Emotions
run high for our nurses
A triumph of mission and mateship
Continuing to live
"I love you. You saved my life."
Ray Martin inspired by the healing hands in Aceh
Emotions
run high for our nurses
By
Andrew Stackpool
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The
ADF has 446
permanent and reserve nurses. They are employed
in general medicine/surgery as well as a wide-range
of specialisations including mental health and
intensive care. They are recruited into their
single Service of choice, however, may be called
upon to work in any environment, air, sea or
land. Consequently, they need to be multi-skilled
and able to transfer those skills as required.
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EMOTIONS
at times ran high and new bonds of friendship were formed at the
2005 ADF nurses’ conference.
Fourth in the series, the annual event was held at the Russell
Offices complex in Canberra from November 9-11.
Aimed squarely at the recent high operational tempo and drawing
on the experiences of many who have deployed to recent crises,
its theme was “Go there with Resolve, Competence, Confidence
and Ethics.”
Channel Nine personality Ray Martin opened the conference, invited
because he had shared the experiences of the nursing officers
who had deployed to Sumatra in Indonesia during Operation Sumatra
Assist, following the tsunami there.
Over the three days, tears were sometimes shed as more than 150
of the ADF’s nursing fraternity heard of the challenges of
setting to work and operating an intensive care unit on the first
and second rotations to Balad, of the work undertaken during the
restoration of Sumatra after the tsunami and earthquake, the terrifying
account of a nurse who survived an AME helicopter crash and the
loss of Navy Sea King Shark 02 at Nias.
“We had tissues available for people to use as some of our
colleagues were getting quite misty-eyed [during the presentations],”
Director Defence Nursing Services Colonel Bev Wright said.
Senior military and civilian nurses, leaders in their respective
disciplines, also addressed the conference on a range of professional
topics.
These ranged from challenges in the future provision of sufficient
educated and trained nurses into the workforce, training, mentoring
and support, and technologies, to a case study of international
military efforts to combat malaria and an exploration of the perceptions
and realities of the changing relationship between nurses and
doctors.
Colonel Wright said that the conference built upon the outcomes
of the previous three conferences. More importantly, it gave nursing
officers, particularly the junior ones, the opportunity to be
heard and to share their experiences.
“It gives the junior nursing officers an opportunity to identify
and meet up with the senior people,” she said. “Many
know that there are people at Campbell Park who work in their
best interests, however, they don’t know what they look like,
or who they are.”
There was also another dimension, with so many nursing officers
having experienced operational deployments this year – “it
allows us to actually catch up and give our people a hug. You
can’t do that by e-mail.”
The conference provided a forum for nurses who had been on operations
to speak about their experiences to colleagues who have not yet
deployed and provided a window for civilian nurses to find out
what ADF nursing was about.
“The civilian sector doesn’t have much idea about what
we do and this permits that interaction to occur.”
Many years and effort had gone into building the profession of
nursing, and while there were many conferences around, there was
nothing focusing on ADF nursing.
“We decided that this was not good enough for us. We wanted
to elevate the profile of our profession and having an annual
conference was a way to ensure that we maintained the professional
interest of our colleagues,” she said.
“[The conference] also gives our people the opportunity to
access continuing nursing education points which are very important
for their annual registration. It also encourages cross-cultural
development – we welcome everyone to our conference and this
year we had doctors and dentists address the conference along
with overseas speakers.”
Colonel Wright said the conference “definitely achieved its
aims and more”.
“Some of the visiting professors of nursing felt that there
was a real sense of community among our colleagues, which doesn’t
necessarily exist in the civilian side of our profession,”
she said.
During the conference, four book prizes were awarded, named after
four significant nursing officers and representing nine decades
of nursing service to the ADF: Flight Lieutenant Lynne Rowbottom
(killed in the crash of Navy Sea King Shark 02 at Nias in Sumatra);
Sister Elaine Lowrey, a former Navy nurse; Sister Betty Jeffrey,
an Army nurse who was a Japanese prisoner of war; and Sister Edith
Cowell, who was executed for trying to help people in 1915 during
World War I.
Colonel Wright said that the different format for this year’s
conference – a mix of professional, academic
presentations and the presentations of individual experiences
during the tsunami and in Iraq – was quite deliberate.
“A lot of people had been to these areas and they needed
the opportunity to talk about their experiences,” she said.
