by Paula Heelan
Wadeye, also known as Port Keats, has grown to become one of the largest remote Indigenous communities in the Northern Territory with a population of more than 2500 people. Isolated, it sits on the Indian Ocean and the western edge of the Daly River Reserve, 420 kilometres south-west of Darwin. During the wet season the roads are cut for about five months of the year from heavy rain and movement is restricted to travel by air or sea. Wadeye is in the Thamarrurr Region, home to three ceremonial groups, at least five languages and four dialects. Languages include Murrinhpatha, Marri Ngarr, Murrinh Nuwayn, Marri Tjevin, and Ngangi Tjemerri. Murrinhpatha is the most commonly spoken, though it may be a person’s second or third language. English is not widely spoken and is used mostly to communicate with non-Indigenous people.
Lane walked courageously towards the medical clinic. She tried to look confident. The expectant mum and her family would be depending on her. But she was nervous. She didn’t know what to anticipate and she worried she mightn’t be up to the task. She would be the only health professional with midwifery skills within an hour’s flight of this remote place.
As she swung open the clinic door, everyone was gathered waiting for her. Their faces looked up at her keenly, relief on each one. ‘Thank God you’re here!’ exclaimed the health worker. Lane’s heart sank. ‘I thought, I’m not telling them this will be my first independent birthing experience,’ she says. But instinctively she clicked into gear, putting all her training into practice. The mother was eight centimetres dilated, but everything else seemed fine. After an hour and no progress made due to the mother’s dehydration, Lane made the decision to commence intravenous (IV) fluids and happily, before long and without fuss, the woman gave birth to a beautiful little girl. ‘It was a lovely, analgesic-free, natural birth and one of the most amazing experiences I’ve ever had,’ says Lane. ‘It was certainly the best first job I could’ve asked for – a lucky start to my professional midwifery career, and I often think back to that perfect, natural birth.’
With her Sydney-based training, where it was all about the importance of natural birthing and encouraging skin-to-skin contact between mother and baby, Lane wasn’t prepared for the plethora of women that was outside the clinic waiting for the women’s business to unfold. ‘Seconds after the placenta was passed they came streaming in to see the new family addition. At just minutes old, the baby was passed around for cuddles and photos with nearly a dozen family members.’ Lane and the pilot flew the mother and her tiny baby back to Darwin for a full check-up and later the pair returned to Wadeye on a commercial flight.
For the next few months Lane attended mostly trauma and emergency jobs, rather than midwifery cases, until one day she got a call-out to a pregnant woman who had gone into early labour. ‘Clinic staff told us she’d missed the bus to the hospital in Katherine and we needed to fly her to Darwin. We arrived and I examined her, but despite being told the contractions were one in ten or fifteen minutes, I couldn’t feel any. We got her onto the plane and into the air and I asked her if she was having any labour signs.
‘Ahww, I’ll be honest with you, Sister. I’m not in labour. There’s no Kmart in town. She didn’t want to take the bus to Katherine to have her baby because her other five children needed clothes and they’re much cheaper in Kmart. We were in the air and decided to keep going. I gave her a magazine. My work was done.’
Darwin has a wet season and a dry season. With the wet comes storms, pounding winds and cyclones, and the dry season brings bushfires, dust storms and fog. ‘Flying up here is constantly a challenge for our pilots,’ Lane says. ‘Even if we can get to a destination, it’s another thing whether or not we can land. There are often obstacles on runways like dingoes, foxes, feral pigs, horses and cattle, or the airstrip lights might be broken and we can’t see where to land. Sometimes if people are intensely sick and we can’t land in their community, we ask if someone can drive them to another place where we might be able to land. That could mean a two- to three-hour drive over a corrugated dirt road. As well as calling into lots of remote communities, we often fly into cattle stations,’ Lane adds. ‘Ideally, their airstrips are well maintained. They need to be the right length and width and have the right ground and lights for us to land safely.’
