Comprehensive healthcare in remote WA communities

Registered nurse and Credentialled Diabetes Educator Kasi Keeffe works to her full scope to provide holistic care 

by Brita Frost, Primary Times writer 

Kasi Keeffe is determined to get the best possible outcomes for her clients, advocating for and delivering better access to healthcare, equipment and education for people in some of the remotest parts of Western Australia. 

When Kasi Keeffe, a registered nurse and Credentialled Diabetes Educator (CDE), first drove into the small farming community of Wyalkatchem, she was a bit scared. Wyalkatchem is 200 km northwest of Perth and located on the traditional lands of the Ballardong Nyoongar people. Kasi had watched a horror movie the night before and didn’t know what to expect! She needn’t have worried. ‘Just to be met by the community, they were like a warm hug from nanna. It was so inviting, and I thought: Why didn't I do this in my pracs? Why didn't I ask to do this earlier?’ 

Kasi is a fierce advocate for access, affordability and improving the health outcomes of all her clients, but especially First Nations people. Working with the GP in Wyalkatchem, she quickly recognised that many in the community were battling chronic health conditions and that residents were missing out on vital health screening, health promotion, education, and intervention due to the fallout from the COVID-19 pandemic. In response, she established the nurse-led Health at Home clinic in 2022 as part of APNA’s Building Nurse Capacity program. Health at Home was focused on taking chronic disease management directly to the community by performing at-home health assessments. ‘I just jumped at it with two hands because my community needed it. Also, it pushed me to do something outside my comfort zone. It was such a rewarding experience. But it was also scary and hard work. I put in lots of hours, lots of hours driving.’  

In 2023, Kasi was a finalist in the Rising Star category at the Rural Health Pro Awards for her work building Health at Home. In November, she travelled to Parliament House in Canberra to attend the ceremony. ‘Being recognised by Rural Health Pro was amazing!’ she says. 

Unfortunately, the Health at Home clinic was recently forced to close when the GP Kasi works for sold the practice, but Kasi continues to juggle her roles as registered nurse and CDE, also working intermittently (read: most days) as an urgent care nurse, often putting in six- and seven-day weeks. 

Her three roles take her from ‘GP Land’ in Perth to remote communities across Western Australia, from Albany to Karratha, as a CDE. ‘A lot of general practice nurses and student nurses say to me, “I didn't know so much of our work would be to do with diabetes.” And I'm like, “No, neither did I!” When I went into GP Land, I thought that was it. But there are so many things that have grown for me, that come from being a general practice nurse. Recently, I've been doing a lot of follow-ups for chronic kidney disease. Talking to people about their kidneys has probably been one of the most rewarding bits of GP Land and Diabetes WA because it's so often overlooked, with or without diabetes. And people don't know that they're unwell, but they could be living with stage-two kidney disease.’ 

Kasi adds, ‘The great thing about GP Land is I can speak to a client who’s just been diagnosed with diabetes and say, “Go do these National Diabetes Services Scheme (NDSS) programs. They're a free/funded program. Then come back and ask me your nitty-gritty questions about your diabetes when I'm at the GP.” I think that's why I have a good rapport with my clients; I understand the financial constraints as well. The costs involved with healthcare are a bit scary. And I think that's why people put their blinkers on and pretend nothing's happening. Offering support through the NDSS programs is a huge benefit to my practice.’ 

Kasi makes it her business to work to her full scope of practice because it benefits her clients. ‘Across the three jobs, there are extra little things that I can do to provide better care. I'm going to sit down with you and talk to you about your diabetes. Or you've got a wound that needs attention. Or you're worried about your breast, and I'm doing diabetes healthcare, but if you're worried about doing a breast exam and you're stressed about it, that's going to bring up your stress level and that's going to affect your diabetes. Let's do a breast exam together. I rationalise.’ 

Her approach to diabetes and other chronic conditions is holistic. Kasi firmly believes that when she sees a client, she is not only there to help them with their chronic health condition. She is treating the whole person. As she says, ‘I tie things in from being a registered nurse into my diabetes role as much as I can. I don’t mind getting my hands dirty. I'll feel someone's feet and do a foot check. We can talk about sexual health. Everyone laughs at me when I talk about my sexual health. They say, “How do you bring that up with people?” But I always try to because I want to be able to write my report to the GP saying they're experiencing sexual dysfunction; they're experiencing chest pain. I see them as a whole person, not just their diabetes.’ 

‘People will come and see me for diabetes education, but they won't want to talk about their diabetes and that's fine. At the end of the day, if it's related to their stress or overall health, it will help their diabetes. They're taking accountability for their health. I'm very lucky across all three jobs that the people I work with understand. They're used to my madness. I think its whatever way it works to get people to prioritise their health because sometimes my priorities for their health are not their priorities. But it's not my body. I need to go with what the patient's goals are. A part of any nurse's role is looking at the patient's health goals. We all have our own agendas, but it's their body, their life, and they are not their condition. Their condition just lives with them.’ 

Kasi is determined to meet her clients where they are, to give them access and to improve their health outcomes, even it if means going to some of the remotest parts of the country to find them. As she says, ‘If they want to sit outside and talk about their diabetes, I'll sit outside with them. They don't need to come to me. I'll go to them. I'll bridge that gap. I'm happy to feel uncomfortable and go outside my four white walls. Plus, it's always nice to sit in the sun!’