by Paula Heelan
Chloe also made sure high-risk patients had the medication they needed before the cyclone and enough medical supplies for a good period following the cyclone in case access to medication became an issue.
The clinic was near to the water, so everything needed to be off the ground, with power points turned off. Anything essential needed to be on the generator outputs. Now it was just a waiting game. Along with Chloe, there were seven clinic staff in the house. They’d decided to wait it out together. Each person was handling the fear differently. Some were trying to find their own quiet space, others were talking nonstop. A few were quite restless and kept trying to create more protection for the house. Chloe had been talkative at first, but as the storm intensified she’d grown quiet.
In a bid to block out the turmoil she tried to think of other things. Her wedding was just weeks away. She tried to focus on all the jobs that still needed to be done. But falling into a state of meditation was hard work when the house was shaking, tin rooftops were rattling and immense trees were crashing down outside. The noise was horrendous and everyone was terrified. She couldn’t help worrying about the little community. Will everyone be safe? With phone lines cut and the power off, there was no contact with the outside world.
Without warning, water began gushing through the front door and people started to get wet. They sprang into action to push it back out. ‘A lady was lying on a mattress a couple of metres from the front door and she told us her mattress had become wet. The water had come into the lounge room and near to the kitchen. It was about an inch deep of water. We used mops, buckets and towels to get the water off the floor. Then we blocked the gap between the front door and the floor with towels. The water was getting in because of the intensity of the rain and the wind.’
It was a long, exhausting night. Finally, at 7 am it was deemed safe to venture outside. Nobody expected the brunt of this cyclone to hit head on.
Meanwhile in Melbourne Chloe’s fiancé, Ian Coker, was pacing. Chloe had called a few days earlier to let him know a cyclone was coming. ‘She said no one seemed to be taking it seriously and the locals didn’t think it would be an issue,’ Ian says. ‘I thought, Okay, maybe it’s just going to pass nearby and there’s nothing to worry about. But then Chloe called back about 36 hours before it landed and said she was worried. All reports were now saying it’s going to land close to Milingimbi.’
Milingimbi Island, 4900 hectares in size, is part of the Crocodile Islands in the Arafura Sea. It’s about half a kilometre off the north coast of Central Arnhem Land, 440 kilometres east of Darwin and 200 kilometres west of Nhulunbuy. With a population of more than 1000, predominantly Yolgnu people, there are 21 different clan groups. Yolgnu people live in locations on the island and the only way to get in is by boat, barge or aircraft.
Up to about eighteen hours before the cyclone hit, only scant preparations were put in place. Chloe still didn’t know where she should shelter or what she had to do. The highest point on the island only reaches ten metres, and the storm surge was predicted to be twelve metres high. When Chloe realised things were getting serious, she got behind the late planning efforts and helped get the community sorted.
‘She’s like that,’ Ian says. ‘She’s all about helping people. She’s incredibly calm in a crisis – especially medical emergencies. The police offered to fly her out in the police air wing but she declined. She wanted to stay and help with the clean-up and recovery.’
After the cyclone the town was without power, water and sewerage for several days. Chloe was one of the first out in rescue vehicles to treat injuries, check that people were safe and make sure everyone had adequate water and blankets. Most of the mattresses and bedding throughout the community were soaking wet. Chloe knew all the babies in town and where they lived. ‘Earlier some blankets had been donated to the community for the new babies returning from Gove and Darwin hospitals post-birth. Luckily they hadn’t been distributed yet and were still dry. So together with the Aboriginal strong women, Judy Lirririnyin and Julie Gapalathana from the health clinic, we got them out to the families with babies and toddlers. Everyone was grateful to have something dry to keep their babies warm. There were some amazing people involved in that recovery.’ As community strong women, Judy and Julie work to improve the health of Aboriginal women and their babies. Rather than imposing Western medicine on young women in their community, they encourage traditional cultural practices to strengthen families and improve nutrition and lifestyle. They educate young women about the importance of a healthy diet, and through their support and antenatal care of pregnant women and their babies they help increase babies’ birth weights as well as improving early childhood development and health. Milingimbi is a dry community, so there is no alcohol. Many of the health issues community members face stem from Western influence, which has been significantly disruptive to the health of people in these Indigenous communities.
There were also people in the community susceptible to respiratory problems, particularly children with bronchiectasis. Chloe flagged this with the local doctor and wrote a list of names for the recovery coordinator. Bedding was checked and replaced if needed. ‘I was paired with Julie and we helped assess the damage and needs for each household. It gave us an opportunity to let people know about the importance of boiling water for drinking, hand hygiene and to deliver crates of bottled water. It also turned out to be a chance for people to debrief about their cyclone experiences.’ Chloe had enrolled a couple of months earlier to start her Masters in Public Health degree – she hadn’t imagined she’d find herself in a situation so soon where she’d actually need to put public health initiatives to work. ‘In general, people spoke about how they sat huddled in the darkness next to their family members and listened to loud and frightening “crash bang” noises. They felt the cold from the rain and wind and their mattresses and bedding were soaked. Many talked about how they prayed that the cyclone would move track. Some experienced large trees falling on their houses or cars and mentioned the fear they felt for the lives of loved ones and of their own. After the cyclone people were concerned about their wet belongings, issues with food, power, lack of running water and the damage to their houses.’
