by Paula Heelan
In Kalgoorlie, Lisa was introduced to the Hay Street sex workers. ‘We did all the screening and sexually transmissible infections checks,’ she says. ‘I did a community placement and I found the work really interesting. The women were straightforward, smart and funny. There were schoolteachers, secretaries and mothers. They came to Kalgoorlie for short periods of time to earn some extra money. I was still in my early twenties and found it a huge eye-opener.’
Over a year in Kalgoorlie, Lisa learned a great deal about midwifery and Indigenous health. ‘It was a great hands-off birthing environment and with high-risk pregnant women sent to Perth, the majority of births were natural and uncomplicated. It was a lovely place to learn midwifery.’
Looking for a new adventure, Lisa left Kalgoorlie in late 1997 to work in Darwin. ‘I was still in contact and friends with Pete. He flew into Perth and we headed off to Darwin.’
Once there, Lisa took a job in maternity at the Royal Darwin Hospital. ‘I loved working there and stayed for twelve months. There were about six of us young midwives who had chosen the Territory for the experience. Most of the work involved Indigenous health with women coming in from all over the Top End from remote communities. English was not their first language and they were the sweetest yet strongest women I’d ever met. They could be quite cheeky so we had some fun times, lots of laughs and it was such a pleasure to work with them. They’d birth beautifully with no breastfeeding problems – no mastitis, cracked nipples or poor milk supply. They’d just put the babies on the boob and off they’d go. When the women are in labour, you know they’re getting close to birthing when a little sweat appears on the mother’s brow. That’s how good the women are. They don’t show pain – just extraordinary strength and resolve.’
Lisa cared for an Indigenous woman from Elcho Island, which is off the coast of Arnhem Land at the southern end of the Wessel Islands group. ‘Jacqueline was brought to Darwin in premature labour at around 34 weeks. Lisa birthed her little boy, David, and cared for him for about six weeks before he was big enough to go home. Years later when I returned to Gove as the Women’s Health educator, Jacqueline and I recognised each other in the clinic on Elcho Island one day. She brought David into the clinic so I could see him. I couldn’t believe how big he had grown. Born a tiny premie, I assumed he would still be small for his age, but he was actually quite tall and very solid. It was wonderful to see him so well as I had often wondered how he was going after he left hospital. You form a close attachment to the babies that stay with you for a long period. David had no idea who I was of course and he was quite perplexed about all the fuss that day.’
At the end of her twelve months in Darwin and keen to return to Queensland, Lisa got a job on Thursday Island. It was at the end of 1998. With a population of 2610, TI is the administrative centre for the Australian islands between Cape York and the New Guinea mainland. It sits in the Prince of Wales Island group, or the Inner Islands, and is 35 kilometres north-west of Australia’s northern extremity, Cape York.
‘I wanted to go to TI because I was really enjoying working in Indigenous health. It was so much more interesting.’ She arrived to a very small midwifery unit in a 30-bed hospital with six maternity beds and two birthing rooms. The midwifery section was built over the water. ‘Sitting on the verandah with women from the Torres Strait Islands and Papua New Guinea is a memory I’ll carry forever. On quieter days, with the sound of water lapping under us on high tide, we’d yarn and laugh away. After giving birth, the mothers would be starving. I’d grab them a meal with dessert from the kitchen. There were lounge chairs all the way down one wall of the ward and the women, to be close to the midwives, loved to sit on those chairs and natter away and give the midwives a bit of cheek, too. I’d sit down next to them and grab any spare meals I could find – my excuse was that we’d both worked hard birthing the baby!’
The heat and humidity were oppressive, but Lisa got used to it. ‘Bad hair days and sweating were the norm for me.’ She laughs. ‘To get to the hospital we’d run a hundred metres from the air-conditioned nurses’ quarters to the air-conditioned hospital as fast as we could. We had to cross the road that circumnavigated the island – TI’s only major road. The island is three kilometres by three kilometres. The hospital was built three years before I arrived. Nurses had their own double bedroom and en suite and shared a kitchen between four rooms and a lounge room between eight rooms. It was a whole lot of fun. Male and female nurses were there from all over Australia.’
