Patricia McPherson finished a decade of work from 1962 to 1973 in the Kimberley region of Western Australia, first as a sister at the AIM Hospital Fitzroy Crossing, and then as the pioneer of itinerant nursing in the Aboriginal camps. She was physically, emotionally and intellectually drained. She left the Kimberley both depleted of energy and without financial resources after years of being on a nominal ‘mission’ wage. 

But Pat McPherson’s Kimberley experiences had left her with two life-changing consequences. One was her realisation that she wanted to dedicate her professional life to community health. 

The second consequence was the meeting between Sister Pat, a legend of a nurse, and Luke McCall, the legendary outback stockman. Their lifelong friendship endured across the continent of Australia and across time.

FURTHER EDUCATION

Her immediate challenge after leaving the Kimberley was to replenish her inner resources, principally through further education.

“The pioneering work was over, new people with new skills were needed to take it to the next level and I was very tired and completely empty. I knew if I wanted to be a contributing person in the 1980s I would have to ‘fill up’, so I returned to Victoria, recovered, then took myself off to University and undertook an Arts Degree for four years, majoring in Sociology and Politics. 

I loved being at University as I found study very energizing. In fact the 70s was my favourite decade. The latest phase of the feminist revolution was in full swing which saw legislative advances in public policy that benefited women, such as equal pay, equal opportunity and anti-discrimination – all heady stuff which I found challenging and stimulating.”

 

 

PIONEERING PROGRAMS FOR THE RDNS

Pat’s plan to dedicate herself to community health was realised when she joined the Royal District Nursing Service (RDNS), the pre-eminent not-for-profit agency for community health nursing. During her years with the RDNS, she was able to plan and pioneer new clinical programs that introduced specialist clinical nurses to meet the challenges of treating existing health problems in the community such as diabetes, and new health perils such as AIDS.

“After Uni. I was invited to join the Royal District Nursing Service (RDNS) in Melbourne where I spent 14 years working in Centre and Regional Management and then in 1987, I enrolled in a Masters Degree in Nursing Studies when it was offered for the first time in Victoria. This was a part-time course which I completed in1991 following which I was appointed as the Policy and Planning Officer for RDNS.

Planning involved developing new clinical programs which only became possible after the introduction of a new career structure for nurses that was one of the outcomes of the big nurse’s strike in the 1980s. The existing career structure only catered for nurse administrators and nurse teachers. The new one opened up opportunities for clinical nurses. New programs involved our specialist clinical nurses in AIDS care, leg ulcer management, continence management, 24 hour care, palliative care, Cystic Fibrosis home care, wound care, homeless person’s health care and a Diabetic Teaching Program.”

DIABETIC TEACHING PROGRAM

“The Diabetic Teaching Program (DTP) came about because I felt that there was an inordinate number of diabetic patients on the books for years in order to receive daily insulin injections and blood tests (finger pricks). I couldn’t see why most couldn’t learn to do this themselves. Not only that, they needed to understand all about their tablets and/or insulin, its administration, side effects and the equipment. They also needed to learn about (and manage) all other  issues related to their diabetes – diet, activity, care of teeth/eyes/feet and monitoring control. The Director of Nursing (DON) accepted my recommendations and together with the best of our nurse educators/clinicians we put together a complete DTP incorporating all of the above.  When this became established practice, 90% of new diabetic patients admitted were discharged because they had learnt to manage their own diabetic care.”

 

AIDS EPIDEMIC

Pat played a critical role in developing an effective community nursing response during the AIDS epidemic.

“The AIDS epidemic caught all health care organisations unprepared and there was a mad scramble to find a treatment. RDNS came into the picture when treatments began to save lives and young men were being discharged to home care and this project became mine to handle. It started with one nurse (who had undertaken self-directed learning)  and the first patient who became a test case. Every issue that came up (i.e parents/partner/gay community relationship, undertakers requirements, non-availability of normal in home supports) was worked through. This pioneer nurse was on call 24/7 but as more men were discharged home, we educationally prepared four more AIDS nurses, one to each region and as the numbers increased even further. AIDS care was devolved to the area nurses who were educationally supported at all times. Regarding the lack  of care from other community agencies,  we set up a joint project between RDNS and Victorian AIDS Council Home Care Unit (a group of gay volunteers who organised themselves into a strong home care team).  It was very successful collaborative (and sustainable) outcome which lasted throughout the AIDS epidemic.”

 

 

 

FRAMING POLICY FOR THE RDNS

“Policy involved keeping on top of federal and state legislation and policies relating to health, aged care and nursing, writing position papers and submissions as required, well over a hundred if I remember correctly.  At the same time, together with a very gifted consultant and technical writer, we re-developed all the Agency policies and procedures within the framework of the Australian Health Care Standards by which the Agency was accredited. 

In my last year I prepared the agency for compliance with the new Commonwealth and State health privacy legislation.”