“We devoted two hours to Iraq and to the tsunami and each
speaker had 30 minutes. We received many papers again this year
and all were of a very high standard.
To accommodate all presentations some of our speakers presented
their papers as poster presentations. The poster presentations
were very successful as an alternate form of presentation and
will be used for future conferences.”
A
triumph of mission and mateship
By
Andrew Stackpool
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SQNLDR
Belinda Ball with a patient inside the intensive care unit
at Balad, run by ADF nursing and medical officers, but part
of the US 332nd Emergency Medical Unit.
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Photo
provided by SQNLDR Belinda Ball
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BALAD
is a sprawling, dust or mud-covered 25 sq km air base complex
in the Sunni Triangle in Iraq. About 68km north of Baghdad, it
has been the home of an extraordinary group of Australians.
They are the 20-odd doctors and nurses of the critical care element
who are posted there to manage the Intensive Care Unit (ICU) of
the 332nd Emergency Medical Unit, a US Air Force organisation.
They are a vital part of Australia’s contribution under Operation
Catalyst to the Coalition forces and they have a word of advice
for future rotations – “leave your ego at home”.
The Commanding Officer of the first rotation, Wing Commander Michael
Paterson, said at the nursing conference that the deployment to
Balad was the most significant deployment of ADF personnel to
a land-based level three medical facility in combat since the
Vietnam War, if not earlier. It also represented the greatest
exposure of ADF nurses to battlefield trauma from a volume basis
within a similar period.
“It was my generation’s chance to see if it had what
it took, in nursing terms, to stand beside a major Coalition partner
on an equal footing,” he said. He reminded his audience that
“it is midnight in Balad. You may rest assured that our colleagues
are still hard at work”.
Balad is the frontline of post-combat military medical care in
Iraq, comprising “tents on concrete slabs which, given the
threat, makes things interesting”.
It is a place where amputations and severe burns are commonplace
and wounds from the 5.56mm, 7.62mmx39 (the round for the ubiquitous
AK-47), IEDs ranging from a few grams in a booby-trapped torch
to 105mm rounds carefully cemented into the kerb-side, harassment
fire from rockets, mortars and car bombs are the norm.
A place that presenters at the conference said provided them the
biggest challenge of their careers. Some nursing officers came
from big, modern comfortable hospitals, which were very busy,
“but the Balad unit was the busiest I had ever experienced”.
“[It] was a culture shock. We had to have a real team effort
to ensure people got the best quality [nursing care].”
“There were no extra staff to back them up, no technicians.
We did it all ourselves.”
But nursing officers who served there say it is the most satisfying
work they have ever done from a professional and military point
of view and a place where “we shared good times”.
Most importantly, it was the ultimate location where nurses go
“with resolve, competence, confidence and ethics”.
These nurses serve everyone, Coalition and Iraqi soldiers, insurgents,
civilian casualties and children. No-one is turned away. Compassion
and ethos rules.
Several members of the first and second rotations presented vignettes
of their experiences in the hell that was the ICU. These were
stories of ordinary people meeting the challenges of an extraordinary
environment.
Wing Commander Paterson said the deployment was challenged to
embed into a large Coalition health facility in the Middle East.
The original intent was a single six-month rotation and was chosen
to represent a “truly Coalition effort”.
“That we are still there speaks highly of the efforts of
my colleagues,” he said.
In July 2004, the first team was tasked to move 28 days later.
Its members were sourced through component command and by September,
it was in Balad. The mission was to provide level three medical
care to units in and around the base, supply inter and intra-theatre,
aero-medical evacuation (AME) support, and provide hospitalisation
to a range of forces.
“In reality, we provided hospital care to anything the helos
dropped at our door,” he said.
Presenters at the conference detailed the widespread problems
they faced upon arrival. Indirect fire from mortars and rockets
were received at the base, providing a number of (non-Australian)
casualties, coupled with casualties from IEDs and suicide bomber
attacks against the base perimeter and its defences.
The hospital was also damaged by fire and there were several near
misses. In tandem with this was the noise generated by counter-battery
fire and the almost non-stop noise from helos arriving with casualties.
The environment brought its own problems. The temperature ranged
from below freezing in winter to the mid-50s in summer. Heavy
dust in summer, thick mud and unrelenting rain in winter, all
of which ended up inside the hospital treatment areas. Problems
in setting the ICU to work were many and challenging.
