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CRANAplus Fellow in Focus: Sally Johnson

11 Aug 2022

Fellow in Focus, from the August 2022 edition of the CRANAplus magazine, is Sally Johnson who, at 81, claims to be ‘absolutely retired’ but she still has ideas for CRANAplus, which she was instrumental in establishing back in the 1980s.

The peo­ple-cen­tred cul­tures of Australia’s First Peo­ples took now-retired remote area nurse and mid­wife Sal­ly John­son into the North­ern Ter­ri­to­ry at the start of her nurs­ing career in the 1960s.

Ever since she’s been dri­ven by the imper­a­tive of health pro­fes­sion­als work­ing along­side Indige­nous com­mu­ni­ties, rather than impos­ing a top-down approach.

Sally’s three major career moments

Focus­ing on the suc­cess­es is why she last­ed so long, says Sal­ly, who lists three major events in her career.

Sal­ly was instru­men­tal in the birth of what is now CRANAplus back in the ear­ly 1980s when she and two fel­low nurs­es work­ing in remote North­ern Queens­land decid­ed some­thing had to be done to pre­pare and sup­port nurs­es work­ing in remote communities.

We were fed up. We were learn­ing on the job and felt that was not good enough. Nurs­es should be pre­pared for what they are expect­ed to do.”

The three of us decid­ed to send let­ters to all the remote clin­ics we could get address­es for, 150 of them. We planned a meet­ing in Alice Springs and expect­ed 50 to 60 nurs­es to attend, and 250 turned up.

The fol­low­ing year anoth­er meet­ing was held and CRANA began (lat­er to become CRANAplus) with lots of ideas, a major one back then to have a post­grad­u­ate course for remote area nurses.”

Sal­ly was pres­i­dent of CRANA for two years and for sev­er­al years was on the Edu­ca­tion Committee.

The nation­al recog­ni­tion of remote area nurs­es and what they do, par­tic­u­lar­ly in Abo­rig­i­nal com­mu­ni­ties, is the sec­ond suc­cess Sal­ly is very proud of. In 1995, Sal­ly was award­ed the Mem­ber of the Order of Aus­tralia for ser­vices to Abo­rig­i­nal Health and remote area nurs­ing, and hopes this is seen by remote area nurs­es as a gen­uine recog­ni­tion of the work they all do.

The third major event was help­ing to estab­lish a rheumat­ic fever pro­gram in Yarrabah in North­ern Queens­land after an Elder approached her for help. At that time, at least four chil­dren a year devel­oped the dis­ease in that com­mu­ni­ty, with many of them devel­op­ing rheumat­ic heart disease.

You must be able to do some­thing about it, he said to me, but I didn’t know much,” says Sally.

I con­tact­ed a doc­tor I trust­ed, who found in his read­ings that the Papa­go First Nations peo­ple in Ari­zona had the same prob­lem and had insti­gat­ed a suc­cess­ful program.

Toni Dowd, Sal­ly and Sabi­na Knight at the 1995 CRANAplus Con­fer­ence in Darwin.

It involved swab­bing all the children’s throats to find the car­ri­ers of group A strep­to­coc­ci – the bac­te­ria that caus­es rheumat­ic fever.

The com­mu­ni­ty was attract­ed, I’m sure, by the fact that it was Indige­nous peo­ple who’d worked out what to do,” says Sal­ly, and they said we’ll give it a go too’.

After the Abo­rig­i­nal Health Pro­fes­sion­als deliv­ered an exten­sive edu­ca­tion pro­gram, the par­ents got on board and took their asymp­to­matic-type chil­dren to the clin­ic for a rather painful peni­cillin injec­tion. There was 99 per cent com­pli­ance; the only way for this to hap­pen was for us to lis­ten to the com­mu­ni­ty, which was lead­ing the way.

Dur­ing the six years after the pro­gram was intro­duced only one child in Yarrabah con­tract­ed rheumat­ic fever.”

This First Peo­ples’ suc­cess sto­ry was an exam­ple of the need for Abo­rig­i­nal com­mu­ni­ties them- selves to be run­ning these pro­grams, Sal­ly points out. How­ev­er, what hap­pened lat­er was a good exam­ple of the main­stream health sys­tem not valu­ing or even believ­ing an Abo­rig­i­nal success”.

