A lifetime of nursing in a rural community: nursing in a small West Coast community has provided a lifetime of satisfaction, challenge and inspiration.

'BETTY G" is an institution in Reefton. Nursing in the small West Coast settlement since 1968, Betty Gilsenan has touched the lives of generations of families in her roles as district, public health and well child nurse and now part-time immunisation coordinator for the West Coast.

She came to Reefton just after the devastating Inangahua Earthquake in 1968. After a stint of nursing overseas and completing her Plunker training in Auckland, she'd applied for a job in Otira. She'd never been to the Coast and remains grateful to the then principal public health nurse for suggesting Reefton might be more suitable. A Nelsonian by birth and nursing training, she had no problems being accepted into the Reefton community, despite the Coast's reputation for taking some time to accept "outsiders". With delightful understatement, she says her arrival in Reefton was "a bit of an awakening". The tiny office she was shown into had its walls lined with manila folders and sheets and sheets of paper--all the Department of Health rules and regulations.

Gilsenan was the only nurse in the area, which stretched from Inangahua in the north, Ahaura in the south and the Maruia Valley in the east. The geographical spread is about the only thing that hasn't changed in her nearly 40 years in the district. She began as a combined district, public health and Plunket nurse, a similar role to that now filled by rural health nurses. Arriving after the earthquake, there were many families who had suffered from its devastation. They had had to be rehoused in Reefton and many had lost all their belongings.

A priority when she first arrived was caring for heavy stroke patients. "As the district nurse, they were always the priority. They often needed dressings, always needed bathing. Others needed insulin, which I often gave on my way to work."

As a public health nurse she regularly visited the 12 schools in the region. "There was a lot more health education in schools then, delivered in the classroom."

There were also the mothers and babies to care for. In her first years in the area, the birth rate was around 50 a year. That has declined to around 25 to 30 annually, although she says there's a mini "baby boom" on at the moment with six babies under six weeks in her care. She also dealt with "anything else that came along". Reefton had a fully functioning hospital at that time and emergencies were dealt with through the hospital.

After a couple of years, she married a local. The time was also right to split the burgeoning nurse role. A district nurse position was advertised and Gilsenan shared that role with another nurse for a number of years. Then with three young children and a husband who had lost his job in the forestry, the family decided that Gilsenan would return to work full-time while her husband, Dan, would look after the children and do some part-time teaching. She returned to a public health and well child role, one she held for more than a decade. Described by a colleague as "a well child guru with a passion for her work", clearly caring for mothers and babies has always been enormously rewarding for her. On the morning Kai Tiaki Nursing New Zealand visited, among the 15 calls that backed up was one from a young mother: "Betty G, I want you to be my Plunket nurse." Another young mother drops in with her bonny baby, who had a very fragile start to life but who is now thriving. The pleasure Gilsenan takes in seeing the baby is evident in her conversation with the mother and baby. "As a well child nurse people invite you into their homes and the beauty of my role is that it is not just the baby I'm involved with."

A young lad, bicycle helmet in hand, knocks at her clinic door and asks a direct question: "Mum's got no more milk. What do we do now?"

She also delighted in the fact that, as a public health nurse, she would be involved with the babies she had once cared for. And with the passing of time, she has cared for generations of some families.

Four years ago, an opportunity to work as immunisation co-ordinator for the West Coast arose and Gilsenan decided to take on the challenge. Her week is now divided into 2.5 days as immunisation coordinator and 2.5 days as the well child nurse, although it's never quite that clear cut. As the co-ordinator, she visits all general practices and rural nurse practices on the Coast, from Karamea to Haast, a distance of some 600 kilometres, ensuring vaccines are stored appropriately and at the right temperature (between 2 and 8 degrees celsius)--never as straight forward as it sounds--and answering nurses' queries. She also provides clinical assessment for practice nurses who have completed their vaccinator training.

Ante-natal education on immunisation is an important aspect of the role, as is educating the over 65s and others at-risk on the importance of influenza vaccination. Immunisation rates around the Coast vary considerably, with some small rural settlements having a 100 percent rate, and the overall rate standing at more than 80 percent. Gilsenan acknowledges there is considerable work to do to reach the national target of 95 percent.

She's found the new role stimulating, a steep learning curve and very satisfying. "Immunisation affects us all."