For Chloe the most stressful part was waiting for the cyclone. There had been a lot of reports about it landing close to Milingimbi Island, but the residents were disbelieving. Some years ago a large rock was placed out by one of the islands and locals believed it protected them from cyclones. They had been told before that a cyclone would hit and when it didn’t eventuate, they were sure it was all down to that rock. ‘There was a lot of denial by everyone on the island,’ Chloe says. ‘No one believed we’d be hit. Also, because the Bureau of Meteorology [BOM] at one stage showed the cyclone could either come our way or turn to Gapuwiyak, another community in north-eastern Arnhem Land about 25 kilometres south of the head of Buckingham Bay, everyone was complacent and that went on for about a week. I tracked it closely through BOM and by Thursday I realised it was definitely coming our way. The clinic staff had a meeting and we did what we could to prepare.’
When the recovery team flew into Milingimbi, Chloe was relieved to see some familiar faces. As a fly-in-fly-out nurse and midwife Chloe is friendly with most of the police and people working for other agencies in the remote communities she works in. ‘It was very nice to see some of those faces from the Darwin Tactile Response Group who came in to help get us back on track. There were myriad jobs to be done. House repairs, adequate drinking water to arrange, sewerage and power to fix and nearly every tree was down. It’s very curious how the majority of those trees missed the houses when they fell. With the direction they fell on one side of the street, you’d think the ones on the other side would have fallen the same way and come down on the houses. But they missed them and it didn’t make sense. The locals told me they’d been praying and the rock had clearly helped.’
Chloe is the youngest of five children and grew up in Port Macquarie on a farm. Her mother, Pam
ela, says she was independent and determined from the get-go. ‘Because there’s quite a gap between Chloe and our eldest child, she became an aunty when she was three years old. We have seventeen grandchildren. She grew up caring for little kids, taking charge and pretty much looking after herself. She’s a leader and runs on high energy. With a farm and three shops to manage we were very busy. We’d say, You right, Chloe? And she’d say, Yep, I’m fine.’
After completing her nursing training through Newcastle University and some tertiary hospitals in Sydney, Chloe, at 23, thought she would give nursing in a remote area a try – just to tick the box. ‘I thought I was going out for a one-off experience. I was sent on contract to Port Keats, known as Wadeye, 420 kilometres south-west of Darwin. With a population of 2500 it’s one of Australia’s largest Aboriginal communities. I was very nervous and a bit naive when I arrived,’ she says. ‘But I was lucky to work with a bunch of old-school remote-area nurses out there. They took me under their wing and taught me an enormous amount. I worked on call and worked in the clinic from Monday to Friday.’ Outgoing and social, Chloe was surprised to find she enjoyed the harshness of a remote community and even the isolation. ‘I had to learn how to spend a lot of time by myself and it did take me a little while to adjust. But I soon learned how to fill in my time.’
Initially, Chloe thought a two-month stint would be enough. The nurses she worked with advised her not to go to Central Australia. They said it was very hard going, rough and isolating. But by the end of the two months she’d organised a placement in a community there. ‘I worked with the Nganampa Health Council and got to experience the difference for myself,’ she says. ‘It was a much smaller community and I liked it. Since then I’ve done quite a lot of locum work in Central Australia and throughout 2010 I juggled contracts between the Nganampa Health Council and Wadeye.’
It was on Chloe’s return to Wadeye in 2010 that she birthed her first baby.
‘It was on the second night after I’d arrived. I hadn’t even met the clinic’s midwife yet. The health worker called me in the early hours to say a woman was having baby pains. I didn’t know what the process was or who to call. I didn’t expect she would be at full term or about to birth. My experience in Central Australia had been that if women experienced baby pains they were signs of a premature labour or a miscarriage – all full-term women were flown out for sit-down. I was very slow to realise I was actually about to assist a woman give birth to a term baby. The woman had been sent out of Wadeye for sit-down but had chosen to return because of family matters.’
Chloe found a woman clearly at full term waiting for her. Her mother was by her side for support. Chloe tried not to look concerned and diligently rang one of the two midwives. ‘The first I called lived across the road. She told me I wasn’t meant to call her, but to ring the other midwife who oversaw all the midwifery management. The other one lived on the other side of town and she told me she’d brush her teeth, get dressed and come along shortly. She didn’t sound happy about coming in so I thought I should do as much as I could. I sent the health worker off to find the women’s business manual while I pulled out the IV trolley with the intention of putting a cannula in.’ A cannula is a tube that is inserted into the body for the delivery or removal of fluid and intravenous drugs and removal of blood for testing if needed. ‘I had a little moment where I thought, Hmm, something’s not quite right. I looked at the woman and she was calmly watching me and smiling. I thought I’d take a little look and lifted up the sheet. To my surprise a little head was presenting.’ Chloe dropped what she was doing and with no time to find gloves she held out her hands just in time to catch a baby boy.
