EHO Knows: Ward Off w/ Kareen Dunlop

[00:00:00] Shane: Imagine being on holidays in a tropical, backwater, sort of ideal retreat, and you’re hit by a car and you break your leg and you rushed to hospital. And this hospital has a 38% death rate post-op. But it’s the only one within hours. Now, imagine if you’re poor and you don’t even have the choice of taking out your, your travel insurance and going to a better hospital.

[00:00:30] Shane: That literally was the choice for an entire group of people just 10 years ago where your local hospital has a 38% death rate, and now it’s down to one or 2%. And one of the people who was instrumental in making those changes is here with me today. Corrine Dunlop, uh, she stepped into this hospital and the story that we’re gonna hear today is just absolutely amazing because it’s not like it took billions of dollars and it took, you know, miracles.

[00:01:08] Shane: It just took knowledge, it took practical steps, uh, and, and it’s something that we now take for granted. Uh, and the reason why I’m doing this, it’s the first time I’ve got someone who’s not an environmental health officer onto the, um, the podcast, but it’s all about the basics. And when I heard this story, I was going, you have to be on the podcast.

[00:01:28] Shane: So Corrine, welcome to EHO knows. Thank you for coming

[00:01:34] Kareen: Thank you.

[00:01:36] Shane: now. Okay, so, so we’ll try and in really soft terms, admit that you’re not an environmental health officer. Who are you? What do you do?

[00:01:45] Kareen: In a nutshell, my background is I’m a operating theater nurse educator and an infection control nurse. I’m also currently, now, if you can see my background there. I’m also an acupuncturist, naturopath, and herbal medicine practitioner. But my main area of expertise, um, certainly used to be in operating theater and infection control.

[00:02:07] Shane: Okay. And so that’s how you became involved in this story. we are not gonna name the hospital. Like, this is not a naming shame exercise. Uh, and we are largely going to try and avoid naming the country, uh, because the truth is what we’re about to talk about could have been in any country. And here’s the thing.

[00:02:26] Shane: This is what the world was like 100 years ago. And so it’s the changes that we’ve seen that have taken place. But let’s go back 10 years. What was the hospital like? How could it be so bad? I.

[00:02:40] Kareen: So probably I’ll, I’ll start you off at the, um, as to why I ended up there maybe, and that that might, then I can segue into that if that’s okay with you. Um, so I was asked to go up and teach total hip surgery to, um, a public hospital, um, biggest hospital in the country. And the night that I got up there and was taken around the hospital, I had grave difficulty in picking my eyeballs up and putting them back into their sockets. So the infections that I saw there, the smells, the, you know, patients with necrotizing fasciitis, lying on the ground with IVs, hanging out, um, filthy, filthy conditions, smells horrific, just. Vulnerable. And so I ended up ringing back to the surgeon who asked me to go and said, look, we teach them hip surgery, they’re all gonna die. Um, do you, do you get that? I had no idea what the death rate was at that point, post-op. anyhow, being my usual tenacious self, I did what I was asked to do put together a theater course for four, um, nurses and one surgeon. And we taught them how to do hip surgery and thankfully they listened to me.

[00:03:57] Kareen: I have no idea why I think the old whiter hair might have helped. and just, yeah, so they did what I asked and, and it was incredibly successful. Um, in fact, they had infection rate pretty similar to what we we have here in Australia. so that was really great. Whilst I was there, the director of that hospital asked me to come back. Um, he just said, look, Corina, I dunno what to do, please help me. And I was like, whew, that’s a big ass, you know, drop my business, drop everything and run. Anyhow, so back to your original question, what was the hospital like? I don’t even know where to start here. so the smell was probably the first thing that hit you when you walked into the grounds. Um, just rotting flesh, um, toilets that weren’t flushing because they didn’t have water coming outta them. hand basins. I couldn’t even see any at the time. Um, if there, there was some in the operating theater or, or where they did their scrubbing, but that was about it. Um, a lot of people, so the hospital itself was a 500 bed hospital, had 620 patients at any given time at a minimum.

[00:05:06] Shane: people on the floor, you literally meant people on the floor.

[00:05:10] Kareen: People on the floor, on bamboo mats lying in the corridor. lying in bamboo mats in the stairway, like, like in the little foyers off the stairway with humongous, like I said, necrotizing faciitis. Like their, their body was just rotting and they were left there to die. the back of the hospital, I mean, then this goes further onto the story, but one particular day when I went back, so I went back for eight months to teach, but one particular day all my students were kind of peeking out the window and I like out the blinds.

[00:05:43] Kareen: And I was like, what if they were looking at? And eventually I went and had a look and we literally had a river where the road was into the back of the hospital and across the road from us was a big, forgotten the name of it. So I’m having a mental blank here, but literally where people lived under tin roofs and that, um, very, very poor condition.

[00:06:01] Kareen: So all their waste and everything was just running down this river, which

[00:06:05] Shane: Yes.

[00:06:06] Kareen: normally walk and, and drove on. And so I had to wade through it later on. So they had really, really poor plumbing in the hospital. didn’t have air con or if you, if you were in the director’s office, you might have had air con, but it was very rare to find air conditioning. the, the kitchen just had a dirt floor. Um, the staff in there weren’t trained at all and, and hygiene at all. So they would just sit on the dirt floor on their, maybe on the dirt floor, on a bamboo mat and prepare the, the food for the patients, um, in very squa conditions. Uh, the laundry, basically the washing went out, came out dirtier than what it went in, with more so when I actually did tests on it and we changed the washing machines.

[00:06:50] Kareen: It had a, had a higher micro burden on it after it had been in the washing machine. yeah, things like, you know, you’d come up the walk up the stairs up towards the theater and the cleaning staff were taking the bloody linen checking it out on the, on the stairway with people all walking through it. sharps containers, I’d only expect you know a lot about them, but sharps containers, we have rigid plastic sided sharps containers. They had just a cardboard box with, and it would be taped up with ELA plus and there would be like a hedgehog that was sharps all pushing through it. And the cleaners would literally take that. then clean, those syringes and needles and then sell them on the private market to the private clinics.

[00:07:34] Shane: Wow. Okay.

[00:07:35] Kareen: Um, yeah, I don’t even know where to start. Things like operating tables, they didn’t know how to move them. So when I actually showed them how to break an operating table and, and move it, they were like, oh, you can move that.

[00:07:46] Kareen: And underneath was all the crap that had been there for the years that they’d been operating on.

[00:07:51] Shane: Yes. So, uh, so award. Um, nowadays we complain when we don’t get a room to ourselves. Uh, there you are. How many people in a, like in, in one.

