It is 1960. Australia is just 25 years off its bi-centenary; a modern nation for modern times, enjoying the last of the long, post-war economic boom. The Kimberley however, is only 80 years old in terms of European settlement and very little has changed, but as the decade unfolds, cataclysmic changes will sweep through the Kimberley.

This paper describes these changes and the Australian Inland Mission’s (AIM) response to them.
 

THE KIMBERLEY CONTEXT

The story of the AIM hospitals and nurses has to be told in the context of the Kimberley in general. In 1960 Broome is a dying town. Derby and Wyndham subsist as government and administrative/medical centres for the West and East Kimberley. The topsoil is being hosed off Bandicoot Bar in preparation for the 3,000,000 pound Diversion Dam on the Ord River. Kununurra, the newest town in the Kimberley (and Australia), is not yet marked on any maps.

The rough unsealed roads and low level river crossings deter all but the hardiest traveller. It will be another five years before tourism tentatively starts as an industry.

In the hinterland, the “AIM hospital towns” of Halls Creek and Fitzroy Crossing are trading posts for the cattle industry, which, with the three meat works at Wyndham, Derby and Broome, sustains the whole region economically. In 1960’s the Kimberley rides on the bullock’s back and the American hamburger market.

The cattle industry is labor intensive. The work force is predominantly aboriginal. There is work for all but the very old and the very young. Two thousand plus aborigines live in small overcrowded camps on million acre cattle stations and a few sheep stations down Quanbun and Noonkanbah way. The station leaseholds cover traditional country so the bond with the land is not broken.

For most of the 1960s the Kimberley aborigines do not have citizenship rights. They don’t vote; they aren’t allowed to drink and the workers earn one pound ($2) per week (paid quarterly) plus keep for themselves and their entire family. All this will change at the end of the decade following the referendum in 1967 when they will be granted citizenship rights and after the Industrial Relations Commission introduces the basic wage for workers in the pastoral industry in 1969.

These two significant developments will precipitate a forced movement of the aborigines from the stations to the towns resulting in a move from a feudal society based on rations and subsistence wages to a cash economy based on welfare. With this will come voting rights, drinking rights and unemployment.

AIM HOSPITALS CIRCA 60s

Kununurra

The AIM responded to the first change in the Kimberley when it was asked by the Western Australian Government to provide a traditional outpost hospital service at Kununurra. With a government grant and money raised by the Associated Women’s Guilds of NSW, a hospital, Manse and community hall were prefabricated in Sydney, transported by ship to Wyndham and from there by road to Kununurra, where they were erected and operational by September 1962. This outpost hospital was to serve the agricultural, pastoral and administrative industry on the Ord for the next 21 years.

Halls Creek and Fitzroy Crossing Hospitals

Meanwhile at the other AIM Hospitals at Halls Creek and Fitzroy Crossing, very little had changed. Nurses still went out in pairs for two years and were paid one pound a day ($2 when decimal currency came in) plus keep and airfares both ways.

Whilst the Halls Creek hospital was custom built when the government moved the old town to new Halls Creek in 1954, the hospital at Fitzroy Crossing was substandard. Built in 1939 of unlined corrugated iron, it had cement floors, shutters and mesh ‘windows’. Patients were nursed on six stretchers and the overload in their swags on the verandah. Accompanying family members camped in the shed and were rationed. There was a wood stove, kerosene refrigeration, no hot water system and no staff quarters until 1968. The nurses pumped their own water, generated their own electricity (and maintained both engines), made the bread and grew a vegetable garden in the dry season to supplement their diet of beef which was supplied by Gogo Station.

Both towns received a mail plane once a week. There was no telephone to Derby or Wyndham (or the rest of Australia for that matter); urgent or family business was transacted by telegram from the local post office.

The nearest doctor at Derby was contactable by transceiver radio via the Royal Flying Doctor Base for the daily medical session, or for an aerial evacuation. There was no radio contact outside of the session times-the two toned emergency whistle didn’t come until the late 1960s, so the nurses just had to cope on their own in emergency situations.

The Flying Doctor held a clinic at each AIM hospital once a fortnight.

In the early 1960s the RFDS plane was a de Havilland Dove piloted by Captain Peter Barreto, who was known as Peter the Pilot but mistakenly referred to as Pontius the Pilot by one of the Mission natives! The Queenair and subsequently the Kingair, came on line later.

These two AIM hospitals were very busy. The 1960 statistics show that they each had a daily bed average of six inpatients. As these were pre-dominantly babies with gastro enteritis their mothers came with them and had to be cared for as well. The workload for two nurses was excessive. They worked day and night and days off were unheard of.

