Stand­ing on the bal­cony of Thurs­day Island Hos­pi­tal, Max­ine Lene­han can see across a few kilo­me­tres of ocean to Horn Island, Prince of Wales Island and Fri­day Island.

If she was to squint while gaz­ing out at the green moun­tain­ous head­lands, she might almost be in Syd­ney, where she used to live in the west­ern suburbs.

But when she steps inside again, it will be into a dif­fer­ent world: her new life as a mid­wife work­ing in the Mid­wifery Group Prac­tice (MGP) on Thurs­day Island.

The MGP based on the island ser­vices the pop­u­lat­ed out­er islands and five indige­nous com­mu­ni­ties on Cape York.

If deemed safe to give birth on TI, women trav­el to stay in local accom­mo­da­tion when they are 36 weeks preg­nant and then birth in the hospital’s mater­ni­ty suite.

“All women receive MGP care,” Max­ine says, ​“mean­ing they are engaged in their own health­care. We have a con­ti­nu­ity of care phi­los­o­phy, where the women get to know the team of mid­wives look­ing after them. 

“Three mid­wives look after the Tor­res Strait islands, and three look after the com­mu­ni­ties on the Cape. On TI there is also a mid­wife 24/7 on shift in the hospital.

“I care for women on the east­ern clus­ter of islands, includ­ing Mur­ray Island, Darn­ley Island, Stephens Island, Yorke Island and Yam Island.

“We make day trips, often by heli­copter or fixed wing, to the islands we cater for, and have appoint­ments with women at the health clinics.

“Hav­ing the pres­ence of a mid­wife who ser­vices com­mu­ni­ties, who comes to women rather than the women hav­ing to come to hos­pi­tal – that pres­ence and con­ti­nu­ity is great for build­ing trust and relationships.”

Before this role, Max­ine worked in West­mead Hos­pi­tal in Syd­ney for five years, begin­ning with a year of shift work before four years with­in the Mid­wifery Group Practice.

“But it’s always been a goal of mine to move out of the city,” she says. 

“I’ve been here 11 months now; I’ve stayed here and loved it. It was def­i­nite­ly a cul­ture shock – get­ting my head around the change in lifestyle. But it was the most wel­com­ing place and I’ve been real­ly well supported. 

“I’m glad I got to start out as one of the shift work mid­wives, to under­stand the hos­pi­tal, the process­es, before mov­ing into MGP.

“I have had a lot of edu­ca­tion­al oppor­tu­ni­ties here. For exam­ple, I did a Strength with Immer­sion (SwIM) pro­gram in Townsville Hos­pi­tal in the neona­tal inten­sive care unit. 

“It was incred­i­ble to see the oth­er side of the sto­ry, to under­stand what hap­pens when the baby gets to Townsville [in the case of a medivac].”

The biggest change for Max­ine since she start­ed work­ing on TI has been the need to con­sid­er logis­tics, not just clin­i­cal care.

“On the main­land, in urban and some rur­al loca­tions, when you need sup­plies or assis­tance, it is often just a mat­ter of a dri­ve away,” Max­ine says. 

“Here, a woman may go into pre­ma­ture labour or her waters may break pre­ma­ture­ly, and if she is on the out­er islands, it usu­al­ly requires a heli­copter flight or task­ing the RFDS. And because of where we are, in the trop­ics, some­times the weath­er means the heli­copter can’t fly or land for a while.

“When I was doing shift work as a mid­wife [on TI], some­times the staff on the out­er islands would have women present who may be in pre­ma­ture labour so we, along with a doc­tor, would sup­port the RANs in the clin­ic, who have mater­ni­ty train­ing but are not nec­es­sar­i­ly midwives.

“We would talk to them over tele­health, and there was one instance where a woman from one of the out­er islands was in labour. She was tasked to come to TI, but in the mean­time, over tele­health, myself and the GP obste­tri­cian pro­vid­ed advice on how to care for her.

“Pro­vid­ing mid­wifery care over the cam­era was daunt­ing, but it was a good out­come for all.’’

Max­ine reg­u­lar­ly pro­vides care in a cross-cul­tur­al con­text and she acknowl­edges the vital role played by Tor­res Strait Islander assis­tants in mid­wifery and nurs­ing, includ­ing Mar­garet and Flo, who have almost 60 years of expe­ri­ence between them.

“Hav­ing that cul­tur­al con­nec­tion is high­ly impor­tant for health pro­mo­tion and for bridg­ing the gap between [non-Indige­nous] mid­wives and the local women, who have respect for [Tor­res Strait Islander] health work­ers and mid­wives,” Max­ine says.

“They have cared for gen­er­a­tions of babies; they are part of the com­mu­ni­ty, and under­stand the cul­ture, and the cul­tur­al dif­fer­ences. Some­times they also sup­port women in labour, when these women do not have their escort or sup­port per­son with them for birth, because they are work­ing back home and can­not take a month off to be on Thurs­day Island.”

Being able to observe and learn from women while deliv­er­ing cross-cul­tur­al care has been one of the most reward­ing aspects of the job for Maxine.

“Tides are some­thing that impacts your work, your life, whether you can get out on the water, and there is a cul­tur­al belief, strong­ly held by the com­mu­ni­ty, that tides also impact whether or not a woman is going to labour and when she will give birth,” Max­ine says.

“Women will look at the change of tides, which are a lot less pre­dictable than on the east coast. One of the beliefs is that if the tide is com­ing in, their labour will be fast and strong, and they’ll give birth soon. If the tide is out, their labour will be slow and pro­longed, and things won’t progress until the tide turns.

“I have noticed that if the women say, ​‘the tide is com­ing in around this time, this is when I’ll give birth’, then they are right every sin­gle time. That’s been pret­ty incredible.”