“In 1999, I had a particularly interesting experience when the head of RDNS education department obtained an AusAID grant to develop a Primary Health Care Plan for the island nation of Tuvalu (formerly Ellis Islands) – nine coral atolls stretched for thousands of miles along the Equator. This was a requirement when the nation signed up to the Health For All By Year 2000 Movement of the World Health Organization. She asked me to go with her because I had done my Masters thesis on the development of this movement and had a full grasp of the WHO framework and requirements.

It was full of highlights not the least of which was having to bribe a baggage handler at Suva airport to get our gear onto the plane. We were told we could go, but not our luggage which contained all of our teaching equipment. But twenty Australian dollars and a bottle of gin soon fixed that.” 

 

 

LUKE McCALL

“The best reward that came my way (in the Kimberley) was meeting someone who was to become my best friend and soul mate. 

In late July 1967, I was waiting on the Fitzroy Crossing airstrip to put an Esky of pathology specimens on the DC3 mail plane en route to Derby when a tall handsome man, dressed entirely in black, came down the steps nonchalantly carrying a saddle over his shoulder, much as a city guy would carry a sports coat. He tipped his hat and said ‘Good morning’ in a plummy voice. 

His name was Luke McCall, a legendary stockman from the Queensland Gulf country who’d arrived to take up the position of Head Stockman on Jubilee Downs station.

I was working in the Jubilee camp later that morning and met Luke at lunch and was quite taken with his quiet dignity and manners. I was a bit blown away actually.

The muster (herding cattle and trucking them to the meat works) started soon after Luke arrived and I didn’t see anything of him until one day as I was returning to town after my weekly visit to the Jubilee camp, I came across a small tree bough placed across the track. Intrigued, I followed the way it was pointing through the scrub and came across the musterers’ dinner camp.  Luke and I had a chat and a drink of coffee and off I went. From then on, I would come across a bough across the track from time to time that would lead to Luke’s dinner camp for another coffee and chat.

During next year’s mustering season these meetings graduated from ‘smoko’ to ‘supper’ when the stock camp was camped not far from town on Jubilee’s No. 4 bore.  I would buy a packet of bacon, half a dozen eggs and a tin of pineapple juice and we would dine by the camp fire under a million stars, serenaded by horse bells and the low mooing of cattle. It was very romantic I can tell you.

At the end of that season, Luke decided that the Kimberley wasn’t for him and returned to the Gulf. He began writing to me and our friendship developed through letters.

1972 when I completed my work in the Kimberley and returned to civilization to recover and undertake years of study, Luke visited me wherever I was during his wet season break. When I got on with my career and bought a house in Melbourne, Luke could stay for the duration of the Wet. He took to holiday life in the southern capital like a duck to water; charmed my family, friends and neighbours; developed a passion for fine dining and learnt to ride a tram. 

Our friendship lasted for over 50 years, sustained by letters, phone calls (when Telstra came to the outback), holidays and Christmases. When we had both retired we made annual road trips to celebrations/reunions at the Stockman’s Hall of Fame in Longreach and the Drovers Camp at Camooweal on the Queensland/Territory border, meeting up with Luke’s old friends and acquaintances along the way.

In his 86th year Luke became very unwell so I brought him home to my place and became his carer. I was with him every day until he ‘left camp’ on 9^th November 2018.” 

Read Pat’s stories in WomanGoingPlaces about Luke McCall’s life as a legendary Australian stockman of the outback.  And about their annual trip to the iconic Drovers Camp Festivals held every year to commemorate the droving tradition when Camooweal Queensland was the centre for the largest cattle drives the world has ever seen.

 

 

RETIREMENT AND REFLECTIONS

Pat retired to Bairnsdale in Victoria in 2002.

“After twenty-five wonderful years with the RDNS, I retired to Bairnsdale at the end of 2002 to enjoy the natural beauty of East Gippsland as a bird watcher, a bush walker, a land carer and a field naturalist  It is refreshment for the soul. And at long last, I have started to make long desired trips overseas”.

In the tough, isolating environment of her life and work in the Kimberley, Pat McPherson had found the strength and resilience she needed to face almost insurmountable challenges. She recognised that her work was of value, but it was her faith that provided the essential support she needed throughout those years.

“My years in the Outback were a time of rich spiritual growth. I found myself in an alien situation where all the props were gone. The church was no longer nailed down on the corner, accessible every Sunday and providing an uplifting gospel reading and a feel good homily for the week.

The AIM conditions, workload and challenges at Fitzroy Crossing so overwhelmed me that I couldn’t do it with my own strength and I needed help. I got it through a personal (direct) relationship with the Lord rather than one mediated by a Minister. I lived by prayer and when the chips were down (seemingly daily) I always got the help and the strength I needed which sustained me – that is my reward.”

And the rugged beauty of the Kimberley with its harsh seasons embedded itself in her heart.

“An unexpected reward came despite all the vicissitudes of the climate that I lived through i.e. the sub-zero nights and dusty, desert winds throughout the Dry season; unimaginable heat in the last three months of the year in the build-up to the Wet; shattering storms followed by stifling humidity when the rains came. 

