COMMUNITY HEALTH MEMORIES, CENTRAL WEST, 1980 to 1986.
Dear former Central Western Community Health Colleagues,
Lucy asked us to write down our Community Health stories so here goes.
My initial office in my new job as Senior Health Education Officer for the Central Western Region of the Health Commission was in the Bathurst Community Health Centre. There was a certain weirdness to my association with this building. In its previous life it had been a BP Service Station. In my previous life to being a NSW public servant I had a clerical job in BP head office in Milsons Point keeping the books for service stations that were not profitable enough to be franchised out. The Bathurst Station was one of these. No wonder BP wanted to sell it. I hope the Health Commission got a good price. Dr Rozalla and John Williams would have been the instigators of the deal, I imagine.
An early memory of my brief time in that office was an unexpected and very unusual (in fact a once only) visit from the Regional Director, George Walker. George and I had a quasi-family connection. We were not related but a family related to him were close boyhood friends of mine in Hunter’s Hill. I’d been in the boy scouts and the altar boys with one of his nephews and sometimes stayed at their place. So our relationship, George and mine, that is, tendered to toggle between the official, always ambiguous and often combative, and the personal, where we’d swap news about his family.
I had also known George before I joined his staff. He had been a member of the Central Western Regional Advisory Council of which I was Executive Officer. I have a copy of a letter from George to Head Office proposing that he had the perfect opportunity to set up his Preventative Services Team (PST) as a suitable candidate for the job of Team Leader of that team had come looking for work. (Regional Advisory Councils had been abolished and been replaced with something much less interesting.) So, you see, all the trouble I caused you had an earlier history than any of you imagined.
I digress, back to the surprise visit. I had no idea how the Health Commission and Hospitals worked administratively. A letter from Head Office came across my desk. It was about a new source of funding for “Health Promotion in Hospitals”. In my administrative innocence, I immediately circulated it to all the hospitals in the Region inviting them to submit proposals for using the money. This upset George considerably and he came to my office to explain to me how the system worked. The only thing I remember about what he said in a long monologue pacing up and down the length of my quite spacious office was that I didn’t understand a word of it but did glean from it the impression that, despite its title, the money was for Regional Office to use on health promotion, not the Hospitals. Later, I came to realise that it was the only operating budget that I was ever likely to have and learnt to hang onto it.
George had written a cogent and impressive vision statement (though we didn’t call them that in those days) for the PST. I saw it as my first job to develop from that a policy document articulating, in some detail, the principles and operational objectives of the PST. I locked myself away in a room that Lucy allowed me to have in the Bathurst CHC (I’d been relocated down William Street to the open plan of the Regional Office, an impossible environment for doing any serious thinking and writing.) I laboured away for days, if not weeks, writing pages and pages but never being able to draw it to a conclusion. Lucy at one stage said, “John, what are you doing in there?” I eventually gave up and said to myself, “Bugger this, lets just get out there and do something and see what happens.” The document never got to the typist (it was long before word processing, remember, we actually had secretarial staff).
During my first weeks in the job I was also running for election to Bathurst City Council. My wife, Barbara, had talked me into this to support my friend Wal Walker’s campaign. Whether it was coincidental or George’s contribution to maintaining the dominance of conservative forces in Bathurst I’ll never know (unless, George, you get to read this document and choose to tell me), but at the height of the campaign he sent me to Sydney for a week for some kind of training. He did me a favour really. With a young family and a demanding job I didn’t have time to be a Councilor and my candidature was enough to ensure that Wal was the second candidate elected with the aide of my preferences.
While on the George theme, abandoning any attempt at chronological order, a couple of other favourite stories.
At the last reunion, I told the one about the mention in our PST meeting minutes of Lois Goolagong’s request for a small amount of cash to buy gardening tools to teach the young ones how to grow vegies and to give them something constructive to do. Our minutes always went to George and it was the only time we got a comment back from him, a note in the margin “The Health Commission does not buy gardening tools”. I bet every hospital has some gardening tools. Anyway, I was delighted to learn, at the reunion, that Lois had got her tools another way. Good on you, Lois.
