Introduction by Croakey: As concern grows about the spread of COVID-19 in western NSW, with 49 new cases recorded in the region in the 24 hours to 8pm on 24 August, it’s critical that pandemic response efforts work effectively with local health services, especially the Aboriginal community controlled sector.
Last week, nursing academic Professor Rhonda Wilson was hard at work in Walgett assisting local health workers with COVID vaccinations. Writing from isolation upon her return home to the central coast of NSW, she reflects below on the importance of relationships, respect and trust in providing culturally safe services.
She also critiques the use of fines and penalties for people who face difficulties in following public health orders because of financial and other determinants of health.
Rhonda Wilson writes:
I have just returned from a week in Walgett in north-western New South Wales, working with Walgett Aboriginal Medical Service (WAMS). The service invited me and my nursing colleagues from the School of Nursing and Midwifery at the University of Newcastle, Professor Amanda Johnson and Associate Professor Donna Hartz, to help urgently with the escalating crisis of COVID-19 cases in their area.
We have been working in partnership with WAMS on another project for some time, hoping to teach Bachelor of Nursing On Country there in the future. As is the case where strong relationships are formed, they often become a firm backdrop for collaborative and authentic work and collegiality: the social apparatus of successful operations.
We saw our partners needed a hand, and we knew we had skills, knowledge, respectfulness, and community connection to help in a culturally safe manner. If we could help, in partnership, we would volunteer to do so.
The response from WAMS was a swift, ‘Yes, your help is needed. When could you come?’
The agility with which our University was able to respond in releasing us for this work was at a pace I’d not seen in any public organisation before, and the rapid deployment enabled us to be with our friends and colleagues when we were most needed.
The key was, we were invited. We came with compassion, connection, and competence to jump in and do the work that was required, without fuss, alongside our WAMS friends, with them leading the process.
The alignment of our partnership demonstrated our respect of the Gomeroi ways of doing things, our respectful approach promoted cultural safety, and relationship was strengthened in our unified equality. And, with this connection, word went out, trust was established, and patients came to receive their vaccinations, in a place where they felt safe.
I have never filled so many syringes nor plunged so many needles into so many arms in one day/week throughout my entire nursing career! We vaccinated hundreds of people.
Never have I been so proud to be a nurse. Our nursing expertise was exactly what was required at the time. Nurses are just the people you need when the public health response requires infection prevention and control (we have always been good at this since Florence’s days!); administration of vaccination injections; operation of flexible clinics; patient information, education and support; and, health screening, assessment, and monitoring. These activities are the core DNA of our nursing profession.
And sending out our most senior nurses provided the community with a sense of them being taken seriously. If nursing professors were coming, patients considered that their need to be taken seriously as the pandemic hit their community was being taken with utmost seriousness.
It gave some of our patients confidence, and our WAMS partners felt they were taken seriously too – some surprised at how easygoing we were! One valuable team member, performing essential care, introduced herself by saying she was ‘nobody’ – we soon convinced her that this was absolutely not the case and that her work in guiding patients through the clinic, her warmth, efficiency and kindness was paramount to success overall. She was soon happily working alongside us in her positive self-esteem, fulfilled with the meaningfulness of her contributions, as were we.
It was good to ‘pick up the tools’ again! Most of my patients said they didn’t feel a thing when they received their intramuscular injection. One elderly lady who was very frightened of needles cried and held my hands afterwards…simply because she had been so frightened and could not believe that she did not even notice the needle had gone in and out at all!
Another young man was astonished not to feel anything… and he kept poking at his arm… looking at me… poking again… and was bewildered and confused that he had felt nothing!
A 12-year-old-boy summoned all his courage after asking really sensible questions about what to expect. After I had answered his questions to his satisfaction, he too was very surprised to find it was ‘not too bad’.
We thanked every single person who came in for their vaccination. We were truly grateful that they came to keep themselves and their community safe, contributing to a greater public good for us all. Each vaccination a potential life saver.
