Island Nurses

by Howie, Leonie; Robertson, Adele;

  For example, she was once told a child had fallen 50 metres down a cliff and was bleeding internally! But when Adele arrived the child was sitting up in bed eating an ice-cream, and it turns out it was more of a roll down a hillside than a plunge from a cliff.

  Or a resident overlooking Okiwi airfield phones to say a plane has crashed on take-off! Adele packs everything she thinks might be useful in treating the horrendous trauma she is expecting—fractures, contusions, internal injuries, burns—and, even so, feels she is going to a disaster area with a Band-Aid. It turns out that, although the plane is badly damaged by the forced landing in a farm paddock, the pilot and the local family on board have suffered minor physical injuries. Adele’s Band-Aid is sufficient.

  Late one night there is a pounding on the door. A panicked local reports that a man who was riding on the tray of their truck on the way back from Claris has fallen off on to the road! ‘Hurry,’ he says. ‘He is bleeding—covered in blood!’

  Adele rushes down the stairs and hurries to the roadside in the dark, thinking head injury, major skin loss, embedded gravel, fractured limbs. She can dimly see the man’s face. His hair is matted and his skin is pale and covered in dark rivulets. Adele starts to talk to him, anxious to engage him and assess his level of consciousness. To her surprise, he responds quite brightly. She feels for his wrist and locates the pulse. It is strong and steady, not weak and rapid as she expects. Adele flicks on her torch, and plays the beam over him. Everyone starts laughing. He is covered from head to toe not in blood, but in mud. The patient tries to laugh, too, but gasps in pain. It is not all high comedy: he has fractured a few ribs.

  The reason Adele coped was the support she was getting—from Shannon, obviously—but also from the community. Gwen became a close friend. While Adele first started visiting her on a regular basis to see how she was coping with the loss of her mum, the boot was soon on the other foot in those sessions. In those early days, she sometimes set off to perform her daily round of home visits but became suddenly overwhelmed with the feeling that she could not go through with them. At moments like those, she would drop in on Gwen. Gwen would just seem to know when she saw Adele’s face that all Adele needed to gain composure and perspective was a friendly cup of tea and a laugh.

  There are others in Adele’s network, too. When she arrived on Aotea, a young mother—one of only two other women of near age in the vicinity—befriended Adele and suggested that she come along to a quilting session with her.

  ‘I don’t know the first thing about quilting,’ Adele said.

  ‘Doesn’t matter,’ her new friend said firmly. ‘If you can sew, then you can quilt.’

  So Adele became a quilter. The venues for the sessions varied. Often Adele had to take a boat to get to the meeting. Other members of the group walked up to an hour through the bush. The food was always outstanding, as everyone brought a dish cooked to their favourite recipe for a shared lunch. But, more importantly, these quilting sessions became a great source of emotional sustenance for Adele. The conversation was always interesting, and there was no pressure to converse. Sometimes she was so tired that she would just sit and absorb the atmosphere. Children ran in and out of the houses: it was an adventure day for them as well, a break from their accustomed isolation, having all these people around. The group worked communally, making quilts for each other as well as for weddings, new babies and as fundraisers. The group made an Aotea quilt as a fundraiser for Greenpeace, and were excited to hear that it was won by a woman whose house had burned down and who had lost everything. Adele always came away from the sessions energised and relaxed. And, even as she sat side by side with other members of her community, stitching together their quilts, she was herself being stitched into the fabric of that community. In a sense, she too was becoming part of an Aotea quilt.

  The biggest lack she feels in her early days on the Barrier is the lack of professional support. Her employers in Public Health are Auckland-based and therefore urban. Her first Director of Public Health Nursing was a rural public health nurse in Northland who understood the effects of isolation and the scope of situations that a rural nurse might be called upon to deal with. She also made several visits to the island to see first-hand how Adele was coping. But, since she retired, relations with the new management have become tense and she does not feel safe disclosing to them the anxieties and feelings the work generates. She has been obliged to look elsewhere for strength and support.

  She sees Nancy Cawthorn at least once a week and, as she suspected when they first met, Nancy has been a huge help, a fount of wisdom and experience about the unique demands of rural nursing in general, and nursing on Aotea in particular.

  In spite of the bureaucratic decree not to have anything to do with Ivan, the GP, it is plain to Adele that they both have the interests of the islanders at heart. She is impressed by Ivan. Unlike many doctors in her experience, he is quite willing to seek help if he is unsure about anything. He possesses the rare ability to instruct—Adele is learning a lot under his tutelage—while also supporting and affirming.

  Adele’s background is in what is called community nursing. Shannon and she were married shortly before she completed her nursing training. A year after she completed her training, they moved to Australia. Coming from the New Zealand winter, they wanted a warm climate, and they settled on Port Hedland in the Pilbara region of Western Australia. Shannon got a job with a mining company, and Adele at the local hospital. This introduction to Australian Aboriginal people and their culture intrigued her so, in an effort to find out more, she applied for a job in community health. Consequently, what was initially intended to be a six-month stay turned into seven years.

