Night Flight to Wyndham
DARWIN, NORTHERN TERRITORY/WYNDHAM, WESTERN AUSTRALIA

It’s 2 a.m. and we are on our way from Darwin to the little muddy port of Wyndham, in northern Western Australia, to pick up a stockman who’s come off second best with a pair of hooves and whose condition is deteriorating.

The Aerial Medical doctors would normally have done the flight but they have flown their maximum hours and the flight nurses have a bug so the Medical Dove is grounded. I am a casualty nurse at Darwin Hospital. That’s why I’m sitting alone in the cabin of a Mickey Mouse Airlines (MacRobertson Miller Airlines) DC3 staring out into the darkness . . .

I remember back to my first week at the Darwin Hospital. I’d spent two days working in, and familiarising myself with, casualty, then found myself on night duty. Just me, on my own, with a doctor on call. The first thing I had to get acquainted with was the night switchboard, which sat behind the door in the sisters’ office. It was a funny old contraption of levers and flaps and I needed to be able to make and take calls on the run. Above the switchboard the air-crash manual demonstrated its importance by hanging from its own hook. Someone had told me I was to read this manual when I had time. ‘No rush, mind. There’s never been an alert that anyone can recall.’

My first night shift went well. The first patient was a rather scruffy man with half a bottle of port in his coat pocket and a dead snake in a brown paper bag. He’d been bitten, he said, and showed me the tourniquet above his knee. I took his obs, which were normal, and looked in vain for fang marks. He had been sleeping rough and was covered with scratches and cuts. His obs remained normal.

I looked at the snake and read up about identification and antivenom. There was a huge amount of information. Some of it, such as the ribbon-like information pamphlets accompanying the antivenom, was so huge it’d been printed in tiny letters and needed a magnifying glass to read it.

A second patient arrived. Did I have anything to cure a hangover? I gave him a couple of aspirin and asked if he knew anything about snakes. As luck would have it, he used to work with the Wildlife Department. I showed him the snake and he became almost rapturous with delight. It was a something-or-other python and appeared to mean a great deal to him. The fact that it was not venomous meant a lot to me and would, I suspect, have meant even more to the bloke in the coat.

With his hangover overtaken by having fun with snakes, he gave me a quick lesson in jaws, retractable fangs, anal scales and a few other identifiers. My snakebite patient snored quietly. His obs stayed normal. Probably all he wanted was a bed. So the night passed . . .

One of the pilots comes out of the cockpit and asks if I would mind playing hostess and make a pot of tea. ‘Have a bit of a poke around,’ he adds. ‘They usually give us something to munch on.’ He shouts this, of course. A DC3 might be fun, but it’s very noisy.

Down the back of the cabin there is a hot-water urn simmering away, loose tea in a caddy, a sugar bowl and a slab of juicy fruitcake in a tin. China cups too. While the tea is brewing I peer out the window. In the distance a storm is lighting up the clouds. Below, it’s pitch black.

I’ve been to Wyndham before; people say it’s a shabby little town but I like it just the way it is. We start losing height and beneath us, I can see just two lights. We begin circling. Round and round. Round and round. I flew in here ten days ago and we didn’t circle like this. I don’t think we circled at all. I start to wonder if something is amiss; the landing gear for instance?

Just before dawn on my third shift of night duty, I had taken possession of a deadly stonefish. It was in a bucket of sea water and still very much alive and the man who presented it to me had been celebrating something – possibly the stonefish – for some hours.

I asked why he was giving it to me. He staggered a little then used his eyes to direct my attention to the top of a cupboard where ancient specimens of box jellyfish, red-back spiders, various snakes, one blue-ringed octopus and several stonefish floated listlessly in jars of murky, yellowing formalin. Considering the state he was in, I figured if I didn’t take it he just might be my next patient.

Before I could tell him the good news the air was filled with a wail that split the night and pretty much sobered Stonefish Man on the spot. I traced the horrific noise to the switchboard, where a little metal flap I had not noticed before had flopped down to reveal three words: Air Crash Alert.