[00:08:06] Kareen: In what our typical two bedroom. Ward would be, uh, a two bedroom room would be, they’d have five to six beds jammed in there. So literally there would be, width of a person, not even a width of a person you’d have to turn sideways on was certainly I would to have to go down between the beds.

[00:08:24] Kareen: There’d be that many people squashed into very, very tight areas. some of the rooms like the, um, orthopedic trauma room, which was a huge problem at this hospital, was just a massive big room with beds all crept in it. Um, and at the back there would be toilet or two for patients and an area where they could wash.

[00:08:45] Kareen: But often the problem was that the pressure wasn’t enough with the water to get the water to those hand basins. were. Private rooms and you had to pay a lot of money to get that private room. So you would have one patient in that private room. And then obviously, like I said, there were people out on the, there was a lot of family there, so they would be all sleeping around as well.

[00:09:08] Kareen: Under the bed. In the stairways? In the corridors, yeah. Yeah, very crowded.

[00:09:15] Shane: Yes. Okay. And so you’ve got one toilet basin, which may or may not have running water if it didn’t have running water. What did they have instead?

[00:09:27] Kareen: So in the back of those, what we would consider a two beded unit, and they would have at least five beds in there. There would be a toilet. Um, the toilet would have a handheld that you use to wash yourself with. So no one used toilet paper there. They couldn’t afford toilet paper, they’d have that. They’d have often, because there was no water, they’d have this huge big blue half gallon. Drum in there and it would have often like a half Coke bottle or some kind of, some kind of scooping arrangement so that they could actually put the hands into that bucket of water and get some water to wash their near regions with Yeah, the actual hand basin, like in the patient’s walls, there was never soap there.

[00:10:16] Kareen: But what I often used to see when I visited many hospitals was a little tiny bag of laundry detergent. So a little tiny one, the size of my hand. And it would be open at the top and everyone would just dig their hands in. And this would be in theaters as well. They would just dig their hands in and get some of that washing detergent.

[00:10:36] Kareen: The, the powder, so it was pink with pseudomonas, um, inside there. So basically they were just washing their hands with a Petri dish of yum.

[00:10:45] Shane: Whoa. Okay. and then just that concept of, you know, the thing that you’re holding, the, the half Coke bottle is just going to transfer from one person straight to the next. You’re dipping it into a bucket of goodness knows what. Um.

[00:11:01] Kareen: That’s been sitting there for a long time. That was a, a lovely, um, holder for mosquito borne as well.

[00:11:09] Shane: Yes. Okay. So it’s fairly obvious that they’ve got a problem. What now? We are, we are skating on the edge of, politics and we’re gonna do our best to avoid naming names. Um, but there were a number of factors that got the hospital to this stage. One of them was politics. there was a whole bunch of bad crap going on in this country.

[00:11:34] Shane: What was the side effects of all the bad crap and how did it impact the hospital?

[00:11:38] Kareen: so what happened in this country was, um, during a war that they had, there with any intellect basically was killed. Um,

[00:11:48] Shane: I.

[00:11:49] Kareen: there were four doctors that survived this particular war. Um, people, uh, like the Tori, I can tell you are shocking. Um, beautiful people that I worked with that were killed because they got a extra little tid of fish outta the river to feed themselves with. Um, whole families that were shocked because the father was a professor at the university. yeah, very, very sad. So a lot, a lot of, I guess you could say, Lack of knowledge because all anyone with intellect was killed. then you’ve been left with this country with an absolute paucity of intellect. then obviously white men coming in to try and help them. But the people that were left just didn’t have the knowledge to do things. And we had, in my instance, a lot of surgeons, a lot of surgeons who Red Cross, everyone had, had been and still is working in this country, but the cultural norm of shame.

[00:12:50] Kareen: So that was one of the other things that is there, is that you’ll find that they just say, yes, yes, yes, yes. But like, like one per person. I’ll just give an example. One person said to me, re we know we should wash our hands, how can we, we know water. Soap, I know. Money to buy and soap for the hospital. The um, other thing about this particular hospital is the government itself, we’re paying the director a abysmal amount of money to actually work in this hospital. So he, he was working there basically for free. Let me tell you. was often paying staff wages out of his, um, pocket because the government didn’t give him any money for three months.

[00:13:38] Kareen: And he said, if I don’t pay it outta my pocket, then they all leave. Um, so he was under a real huge amount of pressure to actually perform in this hospital. And because he has made a difference, they won’t let him leave now. Um, but you know, I’m incredibly thankful to him that he actually, had the courage to ask me for help and to listen to me. Yeah.

[00:14:02] Shane: So what’s really frightening is the description that you have, Wartorn country, the people with the knowledge are either being killed or they’re fleeing for their lives or whatever. And so you’re having that exodus of, of competence and knowledge that could apply to somewhere in the Middle East these days could apply to somewhere in Africa these days.

[00:14:23] Shane: it applied to this country, uh, South America actually, what’s really frightening, this applies to, oh, I’m not allowed to say that country because I wanna visit there later in this year. And, um, and we’re getting an exodus of knowledge from the top, from the people who know what’s going on.

[00:14:42] Shane: And so then you start to get to this position where, uh, who’s left behind, what’s there. Then, like you said, the name and shame, lack of funding. And so things are just being driven down, getting worse and worse. Uh, in one sense, you’ve got a hero story because you’ve got the director who’s actually working for virtually free and funding it all, uh, but absolutely no money coming from the, um, the top down.

[00:15:08] Shane: And unfortunately that’s sounding like more and more countries. So as much as we’re saying, Hey, this is a story from a hundred years ago, the truth is this is a story that can easily repeat in too many countries around the world right now. Okay. So.

[00:15:21] Kareen: And he he also didn’t have the knowledge or know where to start, like this hospital, but like they didn’t have, when I first went there, they didn’t have a director of nursing. I said, can I speak to the director of nursing? Oh, we know have one. really. Okay. what kind of, do you have a nurse educator?

[00:15:39] Kareen: No, we, we, we don’t know what that is. We don’t have a maintenance team. Um, so there was no structure hospital. They didn’t know how to a hospital and all they knew was what somebody had told them from the very top, you know, you must provide us with accounts. So accounts department was huge. Um, yeah. So

[00:15:59] Shane: Yeah.

[00:15:59] Kareen: from the government that, that they had to, you know, be able to show what they’d used every cent. And the board director had to sign every single remit that was going out the door. Yeah.

[00:16:10] Shane: Yes. Okay. So you have surgery. what are your chances of. Um, surviving surgery within the next, you know, 12 hours.

