Remote Area Nurse (RAN) – from the remote Kimberly to Ebola Crises in Sierra Leone

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We are lucky enough to introduce to you Clinical Nurse Consultant and Remote Area Nurse, Kate, who will take you on a journey across borders and into the world of remote and rural nursing.

Join our new FB group Rural & Remote Nursing | The Australian Outback

Introduction

Hi, I’m Kate a RAN Remote Area Nurse and a humanitarian. I LOVE my job, I’m autonomous, have a very broad skill set and scope of practice, and I get to work in some of the most amazing remote, beautifully wild parts of the world and country, with some of the most amazing cultures, and unique, brave, resilient, funny, and vulnerable people.

My current job as a RAN is very similar to humanitarian work, only with more resources, hope, and opportunities. We do lead the world in a multitude of 3^rd world diseases such as Rheumatic Heart Disease, and we as Australians stand-alone in leading the world in youth suicide. This is where a big part of my passion lays, with the kids.

I was a Late Bloomer as far as my career goes. A single mum I worked doing seasonal work for $5 an hour picking grapes, flowers, raking radishes etc., until I was fortunate enough to gain a job at the local hospital. I worked as a kitchen hand, cleaner, gardener, and orderly prior to commencing my nursing studies.

Once I graduated, it was full steam ahead with a passion for Emergency, Paediatrics and Trauma being my speciality areas. I worked fulltime and completed my Grad Dip of Emergency with a paediatric focus. I worked 4 years in a large regional ED followed by 3 years in a smaller rural ED before achieving my goal to work with Medicines Sans Frontiers (MSF) (Doctors Without Borders).

I’d always wanted to “help make a difference” since I was a kid. The genocide in Rwanda, the famine in Ethiopia, kids dying of starvation, earthquake’s, tsunamis floods, I always dreamed of helping.

Vietnam, Sri Lanka, Ethiopia, South Sudan

I worked as an Emergency field nurse for several years in countries such as Vietnam, Sri Lanka, Ethiopia and South Sudan.

Some of the programs I managed included the malnutrition programme, 0-5, Antenates, STI, Emergency Clinics, Emergency Surgical, Paeds, Maternity and Mobile Clinics.

I quickly learned that you can’t save the world, but you can make a difference. One person at a time, you can make a difference in their life. To help them, educate, encourage and empower, to pass on knowledge, share the information which not only empowers them, but all those they, in turn, pass it on to.

Simple things like adding salt to boiled water to clean a wound. Simply boiling water, washing hands, applying pressure, positioning to avoid aspiration. And clinically how to improvises, make equipment out of what you have.

Did you know there are 129 ways to use a glove?

Saying “No” was always the hardest. “No, we can’t help you” No we can’t give you” Simple medications, simple treatments that we would never think twice of here.

But with limited resources and operational priority’s, choosing who will and who won’t get treatment, who will live and who will die, that was hard.

They may have carried someone for 3 days to get to your clinic under a tree on the banks of the Nile, just to say no, there’s nothing we can do.

And they would still say thank you, just for spending the time to touch, to look, to care but it’s especially hard when its conditions so easily treated at home, diseases we are vaccinated against, diseases of hunger and poverty reflect in the hollowed-out faces of children.

The best part of my humanitarian work was the living beside, living within the community, sharing knowledge, stories, myths and legends, learning the cultural values and beliefs, superstitions and being privileged to witness traditional practices, initiations, sacrifices and being immersed in the raw daily life and beliefs of different cultures.

The Kimberly

After several years of humanitarian work, I felt I could never work in a “hospital setting” again. Battered, burnt-out and broke I returned to Australia and went Remote, working 3 years in remote indigenous communities across the Kimberly.

Ebola – Sierra Leone

In 2014 when the world turned its back on the Ebola crisis and Australia refused to assist, I joined the International Federation of Red Cross (IFRC) and worked in Sierra Leone.