I tried to close the flap to stop the noise so I could think, but it wouldn’t stay closed. I grabbed the (as yet unread) air-crash manual folder from its hook and ripped open the cover. There in huge red letters spread diagonally down the page was written: ‘PANIC!!!’

At that moment the wailing stopped and sanity returned. The phone rang. At least I was on firm ground here. I flipped the lever. It was the airport wondering why I hadn’t answered the alert. A voice calmly told me that the Medical Dove with two crew and three passengers was coming in from Snake Bay on Melville Island and they feared the landing gear hadn’t locked down. I was to implement the procedures in the manual and was given the ETA, which was not far off considering the landing gear had already been lowered.

The instructions in the manual were clear and easy to follow. The first thing I had to do was alert our two ambulance drivers and the second was to get two trained, off-duty nurses to go to the airport with the ambulances. Then I had to call the doctors, the matron, the medical superintendent, the on-call laboratory technician, the police, the mayor and the Administrator for the Northern Territory, etc. After that I had to call in all the off-duty nurses.

I rang for the on-duty ambulance driver. It took time for me to convince him I was not playing games. He promised to try to find a second driver. There were two phones in the nurses’ home, one on each floor. No-one answered either of them. I kept ringing and finally a sleepy voice mumbled, ‘Hello?’ I explained the situation and said I needed her and another nurse to get dressed immediately and go with the ambulances to the airport.

She laughed, gurgling, ‘I’m not falling for this,’ and hung up! The airport rang. ‘Where are the ambulances?’ I rang Matron. She told me to call the medical superintendent. One doctor, the one who wasn’t on call, came in. Oh wonders to behold.

In the meantime I went over to the nurses’ home and banged on doors. With some persuasion, two of the nurses finally took off for the airport, one of them driving the second ambulance. The plane landed safely, its landing gear firmly locked in place. A faulty indicator light was the diagnosis.

At the end of the shift I found the stonefish still in its bucket of salt water. A large metal tray had been placed on top with two bricks holding it down. What a nice gift for the day staff . . .

The plane banks. I can see a few more lights and soon we’re safely on the ground at Wyndham. It’s a quick turnaround. Just time to say ‘hi’ to the nurse and get an update on the patient’s condition while the stretcher is secured in the cabin. Soon we’re up in the air again and heading north-east.

The stockman had some morphine and is sleepy. The horse kicked him in the back and there appears to be some kidney damage but no-one is sure how bad it is. His obs are reasonable considering. While he is asleep, I play hostess again and make the tea.

The stars are huge against the dark sky and there is a pale gleam on the eastern horizon. Piccaninny daylight. Later comes the true dawn with a molten sky ahead and away to the west the soft clouds are painted orange and pink and lavender. The cabin is filled with the most beautiful light. Down below is the dark, lacy outline of the mangrove-lined coast.

We begin the descent into Darwin and the changing pressure wakes the man. He turns his head towards the window. ‘Geez, will ya look at that,’ he says drowsily. ‘Isn’t that something?’

Margaret Hanlon Dunn, retired registered nurse

Offshore Nurse
WANDOO B OIL PLATFORM, INDIAN OCEAN

I’d been working in a regional hospital for several years and volunteering as an ambulance officer when a friend started regaling me with stories of life working as a medic on an oil platform. The idea appealed so I put myself through the Tropical Basic Offshore Safety Induction Emergency Training (TBOSIET), as well as Helicopter Landing Officer and Industrial Medic courses. Then I resigned from my permanent job and worked casual shifts so that I’d be free to take off at short notice.

I got my break on the Wandoo B oil platform in 2008. Located 80 kilometres north of Dampier, it was my first time offshore and a real eye-opener! Flying in to the production platform on a helo was no drama as I had been in the army for nine years. The thing that impressed me most was the sheer size and cleanliness of the platform and the variety of marine life living around this artificial reef.

