by Paula Heelan
In that little back room working on her own, Chloe felt nervous. She liaised with the community doctor, who was experienced, but not predominantly in obstetrics. ‘We decided to reshuffle our patients because the woman needed more care and evacuation to Darwin. We moved her to a room closer to the emergency room – with someone else still in there.’ The doctor and Chloe continued to provide care for the woman with instructions from doctors in Gove, including the ongoing administration of drugs to manage her blood pressure.
The CareFlight plane flew in just as the funeral ended. Perfect timing by coincidence! ‘By this stage the woman was very unwell and we quickly boarded her on the plane,’ Chloe says. Once in Darwin she was taken straight to theatre for an emergency caesarian and baby Olivia was born. Olivia was very small as a result of pre-eclampsia and intrauterine growth restriction (IUGR), which often go hand in hand, so she stayed in the special-care nursery for a couple of weeks. ‘With the mother’s four children back on Milingimbi Island with their father, understandably there were some social issues going on with their management. There was involvement from myriad health professionals and ongoing phone calls. But at last, some weeks later, the mum returned to Milingimbi with Olivia and it was time to celebrate.’
Pamela was visiting at the time and with Chloe she was to attend a smoking ceremony for Olivia and another baby. The ceremony is an ancient custom, where various native plants are burnt to produce smoke with cleansing properties and the ability to ward off bad spirits. The ceremony reverses the power of curses and evil spirits. ‘We went to a small billabong to watch the babies get smoked,’ Chloe says. ‘We stopped along the way and the women walked out to an anthill and collected red dirt from the mound. At the ceremony they mixed that with a variety of leaves and sticks and made a very light fire that became smoke only. They smoked the babies and their mothers. The tradition ensures good milk sources and healing powers to make them healthy and strong. The ceremonies are performed for the mothers and babies returning from Darwin to welcome them back to country.’
Pamela says it was a privilege to be there. ‘I was moved to think Chloe had picked up on the problem just in time and more than likely had prevented a tragedy. She saved their lives. It was her first real experience of remote midwifery and I was immensely proud of her. She clearly had a connection with the women and loved spending as much time as she could with them. They were at ease with her and vice versa.’
On her days off in numerous communities Chloe worked in, she often joined the locals to hunt for crabs in the mangroves and mud. ‘I also made good friends with Ramingining police officers, who often invited me to go fishing with them. There was occasionally an odd crocodile spotting, which was always exciting.’ The locals warmed to Chloe and regularly invited her to travel out to their homelands. Back in Wadeye she’d set out in her Jeep Wrangler packed to the rafters with Aboriginal friends and off they’d go. ‘We’d hunt all day, mainly for fish and crabs, and then sit around a camp fire eating together and sharing stories. I learned how to make damper Indigenous style by one of the best damper makers in Wadeye and I learned about bush tucker.
‘During my time at Milingimbi there were usually around twelve to fifteen girls pregnant at any one time. The pregnancies are generally very complex with a lot of cases of anaemia and gestational diabetes,’ Chloe says. ‘Managing these takes quite a lot of work. The girls are all beautiful and it’s very special when you get to know them during their antenatal care. Being there for them during their pregnancy and again when they return with their babies from whatever hospital they went to for their sit-down and birthing is wonderful.’
One night Chloe was to be on call at Milingimbi Island when a woman at 32 weeks pregnant was brought into the clinic by the permanent midwife and Aboriginal health worker. It was 4 pm. The midwife requested Chloe to provide care and initiate the CareFlight retrieval of the woman, who was at that point in threatened premature labour. Sylvie, a medical student, was visiting Milingimbi for remote experience and was working alongside Chloe. Chloe was grateful to have Sylvie at her side to assist. ‘I was asking for things unfamiliar to her. I had to quickly get across what I needed – I was teaching as well as trying to birth a baby. The room wasn’t set up for a delivery and we needed things – like obstetric gear, a delivery pack, baby items, oxygen, a paediatric flow metre, warming gear, towels – it all needed to be brought in from other areas of the clinic. We needed to turn the room into a birthing room and be ready to go.’