[00:16:22] Kareen: Okay. So like I said, when I first went there, their death rate post-op was 38%. their infection rate, I would say would be well on nine on a hundred percent. Like it, it was very, very high. I don’t have those figures because they never measured infection. If you ask somebody why they died, they would just look at you and go, well, Corrine, their heart stopped and

[00:16:46] Shane: Yes,

[00:16:46] Kareen: know why they stopped. Yeah. So, yeah. Survival rates a lot by a third or less.

[00:16:54] Shane: yes. but. So, so I guess my first question is, you know, what’s your survival rate in the first 12 hours? Because that’s really a reflection of, um, immediate post-op sort of complications, whereas to die a couple days later is obviously then infections kicking in and, and problems.

[00:17:13] Kareen: Yeah.

[00:17:14] Shane: Um, so are you relatively happy with surgery there?

[00:17:18] Kareen: no, a lot of people wouldn’t go, I don’t know what the actual rate was, 12 hours post-op there at that point. Um, ‘ cause again, they didn’t collect nosocomial rates because that was embarrassing or they

[00:17:30] Shane: Yes.

[00:17:31] Kareen: know about and they didn’t want anyone to know about it. So that took, and I’m still working on that, a lot of effort to actually get them to recognize what a nosocomial infection is.

[00:17:41] Shane: but how quickly did it take post-op to be infected?

[00:17:46] Kareen: Yeah, very quick. So, uh, give you another example that would tell you. So they used Makita drills that we buy from Bunnings. would just wipe them over with a, with the theater cloth, so it wasn’t even a clean cloth, they would wipe it so it was visibly clean to them, but there would still be a lot of blood left around the chuck and the keys and where they couldn’t see so well. Um, and then they’d put it back in its Makita box, the container, and they’d put a little jar of Formin in there, um, with some cotton wall balls, and they’d leave it for 12 hours. And that was considered disinfected then, and they would use that on the next patient. is the same thing. So literally, the hepatitis B rate, I know in one particular, area of this country was 58%

[00:18:37] Shane: Wow. Yeah.

[00:18:39] Kareen: Because they were just using stuff that was used on the previous patient. Yeah.

[00:18:45] Shane: Yes. Uh, and we’re not even talking about, uh, with all this infection stuff, aids and you know, like you said, hepatitis and all those really bad things that are then, you know, transferred through instruments. We’ve so far mostly just been talking about, you know, infection. Um, so it would be fascinating to know long-term effects, you know, what’s the transmission of AIDS and all those sort of things.

[00:19:11] Shane: We’re gonna skip that because, you know,

[00:19:14] Kareen: I don’t even think you could do that now. And they would be incredibly, um, embarrassed by that.

[00:19:19] Shane: yes. Uh, but what we are gonna do is talk about the transformation then. So we’re talking about a place that is a 38% chance of post-op death, and we’ve now got that down to what percent.

[00:19:34] Kareen: Uh, sorry. It was 2% in 2019,

[00:19:41] Shane: Yeah.

[00:19:41] Kareen: that from, yeah, 2014. So in five years we dropped that

[00:19:47] Shane: Yeah.

[00:19:47] Kareen: 30, yeah, 36% drop.

[00:19:49] Shane: what I find really funny about that is you go, uh, we had a 36% drop. And you go, no, no, no. You went from 38% down to 2%. That’s like a 90% drop or 95, whatever. Someone else can do the maths one day. It, it’s a transformation. Um, and so, but people had gone in before you to try and do it as well. Um, and so as we go through, what did you do?

[00:20:20] Shane: How did the conversation is? What did the previous people do differently that. What did you do differently to the previous people? Um, so, so here we go. How do you get the death rate in a hospital post-op from 38% down to 2%?

[00:20:34] Kareen: You, you kill, you kill the trainer almost. Um, yeah. CDC actually asked me that same question out there. They were like, how did you make the difference? ’cause we’ve been working in this country for ages and we’ve never been able to do it. one, I had a director of the hospital who wanted to see change. think that’s a really big plus.

[00:20:55] Kareen: Yeah. Um, two, he listened to me. Three, I went, okay, they can’t go from here to here. They can make this baby step and let’s do that baby step first. Let’s get that right. So the very first thing that I um, taught in that hospital was hand hygiene. The next thing was cleaning. The next thing was laundry. You know, so late.

[00:21:20] Kareen: Basically, what can I teach and get right will make the biggest difference for them as like, I mean, don’t get me wrong, there was a lot of other things we put in sterilizers. We taught them how to do wound dressings properly. We had actual wound dressing packs that they didn’t use on the one patient all the time.

[00:21:39] Kareen: Like there was a, there was a a lot going on, but there was some really basic fundamentals that we taught. What I taught,

[00:21:46] Shane: And, and that’s what I love about this story, uh, because it literally just starts. With washing your hands. Um, and so, uh, a couple episodes ago we did the ending trama, and that’s literally a story about going into remote aboriginal communities and teaching them how to wash your hands and use a towel. And that is all you need to do to start to break the, um, the cycle.

[00:22:14] Shane: And what you are saying here is washing your hands is enough to start to break the cycle. Like just that grassroots starts to, to make a difference. Okay? But it’s not that simple, is it because.

[00:22:28] Kareen: It is not that simple. So let me give you a, a suggestion. So the surgeon that originally asked me to go up used to teach at a another hospital, and he had told this particular hospital you need to put a hand basin in in. So they put one hand basin in for a 36 bed. Ward, but that was the only hand basin that all patients and all their staff and, and all the family had. So the surgeon that came from that hospital to this hospital didn’t wanna put a hand basin in him because he said, you’ll see our people, they make such a big mess. Because there was so many people using that one hand basin and to wash their dishes, to wash their fruit, to clean their hands, everything.

[00:23:14] Kareen: It was just in that one hand basin. And so it was, it was so he really didn’t want hand basins. And I kept saying to him, like, it took me six months to get permission to come back here get funding. Um, rotary helped me humongously to get funding to go back and put, um, hand basins and water and new pumps and everything throughout that hospital. But yeah, it took a long time to get them to swing around to the idea of, okay, we have to start. Like I kept saying, you have to start somewhere. If you don’t start, it’s, it is always gonna be like this. And I kept saying, you know, you can’t teach a baby to walk, you know, unless they can stand, you know, you have to do, there’s some really basic principles that have to happen.

[00:24:00] Shane: And so, so it’s really ironic that they put one basin in and suddenly went, oh, that’s feral. And I could imagine it being worse because now you’ve got everyone doing everything, like you said, cleaning food combined with dirty hands and bloody, and blah, blah, blah, blah. Of course it’s gonna be worse. yeah.