An oil rig is a drilling rig with a large derrick for drilling oil and gas wells. Wandoo B is a production platform which pumps oil up from reservoirs underneath the seabed and then processes it before pumping it into storage prior to export.

The other significant impression I gained on that first flight in was the potential for injury. I’m working 80 kilometres from the nearest hospital and the only access is via helicopter; if anything needs to be done it’s up to me to do it. I realised my skillset would need upgrading. I started attending courses at Royal Perth and Fremantle hospitals before I heard about the health organisation CRANAplus. Through them I have undertaken several courses in First Line Emergency Care (FLEC) and with support from my employers at Wandoo B, I attended a Remote Emergency Care course in Broome in 2010, and was stoked at the skills I picked up. Recognising the benefits, my employer has made the FLEC training mandatory for all their offshore nurses.

Getting to work means a two-hour drive from Bunbury to Perth then a two-hour flight to Karratha. There I board the helo for the twenty-minute flight out to the platform. On disembarking the helicopter, I hand my lifejacket to my back-to-back (the medic who’s on while I’m off) and start work as the helicopter landing officer (HLO) in charge of the helideck. The next two weeks is very much Groundhog Day as I settle into the routine of life offshore.

As well as being the HLO, my role includes being the remote area nurse, logistics administrator and radio operator. At safety meetings, I’ll often give a health presentation. These tend to be driven by what’s topical at the time, either in the media or for the crew and their families. Then there’s the odd other job the field superintendent handballs to me.

My official day starts at 0600 hours and goes through to 1800 hours, but I’m also on call at night. We have a toolbox meeting every day at 0600 and 1745. For serious accidents I have access to an aero medical evacuation team based in Karratha, who can get to the platform quickly, if they’re available, otherwise as soon as possible. In the meantime, it’s my job to stabilise the patient and prepare them for transport.

Routine and discipline are important factors of life on the platform and we live, for the fifteen days of each hitch, in an all-male environment. That’s fine – we all use ‘man logic’ – we just can’t find anything! The platform has multiple levels and no lifts so everyone gets plenty of exercise. We also have two gyms, indoor and outdoor, and all rooms have wi-fi, TV and a DVD player. The marine environ-ment surrounding the platform is incredibly diverse and a source of continuous interest. We are constantly surrounded by turtles, sea snakes, fish of all shapes and sizes and heaps of really big sharks. I’ve seen manta rays and whale sharks and best of all, we get the annual migration of humpbacks.

Nursing offshore really is living the dream.

Stephen Fuller, registered nurse

Remote nurses aren’t just inland: Stephen Fuller flies a helicopter to get to work on an oil platform north of Dampier in Western Australia. Photo courtesy of Gerrad Meiers

Out on the Wing
ALICE SPRINGS, NORTHERN TERRITORY

A few years ago, we were on a routine RFDS clinic run, taking an ophthalmology (eyes) registrar and an ophthalmology nurse up to Ti Tree, when we get a call on the radio from the comms officer (communication officer) back at base. He said, ‘Judy, you better hang around Ti Tree, you might get a bit of trade.’ From the way the message was passed through, I assumed that the person didn’t have severe injuries; how wrong I was.

So we continue on up; it’s only a forty-minute flight from Alice Springs. We land and taxi in to the gate where we’re met by the remote area nurse (RAN) hobbling.

‘What happened to you?’ I asked.

‘We’ve got road accident. I fell down a pothole trying to get this bloke out of the car. We’ve got him back at the clinic but he’s unconscious, there’s lots of blood around and he’s in a very bad way.’

We get into the clinic and this guy’s very obviously not good. The RAN was still hopping about, but her two colleagues were ex-ICU (intensive care) nurses so between us all, we had plenty of expertise.

‘Right,’ I said to the registrar, ‘can you intubate him?’

But no, she didn’t think she could do that and then the pilot, looking a little pale, said, ‘Judy, I really don’t like the sight of blood.’

