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Back to basics in war zones

Recent Florence Nightingale medal recipient Noela Davies talks to Linda Belardi about the highs and lows of being a conflict nurse.

Flying over the vast swamp region of the Sudd in South Sudan during wet season is an awe-inspiring experience, says Noela Davies. During her six-month stint as a medevac nurse, she flew into 150 isolated destinations across South Sudan collecting the walking wounded, surgical emergencies and women in obstructed labour.

Every day the Bundaberg-trained nurse would be in the air with two pilots flying over African wildlife and barren regions; over the Democratic Republic of Congo and Uganda. Each day would involve approximately six landings in various destinations but all under the one political faction. “When drawing up the flight plan, you were always mindful that you would never cross factions with your patients because that would be detrimental for all of us. We would be considered enemies,” she says.

As a Red Cross nurse, Davies has been taken to some of the most geographically breathtaking but socially and politically troubled hot spots on earth. From working near the Khyber Pass in Afghanistan to sleeping in mosquito domes close to the Danakil Depression, the lowest point in Africa (155 metres below sea level), Davies has a long and impressive list of 10 missions to her name.

Her extensive Red Cross nursing career began in 1999, with a mission to Lokichoggio surgical hospital in northern Kenya. Following a six-month stint there, she travelled to East Timor for three months and then returned to South Sudan after turning down an initial offer to work in Afghanistan.

Returning to Australia, Davies worked at the emergency department at the Royal Perth Hospital and in Kalgoorlie, as well as a chronic disease public health nurse in Wadeye. After four months as a locum public health nurse in Tenant Creek, Davies left again for Africa but this time for northern Darfur and northern Liberia where she helped establish a remote health centre.

With the opening of the clinic the women in the remote community of Lukasu were given access to a midwife for antenatal care, post-natal care and care for newborns and children. There had been no health facility in this region for about a decade as Liberians were only slowly returning, post-war, from neighbouring Sierra Leone and Guinea.

In Darfur, Davies took on a role teaching conflict first aid to civilians and combatants. “These men were young enough to be your sons and they were all wrapped up in headscarfs and glasses. We would conduct the International Humanitarian Law first aid training over a couple of days, teaching them how to manage minor fractures, simple bleeding and dressings. We also talked to them about international humanitarian law and the laws for war.”

Davies has spent 19 months in Ethiopia on two different missions and in 2006-2007 worked bilaterally with the Japanese Red Cross as part of an emergency response unit during the Kenyan floods.

Later in 2008, Davies spent 20 months in Afghanistan mainly based in Kabul but she also visited all of the regions where Afghan Red Cross clinics were located. During her time there, she helped set up some basic healthcare clinics in “white spot” areas – locations previously inaccessible to the Red Cross due to significant security risks.

Her most recent mission in June 2010 was to Kyrgyzstan, following an outbreak of fighting between the Kyrgyz and the Uzbecs “culminating in gross atrocities and death”.

“We went there as a rapid deployment unit because the fighting arose very rapidly. The International Committee of the Red Cross (ICRC) had been working in that country for a long time but in this particular area, right down south, the ICRC had a very limited presence. A significant emergency team was sent in both in the capital, Bishkek and down in Osh.”

As part of her role as a health delegate, Davies was faced with the confronting task of visiting prisons and police stations to document cases of ill treatment and torture.

Challenges in the field

When on a mission, Davies says the national staff and other field officers become your family. “You live, breathe, sleep and work with your field officers and your drivers.”

Despite her multiple trips to Africa, Davies, says no two missions are the same. Each mission is very diverse and has its own challenges but often an experience in one country can be used as a useful comparison when working in another context.

The work is often more mentally rather than physically draining. “Being resilient is particularly important,” she says, and if you are Facebook-addicted or Twitter-obsessed, the isolation and solitariness of being a Red Cross nurse may not be an ideal fit.

Despite significant opportunities to experience diverse societies and cultures, the transient lifestyle can be unsettling. Long stints abroad can also be professionally isolating and too much time away can mean a loss of clinical skills. “What I find is that you adapt to go overseas and in many ways you also have to adapt to come back here. It’s easy to feel like you are a novice nurse again because you haven’t kept your skills up-to-date.”

Her work abroad uses a very different set of skills; it is nursing pared back to its purest form, she says.

“I am used to working in a very basic level, with very little equipment. When you’re up in an old plane, in an old DC-3 that they used in World War II, I don’t have fancy equipment. I have a basic testing pack and I have drugs. Patients often walked days or sometimes weeks to get to an airstrip.

Often when I’m working abroad for two years, I am not working as a clinician, I might take a patient’s blood pressure or a person’s blood occasionally, but I’m usually working either as a program manager, co-ordinator or a medevac nurse.”

Using the Australian experience

Having worked in Alice Springs, Yuendumu and on the lands in Pitjantjatjara on the tri-state border with South Australia, Davies says rural and remote nursing is the cornerstone of working abroad. Under these conditions nurses learn independence, self-reliance, sound problem-solving skills and the importance of working well in small teams.

“You learn to look at things holistically and to have respect for indigenous populations or the man on the land. Those skills are invaluable and Australians are very well regarded by organisations such as the Red Cross and MSF (Medicines Sans Frontieres) because of this remote experience and their flexibility.”

While humbled to have received the Florence Nightingale medal last year, she says the award symbolises for her the hard work of all nurses who work abroad and in remote and indigenous contexts.

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