One night after a very large storm and significant rain in Darwin, Lane received a call-out to retrieve a woman from a large community. The woman waiting for the pick-up was 37 weeks pregnant and had suffered a concealed haemorrhage – the placental lining had separated from the uterus wall before delivery. Together with pilot Matt Mommers, known to his colleagues as Mommers, Lane’s task was to take a neonatologist – a specialist doctor from Royal Darwin Hospital who treats newborn and premature infants – along with them and to bring the woman to Darwin. The CareFlight team briefed the doctor and they left at 8 pm on a King Air plane. When they arrived at the clinic after the 30-minute drive from the airstrip, Lane was surprised to find the woman up having dinner and walking around. ‘We’d been given a much grimmer picture of her condition over the phone,’ says Lane. ‘She was able to walk across to the plane with us. But the weather was very bad in Darwin and it was raining significantly across the region. Mommers told us we couldn’t fly. So we sat at the airfield and waited. Our patient watched TV and I spent the time monitoring the baby and listening to the heartbeats. Everything was fine.’
About 40 minutes later Mommers said the weather had improved in Darwin. The line of storms had passed, but there was still low cloud and heavy rain forecasted with occasional thunderstorms until daybreak. ‘He said we’d be good to go,’ Lane says. ‘By now it was nearly midnight and in a typical wet season it was still raining, stinking hot and sticky.’ The crew and the patient were weary. During the flight Mommers, who is generally a chatterbox with an incessant wide grin spread across his face, was very quiet. Lane could see he was working hard to fly through the storms. ‘Lightning was flashing on both sides of us and the cabin was lighting up like a disco. Violent jabs were tossing us about, up and down, left and right.’ Thinking she could lighten the mood, Lane asked Mommers if he’d like the Curly Wurly chocolate she had in her pocket.
‘No, I do not want a Curly Wurly,’ he replied gruffly.
‘He was flying very hard and he was not happy,’ Lane says. ‘He was flying that plane the best he could. To my disbelief our patient and the specialist were sleeping through it. I thought, I’m standing guard, no worries everyone.’
About 75 kilometres from Darwin Mommers broke the news to Lane that they wouldn’t be able to land.
‘What?’ she asked.
‘I can’t land here,’ he said. ‘I can’t see the runway. We’re going to have to go back.’ Heavy thunderstorm activity, drenching rain and low cloud were a big concern. The storms were developing over Darwin airport and Mommers knew it wasn’t safe to attempt a landing approach. ‘In weather conditions like this the aircraft carries 60 minutes of holding fuel to allow the weather to pass through,’ Mommers explains. ‘And that was the case that night. If I had penetrated a thunderstorm like that, I would’ve risked injury to us from the severe turbulence and also the potentially catastrophic damage to the aircraft. They’re not designed to handle the violent updrafts and downdrafts in the middle of a thunderstorm.’
Watching the radar, it didn’t look like the weather was going to dissipate anytime soon. ‘I had two options,’ Mommers says. ‘The first was to fly to a small community – a ten-minute flight from Darwin – or divert back to where we’d picked up our patient. The smaller place, a remote Indigenous community, wouldn’t have had any medical assistance on hand for the mum or Lane. It would’ve been no better than the baby birthing in the plane. I had to make the call early so I’d still have enough fuel to conduct two instrument approaches – that’s what you do in bad weather to get down to a low level. We were holding for about 40 minutes and I calculated that if we diverted back to the larger community we’d come from, I’d still have enough fuel for three instrument approaches if th
e weather was bad.’
As they flew back towards the town they’d just left, storm clouds were chasing them. They were flying through extremely heavy rain and turbulence and ice was accumulating on the airframe. An ice build-up can be very dangerous in some circumstances and occasionally means the plane has to descend into warmer air. The aircraft was getting thrown about. Lane was worried. ‘I could see a St Elmo’s fire – a blazing light show on the edge of the propellers and along the wing tips.’ A St Elmo’s fire is a rare phenomenon that can occur through electrical build-up when an aircraft is near a thunderstorm. The specialist was woken by a thud and Lane told him they couldn’t get back to Darwin. She could see the disappointment sinking in.
