Remote Nursing Experiences

July 23, 2021

“The day comes in strips of yellow glass over trees” Peter Balakian

There’s a woman who lives in an iron-clad company house, on a red dirt track, at the upper edge of an Aboriginal community in North-East Arnhem land. She’s a nurse in a small doctor clinic a short walk from this house. In Summer she drives a car because going outside from the air-conditioner is like walking into a closed bathroom after a hot shower. Impossibly hot and steamy. It’s winter now and she chooses to walk. The sun is merely warm and the outside air faintly cool on her skin. She feels alive.

The first 100 metres is the red bauxite track covered in tiny marble-like balls, slippery underfoot.

She turns left onto the bitumen, 2,000-steps-to-work road, and the bush warm charcoal smell from last nights cultural burn greets her. It was a cold fire that slowly ate down the undergrowth, overnight, that would otherwise have prevented fresh new growth in the spring. A little further along the smell changes to the sweetness of eucalyptus leaves warming in the morning sun mixed with a profusion of wattle blossoms. Acacia auricululiformis or black wattle. Ubiquitous throughout the Northern Territory it needs smoke or heat from a fire to germinate its seeds. Its flower is paler and smaller than the silver-leafed Cootamundra wattle of her childhood further south.

One of the nurses she works with asked her if she was afraid of the dogs, walking alone without a stick? Dogs of varying degree of dingo heritage station themselves at the edges of the invisible boundaries of their owners homes, watchful but not menacing. She ignores them looking straight ahead and presents no threat to them.

A white sulphur-crested cockatoo screeches out a warning, or a greeting, to others in its flock from the highest branch of a gum tree. Maybe to share or to scare away others from eating the bunches of honey tasting flowers.

The woman approaches the left turn towards the clinic.

Sometimes I feel like a woman in a dream, wandering down this path to work. So far from my family and all I’ve ever known, and yet, by now, so familiar. So many paths to choose from and even on this short walk there are sandy side tracks leading to different destinations. I could take one to the right, amongst the trees and come out at the nearby bay. Sit and read all day. I could take the trodden down bush walk to the left, past the houses and end up at the blue house when the new-born puppies are and play all day with them. But I keep walking on the bitumen past houses and dogs until I reach the padlocked gate of the clinic. I rummage in my bag for the key and with that wake from the dream.

July 15, 2018

Safety

As you know, unless you’re visiting my blog for the first time, I’m a nurse in a remote corner of north-east Arnhem Land. I work in an Indigenous community and live at the edge of another, half an hour away. Recently some young kids broke into the nurses house next door. They took a small blue-tooth speaker and some food. The Aboriginal Medical Service I work for quickly responded by installing security screens on the windows and doors on both our houses. Nurses safety is a priority.

When I started working in remote Australia the Cape York community of Aurukun was my first job and home for two years. It was often in the Queensland media for riots or some other violent infringement. Family and friends used to ask me if I felt safe working there. I always replied that I would feel safer walking down the main street of Aurukun in the middle of the night than my home town of Maryborough because the locals fought among themselves, long standing family feuds that had nothing to do with me.

Safety can be an illusion though. Last Monday morning I woke to a Facebook message from a friend, only it wasn’t really her. Her account had been hacked. The message was about her winning a lottery and my name being on the list. “She” directed me to accept a friend request from a “Ruth Edward” who was the Facebook manager of “360 National Lottery”. But I had to pay an administration fee to collect my winnings. An old scam dressed up in a new guise and yes I fell for it. I was so certain that the first message was from my friend I didn’t even think to pick up the phone to call her and check. I lost $15,000, my savings for a new car. I hadn’t heard of this scam and the only place on the internet I found anything about it was WA ScamNet, a government consumer affairs site that has since been very helpful.

Safety is multi-faceted. Physical safety that needs to be guarded by screens, fences and commonsense. Emotional and mental health safety which needs protective behaviours from high conflict or manipulative people. And Cyber-safety from fraud and identity theft with the resultant violation left with victims of this crime. Is safety from Cyber-crime a priority of the Australian government? In Western Australia alone 18 cases of this Facebook scam have been reported since April this year and over a $100,000 lost to it. The 360 National Lottery website is still on the internet.

So while remote area nurses continue to appeal to state governments and health agencies for safer housing and work safe policies, domestic violence organisations promote having a safety plan and therapists and writers suggest learning behaviours to protect ourselves from high-conflict people close to us. I suggest that Cyber-safety also become a priority  by learning all we can about it and spreading the word.

