Nurse on Horseback
HIGH COUNTRY, VICTORIA

Alice Martin was born at Gisborne, New Zealand in 1891 when her parents, George Henry and Hannah Martin, were seconded to the Salvation Army. The family returned to Australia three months later, where Rev. Martin took up an appointment with the Methodist Church.

After leaving school, Alice undertook her training at Royal North Shore Hospital in Sydney, which qualified her for certified membership of the Australian Trained Nurses Association (NSW), of which she became a Life Member (Badge No. 4848) some years later.

As well as extensive experience in Sydney suburbs, including working in slum areas, she also spent time as a nurse and midwife in the Central Tablelands region of New South Wales.

She later replied to an advertisement for and was accepted as a Victorian bush nurse, in 1921. As a lone bush nurse, Alice had many extraordinary adventures and faced many challenges. While she occasionally got a lift with someone in a car as she travelled around her district, more often than not, she rode her horse.

The following text is in her own words . . .

One night, in 1922, I had been called to an urgent case in the valley. I felt very timid and wished that I had not to go. I had heard that the bush track down the side of the mountain was very steep and had slippery stones here and there and was dangerous even in the daytime. However, there was a patient in need so we hurried along following the guide to the patient.

After a couple of miles of riding, we came to the trail leading down into the valley. As my horse (a quarter draught) followed the other horse down the trail, he began to slip and slide then chomped his bit in a manner that told me he just didn’t like it at all.

I breathed a prayer to God for help, and suddenly the horseman in front called to me over his shoulder. ‘It’s pretty bad going down here, but if you’re nervy or your horse stumbles too much, just lean forward. I’ll pull up my horse and lightly flick him with the spur. He will switch his tail and you can lean forward and catch hold of it. He won’t mind a bit.’ Surely an answer to a prayer.

I had the sense to take it as such and breathed, ‘Thank you, Lord! Now please help me accomplish the impossible.’ It was pitch dark, my horse was nervous, we could not go back, and I could not pull his head into the mountain as he might half-turn and then we would go over the deep drop backwards.

To lean forward and catch hold of the other horse’s tail would be hard enough at any time, and it might annoy my horse. Just how could I do this and not fall off my horse into the depths below? As my horse stumbled, this and that rushed through my mind.

I held the reins tightly and slightly pulled on the left rein as I patted his neck and said, ‘Good boy, good boy.’ I slipped my left foot out of the stirrup and leant right forward, more and more along his neck and a little to the right, then I slipped my hand from his neck to his head, then with a ‘Please, heavenly Father’, I groped for the other horse’s tail with my right hand.

The man in front had told his horse to stop and lightly touched his right side with the spur. At the critical moment, the horse flicked his tail and I caught hold of it, then without mishap regained my seat. My horse settled down, owing greatly no doubt to my own composure and so at last we reached the bottom of the trail safely. I have always felt glad that the leading horse’s tail was so long. My horse didn’t mind the other horse’s tail brushing his face very much after all.

In the valley, the horses had to scramble over stones and wade through shallow water. This continued for a while then the man said: ‘Do you see that light like a candle in the distance, straight ahead?’ I said that I did. ‘Well,’ he said, ‘that is where we are going.’

On arrival, I was able to save the life of a baby a couple of months old. The child would have died before he got as far as my place and the doctor lived 25 miles (40 kilometres) further at Warragal.

I returned home on my own next morning. The beauty of the valley was breathtaking. I felt like staying for a while and feasting my eyes on the beauty. What a different place it seemed to the one we had travelled the night before. No evil befell me; instead, I was surrounded by beauty. I felt I was ready for whatever awaited me at my cottage yonder.

Extracts adapted from Memoirs of a Victorian Bush Nurse in the 1920s by Alice Martin, registered nurse and midwife, transcribed by her daughter, Val Watson

Riding the Seesaw
WESTERN AUSTRALIA

One day we were in one of the communities and we had a Canadian nurse working with us. We had to bring in a very tall man after an accident. We didn’t have an ambulance, of course, just an old troopy. Anyway, we put the patient in the back. We couldn’t fit him in so we left the door open with his feet hanging out the back.

He was very sick and we were concentrating on getting him back so we could stabilise him. Vikki was driving the troopy, I was perched up near his head because we had to maintain his airway, and the Canadian was down the back helping to keep the patient secure. We went round a corner and the Canadian just gently rolled out the door and onto the road. We stopped, he dusted himself off and climbed on board again and we got the patient back to the clinic. We got him stabilised and flew him out to Perth.

After he’d gone, we debriefed; talking about it amongst ourselves, we replayed the roll out the door several times. By then, we were all falling about with almost hysterical laughter. It was such a relief and it’s part of the process of coping.

The patient died a few weeks later.

Sometimes it’s like a seesaw.

Rhonda Smith and Vikki Robertson, registered nurses

On the Edge
HIGH COUNTRY, VICTORIA

One of my bush-nursing centres was Dargo, Victoria, 85 miles (137 kilometres) from the nearest town and doctor. One day, I was taking a very ill patient to the doctor by car. There were many dangerous hair-pin bends on the road.

At one place for 4 miles (6.5 kilometres), the road was very dangerous, winding down steeply with many hair-pin bends. On one side there was a cliff face and on the right-hand side, a steep precipice. The road slanted slightly towards the cliff and along here there was a trickle of water. It was impossible for vehicles to pass.

On this 4-mile stretch, every driver wishing to go up or down had to telephone ahead to find out if the road would be clear. They would ring either from the house at the bottom to the house at the top, if going up, or vice versa if going down.

My driver had telephoned from the top house the day we were going down. When we were about halfway down, great was our dismay to glimpse, on one of the bends, a wagon with four horses coming up. The driver had failed to ring up. Neither of us could go backwards and we could not turn round; the road was too narrow and it was impossible.

My car driver applied the brakes. While the car slipped past the first two horses, the second three horses remained in front of the car. The engine stopped right under the horse on the left with its front legs lifted (one on each side), and its head came within a foot of the front glass. Its distended nostrils and frightened eyes seemed to come within a few inches of my face!

The car driver backed from under the horse, then we had to lay the patient in the trickle of water on the side of the road against the cliff face so he could not roll over the precipice (about a 200-feet [60-metre] drop). The driver of the wagon unhitched the four horses and I breathed a prayer as I led them past the car and as near to the cliff face as possible.

I spoke soothingly to them all the way. They were frightened but remained quiet while the two men took two wheels off the wagon and then miraculously managed to turn the wagon onto its side towards the cliff. The car driver then took his life in his hands as he performed another miracle, driving the car past it. I saw the car take the bend on three wheels. I saw the right-hand side back wheel, for a few seconds, actually out over the precipice. We reloaded the patient, helped the man put the wheels back on and continued on our way.

Extract adapted from Memoirs of a Victorian Bush Nurse in the 1920s by Alice Martin, registered nurse and midwife, transcribed by her daughter, Val Watson

Bushfire
HIGH COUNTRY, VICTORIA

Bushfires are just awful at any time, anywhere, and it is advisable to keep as far as possible from their path, but it came about that one day my faithful horse and I just had to take the great risk of facing a bushfire. What a mighty monster it looked, as it rushed ahead, as if determined to burn up everything in its path.

I had to visit a farm to take the urgently needed medicine. The heat and smoke were with us as we left home. The further we travelled from home, the nearer we came to the bushfire. Then, as we actually turned onto the road leading to the patient’s property and home, the heat was terrific and the roar was frightening.

The fire was on both sides of the road and as the wind veered, the flames in the high trees rushed towards the road and each other. Neither my faithful horse nor I liked it at all but we kept on and at last turned on to the clearing where the grass was free from the big trees, but the smoke and heat kept with us down the hill.

My horse, Teddy, would slip and slide and when we reached the bottom of the hill, we went through the creek then clambered up the steep bank and so to the house. I gave the medicine to the patient and said: ‘I can’t stay at all, dear. You’ll find all the necessary directions in with the medicine. I hope rain will come very soon. Do stay inside with the children because there are plenty of flying, burning, bark twigs and leaves.’

We came down the hill again to the creek and felt the terrible heat. Teddy clambered safely up the steep bank and so on to the road, which had the roaring fire on both sides, very near the road. We actually had to go through the flames in places where the fires had crossed the road.

