Working in the Falkland Islands--a reminder of how nursing used to be; thanks to an advertisement in Kai Tiaki Nursing New Zealand, a Tauranga nurse is finding unexpected satisfaction and a real sense of privilege working in the remote Falkland Islands.

Two years ago, while leafing through my copy of Kai Tiaki Nursing New Zealand, I discovered a full-page advertisement for suitably qualified staff nurses to work in the Falkland Islands. One of the photos depicted a lovely old cottage hospital by the sea and immediately appealed to me and my family. The building, built in another era, had an enduring quality that quietly beckoned.

After I had faxed off my CV, the chief nursing officer (CNO) and ward manager of the King Edward VII Memorial Hospital in Stanley interviewed me by telephone. A personal interview was subsequently arranged with a Falkland IsLander, then residing in New Zealand. It was her job to evaluate whether my family and I would fit into the small, isolated community and way of life on this remote group of islands in the South Atlantic.

Within a few weeks of acceptance of a two-year contract, our family of four, comprising me, my husband Dennis and our two youngest children Adrian and Bridle, then aged 13 and 11, flew to the Falkland Islands via Chile. We left our three older, independent children at home in Tauranga, all collectively united in their devastation at their parents' sudden decision to leave home. "Surely", they cried, "it's supposed to be the other way around?" We flew into Mount Pleasant Airport (MPA) on East Falkland Island. MPA is a British military installation about an hours drive from Stanley, the islands' capital. Nothing had prepared us for the amazing vista that stretched before us--thousands upon thousands of flat to undulating hectares of long, white grass, all flowing eastwards, its grace unimpeded by as much as a single tree. Spectacularly devoid of green pastures or forests, this tiny speck of land in the South Atlantic had its own golden beauty, shaped, wrapped and blow-dried by a constant westerly.

It didn't take long to discover that the lovely cottage hospital I had fallen in love with had burned to the ground more than 20 years ago. Its 28-bed replacement sat serenely under a bright blue roof on Stanley Harbour's southern shore. The 13 staff nurses, including midwives, are gleaned mainly from worldwide locations and are presently all from the United Kingdom (UK), New Zealand and Australia; truly a tri-nations' team! The three midwives, one of whom is the CNO, deliver between 30-40 babies annually, and the nursing auxiliaries are all hired locally. Everyone brings his or her own specialty, thus adding skills to an already efficient unit that is tailored to suit the needs of a territory, which, not so long ago, was under siege from neighbouring Argentina. I am a general registered nurse and work in all areas except obstetrics. My role as a senior staff nurse within the team is to exhibit professional accountability, competent and efficient leadership, as well as to continue developing nursing, teaching and coaching skills. Apart from the present seven elderly residents, the remaining 20 beds are used for acute admissions, either from the local community, the military base or the South Atlantic deep sea fishing fleet. Nurses encounter a wide variety of conditions, anything from acute abdomens to myocardial infarcts and hypothermia. Foreign nationals off the fishing fleet can appear with arms, fingers or even eyes missing. It is quite common to be working quietly in the ward, when a critically fit seaman will arrive off a ship from the fleet; the police will phone with an emergency community call; and the helicopter can be landing with a patient from the outer islands, all at the same time. One of the staff nurses is always on-call for situations such as these. Three GPs are permanently employed, while a surgeon, anaesthetist and radiologist all do three- or four-month contracts, servicing the islands' local population of around 2400. A gynaecologist, orthopaedic surgeon and optometrist fly in from the UK annually, and the pathologist is imported when required.

The hospital is self sufficient. The ward, a separate two-bed intensive treatment unit and delivery suite, operating theatre, x-ray department, pharmacy, accident and emergency, dentist, district nurse, outpatient clinics, physiotherapy, mental health, social services, engineers, medical stores and administration are all housed under the same blue roof. Twenty-four hour care is offered to the community, so anyone who isn't well in the middle of the 11-hour night shift can either just turn up or ring for advice. A dedicated team of drivers operates the ambulances, picking up and delivering patients at all hours of the day and night. Patients with severe conditions are airlifted to either Chile or the UK. The hospital is the base for the Antarctic and South Georgia, and also for the cruise ships which frequent these islands during the summer months.

The hospital ward has its quota of older, continuing care patients, but there are few considering the size of the ageing population. The King Edward VII Memorial Hospital (KEMH) is flanked on either side by sheltered housing units where elderly people can live relatively independently, with assistance from wardens. These admirable, older Falkland Islanders, mainly British in origin, have lived stoic lives in a tough, isolated environment and tend to live independently for longer than would normally be thought possible. The district nurse oversees their health and safety, and the hospital is their base for baths, activities and outings. Meals on wheels are available, prepared and cooked in the hospital kitchens.