‘That’s all right,’ I said, ‘I don’t expect you to look but I do need you to be gopher. I need a couple of pieces of equipment from the aircraft and can you ensure everything is ready so that we can load and go?’ So off he goes and next thing he comes back and he’s crabbing sideways around the edge of the door with his arm outstretched, looking away from the man and the blood, with this bag dangling off his finger. ‘Craig, just throw it in!’

Meantime, I rang the on-call doctor back at Alice who initially told me to just load him in the plane and bring him back. However, part of our job as flight nurses on the ground is ensuring the doctor has a clear picture of the situation, so I said, ‘We can’t just load him. His airway’s insecure; every time we move him he vomits.’

The doctor gave us the go-ahead to intubate him, so between us we got him stabilised and ready for flight. After a quick assessment of the RAN, we decided to take her too as she thought she had a broken bone in her foot.

Leaving the ophthalmologist to get on with her clinic, we took off. Unfortunately, although we got him back to hospital in Alice, from whence he was transferred to Adelaide, ultimately the guy didn’t make it. But at least between us we got him home to South Australia and his family got to say goodbye to him. For us, that was something. The thing is, it’s all about teamwork: everyone pitching in and doing their job or whatever is needed of them.

The weather is a challenge because we’re not working in the controlled climate of a hospital. We can be out there in blistering heat or freezing cold and rain and of course sometimes the weather dictates whether we can fly at all. Working in the confined space of an aircraft can be difficult but you adapt to meet the challenge.

Technically, we work twelve-hour shifts with twelve hours off. Sometimes it can be longer because you have to get back from wherever you are. The duty doctor tasks the plane. That means he/she takes the initial call and does the triage (prioritises severity and therefore order of treatment). We always do a pre-flight assessment so that we can get a comprehensive handover of the patient’s condition; this will also determine if we need additional equipment or if the flight nurse feels they need a doctor on the flight. If the nurse is concerned, the doctor has to fly but most flights don’t have a doctor on them.

Lots of people are scared of flying. When we do retrievals or evacuations, if we’re able to or if it’s really needed, relatives come too. You often have to chat and even joke with the patients and/or rellies during the flight. Sometimes they are terrified, not just of the flight but of the whole scenario and keeping them engaged is part of our job even as we’re working.

I always tell them that the most dangerous part of the journey is the ambulance ride to the strip because there are fewer idiots up in the air!

Occasionally, I’ve been caught out. Once we were on an inter-hospital transfer flying a man to Adelaide from Broken Hill and when speaking with his wife, who was desperate to accompany her husband, she revealed she was very scared of flying; my instinct was not to take her with us. However, we decided after much deliberation to take her along. When we got on board I explained all the sounds she would hear and how everything worked and what the safety procedures were. So, we took off and I just kept chatting to her and we were going along okay then, suddenly, we hit an almighty bump. Next thing the oxygen mask dropped down from the ceiling and she screamed . . .

Oh my God! I thought. To her, I quickly and very firmly said, ‘I forgot to tell you that sometimes, on this plane, the mask falls down when we hit a bump! We’re okay! There’s nothing wrong!’ I finally got her calmed down, reminding her that her husband was the sick one. We eventually got to Adelaide but I later reflected that I should always follow my initial gut instincts.

There is a strong connection between people who work for RFDS. Our success is based on teamwork and the belief that no-one is any more or less important than anyone else. We need everyone to ensure good outcomes. The engineers keep the planes in the air, the pilots fly them, the doctors contribute their skills and knowledge, as do the flight nurses, and the communications staff make all the connections. While the flight nurses obviously aren’t doctors, we do have certain advanced skills and responsibilities. You certainly can’t afford to be a prima donna. At the end of the day, we all need to work together.

I love my current role as nurse manager for South Eastern Section. I like the responsibility and autonomy and that I still get to do clinical work when I relieve staff. This section has bases at Broken Hill, Dubbo and Essendon in Melbourne, where we operate a NEPTS – Non-Emergency Patient Transfer Service – and we have full-time staff at Moomba and Ballera in the Cooper Basin oil and gas fields who undertake both primary health and emergency roles. The section is a big area with diverse people, geography and challenges.