The landing approach was clear and smooth, until suddenly a wild gust of wind picked up the plane and thumped it back on the ground, shaking the crew violently. ‘The patient looked up at me in alarm. I think my waters just broke,’ she said.
‘I got on the intercom and told Mommers his landing was so hard, he had broken the patient’s waters.’ He turned to Lane and with a look of relief at having landed the plane and with the smile almost back on his face he said, ‘I’ll take a raincheck on the Curly Wurly.’
When the plane had stopped Lane looked under the blanket covering the patient to find her covered in blood. It was not good. Lane had begun a vaginal examination when moments later the stair door was flung open. Mommers was checking on her. ‘Are you alright in there?’
‘Get out, women’s business,’ Lane yelled urgently, knowing her patient would not want a male nearby. The woman told Lane she was in a fair bit of pain. ‘I know, it’s okay, we’ll sort it. Take some deep breaths,’ Lane said to her with as much reassurance in her voice as she could muster. She called CareFlight’s logistics team. ‘I think she’s having a haemorrhage. She’s bleeding and her stomach is rock hard. We need to do a caesarian,’ Lane told the team.
‘Luckily there was an anaesthetist in town,’ Lane says. ‘That was very unusual. The stars had aligned. But as we loaded the patient into the ambulance she started screaming blue murder. Her stomach pulled up to one side, like a basketball. She was screaming and afraid.’
Not able to give her any pain relief because of the apparent, imminent birth (drugs like morphine could relieve the mother’s pain, but would cross the placenta and decrease the baby’s ability to breathe and adapt to life outside the womb), Lane tried to calm her and explain what they were going to do. She assumed the placenta was at least partially off the wall of the womb, meaning the baby wouldn’t be getting as much oxygen as it should. Still hours from a major hospital, Lane knew it was serious. ‘Again, communities just pull together when things go wrong,’ she says. Lane and the hastily assembled healthcare team wheeled the patient through to the theatre for an emergency caesarian. She had lost a lot of blood and Lane was worried. ‘The baby came out a little floppy and had some breathing issues, but was okay. The neonatologist intubated the baby. As we had packed all our equipment in case of a worst-case scenario, everything turned out well.’
Lane was working to stabilise the baby when Mommers called in to the clinic to say he was sorry but he was out of flying hours and would have to leave without them. He’d managed to grab a couple of hours of sleep on the couch.
‘Are you kidding me?’ Lane asked.
‘No, but someone will be back for you in the morning.’
Mommers flew the empty plane back to Darwin. As he landed, the day-shift pilot was taxiing out for take-off to pick up Lane and the doctor. Had Mommers waited for Lane, he would have acted against the Civil Aviation Safety Authority’s (CASA) strict flying-hour rules. ‘It was a lonely flight back,’ he says.
‘A strong part of the decision process that night was working out what was going to be best for the mother and baby,’ Mommers says. ‘In hindsight, we picked the better option. Had what happened to the mother occurred at the smaller community, Lane and I were certain she wouldn’t have survived with that kind of blood loss. The medical resources required wouldn’t have been there. We were relieved she was able to go to a place where she could be admitted to theatre.’
The next morning, the baby was stable and the mother out of theatre. She wasn’t stable enough to transfer because she’d lost a lot of blood and when open surgery is performed, flying isn’t recommended. She proudly held her baby while Lane took some photos of the two of them together. ‘Then we took our super-cute passenger in a big crib with all our flash equipment safely back to Darwin. The mother was transferred later that day to join her baby.’
Generally, up to about 36 weeks gestation, pregnant women present to their local health clinic for antenatal care with a resident or visiting midwife. After that time they take a bus or vehicle, often over unsealed roads, to one of the smaller hospitals in the Northern Territory or to Darwin for their confinement for the birth. The government assists with housing and expenses while the mothers wait for their births. But all that is against the Indigenous practice of having a natural birth on the land their baby belongs to. ‘Being away from family for up to five weeks can be traumatic, particularly when you’re in such a vulnerable position,’ Lane says. ‘Unfortunately, it’s not possible to put a high number of birth centres over the Territory’s vast expanse.’
