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Remote child health: a later transition

10 Dec 2022

Child Health nurse and long-time CRANAplus Member Dianne Paul, now 72, describes herself as a ‘late starter to remote’ and yet despite retiring from nursing almost a year ago, still regularly finds herself perusing the employment opportunities section of CRANApulse, imagining a ‘next remote adventure’.

Dianne down by the Nichol­son Riv­er at dusk, ready for a cup­pa and a yarn, and to watch peo­ple fish.

When her chil­dren were in kinder­garten, Reg­is­tered Nurse and Mid­wife Dianne Paul found her­self help­ing more in the com­mu­ni­ty, run­ning school hol­i­day pro­grams, and scouts − a chap­ter that was to set a new tra­jec­to­ry for her nurs­ing career. 

I real­ly want to do com­mu­ni­ty health,” she thought.

Di com­plet­ed her Bach­e­lor of Applied Sci­ence, Advanced Nursing/​Community Health stud­ies in 1990 and she chuck­les recall­ing her next nine­teen and a half years with Knox City Coun­cil, Child and Mater­nal Health.

It was quite good prepa­ra­tion for going up North,” she says. 

You did every­thing from get­ting some­one out to fix some­thing… [to chang­ing] a lightbulb.

It was an extreme­ly hap­py time with the oppor­tu­ni­ty to start new ser­vices like par­ent­ing train­ing in the evenings; help­ing set up a breast­feed­ing, sleep and set­tling cen­tre; as well as run­ning your own clin­ic or clinics. 

[Some peo­ple think Child Health is] oh, we’ll go to see the nurse and get the baby weighed.’ It’s a lit­tle bit more than that! We do the post­na­tal dis­or­der screen­ing, we do fam­i­ly vio­lence screen­ing, we run play­groups in our cen­tres… [and] they’re an inte­gral part.”

Con­nec­tion to the country 

Despite mov­ing to the big smoke of Mel­bourne when she was ten years old, Dianne has always felt con­nect­ed to the country. 

My home, my fam­i­ly con­nec­tion, was out there [in Kerang] all my life and still is… I like coun­try and coun­try life.

I’d always been inter­est­ed in, not just remote nurs­ing, but I’d been inter­est­ed in the notion of liv­ing remote.” 

I trav­elled through remote areas… [and] always had an inter­est in Abo­rig­i­nal peo­ple and their lives. From way back, I realised that in school we were taught such sani­tised history. 

We drew pic­tures of hump­ies, and we were told in pri­ma­ry school how fab­u­lous it was that we got them to come to church and then we built them prop­er houses.

[Grow­ing up] I nev­er real­ly knew or saw any [Abo­rig­i­nal people].”

From the late-60s to mid-70s work­ing at the Roy­al Chil­dren’s Hos­pi­tal, Dianne reflects on feel­ing for­tu­nate to care for chil­dren from across Australia. 

It was­n’t uncom­mon to have chil­dren from the out­back or Abo­rig­i­nal chil­dren from down in Gipp­s­land area, or chil­dren from the Pacif­ic Islands. And you did see things that peo­ple work­ing in lit­tle hos­pi­tals would­n’t see,” she says. 

You saw the par­a­sites, tape­worms, sca­bies, and rheumat­ic heart dis­ease. And maybe not every­one did, but I’d go back and read up about it.”

Look­ing for a new chal­lenge: 2009 – 2014 

In 2009, at 58 years old, and now with grownup chil­dren, Dianne was on the hunt for a new metro-based chal­lenge when she spot­ted a recruit­ment adver­tise­ment for the Roy­al Fly­ing Doc­tors Ser­vice (RFDS) in The Age.

It was a big ad and it just jumped out at me. I cut it out and I took it to where [my hus­band] … was sit­ting read­ing. And I said, How about this one?’ and he said, Yeah, that’s real­ly you. Yeah, you should apply for that.’ I near­ly fell over.”

Dianne step­ping out of an RFDS clin­ic aircraft

Dianne and her hus­band took a leap, estab­lish­ing their new base in Mt Isa. They were wel­comed as a part of the town’ and described the com­mu­ni­ty as a social place to be’ from the Rotary Club and race days to help­ing with the rodeo, par­tak­ing in the Gre­go­ry Canoe Race, and look­ing on at the icon­ic Bou­lia Camel Races. 