By contrast, brief times of sweet coolness, colour and quietness at dusk and dawn and then the glory of the ever lasting stars at night brought refreshment for the soul and renewal. 

Along the way, the Outback became my ‘heart country’ and still is.”

PATRICIA MCPHERSON’S ENDURING CONTRIBUTIONS

Pat McPherson’s pioneering spirit and character together with her care for community and country have been consistent features of her life. Her innovative thinking, meticulous planning and application of solutions in community healthcare have fundamentally improved the healthcare system and saved many lives.

Her enduring contribution was recognised when in 2001, as part of Australia’s Centenary of Federation celebrations, Patricia McPherson received the special honour of being included on the inaugural Victorian Honour Role of Women – Women Shaping the Nation.

By the mid-1960s, Patricia McPherson had been working for two years as a nurse at the severely under-resourced AIM (Australian Inland Mission) Hospital at Fitzroy Crossing in the Kimberley region of Western Australia. (See ‘Sister Pat – A Legend of a Nurse’ Part 1)

Pat and her fellow AIM nurse Gloria (Nat) Natoli were deeply affected by the repeated experience of watching Aboriginal babies die despite their best efforts to save them. 

“After our arrival in Fitzroy Crossing, we soon experienced the first of many major gastroenteritis 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. 

My 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”. 

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.” 

In 1966, Dr. Davidson, the Commissioner of Public Health in Western Australia asked the AIM to find a way to reduce the exceptionally high Indigenous infant mortality rate in the Fitzroy Crossing area which was the highest in the state, as well as the significant number of hospital admissions of the Indigenous peoples. The AIM accepted and handed the challenge to Patricia McPherson. 

Pat was eager to take up a task she had long felt was necessary – treating and getting the sick children to the hospital in the early stages of illness before it was too late.  In taking on the task, Pat McPherson pioneered and established the Itinerant Child Care Service in the West Kimberley.

She created and developed an accessible, unique system of routine preventative treatment and holistic healthcare education that was available to the Indigenous population where they lived and worked. Pat’s project would save lives, reduce infant mortality to almost none, and raise the standard of child care in areas where people lived at subsistence levels. It would also usher in a new public health nursing service to remote areas of Western Australia.

Pat began her task by routinely driving in her donated Land Rover in the cooler hours of the very early mornings to the Aboriginal camps that were attached to 4 stations in her region of the Kimberley – GoGo, Brooking Springs, Fossil Downs and Jubilee Station.  Using the tailgate of the Land Rover, she set up a mobile clinic in whatever shade and circumstances that these impoverished camps could provide. Pat did not see her role as simply dispensing medicines.  She recognised that the illnesses prevalent in the communities she was tasked to serve arose from the powerlessness, abject poverty, and filth in which the people in the camps were forced to live, circumstances that were far removed from their traditional way of life and culture.

CONDITIONS IN THE CAMPS

Pat approached her work by first observing the situation in each camp and grew familiar with the people and culture of the place. She wrote:

“The Aborigines lived in small, overcrowded camps on million-acre cattle stations (privately owned ranches) and formed part of the feudal society which a cattle station was in those days. They had no rights. Furthermore, if they left the station they would be turned back by all the other stations and have no hope of employment or livelihood anywhere else. 

The camps are usually built on high bore ground within calling distance of the homesteads.

They consist of rows of small tin huts, the ubiquitous bough sheds and a washhouse-cum-ablution block, usually communal and detached. A perimeter is formed of old cans, bags and general rubbish and the old bones and hooves of many ‘killers’ – leftovers of the camp’s meat supply.

Goats, cats and pigs stroll around unconcernedly and dogs bark and fight and sleep as one with the inhabitants.

A few trees struggle for life in the rocky ground and the white cockatoos screech and wheel and settle on them.

From the shade of the huts, the people sit and watch. Overall, is the ever-present heat and dust and smell of old bones. The people lived at subsistence level.”

 

INITIAL ASSESSMENT 

“The original aims were to cut down the infant mortality rate and hospital admissions by raising the standard of child care.

My initial health assessment of the Aboriginal people showed that there was over 60% trachoma; one in 12 had leprosy; about 10% suffered from diabetes; at least three-quarters of the population had chronic anaemia; 27% of the babies and pre-schoolers had chronic ear infections with one or two perforated ear drums; about one-third of the group exhibited signs of deafness; 25% had suppurating sores; and nearly all carried a heavy bowel parasite load. Upper respiratory tract infection was rife and gastroenteritis was endemic and very often terminal. No comprehensive immunisation program had ever been carried out; and no ante-natal care was sought by the pregnant women who usually delivered in a creek bed and only presented at the hospital if something was wrong. Sub-nutrition was a way of life and no child under the age of two could be safely expected to last the distance, and most didn’t.

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.”

Thoughtful and analytical, Pat expanded the scope of her service to include a crucial component – health education that involved the participation of the entire community. She methodically worked with the people of the camps to bring changes that would bring a measurable improvement to the health of adults and particularly, their children. 

