Australian Midwives

by Paula Heelan

  Wendy had quite a bit of adjusting to do. ‘I can only describe it as a pure culture shock,’ she says with a smile. ‘I had a lot to learn about Indigenous family relationships.’ The kinship system determines Aboriginal social organisation and family relationships. It’s a complex system that governs how people relate to each other and their roles, responsibilities and obligations in relation to one another, ceremonial business and land.

  ‘I worked with five wonderful Indigenous health workers who helped me along the way,’ Wendy says. ‘I learned to understand who could marry who, who could sit next to who and who could not because of poison cousin relationships. I learned about ceremonial life, rituals around death such as sorry business and needing to close the clinic after a death to respect the deceased. I also learned about the need for ceremonial smoking of the clinic or aircraft if a patient had passed away in either of those places.’

  Wendy was the only midwife and nurse. It was the wet season and the dirt airstrip was often closed due to wet weather. That meant the clinic staff sometimes had to wait for the airstrip to dry out enough for the plane to land and evacuate the sick patients.

  ‘The heat and humidity were draining at times and the number of frogs on the verandah at my flat had to be seen to be believed – they even lived in the toilet bowl. The health-centre staff evacuated patients to Gove or Darwin and if this happened at night, we had to light kerosene flares at the airstrip for the plane to land. At first, I kept thinking, How did I end up here? Going bush was so outside my experience and I was quite nervous.’

  It wasn’t long before Wendy’s triage capability was put to the test. One night three very ill patients presented at the clinic at once. ‘A young boy aged about ten had been stung by an Irukandji jellyfish – an extremely venomous box jellyfish,’ Wendy says. ‘I knew the collective symptoms included excruciating muscle cramps in the arms and legs, severe pain in the back and kidneys, a burning sensation of the skin, headaches, nausea, sweating and vomiting. When I first saw him he was lying limply across his mother’s lap and his eyes were rolling back in his head. I thought, Oh no, this is not good.’

  At the same time the man who worked at the car-repair shop needed his eyes irrigated after a pipe had burst and sprayed hydraulic oil into his eyes. And a woman in early labour presented just after he arrived. Wendy thought, Hell’s bells! Why does everything happen at once? It never rains, it pours. ‘I handled the situation as best as I could. The bloke with oil in his eyes ended up irrigating them himself under my instruction and then he helped me with the envenomated boy, whose blood pressure had elevated. I flushed the red weals on his abdomen with vinegar to neutralise the tentacle stinging, and with no antivenin available, I gave him an intravenous analgesia for the pain.’ The health workers arrived and between them they stabilised the boy and the expectant mother before the aeromedical retrieval crew arrived – the outcomes were good all around.

  ‘In hindsight, it may not have been the best decision for a new recruit to go to a single-post remote area – but I’m so glad I did,’ she says. ‘I learned that my way wasn’t always the right way and I learned to listen and absorb very quickly.’

  Back at Nhulunbuy, Wendy was asked to do a two-month stint for NTAMS. ‘It was my first introduction to flight nursing,’ she says. ‘We’d fly out to communities to pick up patients and bring them back to Gove. I never imagined I’d be doing that and I loved every minute. At the time it was all radio contact, which was maintained between Nhulunbuy NTAMS and the communities in East Arnhem Land in case telephone contact failed. We did twice-daily “radio scheds” with the community staff, relaying hospital inpatient reports. I’d talk to the health workers in communities about patients and organise outpatient appointments. There were three flight nurses providing a 24-hour on-call service and we were kept fairly busy. Often I’d just get home and be looking forward to climbing into bed when the pager would go off again and back out the door I’d go.’

  When Wendy first started as a flight nurse she flew to a remote community with another nurse, Prue, who was training her. ‘As we approached all I could see was red earth,’ Wendy says. ‘Like many of the airstrips out there, this one was very short. The engine noise was loud in the cabin so I was having trouble hearing Prue, who was trying to tell me what to expect. When we were about to land the pilot put the wing flaps into full flap position to prepare for the short landing strip. And down we went. We did what felt like a nosedive into this little community by a lake with an airstrip that, from the air, looked like the size of a small footpath. The steep descent frightened the heck out of me and I think I actually screamed. We landed with red dust billowing behind the plane and when we came to a halt I looked out the window to see a small tin-roofed structure. There was a bench seat in the shade and a jaunty little sign that read, Welcome to Lake Evella Airport.’