It was only a dirt road so Teddy’s feet were safe but, of course, the road must have felt shocking. I had to lie on my horse’s neck and even when I tried to encourage him, my throat felt burning hot. Naturally we were both frightened and knew there was terrible danger.

At last we turned on to our home stretch. We did not catch on fire and my horse did not fall or give in. I did not fall off his back or lose my nerve either. The heat was bad enough along the home stretch but there was a field of wheat now between the fire and us.

We thankfully arrived home. As I undid the gate Teddy whinnied quietly. I felt an answering sob in my throat. We were both sopping wet of course, owing to the intense heat, but so glad to be home again after our mighty adventure. And we were still the very best of friends; tried and true was my faithful Teddy.

Extracts adapted from Memoirs of a Victorian Bush Nurse in the 1920s by Alice Martin, registered nurse and midwife, transcribed by her daughter, Val Watson

Outback Rescue
OODNADATTA, NORTHERN SOUTH AUSTRALIA

After my acceptance into service with the Australian Inland Mission, now called Frontier Services, I joined the enthusiastic team of caring people who strove to make a difference in the lives of folk living in remote Australia. After ten years in the public health sector I was up for a challenge and there was no better way than to roll up my sleeves and jump right in. Following my commitment ceremony in April 1976, I was on my way to Oodnadatta, an isolated town in northern South Australia, to take up a posting at the hospital. The rail link was the only means of transport for groceries and other heavier items that couldn’t be transported on the small weekly mail plane.

Even after attending an orientation program in Adelaide before heading up north, the idea of running an outpost hospital without a doctor on site was a unique nursing experience and one that I found both terrifying and invigorating at the same time. Thanks to my predecessor, who guided my faltering footsteps during those first couple of months, I was able to overcome many of the hurdles of adjusting to life in an isolated town in the middle of nowhere.

Being in a small place, we relied on many people including the wonderful people in Adelaide and head office, who helped sort out problems when they arose. The townsfolk contributed in many ways to the running of our clinic by doing repairs to the car, building, radio and so forth, while we contributed to their health and wellbeing. The community services officer helped our indigenous community with financial assistance and employment opportunities, while the police kept order in the town. The storeowner supplied provisions and the postmistress kept us in touch with the outside world. The teachers and hostel workers cared for the children and liaised with us when concerned about their health. We all played our part in making this small town home.

There was no way that I could have envisaged the work involved when I took on the role as jack-of-all-trades within the hospital environs, for not only were we the administrators of the facility, but also the doctor, nurse, social worker, mothers and babies support person, dentist and local vet. This is not to mention conducting the Sunday school religious program for the kids and counselling folk in need.

As our medical support came from the Royal Flying Doctor Service based four hours’ flying time away, we each depended on our partner to help institute first-line treatment when a seriously ill patient presented. Though we could contact the medical personnel at the RFDS base within ninety seconds, we often relied on a coordinated effort to stabilise the patient for transfer. We were on call twenty-four hours a day, seven days a week, but still had plenty of time to join in the social activities and contribute to the town’s running through the local government body.

When on duty, the sister conducted the radio sessions on the cumbersome double-sideband radio transceiver and made contact with the surrounding properties for any outstanding medicals before opening the airway for general chit-chat, which might include taking shopping orders for the store, or chasing up stock truck arrival and cattle train departure times. Coming from the city, I initially found working the radio network a little daunting, especially when the local vernacular hissed across the static-laden airways. I often felt inadequate when I had to ask for the message to be repeated. We were often the only link for the isolated homestead owners to avail themselves of medical advice and treatment without having to travel hundreds of miles, and this was one of our more important roles in servicing the remote outback.

With this in mind, I am reminded of a call I received on the early-morning session about a sick little boy on a property 100 kilometres away. Having previously managed his older sister’s respiratory infection by radio medical calls and using the antibiotics from the property’s Flying Doctor medical chest a few days earlier, I assumed the young boy’s illness came from her, so recommended the same treatment.

When I tuned in on the radio a few hours later, Pat sounded quite anxious about her three-year-old son’s breathing problem, which was getting worse as time passed. The thing that alarmed me more was that Joshua had asked his mum if he was going to die. I knew that he must be in real trouble to ask that question, so advised Pat to get hold of the Flying Doctor immediately. I listened to the medical call and offered to review Josh as I was closer and the doctor agreed that time was of the essence to treat this little kid. With my initial plan to meet the family halfway to give the toddler medication abandoned after hearing the news that Pat’s husband had taken the last vehicle to muster cattle, I moved on to plan B of hightailing it out to the homestead.

While my colleague, Wendy, jogged around to the community nurse’s place to rope her in to accompanying me on the trip, I filled the vehicle from our 44-gallon fuel drum using a hand-pump then packed the spare wheel, fuel jerry-can, medical chest and oxygen cylinder in the back ready for a quick departure. We took off while Wendy contacted the RFDS base to advise them of our ETA at the property, adding that I’d contact them as soon as I’d seen Joshua. This meant interrupting the School of the Air transmission to update the medico. Wendy took over the running of the hospital and monitored the radio in case Pat called again before we arrived.

Fearing the worst and without a portable radio in the station wagon to update us in transit, I put the pedal to the metal to get there as quickly as humanly possible. Being familiar with the lay of the land and its dirt, gibber stone-strewn road, we arrived at the homestead in just over an hour and pulled up in a cloud of dust. Pat had seen our red-rooster tail of dust a few kilometres out so was waiting for us on the open verandah and quickly ushered us inside to see her son. Little Joshua’s laboured breathing could be heard from the hallway and I knew that things were serious even before I saw his heaving chest and blue lips. I quickly checked if he had an obstructed airway, then gave him a dose of broncho-dilating Ventolin and face mask oxygen before making contact with the Doc for advice and a management plan.

Having heard my clinical finding, the doctor thought that Josh probably had bronchiolitis, a condition that produced thick mucus that could obstruct a small child’s airway. He recommended that we take him back to the hospital for treatment in a high-humidity oxygen tent. We departed with the whole family in tow and returned to town at a more sedate pace. As Wendy had been monitoring the medical call and knew we needed the mist tent, she’d assembled the equipment in readiness for our arrival.

Wendy and I took it in turns in working the night shift and, after three days of high humidity and antibiotics, little Josh’s condition had improved enough to come out of the mist tent and sleep beside his mum. By day five Josh was on the mend and we discharged them home when Dad returned from mustering. Armed with instructions for first-line care if Josh became unwell again, his grateful mum gave us both a hug before heading home. We continued monitoring Joshua’s condition for several more days on the radio network and he recovered fully.

Sue Nilon, retired registered nurse

Beyond the Call
HALLS CREEK, KIMBERLEY REGION, WESTERN AUSTRALIA

In 1912, the Rev. John Flynn gained the approval of the Presbyterian Church to set up the Australian Inland Mission (AIM). John Flynn was appointed its superintendent, a position he retained until his death in 1951.

I grew up in a family of parents and grandparents who supported the Rev. John Flynn’s endeavours to get a Flying Doctor Service started, along the lines suggested by my uncle, Lieutenant John Clifford Peel, whose letter to John Flynn, in 1917, convinced him that aeroplanes could be used to assist medical aid in outback Australia. That dream was later realised, in 1928, when the Aerial Medical Service performed its first mercy flight. Initially part of the AIM, it later became the Royal Flying Doctor Service (RFDS), an independent and world-renowned organisation.

The AIM Hospital at Halls Creek, in the Kimberley region of Western Australia, was established in 1918 in response to an event which became famous. A year earlier, James Darcy, a stockman at Ruby Plains Station, 75 kilometres south of Halls Creek, was mustering cattle when he fell from his horse and was seriously injured. When his friends found him they took him to Halls Creek (the journey took twelve hours) but there was neither a doctor nor a hospital in the town. The local postmaster, Mr Tuckett, realised Darcy needed immediate medical attention. Using only morse code, a surgeon in Perth, Dr Holland, diagnosed Darcy as having a ruptured bladder. He had to be operated on immediately. Messages flashed back and forth in morse code.

‘You must operate.’

‘But I have no instruments.’

‘You have a penknife and razor.’

‘What about drugs?’

‘Use permanganate of potash.’

‘But I can’t do it.’

‘You must.’

‘I might kill the man.’

‘If you don’t hurry, the patient will die first.’