Chloe knew the baby would be born soon and worst-case scenarios were going through her head. ‘I thought, Please don’t let this baby come out screaming – that might only be the response to the baby’s natural adrenaline and that’s not what we want. It will be good at first, but when the adrenaline runs out the baby’s drive will drop.’
Twenty minutes after the woman’s arrival, the baby birthed with no time for the steroids and antibiotics injected into the mother to take adequate effect for the baby in utero. The baby was slow to respond at first, but didn’t need any major resuscitation. ‘It was slowly pinking up and took its first whimper, then a cry,’ Chloe says. ‘And there were no respiratory issues. The Apgar score [a newborn’s first test] wasn’t bad – initially seven out of ten and then hovering around seven to eight. The baby slowly grew more alert and cried louder. It needed a little oxygen support, but really it was fine. It weighed nearly two kilograms – a really good size for a 32-weeker.
‘Sylvie loved it – it was her first experience of seeing a birth. We have kept in touch and she still talks about how great that experience was.’ Chloe and Sylvie waited more than three hours for the CareFlight team – a flight nurse and paediatrician – to arrive and the baby and mum were flown to Darwin.
During her time in remote communities Chloe has seen a lot of miscarriages. Once on Groote Eylandt she responded to an after-hours call-out for a woman with a threatened miscarriage. Her husband had brought her to the clinic. She already had two children and this was an unplanned pregnancy. ‘She had only just found out she was pregnant a few days prior and hadn’t told many people,’ Chloe says. ‘And because she hadn’t had an ultrasound as yet, we didn’t know if it would be a straightforward miscarriage or an ectopic pregnancy. There was significant bleeding and she was in a lot of pain. She wasn’t in a critical state or leaning towards an ectopic pregnancy, so after discussion with the rural medical practitioner on call, I was happy to manage her in the community overnight.’
The woman made it clear to Chloe she didn’t want to be pregnant. It’s not uncommon for midwives to find themselves involved in discussions about unplanned and unwanted pregnancies. ‘The law around terminations differs between states and territories,’ Chloe says. ‘The Northern Territory has the lowest period of weeks where women can legally have terminations. Sometimes if a woman wants one she may need to be sent interstate for the procedure at her own expense. There’s a lot of prejudice and debate about it and the topic arises frequently in the Territory. Currently, there are talks about introducing a medical termination of pregnancy [using a drug – a practise already used in other Australian states] instead of surgical. It’s a topic of controversy and an issue I’ve found difficult as a midwife working in remote areas. We need to be non-judgemental and try to provide the woman with an equitable service. Women in the bush should have the same reproductive rights and access as those in the city.
‘The next day, after an ultrasound, it was found that despite the blood loss overnight, the woman had a viable pregnancy. She didn’t miscarry. But she still didn’t want to be pregnant. She was too advanced to have a legal abortion in the Northern Territory so she planned to travel with her husband to Perth. I assisted in organising her journey and supported her. I put her in touch with the right contacts and processes. I’m not sure of her outcome, because my contract ended and I flew out the next day.’
Once in Central Australia Chloe was heading to the clinic in a troopy (a troop carrier) when a woman waved at h
er to stop. ‘She told me her daughter had something wrong with her boob. I didn’t know her daughter had had a baby. She was in her early twenties and as she walked towards me I could see one breast was significantly larger than the other. She had serious mastitis and it was the first time I’d seen it in an Aboriginal woman. Generally magnificent breastfeeders, the women tend to feed all the time so they rarely suffer from blocked ducts. But this girl was in great discomfort and it took quite a long time to relieve her pain. She couldn’t let her baby feed on one side, she needed antibiotics and to have her breast drained. I spent a lot of time in the clinic that weekend with her and kept in touch by phone consultation with an excellent female doctor for ongoing advice. I was able to get the baby back on the breast some hours after her initial presentation. We continued her on a course of intravenous and then oral antibiotics and it took nearly a week for the mastitis to completely resolve.’