HEALTH EDUCATION – Expanding Scope of the Service

“My area originally covered ‘GoGo’ station and Brooking Springs station, the United Aborigines Mission camps and Aboriginal families with children who camped and worked at three of the houses and at the pub in the town of Fitzroy Crossing. I extended it to include Jubilee Downs and Fossil Downs stations.

“Getting sick children to hospital early did become part of my work, along with medical checks, minor treatments, antenatal care, trachoma and anaemia treatments, immunisations and leprosy checks. This was my ‘hospital half hour’, conducted from the tailboard of my Land Rover, 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 anaemia 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 dawn and at 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. This treatment had to be administered morning and evening, for six months to each patient.

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 Land Rover 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. “

In 1966, at the end of the first year of the project, she wrote:

“I have now worked for a full seven months in the Aboriginal camps and have driven 13,532 miles. An average of 1,933 miles each month and roughly 86 miles each working day.”

REDUCING INFANT MORTALITY 

Pat researched the causes of the illnesses prevalent amongst children in the camps, especially anaemia and gastroenteritis. She reached the fundamental conclusion that “our greatest weapon is to implement a full-scale teaching programme with more Aboriginal participation.”  

ROUTINE MEDICAL EXAMS 

“On each station I visit, the first thing I do is to quickly do a routine check on all babies and pre-schoolers. This means that each week I do 274 checks on the 128 children in the camps in my area.”

INFANT CARE

“I followed a six-point plan for babies’ daily needs – bath, clean clothes, milk, solids, water and sleep.

The first step was to get the mothers to clean their children up a bit, so I spent time observing their facilities and watching their own efforts, and gradually improved on them with what was available. Demonstration baths were done in wash troughs, old coppers, buckets, camp ovens, drums, the guttering in a shower room floor and in an old horse trough on another station.

Clean clothes were a problem at first as most mothers did not have many at all but this was overcome when the AIM Sisters at Fitzroy and the nuns at Derby Native Hospital started issuing layettes to all babies they delivered. These were supplied by the Native Welfare Department and purchased with money from the baby bonus.

The conventional wisdom in the Kimberley was that Aborigines successfully breast-fed their children for two years. Of course, I knew from my hospital experiences that this was not so because most children reached a low ebb at 9–10 months and died from either gastroenteritis or broncho-pneumonia, a complication of their poor general condition. In the camps, my research showed that the breast milk supply began declining after 4 months. I came to believe that in order for Aboriginal children to survive, they had to bridge the nutritional gap between breast and solids.

The aim was to ensure that the baby was well established on an alternative food source when the breast milk supply eased off at four months and mostly petered out at ten months.

As the only alternative food available was damper dipped in tea this raised a host of issues about sourcing a supply of complementary food (baby tucker) and feeding utensils and their storage and preparation. 

The implications of these findings for the Aboriginal women were great. There were no problems about breast-feeding, that was traditional, but they had to grapple with and ultimately accept the difficult notion of the introduction of food and water (of all things) at a time when breast milk was available and at a time when the baby least appeared to need it. 

Bridging the gap proved simple when their weight charts showed periods of decline at 4 and 10 months and I discovered their motor ability was far more advanced at three months than that of a white child. So, I started the early introduction of solids in the form of pre-cooked cereal and water to drink. With almost constant supervision and practice, by four months, they were on to three meals a day with a pannikin of milk to follow and water in between times, and I found they thrived and never really looked back. Their diet then increased, depending on what was made available to them on the various stations and from the store in Fitzroy – whether it was kitchen tucker of porridge, bread and milk, or soup and stew, or tins of baby food and cereal.

 

On the GoGo Station where the endowment money is pooled and food and clothing are issued from the station store, I received a weekly supply from the Manager and issued it and supervised feedings three times a week and just before the ‘wet’, the mothers knew exactly the weekly requirements for the babies; they then went to the station store each Sunday to ask specifically for the various items they had been handling all year – and I had worked myself out of a job!

On Brooking Springs Station, where the Aborigines are supplied with food for the babies from the kitchen and keep their own endowment money and buy from the Fitzroy store, I tried to change their ‘biscuit and cool drink’ mentality. With the co-operation of the local storekeeper, I gathered a crate of ‘good’ food on endowment and pay days and I myself peddled it to the mothers – the bonnet of the Land Rover looked like a self-service grocery store on these occasions and I had great difficulty working out change in (the recently introduced) decimal currency but fortunately, some of the young Aboriginal girls fresh from school could help me out! Eventually, I came to realise that it was easy for the mothers to have money available on these two days so I started taking the goodies out every week and this became a regular thing and slowly the mothers started keeping some money for next week so that the tucker box wasn’t completely bare always.

One thought I had in the back of my mind was to make them familiar with that which was good food value so that when they went into town to do their own shopping and were confronted by a range in the local store (which was made self-service this year), they would see something familiar on the shelves. 