Then there was the courtesy letter from Peter Trebilco, advising us that he was visiting the region in relation to a Head Office project that had nothing to do with us. Peter was a senior health educator in Sydney with a special interest, I think, in drug and alcohol and AIDS. He was gay. He had been a great help to me in my understanding what health education generally was all about, it being a new field for me. The file came to me with “NFA” written in the margin in George’s unmistakable hand. “NFA” seemed suggestive of something rude to me so I went and asked George what it meant. He said “No further action”. I said, “But no further action is required, it’s just a courtesy letter letting us know that he is coming into our region”. “No further action” repeated George, making it clear that Peter was not welcome in his office. I rang Peter, we had a laugh about it, and I invited him home for lunch when he was to come up. We sat on my deck in beautiful Bathurst winter sunshine, much more pleasant than meeting in the office.
One of my early impressions of how the commitment to health promotion was met by Community Health staff was by running relaxation classes. I was pretty cynical about this approach and decided I had better explore it further by doing a relaxation class myself. I enrolled in a class at the Bathurst CHC and dutifully went along. We were asked to lie on our backs on the floor and were given a green leaf to feel. I promptly went to sleep. When I was rightly chastised for this I explained that it was the first time in five or more years that I had been able to lie down on the floor in the middle of the day and not have a small child jump on me. I did, later, come to appreciate the value of relaxation techniques.
Another curious thing about health education was that it seemed to be all about the distribution of pamphlets and, somehow, I was in charge of the pamphlet supply and responsible for keeping the stocks up. Thankfully, Roseanne Hunt knew what she was doing and saved my bacon, god bless her. There was a section in Head Office dedicated to producing and supplying these pamphlets. They were full of good, sound information but noone seemed to appreciate that they weren’t exactly an exciting read (I didn’t read many of them myself) and weren’t going to make much of an impact on the health of the nation on their own.
This Head Office section also produced a journal, I suppose, monthly, I can’t remember. This was little more than an elaborately produced newsletter. It seemed a waste of resources to me. John Williams agreed and we joined forces to have it scraped. Someone in HO must have hated us.
Speaking of getting things scrapped, you will remember the data sheets you all had to fill out, documenting your every move. Margaret Wilson and I had a look at it and asked the question, who analyses this data and how is it put to use. The answer was noone and in no way. We had it scrapped. You loved us for it. It was our biggest PR coup and made you think that, perhaps, PST wasn’t a complete waste of space after all.
Someone in Blayney, I think, got wind of this new PST and wrote to the Regional Director asking that we be sent down to their school to treat the heads of the little darlings with head lice. We demurred on the grounds of incompetence.
So we were under way, Roseanne Hunt, Margaret Wilson, Greg Heys and myself. Margaret and Greg also had duties beyond PST as Research Officer and Regional Social Worker respectively.
Then there was the saga of where we were to be housed as a Team. Three of us were based in Bathurst, one, Greg, in Orange. Greg had made it clear he didn’t mind commuting to Bathurst for PST business. We came up with a couple of options, but the bosses, for no good reason I can understand, decided to give us office space at Bloomfield Hospital. The compromise was that we could clock on for work in Bathurst and then commute to our office in work time. I was tempted to leak that nonsense to the media and regret I didn’t now. The offices themselves were fine, in a beautiful old sandstone building. My office door was very solid, with a handle only on the outside. I kept Greg’s home phone number handy in case the cleaner ever locked me in.
I had been shunted off to Orange before, in my Decentralisation job, when Regional Advisory Councils were abolished and, here I was, doing it again. The two consolations were that I could visit the wonderful Italian amoretti and ice cream shop in the main street of Orange and could listen to Fred Dagg on the ABC on the way home.
During our establishment phase as PST we talked to lots of people, picking their brains. Two such encounters stick in my memory. At the Forbes CHC, Greg and I had a meeting with Bill Rutter, the Aboriginal Drug and Alcohol Worker based in West Wyalong. Quite spontaneously, he gave us a dissertation on Community Development. We considered ourselves professionally qualified as community developers, but this was the most wonderful talk we had ever heard on the subject, and, for me, it remains so. We both expressed regret that we did not have a tape recorder.
