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Nursing on Christmas Island, with Stevhnie Nel
Community health nurse Stevhnie Nel discusses cultural awareness when working with Chinese and Malay clients, community immersion as a self-care strategy, and witnessing the annual Christmas Island red crab migration.
It takes almost four hours to fly the 2600km distance between Perth and Christmas Island. This north-westerly Australian external territory sits below Indonesia, at roughly the same latitude as Bamaga, and rises to 361m at its highest point. Rainforest covers over 60 per cent of it.
Community health nurse Stevhnie Nel first ventured to the populated northern tip of “The Rock” during a contract role with Indian Ocean Territories Health Service (IOTHS) in 2010.
The same health service delivers care to Cocos (Keeling) Islands (but not the immigration detention centre on Christmas Island).
She’s since moved the family over and now lives alongside roughly 1700 fellow islanders, who for the most part summon from European, Chinese and Malay backgrounds. As Stevhnie puts it, “We’re a unique territory.”
“The health service is a one-stop shop,” she says. “We’ve got a GP practice, primary health care facility, a ward for in-patients, emergency care, a midwife/child health nurse, telehealth facility, social worker, laboratory, and nurses based at the hospital. I am the community health nurse and venture out into the community.”
When she does, she takes a garden rake.
“More often than not, Christmas Island red crabs live in the rainforest, but from November to January, they migrate to the ocean to spawn, and the roads will just be covered in red.”
“Most people here are encouraged to have a rake on the back of their ute, so one person can walk in front of the ute and rake all the crabs out of the way,” she says.
“Once the babies spawn, they come back to the forest. It’s just a magical sight.”
A deft touch with a rake is but one of the many unique skills that nurses need when practising on the island.
“We’re far from the mainland and the medical retrieval companies require a jet; we can’t have propelled aircraft land here,” Stevhnie says.
“Jets are often scarce, so it may be a few days before an unwell patient can be medically evacuated. We need advanced life support skills to be able to manage an emergency for a lengthy period and to be able to recognise deterioration in a patient’s condition.”
“Some of our nurses here are X‑ray operators as we don’t have a full-time radiographer. Nurses are required to
have their pharmaco-therapeutics course under their belt and we have a suite of medications that we can administer under a standing order outside of office hours.
“We’re very primary health focused. Our nurses here need to be familiar with RACGP primary healthcare guidelines and have excellent primary health care skills, including but not limited to the ability to undertake audiology and spirometry tests.
“There is a prevalence of diabetes and chronic kidney disease in the community here, and a lot of our health promotion is around those two topics. We also have a very large elderly population, so there’s a focus on discussing osteoporosis, falls prevention, advance care directives and Enduring Power of Guardianship and Attorney.”
Given the work bridges diverse cultures, cultural awareness informs everyday practice and is built into the orientation procedures for new staff.
“We are very fortunate in that we have a few enrolled nurses on Christmas Island who can speak multiple languages,” Stevhnie says.
“We also encourage the local community to apply for jobs, such as health care workers, and assist them with education and training.
“We utilise our multilingual staff, and the telephone interpreting service, to translate. All staff here are very open to learning basic Malay, Mandarin, Hokkien and Cantonese words, which helps with establishing that initial rapport with the patient.”
One of the ways in which the health service demonstrates cultural awareness is by respecting traditions surrounding death.
There are particular cultural and religious needs for patients who die, particularly for those of Buddhist and Muslim faith.
“We always respect the wishes of family and work with them in partnership to facilitate these wishes,” Stevhnie says.
Accommodation is provided on the island to nurses who are recruited from the mainland. The distance from Perth and price of flights – around $1200 return – mean that most staff visit the mainland less frequently but for longer periods.
During the wet season, the humidity sometimes creates low cloud cover, obscuring the airstrip.
When this happens, planes may not be able to land and will need to turn back to Perth.
“That’s one reason why it’s so important to immerse yourself into the community, and make use of the lovely beaches, fishing, and rainforest,” Stevhnie says.
“We have a social club for staff and there is an activity pretty much every day of the week. Mondays are boot camp; Tuesdays, Korean barbecue and karaōke; another night, arts and crafts. The nurses [will] sometimes get together for a sunrise/sunset swim/snorkel at The Cove.
“The husband of one of the nurses created a mini-golf course recently, and there’s also a decent full-scale golf course.
“The whole community gets invited to celebrate cultural festivities such as Chinese New Year with the Chinese population, and Hari Raya Haji with the Malay population.
“We’re a very close-knit nursing team on Christmas Island, and it almost feels like family. Christmas Island is home for me now, for sure.”
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