Tuckett strapped Darcy to the table and began operating according to instructions he received by telegraph. The operation took seven hours – with no anaesthetic. A day later complications set in. It became obvious that a doctor would have to come to Halls Creek. Dr Holland took a cattle boat from Perth to Derby and then travelled the last 555 kilometres by T-model Ford, horse and sulky and foot. He finally arrived in Halls Creek only to find that Darcy had died the day before, though not from his surgery.

The Rev. Dr John Flynn realised that Halls Creek was another remote place needing a hospital.

With nursing for the Australian Inland Mission (AIM) always in mind, I commenced my general nursing training at Geelong Hospital and completed midwifery training at the Queen Victoria Hospital in Melbourne in 1945. During that time I met my husband-to-be, who was an Air Force officer. I had already applied and been accepted for service with the AIM and was awaiting an opportunity to go to Halls Creek.

At this time AIM nurses were appointed for two years. We were expected to fulfil this term without holidays and had to be very fit! It was also desirable to be very good friends. During my training in Geelong, I met Marjorie McKean, who was also training with a view to working for the AIM. We were both members of the Presbyterian Church and followed the work of Flynn of the Inland very closely. In April 1946 Marjorie and I were appointed to Halls Creek.

After almost a fortnight of travelling by train and plane, we finally arrived at the Halls Creek aerodrome about 2.30 in the afternoon. We were met by the Secretary of the Roads Board, who was also Secretary of the Hospital – a Mr Arty O’Leary. Transport from the aerodrome to the town, a distance of 16 kilometres, was by the Roads Board’s tip truck, driven by Arty who was very deaf and only had one eye. We sat in the front seat and the two retiring nurses sat in cane chairs on the back. The road was incredibly rough but the time went quickly as Arty questioned us on our ability to make bread, milk goats and pull teeth!

Our day commenced at 6.15 a.m. when we answered the roll call on our pedal radio to Wyndham, 400 kilometres away. The call sign of the base there was 8WY. This session was the only one where we could get clear reception, so if we needed advice from a doctor we had to use that session. To pedal the radio for transmission was like riding a bicycle uphill, so if we had a lengthy report to give, one of us would pedal while the other spoke.

At this time there was no actual Flying Doctor Service in the Kimberley region. A doctor from Broome or Derby called at Halls Creek every six to eight weeks. By road, Broome was the best part of 800 kilometres away, Derby a bit less. He came on the regular weekly flight of the MacRobertson-Miller Airline (MMA). The plane arrived at Halls Creek about 5 p.m., stayed overnight and left at 5 a.m. next day. We usually had a number of patients waiting to see the doctor and these had to be examined by the light of a hurricane lantern. If possible, we ‘saved up’ any dental extractions for the doctor, but when this was not possible we pulled the teeth ourselves.

If a doctor was unable to come to Halls Creek and a patient needed his attention, we took the patient to either Derby or Wyndham on the MMA plane. Once, however, Marjorie and I had to do an operation ourselves via radio instruction. It was an elderly man who had bladder trouble and just as Dr Holland told Mr Tuckett all those years before, our doctor in Wyndham said, ‘Well you’ll have to operate, sister, or he will die.’

And I thought to myself, Well, he still might die. But he said, ‘Wheel his bed so that you can hear the radio and I will give you instructions.’

The two policemen came over to hold the patient down. The doctor gave us instructions and we made the incision, got the catheter into the bladder and, wonderful news, the water started flowing and there was great relief all round. We did feel very proud. It was quite a nerve-racking thing to do.

Usually though, we had time to get a patient to Wyndham or Derby, which meant that one nurse had to travel with the patient and would be away for a week, while the other kept things going at Halls Creek. In one extreme emergency we had to get an RAAF plane to come from Darwin.

The AIM office teams in the capital cities of Australia kept us supplied with books and magazines for anyone who needed reading matter. These were very popular, especially with the ‘Old Timers’ who lived on the outskirts of the town and came regularly to collect them and have a chat with us.

When we were not busy at the hospital, life was very relaxed in Old Halls Creek. We played tennis each afternoon and this was a great time for the townspeople and the staff who came in from the aerodrome. We enjoyed the beautiful sunrises and sunsets. I shall never forget some of the thunderstorms we experienced. It was wonderful to see Hospital Creek and Halls Creek running so high after being dry for months. After the water subsided we would go down the Hospital Creek with our Aboriginal help, Daisy, and look for gold specks. We were not very successful, but Daisy’s sharp eye would always produce something worthwhile.

Each year at Christmas, before the wet season set in, we held a party for the children on outlying stations as well as those in town. Santa Claus would arrive, very hot in red suit, whiskers and all.

The annual race meeting was the main event of the year. This was held to raise funds for the AIM and Flying Doctor Service. For four days the town’s activities centred around the racecourse, which was 16 kilometres from Old Halls Creek, near the site of the new town. It was hoped that we would not have any patients in the hospital at that time. However, at one time we did have an elderly man with a heart complaint and he insisted that we should all go. So a comfortable bed was made up on the back of the Roads Board’s tip truck for him so we could take him with us and a great time was had by all.

We spent two and a half years in Halls Creek. In October 1948 Sister McKean and I left Halls Creek for home and soon after I was married.

I feel very privileged to have lived and worked for the AIM in Old Halls Creek.

Dulcie Andrew (nee Peel), retired registered nurse

Emergency Call
KALTUKATJARA, (DOCKER RIVER), NORTHERN TERRITORY

It was 4.30 p.m. on Friday afternoon and we were thinking of going home when the call came. Relayed via several people, none of whom spoke English as their first language, it seemed that there had been an accident on the dirt road, about 150 kilometres away.

We were two remote area nurses (RAN) based in the community providing all the general day-to-day health care for a remote Aboriginal population of approximately 300 people. The nearest medical help and hospital was an eight-hour drive away, mostly on dirt roads. A possible accident with no other details meant we had to leave the community to investigate.

An RAN has to think of much more than the immediate emergency response. The ambulance was a 4WD Toyota troop carrier, fitted out with one stretcher and two small oxygen bottles. There are no other emergency services or retrieval support services in the area and the ambulance usually doubled as a passenger vehicle. If the accident was 150 kilometres away, then it had already happened more than an hour before we received the news. The dirt roads and sand hills meant time-wise it would take at least two hours to get to the possible site. All the emergency equipment for responding to off-site situations was kept stored in their packs in the cupboards and needed to be loaded into the ambulance. Loading them in the ambulance reduced available seating from six to four, with one patient lying down.

We did not know how many patients were on site or how critically injured they were. A plan had to be made to deal with the broken-down vehicles that may have been obstructing the road.

I loaded the ambulance, collected food and water to sustain us through what was going to be at least another four hours added onto our just-completed eight-hour day, and advised the Royal Flying Doctor Service (RFDS) of the situation. The closest police were three hours’ drive west, while the potential accident was two hours’ drive east; it would take police five hours to get to the site, if they were available to come and not tied up with other duties. Wendy went off to locate a community member with a utility who was happy to travel with the ambulance – the utility could carry things required from the crash site, which wouldn’t fit in the ambulance.

At 5 p.m. we drove out of the community, heading east. There was no mobile phone coverage and the satellite phone reception was patchy to say the least. We drove on as the sun began to sink, to find our patients just on dusk (about 7 p.m.) scattered over the road. A group of tourists were travelling around Australia on motorbikes and had come to grief on the sand hills of the road. Three were intact, another had injured his ankle and one was lying on the road, conscious, with breathing difficulties. We swung into action most efficiently, uncovering his chest for an assessment, doing observations, commencing intravenous fluids, giving intravenous morphine for pain relief, and tucking him up in thermal blankets to preserve body warmth. The sun had set and it was becoming colder and colder, especially on the sand. We had him all nicely stable and looked around for help to put him on the stretcher and take him to the clinic.

To our horror we suddenly heard and saw all his friends on their motorbikes and our assistant in his ute driving east, leaving us alone on the road with the patient. Did they think we were okay and they could leave? Regardless, we needed their help, so Wendy set off in hot pursuit in the ambulance, while I stood on the dirt road, holding a drip in the air and reassuring the patient that everything would be okay. The abandoned stretcher stood forlornly by, awaiting its load.

Thirty minutes later the ambulance returned with the ute. In his innocence, the assistant had gone to show the tourists a good camping spot for the night; it was too dark and dangerous to travel any more on the road. They intended to return to the bitumen the next day and continue their journey across Australia by another route. We loaded our patient on the stretcher and returned to the clinic for him to be evacuated by RFDS. He turned out to have a pneumothorax and after a short stay in hospital went back to his own home town. His motorbike came back to the community with us in the back of the ute and travelled home on the store truck a month or so later. We got to bed at about 1 a.m. that morning, hoping that nothing else would happen to call us out.

