Dr Pat Nickson examining a baby during her time in Asia
(Photo source: Pat Nickson)
A world expert on community health care, Dr Patricia Nickson has been interrogated, held at gunpoint, witnessed revolution, three coups, two civil wars, and discovered the limitations of Western definitions of good health.
by John Martin
It's the early 1970s. In Angurugu, a tiny, Aboriginal community in the Northern Territory of Australia, two boys are searching for firewood. One climbs a tree and, using an axe, tries to chop off some branches. His brother waits below, ready to collect the wood for the fire.
Suddenly, there's a scream and blood everywhere. The boy has dropped the axe. By horrific chance it has sliced into his brother's skull. Amid 'great pantomime' the injured boy is brought into the local hospital. On duty is a young English nurse/midwife, who's in the Northern Territory to test her call to be a missionary with CMS.
Pat Nickson sprang into action. She recalls, "I did exactly what I had been taught in nursing school. He had a bad cut to his head. I had the child under observation. I sutured his wound. I observed him very carefully as a neurosurgical case, put him in a darkened room and so on. Because I didn't have skilled workers around me I spent the night with him, making half-hourly observations. I wouldn't let anyone else go in except the mother just to look at him but not to talk to him."
Soon another drama was unfolding. "By the morning I heard that the boy's grandfather was dying in the village," Pat remembers. '"How come?' I asked. There had been nothing wrong with him the day before." It emerged that tribal wisdom decreed that the old man was appointed to die before his injured grandson: "He has to die before the child."
Pat found it hard to convince the family that the boy wasn't dying. "He must be dying," they insisted. "You've stayed with him all night. You're not letting anyone near him. The old man assumes the child is dying but he has to die first." I said, "Well, he can't just die like that."
A carer stayed with the boy while Pat ran to where the old man lay. She recounts the scene. "He was extremely ill, semi-conscious. He was breathing his last. I was totally confused by the situation so I admitted him." There being no other space, Pat put the old man in the same ward as the boy and began treating him. He started sipping water, began to come round and recognised the child. That was the cue for Pat to snatch a few hours' sleep.
When she returned, events had taken another twist. "I found the hospital empty. When I asked where the two patients were, they replied, 'Grandfather's gone home and the
child – well, look at the kids walking to school over there.' There was the kid walking to school with everybody else. That was the kid whom I'd stayed up watching all night!"
Nearly 30 years on, the incident remains imprinted on Pat Nickson's memory as a defining experience that shaped her distinctive approach to health care. "I learnt there, in a very clear way, that I had to understand the culture before I could ever begin to practise health care."
The lesson was re-enforced when, a few months later, she moved on to Oenpelli, another Aboriginal community in the territory. There the local understanding of becoming pregnant is related to a rainbow story. "Talking about anatomy, the birds and the bees and family planning was totally irrelevant if you hadn't first considered the rainbow dream and put pregnancy and childbirth into that context," Pat insists. "I was captivated into getting to know local people, understanding what their priorities were, and then adding my technical expertise if it was needed."
Kisembo, the little boy who 'lost his peace', in the arms of his father, a catechist in Boga diocese, while his mother stands watch
(Photo source: Pat Nickson)
Why were they dying?
Two decades later and 10,000 miles away, in Zaire, there was another defining incident. Pat takes up the story. "I was very open and enquiring about culture. I was very hot on primary health care. We had the best immunisation coverage in Zaire; 95 per cent of the children were immunised, the tally of mothers attending antenatal clinic was 100 per cent, and it was all ticking along quite nicely. Moreover, the model of health infrastructure in Zaire was a good one, so we weren't doing it from bare bones and against all the odds, quite the reverse."
Nevertheless, a question haunted her. The work had a deservedly high reputation nationally. On the surface, things were going well. "Why, then, were so many malnourished kids dying? Why were we not doing better?" Did this health-care provision really work?
Then one day a little boy was brought into the clinic. Pat knew the mother and that the boy had been fully immunised. "Why didn't you come in when your child first fell sick?" Pat asked. To Pat's astonishment, the mother insisted that her little boy wasn't sick. "No. He has lost his peace."
Later, Pat walked beside the boy's mother at his funeral. Then she went to consult the local chief. What had this mother been trying to say? The chief was nonplussed too. "I don't know any more because I am separated by my education from my traditional culture," he told Pat. "Let's find out together."
That was the start of an 18-month study that eventually became the groundwork for Pat's PhD. Important principles emerged from the research. "First and foremost, health is not a singular subject," she says. From traditional healers she learned about 'the plurality of health', factors that to Westerners seem far removed from health considerations but deemed vital in other cultures. She discovered what in the cultural approach of traditional practitioners to healing made them more popular with Zaireans than Western doctors.
"I learnt of the need to welcome in the whole family because health touches a family, not just an individual," she says. "I learnt about the place of touch in health care. Traditional Zairean healers have no inhibitions about putting their hands where it hurts. Then there is the role of prayer. People in eastern Zaire expect prayer, Christian or otherwise, to be part of medical care. Also, there was the importance of asking the patient what they thought had gone wrong in their lives and the importance of telling the patient what you're going to do about it to make it better."
"So I learnt a more appropriate approach to health, and I also learnt the local priorities in health which were much more about peace than they were about health as such. In fact, of 10 criteria, peace was the first concern whereas access to health care was the tenth."
What, by the way, had happened to the little boy whose tragic circumstances triggered Pat's quest? "When we looked at the process we found that the child had just had a new-born sibling. So, about four months previously, he had been wrenched off the mother's breast because she was pregnant. He wasn't ready to be wrenched away. In Africa a child is all the time either breastfeeding or on its mother's back. There's no putting it in its cot. It's with its mother all the time. When the mother becomes pregnant, however, the child is separated from her. And in the process this particular child had lost his peace.
"As health professionals, if we see a malnourished child, we say to the mother, 'Now you must give it meat, eggs, milk, cheese', and teach on the nutritional level. But that mother was doing all that. The child was refusing to eat. It was going into a corner, acting out its sense of deprivation, as if to say, 'Nobody loves me, my mother is behaving bizarrely and isn't taking me on her breast or her back anymore, so why should I bother to eat?' So the child had truly lost his peace, and died."
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