The Torres Strait Island–trained health workers worked alongside the midwives in the hospital’s maternity ward. ‘There was nothing we could do that they couldn’t,’ Lisa says. ‘They were fantastic. One in particular, Margie, was incredible. She’d go in and take care of the women and she’d be in there doing all the work. If you had an emergency, you’d want Margie beside you. A lot of the women had eight or more children, increasing the risk of postpartum haemorrhage (PPH).’
Some women bleed too much after birth and require special treatment. It occurs in up to six per cent of births and is most likely to happen while the placenta is separating or soon after. ‘There was also a lot of shoulder dystocia, which can happen during the end of the second stage of labour,’ Lisa adds. ‘A lot of the babies were very big and would get stuck.’ Shoulder dystocia is a case of obstructed labour, where after the delivery of the baby’s head, the anterior shoulder can’t pass through or requires significant manipulation to pass. It’s diagnosed when the shoulders fail to deliver shortly after the head and can be an obstetric emergency. ‘Sometimes you have to break the clavicle [collarbone] to get the baby out or it might just be a matter of manoeuvring women, having them change position to allow their pelvis to open as wide as possible. Margie was unbelievable with all of that.’
The Queensland health department flew the nursing staff as far as Cairns every six months for a well-earned break. ‘There was one grocery store, a post office, newsagent, a clothing store called Mona’s Bazaar and a couple of takeaways and three pubs. So it was a big thing to get home to the coast for a good shop and to see family. I flew home as often as I could. I made some great friends on TI and we still keep in contact today.’
At TI Lisa was assigned to regular night duty. She was keen to get back to working the Monday-to-Friday, nine-to-five shift so she could go camping on weekends. While the outreach midwife was on long-service leave, Lisa relieved in her position for a couple of months. ‘This meant flying out to a different island every day to do the antenatal and postnatal care in midwifery clinics on the outer islands. We’d fly off in a helicopter or small fixed-wing plane. It was exciting to be flying to work every day in such an extraordinary place. It was Monday to Friday and I loved it. I got to see all the outer islands.’
When the position of sexual health nurse became available Lisa put her hand up. She had learned a lot about sexual health in Kalgoorlie and how to do a pap smear while in Darwin. She got the job and began the rounds on the outer islands, carrying out sexual health screening. But it had been a long time since she had cared for ‘grown-up’ male patients. ‘I was doing both boys and girls, so this was another eye-opener for me. I’d trained in sexual and reproductive health with Family Planning in Darwin, so I just had to put the training to practice.’
On her first day in the job as sexual health nurse, a boatload of illegal fishermen from Indonesia had been caught in the Torres Strait and brought in for health checks. ‘I got a call from the receptionist at the clinic saying there were some patients for Thomas and me. Thomas, the health worker, had gone off to lunch. Oh, I’ll be right down, I said, hoping she wouldn’t detect my extreme nervousness. I walked in to find about ten men and the quarantine officer – all dark, all non-English speaking and all with huge smiles on their faces.’
Anxiously, Lisa wondered how she would deal with them. ‘I hadn’t dealt with men for so long,’ she says. ‘Thomas was off on a break on island time and didn’t surface for quite a while. Island time is s
low and relaxed – clock time is unobserved. Eventually, he wandered back in and we ended up staying late that night to process the men. We did full screens and took blood and found they all had infections. I’d never seen anything like it. Thomas was very experienced and led the way for me. After that the men, who were staying on Horn Island in the quarantine area, came back to the clinic once or twice a week for a jab of penicillin. They named me Dr Love. I’d walk into the waiting room be greeted by big wide grins and a chorusing of Dr Looooovvve. They were always smiling and laughing and I soon discovered, very sweet.’
While Lisa was on TI, she answered a call for midwives to work in East Timor in the wake of the humanitarian and security crisis of 1999 to 2000. Lisa took three months’ leave without pay from TI in 2000. One of six Australian volunteers – five midwives and one retired doctor – she joined the International Medical Corps, an American-founded aid organisation.
