Island Nurses

by Howie, Leonie; Robertson, Adele;

  As the time draws near, Adele is in a state of constant, low-level anxiety. She phones a colleague on the mainland who has made home births something of a speciality, and asks what the procedures are.

  The other woman laughs. ‘There are no procedures. Every home birth is different. You just go with what the mother feels she needs to do. Really, it’s her tea party and you’re just there to pour the tea.’

  This is cold comfort to Adele, who has only ever attended hospital births, where the entire process is homogenised. She arranges to travel over to the mainland and observe one of her colleague’s births, but each time the opportunity arises it is impossible due to Adele’s other commitments. Before she has a chance to gain any prior experience of home-birthing, the day is upon them.

  Adele gets the call. Most of what she will need—instruments, linen, bowls, plastic for the floor, a baby resuscitation bag, gloves and absorbent pads—is in the ‘birth pack’ that she has already left with the mother, in case the birth happens before she can get there. She sets off. She can’t prevent vivid scenes of obstetric emergencies flashing across her mind, and she has to will herself to be calm.

  Her inner turmoil is in stark contrast to the scene she finds when she arrives at the house. Ivan is already there, talking softly with the supporters. The woman is sitting quietly on the floor in a warm room, in the lotus position and using yoga breathing to ride through the contractions.

  It is not long before she looks at Adele and calmly announces, ‘I’m ready to have the baby now.’

  They go through to another room where Ivan has spread all the linen from the birth pack over a table in front of the fire. The woman sits down and, with her six-year-old daughter holding a mirror for her, she gives a few pushes and brings a baby boy into the world. Even the baby is calm and breathes immediately.

  Ivan and Adele look at one another in awe, feeling a bit superfluous. The placenta follows routinely a short time later. The worst thing about the birth was that far more linen than was necessary was soiled in the process. Because the boat that took the laundry back to the mainland for washing and sterilisation only came once a fortnight, Adele had to give it a preliminary wash, a laborious process on Great Barrier. They quickly learned to make as little mess as possible.

  She and Ivan cross tracks regularly. The rules segregating the public and private medical systems have created a paradox on the island. The nurses are paid a salary, whereas the doctor is reliant on government subsidies and patient fees. Therefore, if Adele immunises a child whose parents have had difficulty accessing the doctor, she is aware that this is effectively removing income from him and threatens the viability of his practice on the island. If Ivan resents this kind of toe-treading, he never shows it, or lets it undermine the team approach that Adele feels Ivan, she and Nancy are developing: it is simply a practical necessity that they are called upon to assist one another, and to share patient information in spite of the rules that discourage it. One day, in a meeting with her superiors in Auckland, Adele is questioned closely about how much contact she has with ‘the doctor’.

  ‘Not much.’ She shrugs, although the truth is somewhat otherwise. She feels there is no point starting a debate over the rights and wrongs of interacting with Ivan when there is really no alternative. Adele refrains from asking how much practical support they are prepared to give her—would they, for example, supply their private numbers so that at two in the morning she can call them for advice about a patient? That is what Ivan is prepared to do.

  Besides, by now, Ivan has brought a wife—another nurse and midwife—to the island, and with Leonie fast becoming a friend, another layer has been added to the relationship between Adele and the Howies.

  Chapter 4

  DISCOVERING PARADISE

  A terrible noise wakes Leonie. It is her first week on the Barrier as Ivan’s wife, and they are asleep in their small house at Kaitoke Beach—or at least, they were. The house is little more than an unlined, board-and-batten box with an upstairs loft bedroom, and it tends to amplify noise. This noise doesn’t need any amplification. Both of them lie in the dark—which is absolute—trying to work out what is going on. There is metallic clattering, booming, banging, all interspersed with shouts and hoots of laughter.

  ‘What the—’ Ivan says. ‘Is it Charlie’s cows, do you think?’