[00:24:20] Kareen: their patient’s gowns, their family. Yeah. It’s gonna have water all over the floor. Of course. Yeah,

[00:24:26] Shane: so they went, that’s worse. We’re never going down that path rather than actually just going, the solution is to put more and more in. Um, and

[00:24:36] Kareen: yeah. Or how do we manage this? Yeah. critical thinking is not something that is common in this country, nor troubleshooting. So basically when you know, the king or the prime Minister says, do boop, you do boop, you don’t ever, ever question that. Yeah.

[00:24:54] Shane: yes, in Australia, if someone tells you to do something, we basically tell ’em to nick off and go do it themselves. Um, so we’ve got no question at all with, you know, a problem with questioning authority. Uh, whereas there’s a lot of cultures that just won’t question, won’t, speak up.

[00:25:12] Kareen: that and work with that. Yeah. Like how do I, like, oh God. It, I mean, it could have, um, the surgeon often says to me, that’ll drive you to drink up there. And thankfully I don’t drink a lot at all. But man, there was some nights that I was like, oh my God. Like, how the heck am I gonna get this point through? Yeah. Like, what am I gonna try now to try and change their thinking on this? Yeah.

[00:25:36] Shane: Yes. Um, okay, so we’ve got, uh, basic hand washing. So we are getting more sinks in, any resistance from people to actually wash their hands. How does it go with the nurses, the surgeons?

[00:25:50] Kareen: No, at all. So very interestingly, um, like I, I just remember the very first day we, so was a quadrangle outside the ICU. Um, there was a toilet among corner, and again, a lot of family used to congregate around there. So we put a hand, hand in laundry. Set up there. Basically it was just a, a covered roofed tin thing with two hand basins on one side and two for the little kids and around the other side, big laundry trough ones. Um, and the very first day that they were functional, I saw these kids coming out of the toilet and washing their hands and I was like, yes, no, there was actually, um, no resistance because now they had something that they could do. They didn’t have to walk a mile to find a hand basin. it had water in it, um, had soap. We didn’t put paper anywhere ’cause that would’ve been just too messy. Um, and too much of a leap. But it was a start,

[00:26:48] Shane: Yes. Awesome. Okay, so tier one was hand washing. the next step you said was cleaning?

[00:26:56] Kareen: Cleaning. So literally the cleaners, were just non-trained and they just had a straw broom. So they used to see them sweeping all the dust up and the dust would fly up everywhere. they didn’t have a, a basin with soap and water in it and a cloth. It didn’t have anything like that. So beds weren’t clean between clients.

[00:27:20] Kareen: Bamboo floor mats weren’t clean between clients. yeah, it was just a straw room. And then you’d get, you know, you’d have the directors going, oh, they don’t know how to clean ’em. Like, well, no one’s taught them how to clean no one’s. And the other big thing, no one’s provided them with what they need to clean.

[00:27:39] Shane: Yes. Okay, so.

[00:27:40] Kareen: that, that’s the really thing.

[00:27:43] Shane: So knowledge and resources, but when you talk about resources, what resources are we talking about?

[00:27:47] Kareen: well, you know, here we see. They’re not behind me because I’m in Perth for anyone that doesn’t know. And it’s, it’s the sun is hitting out there and it’s probably about 34 degrees out there now. So it’s getting warm. yeah, so resources. So, um, we got, came back here. We got a whole lot of cleaning trolleys.

[00:28:03] Kareen: Now, not that we actually had to provide cleaning trolleys, but we provided each department with a cleaning trolley. it had a and shovel on it. It had a spray bottle with cleaning equipment in it. They had cloths that then went to the laundry. They had a basin that used to get them processed and then new CSSD. Um, so yeah, just like things that web just take for granted here. So they finally had that. Yeah. Yeah.

[00:28:34] Shane: Okay. Um, and so, uh, so we’re now educating the cleaners and we’re equipping the cleaners. Uh, and so now there’s a chance that, uh, yeah. The wards can start to be, uh, cleaned

[00:28:48] Kareen: rubbish bins. bins. They, so they might have one selo bin at the end of the ward. So now there’s a multitude of selo bins and there’s uh, things like a roster. Who’s gonna empty the selo bin? Where are we gonna empty it? How are we going to burn the rubbish? You know, is the smoke gonna affect everybody? Um, is can somebody come and pick it up? So all around the back of this hospital was just rubbish, like, no, tomorrow. ’cause they

[00:29:16] Shane: Yes.

[00:29:17] Kareen: the rub that they had. So,

[00:29:20] Shane: Combined with your occasional flood to bring it back into your car park. Um.

[00:29:24] Kareen: yeah.

[00:29:25] Shane: so now just handling of rubbish, getting it out, um, stopping it from rotting around, having the smell, just adding to the, the rest of smell. Okay, so we’ve got hand washing, we’ve got cleaning, uh, what’s the next step up?

[00:29:39] Kareen: This the next one. This was the one that they really wanted earlier. So when I first was going up there, when I went up the second time for eight months, like I offered all their university staff to come in for free to the course that I was running for the, for national course on infection control. And they went, oh, we know infection control. And I was like, if you knew it, your hospitals wouldn’t be having this issue. so yeah, back to the question of the laundry, um, yeah, they just had these huge, um. Washing machines from the 1920s that used to just pour out soap bubbles everywhere. all the washing, like the, anything that was white that went in there came out gray and brown and I had all just went a funny color after being in that washing machine, the staff and the laundry had no idea how to process the laundry.

[00:30:36] Kareen: So they just with their bare hands, you know, they were sorting through everything and these big troughs. And they would just go in there and then they’d go in this massive big heater wash dryer thing. Yeah. So their, their laundry didn’t work at all. So I have a lovely company hair and I will name them ’cause they were amazing. CS l la went up with me one time and we. Um, installed four washing machines that actually sanitized and two dryers. And I taught the laundry staff at and gave them again, the equipment like, like long rubber gloves to, to actually sort through the line. And so the sharp stuffed in end and the laundry thing.

[00:31:16] Kareen: And yeah, we built a new laundry. We put hand basins in it though the first time I went there, the hand basins were being used to hold bananas, rather than being used to wash their hands. ’cause I had to teach them like, this is important. This is why you wash your hands. When do we wash our hands? You know, like, before and after eating here, after touching all this linen.

[00:31:39] Kareen: La la Yeah. Um, we got laundry baskets. So rather than what they used to use was just tie all the, um, linen up in a big sheet and either put it over their shoulder or put it on a patient trolley and trundle it to the laundry to use. Yeah.

[00:31:57] Shane: Yes.

[00:31:58] Kareen: I’m

[00:31:59] Kareen: you’d have to walk through water and dirt to get there as well.

