Recently Ian Rummery, an Australian nurse who lives on St Helena, sent us some job openings for nurses on the island. Nurse Uncut was intrigued and asked Ian to write for us about his experience as a nurse in such a remote location. Here’s Ian’s story.
I trained as a psychiatric nurse at the Western Australian School of Nursing graduating in 1991. After graduation I worked in South Australia and Victoria before moving to the UK. For some reason I had always wanted to go to St Helena – I remember when living in the Nurse’s Quarters in Clare, in South Australia, having a map of the world on the wall and drawing a circle around St Helena.
St Helena is one of the UK’s overseas territories, a small island in the middle of the South Atlantic Ocean. It’s about 10 miles long and six miles wide with a population of 4000. It’s currently undergoing significant development as an airport is being built which is expected to be operational in 2016. At present there is one dedicated ship, the RMS St Helena, which takes five days to reach here from Cape Town. Everything comes on the RMS – people, food, cars, medicine; it is our lifeline.
The building with the light green roof is the current hospital, built in the ’50s, the white building next to it is the original hospital, over 100 years old.
I first visited the island in 1994 and met Belinda who I am now married to. I met her on the RMS but we returned to live in London before moving to St Helena permanently in 2003.
My first job on St Helena was as the Nursing Officer – Mental Health. This involved managing a small psychiatric unit that was in effect a psychiatric nursing home. One resident was admitted in 1954 and is still alive today. It was built as a miniature asylum, with high walls and dormitories, and when we did have to care for acutely ill psychiatric patients it was very difficult. The unit was also 50 metres from the edge of the cliff with a several hundred metre drop to Jamestown below.
I also worked in the community, initially as the only psychiatric nurse, though several years later we moved to having two fulltime community psychiatric nurses.
For years there had been talk of building a nursing home on St Helena and I was appointed the Manager of the Older Persons Service. In this role I helped set up the new nursing home and a home care service. Prior to the new nursing home there was an old peoples’ home in a rundown complex, a geriatric ward in the hospital and the psychiatric unit. The residents of each of these places were brought together to live in the new nursing home.
I left nursing and last year was elected to the island’s council and now serve as Chair of the Public Health Committee.
Working as a nurse on St Helena was an extraordinary experience. The biggest difference and greatest challenge I faced was working in isolation with very little professional support. There are usually six doctors on island but it is rare for any of them to have specialist psychiatric or geriatric experience. What this did mean though was that you often were the only professional to journey with someone throughout their illness. I was privileged to be part of many people’s lives from first diagnosis through arranging home care, then transfer to the nursing home, coordinating palliative care and then, sadly attending that person’s funeral. To be so involved in caring for people was often a very humbling experience.
On St Helena we face all of the challenges of remote health care services with the added complication of a five day sea voyage to Cape Town if a patient requires specialist treatment. We have a very high burden of chronic disease with diabetes and heart disease well above the UK averages.
With the coming of the airport we are going to need to develop a new healthcare model – 0ne that is based on telemedicine and providing support for specialists to come to the island for short term placements. Though I miss the patient contact, it was this new challenge that motivated me to change careers.