  There are no fences between the neighbouring properties and their own. But a particularly loud bang is greeted with an unmistakeable roar of what sounds like someone in pain. Ivan has decided a major emergency is happening. He is up and has grabbed his medical bag and is all ready to race outside, apart from the fact that he has not put his clothes on.

  Leonie has realised what is happening. As she, too, scrambles to get dressed, hopping around with one leg in her jeans, she tries to explain.

  ‘We’re being tin-canned,’ she says.

  ‘We are what?’ Ivan is nonplussed.

  Leonie is having to reach far back into her memories of life up in rural Northland to recall what she knows.

  ‘When someone brings a new bride home, everyone marches up the road banging saucepans and tin cans to serenade the couple to wake them up.’

  She can sense Ivan staring at her in the dark.

  ‘Why?’ he asks at length.

  ‘To wish them good health and to show support. Then it evolves into a party.’

  ‘But we haven’t got anything to give people.’

  ‘I don’t think that matters,’ Leonie says, and she is right. They race to finish getting dressed and quickly swing open the door. There is a rousing cheer from the crowd assembled outside. Somehow they all pack into the house, all 23 square metres of it. Candles dimly light the scene —lots of big grins, people they know well and some Leonie has yet to meet—and there is no shortage of food or drink. Island hospitality is legendary and this is Leonie’s first real taste.

  Over the years, people have often asked Leonie why she became a nurse and did not ‘do medicine’. The answer is that nursing simply fits best with who she is. She flirted with the idea of becoming a doctor in her late teens, but the financial demands of medical school were probably always beyond her family, let alone her. But one of her most vivid memories as a child was sitting excitedly in the dark, watching an image flickering on the screen in her rural school as part of a series of sessions on the amazing things that people can do ‘when they grow up’. This was the first to grab her attention.

  The film followed a nurse sitting on the ground in an African village, white veil and all, teaching the children about handwashing. The nurse spoke also about caring for several unwell children in a small hospital in a nearby town. Something took root in Leonie’s mind, and for weeks afterwards her thoughts kept returning to the nurse in that film.

  That’s it, she decided. That is what I want to do.

  She felt she could just about reach out and touch the job, and in her naiveté she thrilled at the thought of the romance and adventure of a life like that—exotic places, doing good. For several years, she fervently knitted peggy squares and made stuffed animals for Junior Red Cross to send across the seas ‘for the needy’. What she sees, looking back, is that the film and her imaginings about nursing fed into a deep-seated desire she harboured to care for people. The hallmark of a good nurse, her mother would tell her later, was to be ‘caring’. Her dad just seemed delighted with the idea that she would want to be a registered nurse like her mum.

  Through this phase of Leonie’s life, her mum was providing for her the very model of the ‘rural nurse’, caring in an unpaid capacity for their extended family and unwell community members. If someone asked for help, there her mum would be. Her mum’s willingness to always be available was never questioned by her family or neighbours. When she looks back, Leonie sees that she has always placed upon herself the same set of expectations in her practice that her mum placed upon herself. Such dedication can be an asset to a rural nurse—but it can also be a two-edged sword.

  Whe
n she finished school, Leonie and her best buddy embarked on what they imagined would be a grand adventure out of their rural comfort zone and among all the excitement and glamour of Auckland. And, in fact, Leonie loved the years of hospital-based training and staffing. No sooner had they been awarded their nursing badges than they departed on the ‘overseas experience’ that New Zealanders regarded as compulsory. They bumped their way across Asia to eventually arrive in Europe via Afghanistan, Turkey and Iran. They settled in southern England, and registered with a nursing bureau. New Zealand nurses—then as now—found themselves much in demand, and, with work easy to come by, they divided their time for several years between stints nursing and discovery trips abroad.

  Bureau work was stimulating and varied. One post she had was as nurse at a Butlin’s Holiday Camp at the seaside resort town of Bognor Regis. Here, she was the night nurse in sole charge of a very well-equipped emergency clinic within the complex. On her first night, the management locked her in with strict instructions not to open the door to anyone other than a security guard. Under no circumstances was she to visit a room without a guard.

