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.

“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 3^rd 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.

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.