  She was given some training. She was put behind the wheel of a long-wheelbase, four-wheel-drive Toyota Land Cruiser and taught how to drive around and around in an abandoned Perth quarry, in order to prepare her for driving in the outback. There was no doubt the vehicle was fit for purpose. But when she was given her first caseload she sat at her desk with a pile of records of the families she was to visit in town that day and she had an anxiety attack. She knew next to nothing about Aboriginal people. She was going into strange territory, all on her own, to knock on the doors of people she had never met and who had never heard of her and who may or may not want her to be there. What would she say? How would she feel if they were rude or hostile? What if the timing was simply wrong for them? What if there were dangerous dogs or drunken or violent people in the house? She was a hospital-trained nurse. Hospital training, she realised, hadn’t prepared her for work in the community at all.

  She realised that the only way to deal with her fears was to confront them. She made her rounds, and for the most part was very warmly received wherever she went. She found that she needed to learn another way of thinking, talking and operating. Time moves more slowly in the community than it does in the pressure-cooker of a hospital, and it relies intensely upon the building up of relationships and trust. The focus is not on the performance of tasks; rather, it is on a partnership that involves helping people to help themselves over time. It is often less threatening to start on minor issues and build up to the bigger ones, so as not to compromise that fragile trust. The focus is on the person—or, more often, the family—not on a particular problem.

  The clinic out of which they were based was little more than an old shed in the grounds of the hospital. There was a tiny waiting room—so small that most patients preferred to sit outside on the grass—and besides that it comprised three rooms: one was a storeroom, another was for the doctor, and the other was for the administrator and nurses. There were six people, but only three desks—reflecting both the low priority health funders gave to Aboriginal health at that time, and the expectation that community nurses would spend most of their time out in the community.

  Sure enough, her first week in the job was not over before Adele was directed to do a station visit. She stood in the doorway of the storeroom staring at the shelves of supplies an
d felt completely overwhelmed.

  ‘I don’t know what I’m supposed to do,’ she said to the administrator.

  ‘What you do is you fill three of the eskies [as the Australians call chilly bins] with drugs, dressings and vaccines, and you put the eskies, the baby scales, the measuring board and the box of patient notes in your vehicle and you head off.’

  Adele hit the road. The vehicle was air-conditioned and had a built-in water tank (for hand-washing) as well as a 12-volt refrigerator for storing vaccines, and a radio link to the office and the Royal Flying Doctor Service base. The outback was another kind of isolation. The empty spaces and the heat; the ragged, parched vegetation extending to the broad, unbroken horizon. It was possible to feel pretty alone out there.

  Adele’s biggest fear was that she would miss the turnoff from the main road to the station, or that the vehicle would get bogged somewhere along the way. Her heart was in her mouth as she negotiated a riverbed, but once she was across it was plain sailing to the first camp at the station. She had barely got the back door of the vehicle open before an orderly line of mothers and children had formed. Adele wanted to take about ten of the children back to the hospital with her, but the hospital only had eight paediatric beds. How to choose who stayed and who went? So Adele opened the chilly bin containing the medicines and started dispensing. This was the beginning of her lifelong work with women and children.

  The area that Adele’s service covered was a little over a million and a half acres. There were some mining communities in her territory—the towns of Shay Gap, Goldsworthy and Telfer—but most of her work was in far-flung Aboriginal station communities such as Strelley, Lalla Rookh, Warralong and Yandeyarra.

  Adele soon learned that the women she was working with lived in a traditional society where men had all the power and made all the decisions while their wives were regarded as mere chattels. Aboriginal women were doubly condemned—they were treated as second-rate both by their own society because they were women, and by wider Australian society because they were Aboriginal.

  As a nurse working with Aboriginal communities, Adele herself was often treated badly by some of the medical and nursing staff of the hospital. She did not fit the ‘nurse’ stereotype. Instead of appearing pristine in white with tidily groomed hair and make-up on, meekly deferring to the doctors’ wishes, she came in after a long clinic day, dusty, sweaty and tired, with patients to be admitted—and it clearly irked the doctors that a nurse would presume to make this decision. Quite often an ill infant would have soiled her uniform. Her appearance was bad enough. As time went by, she learned to be assertive and to demand that her patients be given the treatment and respect they required.

  It was hard work, physically certainly, but far more so from a psychological and emotional perspective. Adele’s Aboriginal clients died. They were beaten to death by their husbands, they died in prison cells from injuries that should have been treated in hospital—a health worker and his pregnant partner were electrocuted in a shower block that had been wrongfully wired by a council contractor. They died from poverty, alcohol abuse and a lack of adequate and appropriate health services, housing and clean water. Adele had imagined that it would feel good to be making a difference. Instead, she found it soul-destroying to be confronted daily by so much injustice in the face of which she and her clients were all but powerless.

  One day, towards the end of her time in the job, she received a note from one of the young mothers she had been caring for.

  Dear Sister Dell, it read. The baby is born. She is called Mary and she is beautiful.

