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Source: APNA Primary Times Summer 2021 (Volume 21, Issue 2)
In August 2021, COVID-19 surprised health services with a rapid outbreak in outback NSW. The virus spread quickly within rural communities, including some of our most vulnerable First Nations communities where vaccination rates were low. The NSW Rural Doctors Network (RDN) – a workforce agency – was quick to call on APNA for help with the health-care response and APNA CEO Ken Griffin (who grew up in regional NSW) was heavily involved in coordinating APNA’s NSW members to form a surge workforce to help fight the outbreak.
APNA members responded enthusiastically to the call for help, with 140 nurses from all over NSW immediately putting their hands up to participate in the relief effort. Of these, more than 70 were quickly deployed across 14 different towns in rural and remote regions of western NSW, where they worked in hospitals, general practice clinics, Aboriginal medical services, vaccination hubs, COVID testing sites and quarantine hotels.
The coordination of this deployment was quite complex, and APNA worked closely with several health authorities, including NSW RDN, NSW Health, and Western NSW Primary Health Network, to ensure that the scheme ran smoothly and efficiently.
Most APNA members were contracted directly by NSW health services, which meant that all deployed nurses, including accredited nurse immunisers, could operate quickly and efficiently, utilising their top-of-scope skill sets under the state-run system, without the direct medical supervision funding impediment that constrains nursing activity in general practice clinics. This was also the most cost-effective way to manage the scheme, as agency fees would have put even greater strain on already stretched rural health-care systems.
Each nurse’s clinical experience and geographic location were considered to determine the most suitable and convenient settings for their deployment with many nurses requiring travel permits due to the whole state’s strict lockdown at the time.
With so much pressure on the health-care system, many primary health care nurses in the affected regional and remote areas had not been able to take leave since the start of the pandemic. APNA members deployed from other parts of NSW were able to provide some relief for these local nurses by taking on their shifts, which gave them the chance to take a break and re-energise.
Many of the APNA members involved in this relief effort appreciated the opportunity to assist. They had the chance to see how regional and remote healthcare settings are run and to work alongside some very dedicated and hard-working health professionals. Their deployment also gave them the opportunity to gain insight into regional culture and to obtain new experience in rural health.
We caught up with a couple of the nurses involved in the scheme to hear about their experiences.
APNA President Karen Booth spent a month at Maari Ma Health Aboriginal Corporation’s Primary Health Care Service in Broken Hill, far western NSW, where she worked in the vaccination clinic and the respiratory testing clinic. She explains that vaccine uptake had been slow in the area due to hesitancy within the community, and also some complacency. ‘During 2020, there had been very little COVID disease out west,’ she says, ‘and this outbreak came upon the community quite suddenly. My friend and fellow APNA member, Caroline McDonald and I were sent to Maari Ma because a COVID-positive case had come into the clinic and half the staff had to be furloughed for 2 weeks.’
Broken Hill was eerily quiet due to the lockdown and Karen describes the scene on the streets: ‘NSW Health had a lot of nurses there as well, who’d come from the city to service the hospital. They were probably the only people you saw walking around town. Every coffee shop had a queue of nurses out the front, and you could tell by their scrubs who they were.’
She says Maari Ma’s vaccination clinic was a little slow during the first part of her stay, and gift vouchers were offered as enticements for people to get vaccinated. She and the other nurses spent time talking with people from local Indigenous communities about vaccine hesitancy and tailoring information about the vaccine’s safety to make it more accessible. With time, word of mouth began to spread and whole families would show up to get vaccinated.
Karen says the team at Maari Ma were doing a great job and she really enjoyed her time there. ‘It was a great multidisciplinary team, including registered nurses, an amazing team of Aboriginal Health Workers, a speech pathologist, a pharmacist, and a dietician. Everyone was participating in the COVID response: processing paperwork and providing reassurance to those who were nervous about having the jab.’
If members of the Indigenous communities were unwell, the Maari Ma respiratory team would dress in PPE and visit them at home to symptom check and test them for COVID. In this way, the staff were able to keep track of who was infectious and who needed GP assessments. Most of those with COVID were managed at home and the Maari Ma team would call them every day to check in. They also arranged food drops for isolating households.
Karen says that the community worked hard to contain the virus. ‘Even in Wilcannia (2 hours from Broken Hill), despite difficult circumstances, people were very resilient. Lots of families cooperated to look after one other. It was really heart-warming.’
A couple of COVID patients had to be flown to Adelaide for ICU treatment, but the mortality rate in the region was very low and by the end of Karen’s stay, 50% of the people listed on Maari Ma’s database had been vaccinated.
‘I would love to have stayed longer! I loved the community attending Maari Ma’ she says. ‘I really wanted to sit down at a Broken Hill pub and have a beer with my co-workers, but the pubs were all shut due to the lockdown. I’ll have to go back!’
APNA member Rebecca Dowd travelled from Canberra to spend a month in Dubbo, where she worked in a vaccination hub that was set up at the local showgrounds. She describes the atmosphere at the clinic as friendly and supportive. Many locals had to travel long distances to get vaccinated and there was some confusion around the online booking system. This caused a bit of frustration, as some people had to be turned away and asked to come back later, but most were patient and cooperative.
Bek says she felt especially proud and privileged to vaccinate the local school children, who bravely showed up to protect their families and their community, and who were keen to get back to school.
She appreciated the vaccination team’s kind and considered approach to the care they provided. She says they took their time to explain symptom management after vaccination with everyone who received the jab.
Dubbo Base Hospital was placed under a lot of strain during the outbreak, due to rapid transmission rates. At one point, 70% of its staff had to be furloughed due to contact with positive cases. Bek spent some time in the COVID ward at the hospital. The staff were welcoming and generous; however, the experience was quite daunting, as she had to learn her way around a new building and the PPE protocol was complex.
‘It was complicated getting to the COVID ward through a clean zone, a clean lift, and donning correctly,’ she says. ‘It’s a tough job wearing PPE for a long time. No popping down to grab a coffee in your break! Everything is itchy and hot, and I felt claustrophobic. The masks are tight and can cause pressure sores on the nose and behind the ears. It’s also really difficult to understand people when they speak. I sometimes felt a little anxious. To stay calm, I would remind myself that I was there to help my fellow colleagues and to protect the community.’
Bek let off steam every day by riding her push bike around the Macquarie River cycling track, known locally as Tracker Riley. She says she adored this beautiful track and by the end of her stay in Dubbo, she felt fit and strong and connected to country.
Bek describes Dubbo as a lovely town, with wide streets and beautiful architecture. She says she was sad to leave and has plans to visit again soon. One of the most rewarding parts of her experience was the sense of camaraderie she shared with the team running the vaccination hub, including the other health workers, the council workers who directed traffic and the showground staff, who graciously shared their workspaces.
‘The kindness and respect we treated each other with was a great experience. The team effort I was part of in Dubbo is a memory I’ll keep forever.’
There were many APNA members who were willing to be part of the western NSW response efforts but who couldn’t be deployed at that time due to logistical reasons. We’d like to take this opportunity to thank each member who expressed interest in the scheme – those who were willing to take a leap into the unknown during a crisis. It’s this kind of agility and fearless generosity that makes the primary health care nursing community so great!