‘This young mother was actually smiling at me as she was birthing her baby,’ she says. ‘I was thrilled and that sense of bewilderment and elation stayed with me for a very long time. The baby pretty much delivered itself within ten minutes of my arrival. And thinking back now, I wasn’t a terribly big help. But the experience was defining; that’s when I decided to become a midwife.’
Chloe’s parents, Pamela and Arthur, visited her in Wadeye a couple of times and watched her work. When Pamela visited in 2010 for a month she was in awe of the effort she saw Chloe put in. ‘She’d be on call all hours of the night. One night she left the house at 1 am. She went out bush somewhere because there had been a fight. Someone had sustained a leg injury from a star picket and needed help. When she came back and told me, I was horrified. She just said, It’s fine, Mum. I’ve done all I can do. I’ve called the plane and they’ll fly him out to Darwin. That’s where I saw her strength.’
At times, there would be physical riots in the streets of town at night and Chloe would be called to go in after the riot had been dispersed to help those injured. Occasionally someone would be flown out for medical treatment, but most of the time injuries could be treated at the clinic. There were two elders in town who looked after Chloe and she would have locals drive her at nighttime. One night following a riot at the airport, Chloe was trying to put a young girl on a CareFlight plane. At one point, she tried to find the drivers but couldn’t locate them. After everything settled, the driver team crawled out from under the clinic ute – they had been terrified and were hiding from the rioters. Chloe had been too focused on her job to even consider it.
Chloe took contract work with the Northern Territory government in Wadeye and in different communities for the Nganampa Health Council. ‘Wadeye is a very busy place and when I felt I needed a break, I’d go to a smaller community. It would still be busy, but not as stressful.’
When she finished her midwifery training at Deakin University in Melbourne in 2013, Chloe applied for a graduate midwife position at the Mercy Hospital in Heidelberg, Victoria. She knew that to make a good midwife in a remote location she’d need that extra training. With a six-month wait before starting, she took a job at Milingimbi Island to fill in the time. But not as a midwife – she didn’t feel ready for that.
When she arrived the staff had heard she’d done her midwifery training. ‘When I told them I needed to do my new graduate program in a tertiary setting before I could feel competent to work in a remote setting they said, We haven’t had a midwife for six months – no midwife at all. So we’d prefer to have someone with at least some training rather than a nurse with no mid training. It took a bit of persuasion because I really wasn’t keen to hold that title. But I felt better when they put me in contact with the outreach midwife, Lisa, who turned out to be someone I knew well and was inspired by.’
Prior to Chloe’s midwifery training, Lisa was the first person to teach her how to birth a baby in a remote setting. They had worked together in remote communities a few times on the Anangu Pitjantjatjara Yankunytjatjara (APY) lands with Nganampa Health Council. Lisa had taken Chloe through a mock scenario of birthing a baby. ‘She showed me where the midwifery packs were kept, oxygen bags and any drugs you might need,’ Chloe says. ‘I was thrilled that day when I rang the number for the East Arnhem Land outreach midwife, to find it was Lisa. She was incredibly supportive and came out a few times to work with me. We also did a lot of group education together with the girls in Milingimbi, which was really great. I was also able to call on the female doctor based in Darwin any time and she came out a couple of days each month and was incredibly supportive.’
The Milingimbi girls went to Gove for sit-down and had their babies there. The clinic was at that time very small and built right on the edge of the beach. ‘It’s a very beautiful place,’ Chloe says. ‘My consulting room was tiny. The shower area had been converted into a storage room and there was a back-door entrance. The girls could knock on the back door if they didn’t want to be seen going through the entrance. On my second day in the community the clinic receptionist, Nicki, told me she’d noticed a woman at the shop who looked very pregnant. She didn’t know her so assumed she was from another community. She said to me, You probably should plan to see her on Monday. It was 4 pm and the clinic closed at five. I thought, I sho
uld try to find her now. So I sent some health workers off and they brought her in to see me. She was 36 weeks pregnant and visiting from another community. I called the clinic in her usual community and found she’d had minimal antenatal care at her local clinic during this pregnancy. The staff told me she’d spent a fair bit of time in Adelaide because her son was in hospital after a bike accident. She was expecting her fifth child. After an antenatal check I found she had significantly high blood pressure and excessive protein in her urine. She felt well, but those two warning signs had me concerned. I rang the outreach midwife and the Darwin GP to ask advice.
‘At that point there were another two emergencies in the clinic and a funeral was going on outside. Earlier that day we were instructed not to put lights on when it got dark because of the funeral. Aboriginal customs and traditions are very different. This was a funeral for a very important community elder and the request was accepted in respect – it’s about adhering to cultural need. We used torchlight and medical lamps to create enough light to do our jobs. We thought no worries, nothing much was going on so we could make sure we were back at our houses before dark. But in the end, all of us were held back with the emergencies. When it grew dark we worked in torchlight. Not being able to use the emergency room, I was in the very small back room. I was on my own with a woman and a baby in utero so I was mindful that I was caring for two. As time went on the woman became quite unwell. Her blood pressure rose, her vision blurred and she had a headache and nausea. I administered drugs to manage her blood pressure.’