Patricia McPherson (Part 2) – Becoming Sister Pat
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.
If you liked our post, please consider becoming a supporter of
A social enterprise advocating for economic security and social inclusion of Australian women aged 50+.
We campaign against the discrimination and general invisibility women 50+ face.
We tell the stories of women 50+ who are re-defining how women age.
SUBSCRIBE to receive latest posts in your Inbox.
SUPPORT our advocacy and keep us accessible to all women.
Just wonderful work
I feel privileged to know Pat as a good friend
I worked as a Community health nurse in the Kimberley and with the RFDS in the 80,s
It’s so good to hear from you Kathryn, not only as a friend of Pat’s, but someone who herself had personal experience of the public health nursing that Pat pioneered in the Kimberley. Thank you.