  What have I got myself into? she wondered. This was supposed to be a fun place where people went on holiday, not a maximum-security compound.

  By the time she had dealt with pairs of staff members on two occasions who had sustained injuries from bouts of fisticuffs, she began to get the drift. On each occasion, there were security guards hanging on to each protagonist for dear life. She needed no further persuasion to keep the door locked and bolted.

  When eventually she returned to New Zealand, Leonie trained in midwifery, motivated by the same urge to care that had called her to nursing. Once she had consolidated her midwifery, she chose a job that served to give her a solid grounding in community health. She became increasingly conscious of Māori health needs and the way in which the health system was failing to address them. In 1984, she attended Te Hui Whakaoranga, a large, national hui where issues surrounding Māori health were aired. Here, Dr Mason Durie spoke on Te Whare Tapa Whā, his conceptualisation of the Māori belief system, and the way in which Māori approaches to health flowed from principles grounded in mātauranga Māori (simplistically defined as Māori ways of knowing) and te ao mārama (the Māori world view). Not only did she learn much about her patients; Leonie also began to understand better who she was, embracing at a deeper level her own Māori heritage and tikanga, guided by her older sister, who had trodden this path before her.

  Her nursing and midwifery role saw her work as part of an urban health team that worked on holistic and Christian principles. The suburb in which they were working had, at that time, a wide range of health needs, and because she lived (and worshipped) amongst her patients, this was her first experience of the complex relationships that are such a big part of rural nursing. She revelled in it, and there is no doubt that it played a big part in shaping her for her role on Aotea, quite apart from the fact that it was in 1980, during this time in her life, that she first met and worked alongside Dr Ivan Howie.

  Ivan always intended to be a doctor, but also wanted to study theology. After graduation from med school, he completed a degree in Divinity. He served for a time as a Baptist minister, but medicine called him back. He worked (among other posts) in the same Christian community health team as Leonie and—though she didn’t know it at the time—would much later become her partner in life.

  In the meantime, though, the dream of being the nurse in that flickering black-and-white film was still there, and it drew Leonie towards the idea of missionary nursing in a developing nation. When she was asked to be part of a community health team in Nepal, it seemed truly providential: she believed that, in this role, she would get the chance both to put into practice the cultural and spiritual understanding she had lately gleaned, and to learn. It would be a short-term taste of what might lead to a longer commitment. So she stuffed her belongings in her pack and set off for the Himalayan foothills to join the community health team based in Tansen.

  When people ask Ivan how he and Leonie came to be married, he usually tells them that she had suffered a head injury and he struck while her judgement was impaired. The first part is true. In 1984, Leonie was recently back in New Zealand from her stint nursing in Nepal. She re-joined an all-woman crew racing a little 7.7-metre yacht in the Royal Akarana Yacht Club’s Winter Series—lots of fun and good for the soul. At the time, although engaged again in the community nursing role that she loved, she still had thoughts of university, then returning to Nepal. One day out on the water, she neglected to observe one of the cardinal rules of yacht racing: duck when the boom is swinging. The subsequent concussion had a lingering effect.

  While she was still in the process of rehabilitating from that trauma, as well as from a painful relationship break-up, she went with a group of friends in the summer of 1986 on a yachting trip to Aotea. They spent most of their time in the waters surrounding Port FitzRoy, and then those who had to return to Auckland all squashed into a taxi travelling down to the airfield at Claris, 60 minutes away. While she was waiting to board her flight, she spotted a familiar face. It was Ivan. They got talking and reminiscing about the three years they had worked together in Auckland. Leonie is amazed at how the years have flown by, especially when she hears that Alastair, Ivan’s son, is now at high school. Leonie learned that Ivan had now been working as Great Barrier Island’s sole general practitioner for six years. For the first three, he had commuted from Auckland—that much she knew as their paths had crossed through work. Then he had taken the plunge and settled permanently on the island near Kaitoke Beach, and he and Leonie had fallen out of touch. He told Leonie he was running his practice out of a caravan. It sounded adventurous and she was intrigued.