The second one was with the Psychiatrist Director of Bloomfield Hospital. I have forgotten his name. He had us around to his place for a barbeque one evening and regaled us, at great length, with his methods of drug and alcohol rehabilitation. After listening patiently to an hour or two of this, and enjoying his beer and chops, Greg said, with a note of frustration in his voice, “But we are about prevention.” “Prevention”, said the good Doctor, “creative play for the under fives.” When you think about it, he was right on the money.
Apart from my above mentioned failed attempt at Grand Policy Development, we started with data collection. I remember an enthusiastic epidemiologist in HO taking Margaret and I through the statistics. It was where I learnt the term “temporary Australian”, an apt description of young males on motorbikes. In an earlier life I had been one of those stats myself, though I had lived to tell the tale. You’ll remember my permanent limp. I celebrated the 40th anniversary of my motor bike accident on 19th March this year (it was Easter Sunday in 1970 and here I am writing about it on another Easter Sunday).
Out of the stats a number of major preventable health issues were apparent. We came home with a shopping list. We knew we couldn’t do it all, or not all at once anyway, and decided that we would put the options to all of you and let you choose, to give you ownership of the program, but without you really knowing what you were letting yourselves in for (we didn’t know either).
We started with a meeting of Robyn’s team in Forbes. Leah Griffiths, the wild nurse from Grenfell, plumbed strongly for hypertension. The team went along with this suggestion. We broadened it a bit to heart disease, as the same health promotion strategies applied to both. We took this to the other teams and all agreed to “Give It a Go”. And so the program was born.
I really liked the spirit of the “wild nurse from Grenfell”. Sadly, she was a bit too “out there” for the bureaucracy to handle and John Williams had to give her the chop. At one stage, I can’t remember the details, I got myself into some kind of controversy with the authorities of Grenfell and Leah wrote a glowing defence of my actions in the town. Advocacy from this source didn’t exactly help my case back in Regional Office. One of my treasured possessions, rediscovered by chance while writing this, is a personal letter from Lear supporting me in an altercation I had with some members of Robyn’s team. I can’t remember the details, which is probably just as well.
The Orange Community Health team bravely agreed to pilot “Give It a Go” with a caravan we borrowed from my former colleagues in the Bathurst Orange Development Corporation. The team, ably led by Jenny Hazelton, had everything in readiness on the main street the day before the launch and we wondered whether we would attract any takers. We got to the van bright and early the next morning to find a queue down the street for about 100 metres. That kind of response was maintained throughout every town and village in the Region over the next two years.
Dr Jim Lawson, a medico in HO with a strong interest in health promotion, dismissed our program as ineffective based on evidence from similar strategies elsewhere. His criticism of the other programs was well founded. What he did not appreciate, and neither did we at the time, was that to be successful you had to reach a critical mass of participation. I don’t know what that figure is, but I believe we exceeded it. We put 12,000 people (Margaret will correct me if my memory is faulty on the figure) through that program. Years later Sue Wade told me that the Central West was no longer on the top of the list for heart disease and I like to think that our huge “Give It a Go” effort had made an impact.
Jenny Hazleton and I went to the TV station to negotiate a community service advertisement for the program. We showed the Manager the advertisements we had borrowed from the North Coast Region. He said, because they were professionally produced ads, he could not give us free air time. I did a quick rethink and said, “Well, I could squeeze $8,000 out of the budget for it”. (Not much for paid TV ads.) He agreed.
Later on, the actors in those ads indicated that they were entitled to royalties. We could not afford that. The TV people suggested I could make a local ad with them for $100, with me as the talking head. I nervously went to George asking him if I could go on TV for the program. He agreed and you’ll remember the ad. Later, at a meeting in Sydney, Simon Chapman was showing us a Quit Smoking ad that was going to cost them $80,000. I offered to do it for $100 but he didn’t take up the offer.