Lately, I have stopped taking food to Brooking Springs and tend to run a delivery service instead. The mothers give me money and tell me what to buy and I take it out next visit. They themselves do most of their own buying now – true, they still buy biscuits, lollies and cool drink but they also buy Weeties, milk, tins of fruit juice and packets of dried fruit.

A slow change has started but whether it will gain impetus I cannot tell.”

WATER TO DRINK

A critical component of Pat’s 6-Point plan to reduce the very high mortality rate was the early introduction for babies of plenty of boiled and cooled, sterile drinking water. Babies who weren’t doing well were put onto water from a bottle to complement their waning breast milk supply.

“Water became my private obsession although I fully realise it is a national one too and this proved to be the most beneficial, yet most difficult, to introduce as Aboriginal mothers just did not give their babies water to drink at all and it wasn’t until the kids were old enough to dip their heads into the billycans themselves that they began to get an adequate intake.

Eventually, all this changed. I found myself constantly reiterating ‘water to drink’, ‘water to drink’ and slowly established a pattern. New babies were put onto a bottle straight away. The first step was to show the mothers how to make a billycan out of a milk tin which was not to be used for any other purpose. When the bottle was cleaned and boiled it was left in the billy, covered with a net and hung up to cool. This was done after a drink so that there was always a supply of cool, boiled, sterile water whenever the baby was thirsty.

When they started drinking from a pannikin at six months, I took the bottle away and the baby’s billy then went into general circulation.

My final aim in this total child care programme was to extend the care from camp to wherever they journeyed and I had the ‘wet’ season walkabout in mind. I had to get the mothers to take food and water for the babies with them wherever they went – and finally settled on the idea of a ‘Walkabout Bag’ fashioned on the principle of the ‘rabbiting bag’ my brothers and I made when we were younger. It is a flour bag with a piece of rope tied to one corner and finishing with a noose around the neck, and both of these are available on any station. This is then carried over the shoulder and rests on the back. Into this went the cereal and tinned milk, tin opener, plate, spoon, pannikin and a bottle of water.

These things were stored in the bag always, and this kept them out of the dirt, and, when they left camp, this was automatically shouldered and the needs of the babies could then always be met, whether they were in Fitzroy for the day or out on the tractor or on their ‘wet’ season walkabout, and this caught on. So much so, that on one station the mothers themselves went one step better. They chose to cover the water bottle with hessian extending into a handle and this they kept wet from time to time to cool by evaporation, and carried it by hand.

After this huge initiative, health education continued to environmental care such as rubbish disposal and housekeeping, teaching mothers personal care and eventually growing a vegetable garden.

This then, is my health education programme. Not a great contribution and, perhaps, of doubtful benefit but time alone will put it into perspective and reveal its worth, if any.”

 

Time did indeed reveal the worth of Pat McPherson’s initiatives.  Three years into her work, the benefits were evident and dramatic. Fitzroy Crossing had held the record for the highest infant mortality rate and number of hospital admissions in Western Australia. But by 1968, Pat recorded that:

“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. Gastroenteritis was episodic rather than endemic. The gap between breastfeeding and solids, a critical factor in Aboriginal child rearing had been bridged. Complete immunisation 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.”

“It took over two years for my health and education program to be translated into routine behaviour. 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 critical phases within her reproductive life cycle. 

PAT’S PROGRAM – A TEMPLATE FOR COMMUNITY NURSING SERVICE 

The success of Pat’s program and pioneering work led to the decision by the West Australian Health Minister and the Commissioner of Public Health to appoint public health nurses to other centres – Derby, Wyndham and Broome, and AIM to appoint additional itinerant childcare nurses based in Halls Creek and Kununurra.

“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.” 

In 1970, Patricia McPherson received the British Empire Medal for her pioneering work in the Fitzroy River region. Sister Pat had become a legend of a nurse.

 

 

 

 

 

In 1963, 25 year-old Patricia McPherson crossed Australia’s vast continent from her home in pastoral Gippsland in Victoria to arrive at Fitzroy Crossing, a tiny remote settlement in the centre of Western Australia’s rugged Kimberley region.There she would begin work as a nursing sister at the Australian Inland Mission (AIM) hospital. By the time she left her work with AIM some ten years later, she had made an extraordinary and indelible impact on the health and well-being of hundreds of people in her region, and by extension, in other remote regions of Western Australia.

Nurse McPherson became ‘Sister Pat’ a legend of a nurse who transformed the delivery of health services to a vast region of Australia’s outback and set the template for public health nursing that was adopted statewide. In acknowledgment of this work, Pat McPherson received the British Empire Medal in 1970. 

Pat McPherson’s story is one of exceptional service and far-reaching achievements.

But it’s also a story of great adventure. It is a remarkable Australian story.

Pat is now 86 years old and lives in Victoria. Pat McPherson’s own words best tell her extraordinary and heretofore not generally known story. WomanGoingPlaces is therefore presenting in several instalments, some excerpts of her diaries, letters and interviews from her time in the Kimberley. 

PAT’S STORY – BEGINNINGS

Pat became a nurse because she wanted to work  with the AIM in the Outback.