Her work was based in Oecusse Enclave, where 45,000 refugees were displaced in camps. Because of the geographical isolation from the rest of East Timor, this was where the worst of the atrocities had occurred. ‘We provided clinical support and education to local health staff and were on call 24 hours a day, six days a week for obstetric and general emergencies at the district hospital. We also ran mobile clinics to remote villages in the hills under armed guard from the Jordanian and Australian armies, as there were still rogue West Timor soldiers. We also developed education programs for midwifery care, women’s health, sexual health and child health.’
Volunteers lived and worked under extreme circumstances with a moderate to high security risk. There was no electricity, running water or diagnostic or screening equipment; there were limited pharmaceuticals, they were isolated from support military units and there was an extreme language barrier.
Back on TI, when the position of mobile women’s health nurse came up in Mount Isa, Lisa applied. Still in the area of sexual health, she wanted to get back into women’s health. ‘I had no desire to go to Mount Isa. I was aware it was hot, dry, ugly and in the middle of nowhere. My preference was a coastal position in Cairns, or perhaps Townsville – somewhere nice. But lo and behold, I got the Mount Isa job. I had only really interviewed for the experience, and despite getting the job, I had no intention of taking it.’ But every time Lisa called to decline, Matron Beth Anderson was on the other end of the phone. She had established the position and been in the job for ten years and she had been matron of the hospital for more than twenty years before that. ‘I kept trying to say I wasn’t interested, but each time Beth would talk me out of it. You soon learned you just didn’t say no to Miss Anderson. I had got myself into this predicament and the next thing I knew I was heading to Mount Isa.’
It meant leaving the Torres Strait before she was ready. Every day for the first month in Mount Isa Lisa cried. ‘It was worse than I’d imagined. Brown, dusty, full of flies and there was no water to swim in. I moved in December 2001 and every day the mercury was pushing 40 degrees. I hated it. I kept thinking, What have I done?’
Lisa stayed in Mount Isa for three years and after that first harrowing month, began to love it. Her job was to run the women’s health clinic in Queensland’s Gulf region. ‘We flew or drove to wonderful small towns, including Cloncurry, Burketown, Normanton, Karumba, Camooweal, Doomadgee, Julia Creek and Mornington Island. Under the Rural and Remote Women’s Health program we ran clinics in remote places in conjunction with the Royal Flying Doctor Service [RFDS]. The RFDS has several different programs – the emergency retrieval service, primary health clinics and women’s health clinics. The Queensland Health Mobile Women’s Health Service worked in partnership with the RFDS Rural and Remote Women’s Health Program and Queensland Health part funded the RFDS program.
‘I grew to absolutely love the country I was working and the work itself. I lived in a little house next to the hospital, which was in turn next door to the units where all the young doctors lived. On weekends the other nurses and I would go out with them. There was a whole new bunch of people to get to know. Some I had already met in Darwin or the Torres Strait. When you work in rural and remote you often see the same people. The same group tends to move around the posts. I was really drawn to that lifestyle.’
Lisa travelled to outreach health clinics in a LandCruiser, mostly on her own. One day on her return to Mount Isa from Normanton, her vehicle was packed to the hilt with clinic and lab gear, a folding bed, speculums (the ‘duck bill’ tool used for pap smears) and more. ‘It was late afternoon and I had just driven past the Cloncurry turn-off when I heard, hiss, hiss, hiss followed by a loud bang. A blowout. I pulled to the side of the road and took a look.’ There was very little left of the tyre. Lisa knew she had to change it on her own. ‘I thought, I’m too far from anyone to call for help. I had to unload the back of the vehicle and lay all the gear on the side of road. Then I tried to jack the car up. But I couldn’t raise it high enough to take the blown tyre off and put a new one on.’ The ground was rock hard. She decided to dig a little trench to make it easier. The sticks she gathered were too weak; then she remembered she had some metal speculums left over from the clinic. She could use one of them like a shovel. She got the largest one out and started digging. After 45 minutes and getting quite tired, she could hear a vehicle approaching. ‘I thought, This could be good or bad. I’m in the middle of nowhere.’
