“We are all visitors to this time, this place. We are just passing through. Our purpose here is to observe, to learn, to grow, to love and then we return home”. Aboriginal Proverb
Like many health care professionals before me, a lifelong professional and personal aspiration of mine has been to volunteer and give back some of the good fortune I have been graced with. In May 2017, an advertisement passed my inbox – an opportunity to join Volunteer Service Abroad (VSA NZ) in PNG as a Diabetes Nursing Advisor.
Papua New Guinea sits in the Southwestern Pacific. East New Britain is part of the small group of Islands referred to as The New Guinea Islands, off the mainland. Estimated population is 8 million with over 850 languages and many traditional tribal villages and customs.
My first weeks I joined ward rounds, sat in diabetes physician appointments and worked alongside the nursing staff who prepared patients for their appointments. I was overwhelmed by the absolute lack of both basic and sophisticated resources that were missing every day. The impact of this coupled with cultural differences and how this translated into care delivery was often confronting for example, patients would come out of a below the knee amputation and there would be no dressings or pain relief, instead a pillow case placed gently over the wound. The surgical team would go from a young man of 32 with heart failure (childhood Rheumatic fever) to a ruptured spleen (where they did emergency surgery with no blood in the blood bank) to a lady with Stage 4 Breast Cancer, to a spinal injury of a 5-year-old boy who had fallen from a coconut tree (this is an occupational hazard). The surgical team were not specialised in defined medical/surgical areas such as I know. An old British saying “jack of all trades masters of none” sprung to mind. However, very quickly I came to realise the bare faced truth was in fact that this surgical team were indeed “masters” of their profession, who demonstrated expertly what resilience, faith, hope, trust and compassion look and sound like. Every single day despite so many challenges and a continued prolonged lack of resources the team of medical professionals faced each day with compassion and strength. Arriving at every bedside putting aside all their challenges, to face their patients with humility, compassion, strength and a professionalism that reached deep within my heart and soul and I will forever be touched by this entire team: for the service they have provided and will continue to provide for their people.
The bi-weekly diabetes clinic saw over 60 patients each day. Usually just one doctor and one nurse. Patients travel from rural villages often a three hour walk at 5am to catch up to 3 or 4 local buses. A wait of anything upward of three hours to be seen. More often they would leave not fully understanding their diagnosis, the impact of it and unlikely to fill the prescription: this would equal the cost of their family monthly budget with a long and arduous journey back home.
The Frangipani Friendly Clinic is one of two clinics in the whole of PNG that offers free health screening appointments. (CVD risk assessment and health promotion advice). This clinic was set up by the leading Physician for the New Guinea Islands, (Dr Al Maha) to combat the rapidly rising numbers facing amputations - one of the many complications of their often undiagnosed and or untreated, diabetes. Funded by awareness campaigns and one local oil company. Metformin was rarely prescribed (due to both financial and cultural challenges) and insulin was a rarity and a huge expense. I listened as patients described what was likely to be a hypoglycaemia event following commencement on first line treatment a sulphonylurea.
I discovered that general knowledge on diabetes was low and there was confusion between Type 1 Diabetes and Type 2 Diabetes.
I set up two eight-week workshops for all staff across both hospital sites, these were hugely well attended and received, something I had not really anticipated. Everyone I met listened, soaked up every single piece of information and then acted on their improved knowledge. I felt like the owner of snow globe shaking up the environment and watching life resettle and the picture change. I am not convinced that I would afford such graciousness to visitors entering my workplace suggesting different ways to work.
Weekends were spent playing basketball with the local children and at churches: invited to share our journey. My lessons on health promotion now have a home in almost every church and school in Kokopo.
My energy levels were high and continued when each day I was met with such openness to learn and create a healthier and safer community. I needed to embrace the power of this community. I connected with the local Christian radio show, every Tuesday morning I skipped my dancing heart to Joe Dunlee and his fabulous dedicated team. (Joe is now affectionally known as Dr Joe around Kokopo). The impact of this weekly radio show was astonishing. I guess I should not have been surprised for anyone who knows me, will agree at the best of times I have a distinctive voice – no more so that miles from home in this quietly modest Pacific Island that is PNG.
The clinic was suddenly overwhelmed, and we were seeing up to 50 people a day for healthy screening – “we listen on the radio”
The clinic provides workplace screening on Friday’s and suddenly we were booked up for the next 4 months.
At our first drive of the year March 2018 at the local council offices, I begun to understand that this community were unsure what a healthy balanced plate could look like. The basic concept of ½ half a plate of vegetables, and ¼ protein and ¼ carbohydrates was introduced. Nursing Officer Ashwin Lau – was flying high with this concept. We met at the end of the session and the Healthy Eating Plate and the 7 goals was created.
