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.”