Lyn Byers, midwife, remote area nurse practitioner and Wendy McNicol, remote area nurse

Christmas Sister
DOOMADGEE, NORTH-WEST QUEENSLAND

‘Angry and, at times, intoxicated men can come with weapons seeking their women.’ My induction had commenced. ‘Lock the doors and drop the front security roller door, if you have time. Then, if you can, exit out the side door; not the back door as others may be waiting. Escape with as many persons as possible to the doctor’s residence for safety.’

The voice continued, ‘And if a person comes waving a gun, duck down behind the counter and make your escape as best you can.’

‘What if I get shot?’ I asked, on this my first shift at Doomadgee Hospital.

Point blank, I was told, ‘Well, you were just meant to die here!’

‘Doom City’ was the translation I was given for the Aboriginal word ‘Doomadgee’. It was a dry community where some people drank intensely on the other side of the river, then staggered into town bringing violence and aggression with them.

I was told by some, ‘If you can nurse here, survive here, then you can nurse anywhere in Australia.’ Many persons offered a contract flew in, walked down the steps, looked around and went back on the plane they arrived in.

To me, over time, Doomadgee became the people themselves and a symbol of survival and community against all odds and harsh realities.

At the time I was around, there had been many changes of policies and programs with funding brought in by various ‘good’ persons. However, just as everything started moving in a certain direction, change was required and it became a case of ‘having the rug pulled out from under the feet’. To obtain monies to assist the community, the hope of the community rang through the words, ‘We just have to learn to dance on the shifting carpets.’

With the summer rains, the community was isolated, unable to be accessed by road and on many occasions unable to be accessed via air either. I arrived on a small plane for my first Christmas of many to come. Food and even basic medical supplies were very limited for all. There was never any safe drinking water. The children suffered from Third World treatable medical conditions and I soon came to see the differences between town and remote. Senior and discount cards meant nothing here; items seen as rights in the city are unthinkable there.

Assuming they were available, basic treatments and tests performed in the city, without question, had to be justified even for children. Once justified, blood tests which could be stored were collected, spun and sent back with the plane approximately three times a week. Due to the expenses of getting even food in, medical resources were limited and nursing required ingenuity for there were no dressing packs, no ECG machine for heart tracings or ISTAT machines. However, there was a pharmacy and an X-ray machine. I soon learnt as a remote nurse using primary health care guidelines that you had to diagnose, prescribe and dispense plus perform X-rays with limited on-site training. The Royal Flying Doctor Service was a blessing beyond words and the difference between life, death and hope.

Out there, one had very limited choice in food and it was a blessing to have something to eat. A can of spaghetti in the city costing $1 compared to a minimum of $3 at the one store in town and generally there was no fresh food. That first Christmas it was so bleak with limited basic supplies and concern was high for the children, who were showing signs of increasing malnutrition. The elder women worked together to salvage whatever food was available. The children lined up outside on the verandah as the women of the community used the church hall to cook food and serve it to the children. The many hungry adults of the community stood back, going hungry, putting the feeding of the children first. I saw the disease and starvation of Third World countries present here in Australia. My heart broke and my eyes opened.

Except in emergencies when all hands were on deck, we were working minimum twelve-hour shifts with two nurses back to back with two other nurses. We would only call the one available doctor in extremes of life and death.

During another Christmas and New Year period, the town was restless. The hospital wards were full, with weather conditions not allowing the RFDS to land for days.

‘Sister, sister. There’s a man with a large knife sitting out in the waiting room.’

In the emergency room, when the man with the knife arrived, we were already monitoring the breathing of a male person with a 5-centimetre fish hook embedded in his mouth/throat region, an unconscious woman who overdosed and a male with a neck sliced by a machete that had nicked the carotid artery. Untreated, pulsating blood usually meaning death in a few minutes.

The community had already suffered recent deaths. The crying and gut-wrenching sounds made when a member of community died resonates with me still. We nurses and the doctor were for fighting for the lives of those in the emergency room while monitoring the others. There was no way anyone could move to safety if it was required.

After notifying the police, who were restricted in their ability to respond at that time, I had no choice but to go to the male with the large knife, approaching carefully as he was in distress and could turn it against himself or others at any time.

Fortunately, miracles happen. After several hours had passed, the man handed over the large knife after performing some cuts to his chest and in the nick of time, the RFDS was able to land, retrieving the man with the slash to his neck, the conscious woman recovering from an overdose and the man with the hook in his mouth.

We had been desperately waiting for more staff to arrive, but unfortunately the staff who came to give us some relief returned on the plane they arrived in.

While waiting for still more staff, I was woken from a couple of hours’ sleep, called in to assist with a young man wanting to hang himself. There was no other person available and I was studying social work at university. I spent time with this young person and about twelve hours later, he went home speaking about being a role model for other youth in the community.

I became known as ‘Christmas Sister’, the sister who would, in my uni break, go to Doomadgee to work over the Christmas/New Year period releasing the long-serving nurses for a holiday.

I learnt a new mindset and in the beauty of isolation, learnt to leave behind what I call my ‘white mind’. In one Christmas period, Aunty April took me on a walking journey to show me some bush medicines. Aunty April, a respected Aborigine, had a knowing and knew when my time was finally up. That time, Aunty April came to the plane when I was leaving and brought a white handkerchief.

All I saw as the plane took off, and in the air, was Aunty April waving the white handkerchief and eventually, just the white handkerchief; it was my last Doomadgee Christmas.

Kari Richter, registered nurse

Pushed to the Limit
KIMBERLEY REGION, WESTERN AUSTRALIA

Community nursing can be pretty demanding with its 24/7 on-call system for three months at a time, but it can also be very rewarding, where one can forge relationships with the locals on a level that would have no relevance in the world outside. Sharing in the evacuation of an area (due to heavy rains, rising river levels and a proposed ‘king tide’) by helicopter was indeed an experience that brought out the best and the worst in people.

The helicopters were provided by a nearby off-shore drilling rig and the protocol was to be pregnant women, small children and the elderly first. It was amazing the number of ‘older’ people who were suddenly quite infirm and the number of women who were suddenly pregnant and who were not willing to risk having their baby on the community, to allow them to have an earlier flight out. Under normal circumstances trying to get heavily pregnant women to go to the nearest big town for ‘sit down’ and birthing was a constant struggle. Fortunately no-one came to any harm and within days everyone was back (same helicopters) and life returned to normal, apart from a lack of running tap water due to the pump being submerged in the rising waters.

While the pump was being removed and moved to higher ground to prevent a similar situation in the future, bottles of drinking water were flown in for everyday use and 44 gallon drums installed at houses (and the clinic) for washing and toilet-flushing purposes. The 44 gallon drums were filled by a road works water truck at regular intervals and no-one took any harm from the inconvenience.

Being without contact with the outside world was not an uncommon occurrence when the phones were out due to storms or some other interference with the cables. To be on a very isolated community where, during the wet season, the airstrip was out for anything up to three weeks at a time meant using all of one’s ingenuity to manage the clinic supplies and to prepare meals at home that were appealing.

Some communities had airstrips that could be used at night for medical emergencies, but flares had to be lit along the boundaries and someone had to drive a vehicle up and down the strip to remove the kangaroos and donkeys so that the plane could land safely. Unless daylight came before it was time to evacuate the patient, the same procedure would have to be repeated for take-off and then the flares brought back in to be safely stored until next time.

On one community I had a middle-of-the-night emergency and with the promise of a plane within the hour, the flares were set up, animals scared off and the patient stabilised for retrieval. Although the patient had suffered a knife injury to his leg that was not life threatening, the knife, which I was not about to try and remove, was still in situ. He was also in a heavy alcohol-induced sleep that lasted until nearly lunchtime, when he eventually surfaced only to be informed that he was still on the community as there had been three attempts at getting a plane in to take him out but, for a variety of legitimate reasons, none had made it.

After two more abortive attempts and with nightfall approaching again, one was finally scheduled to arrive so the setting up of the runway had to proceed all over again. By this time, it was hard to find someone sober enough to help out as some members of the community had been drinking steadily all day. Once the patient was awake and I had adequately shielded the imbedded knife from their curious eyes, he had a steady stream of visitors through and everyone could see he was taking no harm but they still worked themselves into a fury over the repeated delays. By the time the plane arrived the community was near riot point.