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April 9, 2016

Lunch…

I still work in remote Australia. In a top right-hand corner of the Northern Territory. Like all far away places choices are limited. On the Gove Peninsula it’s luckier than most because there’s  Woolworth’s (and a hospital…no late night emergency call outs for the nurses who work here). Until recently, if I wanted lunch I had to make it everyday and bring it to work, eat it in the small clinic kitchen or try to find a quiet nook somewhere out of the summer heat. This year there’s a choice…an Op-Shop (Second-hand goods) has been opened in Yirrkala by an employment company to give the local women an opportunity to learn how to sort, arrange and display donated clothing and a variety of general goods. But best of all, on Wednesday and Thursday they open a cafe for lunchtime, and learn to cook, serve customers and plate food tastefully on local banana leaves. It’s a welcoming haven for customers, to the background of Gurrumul’s songs, we choose from the menu which includes baked filled potatoes (cheese and bacon), fried rice, fruit skewers, toasted sandwiches, local bush lime juice or brewed coffee. Prior to it’s opening there was no place, apart from the local art gallery, where the community, locals and those who travel to work here could mingle informally. It’s managed by the vibrant warm Ali, whose personality draws you imperceptibly towards, her just to see her smile. I enjoy browsing through donated books, DVDs and music and donating back. To say this old banana shed-turned occasional cafe, is a good thing for the community, is to understate the power of creativity, thought and effort to enhance the lives of others. My Thursday lunchtime baked potato and browse is the highlight of my week. Thank you Ali and the girls!

April 4, 2016

Beauty

Losses and griefs of all kinds fade a sense of beauty out of our lives. We  forget what we once appreciated and held dear, even what we love and who we are. During the past two weeks remote area nurses in Australia have grieved the murder of one of our colleagues. After the first few days of shocked incomprehension someone on our Facebook site encouraged us to post photos of things that captured our reasons for doing the hard work that we do. The beauty in those shared photos was varied, individual and ultimately uplifting…some were of landscapes and adventures, others were of new-born babies and healthy mothers.Many of us will always see beauty in the shape of a Royal Flying Doctor plane coming in to land after a long night of waiting. Beauty is as unique as a snowflake, it’s to be cherished and nurtured in our lives wherever we find it and however we define it.

I’ve had my share of losses and difficulties since I began this blog site. I had a desire to share my experiences and insights from my remote area life, but beauty quietly disappeared for a while and all I could see and sense around me was a dull, drab landscape. The gentle energy of beauty hid in the shadows from me…until the past few weeks, for all kinds of reasons, and none in particular…colours are appearing again and curiosity beckons me forward. Life is interesting and I’ve picked up my camera and wandered outside.

May 28, 2014

Expectations

When I arrived for my first agency nurse contract on Badu island in the Torres Strait I wasn’t aware of having any expectations. My main thought was that I was having an adventure. After a day or two I realized I was waiting for “something” to happen. Maybe shouting in the street, or some other type of sudden violence. The Cape York community I’d worked in for two years experienced a high level of violent outbursts. Raised voices in the streets were often the background noise to every other day. I had been initially shocked at that, but by the time I left I had grown accustomed to it.

The Cape York community was my first experience in working as a remote area nurse. I learnt my emergency skills there and began to have some understanding of the health and social difficulties of Indigenous people living in traditional lands. I didn’t know, though, that I expected every group of Indigenous people to be similar. Leaving the place I knew and arriving to work on a small island, my first lesson was about my own expectations. The fact that I had them, and that they were wrong.Since then I have worked almost two years in various Torres islands and can count on one hand the number of times I’ve heard shouting in a street. Becoming aware of my expectations and letting them go is a lifetime’s work. I learnt after those first few days to be more open to what I actually saw and heard instead of living from my assumptions. And I’ve been constantly and wonderfully surprised at the differences within Australian Indigenous cultures and individual people.

May 15, 2014

Singing Days

The French author Marcel Proust once wrote “There are hilly, difficult days that one takes an infinite amount of time to climb, and there are downward-sloping days that one can race down singing.”

I knew I was going to have many singing days when I stared out of the window of the small plane flying low over the Torres Straits, just off the top of north Queensland. The water below was a collage of blue greens and tiny uninhabited islands. I was on my way to work my first nursing agency contract on Badu island. I had grown used to island life in Samoa, where my partner came from. The long, lazy fishing days, the close knit family and community life that comforted me with the feeling of never being alone, and the endless beauty of the surrounding sea.

From the moment the plane touched down on the Badu airstrip and I saw coconut palms fringing the fence line, I couldn’t stop smiling. The two years I’d been in Aurukun on the western side of Cape York, had been mostly “hilly difficult days”, coping with being a long way from family and friends in a harsh environment. I was looking forward to living and working in a quieter environment. There is nothing as restful as being able to look at the sea and what I enjoyed as I walked in through the door of the Badu clinic, was being able to see straight down the corridor to sparkling water.

Singing days can be created or caused by any number of reasons. My Badu six weeks were filled with songs from the sea.