“I took the right subjects at high school to gain the right entrance qualifications to a nursing school. I sought and undertook the most comprehensive nurse training available to me at the time and I undertook further training as a midwife. And I didn’t only learn to pass exams. At every stage of learning during these years of training I extrapolated from The Royal Melbourne Hospital and The Royal North Shore Hospital to the bush. I’d say to myself, ‘If this or that happened in the bush and I was IT, what would I do?’ or ‘If I had to do this or that procedure in the bush and I didn’t have all the equipment, how could it be done?’ And so, I asked questions of nurse tutors, doctors, my senior nurses and became a bit of a pest. I also read widely and pursued some ad hoc preparation like learning to pull teeth, to suture wounds, to make bread, and to do a grease and oil change on an engine.

So, armed with these impeccable credentials and a sound Presbyterian background, I volunteered for the inland service with the AIM and, accompanied by another young volunteer nurse, Nat (Gloria Natoli), I arrived at Fitzroy Crossing at the beginning of the Wet season in 1963.”

FITZROY CROSSING, BUNUBA COUNTRY, WESTERN AUSTRALIA

“Fitzroy Crossing was a small, isolated trading post in the heart of the Kimberley cattle country, an area where white settlement was only 80 years old. It consisted of six buildings – post office, police station, AIM hospital, United Aborigines Mission, state school, and pub/general store. These buildings were widely separated from one another along two miles (approximately 2.25 km) of the banks of the Fitzroy River. In the winter (the Dry), the river was a dry gully. In the summer (the Wet), it was about 36 feet (11 metres) high and spread across the flood plain for 30 miles. The town was isolated for 3 months”.

 

THE LOCALS

“Besides we two nurses there were three other single people employed by the pub. Fitzroy Crossing’s other residents were couples at the post office, a police station, school, hotel and the United Aborigines Mission. There were no children in any of these households.

We were totally unprepared for Fitzroy Crossing. We found ourselves in a society that had a different value system to ours. People went to the session at the pub on Sundays and, whenever the Lord’s name was mentioned, it was used as a blasphemy. The other people in town – the postmaster, the policeman, the school teacher and the publican – were there for either promotion or money, or both.”

“There is no real community spirit in this small town of 23 whites. We have no one to turn to for help. There is absolutely no maintenance done here (at the hospital) other than what we do ourselves. We have had to mend doors and fences, prop up the bough shed when it sags, mend toilets and fix the engines. We couldn’t even get anyone to chop our wood for us when the Aboriginal helpers were sick so we did that too.  The partnership (2 families) running the pub has crashed and has split the town.  One family doesn’t even speak to the other. There is friction between the 2 policemen, but they still speak to each other, which is their saving grace.  The postmaster who is a recluse and uncooperative, won’t speak to anyone, and the mission folk hold themselves apart and have nothing to do with the community.  So is it any wonder that our friends and interests are the station people.  We only see them occasionally, but these meetings are full of pleasure for them as well as us, and are free of petty gossip and back biting.”

THE STATION PEOPLE 

Sixteen stations within an 80 -100 mile (129 – 161 km) radius of Fitzroy Crossing were served by the AIM hospital. Almost a thousand Aboriginal people lived and worked on these stations and fewer than two hundred white people.  

The stations in the area primarily covered by Pat were: Gogo Station, Brooking Springs Station, Jubilee Station and Fossil Downs Station, all in the country of the Walmatjarri, Bunuba and Gooniyandi peoples.

“ The station people looked to the Hospital for something else. Very few sought medical help other than in an emergency such as a suicide, burns and mustering or a motor vehicle accident. The white station community saw the hospital as their social centre. Whenever they were in town, they came to the hospital. They came for a cup of tea or a meal or just to talk and relax or to wait for the mail plane. We saw this as a very important part of our work and are pushing ahead with our policy to try and consolidate this place a social centre as well as a hospital.  We are getting to know a lot more station folk now and they show us appreciation and great respect.

 

THE HOSPITAL AT FITZROY CROSSING

“The Hospital was a shock. It was built in 1939 of unlined tin. It had cement floors, fly wire ‘windows’ and tin shutters which had to be closed when it rained, thus excluding both air and light. It had a wood stove and a kerosene refrigerator. There was no hot water system. We boiled a copper for the washing water. There was a 240KVA Southern Cross lighting plant and a water pump. We generated our own power and pumped our own water. There were two wards: a ‘native’ ward (the gauzed-in verandah) which had eight camp stretchers and a ‘whites’ ward which had two hospital beds. A divided bed in the corridor next to the lavatory served as the labour ward. 

Our nearest doctor was the Flying Doctor (Royal Flying Doctor Service) at Derby two hundred miles (322 km) away with whom we were in radio contact each day and who held a clinic at our hospital once a fortnight.

Despite my well-thought-out preparation, I wasn’t really prepared for bush nursing. The day we arrived the lighting plant wasn’t working and the kerosene fridge was smoking and the water pump wasn’t pumping. Within an hour of our arrival we set to and had fixed the lot of them. 