Although "Betty G" may have nursed in Reefton for close on 40 years, her nursing practice has never been boring. "There has always been such variety in my roles and that variety is inspirational." Her diary for a week reflects that. The afternoon of Kai Tiaki Nursing New Zealand's visit she is off to Greymouth, 80 kilometres away, to visit two practices about vaccination storage. The next day is spent on well-child checks and a visit to Inangahua Junction, 40 kilometres north, to give a mother some ongoing parenting advice and support. That night there is a meeting of the Coast Care Trust, a Coast-wide trust for people with physical and intellectual disabilities. The next day there's a trip to Westport, a good hour's drive, to talk to a new mother, referred by a midwife, about immunisation. "I'll give her information and show her a short video so then she is in a position to make the best choice for her child." The rest of the morning is taken up with a meeting with the early intervention team of occupational, physio and speech and language therapists, public health nurses and staff from Group Special Education to discuss the progress of children referred to the team. The meeting also provides an important networking opportunity. Another meeting at the Plunket rooms, to discuss the upcoming well child week, is squeezed in. That night there's an ante-natal class in Greymouth, an hour's drive away. Gilsenan has been invited by midwives to talk on immunisation. The next day there is a public health nurses' study day in Greymouth. The first part of the day will look at promoting activity in the community as part of an Active West Coast promotion. In the afternoon Gilsenan will update the nurses on immunisation, the national immunisation register and on an upcoming road show promoting immunisation. On the Friday, it's back to Wesport for a hui on children's oral health and oral health in equalities. There's a drive on to improve Coast children's dental health.

Then there's the calls and emails which have backed up while she's away and the paper work that has to be completed.

Gilsenan regularly works more than 40 hours a week and can clock up more than 2500 kilometres in a month.

"The day I think 'Oh, I've got to go to work today' will be the day I decide to finish. While I'm still enjoying my work and have something to contribute, I'll stay."

Caring for each other

IN HER time in Reefton, Betty Gilsenan has seen the decline of many rural industries, the halving of the number of schools and a significant reduction in the population, from around 2700 over the whole area to around 2200 now, with about 1000 of those people living in Reefton.

Reefton, a town founded on alluvial gold in the 1870s, was the first town in the Southern Hemisphere to generate and reticulate its own electricity for public use in 1888. Since then, "the Town of Light" has shone with greater or lesser brilliance, depending on economic circumstances. In the late '60s it was a typical West Coast settlement, depending on mining, the railways, saw milling and farming for its economic livelihood. In the 1980s, like so many rural communities throughout the country, Reefton suffered a severe body blow from the economic reforms of that era. Many people moved away in search of employment; many who remained struggled.

It took some time to recover but the town's light is shining brighter now with the prospect of a new coal mine in the hinterland, developing tourism and a gold mine development.

The atlas of socioeconomic difference, Degrees of Deprivation in New Zealand, gives Reefton an average deprivation score of seven, with one representing the least deprived areas and 10 being the most deprived. (1) Gilsenan says there are around 60 unemployed people in the area she covers.

But in good times and bad, Reefton has always been a caring community, according to Gilsenan. "One of this community's strengths is its sense of support for each other. It's a wonderful community. If anyone's been ill or is struggling, people will drop in soups or a casserole."

Then there's the local woman, Rosemary Waghorn, who for years has knitted blankets for every baby born in the district and woollen vests, which Gilsenan distributes. "She must have knitted hundreds of them over the years."

A local spinning group has also provided blankets, booties, cardigans and other clothing for mothers and babies. "At least I know all our babies are warm."

The Inangahua Children's Trust, formerly the CCS, is a "very local, very pragmatic" trust which provides money for health needs such as glasses and ointments; petrol vouchers for trips to Greymouth for doctors' appointments; and other things which may be beyond the means of a family at a particular time.

Regular well child checks are a way of identifying other problems in a home and experience has honed Gilsenan's instinct for when something may be wrong, eg violence against the woman. A discreet visit when the man is not around has often confirmed her suspicions. "I'm a great one for referring on to the appropriate service and that's what I do in such situations but remain as a key support person."

Gilsenan also knows that whenever she sees a need in the community there are a number of organisations she can contact and "some coal is organised, or a load of wood or some groceries are delivered".

She says that there are few homes where the man is unemployed and sitting around twiddling his thumbs. "People are fairly self sufficient and if a man is unemployed he'll often go hunting and get some food."

For a community of just 1000, there are an impressive range of services for families: a toy library, kindy gym, self-funding car seat hire, a service originally set up by Gilsenan, as there is no Plunket Society; playcentre; a mothers' support group; and a music group.

Gilsenan, while reluctant with the label poverty, acknowledges there are families in Reefton who are disadvantaged. "I'd never want to impose the way I live on anybody. As long as families are providing love and warmth and food for their children, they are doing well."

REFERENCE

(1) Crampton, P., Salmond, C., Kirkpatrick, R. with Scarborough, R. and Skelly, C. (2002) Degrees of Deprivation in New Zealand An atlas of socioeconomic difference. Auckland: David Bateman Ltd.