The impacts of climate change upon remote communities, and the importance of accessible education for remote area healthcare professionals are among the issues highlighted by remote area nurse John Wright, the new chair of CRANAplus, who recently spoke with Croakey’s Alison Barrett.
Alison Barrett writes:
At Tennant Creek, on Waramungu Country in the heart of the Barkly Tablelands in the Northern Territory, local health services are seeing first-hand the impacts of heat upon health and wellbeing.
John Wright, a remote area nurse at Tennant Creek Hospital who was elected in December as Chair of CRANAPlus – the peak body for remote health in Australia – says the impacts of heat are exacerbated by social and economic inequities.
Many people living in Tennant Creek can’t afford air conditioning, homes are poorly insulated and solar panels are rare. “Energy bills are very high and always increasing,” Wright said.
The hospital sees a “steady trickle of people with heat illness” when it gets very hot, according to Wright.
In recent months, temperatures have reached 44 degrees in Tennant Creek – the December 2023 average was 3.3 degrees warmer than previous December averages.
Wright’s observations are underscored by survey findings released this week by Australian Council of Social Service (ACOSS) showing that nearly half (45.5 percent) of Northern Territory residents struggle to cool their home.
Additionally, of the 1,007 people surveyed, 80.5 percent said they experience poor health when their home is hot.
Wright said this is something he identifies with – as his wife has multiple sclerosis, the temperature of their home has to be closely regulated around the clock, which costs a huge amount, particularly during NT’s wet season.
First Nations Clean Energy Network – made up of First Nations people, communities and organisations to support community-owned renewable projects, and which assisted ACOSS with the survey – recently said it is critical to include Aboriginal and Torres Strait Islander people in renewable energy projects.
“The rights, interests and aspirations of First Nations peoples must be front and centre to achieve a just clean energy transformation,” co-chair of the Network Karrina Nolan said.
Local education
Wright’s main passion is education, and he is working towards his dream of establishing a nursing and healthcare practitioner education hub in Tennant Creek to manage healthcare education for the entire Barkly region.
He envisages that the education team would consist of educator(s) from the hospital, from remote health, and from town-based community health services and would include hospital placements, Aboriginal and Torres Strait Islander health sector training and professional development for existing healthcare staff.
This would help overcome some of the challenges associated with Tennant Creek’s remoteness, Wright said. The next closest education centres are in Alice Springs and Darwin, and travel is expensive.
Additionally, if Tennant Creek Hospital is short-staffed, they are unable to release staff to go away for a three-to-four-day training course, he said.
Ideally, the major funder for the hub would be NT Health, by consolidating existing education positions in the Barkly into one hub. It may also be supported by service agreements with the NGO sector if and when they require clinical education for their staff but can’t afford their own educators.
For the hub to come to fruition it “needs a commitment at executive level to remove the siloed approach between acute care and primary healthcare,” Wright told Croakey.
In terms of building up the rural workforce, Wright said “it’s about sowing the seed”. Some of the nursing students who do placement in Tennant Creek return, but it is not for everyone, he said.
To work in rural and remote healthcare, “you have to be flexible, adaptable and willing to turn [your] hand to anything that needs to be done,” he said.
Overcoming challenges
Tennant Creek Hospital and Barkly Public and Primary Health Care provide services to approximately 8,000 people – just under 3,000 of whom live in Tennant Creek. Wright told Croakey the key health issues are skin disease, respiratory disease, diabetes and heart disease.
Other than visiting specialist services and the “incredibly valuable Aboriginal Health Practitioner partners”, there is no one to refer patients to within or near the Tennant Creek community, Wright said, which is one of the long-standing challenges of remote healthcare.
Anyinginyi Health Aboriginal Corporation provides primary healthcare to the Aboriginal people of Tennant Creek and several surrounding communities.
While Wright doesn’t officially work with Anyinginyi, he said its staff are routinely invited to attend in-service education sessions he runs at the hospital, and he facilitates nursing student placements at Anyinginyi’s Health Centre.
To overcome some of the remote healthcare challenges, telehealth is used frequently, but some specialists prefer to see the patient face-to-face, according to Wright. Alice Springs is a 500 kilometre drive each way from Tennant Creek, which for a 30-minute consultation, is a “terrible waste of time”, Wright said.
According to Wright, trust needs to be built up between specialists and the remote health practitioners in order to help deliver services remotely.
He told Croakey they have high-fidelity cameras in Tennant Creek which are very good at being able to see symptoms clearly, but in some cases a specialist may want to feel a lump or bump, for example. The remote practitioner can do this and feedback the information to the specialist but this requires the specialist to learn to trust the remote health practitioner, according to Wright.
Staying connected
Wright has been on the Board of CRANAplus since 2005, and seen the organisation grow from a “little cottage industry of 150 members to now over 2,100 members right across Australia”.
He told Croakey this would be his final term on the Board, stepping down in 2025.
While Wright thinks he is still a useful contributor, he is “getting to the end of [his] level of skill and contribution” as he doesn’t have business qualifications, which are important in the modern environment.
It has been “absolutely brilliant being on the Board”, he said, enabling him to stay connected with the rest of the industry and helping to overcome some of the isolation from being a remote practitioner.
Rewarding career
It was not until he started to do some nursing agency work – after resigning from a senior trauma nurse role in a major metropolitan hospital – that Wright realised he was happiest further away from the city.
Although Wright – now Nurse Education and Research Coordinator at Tennant Creek Hospital – has not always worked in remote healthcare, it was perhaps destined to be.
After growing up on an “isolated scrub block” on Eyre Peninsula in South Australia and a self-described “failed” stint at farming, Wright was encouraged to become a health professional by his then girlfriend’s mother, who was a GP.
Once he discovered emergency nursing, and then remote area nursing, he was “hooked”, Wright told Croakey.
He loves the chaos and autonomy of emergency nursing. It’s also not boring – you have to think fast on your feet as you never know what’s coming.
Working in a remote area was “not a problem” for him, Wright told Croakey – it is where he feels most comfortable, and where he can “actually make a difference”.
In city hospitals – where Wright worked for seven years before experiencing burn out, and trying agency work – you may see people for a few minutes or a few hours. “You patch them up and send them off”.
In the country, “you are the health provider for the community,” he said. “You are doing all of the healthcare you possibly can.”
He added, it’s also “the most fun you can have as a registered nurse in Australia” and highly recommends healthcare workers try remote work. “It’s incredibly rewarding”.
Previously at Croakey
On climate justice in Tennant Creek:
Rising up – Aboriginal and Torres Strait Islander people leading for climate justice
See Croakey’s archive of articles on rural and remote health