Most people, especially nurses, stay with RFDS for a very long time. The organisation prides itself on appointing the best person for the job and we have some extraordinary people working for us. For instance, Chris Belshaw was the first nurse practitioner in the RFDS in Australia. He’s the team leader in the Cooper Basin based at Moomba. He grew up in Belfast during the troubles and he tells a story about wanting to join the army, but his father told him he thought that was probably a poor career choice in Northern Ireland! Instead he trained as a nurse in Belfast and then England. The scope of his training and experience and how he came to be working for us is a story just on its own.

People will often remark how exciting our jobs must be but, while we certainly can have our share of excitement, it is not all high-end drama. We have some quite routine flights which can also be great; just having the time to chat and hear a patient’s story or witnessing a patient’s excitement about returning to their home town after receiving treatment in a city hospital away from their family and friends is satisfying.

If there is an emergency, for the staff or people waiting for us on the ground, hearing the aircraft flying over is said to be such a relief.

As a team, we all know we’re contributing to the health and wellbeing of the people who live, work or travel in the outback and that’s a pretty good thought to take home at the end of the day.

Judy Whitehead, nurse manager, South Eastern Section, RFDS

Pormpuraaw Dreaming
WEST CAPE YORK, NORTH QUEENSLAND

I’m a clinic nurse based in Cairns with the Royal Flying Doctor Service. I was in Charleville for five years when I first joined the Service then five and a half years ago, I moved to Cairns. I was on the evac and primary health care teams when I first came up here but for the last five years, I’ve been doing primary health care clinics at Pormpuraaw, which is a fishing community located just south of Weipa on the western coast of Cape York. In the first couple of years I also did the western clinic run; these clinics included Georgetown, Einasleigh, Mount Surprise, Forsayth and Croydon.

Each week, I fly over to Pormpuraaw for three days so I basically have two lives: my Pormpuraaw life and my Cairns life. Pormpuraaw has about 650 residents plus people in the fishing camps and on properties, some of whom aren’t Indigenous. It takes about two hours to fly to Pormpuraaw in a Cessna C208 (Caravan) and I stay Tuesday and Wednesday nights, which gives me an opportunity to do some extra education with the community. I might have a video night or a girls’ night or run Core of Life program.

Sometimes I do other clinic runs on other days of the week, to Croydon for instance, or Chillagoe. It’s a dream job, the best in the world. I do some emergency clinical work when in community though there are remote area nurses based there with Queensland Health, so I only need to help in an emergency if the clinic does not have enough staff on the ground. Mostly I undertake primary health care, including health promotion. I do a lot of child health and immunisations. The child health includes treatment of skin conditions, ear infections and anaemia, and completing child health checks, including keeping hearing screening up to date. The RFDS nurse has the endorsement that allows us to treat and then supply medications for these conditions.

Pormpuraaw is a happy, relatively healthy, self-managed community. There is a canteen at the football club. They have a football team and it’s a very active and well-run club. Grog is banned out in the community and there is a limit to the amount of drinks you can buy at the canteen. Patrons are breath-tested on arrival and if they’re not zero blood alcohol, they are not served and as it means they must have sly grog, they may be reported to the police. Everyone has a Pormpuraaw Football Club card that is swiped with each drink bought. When the limit is reached, that’s it, no more. You can’t buy takeaways. It was the community’s decision and they manage the club and the canteen.

The school retention rate is pretty good although it can always be better. The personalities of the staff sometimes has an impact on retention levels. Someone in the community is responsible for getting older children organised to attend boarding school, as Pormpuraaw School goes to Grade 7. The children go away to Cairns, Rockhampton, Brisbane, Herberton, Ingham and Toowoomba schools. One of my roles is making sure the children have bodies and relationships education before they go away. I run Core of Life a couple of times a year for the children twelve years and above. This program teaches the adolescents the skills that they need to make lifestyle decisions, you know, educated choices about whether they want to be pregnant or not, and learning to budget so they know the cost of having a baby. One of the girls who finished Senior is off in Cairns doing her enrolled nursing at TAFE, which is a great outcome. She is doing well.