[00:32:03] Kareen: Yeah, so there were times when I to go to that laundry and I was actually in my tuk tuk and it was all flooded again out there, and the kids from the family were all playing in the dirt and the water. And my lovely tuk driver managed to get me right up to the steps so I could step out and not step into the flooded water again

[00:32:23] Shane: yes. Yes. what I found funny though about that, uh, is yeah, the bananas in the hand washing sink. And you go, actually, how many restaurants do you go to in Australia where they’ve got the hand washing sinks and it’s filled with food anyway. So as much as we’re saying, oh look, this atrocious conditions, the truth is we’re talking basics here, and everyone around the world screws up the basics.

[00:32:49] Shane: but it doesn’t help when yes, you’re in a tropical zone and, um, and you’ve just got mud outside and you are meant to be attempting to do the laundry. But having said that, mud is the least of their problems. It’s all the, the blood and feces and all that crap that’s in the laundry just nicely being shared around for the next person.

[00:33:10] Shane: Um, so the washing machines, commercial grade washing machines, or.

[00:33:15] Kareen: Yeah, yeah. From commercial laundry solutions. Um, so they’re a lovely country in Jan Dicot that I happened to ask if ended up, it was forever pleading for equipment from here that hospitals were chucking out. And somebody said to me, oh, look, yeah, ours is going and these are the guys that normally fix it.

[00:33:33] Kareen: And so I rang them to ask if they could check it before we sent it up, and they went, hang on a second, Corinne, let me think about it. And came back, said, we can give you four new washing machines and two dryers. Um, and we went up and I remember we did, um, agar plate testings, um, before the washer went in, and then the same load when it came out, and then after that.

[00:33:53] Kareen: So we, I had very visual things, which always worked. If I had visual things to show them that, and like the, the surgeons who, like I said, look here, here’s what it looked like before and after. And they’re like, yeah. So they were so excited that yes, we managed to kill all the bugs that were on it.

[00:34:10] Shane: Oh, yes, as a.

[00:34:12] Kareen: another thing was right at the very beginning, teach them what, what a bug was. What, what a, you know, bacteria virus is. Fungi, they didn’t know that. Yeah. So,

[00:34:23] Shane: Yes. and the problem is, uh, you know, seeing is believing. Um, yeah. You know, that people die. They die because their heart stops. Well wait a minute. It’s because of the bacteria from here to, to there. And so, um, yeah.

[00:34:38] Kareen: Lack of recognition of what an infection was and how to you know, redness, fever, swelling, pain, uh, they didn’t know those really. Yeah. Fundamental things. Yeah.

[00:34:50] Shane: okay, so now we’re starting to spend more money. Um, so we’ve gone from, uh, hand washing. Yes, we did have to spend money and get,

[00:34:57] Kareen: 50,000 that we had to raise to put all that in here.

[00:35:01] Shane: yes.

[00:35:02] Kareen: that in that, a massive hospital.

[00:35:03] Shane: Uh. But huge turnaround. And then cleaning, uh, relatively speaking to the taps, going in cleaning was a relatively cheap, sorry, cleaners, education and equipment. Now we’re talking about washing machines. And so, uh, the cost is going up. What’s the next level above that?

[00:35:23] Kareen: So before that to

[00:35:25] Shane: Okay.

[00:35:25] Kareen: um, yeah, so before that, so their sterilizers didn’t sterilize what they had back then. Um, so the equipment was coming out wet. it had been so, so as soon as it comes out wet, the pores are open and the material that they were using to wrap it, that they actually had holes into the instrument. Tubs, would leave them in front of the open windows so the flies and everything could fly in. Um, and, and so yeah, it, yeah. um, what I did. After the first one. Yeah, after the first visit. So that was a month visit as we got actual sterilizers that sterilize. And I designed a, a central sterilizing department for them.

[00:36:08] Kareen: So had to teach them about sequential, you know, like this is where we, where we clean, this is where we decontaminate, this is where we assemble and pack. This is where we sterilize and this is where we store dry and clean. And that was a very big task in itself as well. But yeah, we’re very good at building.

[00:36:27] Kareen: Yeah. And then, yeah, again, fundraising back from here again. Um, so I have a lovely surgeon. I work with , Dr. Tim Keenan. , He is a humanitarian surgeon that does work in Palestine and trying to get someone to go to East Timor, if anyone’s listening to this and wants to do the similar sort of thing in East Timor. yeah. And he works all around the world and just an incredible man. He’s 80. Is he 82 or 84? He’s in his eighties now. Still doing this

[00:36:55] Shane: Wow. Yes.

[00:36:56] Kareen: Palestine just recently, but um, obviously a little war happened in the middle of all this. So he’s not gone now. Yeah.

[00:37:03] Shane: Yes. and so like with CSSD, uh, now depending on my audience, some people will be going, Hey, we now understand what you’re talking about. Um, but. It’s really just about, cross-contamination. And so you’re just going, they’re really dirty. Keep them away from the clean stuff. Uh, and then, you know, once something has been cleaned, once it has been sterilized, avoiding it being contaminated again.

[00:37:29] Shane: Uh, and so really, really basic principles. what were they doing before you put in A-C-S-S-D then?

[00:37:36] Kareen: So the instruments, so any theater nurses listening to this will be like, oh my God, any theater managers are like, well, we’ll make them work harder. So they’d have one scrub nurse per three to four theaters, and they would be running between every theater. So that was a problem. they’d literally get the instruments from the surgery that had just been done, and they’d just tip them. So they’d break, and into the scrub sink where you actually did your scrub prior to surgery, and they would wash them there while they were listening out for the other three theaters. And then they would just literally pack them back into a little tub, a metal tub thing, and send them down to C um, put them in their sterilizer.

[00:38:23] Kareen: That didn’t function.

[00:38:25] Shane: Yes.

[00:38:25] Kareen: So, yeah.

[00:38:27] Shane: Wow. Okay. Um, and so then introducing a proper CSSD, now at this stage then I assume that the bills are going up, so a, a sterilizer and a, um, a proper, um, washer. What sort of money are we talking about now?

[00:38:47] Kareen: I’ve never actually kept a running tally. I know it costs me, um, like my husband and I, he, he worked out the other day. He said, honey, I think that we’ve spent just an hour time, my time alone, well over 250,000, at loss of wages. What we did up there. and certainly we went into negative and forget it. But, you know, I have gratitude for what I’ve been able to achieve up there. I’m very proud of what I’ve achieved up there. Um, and I was able, for whatever reason, they listened to me and did what I asked them to do. And now this hospital is considered the role model for the rest of the country and they are literally role modeling the rest of the hospitals on this

[00:39:29] Shane: Yes,

[00:39:30] Kareen: So I’m, I’m quite chuffed about that ’cause that was what I hoped it would achieve. I thought if I take the worst hospital and can turn that around, then to God they can do the rest.