This was my privilege, to work alongside some of the bravest, most courageous national staff in the world, Muslim and Christian united. “God bless Allah”. The catch cry.

As horrific and challenging as some of it was, it’s one of the highlights of my humanitarian career.

The Kenema Ebola Treatment Centre was located five hours from Freetown. In 2000, Ebola killed just over 400 people in Sudan, but by 3rd December 2014 more than 6000 people had died from the outbreak, mostly in Guiea, Seirra Leone and Liberia. Opening in September, the Kenema Ebola Treatment Centre saw hundreds of patients by November (Passi, n. d; WHO, IFRC).

Worringly, Ebola has not slowed down, with 2019 seeing an Ebola outbreak in the Democratic Republic of Congo. Read more here

Northern Territory and Queensland

Since then, I’ve spent the last 4 years working as a locum RAN around the Top End of NT and Qld, with a few short stints in Vietnam and Papa New Guinea in between. I really love my job, the challenges, the diversity the Autonomy. I love the naivety of the indigenous, the strength, the courage, the knowledge, stories and humour.

Numbulwar is a small, primarily Aboriginal community on the Gulf of Carpentaria in the Northern Territory of Australia. The major language group of the community is Nunggubuyu and their language, Wubuy, is used by older generations. Kriol is also widely spoken.

Now as I write this, I am here on Cocos Keeling Island. The remotest of Australian clinics. A Stunning tropical paradise 4.5 hrs from Perth, a small volcanic atoll in the middle of the Indian Ocean. Serviced by plane twice a week and medical evacs weather dependant. Yep, I’m getting paid to work in paradise, and you could too if you’re willing to work hard, study hard and are determined.

I think the most important thing about being a RAN

Having excellent assessment skills. You never know what you’re going to get in at any moment. You need to have the skills to assess, diagnose and treat independently until help can arrive. This can be anywhere from a few hours to several days. (My last evac took 69 hrs). Yes, there will be a doctor on the end of the phone (if you have reception) but they are guided by your assessment, evaluation and treatment. I believe my patients get as good a treatment/care remotely as they would in a city ED.

Not wanting to pass it on for fear of losing something, for allowing our colleagues the possibility to gain one up on us. We are so often competitive, aiming for specific roles that we won’t share, but the truth is, by sharing your knowledge you are gaining more skills than you are giving away. You’re empowering others and enhance your own practice.

Knowledge is power, I always explain what I’m doing and why

Break it down to simple language. I get a real kick when one my patients call telling me “sister him propa sick, him doin that breadin quick wid him belly up n down” they’ve listened and learnt and are seeking assistance, allowing for early intervention. They are empowered, proud and pass that knowledge along to family and friends. We as practitioners also benefit as early intervention can be the difference between a few hours in the clinic and all night waiting for a plane, or worse….

I am also very interested in bush medicine and spiritual beliefs and superstitions. I ask about what they use/ do etc. sharing works both ways. It puts us on a more even ground and ensures I don’t inadvertently offend anyone.

What to do when arriving in a remote clinic in Australia

First thing I do when arriving in the community is ‘ORIENTATE’, preferably with a local. Find landmarks and where you can and can’t go. Make a list of KEY people.

Men’s business areas may mean you can’t even look at that hill or in that direction, that you travel past with eyes down. This is extremely important as if you were seen going near or even looking at a particular place and then something happened, it could be associated with “you looking at men’s business”. It would be disrespectful and could cause you grief down the track.

The most important thing when arriving at the clinic (after meeting staff) is an orientation to the Resuscitation room. As a locum you can expect to get the hardest positions, to work your ass off and cop an absolute flogging. It would be VERY likely you will be on call the day you arrive, so a good orientation is essential and YOUR responsibility. I always go through the emergency gear, check the defib, the crash cart and the Thomas packs. I can’t tell you how many times people have said “oh plenty of time for that” only to be attending a full-on emergency within a few hours of arrival. It may be me, (I do have a reputation as a shit magnet) but it’s what I do (and what I expect) so that I know I’m ready.

