“Even before the pan­dem­ic, safe­ty issues were recog­nised as a most press­ing and urgent pri­or­i­ty fac­ing remote health,” says Kellie. 

“Health work­ers face unac­cept­able work­loads, chron­ic lack of resources and inad­e­quate prepa­ra­tion for ​‘all things remote’, includ­ing cul­ture shock.

Now, more than ever, agen­cies and health ser­vices are so des­per­ate, they are send­ing out peo­ple who are, at times, total­ly out­side their com­fort zone.

“[That] can set staff up to fail, and so the staff don’t hang around. High turnover is not good for the Health Ser­vice, com­mu­ni­ties; not good for the nurs­es who can’t stay, not good for those who do stay, and not good for the agen­cies,” says Kellie.

Kel­lie, a nurse for 26 years, has seen this pat­tern repeat itself. She came full cir­cle over an eight-year peri­od by mov­ing from metro to region­al to rur­al quite quick­ly, and then onto remote. In the same speedy fash­ion, she then reversed those steps to move to Bris­bane to under­take fur­ther study.

“I was young, enthu­si­as­tic and full of adven­ture, seek­ing that buzz [of] adren­a­line when I start­ed prepar­ing to go remote in 1997,” she says.

​“The day before I left for my R&R expe­ri­ence, my Mum dis­cov­ered the fam­i­ly she nev­er knew of and I dis­cov­ered my own Indige­nous heritage.

“I hadn’t been raised in the cul­ture, and in those first five years work­ing remote, I learned how mis­in­formed, une­d­u­cat­ed and naïve I was. I wasn’t aware just how much until I embraced my own identity.”

Kel­lie went on to gain a Diplo­ma in Health Sci­ence (Holis­tic Coun­selling) to improve her com­mu­ni­ca­tion skills, worked through her own lived expe­ri­ence of PTSD, became a Facil­i­ta­tor in the Applied Sui­cide Inter­ven­tion Skills Train­ing (ASIST) and obtained a Cer­tifi­cate IV in Train­ing and Assess­ment. She worked in men­tal health for eight years, in areas includ­ing sui­cide pre­ven­tion, clin­i­cal super­vi­sion, patient safe­ty and the prison system.

Kellie’s cur­rent job with the Abo­rig­i­nal Med­ical Ser­vice Alliance NT is in the role of clin­i­cal COVID-19 advi­sor, and it cov­ers the Top End includ­ing the Big Rivers and East Arn­hem regions.

“I put my hand up to invest time on the CRANAplus Round­table because of my pas­sion to share my knowl­edge on psy­cho-social aspects, emo­tion­al well­be­ing and the trau­ma peo­ple are exposed to – whether it’s vic­ar­i­ous or pri­ma­ry – when they go into remote loca­tions,” she says.

“My pas­sion is to raise aware­ness, to high­light that going remote is going to be a life-chang­ing deci­sion,” says Kel­lie. ​“There are going to be extreme highs and extreme lows.

“A lot of con­ver­sa­tion around safe­ty issues and the fact that remote health ser­vices are gross­ly under-resourced con­tin­u­al­ly falls on deaf ears,” says Kel­lie. ​“It’s time it was made a priority.

“There is a high burnout rate, a high attri­tion rate, for many well-known fac­tors, his­tor­i­cal and on-going.

“The trou­ble is remote health tends to be reac­tive. There are so many com­plex and over­lap­ping demands. But aim­ing to keep staff hap­py, healthy and con­tent, that should be a priority.”

The Round­table in Feb­ru­ary explored rea­sons and pos­si­ble actions to address safe­ty issues, includ­ing direct advo­ca­cy in the polit­i­cal are­na in the lead-up to expect­ed elec­tions this year.

“We need to pre­pare peo­ple bet­ter, be frank and upfront about what they will be deal­ing with,” Kel­lie says. ​“It’s about being aware of the skills that will be need­ed, and the day-to-day sit­u­a­tions that arise.

“A lot of peo­ple don’t realise… how com­pre­hen­sive the pri­ma­ry health care mod­el is in remote, the advanced clin­i­cal skills required, the extra qual­i­fi­ca­tions and expe­ri­ence you need. You can have the best inten­sive care or emer­gency nurse, but when you’re out there, you face less equip­ment, less resources, maybe two peo­ple to assist if you’re lucky – not 10 peo­ple who respond at the push of a but­ton on the ward wall.”

The sit­u­a­tion forces some peo­ple to leave because they feel unsup­port­ed, as does the liv­ing stan­dards and sub­stan­dard accom­mo­da­tion for which they may not have been prepared.

The solu­tion requires pre­pared­ness for cul­ture shock and Kel­lie wants to see a New to Remote pro­gram focus on resources and assis­tance for nurs­es and mid­wives, with ​‘new’ apply­ing regard­less of age or expe­ri­ence elsewhere.

“Health work­ers go out there because they want to work in cul­ture and with the mob and that’s great, but they need to be giv­en as much cul­tur­al infor­ma­tion as pos­si­ble,” she says.

“When they put their feet on Coun­try, they are in anoth­er world… Each com­mu­ni­ty, each lan­guage group, and sub groups have their own cul­ture. It’s much more than the dif­fer­ence between trop­i­cal coun­try in the North and the desert coun­try in the Centre.

“They hit the ground run­ning. If they’re lucky, they might get the keys to their accom­mo­da­tion before they get thrown into a clin­i­cal situation.

“Every health ser­vice should have a loca­tion-spe­cif­ic cul­tur­al man­u­al pro­vid­ed imme­di­ate­ly to new staff, infor­ma­tion that is con­stant­ly updat­ed. There is not one size fits all.”

Kel­lie sug­gests one of the best ways to pre­pare peo­ple for remote work is through sto­ry­telling and pho­tos where appro­pri­ate, using real-life expe­ri­ences to show ​“this is real­i­ty and this is what happens.”

She high­lights that sup­port needs to con­tin­ue even after nurs­es and mid­wives return home.

“When nurs­es return home, the ten­den­cy is to share the won­der­ment, the unique­ness, the fresh sto­ries full of adven­ture which are grip­ping to lis­ten to,” she says.

“Peo­ple may not be ful­ly aware they have been trau­ma­tised. They have inte­grat­ed into the set­ting. It has become the norm. They for­get basic bound­aries and decide ​‘we just have to get on with it.’ They might say, ​‘I would not nor­mal­ly do this, but I am on call, I bet­ter do it.’ They make mal­adap­tive deci­sions, psy­cho­log­i­cal­ly sac­ri­fic­ing them­selves, mov­ing into the local groove.

“Often, the real trau­ma is pushed aside. It’s still pro­cess­ing and the full impact is yet to come.”