[00:39:40] Shane: yes.

[00:39:41] Kareen: yeah, cost wise, um, I’ve gotta say I use mainly Rotary a lot here. There’s, uh, rotary Osborne Park, um, there’s a, a band of lovely guys up there, but one of them particularly went to school with Tim Keenan, so he’s, um. Very, um, he’s also in his eighties he, um, got his rotary involved. Um, and so when I came back that first time and saw the poor city of gear that they had, I wrote to every single director in the and wa of the big hospitals and said, please, if you’re chucking out scissors, you know, we have single use scissors here.

[00:40:20] Kareen: Don’t chuck them out, keep them, send them down to CCC, decontaminate them and keep them and we’ll send them up there. And I think we’ve sent up more than, or they have rotary sent up more than 60 shipping containers now to this country. They now ship to Africa to other countries as well.

[00:40:38] Shane: Yes.

[00:40:39] Kareen: But we shipped a lot of beds up there.

[00:40:41] Kareen: Initially we were shutting down lots of hospitals here. The beds were being out, which is just ludicrous. Um, yeah, the waste that we have here, sorry if the government are listening here, the waste that we

[00:40:54] Shane: The government are always listening.

[00:40:56] Kareen: Yeah. Yeah. Our waste is terrible, but a lot of it went to really good use up there.

[00:41:01] Kareen: We sent neonatal cribs up there, um, instruments. Um, I begged and pleaded from a lot of companies like yourself. Um, I, you know, anyone that was getting rid of their old, like tools, I was like, please, can we have them?

[00:41:17] Shane: Yeah.

[00:41:17] Kareen: yeah. So yeah. So a lot of the stuff came from Yeah. Begging

[00:41:22] Shane: Yes. Yeah.

[00:41:24] Kareen: Yeah.

[00:41:25] Shane: And so in terms of, of cost, you know, we we’re doing a steep trajectory up now. Um. You’ve now got new washers, new sterilizers and everything. Uh, what’s the next step? Like, you know, once you’ve done all of that,

[00:41:42] Kareen: when I went back the second time, which was for eight months ’cause I was well aware that they needed to know infection control, but they thought they knew it. They wanted me to teach operating theater nursing. And I was like, happy to do that. And so a lot of that was about infection control. I taught that infection control course over six months. I had to develop it, write it, and teach it at the same time of doing a theater course. Um, and teaching that hospital how to be a hospital. So working with the directors, you know, like, let’s get a mate and it’s sent together. This is who you need, A plumber, a carpenter, an electrician, you know, blah, blah. So I was doing all that at the same time. And then, um, I had a lovely lady from here, Sam Gen Away, who’s a nurse at Rural Perth Hospital who ca came up for two weeks when I was there for the eight week, eight months. And she came back with me quite a few times support me and teaching as well. And we just got more, I guess more people knowing about it. go up and I’d teach basic life support and we’d, we took from St. John’s a whole heap of, um, defibrillators and taught them how to use defibrillators. We sent up an ambulance, what else did we do? So one time was teaching wound care, that that was one huge lesson. So how they used to do wound dressings was one trolley per the whole ward for every patient at the same time. So the nurses would be running backwards and forwards dropping their instruments and their stuff from that one trolley to multiple patients. So, One time we took a, uh, took a first group of nurses, eight student nurses from ECU up with me. They fundraised for me, went to the markets, and we bought kidney dishes and forceps and little galley pots, and we went and got the proper material and I taught them how to wrap them and make them.

[00:43:27] Kareen: And we had reusable dressing packs. Um, so that, and we had, but you have to go through how does that dressing pack, who, who takes it to CSSD, you know, who’s, who’s gonna pay for that? Who’s gonna walk it there? Whose job is it to do that? How are we gonna get it back if it belongs to our ward, is it gonna come back? You know? it was a, yeah. Yeah. So that’s another thing that I did. Lots of things. How to, you know, what’s a job description of a nurse? Outta care and comfort for a patient. That was a very interesting lesson. A hundred nurses,

[00:44:02] Shane: Yes.

[00:44:03] Kareen: for a patient. yeah, just, just, yeah. So every time I’d go back I would add on to what I’d taught to just take them up another level.

[00:44:12] Kareen: Yeah.

[00:44:13] Shane: Yes. and it’s, yeah, how to have compassion on a patient. When you are a hospital for 400 people, currently with 500 people, most of ’em are dying. If you had started there, there’d be go like, but eventually you get to the stage where you’re going, look, compassion is a critical part to recovery. so it’s just,

[00:44:33] Kareen: It is quite

[00:44:33] Shane: yeah.

[00:44:34] Kareen: actually. So I used to like walk into recovery and two nurses would be down the end of the recovery room on their phones you’d see a, wife of a patient crying in the corner. Really worried about it. And the nurses would never go up and go, you know, are you okay? So one of the directors from another hospital said, oh, you can teach my nurses how to show compassion. I smiled ’cause I knew exactly what he was talking about. So I put together a course that was a day course, and one of the senior nurses from this town sent me an text going, cream, you cannot teach patient nurses to touch patients. Nurses cannot touch patients. It’s absolute. No-no. And I thought, oh God, I really got my work cut out for me here. I had 50 nurses from that hospital and 50 nurses from other hospitals. And um, so the first part of the morning was, you know, what’s a good nurse? What’s a bad nurse? You know, is this a good nurse? That’s a good nurse. You know, how do I say, how are you? Are you okay? know, and so that was one session.

[00:45:41] Kareen: Then the next session was, and we got ’em to practice on each other. Where do I touch a patient? You know, how long do I touch for? how do I know if they don’t like it? So very, very literal teaching.

[00:45:52] Shane: Yes.

[00:45:53] Kareen: And then I got them to go out and practice showing compassion to a patient two by two out into their hospital. And this particular nurse came back and she was so gobsmacked at how the patient felt. She went and found another patient. Now she teaches that subject. recently I have a, a chap here who’s here doing a master’s. And he said, oh, he said, you know, my father had to go to that hospital recently. He didn’t know about me teaching there. And he said, you know, now they’re really good. They smile at you and they, they look and they’re kind and they’re caring. And I was like, yes.

[00:46:31] Shane: Yes. and, and it’s funny that, yeah, it’s, I feel like I’m being looked after and they care about me as opposed to, I don’t know, I’m, uh, Dr. Gregory House, you know, probably the worst TV show ever because now you think that if your doctor is rude, he must be brilliant. Um, but yeah, to actually say no, be nice, be caring, uh, and it makes such a big difference.