As well as the TV ad, we had press releases in all the local papers, coverage on all the radio stations and you’ll remember the very colourful van. George had scored the van for us, I think, from a defunct program at Sydney Hospital. The Cowra Hospital maintenance crew did a great job of fitting it out to Jenny H’s design and decorating it to the design of a graphics lecturer at MCAE. And remember the posters we plastered up everywhere. They were designed by a graphic artist at MCAE too.
You’ll remember the questionnaire Margaret designed for us to fill out for each participant. I cannot forget the big farmer towering over me at Tullibigeal as I asked him the question: “How did you come to know about the campaign?” His answer was a great complement to our media effort: “You could hardly bloody miss it, mate.” George had a similar comment about the van when he returned from a Sydney trip, having driven past it in Lithgow.
The oft told stories out of Lithgow have to be on the record. One question we didn’t have to actually ask (well, I didn’t anyway, did anyone?) was SEX. We wrote in the box a 1 for male and a 2 for female. One Lithgow miner, when he saw a 1 being written beside SEX on his questionnaire, protested, “ I’m better than a 1.”
With experience we suspected there was a tendency for people to understate their alcohol intake. Marilyn Weaver (as she was then) gave us a technique for overcoming this. You suggested a figure that you thought was way above their consumption and they would bring it back to the real figure. This backfired with the Lithgow miners but we still got the result we wanted. “How many drinks would you have in a session, 20?” “No mate, at least 40.”
On one occasion, I had to tow the van from Cowra to Bathurst. Going through Lyndhurst someone waved me down and pointed out that flames were coming out of one of the wheels of the van. I didn’t know what to do so I went looking for a phone to ring the Cowra Hospital team for advice (it was long before mobile phones). The first door I knocked on was the home of a young family. The motor mechanic dad was out of work and they were too poor to have a phone. The house had the smell of poverty about it. They were ashamed of their state and I regretted causing them embarrassment. The second house I went to was an elderly lady who kindly let me use her phone. I picked it up and turned the handle and the local exchange operator said, “Yes, Elsie.” I had to explain I wasn’t Elsie and why I was using Elsie’s phone. (Local exchanges were a wonderful piece of community infrastructure and small communities are the poorer for the loss of them). When I had made my call I thanked Elsie and she said it was nice to feel useful for once.
I had always wondered about the life in these small villages scattered throughout the Central West. In my previous job I had wanted to do some research on them as they seemed to be overlooked by the demographers and planners. A Human Geographer friend at MCAE, Peter Murphy, had called them “social sinks”, places where the poor congregate because of cheap rents and become socially isolated. My two encounters in Lyndhurst supported this view. I did make it to Bathurst with the van after good advice from the Cowra boys.
At our last reunion in Canowindra, I was invited to speak about “Give It a Go” and as I was getting to my feet Margaret Wilson whispered to me, “They hated it, you know”. I replied, “Yeah, but it was good for them.” That was a light hearted retort but it sounds a bit patronizing now. Far be it from me to be patronizing to you guys. You were bloody marvelous.
Health promotion generally, and “Give It a Go”, in particular, took you all out of your comfort zone. You were all trained to be clinicians of one kind and another, in the framework of acute medical and paramedical care of individual “patients”. Community Health demanded of you that you become agents of social change. This was a huge ask and you all responded generously and magnificently.
The majority of you were Community Nurses and, with no disrespect or lack of appreciation of the other professions in our ranks, I would like to say something special about you. To a sick person, a good nurse is like an angel. You are wonderfully practical and down to earth, skilled at making the patient comfortable and at ease, caring and compassionate without being sentimental or emotional, strong, firm and calm in a crisis or when a patient is anxious. I remember being referred to Liz Bonham when I was diagnosed with bowel cancer and was looking at the prospect of a colostomy. While explaining the process to me she said, “This is the most rewarding part of my job.” Here she was being the nurse she had trained to be and wanted to be. I was fond of saying that a nurse’s mindset is such that anything that isn’t done and dusted by afternoon tea time isn’t worth thinking about, and here was I asking you to do things that might have a salutary effect in twenty-five years. My thanks and congratulations to all of you for the way you responded to the challenges we threw at you.