  In those days, many flights were nurse-only and there was a fair bit of daring and dangerous flying. ‘It was hot, dusty, exciting work and for me, the remote-area lifestyle was unparalleled. We’d go fishing and camping to far-flung beaches and we’d be the only people there. We knew crocodiles could be around, so we swam vigilantly and briefly in clear, shallow water. I remember swimming at a beach with a couple of nurses once and when we came out of the water the tide had receded and we saw a distinct angular jawline imprint in the sand. He was in the same water we had just emerged from.’

  At the end of 1990 after her three-month stint as a flight nurse in Nhulunbuy, Wendy took a job in Darwin with NTAMS as a flight nurse and midwife, where she worked for the next three years. Darwin was a much bigger operation and nurses flew out to run clinics and for medical retrievals. With higher acuity and more critical cases, Wendy experienced some very long periods on call and a few scary evacuations.

  ‘On one retrieval we lost a 27-week premature newborn when the baby died mid-flight,’ Wendy says. ‘And we had an ill baby die on a tarmac before we could get him into the plane. You don’t forget those tragedies. But thankfully, there are innumerable successful evacuations that saved lives – and that’s what keeps you going.’

  After three years in Darwin nearing the end of 1993, Wendy found herself at a crossroads again. She applied to return to Gove as a midwife. ‘I’d had enough of being on call and was missing midwifery, so I went back to maternity in Nhulunbuy. I was happy to be back at the smaller hospital, working again in midwifery and back to the lifestyle of beach trips, four-wheel driving out bush, swimming at waterholes and knowing people by face – seeing women I had helped throughout their pregnancies or during their births at the shops with their babies.’ Wendy had only been back about eight months when she was asked if she could relieve in aeromedical retrievals again, and from 1995 to 2005 she did mostly flight nursing and midwifery stints at the hospital.

  One morning on a first-light evacuation, Wendy and a doctor flew into an outstation south of Nhulunbuy, where a woman had given birth in the early hours of the morning and needed an aerial retrieval. ‘The station had an airstrip but no light flares so we had to wait for first light to go in,’ Wendy says. ‘We landed on the red-dirt airstrip and the family was there to meet us in their four-wheel drive. The baby was fine and in the back on the lap of his adoring aunty. The mother was on the front seat, which was reclined. She had a retained placenta and had started to bleed. The doctor and I inserted a couple of IV drips and we had blood to give her. We were having trouble removing the placenta. Stepping in to help, the aunty stood at the side of the car holding the baby, while the doctor administered the blood and drugs for the mother. The baby’s father was sitting cross-legged on the roof of the vehicle holding the blood pack. Someone took a photo of that, and to this day, it’s one of my favourites. We managed to stabilise the mum and flew her out with her baby.’

  Wendy’s work colleague and long-time friend Catherine Hurley remembers her time working with Wendy at Nhulunbuy. ‘Wendy is someone who gets things done,’ she says. ‘She’s a quiet achiever and good-humour
ed – people want to be with her. She’s great at getting the best out of everyone and she’s an excellent midwife who’s admired by her peers. If there was a crisis, Wendy was the one you’d want to be with.’

  Once Catherine and Wendy went off for a day of swimming to a beach out of town. ‘I managed to get the car hopelessly bogged,’ says Catherine. ‘No one knew where we were and no one missed us. So we had to spend a long, uncomfortable night on the beach. It was October, and despite being in the tropics it got quite cold overnight. The only clothing we had was damp bathers, sarongs and shirts. We had a little pop-up shade tent to sleep under and took the sheepskin seat covers out of the vehicle to sleep on. The foil blankets from the first-aid kit and the toilet-roll pillows were the difference between a truly miserable night and a bearable one,’ Catherine says with a laugh.