In 1964 the AIM reluctantly agreed to increase the staff three. The reason for their reluctance was that it was a break with tradition, and there was a risk of three being a crowd and one staff member being on the outer with the other two.

Arriving at Fitzroy Crossing

Gloria Natoli (Nat) and I ran the Fitzroy Crossing hospital between 1963 and 1965. We finished our midwifery training at Sydney’s Royal North Shore Hospital in January and left the next day for Fitzroy Crossing. I will never forget our first impressions when we arrived three days later. It was stinking hot and we had been air sick all the way from Wyndham on the DC3 mail run. The only relief we got was to squat under the wing in the shade whilst mail and freight was unloaded and news exchanged at the various stations. In those days the MMA hostesses handed out fresh fruit to station children who came out to meet the mail plane.

The Fitzroy Crossing airstrip featured a broken down bough shed, which offered no shade, a windsock and a fuel dump. Nobody met us. After he had refueled the plane by hand pump from the 44 gallon drums, the MMA agent gave us a ride to the hospital, which was barely visible above the shoulder high wet season cane grass and weeds.

The relieving sister greeted us with the news that the lighting plant wasn’t working, the fridge was smoking and there was no water because she had a sore back and couldn’t start the water pump. Nat, who had a mechanical bent, went to the engine shed where she checked the engine and found the problem in the switch board, which she rectified, and we had light. Having grown up with kerosene refrigerators, I was able to change the wick and we had refrigeration. We then both wrestled with the water pump, cranked the small fly wheel which in turn articulated via a long, long belt with a bigger wheel which eventually engaged and started pumping, and we had water.

I will never forget our sense of desolation. We had travelled so hopefully and here we were in this horrible ‘town’ which in the 1960s consisted of five buildings scattered for two miles along the banks of the Fitzroy River. The rains came soon after we arrived, the river rose and swept across the floodplain for about 20 miles and we were left isolated on our own little island for two and a half months. We hardly saw another white person.

Somehow or other, station people made incredible efforts to get sick aboriginal children and their mothers to within striking distance of the hospital so that they could make the rest of the journey themselves. We soon experienced the first of many major gastro-enteritis epidemics. We admitted 20 dehydrated babies, who despite our 24 hour nursing care, nearly all died because they came to us too late. This was to be the pattern of our next two years.

Our strongest memory is of working night after night on moribund babies; of watching them die. Of wrapping little bodies in a blanket and leaving them in the engine shed for the Missioner to pick up and bury the next morning. Of the mothers wailing and hitting their heads with stones in their sorrow. Of walking up to the police station in the middle of the night to report the death/s to the policeman. Of being told off for waking him up (despite this being his requirement). Of biting my tongue when he invariably asked if the death was caused by a spear or other suspicious circumstances. Of always replying “no, just a preventable disease”.

Nat and I would often say “If only we could get out into the camps and pick them up in the early stages, before it was too late”. If only!

The opportunity to do just this came my way in 1966 with the commencement of an itinerant child care service as an outreach of our traditional hospital service.

AIM ITINERANT CHILD CARE SERVICE CIRCA 60s

That I happen to be the pioneer of this particular field of nursing as far as the AIM is concerned came as a result of my experiences at Fitzroy Crossing Hospital and at the request to AIM by Dr Davidson, the then Commissioner of Public Health in Western Australia. The Commissioner had long cherished the idea of public health nurses working at community level, but had been unsuccessful in his prior endeavors. As the AIM ran the hospitals in Kununurra and Fitzroy Crossing, it was a natural challenge for us to accept the gauge, which the Commissioner threw down. Olga Harris was appointed in 1965 to work in the Kununurra/Wyndham based on the Kununurra Hospital, and I returned to the Fitzroy Crossing Hospital in early 1966 after completing Infant Health Training at Ngala in Perth.

Starting the service

I went out in Landrovers equipped with a portable radio, a functional clinic and a basic home (swag, tucker box and water bag). My instructions were to reduce the infant mortality and morbidity rate by raising the standards of childcare in the aboriginal camps. These camps consisted of rows of small tin huts in which an average number of eight people lived. Some (not all) camps had a central ablution block. A perimeter was formed of general rubbish and the bones of many dead bullocks (the meat supply). A few trees struggled for life in the rocky ground and white cockatoos settled on them and screeched incessantly. Overall was the dust, heat and flies and the smell of the old bones. This then was the utterly depressing setting in which the work had to be initiated.

My area covered six such camps within a 30-mile radius of Fitzroy Crossing in which seven hundred aborigines lived. I drove to each camp twice a week thinking at first that all I had to do was to pick up the sick children early and take them to the AIM hospital. My thinking proved very wrong. This did become part of my work, along with medical checks, minor treatments, antenatal care, trachoma and anemia treatments, immunizations and leprosy checks. This was my “hospital half hour”, conducted from the tailboard of my Landrover, before my major work for the day – health education.