  If you ask Leonie how she came to be married to Ivan, she will tell you that he was a GP working on a remote island who needed a nurse but could not afford to pay for one: marrying one was his only option. It is true that the relationship began somewhat tentatively from her side. But in March 1986, Ivan invited her back out to the island to spend some time with him, and she found herself accepting.

  That trip—the first official ‘dating’ expedition—didn’t start so well. Just as the little commuter plane she was on was about to take off, someone shouted from a seat at the back of the plane that the back baggage door was flapping open. The plane stopped with a lurch, and the cabin filled with the roar and whine of the engines and the smell of fuel as, right there in the middle of the Auckland International Airport runway, the pilot opened his door, leaped out, ran to the back and banged the offending door shut, then sprang back into his seat as though this were an everyday occurrence. They were in the air a few seconds later. Leonie prides herself on her sense of adventure, but at that moment she wondered what else might malfunction on the way over.

  Ivan met her at the airfield at Claris, and she wasted no time in telling him about the ‘drama’. If she was expecting him to be mortified and sympathetic about her apparent near-death experience, then she was wrong. He launched into a series of tales of the joys of commuting in small planes, and told her that it was all part of the experience of island life. Trying to be reassuring, he added that he regularly shared the cabin with cats and dogs, and had even flown with a goat and chickens.

  ‘The airline is great,’ he said enthusiastically.

  If this was meant to be reassuring, it didn’t have the desired effect. Leonie was already dreading the return flight, and was tempted to agree with those of her friends who thought she was mad contemplating a relationship with someone who lived in such a remote place.

  But Leonie survived the return flight, and many subsequent flights. The relationship flourished.

  If Ivan is being serious (he is well known for his fondness for a joke and a propensity to pun) and you ask him how he came to be with Leonie, he will tell you that he knew from the outset that she was the one. He suggested they should get married. Leonie found herself readily agreeing. She realised sh
e had fallen in love with Ivan. She had grown up in Northland and, despite having lived in Auckland and overseas, she was a rural girl at heart. Aotea and its wonderful, ruggedly individual people called to that part of her. She and Ivan were married in November 1986, and soon after that Leonie set off to join him in paradise.

  ‘Right. Welcome to the Tryphena Medical Clinic.’ Ivan proudly opens the door to the old school building, an old kauri affair, two rooms—well, a room and a kind of porch or anteroom annexed to it—fitted out as a perfectly functional medical clinic by a committee of dedicated locals. It is relatively sparsely furnished and equipped, but it serves the purpose. Ivan holds regular clinics here, down in the southern part of the island, over the hill from where he and Leonie live on Kaitoke Beach.

  Ivan turns the radio on. It echoes loudly in the empty wooden space. ‘I do this,’ he tells Leonie apologetically. ‘It’s the only way I can prevent my conversation being heard in both rooms.’

  ‘What do you do for special equipment?’ Leonie asks, looking around.

  Ivan hoists his medical bag. ‘I have become adept at carrying all I need.’

  Soon the patients start to arrive. They know about Leonie, and they greet her with a mixture of curiosity and what she begins to realise is proprietorial satisfaction. She has married ‘their’ doctor, so she has chosen to be ‘their’ nurse. Her decision to marry and live on the island is a gesture of commitment to them—although she didn’t realise this at the time.

  Mostly Ivan works behind the closed door of the main room while the porch serves as the waiting room. In the first few months, Leonie is confused about what her role is, as she is used to working in a busy urban practice with her own space. But here, unless Ivan specifically needs her, Leonie realises she is best employed sitting on the porch and just getting to know the locals and listening to their incredibly interesting stories. She feels like a fish out of water, not understanding who is related to whom or why two people could be sitting in the waiting room talking to her but not knowing each other. She introduces them.