They ranged from the potential infection hazard presented by pollution
from many sources, the ubiquitous dust and mud, the porous nature
of the concrete flooring which made cleaning almost impossible
as blood, soiled water and body fluids tended to soak into it,
lack of ventilation, air conditioning that couldn’t handle
the high temperatures and the lack of proper linings in the tent
ceilings.
The ICU Manager on the first rotation, Major Malcolm Evans, said
other physical problems included a lack of shelving by the beds
and a lack of storage, including for individual body armour.
Other problems were more human. These included different procedures
and processes from the Americans, times when patients had to be
treated on the floor by staff in full body armour or when people
had to take shelter in the bunker complexes because of incoming
fire.
Even patient management brought unexpected problems, including
coming to grips quickly with the cultural differences between
Australians, other Coalition partners and the Iraqis themselves.
Horrific injuries were often compounded by severe pain, the environment,
transport difficulties and the length of time taken for patients
to be admitted. Coalition casualties normally had undergone some
aid before they arrived, while civilians and others normally arrived
with untreated injuries.
Major Evans said that in time the problems were overcome with
ingenuity, planning and hard work; everyone turned out to improve
the unit. “Our aim was to leave it a better place than when
we found it.”
With the enormity of their tasks and the problems, it may have
been easy for the nursing staff to feel overwhelmed. But they
were always focused on their mission and professional responsibilities.
Lieutenant Gary Steer told the conference its theme of resolve,
competence, confidence and ethics typified their time in Iraq.
“Had the teams not displayed these qualities, then our mission
would not have been the success it was,” he said.
Despite the horror with which they were constantly surrounded,
the teams did make a life for themselves and did find ways to
have fun.
“Mateship and a sense of humour was the glue that kept us
all together,” he said, a view also expressed by other presenters.
As Lieutenant Steer said, “through mud, mission and mateship,
we triumphed”.
Continuing
to live
By
Andrew Stackpool
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FLTLT
Sharon Cooper is comforted by LTCOL Ross Bradford before
her evacuation to Australia in 2004, after a UN AME helicopter
crashed in East Timor.
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Photo
by PTE John Wellfare
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FLIGHT
Lieutenant Sharon Cooper from RAAF Base Amberley is a true survivor.
In the space of 10 short months she survived the crash of a UN
AME helicopter in East Timor with shocking injuries.
Still coming to terms with her physical and mental trauma, she
then survived the death from cancer of her mother and then the
shock of losing friends and colleagues in the crash of Navy Sea
King Shark 02 at Nias in Sumatra.
In her crash on June 2, 2004, Flight Lieutenant Cooper had sustained
a burst wedge compression fracture to her back, three fractures
of her jaw and was covered in aviation fuel. She spent two weeks
in Brisbane hospital, including a stint in intensive care and
then months of often excruciatingly painful rehabilitation.
With a voice that sometimes trembled with emotion and occasional
pauses, Flight Lieutenant Cooper told the nurses’ conference
that, while it was difficult if not impossible to empathise with
survivors, she hoped that through sharing her experiences as a
survivor, and, “more importantly, as a survivor as a serving
member of the ADF”, she could provide them some insight to
the management of survivors.
“Experiences of survival may be as public and as dramatic
as aircraft crashes or as famous and as remarkable as that of
Stuart Diver in the tragic Thredbo landslide,” she said.
“They may also be of the more socially tolerable incidents
such as motor vehicle accidents or serious disease.
“[Or] of surviving the trauma of ADF deployment, of coming
home to Australia having witnessed what we witnessed and getting
back on with our lives.
“Each individual will embrace or endure survival in their
own way.”
She said that things she had experienced after her crash included
the actual physical survival of the crash and the injuries and
rehabilitation involved in getting her life back together.
She told the conference that injuries she couldn’t show were
the emotional and mental trauma. After she arrived in hospital,
she concentrated on the crash and often woke feeling herself falling
through the air.
“The rescue helo landing on the roof of the Brisbane hospital
had my heart racing before I realised what it was.
“Those early days were also full of elation. I had been away
for three months and now was hearing regularly from family and
close friends.
“Also high on the adrenaline of survival; I had cheated death.
I felt so incredibly lucky just to be alive.
“As reality dawned on me, I wondered if my luck was in fact
anything but bad. I recalled hearing for the umpteenth time, ‘You
are so lucky.’
“On one occasion I replied, ‘I am lucky, aren’t
I? I can’t believe my luck [at what I had experienced]’.”