From devel­op­ment and behav­iour­al health checks to imple­ment­ing treat­ments such as wound dress­ings and iron injec­tions, Dianne also spent much of her work time focused on health promotion. 

[My col­league Maree] worked on Morn­ing­ton Island (Gununa), I worked in Doomadgee, and we did one day a week where we went out to one of the pri­ma­ry health care clin­ics,” Dianne says. 

Dianne and her col­leagues pro­vid­ed parental edu­ca­tion to increase health lit­er­a­cy, admin­is­tered pre­ven­ta­tive vac­cines to chil­dren, and sup­port­ed fam­i­lies through advo­ca­cy and refer­rals to oth­er com­mu­ni­ty services.

They also worked close­ly with oth­er health spe­cial­ists and ser­vices and expand­ed fam­i­ly sup­port includ­ing preg­nan­cy edu­ca­tion and moth­ers’ groups. 

Dianne (right) with Dorothy (left), Child and Fam­i­ly Health Indige­nous Health Work­er prepar­ing for meal time with the group.

In 2012, Dianne start­ed a moth­ers’ group in Doomadgee called Mums and Bubs’ designed to increase par­ent self-effi­ca­cy, skills and con­fi­dence, and pro­vide a non-clin­i­cal envi­ron­ment to observe children’s development. 

I always judged my suc­cess by the num­ber [of peo­ple] who came [to clin­ic or play­group] with­out me hav­ing to recall… when they turned up at their own voli­tion… I thought, Oh, that’s fan­tas­tic. That’s real­ly love­ly,’” she says. 

You just had to learn to work at a dif­fer­ent pace and to be more patient. 

To realise that every­thing you thought might take a cer­tain time, might take up to dou­ble or triple that time but if you were will­ing to just go along, gen­tly [you would have an impact].”

Becom­ing a seag­ull’

After two years full-time, Dianne tran­si­tioned to FIFO for RFDS, or became a seag­ull’ as some of her col­leagues joked, fly­ing in and fly­ing out of Melbourne.

Liv­ing in a guest­house in Doomadgee was anoth­er pos­i­tive expe­ri­ence Dianne recalls, pro­vid­ing oppor­tu­ni­ties to have a chat with oth­er health work­ers, or peo­ple vis­it­ing the com­mu­ni­ty such as the local vet or audiologist.

I think I made a bit of a difference.”

Dianne reflects on her time work­ing remote­ly, explain­ing that the Mums and Bubs play­group she devel­oped, is still oper­at­ing in Doomadgee after 11 years. 

Though Dianne strong­ly attrib­ut­es much of this suc­cess to the assis­tance and unwa­ver­ing sup­port she received from the Doomadgee locals, and Indige­nous Health Work­ers, giv­ing an extra spe­cial men­tion to Dorothy George (pic­tured below), whom she still keeps in touch with today. 

Dianne (left) and Dorothy (right) catch­ing up after 10 years, in Ade­laide (Octo­ber 2022).

There was [also] a ter­rif­ic com­mit­ment from the nurs­es who fol­lowed me to keep it going.

I think I was very much a novice. A lot of [pae­di­atric and mid­wifery] expe­ri­ence, but a novice in Indige­nous remote health. And I acknowl­edge that, but I was­n’t afraid to ask [when I wasn’t sure].

[I am proud that we] had 97 per cent full [immu­ni­sa­tion] cov­er­age for our cohort of chil­dren when I left Doomadgee. That was high­er than the state aver­age,” she says.

Dianne encour­ages those both in the ear­ly and lat­er stages of their careers, with a bit of prepa­ra­tion, to give remote health a try.

I was always glad I had a few grey hairs… because I think it did help to be an old­er per­son with a lot of experience.”

Cer­tain­ly, the grannies and the aun­ties were quite respect­ful of me and would come to ask or come to tell me they were wor­ried about [some­one in their family].

I loved every minute of it. I mean, it was dif­fi­cult at times, but on the whole, it was amaz­ing. And peo­ple, I think, were appreciative.”

If you’re inter­est­ed in learn­ing more about remote child health, watch CRANAplus’ free, on-demand, three-part Child Health webi­nar series.