A major part of Lane’s work in the Northern Territory calls on her ability to understand cultural differences in the remote Aboriginal communities she works in. Delivering services to Aboriginal families and communities can be complex. Social problems can be deeply entrenched and historical, social, community, family and individual factors need to be considered. Australian Indigenous cultures are not homogenous and communities differ widely. They often have characteristics specific to geographic location and vary significantly to one another. Many Indigenous families and communities face immense challenges, some of which contribute to high levels of poverty, unemployment, violence and substance abuse.
‘I’ve learned about different cultures, languages, tribes and communities – it’s a whole other world up here and one Sydney didn’t prepare me for,’ Lane says. ‘I was completely ignorant of the issues when I arrived. I learned that women often have pregnancies with no antenatal care until they give birth. On the whole, pregnancy and birthing is sacred women’s business. The men wait outside. The people have an incredibly strong connection with the land and are desperate to have their babies birthed on the land. They’ll try to avoid coming into town to birth their babies. It’s everyone’s right – you should be able to have the birth you want. But sadly, we just don’t have the resources to be able to support that.’
CareFlight senior flight nurse Jodie Mills says Lane is a joy to work with. ‘We see her as the baby of the fleet,’ she says, smiling. ‘But her skills certainly don’t represent that. She’s an extremely talented nurse and midwife. Even though she seems to always get herself into hard situations with little neonate babies, her ability to deal with emergencies is exceptional. We have a running joke that if a neonate is going to come in, it’ll be Lane that’s on. But in saying that, she always conducts herself with the utmost professionalism and her competency in looking after the extreme neonate [24 to 25 weeks] is unquestionable. She works in exceedingly difficult situations where she doesn’t have the luxury of being in a major hospital with a lot of support – 85 per cent of the time it’s flight nurse only and she’s on her own. Lane’s extremely capable of handling that. She’s an incredibly important part of our team and we’re really proud of her at CareFlight.’
The very first time Lane helped birth a baby set the tone for her midwifery career. ‘That plain-sailing, natural birth was a really moving experience. I feel very privileged to be involved in midwifery in remote communities and all the wonderful experiences that come with it. It’s fantastic to be one of the very few people who often gets to coo and ahh over a newborn. Despite being a bit of a disaster magnet and known for it, I’m living the dream. I have a lovely boyfriend in Darwin. Joe is from Victoria and we met h
ere. He recently decided to return to university to study biomedical science. He’s a very smart man.’
Sitting in an egg chair on the deck of her apartment looking across the ocean, Lane says she loves Darwin’s laidback way of life. ‘It’s totally different here and the fact that I get a glimpse into very sacred and ancient Aboriginal communities and have an opportunity to help improve the health and wellbeing of those living there is a great honour. I’m working in a vast, incredible part of Australia that most people never get to see.
‘My midwifery career started as a huge task and undertaking. To think I dreaded the course and pretty much let everyone know I hated it! But now it’s my favourite job. When I’m tasked to a midwifery case, I get excited. These days I’d much prefer to go to a beautiful birth than a roadside trauma. Blood and guts used to be my thing. But now I am loving midwifery. I am a midwife.’
CHAPTER
2
Catherine (Kate) Austin
As Kate hurried to the health centre in a small community in the Victoria River District, 580 kilometres south-west of Katherine in the Northern Territory, she turned over in her mind the procedures she’d need to put in place for an upcoming birth. It was two in the morning and Kate had just had word that Mary’s waters had broken. Not long in remote midwifery work, Kate was about to experience her first independent Indigenous birth – and she was a little on edge.
An experienced nurse, she had been providing antenatal care for Mary for the past few months and had organised an air transfer to a regional hospital for Mary’s sit-down [her waiting time away from her community, usually between 37 and 38 weeks gestation] for later in the week. Mary was expecting her third child and Kate knew it could be a rapid birth. She also knew Mary had haemorrhaged following both previous births.