Since February a Sydney-based paediatrician has been flying to the central western community of Warren to see children who have been waiting up to six years for specialist appointments for their complex health needs.
A monthly clinic is run there by Dr Mary Iskander, an experienced Sydney- based paediatrician, who flies to the remote region with the support of Little Wings, a not-for- profit organisation that transports seriously ill children in rural and regional areas to city hospitals.
Nicki Callan, a child and family health nurse who works across Warren and Trangie Multi-Purpose Health Services, told The Lamp that Dr Iskander is nearly “halfway through a wait list of 50 children”.
“While previously dads had never been to our service, even dads are now reaching out and booking their babies for appointments.”
Without a locally based paediatrician, and with 1000km round trips to Sydney for specialist assessment and diagnosis taking up to a week, families in Warren and surrounding were being denied access to basic health care.
“Dr Iskander sees six children during each monthly visit,” says Nicki, who has been a nurse and member of the NSWNMA for 30 years.
“While that might not sound like very many, these children have complex needs and they have hourly appointments.”
When she began working in her position in 2022, Nicki discovered that “the Warren community had not had a child and family nurse for 12 months, while Trangie had not had one for 18 months.”
Since then, she has been working closely with local communities to bring much needed services and support to mothers and children.
CREATING CULTURALLY SAFE SPACES FOR CARE
Working with Mary Small, an Aboriginal Health worker in Warren, and in close partnership with the Warraan Widji Arts group, Nicki has been able to dramatically increase the engagement of mothers-to-be and their children with health services.
The first step was to build relationships with the community in culturally safe spaces.
“Mary Small quickly identified that there was poor engagement with our Aboriginal families. Many did not utilise the Child Youth and Family service. So together we created the Bellies and New Life project alongside a local arts organisation.”
Nicki and Mary worked with the Warraan Widji Arts group, who gained funding through Aboriginal Affairs to provide a women’s group where mothers-to-be came together to paint and tell their story through their belly casts and their canvases.
“We work alongside mothers creating art, while Wayilwan elders teach mums-to-be women’s business. It is a culturally safe space where we can build relationships with women in the community.”
In this environment, working with mothers to make their belly cast, Nicki could develop a relationship with new mums and encourage them to start thinking about accessing child and family health nursing support before birth, rather than after.
“Mary says to me that while previously dads had never been to our service, even dads are now reaching out and booking their babies for appointments.”
The Bellies and New Life Team have now also partnered with the Trangie Local Aboriginal Land Council and Wungunja Cultural Centre to run a second community arts program for women in Trangie.*
THE NEXT PART OF THE PUZZLE
The belly cast project has seen a huge uptake in women accessing health services for themselves and their children, and a big increase in childhood immunisation rates.
“The problem was that while I could make initial diagnoses and referrals, there were still massive gaps in services and resources available to the many children exhibiting sig n s a nd s y mptom s of developmental delay, global delay and behavioural concerns.”
“Children commencing school for the first time in Warren and Trangie were behind the state and national average,” says Nicki.
LITTLE WINGS PILOT GLENN BRIDGELAND
Working with the school and the local health centre, Nicki has worked to increase speech pathology and occupational therapy assessments and programs.
“Our speech pathology and occupational therapy services have gone from just one service to five services. The NDIS team also attends every clinic to assist families with the process for further support.”
For school-aged children, NDIS requires specialist paediatric assessment and diagnoses before they can be allocated resources. So Nicki’s next task was to lobby for Dr Iskander to fly to Warren for monthly face-to-face appointments that are fully bulk billed.
LORRAINE SMYTHE AND HER TWIN GIRLS ALISHA AND ALERAH WITH DR MARY ISKANDER AND LITTLE WINGS PILOT ANDREW BAILEY
“These come at no cost to families and are the gold standard of health care delivery,” she says.
It has all been made possible thanks to a team effort, Nicki says, including her colleagues Mary Small, child and family nurse Sarah Webb, the practice nurse from the Warren Medical Centre, Chris Letton, the Warraan Widji Arts group and community elders, Little Wings, Western NSW LHD, the Royal Flying Doctor Service, Warren Rotary and even support from the NSW Health Minister, Ryan Park.
Meanwhile, a second arts group is about to commence in the nearby community of Trangie, offering a belly program.
NEVER ACCEPT NO FOR AN ANSWER IN CHILDREN’S HEALTH
“When we live and work in rural and remote communities, we often can become complacent. We accept that services are less, or we can feel powerless at trying to create change,” Nicki says.
“Under the United Nations Convention on the Rights of the Child, Australia has a responsibility to ensure these rights of children are recognised and upheld.”
“However, we should never, ever accept no as an answer when we are looking at the health and well-being of a child. Under the United Nations Convention on the Rights of the Child, Australia has a responsibility to ensure these rights of children are recognised and upheld.”
Although she can’t divulge details until an official announcement is made, Nicki is excited that another paediatrician, who learnt of Dr Iskander’s Warren clinic in a television news report, will soon establish a second monthly service in a neighbouring council area.
“We have to continue to look outside the box to enhance our referral pathways for our children and families,” says Nicki.
* Additional funding for this project has come from Alkane Tomingley Gold Mine, Narromine Shire, FRRR funding, Western NSWLHD, and Grain Corp.
Nicki features in Stronger Together Awards
Nicki was acknowledged for her outstanding efforts to improve health outcomes in rural and remote communities through her projects Bellies and New life and the Little Wings program.