right leg. He is taken from the recovery room back to the surgical ward by 12 noon. Jessica’s Journey Jessica has a sister in Alice Springs and the family end up staying with her until she can catch the bus to Adelaide Wednesday. The bus left Alice Springs at 10.30 am on Wednesday and arrived in Adelaide Thursday at 6.25 am. She has enough money to catch a taxi to the Royal Adelaide Hospital (a 10-minute drive). It is too early for her to visit so Jessica ends up waiting in the reception area until 8.30 am when the Aboriginal Health Unit opens, and she is able to find the ward that Billy is on. Eventually she is seen by 9.00 am and she tells the Aboriginal Liaison Officer (ALO) that she has no money for food and is hungry. She speaks good English and does not need an interpreter. The ALO finds some sandwiches and a cup of tea for Jessica while he tries to find the Ward that Billy is on and eventually finds him in Intensive Care Unit 4G. Accommodation has been arranged at the Kanggawodli Caring House in Dudley Park and as this is her first time in Adelaide Taxi vouchers are provided for her to get to and from the Hostel. Billy is recovering well. He is now communicating in Luritja and English, so Jessica can translate when needed. Over the next 10 days Billy slowly improves, and Jessica visited every day arriving in the morning and leaving in the afternoon. The doctors decide that he can return to Alice Springs Hospital by RFDS and is flown out on Friday morning arriving in Alice Springs early in the afternoon, where he is admitted into Alice Springs Hospital. Jessica is booked on the next Greyhound bus which leaves on Saturday at 6.00 pm and gets into Alice Springs on Sunday afternoon at 2.30 pm. As she wants to see her children, she decides to catch the next Bush bus back at to Imanpa on Wednesday which leaves at 7 am in the morning and arrives as the Community turn off at 11.45 am and she must organise for someone to pick her up from the Lasseter’s Highway. The doctors tell the family that it will take at least 4 weeks for Billy to fully recover so his family decide that his younger brother Robert will stay with him in the hospital to assist with his needs until he can be discharged home. Jessica and the kids visit him whenever they can afford to buy petrol and try to drive into town most weekends. 6 weeks later Billy is discharged home and can move well after having physiotherapy.

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