To get the patient from the clinic to the plane meant a ride in the back of an open-tray top, and I became aware of the sullen and dangerous atmosphere among some of the local community members who stood along the road as we drove back out to the airfield. We were followed to the airstrip by the community members and, led by a couple of very drunk and abusive people (male and female), a large group stormed the area around the plane where we were attempting to load the patient aboard. The patient’s entreaties that he was okay fell on deaf ears and the racist remarks being hurled at us from two people in particular were so out of context with the whole situation that if it hadn’t been so serious it would have been funny.

It was not until the pilot refused to continue with the evacuation until the immediate area was clear of all people not authorised to be there that they moved back behind a perimeter fence and allowed the evacuation to take place. By this time, it was fully dark and as the plane taxied to take off, the non-Indigenous community members who had provided the vehicle used to transport the client wanted to leave the area before the situation got completely out of control. However, it was policy that I remain at the strip until the plane was in the air and out of sight, so they drove away and left my husband and I standing beside the clinic vehicle that had accompanied us out there.

I was unnerved by all of this but not really frightened and it was a huge relief when the chairperson’s wife left the still-muttering crowd and came stood by me and said, ‘Molly, it was not meant to be like this,’ and we stood holding hands until the plane was airborne and out of sight. She remained with us until we were safely in our house and left us with the promise that there would be no more disturbances that night.

I had, of course, been in touch with my team leader throughout the day and when I reported this last episode it was decided to pull us off the community at first light. Although I readily agreed, a few hours’ sleep (with no callouts) allowed me the space to see that ‘running’ from such a situation was not the answer to the problem, so, along with the chairperson and his wife, a small group of senior community elders was called and the situation discussed. As there really were only two perpetrators who led the disturbance, I was satisfied that they had been suitably dealt with by their own council members. However, a remark made later in the day to the effect that, had the patient died it would have been Dick and I on the stretchers being taken out, made me realise that ‘payback’ appeared to be alive and well on this community.

Molly Cobden, registered nurse (remote)

A Tragic Weekend
NORTH-WEST NEW SOUTH WALES

We had been looking forward to the race meeting for months. Pretty dresses and champagne had been sourced weeks before, just for this weekend. This particular race meeting is an annual event in outback NSW where a sleepy little town comes to life, where the population explodes from twenty to 5000. It was only a couple of hundred kilometres away; not so far in the outback.

Very early that Saturday morning, the phone rang.

‘We need you at the hospital urgently.’ From her voice, I knew something really bad had happened. ‘There’s been a house fire; two kids are dead.’

I was working in a remote hospital two hours’ drive from Broken Hill. When there is an emergency in these small communities, all hands are on deck: to nurse, to make tea, to get notes together, to support your colleagues or do whatever needs to be done. It’s not about who’s on call; it’s about patient care and helping your mates.

In any community the death of a child is devastating. For a nurse in a small remote community where you know the children and their families, it is horrific. I arrived at the hospital to find crowds of people inside and outside the hospital in utter grief and shock.

The grandmother of the children worked at the hospital with us and was much respected and loved. The role of the nurse in this situation is to just be with your grieving community. We are not taking blood pressures or handing out tablets. We hug those that need a hug, make cups of tea, let people cry, talk; just be with them.

When the family, friends and police had gone, we went over to the nurses’ home to debrief and grieve together. The camaraderie of colleagues together in grief and shock was most comforting.

While we were still reeling from the death of these children, three nursing colleagues and I all agreed that an outback race meeting and a trip out of town might be good therapy. We headed out late in the morning.

The two-hour drive was an opportunity for the four of us to debrief and cry some more. Playing music in the car also helped. The closer we were to our destination, the more excited we became; it was going to be a good day.

Ten kilometres from the races we came around a bend to see a car on its side, on the side of the dirt road. People were standing around a man lying on the ground, perilously close to the upturned and unstable car. As we pulled up, I recognised one of those standing there; I will call her Sandy. I knew that Sandy had recently become engaged so it wasn’t rocket science to conclude that the injured man was in fact her fiancé, whom I will call Aaron.

We jumped out of the car and ran over; Sandy recognised me immediately and told the bystanders to let me help. Before us was a critically ill patient and the nearest hospital was a significant distance away on an appalling road.

In the first aid algorithm, D comes first, D for Danger. The car was on its side and potentially going to land back on the injured patient and on those near him.

The men rolled the car away from Aaron, making it safe to treat him. His injuries were extensive and life-threatening. His airway was severely compromised. Race day was and is the only day of the year that there was an ambulance in this little town, so someone was tasked to go and get help. We had no medical equipment with us.

We had to do something about Aaron’s airway immediately. We needed oxygen, suction, IV fluids, and a Guedel airway as a minimum; if we were in any emergency department of any major hospital he would have been intubated, had chest drains inserted and had lifesaving intravenous fluids running. As it was, we didn’t have any of those things. We did not have time to wait for the ambulance to come and I wasn’t going to sit down and wait, do nothing; things were pretty bad and getting worse.

I had a light-bulb moment. Connected to the windscreen wipers of cars are two small hoses which provide water from a water reservoir under the bonnet to the top of the bonnet. These provide water with which the windscreen is cleaned. While the hoses are not sterile, they are clean. They do not have any residual corrosive or dangerous chemicals like petrol in them; they have only had water in them. So we cut the hoses and used them as an airway. While it did not help Aaron’s other injuries, at least he could breathe.

The ambulance arrived and the paramedic gave Aaron IV fluids and oxygen and inserted an airway. A helicopter was said to be in the area and an urgent request was sent out for it. Then we sent a message to the nearest hospital notifying them of Aaron’s pending arrival.

Sandy was uninjured and had not left Aaron’s side. While we knew it was a horrific thing for her to watch, there was nowhere we could take her to shield her from this terrible situation. We were on the side of an isolated road with no form of protective structure nearby, not even a tree.

And then Aaron’s heart stopped: cardiac arrest. It was awful to be doing CPR (cardio-pulmonary resuscitation) while this young woman, so much in love with her man, pleaded with him to keep fighting to hang on, to stay with her. Finally we got a pulse; the paramedic continued providing ventilation to this very sick man. The helicopter arrived and Aaron was flown out.

As the whirl of the helicopter faded away, we were numb. We had left home gutted by the death of two young children and had then come upon this. We stood almost whispering amongst ourselves, not sure what to do, where to go. Someone said, ‘Let’s go to the racetrack.’ We had lots of our friends there and we needed to be somewhere, doing something.

As we arrived, we could see the police talking to Sandy’s parents and we knew that Aaron hadn’t made it. We four nurses, who had seen too much for one day, broke down and wept. From out of the crowds around us, some women emerged, whisked us into a private area and allowed us to cry. They hugged us, they comforted us, and they let us grieve. Women in the bush look out for each other. Words could not comfort us in that moment of exhaustion, but the strength and compassion of those women did.

It has been many years since this horrendous weekend. I will always have a great sadness that we lost three good people. However, I will always remember the camaraderie of the nurses on that day, and the compassion of those women who did not shy from others’ suffering. They reached out to four distressed women they barely knew, giving us solace and friendship in our time of need. Amidst the tragedy of the weekend, my faith in the human race was strengthened.

Monica Mary Brown, registered nurse

Rollover
BEDOURIE, FAR SOUTH-WEST QUEENSLAND

Several years ago, I was working for Frontier Services at the clinic in Bedourie. Late one Sunday afternoon I got a call from Cluny Station to say they’d had a call on the radio, from a truckie, reporting a bad accident about 80 kilometres east of Bedourie on the Diamantina Developmental Road. The accident site was about 750 kilometres from Charleville and 600 kilometres from Mount Isa so, initially at least, I knew we were on our own. I tried to find the policeman but he was busy elsewhere; consequently, it was the local council mechanic who volunteered to come with me to drive the ambulance and to assist. Having advised the RFDS that I was going out to an unknown scenario, we finally got hold of the policeman to let him know and we headed off.