It was a tremendously busy hospital. We had a daily bed average of eight in-patients, all Aboriginal. They presented with anything and everything, mostly caused by infectious diseases or trauma. Most of the patients were children under the age of two with gastroenteritis. Because they were breast-fed, their mothers stayed too and camped in the shed. During some gastro epidemics, we nursed up to 22  babies, in the passageway and on the verandah, in potato crates, cardboard cartons and even in the wheelbarrow.”

THE TASKS: NURSE AND COOK

“Nat and I took turns sharing the work. For one week, one of us was the nurse and the other was the cook. 

The nurse looked after the in-patients and did the out-patients’ clinics every morning and did all the radio work ( communication with the Derby Hospital doctors, the RFDS, the stations etc.). One rarely slept for the whole seven days when one was on nursing duties. My main recollection is working night after night with desperately ill babies, getting some through and watching many others die. 

But there was another part of the work. On the week when one was cook, one cooked meals for about 20 people each day – the patients, the breast-feeding mothers, 3 Aboriginal staff and ourselves, and baked the bread every second day (6 high tins). One also supervised the cleaning of the hospital; did the washing and ironing; looked after the chooks; grew the vegetable garden in the Dry season; organised the huge bi-yearly orders for supplies from Perth; entertained the station visitors, and looked after the lighting plant and water pump. In the Wet season, one measured the river height twice a day and reported it on the Royal Flying Doctor radio to station people downstream.”

 

PIONEERING ITINERANT PUBLIC HEALTH NURSING

Patricia McPherson pioneered itinerant public health nursing in the Kimberley. Before she came to Fitzroy Crossing, the established practice was that people needing medical attention were expected to make the arduous journey of miles, to the AIM hospital in Fitzroy Crossing. Pat changed all that. 

Pat travelled hundreds of miles to introduce a comprehensive immunisation program to the whole community; Aboriginal and white. She administered all the childhood immunisations and those against other common diseases of the region such as Tetanus and Measles, as well as the Sabin oral vaccine against Polio. Pat immunised everyone and went everywhere, wherever people happened to be – in the Aboriginal communities, the stations, the cattle camps, at work on the roads, in the hotel bar and the local gaol.

In a pivotal departure from past practice, she went out to treat the Indigenous people in the camps on the million acre cattle stations where they lived and worked. She did it by driving miles every day and working from the tailgate of her donated Land Rover while battling considerable odds – environmental, bureaucratic, human and cultural.

“As God’s people, we recognise social injustice and, in the name of Christ, we move to correct it. Therefore, after years of watching Aboriginal babies die (at the hospital), I responded immediately to the opportunity to do something about the infant mortality rate in Fitzroy Crossing which was the highest in the State when the Commissioner of Public Health in Western Australia  (who had long wanted preventative health work there) asked the AIM if they would provide this service. The AIM agreed and offered me the challenge. 

I was in Perth at the time completing my Infant Welfare training. So in early 1966, armed with my Third Certificate, I set off in a short wheel based Land Rover equipped as a functional clinic and a two-way radio, a swag, and a tucker box, to become AIM’s first Itinerant Child Care Sister in the region.” 

 

THE LAND ROVER

“The trouble-free performance of my vehicle has been a great joy and I have a great affection for the ‘Gypsy’ which is my second home. At first, there was no-one available locally to do the grease and oil changes every thousand miles. After I had done one myself and bungled it somewhat, I was very glad when the new mechanic on Brooking Springs Station took over this task for me every month. I now take it into Derby for the major checks about every three months after the Mechanical and Plant Engineers (a W.A. Government workshop) who had heard about my pioneering efforts kindly offered to do the work on it.

 

I have enrolled to do a course on Motor Maintenance by correspondence this wet season and this should enable me to do minor repairs myself and give me a working knowledge of the anatomy and physiology of the vehicle. The mileage meter at the end of my first year (1966) reads 17,748 and the tyres are 50% new.”

PAT’S PROGRAM OF HOLISTIC HEALTH CARE

Pat realised that she had to expand the traditional role of nurse if she was to make any difference to the lives and welfare of the people in her care. First, she carefully observed life in the camps attached to the stations and kept meticulous records of all the infants and children. 

She researched the causes of illnesses such as anaemia, broncho-pneumonia and gastroenteritis, prevalent amongst children in the camps, and stemmed the epidemic of gastroenteritis through early detection and treatment. 

From her observations she created a new holistic program of care that engaged and paid respect to the people and their culture, especially that of the women whose cooperation was vital to its success. 

Pat also introduced antenatal care for Aboriginal mothers.

Pat’s holistic program almost completely eliminated infant mortality and morbidity rates in Aboriginal communities in her area. These rates had been exceptionally high. In three years, Pat’s program reduced the number to two deaths and cut hospital admissions by 50%.