The fizzy drink challenge was next. A local company alongside all the giants produces in mass supply sugar fuelled fizzy drinks. You rarely find a diet or no sugar option. The sugar information was met with astonishment and disbelief that companies would produce and heavily advertise products that were full of sugar that damage our health. A long steady process of education is beginning to unfold, and this nation are standing tall and strong and wanting change - something that is not easy here in PNG. Everywhere you look around Kokopo – the healthy eating plate is shining strong, for local businesses, the ENBP Market Authority, and church communities have come together to embrace the knowledge and the power of understanding what to eat.
Evenings were spent getting creative putting together two sets large posters – all things diabetes: prevention, detection and management I encountered so much generosity, a local business man donated four mobile phones as spot prizes for our live on air screening show, another local business house paid for a full set of posters – overwhelmed but inspired by this communities’ connections to each other and the greater good of the entire community.
Momentum was steadily growing, and we now had four nurses helping in the Frangipani Friendly Clinic.
The hospital CEO welcomed my thoughts and we discussed Metformin. I was encouraged to discuss with patients and ask them to find a way to pay for this. I recorded the results. Again, the CEO’s door was wide open. Incredibly he managed to find funding for all in-patients with diabetes to receive Metformin. Ten weeks and we saw a noticeable difference in recovery, shorter hospital stays and the uptake of a drug that has very little side effects and has such powerful protective factors across all areas of health. A drug that suits the demographics of rural communities with often little food or ability to get into the township – with next to no risk of hypoglycaemia.
I was asked to present to ground round. The entire team shared their time and their minds with me and they drank in the power of Metformin.
I challenged myself to write some easy to follow T2DM diabetes prescribing guidelines, that incorporated the healthy eating plate and basic but crucial nutritional advice. I asked some of the team to peer review, the joy in their eyes was all the encouragement I needed.
Before leaving for PNG I was donated glucose meters and stethoscopes from colleagues, these were received at Nonga Hospital as if it was Christmas.
My blogs were reaching friends in NZ and the UK. Bernadette in NZ found a spare AED (heartstart) at her workplace in Palmerston North and organised for this to be sent to PNG. This gift was received with no words. The stunned face of the medical officer and the way his eyes clouded over was a touching and humbling moment.
Returning from our NZ holiday we were weighed down with stethoscopes and BP machines to give to the dedicated health care professionals who were rounding up their own communities to take control of their own health by starting up community run and owned screening clinics.
Friends from the UK were collecting old prescription glasses, fellow VSA volunteers asked their NZ friends to do the same. 130 prescription glasses. The joy and delight of the staff in the eye unit was priceless. The love continues, and another box of glasses has recently been received.
A NZ diabetes nurse visited us. Suitcases overflowing and crammed full of metres, strips, leaflets, plastic healthy eating plates and a heart full of love. Another friend left his family behind in the UK, sponsoring the production of all the printed guidelines and posters. Armed with much needed sterile surgical gloves. The tears of love flowing.
As a “white couple” we were becoming well known around town. I found myself being greeted with “Boss Meri” and “Aunty”. One day, a group of elders came up to myself and my husband and remarked “hey you two, you are not white, you walk around town as if you are one of us - a black fellow”. Not sure it can get any better than that.
World Diabetes Day was at the market, an education tent and testing station, the last of the donated glucose strips, screening 110 people. Staff came from all areas of the hospital, unpaid on their day off to help continue empowering their community.
World Health Organisation Sixteen Days of Human Right Activism, under the bus shelter outside the market. Another Saturday, with 20 dedicated hospital staff on their day off working hard. We captured 320 people, screening for diabetes and hypertension.
Time was running away, and my focus had to shift to what lasting resources to leave behind.
40 plastic resource folders: I included as much information and resources as I had left, using every opportunity to take sneaky copies at various business houses and local council offices. These were received with gratitude and nurses were organising for further copies for community members to photocopy and use for their own communities – sustainability and capability building at its best.
We return home
Farewells were tearful heartfelt. Two of our closest friends and their entire family were with us throughout our last night and our 5am start to the airport.
Reflecting on our year “in the land of the unexpected”. The Tolais‘s are a straightforward community, if you show them a smile, it will be returned, if you frown… Share your heart and you will be overwhelmed with a love that is true, resilient and loyal. It is these connections that we made that wholeheartedly made 2018 a treasured gift. A year full of love, joy and laughter is what glues together the memories of our journey.