At the Aboriginal community of Bidyadanga, 190 kilometres south of Broome in Western Australia’s Kimberley region, Chloe was contracted for a two-week stint over the Easter period. As she was now engaged to Ian, she was no longer working full time in remote areas, but she continued to fly back and forth as often as she could to wherever she was needed. Early in the morning on Easter Monday Chloe heard children singing out her name from outside her house. She smiled and grabbed her things. The day before the Aboriginal Liaison Officer at the health clinic, Barb, had invited Chloe to spend the day with her family. Knowing the visiting nurse/midwife in town would be at a bit of a loose end on the public holiday, Barb had asked Chloe if she had any plans. ‘Whenever I was called out, day or night, I would go to Barb’s house to collect her in the clinic ambulance and together we would go to the clinic and sometimes a house to see a patient,’ Chloe says. ‘Barb often brought along her grandchildren – “grannies”. I was on call the whole week and I got to know and really enjoy the time with Barb and her grannies.’
Set to go, she raced out to Barb’s grannies and waited out front with them to be picked up. Within minutes a ute flowing over with Barb’s family came clanking down the road and pulled up. ‘We all piled in and drove for nearly two hours,’ says Chloe. ‘I was absolutely in awe when we arrived at the most spectacular place I have ever seen. We were on the banks of a crystal-clear river, lined with sprawling trees. The river spilled into the ocean. We swam and fished and laughed most of the day. Then we piled back into the ute for an hour to meet up with other Aboriginal families who had also been out hunting and fishing. We came together and cooked our catches. One family had caught a large turtle and gave it to Barb’s family. When we got back to Bidyadanga Barb’s son-in-law showed me how he extracts the turtle meat and cleans the shell. They told me they would cook the meat and then dry the shell and paint on it.’
Chloe was aware she had experienced a very special day. She had been given an opportunity very few people come by. ‘I kept telling myself how amazing it was and how lucky I was to be sharing something so unique.’ She stayed in the community until the end of that week and when she left she was driven out on the community mini-bus back to Broome to return home to Melbourne. She drove through town and when they passed Barb’s house her heart sank. ‘I thought I would’ve had the chance to say goodbye to Barb at the clinic that morning, but she didn’t turn up.’ Not far along the road the driver called out to Chloe. ‘Hey I think they want you,’ and pointed to the back of the bus. Through the back window Chloe could see Barb and her big bunch of grannies chasing the bus along the road, waving hands and yelling out. The driver pulled up and flung open the door. The grannies scampered up and ran to Chloe, smothering her in cuddles. She hopped off the bus, holding back tears, and fell into Barb’s arms to hug her. ‘I thanked her for having me in her community and for giving me one of the most unforgettable times of my life.’
Based back in Melbourne, Chloe signed up for her Masters in Public Health, and apart from an intensive block of study in Darwin, she studied at home. ‘I had completed the basic level of the Major Incident Medical Management and Support (MIMMS) course in 2009 and after Cyclone Lam I decided to complete the advanced commander course of the MIMMS, which I completed early last year in Darwin. The course is designed as a preparation to manage an overabundance of patients or victims in a mass casualty, such as a cyclone, earthquake, train derailment or terrorist attack.’
On top of this, Chloe had a mid-semester wedding to plan. Two weeks after she and Ian were married she flew back to a community in Central Australia and later to the Tiwi Islands, Groote Eylandt and Maningrida a few times. Chloe was well known by the Northern Territory government. They knew she could fly into a community and hit the ground running wherever she was needed. She could stay out for as little as four nights and anywhere up to three months. ‘It was great because it fitted in with their schedule and my university work.’