Calling in at Cluny homestead on the way past, we found they knew little more than the basics first called in. When we got to the accident, we found the truckie waiting, assuring the injured that help was on its way. It was a really nasty single-car rollover involving four young people from one of the stations. One of them had been thrown out so we did a bit of running around the paddock and up the road getting everyone sorted, trying to work out what had happened and, therefore, what their less obvious head, spinal and internal injuries might be. I did consider reverse triage to begin with, sending the case most likely to survive back first, but they were all so badly injured, I decided we needed to get them all back as soon as possible. The young driver had major head injuries and she had developed what’s called raccoon eyes and other Battle’s signs. They’re an indication of brain trauma and I’ve never seen them develop so quickly.

This was in the days before satellite phones so I had no contact with a doctor or anyone else for that matter. The troopy-cum-ambulance was only equipped for one person so we had limited resources available to manage so many people. We didn’t have enough cervical collars; we just managed the best way we could.

In the end, having patched everyone up as well as possible, I commandeered the truckie’s semitrailer to help transport the four of them, loading two of the head injuries into his sleeping cab. We loaded one into the back of a ute that had come with us from Cluny and the worst case, a young man with leg deformities and a very boggy pelvis, into the ambulance. He was conscious but I just knew he wasn’t well.

I travelled with him and we kept in touch with each other via radio. On the way back, my patient was distressed and uncomfortable and in the confined space of the back of the troopy, he managed to tangle up the IV line so that no fluids were going through. We had to stop, unload the stretcher, sort the IV out and get him stabilised again before proceeding steadily westwards.

Once we got into radio range of Cluny, I was able to get them to call ahead and advise the RFDS that we’d need every-thing they could send, on the ground, asap. I also got a message to Joyce, the Aboriginal health worker in Bedourie, to get the clinic opened up and ready. Remembering she didn’t have keys, when we arrived back at midnight, I was surprised to find the clinic wide open, all the lights on and everything set up. She’d found the bloke who built the clinic and he’d dismantled half the double front door.

It was all hands on deck. Most of the (very small) town appeared to have turned up offering to help and, as I directed them, they helped get all the injured safely into the clinic and as comfortable as possible. Because we didn’t have enough beds or trolleys, a couple of them were on mattresses and pillows on the floor. Everyone just did a great job. Joyce took BPs and obs, someone else gently cut off clothes, and every time I looked, the policeman seemed to emptying the rubbish bins . . .

The first RFDS plane arrived from Mount Isa at about 2 a.m. Even the pilot asked how in the hell had we managed to get them all back to Bedourie. A second plane from Charleville arrived shortly after and the doctors decided who was going where. Once the planes were loaded and safely away, we did a basic clean-up and a bit of a debrief then went home and tried to get some sleep.

The community rallied around and supported us by staying away next morning until we got everything in the clinic properly tidied up and ready for the day. I talked to Joyce and the mechanic and the policeman and over the next few days things slowly started to get back to normal. Officially, I never heard anything of the outcomes for the four young victims, but people heard things around the district and let me know that they all survived, although with significant and life-changing injuries.

With time to think about it, I couldn’t work out how the young man with the pelvis ended up where he was or how one of the girls managed to crawl into a gap under the upside-down car. And for the life of me, I still don’t know how we managed to get them loaded up into the sleeper cab right up in the back of the cabin of the truck. I just know we did exactly what we had to do, with the resources we had, to save their lives.

Over the following days, there were repercussions because I had called Joyce in to help. Her employer in Queensland Health said it wasn’t her role, but she did nothing she couldn’t do or that I didn’t direct her to do. A lot of people just don’t understand that when you live and work in a remote area, you make the best possible use of the resources you have.

As a consequence of this experience, I realised that a disaster is not necessarily a cyclone or a bushfire; for a small remote town, a car accident like this is a catastrophic event. I’ve since got very involved in disaster management so the lessons learnt have been invaluable. In Frontier Services, we have developed strategies for managing multiple injuries should they occur. All of our clinics are better resourced and much better prepared.

Anna Burley, registered nurse

Christmas Every Day
CHRISTMAS ISLAND, TERRITORY OF AUSTRALIA, INDIAN OCEAN

It’s mid-December and a tropical low is developing offshore causing high winds and seas. The supply ship has left again after another unsuccessful attempt to offload essential supplies on Christmas Island. Plumes of sea spray shoot up into the air as waves hit the jetty and surrounding cliff face, and roads are covered in wind-blown debris. As I drive down the cutting, curtains of rain sweep across the point and the sun sends splinters of light onto Flying Fish Cove.

Weather dominates conversation here on this tiny speck in the Indian Ocean as it dictates much of the activity and movement on and off the island. Christmas Island is one of Australia’s most remote territories and is situated 2600 kilometres north-west of Perth and 350 kilometres south of Jakarta. The island is a volcanic plug that soars thousands of metres out of the sea bed and is home to a permanent population of around 1500 people. Three-quarters are of Malay, Chinese, Indian or Eurasian descent, with Chinese dialects and Malay the primary languages spoken. The rich cultural heritage is due to a long history of Chinese and Malaysian migration to service the phosphate mining industry over the last one hundred years.

Over the last three years the island’s population has swelled due to the influx of asylum seekers and the fly-in-fly-out population employed at the detention centre and the associated service industries. This, along with a rapidly ageing permanent population with a high burden of chronic disease, has provided unique challenges to an isolated health service providing care to a widely disparate group of people. The island had two health services: the Indian Ocean Territories Health Service (IOTHS), which has an eight-bed inpatient facility, and a private health contractor providing initial health induction and ongoing primary health care to asylum seekers in detention.

For the next couple of days, the jetty is closed as 2-metre swells roll in, gouging out the beach and tossing huge logs like twigs. The wind has changed pitch overnight and has gone from a low groan to a keening roar. Next morning there is a low sea mist and driving rain and amongst the howling wind people can be heard yelling, calling; the words can’t be discerned but the meaning is clear.

Locals have arrived and are standing along the rocky cliff as a refugee boat has lost power, is pounded by churning surf and is edging dangerously towards the cliff face. People are desperately trying to help by throwing life jackets to the stricken vessel and trying to make human chains, but 3-metre swells and razor-sharp rocks make it almost impossible to do anything until the navy arrives.

A man in the water is trying to keep his head above water but is tiring. He takes a few desperate paddles, goes under and comes up. ‘Swiiiiiim!’ yell the navy guys. He goes under again and as he comes up is plucked from the churning water. In driving rain, emergency tents are set up at Ethel Beach to receive survivors. Everything and everyone is permeated by the smell of diesel. After initial triage they are transferred to the hospital to be fully assessed. All through the day they come. Some are admitted; some require transfer to the mainland with the RFDS. An emergency morgue is set up.

A man weeps, another woman is inconsolable at the news that her daughter is missing and many are dazed, unable to fathom what has happened. Each survivor has a story. Some have lost their whole family; nobody is unaffected. The media circus starts with phone calls from as far away as Sweden and Iran. A journalist tries to enter the hospital to take pictures of survivors and is intercepted by staff.

As the evening rolls on the RFDS leaves with patients, staff clean and restock, looking for a reason to stay close to others, and then it is time to go. Outside the whole world is exhausted. It is still, no wind, no rain nothing stirs. It seems that all that can be wrenched and laid waste has been.

It’s early April and the smell of diesel, faces of the living and the dead, and high winds and seas leave many with a sense of unease. The island’s children are still waiting for their Christmas presents to arrive on the supply ship and diesel is running low. Red crabs are crawling up the screen door and out my window I can watch Christmas Island boobies doing aerial dances as they swoop and dive on the updrafts.

It’s nearly two years on and a blood red-orange sun sets behind a bank of storm clouds on the Cocos Keeling Islands. Eight asylum-seeker boats are moored in a row in the lagoon. The doldrums have arrived and with it another cyclone season.

Christine Foletti, registered nurse

Highway Patrol
SANDFIRE, NORTH-WEST HIGHWAY, WESTERN AUSTRALIA

The scene was one of utter carnage. With crumpled bodies lying over the road and verge, the smashed-up hull of a ute gently smoking in a culvert and pools of blood seeping into the red dust, Mick Lanagan went, without hesitation, straight to work.

He raced from casualty to casualty, assessing injuries and working out whose lives he could save and who was just too far gone. The ute had been crowded with people, both front and back, and, driven by an unlicensed minor, had careened off the road and rolled, flinging passengers in every direction. Many were either unconscious or writhing in agony. Even as he was calling on the satellite phone for backup, Mick knew, 270 kilometres south of Broome on Western Australia’s Great Northern Highway, it could be a hell of a long time before any other help arrived. Calmly and efficiently, he administered emergency first aid to those he knew stood a chance, tried to stop their bleeding, bandaged their injuries, placed them on their sides and soothed the panicky.