Belonging is all about the people, the connections you make – being open and warm is all the Tolais community needed to share their loyalty and love. And yes, we had an overwhelming sense of belonging. Humans need connections with those around us, we need to engage with creativity and we need to dig deep and find our very own unique spiritual well-being, and we must always love thy neighbour.
I shall forever remain in debt to the entire community who opened their hearts and minds and welcomed us to share just a small part of their long challenging ride.
Since our return, I have connected my mind and physical self with yoga and find myself using my muscles and limbs in the way they were designed for (something that is very apparent in PNG) and I have started to learn to paint.
PNG will forever be etched in our hearts.
Applications to join the newly formed CATSINaM Student and Early Career Advisory Committee (SECAC)
If you are a pre-registration student, early career nurse or midwife or post-registration student, this is a wonderful opportunity for you to gain experience of working with our leaders in nursing and midwifery, be mentored by the CATSINaM CEO and Board Directors, develop knowledge of governance, and contribute your ideas for the development of our professions
CATSINaM is calling for expressions of interest from CATSINaM members who are current pre-registration students, or, new graduates of Nursing and/or Midwifery at an Australian University, Registered Training Organisation or TAFE within the last five years, or nurses or midwives currently enrolled in postgraduate studies to join the CATSINaM Student and Early Career Advisory Committee (SECAC)
This committee meets at least four times a year, including face-to-face at the annual CATSINaM conference. The purpose of the committee is to:
To build leadership and governance capacity, by assisting nursing and midwifery students and recent graduates in gaining leadership skills and experience.
Give students and early career nurses and midwives a greater voice in decision making roles within CATSINaM and the nursing and midwifery sectors
Provide an opportunity for students and early career nurses and midwives to actively participate in and lead CATSINaM initiatives.
The committee’s responsibilities include:
Advise the CATSINaM Board on issues and strategies affecting Aboriginal and Torres Strait Islander nursing and midwifery students, early career nurses and midwives and postgraduate students
Provide advice on the issues, challenges and successes faced by Aboriginal and Torres Strait Islander nursing and midwifery students and early career nurses and midwives
Provide advice and assist in coordinating student and new graduate focussed initiatives at a local, strategic and national level
Share and distribute information to students, educational institutions and new graduate networks regularly
Actively participate in CATSINaM communications, marketing and promotion activities and events
Represent CATSINaM at forums, seminars, conferences, their own University (if applicable) and as required.
Operate in accordance with the organisation’s code of conduct and ethics, as well as constitution and Board policies.
If you would to apply to be on the committee, email the following information to Sarah Stewart (email@example.com) no later than COB Friday 26th April 2019:
Confirmation that you are either a student or ordinary member of CATSINaM
Confirmation of either your current student (re-registration or postgraduate) enrolment including the university, or the date you become an enrolled nurse, registered nurse or midwife
Short CV, no longer than two A4 sides
Short paragraph, no more than 300 words, explaining why you would like to be a member of the advisory committee
For full information about the committee, refer to the committee’s TOR. If you would like to discuss further, contact Sarah Stewart (02 62625761, or firstname.lastname@example.org).
Good Medicine Better Health
Good Medicines better health is being redesigned and reinvigorated
In 2010–12, a program called Good Medicines Better Health (GMBH) was designed and nationally delivered. This program was designed to help Aboriginal Health Workers and Practitioners (AHW/Ps) improve their knowledge about medicines, based on the principles of quality use of medicines (QUM). The program was delivered in partnership with the National Aboriginal Community Controlled Health Organisation (NACCHO), the Heart Foundation and the Aboriginal Health Council of South Australia (AHCSA) and NPS MedicineWise. GMBH program delivered a series of training modules— a foundation module on QUM and chronic disease specific modules (QUM in asthma, hypertension and type 2 diabetes) –– to AHW/Ps.
NPS MedicineWise would like to reinvigorate the GMBH program and would like to explore how to do this with those who will use it
NPS MedicineWise would like to hold co-design workshops for RNs, ENs, Midwives and AHW/Ps in both Sydney and Darwin to explore and capture the stories and needs of AHW/Ps within these areas. We want to explore how we can develop ideas and different approaches that will better support the QUM/MT educational needs for AHW/Ps.
We had previously explored insights of AHW/Ps working within Northern Queensland Primary Health Network and health service managers at the NACCHO conference in Brisbane in 2018. We are hoping to explore further insights from other States and Territories as the redesign progresses.
Who will be involved?