[00:46:56] Shane: Okay, so. we’re now getting to, you know, it’s the small incidentals, but let’s run backwards. Let’s just say on day one you had stepped in, so we’re talking day one, 38% death rate. Let’s just say you had replaced the sterilizers on day one. Okay. Gone in, done. The big change. What impact would it have had you only change the sterilizers?

[00:47:22] Shane: Nothing else.

[00:47:24] Kareen: It would’ve had a reasonable impact because now that have, well, the instruments were sterilized between there, but wouldn’t have stayed sterile when they come out of there be, oh, actually, they would’ve ’cause they would’ve been dry. But they would’ve not known to close the holes up in their step, in their little buckets. so in their tins, they would’ve kept them in still very humid conditions. yeah, there, there would’ve been a little change maybe,

[00:47:54] Shane: But you’re still gonna end up back in a ward with dirty rags as dressings.

[00:48:01] Kareen: yeah. So you would’ve, instead of dying on in the first 10, 12 hours from the operation, which you, you might have had a slightly bigger chance there, like, this hospital now is considered incredibly popular hospital, so they, I think it’s 1,600 bed hospital now. Uh, it’s grown exponentially because people actually are happy to go there because they actually survive.

[00:48:22] Shane: Yes.

[00:48:22] Kareen: So I had a very bad name before, but yeah. Yeah, yeah. Good question.

[00:48:28] Shane: Uh,

[00:48:28] Kareen: can’t give you percentages ’cause I just don’t know.

[00:48:31] Shane: no, but my guess it’s gonna have almost zippo. Zilch, because most of the infections were just. Everything’s dirty. And so just to have a clean scalpel is gonna do buckleys when everything’s just bad. Um, hypothetically changing the washing machines. forget the sterilizer, forget everything else. All we do is put in new washing machines so they’ve got clean linen.

[00:48:54] Shane: What sort of impact?

[00:48:55] Kareen: Bearing in mind that most of ’em didn’t have linen on their beds anyhow. They just lay on top of a hard bed,

[00:49:01] Shane: Okay.

[00:49:01] Kareen: no. Um, but yeah, so the linen that was washed was theater linen.

[00:49:07] Shane: Yes.

[00:49:08] Kareen: yeah. So the, yeah. So if we just change the, the washing machines, yeah. It, it, it’s, you know, it’s a package. You can’t just do this and not do that. it’s a package. It really is. Yeah.

[00:49:24] Shane: Uh,

[00:49:25] Kareen: Yeah.

[00:49:25] Shane: I find amazing is it’s the concept that. At the end of the day, you are spending a lot of money to, you know, putting in sterilizers. Like to be world class, you have to be up here and you have to spend the money, you have to have the sterilizers, you have to have the washes, you have to have all of this, and that’s how you achieve.

[00:49:43] Shane: Um, you know, 2%.

[00:49:46] Kareen: that were reasonably priced. So, so, uh, uh, we went to China.

[00:49:50] Shane: Yeah.

[00:49:50] Kareen: I didn’t go to China. I ended up, you know, soap that was being sold to us from one country that was coming in at $4 50 a bottle. But then being through all the corrupt hands, arriving at the hospital at $35 for a bottle, I then found from a neighboring country at $2 50 that that country could, that hospital could then use.

[00:50:13] Shane: Yes. okay. So, but my point is, you know, to get to 2%, you have to do all the amazing stuff. But to get away from 38% and have it, um, or get that really big change, it’s back to the basics of, you know, having the sinks, having the, the washing of your hands, having soap, um, having cleaners who actually clean, removing garbage.

[00:50:38] Shane: Those are the, the fundamental basics that, from 38 down. and yet that was the stuff that had previously struggled to happen. Um, and the reason why I wanted you on EHO knows is because, well, wait a minute, what’s environmental health all about? Well, it’s about. Prevention and it’s about, you know, the basics.

[00:50:58] Shane: And so all of those things are just fundamental environmental health. And in this case, it’s a hospital. When you neglect those, it goes horribly wrong. Um, but be it hospitality, be it whatever, you get the basics wrong and things can go horribly wrong. and so yeah, that’s, that’s the amazing stuff.

[00:51:16] Shane: You don’t have to spend a huge amount of money, but you always need to get the basics right. Um,

[00:51:21] Kareen: Interesting. Like, like I know the sterilizer costs us 30,000 us, that first one that we put in.

[00:51:29] Shane: yes.

[00:51:30] Kareen: So, yeah, there wasn’t like, we, were pretty tough on, on what things cost.

[00:51:37] Shane: Yeah. Now you’re gonna be banned from all the, uh, Australian sellers of, uh, you know, um, sterilizes, because the hint that there’s a $30,000 sterilizer out there probably doesn’t go down too well.

[00:51:51] Kareen: Back in 14, so 12 years ago.

[00:51:53] Shane: Yes. Yeah. Pre COVID pricing. Um,

[00:51:56] Kareen: Yeah.

[00:51:57] Shane: yeah. Okay. so here we are now 10 years later. Uh, and like you said, it’s now a hospital of choice. if you are holidaying in this country and you do unfortunately have that accident and you’re now taken to that hospital, um, you know that you’re gonna have sterilized, uh, instruments being used, you know that you’re on clean linen, uh, you know that post-op, you’re gonna be going to a clean ward.

[00:52:26] Shane: Um, you’ll probably be paying for the private ward. and you’re gonna have a nurse who cares? She’s going to show compassion. Um, she’s going to have washed her hands before.

[00:52:40] Kareen: I hope, I

[00:52:40] Shane: Yes. Um, and yeah. Um, and there’s gonna be a sink in the, the ward. and so now you’re gonna be going, you’ll probably be sitting there going, Hey, this hospital is not as good as, but the point is that you are now talking about a, a hospital where you are gonna walk out again.

[00:53:06] Shane: and yeah, you’re not now tossing a coin going, am I gonna live? Am I gonna die? Um, that’s a huge, huge, uh, transformation. Uh, so any last minute tips for anyone who feels like they’re up against a insurmountable barrier or, you know, is trying to do a radical change? Hindsight, what are your thoughts?

[00:53:31] Kareen: City. Um, see it and hear it a lot in the field I’m in now. Um, I remember anesthetist saying to me, Queen’s very tenacious when I was trying to get alcohol hand gel into a hospital. you know, like, yeah, so just sticking to your guns when you, when you know you’ve done the research and you know that this is the cheapest, best alternative to actually making a difference. Then looking at all the different ways, like I’m, you know, there’s four different types of people. I’m not very influential, I didn’t think. Um, but I’m very conscientious. I’m very, um, pragmatic and I think you, you need to be tenacious and you need to just go, well, baby steps. So if I can’t. Get them here.