Essentials to carry when on call

Have a grab pack
Head torch
Bug spray
Water
Dazzer (a tazer for dogs)
Knife
Pen and paper

Courses you can take

There are now postgrads in remote practice, and bridging courses such as: “Transition to Remote Area Practice” run by the Centre for Remote Health.

If you’re interested in remote work you can study and work as a Nurse N3 in NT in a Remote Community with the support of a Nurse N4s and Doctors until you gain the experience and get a handle on the cultural aspects.

To be working as a RAN in small clinics without a doctor, I’d advise these courses as the best for the basis

Emergency Assessment skills (> 2 yrs. Emergency) post-grad Emergency
(Alice Springs ED gives a great experience in a supported environment.) You CAN NOT LEARN emergency skills at 3 am alone in the dark!
Advanced Life Support, (ARC) (NCCTRC)
Advanced Paediatric Life Support including Neonatal Resuscitation (ARC) (NCCTRC)
Trauma-based course, i.e. REC (CRANA), RATE (NCCTRC) in my opinion the best by far is TNCC (ACEN)
Prehospital Emergency course ITLS (ACEN) Remember you’re it, you’re the Ambulance driver, SES, Paramedic and Nurse all in one.
Maternal Emergency Course MEC (CRANA) PROMPT, MEM, MIDUS (midwives)
Immunisation Certificate, National = CRH but doesn’t cover Qld. (CRH)
Pharmacotherapeutics Flinders Uni (CRH)
RIPEN (Qld)
Primary Health, School Health, Child Health.

There are lots of courses and course providers. It’s a big business now though some are not worth the paper they are written on. Just because you have the paper doesn’t mean you know your stuff.

I have always judged my own skills by “what I would expect from someone treating my child/ family member”. I didn’t go remote, or off with MSF until I felt I was safe (for my patients). I was scared to death of kids so when I did my Grad Dip Emergency I did a Paeds focus.

After 5 kids attempting suicide in 2 week period, and not getting any support/ help on the ground for 7 weeks I studied my Grad Cert in Child and Adolescent Mental Health, so that I could have better skills on the ground.

Out Remote, sometimes you have to work out of your scope in a life and death situation

It is very scary and you need to know that even though a doctor is directing you over the phone, they will NOT be standing next to you in coroner’s court. Just as no one will be if you make a mistake because your skills don’t match the requirements. Many nurses get caught up in the “romance” of working remote, or the money. Let me tell you, you earn every cent, and can’t sustain the workload for too long and still remain efficient. There’s not much romance being the only medical person at 3 am, and 50% on call.

In saying that, it’s still the best job in the world for me, I LOVE it and hope I am making a little difference each and every day.

So some tips for those chasing the remote/humanitarian dream?

Go for it. If I can do it anyone can.

Words of Wisdom?

Number one #Gayleslaw Never Alone. Always have back up, any set of eyes, Never Alone.

(Google the story of Gayle Woodford) I believe Single nurse posts should be banned and question the skills and motives of anyone willing to work in one. #Gayleslaw Never Alone!

Study hard, work hard and treat others how you’d want to be treated.

Put yourself in the patients/ family’s position. Look from their perspective.

Who knows? – Mum knows! Trust mum, she knows her child best. If she’s worried so should you be!

Make sure your skills match how you’d want your own family cared for.

Open-doors, challenge yourself. Sometimes the worst things ever happening leads to something Awesome.

Be kind, you never know what people are living with!

“See One Do one Teach one”. Share your knowledge and be prepared to listen and LEARN.

Empower your patients, build resilience, encourage responsibility, acknowledge effort and progress.

Everyone is good at something, Everyone. Look for that, it’s a key.

No Helmet No Ride!

We are here for a good time not a long one. You’re a long time dead. Get out there and chase your dreams!

We hope you enjoyed this insight into the life of a RAN nurse. Please comment and share!