We are very grateful for the warm hospitality of the Walgett Aboriginal Medical Service and the Walgett community. It is an honour to work alongside such expert and highly competent local health professionals at WAMS, and to work in partnership with the community at their invitation – that is, not Doing To community (without consultation or collaboration) as an outside ‘pop up’ or ‘roll in’.
Our partnership positioned us as ‘insiders’ and contributed to reinforcing the social capital assets already present in the community, in contrast to the social ecological disruption (something I have researched and published articles about in the past) of some external public initiatives.
I strongly advocate for ways of working that seek to support the local workforce in authentic partnership, with the locals reinforced as leaders and champions.
Institutional organisations from afar need to inform themselves so that their disruption is minimal, their contribution maximised, and their cultural safety is strengthened. This is especially important in such critical times where trust and confidence in a vaccination response is so vital on the ground.
Walgett is a community that I and my colleagues have been working with for the past 18 months, and with that, comes a strong relationship. We were proud to be able to help in the way that the community wanted us to help, and not in a way that was imposed upon them without effective and respectful communication.
The warmth of our collaboration was an added bonus. But, more broadly, I was struck again with the wider communication challenges – such as my cheapskate pre-paid phone plan that works well on the highly populated coastal strip where I live, but sheds bars on the edge of the Great Divide, and dies on the Western Plains completely, rendering my digital lifeline lifeless.
A timely reminder that in the bush, you must pay more to get an otherwise taken-for-granted basic telecommunications service in rural and regional communities. This is simply not possible for many low- or no-income people who are required to pay more for transport, food and services in the bush.
This is a significant problem when we have public health orders in place that require that people stay home, isolated until they receive a SMS message on their phone (with limited coverage or no credit) of a negative result, or who are told to scan a QR code to access information or businesses (essential or not).
And, then, to discover no free-to-air-ABCTV – a place where the only television messages about COVID19 responses are filtered through commercial TV stations. It was further crystalised for me that not-one-size-will-fit-all, in regard to a consistent public health response.
And, don’t even get me started on overcrowded housing and attempts to isolate in a context where it is impossible.
The affluence and privilege required to adhere to many public health responses and solutions to address COVID19 restrictions are simply not possible to adhere to in some of the circumstances we encountered, and so fines and penalties seem misaligned to me as well, with the complete inability of many people in communities such as this to ever pay. This punitive approach risks perpetuating inequalities.
From my first patient, a beautiful and precious elderly Gomeroi woman, through to my last patients, health service staff themselves, we vaccinated and provided expert nursing care. Nursing was the specific expertise required on the ground.
I met so many beautiful people, some who were scared, worried, fearful. Some reluctant and even sceptical. Most of whom were courageous and brave. We are proud to have contributed to the urgent need to vaccinate rural and regional people to make these communities as COVID-safe safe as possible at this incredibly volatile time.
We know we have contributed to saving many lives. We know that the hundreds of people we cared for are that little bit safer. These last few days could well be the most meaningful week of my nursing career. We wished we could have stayed longer.
Though we didn’t anticipate it, going into isolation on our return to our coastal community for 14 days is a small sacrifice to pay. I will stay put, satisfied that I have played a part, all the while thinking of my Walgett Aboriginal Medical Service friends who have yet more work to do.
We flew back home with the Royal Flying Doctors Service, COVID negative, with heavy hearts, and a prayer that all will be well, that people will stay home, socially distance, wear masks, wash/sanitise hands and continue to come out for their vaccinations. And, that the government services will follow our example to work respectfully with our WAMS colleagues, in partnership; not disengaged and isolated in their various forms of ‘pop-ups’ and ‘roll-ins’ and to continue the work that must be urgently completed.
My biggest thank you and hugest love to my wonderful family, who as always are my inspiration for everything, the wind beneath my wings, and were courageous enough to support me in my swift departure to go and do what I am well educated, experienced and researched to do – that is, to provide expert nursing care to people in the bush, in Outback Australia.
Professor Rhonda Wilson RN, Deputy Head of School – Central Coast, Head of Indigenous portfolio, School of Nursing and Midwifery, University of Newcastle
On Twitter, follow @rhondawilsonmhn @uni_newcastle
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