The pro­gram didn’t get the finan­cial sup­port it need­ed, it all got too hard, and Abo­rig­i­nal com­mu­ni­ties are still try­ing to work out what to do.

Some­times, at the cut­ting edge, we know that top down’ doesn’t work, but think of the Abo­rig­i­nal peo­ple. They’ve been liv­ing with this for more than 200 years.”

Bush nurs­ing 50 years ago

Sal­ly, who spent 25 years as a remote area nurse, head­ed for the North­ern Ter­ri­to­ry after her nurs­ing train­ing and mid­wifery studies.

As far as I know, I nev­er met an Abo­rig­i­nal per­son in my child­hood and ear­ly adult­hood in Syd­ney, but then again, peo­ple didn’t iden­ti­fy in those days,” Sal­ly says. 

My inter­est in Abo­rig­i­nal cul­ture came from read­ing. I realised I had so much to learn, so I decid­ed I should get out there, live and work with them and try to listen.

My very first post­ing was to a lep­rosy hos­pi­tal out of Dar­win. I was very lucky to have gone there – as the view of the doc­tor in charge, John Har­grave, was that, to get on top of lep­rosy we had to involve the com­mu­ni­ty itself. To train com­mu­ni­ty mem­bers was the way to go, he said, and he called them para­med­ical workers’.

That was in 1969, before Abo­rig­i­nal Health Pro­fes­sion­als were thought about.”

While work­ing in Queens­land in the 1980s, Sal­ly was asked to help write a course, ini­ti­at­ed by Abo­rig­i­nal activists in Cairns, to train Abo­rig­i­nal Health Work­ers. Queens­land was the last State in Aus­tralia to intro­duce for­mal edu­ca­tion for Abo­rig­i­nal Health Workers.

In the 1990s, Sal­ly relo­cat­ed to Alice Springs where some com­mu­ni­ty mem­bers were writ­ing a course to pre­pare health pro­fes­sion­als to work appro­pri­ate­ly with­in their com­mu­ni­ties in Cen­tral Australia. 

She was already a co-author of Binan Goonj, first pub­lished in 1992, now in its 3rd edi­tion, and still used by uni­ver­si­ties in their train­ing of health pro­fes­sion­als. Binan Goonj trans­lates into I know you hear me but you’re not lis­ten­ing.” The sub­ti­tle is Bridg­ing Cul­tures in Abo­rig­i­nal Health.”

And that dream of a post­grad­u­ate cer­tifi­cate in Remote Area Nurs­ing? It final­ly came to fruition, with Sal­ly again invit­ed to be involved in the course design.

Sal­ly speak­ing at the 2006 CRANAplus Con­fer­ence in Hobart.

Defin­ing Pri­ma­ry Health Care

Sal­ly would like to see the mean­ing of pri­ma­ry health care’ in Aus­tralia revert to the def­i­n­i­tion set by the World Health Organ­i­sa­tion (WHO) in the 1980s.

Pri­ma­ry health care used to mean essen­tial health care pro­vid­ed for the peo­ple, by the peo­ple and under­ly­ing that tenet was social jus­tice, equal­i­ty and self-reliance,” she says.

In Aus­tralia, how­ev­er, in the health sec­tor gen­er­al­ly, the eas­i­er way out is tak­en, and they talk about pri­ma­ry health care as the first point of con­tact.’ Of course that is impor­tant, but the WHO def­i­n­i­tion is broad­er and talks about how we deliv­er health care rather than what.

CRANAplus has tremen­dous cours­es to improve clin­i­cal skills which of course are very nec­es­sary. How­ev­er, more impor­tant, in my view, is know­ing how to be a health pro­fes­sion­al who is not adding to the pow­er imbal­ance that is large­ly respon­si­ble for poor health.”

The fol­low­ing quo­ta­tion from the guide- lines of TANU, the Nation­al Move­ment of Tan­za­nia 1971, encap­su­lates the prin­ci­ples of pri­ma­ry health care, says Sally.

Any action that gives peo­ple more con­trol of their own affairs is an action for devel­op­ment even if it does not offer them bet­ter health or more bread.

Any action that reduces their say in deter­min­ing their own affairs or run­ning their own lives is not devel­op­ment and retards them, even if the action brings them a lit­tle bet­ter health and a lit­tle more bread.

To learn more about rheumat­ic heart dis­ease, check out Five things you should know about RHD.