  The women had to sleep far enough away from the water’s edge to avoid any crocodiles that could be around, but not too far up the beach because there were free-range buffalos to worry about. ‘With snatches of sleep we waited the night out,’ Catherine says. ‘We knew people wouldn’t miss us until the next morning when we didn’t show up for work. We were camped under the direct route of our medical plane’s flight path and in the middle of the night we saw it fly over us heading for Darwin. We knew then that the person on duty wouldn’t be there first thing in the morning – further delaying the time before someone missed us.’

  Fortunately, a woman in a car came across the two flight nurses at lunchtime the next day and helped them dig the vehicle out. ‘She offered us freshly baked muffins and as we’d only had a banana to share the night before, it took a lot of self-control not to take one in each hand,’ Catherine says. ‘It could have been wretched, but Wendy made it fun – we laughed our way through it.’

  After many years with NTAMS in Nhulunbuy, Wendy felt the need to move on and have a break from the on-call lifestyle. ‘At that time we did many days of either eighteen or 24 hours on call, which took its toll on the work–life balance. I often felt I was just recovering from one long on-call session and it was time to go back and do it all again. The sound of the pager going off began to jangle my nerves, and as much as I loved the flying, my thoughts again turned to purely midwifery.’

  In 2002 Wendy returned to Adelaide to study neonatal intensive care nursing. She thought it was time to go back home to family and this time she thought she’d stay. But still she couldn’t settle in the city. ‘So I went back to Nhulunbuy and at the same time started to think about my future. A few years earlier I’d bought a unit in Cairns and I thought I might just go there. I’d always loved Cairns. With no job arranged, I moved there in 2005 and that’s where I’m based now. It’s such a beautiful place and my parents and family visit me often.’

  Soon after settling in, Wendy got a job in midwifery at the Cairns Hospital and joined the Midwifery Outreach team visiting Cape York communities to provide antenatal care and continuity of care to those women when they came down to Cairns to give birth.

  Kelly Kearns works with Wendy at the Cairns Hospital. She helped establish Team Midwifery in Cairns to set up the Outreach Midwifery service, and then another team later to solely look after the needs of the Indigenous women in the Cape York Peninsula communities. They would fly into the Cape with the consultant obstetrician for at least three days to do three or four communities in a run, once every six weeks. ‘I had a list of criteria written out that I thought were the attributes the women we care for would respond to,’ Kelly says. ‘When Wendy started work with us, I noticed she had a lovely rapport with people. Unlike me, outspoken, she’s the opposite. She’s soft, loving and very giving – she’s just a beautiful person. It’s a privilege working with Indigenous girls and it takes a special kind of person to set up a rapport and to connect. You are working with a woman at a most difficult time of her life, so it’s very important to have a strong understanding of her culture and her needs. Wendy not only has an excellent clinical background to take on this role in midwifery and to work with Indigenous women, she works from the heart.’

  One day a woman and her husband and their three boys came in by bus from a town just north of Cairns for the mother’s antenatal appointment. She was around 37 to 38 weeks pregnant. The bus ride was about an hour long. On the way the woman felt a few contractions but they weren’t regular or painful. The bus dropped the family off at a local shopping centre and as the boys were hungry they stopped at the food court for lunch. While her family was eating, the mother’s contractions grew more frequent and painful. She pressed the boys to eat up; it was time to get to the hospital.

  As the family waited at the taxi rank the mother’s waters broke with a gush. When the mini-bus taxi pulled in the mother climbed quickly into the small seat next to the sliding door and the boys sat in the back. Her husband sat in the front with the nervous driver. Stepping on it for the five-minute trip, the driver headed to the base hospital as fast as she could. ‘She alerted the hospital that a pregnant woman was on her way and in labour,’ Wendy says. ‘The message came through to us in the birth suite. Another midwife and I grabbed our emergency pack and raced down to the emergency department.’

