Emergency Parry Packs are being Removed from the Wheatbelt Health Sites. 3oth Nov.2018.

Goomalling, Western Australia. 2018. Photo by D.Quirke. 

Attendees at the Senior Nurses Leadership Group were instructed yesterday to remove the emergency Parry Packs from all Western Australian wheatbelt sites. The Parry Packs were supplied to rural and remote area health sites and  nursing posts in 1996 to support our capacity to deal with trauma. It can take between one and three hours to cut a casualty out of a motor vehicle on isolated roads. I would like to say that I personally do not support this action. I have always endorsed the use of and availablity of the Parry Packs, having worked in rural and remote areas for years. The packs are medium weight, large high visability back packs that contain equipment for dressing wounds, suturing kits, chest drains, basic dressings, and airway equipment. From a personal perspective, it's not about the cost (the packs and contents are over a thousand Australian dollars) but the purpose. I feel if they haven't been used, then we were lucky...very, very lucky. 
Dheborah Quirke. Senior Registered Nurse.

Western Australia... Two new jets for RFDS.

"The New semi-Geometric Possibility"

photograph by D.Quirke. 

"Our E.T.A will be in 17 minutes..." are words that fill us both with relief and cold pressured fear.  I don't know how many times I have heard them over the years. It means the ambulance will pull up in seconds and I have to have a patient 'ready to go', copies of every document photocopied, and answer the questions thrown at me by someone's family while I attempt to calmly make last minute calls. It also means that I've probably got 5 minutes to get ready because it takes 12 minutes to get to the runway. Heofonlic angels will soon arrive as we finish unpacking bits of hell. 

A short time later, I might be standing in an aeroplane hangar  under the shadow of large, silent propellas, or outside on a runway. Sometimes a plane pulls up next to our ambulance moments after we park and sprays us with fine gravel. I don't know how many times I have wished I wore seven padded jackets. Sometimes we stand in tin sheds. Once an ambulance volunteer held a tiny injured bird while we loaded a patient onto a trolley out under a black, silent, star-lit Heaven's Gate. 

Next week, two new Pilatus PC24  jets are being made available for casualty and emergency retrieval at Jandokot for the RFDS and Broome base. West Australian RFDS presently uses Pilatus PC12 single engine, pressurised turbo prop planes which can hold two stretchers and seat 3 people. These can fly at 450 km per hour. Emergency RFDS retrieval expert Hakkan Yaman describes them as "mini I.C.Us in a tin can". These tin cans can glide.

Dheborah Quirke. 27th November 2018.

"Used to be Silver": Trains in the Western Australian Wheatbelt.

photographs taken in Mukinbudin, West Australia by Dheborah Quirke 26/09/2018

Rural nursing in Western Australia.

The pilot of RFDS doing some of his checks before flying out 2 doctors that held womens clinics in the region recently.

I was at an advanced life support class in Perth a few weeks ago (with some commercial divers) and someone asked,"what is a nursing post?" Koorda, half an hour away from Mukinbudin, have a beautiful nursing post. From the outside it looks like a shed. Inside, it is a modern, contemporary place that is capable of all the services offered by doctor's rooms and health services. Their Comunity Health nurse has just been told that her services have been reduced to ten hours a week. She has also been told she can't take bloods and can't triage any more. This defies normal sensibilities. Rural and remote communities have always questioned the logic behing government funding, especially with regards to health resourses in small, more isolated Australian towns. Munkinbudin and Koorda have no pathology service or collection service. We can both take bloods but we are not allowed to use government cars to take them to Merredin, an hour away, for pathology. A doctor visits Mukinbudin and Koorda nursing posts once a week.

My own skills include suturing, applying casts (I tend to put on backslabs and transfer for x-rays), putting in intravenous drips, and examining ears. I do simple and complex wound dressings, as well as changing PICC line dressings. I have midwifery skills but don't practise in Australia. I have a background in working in elective surgery post-operative areas such as plastics, orthopedics and bariatrics. My first few years after graduating (that was a long time ago) were spent in an Intensive Care unit in Durban, in the Republic of South Africa. I have  worked in most of the smaller whealbelt emergency departments so arranging Royal Flying Doctor Service transfers and chopper transfers almost seemed easy some days. 

After years of extending my scope of practice, regretably, my lifetime of skills are slowly being shut down by primary health services that think our patients should only come if they have appointments. It's a funny thing...but people that chop their fingers off when untangling sheep from fences...haven't got time to make an appointment. They are going to be too busy working out how to hold their steering wheel while they drive to the closest place for help...while they are in shock; in agony; and their hand is sliding off the gears and the wheel. We may not be called an emergency service but we are an emergency service...a basic, fundamental emergency service that is about one thing...survival. Survival in rural and remote areas of W.A can mean anything from snake bite to not being able to purchase shoes and underpants (underpants are a rare commodity in Mukinbudin).The places that are in the most need of services are having them removed. 

There are 49 nursing posts in W.A. We can do almost everything except take x-rays. We do have urinalysis and pregnancy detecting gadgets but don't have i-stat equipment : these read venous blood gases and are found in most rural emergency departments. Most of the small West Australian rural hospitals have the Emergency Telehealth Service with virtual doctors from Royal Perth to assist them. We also do everything on our own. When we haven't done it on our own, it has been with the assistance ot the people in the town. My last two resuscitations were in Wyalkatchem hospital: unpaid St John's Ambulance volunteers (some were local mechanics) and the local pub were our emergency responders, medical team, and communications. Above us, on a T.V screen, a doctor from Royal Perth Hospital spoke to us and 'gave us a hand'. The nursing posts, however, although patients can have appointments arranged via telehealth, don't have E.T.S. yet. Removing nurses from the health formula is going to leave a huge gap in health services in the country. Nurses need nurses in management. They understand that a mixture of calmness and cold fear are our drivers behind decision making. Everyday is an exercise in potential emergency management. A normal day is based around the fact that anything could happen. If nothing happens...absolutely bl**dy nothing...it either means everyone is well (which is fabulous) or no-one has had an accident (which is also fabulous). Why would anyone, in the search for productivity, resent that. Who is going to predict that a man in the rubbish truck is going to knock on the door 2 minutes after closing time because his truck window exploded next to his face?

So, you thought you were really famous...and you came to Perth..

image by dheborah quirke

"fancy pant's secret pakheha hideout"

When the sun.

Photograph by D.Quirke.

Kellerberrin, Western Australia.February 2018

The Night after the Super Blue Blood Moon...Australia.

Photograph taken by D.Quirke at Cunderdin, a few metres off the Great Eastern Highway, Western Australia.1st February 2018.