We would like to recruit between 8–10 people per workshop. Across both workshops we would like a mixture of those working within urban, regional and remote areas to capture the experiences of working in a mixture of health service settings and in different States and Territories.
For those participating, we offer a $150 Coles Myer voucher to recognise their valuable feedback.
NPS has previously worked with Aboriginal woman Leeona West to co-facilitate design workshops on QUM/MT in Aboriginal and Torres Strait Island communities and will continue this partnership throughout the redesign of GMBH.
We would like to hold these workshops between April – June 2019, depending on recruitment and availability of staff. The workshops will be no longer than 4 hours.
We are hoping to partner with local community health organisations/services within the areas of Sydney and Darwin to promote and recruit workshop participants.
The workshops will also enable NPS to develop valuable partnerships with AHW/Ps in different communities that we hoped can be sustained beyond the redesign of GMBH.
Hawker Memorial Hospital is located in South Australia, approximately 365 kilometres from Adelaide. Hawker is a regional town with a population of roughly 300 residents. The hospital has eight residential aged care beds, four acute beds and an outpatient/emergency department. The medical centre is also located onsite with a general practitioner consulting three days a week and available on call for the remaining four days.
In a small rural/remote community it is almost impossible to cover all staff that go on leave as the population size lends Itself to staff shortages and difficulties in maintaining a sufficient casual staff pool. This forces rural and remote hospitals like Hawker Memorial to rely on agencies to backfill positions which can be very costly.
Bernadette Rogan is the Nurse Unit Manager at Hawker Memorial Hospital and her role is to ensure that the hospital can still provide minimal staffing 24 hours a day. The team at the hospital found a way to provide adequate staffing at all times in August 2014 when they submitted their first application for locum support with the Rural Locum Assistance Program (Rural LAP).
"It is a very good service for rural and remote communities. We have used Rural LAP several times now when our nurses go on leave and the locum nurses that come here all have a wide range of experience and are happy to work in any situation" Bernadette explained.
The Australian Government-funded locum program appeals to rural and remote hospitals and health services in many ways but most importantly it is cost effective. Bernadette said, "it is better for us to use Rural LAP as opposed to agencies as there are no fees and charges. The application process Is also very easy, and the team are always very helpful and prompt with their replies."
Rural LAP is a component of the Australian Government’s rural workforce capacity agenda managed by healthcare solutions provider, Aspen Medical. The program aims to provide targeted rural and remote support services to general practitioners (obstetricians and anaesthetists), specialists (obstetricians and anaesthetists), nurses, midwives and allied health professionals in rural and remote Australia. All Aboriginal medical services throughout Australia are eligible to receive locum support.
Grace Kinsella Women's Health Memorial Scholarship - 2018 Recipient Monica Hooper
I identify as an Aboriginal woman of Arabuna and southern Arrente heritage. I have recent and current nursing experience within multiple Aboriginal medical services which include: Kambu Goodna, Kambu Goodna Mums & Bubs, IUIH Inner City Referral Service, Northgate ATSICHS, Inala Indigenous Health, and Georgina Aged Care.
I have an extensive history applying clinical skills in varied environments within multi-disciplinary teams with previous employment at Princess Alexandra Sexual Health as a Clinical Nurse with extended scope of practice in the field of sexual and reproductive health. I have completed a graduate certificate in clinical nursing specialising in chronic disease with units completed at a level of high distinction. In addition to working in specialities such as paediatrics, mental health, and primary health care. I also maintain clinical competencies in aged care and acute care nursing with a current agency nursing role that has allowed me to work in over 20 different hospital and community facilities within south east Queensland.
In addition to current full-time study and full-time nursing I also held a role as a clinical advisory panel member with The Benchmarque Group for the development of a cervical screening course. This roles entailed developing course material directed to health professionals, specifically A & TSI health workers. The cervical screening course required liaison with government funding bodies, non-government agencies and consultation with various A & TSI communities. Further to my employment for Benchmarque I now facilitate these training sessions all around Australia.
I have a varied nursing history that spans several specialities. However, my main focus is Aboriginal and Torres Strait Islander reproductive health. My current studies with Charles Darwin University largely focus on reproductive health and chronic disease within my current primary health care workplace of Kambu Goodna. Completing this course will enable me to have a wider scope of practice to work with my community as a specialist nurse in reproductive health. Obtaining funds to support the cost of textbooks and subscription to clinical guidelines will be of great benefit to me during study and beyond.
Monica Hooper is currently undertaking the Masters of Nursing – Nurse Practitioner which she commenced in 2018 at Charles Darwin University, with the view of becoming a Women’s Health Nurse once she finished her studies.