Two I would like to mention especially were Helen Davison and Gloria Summers who were full-time community nurse coordinators for GIAG, working with me from Regional Office. They were a godsend. There was also that dynamo, Bruce Andrews. I kept him employed for two years on eleven different grants.
My role, when I was rostered on to van duty, was to measure height and weight. It was the only thing I was competent to do. I did so many that I could pick a person’s height and weight just by looking at them. The old Second World War diggers were funny. I ‘d measure their height and write down 5’11”. They’d say, “I’m 6’1”, mate.” I’d say, ”You were 6’1” when you joined the army at 18, mate, you’re not any more.” I have just discovered that I have lost about a centimetre in the intervening years, just like the diggers.
We did lots of other things during and after “Give It a Go”, but my memories of them are vaguer because GIAG was such a big event.
I do remember, painfully, undertaking to help the Orange CHC team to set up their health education stall at the Orange Field Days one year. Then a hot shot young doctor came up from HO charged with coordinating some kind of book on regional health services. I was dragooned into writing the chapter on Community Health and, of course, there was a demanding deadline that took precedence over everything else. So I neglected Field Days preparation and found myself on the sharp end of Jenny Smith’s wrath. In a desperate last minute effort to make amends there I was out at the Field Days site the day before the show opened with a trailer load of dirt and a shovel leveling the site for the stall.
With borrowings from elsewhere, we developed a manual for planning, documenting and evaluating health promotion programs which we then toted around for you all to use. Do you remember the pain of it all? Marion Wilson showed me a program put together by a couple of her bright young OT’s out Canowindra way. It was all perfectly done and I was duly impressed. I discovered later that they had done it with the quiet and unobtrusive, but highly skilled, help of Denis Golding. All credit to the OT’s, but a tick for PST too, I thought, with satisfaction.
As a team leader, I attended the monthly Community Health Team Leaders’ meetings. These meetings typically went all day, from say, 10.00am to 4.00pm, with an hour for lunch. The chair was rotated amongst the four Area Team Leaders. On one occasion, they decided to give me a turn as chairman. The meeting was over in half an hour with all matters discussed and decisions made. I wasn’t asked to do it again! I’d ruined the visit to Bathurst.
I had to fight the good fight on two fronts, of course. There was working with you guys, but there was also HO and the State and International health education arenas.
At the International Health Education Conference in Hobart I asked a Canadian speaker how his government’s fiscal commitment to health promotion compared to NSW which was 0.8% of the Health Commission’s budget. After the session a member of the Commission approached me and asked me where I got that figure. “Out of your Annual Report” said I. In a reprint of the Report, that page was missing.
I was invited to give a lecture on health promotion to Hospital CEOs studying at MCAE. In the question session one of them asked, “Hasn’t health promotion been tried and failed?” “Not at all” I said, “it hasn’t yet been seriously tried” and quoted the 0.8% figure to him. Dr Stephen Leeder, a great advocate for health promotion, was fond of pointing out that Westmead Hospital, where he was based at the time, spent more on butter than on health promotion.
Within health promotion there was an ideological split between the medical model/individual behaviour change devotees and the more radical social change advocates. I was fond of saying that, as health status is clearly related to socio-economic status, we should be doing something about socio-economic disadvantage. Repeatedly, I was told this was not the responsibility of the health service. The International Conference showed my like minded confreres and I in NSW, and there was a band of us, that we were ahead of the game. We didn’t have the data then, but it is in now. Sadly, governments are only just beginning to get the message. But, as Barack Obama says, “That’s what change looks like.”
At one meeting of health educators in HO a bright young doctor, interested enough to be involved, made the comment that health promotion needed sociologists rather than doctors. New to the group, she then asked if we could each introduce ourselves and give some indication of our background. She was impressed with finding that three of us had degrees in sociology.
I am beginning to blow my own trumpet so it is time I stopped. It was great fun working with you all and I feel privileged to have been part of Community Health.
John Murray, March/April 2010
Thanks to Rafe Champion for hosting this memoire on his website, the notorious Rathouse.