I just finished reading a book called “Madness: a memoir” by Melbourne doctor, Kate Richards. It’s an honest and poignant account of her experience with mental illness. She ends the book by saying…”I’m grateful to be living in a country where medication and therapy are mostly available and affordable. However even in Australia, we are still not caring for the most vulnerable members of our communities. Those who, through no fault of their own, are not as lucky as I have been to respond to medication or to be able to find the right kind of therapy. These people are of all ages and backgrounds, and we ignore their suffering because most of us don’t understand their ways of seeing the world or we are afraid of their difference or embarrassed by their appearance and because we don’t see their injuries. No-one ever wakes up one morning and thinks, today I’d like to go mad, lose my job and friends, and end up odd-looking and living on the streets, anymore than they think, today I’d like to get cancer.”
Aurukun has the highest number of mental health clients in Cape York and is serviced well by visiting mental health teams. The RFDS built a Wellbeing Centre (pictured here) in the grounds of the clinic a few years ago which offers support, counselling and education. But providing services is just one way to support “vulnerable members of our communities”, having, and showing, kindness and compassion, firstly on ourselves in our demanding work as remote area nurses and then to others is the key to our continuing mental health and our patients healing.
When I applied to work in a remote clinic I assumed that being on call after hours would be like doing night shift. It wasn’t. With night duty you know what hours you are rostered to work, with remote area after hour call outs, nothing is certain. You quickly learn that you could be woken up several times a night, rarely for real emergencies.Nurses are often told to educate the community on what an emergency is, but at 3am arguing with someone who’s woken you with a toothache,simply guarantees that you lose more sleep than if you just get out of bed and go and see them.
The US National Sleep Foundation recommends that adults need between seven and nine hours sleep a night. Continued lack of uninterrupted sleep results in sleep deprivation with potentially fatal effects.Remote area nurses usually have fatigue leave (if they don’t work in a single nurse post) which is supposed to make up for lost sleep. While we all value it, it is rarely a substitute for sleep. If staffing is short or clinic demands many, a nurse repeatedly on call can be functioning at a much reduced level of competence. When important decisions have to be made for patients health one has to wonder if the added responsibility put upon them to “educate” the community about what an emergency is, is a wise thing?
Among the many results of lack of sleep are an increased risk of accidents and injury, impaired attention, alertness, concentration, reasoning, memory and problem solving. It can lead to health problems such as heart disease, stroke, diabetes and depression. Judgement can be impaired, especially in regard to being able to assess what lack of sleep is doing to oneself. Also hurting their ability to make sound judgments because of a reduced ability to assess situations accurately and act on them wisely.
Before deciding to work in remote areas nurses do well to assess how well they function without sleep.
Most nurses who work in Australian remote locations have to take turns at being on call for emergency after hours call outs, from the clinic where they work. If a community is large, or staff few, a nurse can quickly become exhausted from being called out several times during the night. In Queensland a nurse is allowed a 10 hour break from any call out after midnight, it’s called fatigue leave and is a welcome relief, to sleep in and just stay at home.
Here’s an excerpt from my journal in late 2008:
” On call last night, did overtime with a vomiting child, a nose bleed that had stopped by the time they got to the clinic, a cut foot and a crying baby. I got into bed after midnight…now enjoying the luxury of fatigue leave, sitting in bed with coffee, books and my own company. I’ve opened the curtains to let light in. I can see straight out onto the clinic grounds, the wind is scattering gum leaves and dried palm fronds, sunlight and shadows making interesting patterns through the eucalyptus trees when I half close my eyes, all from the safety of my bed, my haven. This is day number six in a nine in a row stint and I’m already weary of people and their needs.”
Getting caught in the rain, Mel and Fasi managed to turn it into an adventure while I was nursing what I thought was a broken wrist…but it was a memorable Christmas for us all and the first North Queensland one!
At the Aurukun airport waiting to say goodbye….all the teachers flying home, Fasi about to fly and hoping that the storm coming in off the Gulf wasn’t going to delay the Skytrans flight to Cairns.
My first remote area nurse Christmas was in Aurukun 2008. Well….it was meant to be, but I ended up flying to Townsville for a CT scan of my right wrist. All the preparations were made….I had tinsel, lights and decorations posted from home. My then 16 year old daughter was flying up for two weeks, presents bought from before I ran away from home and ready to post from the top of Cape York and all the ingredients I needed for a boiled fruitcake were in the local store. I was set to enjoy a tropical wet season Christmas in the middle of “nowhere”.
But late one afternoon my desire to explore got the better of me. My daughter, Fasi and I walked about an hour along a bush track next to the Archer river…admiring the lush growth of pandanus on one side of the red dirt and mangroves on the other. I walked in the middle while the other two talked….suddenly they were still talking and I was flat on my back in sticky mud….trying not to make a fuss about the sharp pain in my wrist. They helped me to my feet as if I was an old woman, made a few jokes and wondered if we should keep walking or return home. The clouds were darkening and the tide was washing across the river bank. We pressed on, only, to be soon drenched in a heavy shower of rain. Fasi took that opportunity to closely peer into the water looking for fish, then made a hasty repair to an old net hanging in a tree while Mel and I were shivering with cold and water dripped off our noses and down our backs.
We walked home in semi-darkness feeling a bond forged by the experience….still making jokes! We still talk about it five years later as if it was a big adventure.
My arm was plastered back at the clinic, Fasi flew back to Brisbane, we enjoyed a clinic Christmas party and a few days of the house being lit up, then flew to join the family in Townsville. It was Christmas with a difference alright and one of the most memorable.