‘You have to be a little bit hard sometimes to do triage,’ he says. ‘But you’ve got to concentrate on where you can make a difference.’ In this case, the volunteer medical worker knew his work could prove critical.

By the time Mick took a breath to look up, five ambulances had arrived at the scene. A Royal Flying Doctor Service (RFDS) plane had landed on a local airstrip, since it was too windy to attempt to put down on the road, and was ready to airlift patients to Perth.

By then, Mick had been working for a couple of hours in the blistering sun in 47-degree Celsius heat. ‘I’d started to feel ill myself, but I hadn’t been able to stop,’ says Mick, who is diabetic and has chronic back problems. ‘But with others on the scene, I slumped down in the shade and a young paramedic came over and said I looked like I should eat something. He gave me a couple of biscuits, which got my blood-sugar level back up again, so I could carry on. I suppose I’d forgotten to look after myself, but I was all right.’

Thanks largely to Mick, who is a resident at the Sandfire Roadhouse halfway between Broome and Port Hedland, just one of the thirteen people in the horror smash was pronounced dead at the scene, and only two died later in hospital. ‘You have to be ready for anything when you live in a place like this,’ Mick says, sagely. ‘The Australian outback can be a tough place, but you have to be prepared for it.’

Mick loves the wide-open spaces of the vast, flat ochre-dust plains that stretch from Sandfire as far as the eye can see, and is eager to help others appreciate its wild beauty. ‘I had one young couple call in once who said there was nothing here,’ he grins. ‘But I told them this is a place you have to look more carefully for the beauty to reveal itself. In one square yard on the ground you can see maybe ten different sorts of little native wildflowers. Then there are so many birds and so much wildlife – although unfortunately a lot of it without legs – it’s just incredible. ‘And out here, at night, it’s so silent you can actually hear the stars . . . I can’t imagine a better life.’

Along with the beauty, however, comes a fair amount of savagery. The two-lane highway that runs past Sandfire is so dead straight that countless drivers fall asleep at the wheel. That’s not to mention the 51-degree Celsius temperatures and the deadly bushfires and fierce cyclones that strike without warning at any time, day or night. People living on stations inland, towards the coast 20 kilometres away, and just about anywhere along the 600-square-kilometre stretch of lonely outback that Mick looks after, all turn to him for help when sickness strikes, accidents happen or someone gets bitten by a snake. He drove 1900 kilometres on a shift once. But as a volunteer for forty-five years with the RFDS and St John Ambulance, Mick always has a safe pair of hands, whatever happens.

‘He’s unbelievably helpful and his skills are highly regarded,’ says Lyle Gilbert, the St John Ambulance station manager at Port Hedland. ‘Without him we would certainly have seen a lot worse outcomes, with people having to go a long, long way for help. He started with a genuine concern to help others and he now provides the best care possible for people. He’s real salt of the earth, his heart is definitely in the right place and he’s a great part of the team.’

By now, Mick’s learnt to cope with every kind of emergency, and he says some of his strength comes from being of good, hardy Irish stock. His mum Eileen O’Connor arrived in Australia from Cork as a nine year old with her family and later went to work as a cook and companion on an outback sheep station at Turee Creek, between Paraburdoo and Newman in the Pilbara. There, she met and married George Lanagan, a NSW-born head stockman, and the pair went on to manage a number of remote stations.

George drove cattle four times down the Canning Stock Route and, on his last trip in 1940, thirty-year-old Eileen came along too and, carrying only five possessions – a diary, a pencil, a camera, a gun and a jar of face cream – made history as the only white woman ever to traverse the route with a full mob of cattle. Today, her beautiful black-and-white photos are stored for posterity by the J S Battye Library of West Australian History, an arm of the State Library of Western Australia.

Mick was born in Geraldton in 1946 and was a chip off George’s block. By the age of four, with his dad managing Carnegie Station some 500 kilometres east of Wiluna, Mick was riding horses like he’d been born on one, and mustering 500 sheep on his own. Working side by side with his dad, he soon became an expert at running stations, often taking time out going contracting: building fences, installing tanks and putting in windmills.

He fell in love with the RFDS when a stockman was injured and their plane appeared, like an angel, to help.

He tried living in Perth, when his sister Mary fell ill and needed support and help with her kids. But it wasn’t for him. ‘I hated waking up in the morning, knowing I was in a city,’ he says. ‘People in the city don’t seem to have any manners; they push past you, they’re rushing and they’re always walking around with their heads down. In the bush, you don’t have those kind of routines. You work with the seasons, you fix things when they go wrong, and you’re master of your own destiny.’

The only times he returned to the city after that were when he had to be fixed up after station accidents or when, in later years, a battery of tests revealed he had cancer in his spine. Then, after six months in hospital, he discharged himself. ‘The place was doing my head in so I decided I’d go back to the outback for some peace and quiet and see how I went there. And I managed to cure myself, with the power of positive thinking. Being out there always helps.’

That kind of mental resilience when the chips are down never fails to impress those who know him best. ‘He just willed himself better through sheer determination,’ says Meredith Earnshaw, the medical chest officer for the RFDS’s Western Operations. ‘He makes the best of absolutely everything. He’s an old-style bushie, incredibly self-reliant and strong-minded.’

Unable to go back to riding horses, Mick went to join an old mate, Ken Norton, the owner of the roadhouse at Sandfire, who asked him to look after the engines, pumps and lighting plants on the site.

Nestled between the last two monster sand dunes of the Great Sandy Desert, the Sandfire Roadhouse doesn’t look too impressive. In 2007, a blaze from an electrical fault roared through the roadhouse, gutting the building and causing $1.5 million worth of damage, and many of the trees that provided shelter to the site were flattened by the ferocious Cyclone Laurence that hit the west coast in December 2009. Everything is now gradually being rebuilt.

Now sixty-three, Mick has become tireless in his devotion to the RFDS and St John Ambulance, and is happy to be the man everyone turns to for help in that part of the world. ‘I just love people and it’s fun helping,’ Mick says. ‘Over that 600-kilometre gap between Broome and Port Hedland, they rely on me and my ambulance. It’s just a way of life. There’s always something that goes wrong in a remote place like this and there’s never time to get bored.’

Sue Williams, author and journalist (Mick’s story first appeared in Sue’s book, Outback Spirit, in 2010. This edited extract appeared in RM Williams OUTBACK magazine in 2011 and appears here courtesy of both Sue and OUTBACK.)

Postscript: Mick was recently forced to retire from driving the ambulance as he is no longer able to manage the stretcher on his own. However, when called, he still goes out in his own vehicle to assist at accidents on the Great Northern Highway. He will triage and treat just as he’s always done and provide basic comfort and company to those who wait the long wait for an ambulance to come from Port Headland or Broome and/or the RFDS. He still runs a clinic for the local community, surrounding stations and any passers-by who find themselves in need.

Now retired, Mick Lanagan still assists at accidents on the Great Northern Highway in Western Australia when called upon. ‘The Australian outback can be a tough place, but you have to be prepared for it,’ he says. Photo courtesy of Leon Mead: leonmeadphotography.com

Thank God, Here Comes the Flying Doctor
NORTH-WEST NEW SOUTH WALES

As there was some perception, among the powers that be, that the ambulance was being misused as a taxi service, it was taken off the road for a fortnight and sent away for a service. A station wagon was our backup. There was no room for a trolley, but we called on the SES, should the need to transport patients arise, as they were in possession of a retired ambulance.

On my last work day before going on maternity leave with my first child, a call came through that a truck had rolled about 55 kilometres east of town with one unconscious, one ‘real crook’, and two walking wounded. Having alerted the Royal Flying Doctor Service (RFDS) that we were going to an accident and the SES that we would need their services with the old ambulance, the Deputy Director of Nursing (DDON), a wardsman, a medical student and I bundled into the wagon and headed east.

Upon arrival we found the unconscious man was deceased. His mate with head, chest and suspected abdominal injuries, as per initial notification, was indeed ‘real crook’ and there were two walking wounded with no obvious injuries. The pantech had been towing a trailer and, having perhaps gathered speed on the decline, the driver appeared to have lost control and ended up some distance down an embankment.