I have been running a program every Thursday for three years with the preps and pre-preps called Crocodile Kids. This is an early literacy program (singing songs, rhymes with Indigenous focus) and also encourages the children to care for each other. I also read a book with a health message. The book could be about lying, worries, protective behaviours or acceptance of each other. This program also builds relationships with the education staff, health staff, children and families.

The Circle of Security Parenting Program is making an impact. Generations ahead will see a difference. This is a parenting program based on attachment and is being well received.

Currently, I have four anaemic kids out of roughly 150. That’s great. Their ears and eyes are good though dental care is still a challenge. Apart from the lack of available dentists, parents want to please their kids so they buy them lollies. Consequently dental health is suffering. We do have dental care programs happening at school and one-on-one education is provided in the child health room, but it is a problem still.

Another issue that could be minimised is gambling. Card games are popular and are very social. I would like people to have more education around budgeting so that they have their gambling money and enough money to buy food for their families. When the tax cheques come in gambling is huge; thousands of dollars can be in the ring. Some people don’t go to work then – instead they stay home and gamble. There’s not much in the way of hard drug use in the community but some people do smoke gunja (marijuana) and that can cause mental health problems, particularly schizophrenia. There’s a high incidence of mental health problems running in some families.

It’s still the best job in the world though. I love working for RFDS because you have so much autonomy to get on and do the best job you can. If the funding was cut or Pormpuraaw didn’t need me any more I’d go out and take up remote area nursing, but while they’ll have me I’ll stay here.

The kids at Pormpuraaw call me Nana, Aunty, big mooki or Miss Lisa. When they leave the room I often say ‘love you’. The mothers and children now say ‘love you’. Hopefully my time here will add to the children’s great memories of their childhood.

Lisa Smith, registered nurse

Lisa Smith (front right) loves her job as a nurse in Pormpuraaw, North Queensland, where the kids call her ‘Aunty’, ‘Nana’, ‘big mooki’ and ‘Miss Lisa’.

The Airstrip Clinic
WEST KIMBERLEY REGION, WESTERN AUSTRALIA

We did all the maternity and antenatal assessments on our RFDS clinic runs. At one station, there were probably five or six house girls who were pregnant at the same time. We didn’t go into the homestead for cups of tea, so we did everything under the wing of the plane on the airstrip. I gave out the little yellow-topped bottles to get a wee specimen, but it took so long because the ladies had to find a bush and then they’d have all the petticoats. The skirts and the petticoats would come up and eventually you might get the specimen.

So I thought, Well, I’ll streamline this. I’ll give them all a bottle and when they hear us coming next time they’ll have the ‘speci’ ready when we arrive. I’d never ever said piss or shit in my life, but I had to because this was the language that was used. I couldn’t say to them, ‘I’d like a urine specimen in this bottle.’ So I said to them all, ‘Every time when that Flying Doctor plane comes, now you piss in your bottle and bring them up to me.’

We only used to go there for clinic once a month and I’d forgotten that other planes came to the station. Anyway, in the end, the Flying Doctor plane did land, but it wasn’t our clinic flight; it was Mr Holman and Sister Camille doing the leprosy survey. Mr Holman came back that evening and said, ‘I don’t know what you want them for, Doll, but I’ve got six specimens of piss here for you!’

Apparently it created a bit of a disruption to the household. The manager was quite cross in the end; every time the pregnant house girls heard a plane, they downed tools, raced off to piss in their bottles and then ran them up to the airstrip.

Adapted from ‘The Airstrip’ by Dasee Gugeri, RN, RFDS Derby, 1967–69 courtesy of the Kimberley Nurses History Group publication, Boughsheds, Boabs and Bandages: Stories of Nursing in the Kimberley