[00:54:19] Kareen: Can I get them to here? Is this one step enough?

[00:54:22] Kareen: You know, sometimes a little bit of bravery

[00:54:25] Shane: yeah. Um, so message to all our government employees. A little bit of bribery works. Okay. Um, yes. but.

[00:54:38] Kareen: I think. And you know, like one thing that we haven’t mentioned and that I really like, I worked really hard during COVID. Um, with them, their transmission rate to their staff was 0.1%. It was way less than ours. And this is a third world, or was a third world country who had a death rate. That was incredible. But they did exactly what I asked them to do from the get go and followed that. And we did things very cheaply, that isn’t considered the norm, but it was like, what else can I do? How can I make this work? Um, that so that people don’t die. That all their staff don’t die of infections, you know, so, and yeah.

[00:55:24] Kareen: So I come up with some novel ideas. I’ll say, I won’t put them on on your podcast ’cause I would be shot down in flames and I was shot down in flames from World Health Organization and all sorts with saying and doing what I did,

[00:55:37] Shane: But it is actually a huge testament because you’re talking about from, uh, 2014 to 2020 was COVID. And so in that space of, uh, five years, six years, you transformed, um, how things happened such that when COVID came along, here’s the ultimate test as to what’s your infection control like, and you can basically pass with flying colors and yeah, outperform, uh, what happens around in a lot of other countries.

[00:56:05] Shane: Um, yes, and that’ll be the, um, the, the sequel secret episode, uh uh, which will then get you banned from, uh, practicing every again. Um,

[00:56:17] Kareen: Yeah. I see.

[00:56:18] Shane: there was nothing wrong with those leches. Those leches were great. Um, that’s a joke, by the way, just in case for any of.

[00:56:26] Kareen: mean in basic, so anyone is listening. I got them using airborne percussions from the get go.

[00:56:32] Shane: Yes.

[00:56:33] Kareen: Right at the

[00:56:33] Shane: Yeah.

[00:56:34] Kareen: Uh, and they did that and I guess the way I got them using them was a bit novel, it worked. ’cause they couldn’t afford to chuck their masks out.

[00:56:46] Shane: Yes, yes.

[00:56:47] Kareen: I,

[00:56:48] Shane: Mind you.

[00:56:48] Kareen: I basically, yeah. I won’t go into that ’cause I will get in trouble.

[00:56:54] Shane: Oh,

[00:56:54] Kareen: Been in enough.

[00:56:56] Shane: and so, so where we’ve finished, yeah, just that concept that, yeah, be tenacious and you can make a huge difference. Uh, focus on the basics first. Work up from there. Work with people. Um, yeah. There’s so much in this, uh, episode that be medical hospitality or whatever. Um, it,

[00:57:17] Kareen: one other

[00:57:18] Shane: yeah.

[00:57:18] Kareen: you um, that, so when you’re dealing in a foreign country, so if anyone’s doing that so in a foreign language, um, and with people with maybe lower intellect that if you can make your training very visual, that that was really handy as well. So I’m gonna say, Shane, uh, plug your, plug your product here.

[00:57:43] Kareen: ’cause you know, I used it. So, uh, at that stage I used a uv, um, sanitizer product to show hand washing, show what bugs were, show how they transmitted, show how we cleaned, and how to get rid of them. What worked, what didn’t. Um, that, that was really good for, you know, like cleaners that had no education whatsoever.

[00:58:06] Shane: Okay. Okay, so if we’re gonna finish on a shameless plug, then we’ll finish on a shameless plug. Um, so, so Glitter bug is the product there, but we’ve now got our own Aussie version of Glo to show. Uh, and at this stage, uh, a lot of people come to me and they say, look, can you do a charity discount? And the problem is most of our customers are charity.

[00:58:26] Shane: Uh, but here’s the thing, if you are doing something, and in this case, um, uh, KARE literally was, she’s doing all of this and she’s not being paid for it. Um. If that’s you, if you’re doing any charity work and you’re trying to teach people hand hygiene, come to us and we’ll just give you the product. Um, and I can largely say that because not many people will take me up on the offer.

[00:58:53] Shane: Um, but at the end of the day, yeah, it’s just teaching people those basics, saves lives. Um, and so yeah, if you’re giving away your time, I will gladly give you the product so that you can save lives. Um, and for your eh, hos out there, just buy the stuff and just teach people how to wash their hands and do the basics.

[00:59:17] Shane: Um, and so, yeah. Thanks for that shameless plug at the end.

[00:59:23] Kareen: I’m happy. I even had a teacher here, a primary school teacher here the other day. I said, here, if you’re not using this, give us a go. Show you how it works.

[00:59:31] Shane: yes.

[00:59:31] Kareen: was like, oh, really neat. And I’m like, yeah, it is. It’s very visual and especially for, you know, if you don’t have a high intellect or you’re struggling with a language problem, it’s such a good tool.

[00:59:44] Shane: Yes.

[00:59:45] Kareen: for that, because I’m taking some of those freebies up. I actually was gonna be paying outta my own pocket, but Shane, you for your freebie pack Arrive today, which they’ll be most chuffed for.

[00:59:56] Shane: yes. No, no, it’s, and yeah, it’s, it’s just awesome. Um, so I love the story. So thank you very, very much for being on the podcast. Uh, if anyone wants to be in contact with you, uh, we’ll drop your, uh, email, if that’s okay, at the end in the comments.

[01:00:16] Kareen: look, I’ve got a website. They can look Karine done knock up. Yeah. So it’s with two E’s instead of Karen with one E.

[01:00:23] Shane: Um, so yeah, K-A-R-E-E-N Dunlop, as in Goodyear. Uh,

[01:00:30] Kareen: yeah,

[01:00:31] Shane: And so, uh, dot com au.

[01:00:34] Kareen: Uh, it’s ka do za actually,

[01:00:37] Shane: Okay.

[01:00:38] Kareen: uh, my actual website is, yeah, Karine do is BIZ.

[01:00:42] Shane: Yes.

[01:00:42] Kareen: But

[01:00:43] Shane: Awesome.

[01:00:43] Kareen: you put Karine, Dunlop, then I pop up.

[01:00:45] Shane: Yes. And so thank you. Thank you so much for being on the, um, the show today and all the best with your many transformations ahead.

[01:00:55] Kareen: Next one. Yeah. Up there again in May. Cool.

[01:01:00] Shane: Okay. Thank you.

[01:01:02] Kareen: Bye. Bye everyone.