  About halfway to the hospital the woman felt an overwhelming urge to push and pulled off her briefs. The worried taxi driver sped on. The woman’s husband turned around to see how his wife was going and was astonished to see the baby’s head emerging. He clambered over the front seat to reach his wife, tore off his T-shirt and spread it out like a sling – just in time for his baby boy to fall into it. On arrival at the ambulance bay a sea of expectant faces from the emergency department and the birth suite met the family.

  The baby was crying furiously, dad was all smiles, the boys were bursting with excitement and the taxi driver was holding her chest and worried she might need assistance from the emergency department.

  The mother looked at Wendy and said, ‘That was very uncomfortable giving birth on that tiny little seat.’ And with that, she was helped onto the stretcher and wheeled up to the birth suite, where the baby’s cord was clamped and cut and the placenta delivered. Apart from the mother giving birth in a taxi, there were no complications around her son’s birth and the family returned home several days later. A very proud taxi driver was interviewed and photographed the next day for the local newspaper with her special passengers. ‘I love that about midwifery,’ Wendy says. ‘You just never know what the day will bring.’

  After two years in maternity an opportunity to work with the Royal Flying Doctor Service (RFDS) in Cairns came up. ‘Once again missing the flying, I began work with RFDS in 2008 and in 2010 I split jobs to work two shifts per week in maternity at the hospital and two flying shifts per week with RFDS. With the best of both worlds, I’m loving the variety between the two.’ In addition, Wendy is studying Bowen Therapy, a soft-tissue body therapy, to complement her midwifery practice and, essentially, help newborn babies.

  CHAPTER

  9

  Gayle Donaldson

  Gayle Donaldson stirred from a deep sleep when her phone rang at 12.55 am. By the time she reached it, she’d missed it. She crept back into bed without waking her husband, Rob – taking the cordless phone with her. Wide awake now she started to worry. Is Mum okay? Are the kids okay? Why is the phone ringing? It rang again at 1.05 am. Jody, the night-shift nurse at the Alpha Hospital, was on the other end. ‘Angie’s waters have broken. The ambulance is bringing her in. How fast can you get here?’ she asked.

  Gayle tried to get her head around the call. ‘Why is she at home?’ she asked Jody, remembering Angie had left her cattle station a week ago to wait in Emerald (the nearest regional centre) for her baby.

  ‘Her other three kids were in Emerald all week for the School of the Air mini-school, so Angie thought she’d take them home today and have the weekend with them before going back on Monday,’ Jody explained.

  Gayle dressed quickly and kissed Rob goodbye. As a nurse and midwife based at the Alpha Hospital in the centra
l Queensland highlands, she needed to hurry. It was mid-winter and overnight temperatures could plunge. It was three degrees.

  Gayle ran across to the shed and tried to open the Toyota door, but it was locked. ‘I thought, What the hell? We never lock cars,’ Gayle says. It turned out Rob had locked it because they were heading off to Brisbane the next day for their eldest daughter Laura’s 21st birthday and their bags were in there. Gayle hunted for the keys. They weren’t where they should have been. She darted back into the house. She found them and rushed back to the Toyota. Then she noticed there was hardly any fuel in the tank. Alpha, a tiny rural town, which locals refer to as ‘The Gateway to the West’, sits on the Capricorn Highway 168 kilometres west of Emerald and 930 kilometres north-west of Brisbane. And it’s an hour’s drive from Gayle’s cattle station, so being low on fuel was a problem.

  Gayle had to quickly decide what to do. ‘I thought, Do I spend ten minutes putting diesel in or just go? I decided to go. I could fuel up in town for the drive back.’ While dodging kangaroos and cattle on the road along the way, Gayle went over and over labour and birthing procedures in her mind. She hadn’t birthed a baby for several years – not since Alpha’s facility had closed in 1995, forcing expectant mothers to leave home to wait for their babies in larger centres. ‘I thought, I have no warmers. Oh God, I hope we can keep the baby warm.’ She was also thinking how glad she was that she’d just done a midwifery update course through CRANAplus (an organisation to support health professionals working in rural and remote Australia). It was still fresh in her mind.