In 2015 Chloe and Ian planned to move to Darwin. But not long before they were due to leave, Ian’s company needed him in Adelaide. ‘We were both a bit disappointed at first,’ Chloe says. ‘But within two weeks of being here I got a job with the Royal Flying Doctor Service [RFDS] and we’re both really enjoying South Australia. I had aspired to a career with the RFDS for a long time and had been working towards it since graduating as a nurse.’ All RFDS flight nurses require their midwifery certification as they transfer pregnant, labouring and postnatal women who may require a higher level of obstetric care than is available in their town or community. As a flight nurse, Chloe now flies across country South Australia and sometimes interstate to transfer people to tertiary hospitals. She hopes to do some relief work in the Alice Springs and Port Augusta RFDS bases in the future. ‘I’m working in remote Aboriginal communities – which is what I love most.’
CHAPTER
4
Marg McDonald-Ashe
A cluster of small children squealed with delight as the four-wheel drive pulled up in front of the Ingomar Station homestead. They had been waiting for days for the Remote and Isolated Children’s Exercise (RICE) team to arrive. When the back doors flung open and the kids saw that the vehicle was packed to the gills with toys and games, their squeals became heightened. They eagerly helped unpack, and in no time, they were deeply absorbed in this highly anticipated day of serious play.
There isn’t a ‘Welcome to the outback’ sign anywhere in Australia, but you know you’ve passed through the gateway when not far into the journey across sparsely settled country the earth begins to redden and the landscape becomes a panning shot of harshly coloured, sweeping plains. Nurse and midwife Marg McDonald-Ashe and her RICE colleagues, Manoah McRae and Nicole Yendall, arrived from their base in Port Augusta to run a play day and health checks for the Ward family and some neighbouring families who had also come into Ingomar.
Marg, now 58, is a mobile family health nurse and midwife and she travels out to far-flung places in remote South Australia to provide child health care and antenatal and postnatal care for women living on stations. Marg visits these remote families to do universal health checks for newborn babies and maternal health checks for their mums which might include C-section wounds, mastitis or breastfeeding problems. She liaises with the Royal Flying Doctor Service (RFDS), particularly when she finds women with infections or suffering from postnatal depression. Sometimes she travels with a RICE team, sometimes she goes alone. ‘Mothers and children will travel up to four hours to attend a playgroup and health check,’ she says. ‘If they’re meeting at a community centre, they turn up early to clean the place for everyone and they bring copious amounts of food to share whether they’re meeting in a community or at a station.’
When the RICE four-wheel drive pulls in, it’s like Christmas for the kids. ‘They get so excited when they see the toys,’ Rinnah Ward, a mum under Marg’s care, says. ‘The RICE team sets up loads of activities and if it’s hot they include lots of water play. They bring fresh fruit out for us and we all sit down for morning tea and lunch together. Everyone brings a plate to share. The
mums yarn while the RICE team keeps the kids amused. Marg is a wonderful storyteller and interacts beautifully with the kids.’
With several complications during Rinnah’s pregnancy, Marg was one of the midwives who supported her and she continues to do so with postnatal and child health care. ‘There’s nothing Marg hasn’t been able to help me with,’ Rinnah says. ‘She’s the best person you could ever find for the job – she’s very experienced and is really, really good at what she does.’
Rinnah’s baby suffers from food intolerance and from a very young age she was incredibly irritable. ‘Marg is our first point of contact, so I called her for advice,’ Rinnah says. ‘She was so supportive and recommended a specialist. We had a difficult time and Marg really helped us through it. Having her come to us is amazing and we can call her on the phone any time. It’s a long way for us to go anywhere for medical support, and difficult with little children. Marg comes to us regularly and takes the time to sit down with us to chat and discuss any issues we have.’
Marg is away from home on average two nights a week and stays overnight on the cattle stations or small towns she visits. Her destination and time away are determined by the dates babies are born and where they live. In some cases, women living in isolated areas and in extreme conditions cope exceptionally well. ‘My hat goes off to those women. They just take it all in their stride and are very resilient and incredibly positive. Others, who are perhaps newer to the bush, can find the isolation difficult. In a lot of cases women marry a cattleman and suddenly find they’re living in the bush without access to resources, and in particular, close family. This can cause quite a high level of postnatal depression, which can be a given in remote areas – and that’s why we’re here.’