Flight Lieutenant Cooper said when she returned to work, initially
on half days, some people felt she went back too soon. But, she
believed that this was an essential part of her recovery as her
work colleagues were her main support. Staying at home would only
risk dwelling on what had happened and worrying about her future.
“By returning to work, I felt I was more valuable and it
gave me sense of belonging.”
She said that another important and difficult aspect of being
a survivor in the ADF is that military life continues.
“The need to secure Australia and its interests doesn’t
pause to allow an injured nurse to catch up. Nor does it have
the courtesy to wait for her to give permission to continue on
without her,” she said.
Shortly after returning to work, three of her closest colleagues
were deployed to Balad.
“Essentially [she felt] the ADF was taking from me a large
chunk of my support network. My world had become focused around
me, partly because I was so overawed by what had happened to me
and focused on my recovery, that I was blinkered from all else
for a very long time.
“I was also very conscious of my desire to protect my friends
and not let them deploy. Although rationally I knew they had a
job to do, now I feared for their safety. I did not want anyone
to experience what I had.
“There were, however, definite positive aspects to life.
My determination pushed me to fulfil the commitments that I had
made prior to my deployment to East Timor, both professionally
and socially. I was determined to regain as much control of my
life as I possibly could.
“While I had to accept that my life wasn’t going to
be quite as I had planned it, I tried to limit the impact of the
crash and the injuries on those around me.
“One of the biggest emotions I had to grapple with during
my recovery was grief. I didn’t want to lose any more than
I had already lost. I felt the helo [crash] had robbed me of so
much and I was determined that it was not going to take anything
more.
“Then earlier this year I lost my mother. I lost my reference
point. In coming to terms with my experiences, I felt a bit flat.
Losing my mother was the worst thing that could have happened
to me. I thought I was prepared for whatever was going to happen
next. Again I was wrong.”
Exactly 10 months after her own crash, Flight Lieutenant Cooper,
along with her ADF health peers, faced the tragic loss of friends
and colleagues Squadron Leader Paul McCarthy, Flight Lieutenant
Lynne Rowbottom and Sergeant Wendy Jones when Navy Sea King Shark
02 crashed at Nias in Sumatra.
Flight Lieutenant Cooper now faced another hurdle; survivor guilt.
No-one had died in her accident and she thought she escaped it.
Now, she felt guilty that she survived her crash, but those in
Shark 02 didn’t. Her feelings of guilt remained at the conference.
She said that during the whole process, she had found positives
in meeting milestones that at times had seemed out of reach.
She passed her PFT with no waivers, took her first helo flight
since the accident and then deployed to Bali.
“The past 18 months of my life seems like a tragedy but from
them I have learnt and I have grown,” she said.
“Survival is one hell of a rollercoaster ride and one which
I am eternally grateful for. Life does not wait for you to recover.
It continues on with both the good and the bad.
“For most of the past 18 months, I have felt I was trying
to pick myself up and the world was continually knocking me back
down again.
“In a short period of time, I had endured more than most
and some days it was much easier to bear than others. I have learned
to appreciate what I have and I have learned to recognise who
and what really warrants my time, energy and concern.
“Survival is more than not dying in a helicopter crash –
it’s about continuing to live. I lost my life in a single
moment. My life as I knew it was gone. I picked up the broken
body I now have and the sad and frightening memories and did what
I could to move on.
“I started to learn how to live with this new me and I moved
on. No-one will ever follow my path; each will learn to navigate
their own.”
‘I
love you. You saved my life.’
By
Andrew Stackpool
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FLTLT
Amanda Banks served at Balad in 2004.
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DURING
the house-to-house fighting between Coalition forces and insurgents
in the Iraqi city of Fallujah in late 2004, two women from different
backgrounds, with different outlooks and different circumstances
met and formed an unbreakable bond.
Flight Lieutenant Amanda Banks was on duty in the intensive care
unit when the Iraqi woman was brought in.
“There were so many patients and after a while their faces
and injuries tended to meld into one,” she said. “Males
dominated [but] it is the women and the children I looked after
[that] I tend to remember.”
The Iraqi woman was unremarkable from the others, in conservative
dress, but badly disfigured and burned, with severe wounds to
her arms and legs.
“I was told that her husband was an insurgent, who could
be dead, and she had been making a bomb when the injury occurred,”
she said.
“When the interpreters came in, she said to them that it
was up to God if he was dead or not.”