The British military installation has a combined force of about 2000, some of whom get admitted to the hospital. The military does an outstanding job airlifting ill or injured people from the remote islands or farms, often in extraordinarily inclement weather. The emergency nurse and a doctor accompany the helicopter on these occasions, with the chopper eventually landing on the school playing fields opposite the hospital.

I love the family atmosphere at KEMH. Indeed, the community at large treats the hospital as an extension to their own homes. It reminds me of how nursing used to be. The camaraderie among the staff is wonderful. With their own families thousands of miles away, strong, life-long friendships develop quickly. It didn't take long for the children to settle into school and Dennis was hired as the Falkland Islands' Company handyman. A self-employed farmer back in New Zealand with a lot of Kiwi ingenuity, he soon became involved in just about every fix-it situation imaginable. He earns about 15,000 [pounds sterling] a year, on which we can easily live. The nurses are paid monthly, between 8-10 [pounds sterling] an hour, plus extra for unsocial hours. Tax rates are 17 percent less than in New Zealand. We get a mid-contract return flight home and the annual leave is about seven weeks. Normally, staff work an average of 160 hours a month, with two days off a week. At the end of my contract, I receive paid flights home plus 25 percent of the annual basic wage. The rent for our furnished, three-bedroomed bungalow, which is a century younger than its neighbours, with double glazing and central heating, is almost 500 [pounds sterling] a month. With the relocation grant, we were able to buy a 4WD vehicle, a necessity in this country if one wants to see anything of it. Basically, there is only one main road on East Falkland, so in order to see the coastal wildlife, which is magnificent in its variety and abundance, one has to traverse miles of wet, boggy, peat land. During the summer, many varieties of penguins, sea-lions, black-browed albatross, and an extraordinary number of coastal birds attract thousands of tourists. These islands are a photographer's paradise.

Last year, the children both attended the Falkland Islands Community School, where a good education, based on the British system, is offered to year 8-11 students. The school has a truly spectacular view of the harbour and beyond, and presently has around 145 students.

A large leisure centre, pool and library are part of the school complex and are used extensively by the community in general. Students who achieve a certain level in the GCSE British examinations held during year 11, then go on to further education in the UK, assisted by the government. Children younger than year 8 attend a junior school.

The Falkland Islands are very safe for children, as it seems everyone keeps an eye out for them. Fast foods are at a minimum, with no McDonalds closer than South America. The Government has a low tolerance of drugs, which adds to the safety net in place for young people. Our son Adrian now attends Tauranga's Bethlehem College, with the fees paid by the Falkland Islands Government, as are his holiday return flights. Both our children live harmoniously in a multi-national community, their lives enriched by this experience.

One dairy farm, with 18 fat Ayrshire cows, supplies milk and cream to Stanley. Fresh beef is usually available, as is fish, but the mainstay of an islander's diet is mutton, which is very cheap. A local grower produces some fresh vegetables and acres of potatoes, but most fruit and a lot of staples are imported from Chile. Virtually all grocery lines are freighted from the UK. A constant feature of the Falkland Islands is the prevailing westerly wind which blows 2030 knots, frequently stronger. The odd thing is that the wind blows flat out all day, then totally dies down at night, only to resurrect itself about 8am. However, you get used to it, although I didn't think I would ever say that. Stanley is the only town on the 700 islands. Farm settlements, virtually the only other names on the Falkland Islands' map, graze around 612,000 sheep. The majority of the population live in Stanley. Nestled into the steep southern slopes are delightful stone cottages built in a by-gone era. The iron roofs and tall chimney pots look like a scene out of Coronation Street. Shops are scattered from one end of Stanley to the other, but the bank, post office, the largest grocery store and the cathedral all have prime positions along the waterfront, alongside the inevitable gift shops. Access to the West Falkland Island and the small outer islands is by air. Britten Norman Islander Aircraft fly to all the larger farm settlements, landing on either grass or clay strips. The planes do not fly in poor visibility or in winds above 50-60 knots, so it is quite possible to have a longer than intended stay on an island visit. To date, it has been a heart-warming, memorable and rewarding experience, both working at KEMH and living within the community. We continue to meet wonderful people whose characters have been shaped by isolation, moulded by war and, like the land itself, finely tuned by the wind. If it hadn't been for that photo of a non-existent hospital, we would never have had the privilege of this extraordinary experience. We have liked it so much that I intend renewing my contract for a further two years, so we will be here until the end of 2006. If anyone would like further information, please email me at [e-mail].

Jennifer Webster, RN, was a staff nurse at Omokoroa's Acacia Park Residential Home for the Elderly before accepting a contract in the Falkland Islands in 2002.