April 26, 2014

New Chapters

When I left Aurukun and began working for a nursing agency it was certainly a new chapter in my life. I’d worked for Queensland Health for around 20 years. I enjoyed the certainty and security of permanent work and, while I listened in awe to the stories of agency nurses I’d worked with, I was too afraid to follow them into the wide world of choices and possibilities.
In late 2010 I began work on my first agency contract on Badu island in the Torres Straits off the top of North Queensland. Prior to arriving I knew hardly anything about the islands, but the flight from Cairns to Horn island and then on a smaller plane to Badu whet my curiosity. I had never imagined any kind of life off the tip of Cape York. There had been a time in my adult life were I’d never been further north than Bundaberg, and even that felt like I was about to drive off the edge of Australia.
Flying over the Torres I stared down through a smudged plane window at a blend of ocean blues and greens and tiny uninhabited islands and knew I wanted to stay awhile to get to know this place.
So much has been written and said about new beginnings, basically the fact that the past needs to be let go of to embrace the new. I let go of the need for certainty and security and whole-heartedly embraced a sense of adventure which opened a fascinating chapter of island life and culture.

March 2, 2014

Loss

Everyone experiences loss, in different ways and at different times. Each loss has a different meaning. I’d worked in Aurukun about a year and a half and decided I’d stay for another year and a half. I bought a Toyota landcruiser, rescued a camp dog puppy and was given a scrawny bedraggled looking black kitten, with a car and pets I was ready to settle for a bit longer in a place far from home. Fasi and I nursed our puppy named with the Samoan word for baby, Pepe, to health. We delighted in her antics, Fasi even let her sleep on him. When she was about six months old I went to Samoa for a few weeks to visit Fasi as he’d returned to care for his elderly mother, and arranged for a nurse who lived next door to care for her.

Apparently all went well until the day before I was due to fly back into the community, Pepe became unwell with gastro symptoms. I wasn’t contacted. I had only her to look forward to seeing when I returned, as Fasi had left Aurukun permanently. I kept imagining her joyful welcome during the long flights from Brisbane to Cairns to Aurukun.

As soon as I reached the gate to my yard in the semi-dark of a Cape York evening I knew there was something wrong. The manager of the clinic came across and told me she put Pepe to sleep herself that morning. She hadn’t bothered to phone me.

I walked away and up my steps and sunk to the floor once inside and sobbed. I phoned Fasi in Samoa to tell him and we both cried. It seemed such an unnecessarily cruel thing to do, normally the nurses do all they can to save each others dogs.

I lasted a few days and handed in my resignation, I couldn’t work with the attitude of that manager.

There isn’t just one side to a loss. I felt Pepe’s death keenly, especially the way she died and the thoughtlessness of a nurse from whom people would expect better. After a few days Fasi rightly pointed out that Pepe would have kept me in Aurukun had she lived, I couldn’t travel with a dog. So I reluctantly turned to the next stage in my remote area nursing journey and took up life as an agency nurse, travelling over the top end of Australia experiencing places and people I barely knew existed.

Thank you Pepe.

February 6, 2014

Belonging

I’ve often said to other remote area nurses that we haven’t done ourselves any favours by doing the work that we do as we often feel we don’t fit in anywhere anymore. I read something recently that reinforced that opinion. In a book called “Other People’s Country” by Maureen Helen, her account of her work in remote Western Australia in the nineties, she speaks with a nurse who’s leaving after many years working in the same community: “It was to have been my big adventure,” she said wryly. ‘I’d planned it for a couple of years and thought I was lucky to get this job. But I hate the heat. And I miss my family, ‘she confides. ‘Sometimes I can’t remember why I came. everything’s so different. It’s like a foreign country, isn’t it? I feel as if I can’t talk to people who’ve never been here because they don’t understand. And people who live up here permanently are so comfortable they’re almost smug.”

January 31, 2014

Trauma

How many times do we hear the news of a traumatic death in the media? We might stop for a moment and think how shocking it is or we might not even do that, we might be too busy to ponder anything except the task at hand. I remember when I worked in hospital I often thought, after I’d nursed someone with a broken leg, that never again would I say “oh, that’s good they just got a broken leg” after hearing about an accident. Until you see injury and death up close you don’t realize just how physical it is, how weighty and wearing on all involved.

A year into my remote area nursing I was called to a stabbing where a short while later the victim died. I couldn’t sleep properly for weeks. The sheer physicality of the event had lodged in my imagination, I couldn’t get free of the movie that kept replaying in my mind.

I saw a visiting psychiatrist who told me that the murder had ticked every box indicating it was indeed traumatic, but as I spoke to him throughout the week he was visiting the community, he told me in his opinion, I’d been more traumatised by a sequence of events involving bullying by two nurse colleagues in a hospital prior to me working as a RAN.

What traumatises us is as unique to each of us, as is what contribute to our recovery, and the time and the journey our healing takes.

For me, I’ve always needed to get out into nature on my own and just be. It somehow seems to put emotional upsets into a larger, calmer context. Pictured here was my favourite getting out into nature spot in Aurukun, the landing, where I often walked to after work and sat until sunset or the mosquitoes came out.