As the woman recovered, Flight Lieutenant Banks wanted to look
after her – “it was part fascination.”
“I asked myself how a woman like this could do something
so bad,” she said.
“She almost died on me. She had a fractured right femur and
80 per cent burns.
“I cried when I was giving her the drugs.
“Throughout my care for her I thought about the Geneva Convention,
about ‘care for all, no matter’ and that kept me going
looking after this lady.
“She questioned my belief system; about how I am as an Aussie
female and asked me what I would do in her place if I had been
born into this country, Iraq. How would I be?
“I found myself comparing our lives, my uniform with my boots
covered with human body fluids and her dress. Her hair was long,
matted and full of straw, blood and cow dung.
“Mine was pulled back in military style with hairnet and
two pins. I cut hers into a modern style and hoped it was culturally
appropriate.
“Her acceptance of her missing husband killed in Fallujah,
while my loving boyfriend had just proposed to me in Venice and
was safe back in Australia for Christmas.
“Her face, arms and legs were disfigured from burns –
my face, legs and arms were thinner from cafeteria food and long
working hours.”
Flight Lieutenant Banks presented her thoughts in a poem to the
conference.
The two women’s lives may have been worlds apart, but at
the end, it really didn’t matter. One day, the woman looked
at her and in limited English said, “I love you. You saved
me.”
“Holding her hand and in limited Arabic I told her I loved
her, too.
“On the surface, we seemed so different, but underneath I
found we were really the same.”
Flight Lieutenant Banks is now safely back in Australia, preparing
to start a new life while the fate of the woman is unknown. But
for a brief time they shared something that transcended Iraq and
the hospital of Balad; a universal, shared emotion.
“I became very attached to her and she is a patient I shall
never forget.”
Ray
Martin inspired by the healing hands in Aceh
By
Andrew Stackpool
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Ray
Martin
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RAY
Martin from Channel 9 is proud to be an Aussie, thanks to ADF
nurses.
Shortly after the Boxing Day tsunami, he found himself embedded
with ADF nurses working at the Anzac Hospital in Banda Aceh.
In his keynote address to the conference, he said that in more
than 40 years of journalism he had travelled over two million
miles, visited more than 100 countries and covered thousands of
stories. This included war and conflict in Iraq, Iran, Afghanistan,
Northern Ireland, Israel, Lebanon, Grenada, El Salvador and Panama.
“I’ve seen war and dead and broken people,” he
said. “But nothing prepared me for Aceh in the tsunami aftermath.”
Mr Martin spent a considerable amount of time with the nursing
officers during the weeks that he was in Sumatra.
He praised the work of the Australians who were involved in recovering
bodies and body parts as well as cleaning up the debris and toxic
mud that covered everything.
“I was wearing Blundstone boots and you know you can’t
bust them,” he said. “I left them outside the place
where we were staying and next morning I found that the mud was
so toxic that it had eaten through their soles.”
Mr Martin said that the work the ADF, and particularly the nurses,
had done in Banda Aceh was an inspiration to the people back in
Australia, and was, in many ways, responsible for the success
of the various television fund-raising activities.
“I’d like to say a few words about you, the personnel
whom we watched and with whom we worked,” he said.
“Over the next few days you will be addressing issues of
the need for cultural sensitivity, respect for others, etc., what
I call ‘cultural safety’.
“From what I saw first-hand in Banda Aceh for well over a
month, the nursing service is in remarkably good hands in the
area of cultural safety.
“For you ADF personnel in uniform, but without weapons, you
had to be diplomats as well as nurses. It was extraordinary to
see.
“Watching the hospital go to work under such conditions was
mind-boggling. I felt proud to be an Australian because of what
you did.”
He described how he had seen nurses break down in tears and frustration
after losing patients against impossible odds, but what impressed
him most was the nurses’ dedication to duty. He recalled
one nurse who had greeted many patients outside the hospital one
morning, “Good morning, ladies and gentlemen, we’re
here to help you”.
“It was more than medical skills on parade,” he said.
“It was all about attitude, the Aussie laid-back way of doing
things that is efficient and highly professional. It is not arrogant,
officious, overbearing or patronising. It was comfortable and
caring; friendly and recognised that the people there had been
to hell and back.
“It was a compassionate operation, wounds were mended and
babies born to replace those who had died. Acehnese wanted to
give their children Australian names after the nurses.
“I was really proud to watch the way you went about business
and it is a privilege to be with you here today.”