The nurse became a teacher of:

• Child care, with emphasis on adequate and appropriate food and water, hygiene, clothing and care of it.
• Environmental care, with emphasis on rubbish disposal, camp cleaning, housekeeping and vegetable growing.
• First aid with emphasis on self-reliance. I taught the mothers how to care for their children’s sores, treat their infected ears, and administer treatment for their anemia on an on-going basis.

A normal working week

A normal working week consisted of five days in the camps. Trachoma treatments were carried out at daylight and dusk for maximum cover when the people were either getting out of, or getting into, their swags. Then I’d conduct my “hospital half hour”, routinely checking the health of babies and preschoolers and seeing anyone else who was sick or pregnant. Then I’d carry out my various health education programs. After lunch I’d go to a second camp and repeat the process there, returning at sundown to the camp receiving the trachoma treatment that week to administer the oily Achromycin eye drops.

On Saturdays, I did all my writing up for the week in comprehensive records that I’d established for each child, as well as the graphs and the action research data that I happened to be working on at the time. On Sundays I cleaned my Landrover and gear and washed my clothes, which were always filthy. I played tennis on a Sunday afternoon at the AIM Hospital tennis court. After two years I had a holiday.

Developing the service

It took over two years for my health and education program to be translated into routine behavior. However, with the health of the babies and pre-schoolers under control in 1968, I spread the work from a child oriented service to a more public health oriented one to cover the family unit. This involved the introduction of school medical examinations and more emphasis on the care of the mother, especially during the three critical phases within her reproductive life cycle:

• the antenatal phase, because of the critical need to control maternal disease and nutrition to reduce infant brain damage from protein/calorie malnutrition in utero.
• the breast feeding phase, because of the critical need to successfully bridge the gap between breast feeding and solid foods.
• the re-productive phase in general, because of the need for birth control for ‘better’, not ‘more,’ children.

At the end of three years, the infant mortality rate at Fitzroy Crossing had dropped dramatically; my records indicated only one infant death in that time. Gastro enteritis was episodic rather than endemic. The gap between breast breastfeeding and solids, a critical factor in Aboriginal child rearing had been bridged. Complete immunization cover for

the community, (Aboriginal and white) had been achieved, including direct BCG at birth, which in those days, was considered to be a preventative measure against leprosy.

Pre-school as part of the service

In order to bridge the gap between camp and school, I commenced structured preschool play sessions in the shade of my Landrover. These sessions were formulated in consultation with teachers at the station schools. The first station school began operating in a cave in the range on Gogo Station in 1962. Schools on Kimberley Downs, Cherrabun and Christmas Creek stations were in operation by 1968.

The pre-school work was to be further developed by Maisie Ross at Halls Creek within the context of her holistic health education program. This initiative also showed the way. The AIM established fixed and mobile pre-school services in its areas of operation and the Western Australian Education Department did likewise in other areas.

Expanding the service

From my point of view, 1969 marked the end of the ‘pioneering phase’ of the extension of AIM’s hospital services into the camps, but it didn’t end there. The work had been fostered by the Commissioner of Public Health and who had a wider agenda, that of a public health orientated community based (as opposed to hospital based) health service to cater for the basic health needs of disadvantaged Western Australians.

Following a visit to Fitzroy Crossing in 1968, by the Minister for Health (Hon Graham McKinnon), the Commissioner of Public Health (Dr Davidson) and the Chief Matron of WA (the redoubtable Miss P Lee), a decision was made to expand the work.

Joan McDonald was appointed as the first itinerant AIM sister at Halls Creek later in the year. Grace Finlayson and subsequently Brenda Arnold were to continue the AIM work at Kununurra.  Government funded nurses were appointed to the Government towns of Derby, Wyndham and Broome.

That’s the end of the AIM story in the 1960’s although the story goes on, one way or another.

The success of these pioneering efforts would subsequently lead to the establishment of a new branch within the Western Australian Health Department in 1972, called the Community Health Services. The enabling Act of Parliament established the infrastructure to carry a statewide public health nursing service, which was called the Community Nursing Service.

CONCLUSION

The decade of the 60s was a watershed for the AIM in the Kimberley. The outpost hospital system that had suited the Kimberley well, for over 40 years was called to respond to changing times and changing demands. It is my belief that the AIM not only met the challenge, but also made public policy with its itinerant nursing service.

However, the powerful external constitutional and industrial forces of the late 60s led to population explosions in the “AIM towns” which was brought about by the mass movement of the aboriginal workforce from the stations in 1969.

These changes threw the whole concept (and future) of AIM outpost hospitals in the Kimberley into question.