To her relief it was a Queensland Health four-wheel drive full of medical students and an intern. ‘I recognised them from around the hospital. You’re in a spot of trouble, they said. I was standing there covered in dust and holding a dirty metal speculum. We’ll give you a hand. So I passed the speculum to one of them and said I still have six more in the car. I handed them all one and saved the smallest one for me to make sure I did the least amount of work from this point in. There we were all armed with a speculum. We dug the trench and changed the tyre. We couldn’t stop laughing as we were working. The boys were coming up with 101 uses for the metal speculum.’ The Mount Isa paper heard about that day and wrote about the women’s health nurse who used a metal speculum to change a tyre.
At the same time Lisa was in Mount Isa, Vivienne Manesis worked as a general practitioner for the Aboriginal and Islander Health Service based in Townsville and regularly flew to Mount Isa and then into remote communities for Rural Women’s Health clinics funded by the RFDS.
One day Vivienne and Lisa were flown by charter flight to Mornington Island to run a clinic. ‘It was only the second time we’d met,’ Vivienne says. ‘It was the wet season and we ran into a storm during the flight. It came up suddenly and the pilot couldn’t get above or below it. I suffer from motion sickness, so I was feeling physically unwell and was about to vomit in the sick bag. There was an Aboriginal health worker on board who neither of us really knew. She was on the exit window and looking as though she was about to open the exit door and jump out. Lisa just kept talking and talking and talking. When you feel sick and anxious like I was, and this person was yak, yak, yak the whole time, it’s not good. Apparently I told her to shut up. And she basically said, Nah, if I’m going to die, I’m going to die talking. She was obviously anxious, too, and that was her way of getting through the flight. When you land on Mornington Island the first thing you see is a memorial for eight people who did lose their lives in an air crash. I said to the pilot, If that storm’s still there this afternoon we’re not getting back on the plane. He was a very good pilot though, and he got us there and back safely.’ As a result of the storm, Lisa said it was at that point when they were returning to Mount Isa that she considered launching her open-ocean-swimming career to get back to safe dry land – crocs or no crocs in the water.
Lisa also spent time on the Gove Peninsula as a women’s health educator, which was the next level up for her. Gove is on the west coast of the Gulf of Carpentaria within Arnhem Land and includes the towns of Nhulunbuy, Alyangula on Groote Eylandt, the islands of Galiwin’ku and Milingimbi and the major Aboriginal communities on
the main land. It’s a vast tract of Aboriginal title land on the Northern Territory coastline. The little township of Nhulunbuy is the main commercial and service centre of the Peninsula and lies 600 kilometres east of Darwin.
The hospital is a 32-bed acute-care facility and fifteen remote community clinics refer patients to the hospital for inpatient, outpatient and specialist care. Sitting just twelve degrees south of the equator, the Gove Peninsula has a monsoon climate. Two distinct seasons are recognised as the dry season from May to October and the wet from November to April. During the dry season there is virtually no rainfall, clear blue skies and cool ocean breezes. The wet season brings the monsoon weather with hot and humid days and warm nights. Electrical storms are spectacular and cyclonic activity is not uncommon in the wet season. The majority of transport is by aircraft.
The time came when Lisa thought she was ready to head home. ‘When I was based in Mount Isa, I was one of thirteen mobile women’s health nurses employed throughout rural and remote Queensland and we were coordinated centrally through Queensland Health’s Cancer Screening Services unit in Brisbane. When the position of coordinator for those nurses came up, I applied and got it. Once again, I wasn’t expecting it – I just threw my hat in the ring. That’s how I came back to Brisbane in 2005.’ Lisa enjoyed working there until October 2012, when the Newman state government suddenly made 15,000 public-servant positions redundant. She was working in cancer-screening services at the time as the Nursing Director, Cervical Cancer Screening. The government felt it was too top heavy and too costly to continue, so disbanded the cancer-screening coordination unit, along with many other specialist units.