These four men were a long way from their home in WA and I remember feeling such sorrow for them knowing that it would be some time before they would be reunited with their families, and that one of them would not see his family again. We had no portable radios, so I was going up and down the bank to my colleagues, relaying the doctor’s orders as I was getting them over the VHF radio in the car. Not that steep, but somewhat an effort with the load I was carrying.

After a stern instruction from the DDON to say that they were not out on the side of the road to deliver a baby, I was confined mostly to staying with the vehicle. In contact then with the RFDS pilot, I was asked to drive along the highway and find a straight stretch of road for the plane to land.

A few kilometres from the accident scene I found what I thought might be suitable. The only problem was a slight dip at one end. The pilot suggested I drive at 100 kilometres per hour and determine if the car ‘bounced’ when it hit the dip. Is he serious, I wondered? I actually did as requested, slowing down before I became airborne! I reported in that I thought it may still be okay, throwing in all disclaimers of responsibility for my lack of knowledge in construction of airstrips!

Next question from the pilot: did the newfound airstrip run east–west or north–south? In this modern age of mobile phone apps I would have been able to tell him. In their absence, we could both only laugh when I told him the sun was directly above me so I had no idea!

Final test was to take out the guideposts with the bull bar. I thought this was another odd request but the pilot reassured me it was necessary to avoid damage to the plane. Really? I wasn’t exactly going to argue, being very new to this job description! So I ran over the posts but much to my amazement some sprang back up. On closer examination, they were not the usual wooden ones, but a flexible new design. I’d never seen them before. I had to line them up directly under the tyre to get them to snap off.

I returned to the accident scene where the badly injured patient was stabilised and the walking unwounded had been properly assessed. Some time elapsed and then away in the distance, the first rumbles of the approaching plane whispered over the horizon. As it came into view, I burst into tears. It was the most amazing sight. I was so relieved to see the RFDS and watched in absolute awe the majestic spectacle of this Nomad aircraft soaring above the treetops directly overhead.

We took the patient up to the highway and awaited the landing of the plane. The SES had by this time closed the highway at both ends, and there were many vehicles banked up either side. Some traveller had a video camera and was filming the scene. Poor bugger copped a bit of a mouthful from one very emotional young nurse, upset by the fact he was filming a tragic situation where mates had lost one of their own. I thought it was very insensitive until I turned around, witnessing one of the most memorable days in my nursing career, and wished I’d had a camera too.

Jane Clarke, registered nurse

Somebody’s Listening . . .
DOCKER RIVER, NORTHERN TERRITORY

In the autumn of 1975 I was stationed at the small, isolated community of Docker River, a settlement scenically nestled against the Petermann Ranges, 200 kilometres due west of Uluru.

The community had a largely transient population, about 400 people: Pitjantjatjara, Ngaanyatjarra, Yankunytjatjara and Pintubi; all desert peoples who used the fledgling outpost as a convenient staging post as they moved around their traditional countries, at the intersection of the Northern Territory, South Australia and Western Australia.

A basic services infrastructure was provided by the government. It was delivered via three teachers, two nurses, a shopkeeper, a general maintenance handyman and me, the community advisor.

We lived and worked out of a mixture of odd abodes including a corrugated-iron shed designated as my office, a generator shed and a number of ‘silver bullets’: large caravans looking something like huge Lego blocks, four kitted out as classrooms, the remainder as staff housing. The store was the community’s centrepiece, a solid brick and mortar construction that was actually close to looking like a conventional building. Another corrugated-iron and bush-timbered shed served as the medical clinic. There was a desk and two chairs and a rickety old iron bed as the consultation facility, and the waiting room was a long bench seat on the verandah out the front, as the song goes!

The old Ayers Rock Hotel provided a social outlet and the tortuous four-hour trip, following two wheel ruts between and often over the drifting sand dunes, was considered a small price to pay to occasionally access the ‘outside’ world. The road had regular use, often three or four vehicles a day. Irregular grading had lowered the track surface several feet below the surrounding levels, a bit like driving in a deep, extended rut. It was a track that required extreme care and attention and definitely not one for the faint-hearted!

Our head nurse, Rae, and her husband declared an intention to spend the weekend at the Boomerang Hotel, at the Rock. As was the custom, they advised me to expect their return on mid-Sunday afternoon. It was duly noted and I reminded Rae to keep a lookout on the road, as we were expecting the arrival of our fortnightly supply truck sometime over the weekend.

Four o’clock Sunday afternoon came and went. The truck had arrived, unloaded and left at midday for the nine-hour trip back to Alice Springs. At five, our second nursing sister, Pat, came over to my caravan, noting that Rae and her husband hadn’t returned. I begrudgingly suggested that they had stayed on for a few extra bevvies, but Pat would not be put off. She returned a few minutes later with the large portable first-aid kit and sent me on my way. I fuelled the Toyota, mumbling about the long trip ahead and thinking about what I would say to the errant couple when I arrived and found them breasting the pub bar.

One hundred kilometres down the track, I came across Rae’s husband stumbling along the sandy track. He was mostly incoherent and dehydrated, but managed to tell me that they had hit the supply truck! Another 10 kilometres on, I came upon mayhem: a head-on collision. Rae looked up gratefully, as we pulled up.

Rae had a ruptured patella but for the next ten minutes she hobbled around giving me a comprehensive briefing on the damage. They had offered a lift back to Docker to several local women who had been sitting in the rear of their utility when the accident happened.

I got Rae seated and over the next two hours she closely directed my activities. There was a suspected fractured skull, another compound bone fracture, the two drivers in shock, many cuts and extensive abrasions. Under Rae’s supervision I wrapped blankets around the shock victims, gently splinted the break, bandaged a head, applied ointments and successfully immobilised Rae, who chose this moment to tell me that she was also four months pregnant!

I was working by car headlight now. It must have been about nine o’clock when I thought I heard a car approaching. Two minutes later, headlights could be seen bobbing and weaving towards us, from the direction of Uluru. Another two long minutes and four nurses stepped out of their vehicle! They were a nursing crew heading out to Warburton, our neighbouring community in Western Australia, another eight hours west.

Coals to Newcastle and a thousand similar thoughts went whizzing through my brain as I quickly did the rounds of our patients with the girls. Satisfying myself that we were now all in good hands, I apparently strolled behind the Toyota and fainted!

The extra vehicle solved the dilemma of how we would get everybody back to Docker. It was squishy, but we got everyone into either the girls’ Land Cruiser or into my utility for the slow drive back. We arrived at around midnight with Pat, our ever-vigilant sister, walking into the clinic as we pulled up.

At midnight, the generator had long been switched off. Paraffin tilly lamps lit the scene, casting eerie, elongated shadows across the room. While the phalanx of nurses regrouped and worked their wonder, I went across to my ‘office’ and sought medical support.

In 1975, the RFDS in Alice Springs had a duty officer sleeping in the office every night. Outlying settlements and stations were issued with a special two-toned whistle which, theoretically, when blown into the two-way radio, triggered an alarm at the base alerting the duty officer of an emergency. That was the theory! From midnight until 5.30 a.m., we whistled, three seconds on the long whistle, two seconds on the short. God I hated that device.

As dawn approached, a deep Texan drawl came over my radio.

‘Who in hell is making all that squawkin’ racket?’

A brief pause of bewilderment and disbelief as I replied, ‘Ah, hello.’

‘Yep, who are you guys makin’ that god-awful noise?’

Relief started to flood through my system. ‘Ah, g’day, I am at Docker River and we have a medical emergency.’

‘Goddam, where on this good earth is Docker River?’

‘In Central Australia,’ I replied. ‘Look, I don’t have their number but could you get it and phone the Royal Flying Doctor Service in Alice Springs and get them to come to the radio?’

While we waited about five minutes for the RFDS duty officer to come on the line, our Texan saviour advised that he was in a US military transport approaching Guam!

The RFDS plane arrived at about nine o’clock that morning and all patients were air-lifted in to Alice. Our tired, extended crew drew breath as the Warburton-bound nurses radioed Warbo’ advising that they would be a day late. They then threw their swags under my caravan and had a breather as the community got on with another day.

I have often pondered the wonders of technology; Guam, but not Alice! I never did think to ask for the guy’s name, nor that of the nurses, but belatedly, a grateful thank-you for your collective efforts on that night so long ago!

In due course all evacuees recovered and returned to Docker, and Rae’s baby arrived fit and healthy several months later.

Chris Burchett, former community advisor