“My instructions were to reduce the infant mortality and morbidity rate and hospital admissions by raising the standard of child care in the Aboriginal camps. My area covered six such camps in a thirty-mile radius of Fitzroy Crossing, in which 700 Aboriginal people lived – Gogo, Brooking Springs, Fossil Downs and Jubilee Stations all in the country of the Walmatjarri, Bunuba and Gooniyandi peoples.

I drove to each camp twice a week thinking, at first, that all one had to do was pick up the sick children and bring them into town for early hospital care. My thinking proved very wrong. This did become part of my work, along with daily medical checks, antenatal care, trachoma and anaemia treatments, leprosy checks, minor treatments, immunisations and perhaps our greatest role, health education.”

 

This was a rare approach at that time. Education in hygiene, nutrition, hydration, child and infant care were all key to her belief in the crucial role of preventative care to lessen the need for symptomatic or curative treatment of preventable illnesses. Her program was comprehensive. It also led to working together to clean up the living environment and planting vegetable gardens to enhance nutrition.

“The nurse became a teacher – of child care, hygiene, care of clothes, budgeting, toilet training, housekeeping, rubbish disposal and growing vegetables. One also had to teach the mothers to care for their children’s sores; treat their infected ears; give medicines, trachoma and anaemia treatments; and postural drainage and percussion – all from the tailboard of my Land Rover.”

SISTER PAT’S SCHOOL FOR LITTLE KIDS

Pat extended her concept of care to set up kindergartens to stimulate the toddlers. They were very successful and became known in the communities as Sister Pat’s School for Little Kids.

“Towards the end of my third year (1968) when this ( the health care program) had become more or less routine, one had to ask, ‘for what have I helped rear these children? Do I now abandon them because they are past the danger period health-wise?’  To me, the answer was no, so I took the next natural step and commenced pre-school play and kindergarten – this time in the shade of my Land Rover. I asked the teachers at the Gogo Station and Fitzroy Crossing schools  to help me develop this programme because the rationale was to bridge the gap between camp and school.”  

Fundamental to all her activities was Pat’s view, rare at the time, of how Indigenous people should be regarded and treated. She believed in the necessity of understanding the values and social relationships in these communities. 

“Concern for the health of Aborigines must be supplemented by increased interest in their view of life, and cultural issues surrounding health practices.”

 

CREATING THE TEMPLATE FOR PUBLIC HEALTH NURSES IN WESTERN AUSTRALIA

Pat advocated for a dramatic re-definition of Public Health, to locate it within the context and conditions of a community and maintained that the “diseases of a community – endemic infections, sub-nutrition, anaemia, growth retardation, maternal stress etc were all as destructive as tuberculosis and leprosy.” 

She pointed out that “Poverty is a disease of the community. So too is ignorance. Until the notion of Public Health is re-defined, we will continue to concentrate on infectious diseases and leave these equally pernicious situations untouched.”

“With the health of the baby and pre-schooler under fair control, the work then spread from a child-oriented service to a more public health oriented one to cover the total family unit. I introduced school medical examinations, and a more direct attack on leprosy in the adults.

At the end of three years the Aboriginal infant mortality and morbidity rate in the Fitzroy Crossing area was less dramatic and life would never be the same again for these people. 

The Public Health Department of the Western Australia Government evaluated this experiment and made a decision to spread this work to other areas where large numbers of Aboriginal peoples lived at subsistence level. 

This was a real breakthrough – Government recognition that we had delivered what the Commissioner had wanted, so we rejoiced when the Government appointed their own nurses whom they called Public Health Nurses, to work out of the hospitals in the three government towns in the Kimberley – first Derby, then subsequently Broome and Wyndham.

In order to take the work out of the Kimberley, in 1971, I myself went to Roebourne in the Pilbara, 1,000 miles south of Fitzroy Crossing. This was  iron ore country and the construction of a massive new mining facility there was rubbing off in a disastrous way on the Aboriginal community. Soon after, the Government appointed their own Public Health nurse to spread the service to a second area in the Pilbara – Port Hedland. 

They continued to do this until 1972 when an Act of Parliament was passed in the Western Australia Parliament which set up the Community Health Nursing Service. This Act set up the infrastructure to carry the development of the work to all areas of the State where people lived in low socio-economic circumstances.

We had pioneered a new service – two actually, for the pre-school work in the camps led to mobile AIM pre-schools staffed by pre-school teachers. Subsequently the WA Education Department set up pre-schools in the Kimberley towns.

It was a time of great rejoicing.”

 

 

Patricia McPherson subsequently continued her innovative work in community nursing after her return to Victoria when she worked for twenty-five years for the Royal District Nursing Service in management, service planning and the policy sector. During these years she also did an Arts degree in Sociology and Politics and achieved a Masters Degree in Nursing Studies. 

In 2001, as part of Australia’s Centenary of Federation celebrations, Patricia McPherson received the special honour of being included on the inaugural Victorian Honour Role of Women – Women Shaping the Nation. She was one of 250 Australian women who were honoured because they made key and enduring contributions to Victoria and the Nation.

 

Patricia McPherson’s story is continued in the next instalment: Becoming Sister Pat