  Soon afterward, a cyclone hit the coastline north of Port Hedland. The news was lackadaisical about it: the reports described the affected area as uninhabited—somehow overlooking the 500-strong Aboriginal community of Strelley Station. The day after the cyclone, Adele was contacted at work by Civil Defence who reported that, on a flyover of the community, they saw a cross laid out on the ground signifying a need for medical assistance. Adele and the doctor were despatched to the area to render what assistance they could. A Civil Defence vehicle accompanied them so that, if either became bogged, the other could drag them out. It was a terrifying drive: the very first creek they crossed, the water rose to the door handle and the current was very swift. Once off the main road, they were forced to crawl through the devastated landscape in low ratio. It took forever to get where they were going.

  They eventually reached the Strelley Station clinic, miraculously unscathed among the ruins of the houses, and found the women gathered outside it, wailing. Lying inside on the bed was the lifeless body of baby Mary. Her mother, sitting beside her, reached out to Adele and tearfully told her that they were all sheltering in a strong communal building and that she’d had little Mary in her arms when she just stopped breathing.

  The mother’s note had been right: baby Mary was beautiful.

  It was the final straw. For her sanity, Adele decided she and Shannon would return to New Zealand. Her thought at that stage was that she would train as a midwife and return to Australia. At her farewell, her colleagues told her they’d been taking bets on how long she would last back in a hospital setting. It is true that her reintegration was tricky at times: she had become sensitised to racism and to the subtle ways in which institutions and policies entrenched it. Nor after seven years in the frontline of community nursing was she shy about expressing her opinions on injustices wherever she found them. But what kept her going and ensured she proved her former colleagues wrong was her passion for midwifery. As a community nurse, she had felt helpless in her work with women, unable to change the way society treated them. Midwifery offered her the chance to advocate for choice and control in some of the most important moments in women’s lives. She developed a belief that the key to health lay at the foundation of life and that the key holders were mothers.

  Adele’s own mother was unsurprised that she had found her vocation in midwifery, but she thought it had less to do with philosophy than with genes. When Adele’s great-great-grandmother, Eliza Carrington, was widowed in 1890, her husband, Wellington, left her destitute with five children. To support her family, she returned to her profession as a Taranaki midwife. From the age of about thirteen, Eliza’s daughter—Adele’s great-grandmother—assisted Eliza at births and became a lay midwife. She then assisted at her own daughter’s—Adele’s grandmother’s—births. Adele’s mum occasionally joked that if Adele, as a child, had asked her the age-old question ‘where do babies come from?’ she would have replied that her gran brought them in her bag! Every time her grandmother came to visit, a baby came soon afterward. When she is sitting quietly with a mother in childbirth, Adele often thinks about this long line of her forebears who have performed the same ancient service, and of the thread that connects women and midwives through time.

  After completing her training, Adele consolidated her midwifery practice working for two years at St Helen’s Maternity Hospital in Auckland. Although the midwives at St Helen’s had a considerable amount of autonomy, many aspects of practice were still controlled by the bureaucracy, and Adele’s spirit chafed against it. In the end, her heart remained in the community, and when she saw an advertisement for a combined Public Health and District Nurse and Midwifery position on Great Barrier Island, her fate was sealed.

  One of Adele’s first experiences working with Ivan, the doctor, is the happy occasion of a birth. She has been on the island for less than a month when Ivan contacts her and asks if she will support him as midwife when he attends the birth at home of a local’s baby. Neither Ivan nor Adele have attended a home birth, and this is a home birth with a difference: it is going to happen on Aotea, a remote island a long way from secondary support.

  ‘She did not really give me much choice,’ Ivan tells Adele. ‘She said, “Well, doctor. I am pregnant with my third child. The first two were born at home, so I would like to know if you will come to the birth. If you don’t, it will just be me and my husband because I have got no intenti
on of going to the mainland.”’

  ‘Well, I’d be happy to come along, if I can get permission,’ Adele says.

  She phones the Director of Public Health Nursing in Auckland. They talk through the possible issues.

  ‘I am experienced,’ Adele says. ‘And, of course, being a midwife is part of my job description out here.’

  ‘OK,’ concedes her supervisor. ‘But we were thinking more that you’d be attending unexpected births rather than planned births.’

  They talk some more. Adele likes this particular supervisor. She has been to the Barrier and, more than most, she understands what Adele’s position involves. She also has more respect than many of the others in head office seem to for Adele’s professional skills and judgement. ‘If you and Dr Howie think that it’s within your scope, then I’m happy to give permission.’

  Adele lets Ivan know, and Ivan lets the mother know. Panic sets in! Both Ivan and Adele are products of the 1980s hospital system, which takes what in technical language you would call a ‘biomedical risk-averse’ approach to childbirth, rather than regards it as a natural process and presumes, in the absence of indications to the contrary, that it will go smoothly. It is hard, even for someone with Adele’s firm convictions—she believes that if ever there is a moment in a woman’s life when she should have the right to control her situation it is childbirth—to shake the precautionary mindset.

  The woman lives in an isolated bay with no road access, power or telephone, so Ivan and Adele persuade her to find somewhere closer, so that if an emergency arises they will have some chance of summoning assistance in time. A friend offers her house. That is some comfort.