Thirty years ago, Annette Milligan opened Independent Nursing Practice. After recently selling the business and retiring from nursing (though not from community support) she talks to Naomi Arnold about the changes she’s seen in health over her career.
Abortion law hasn’t shifted since Annette Milligan was a teenager, and in her opinion, change is long overdue. Recent proposed law changes, taking the procedure out of the Crimes Act and making it easier for women to access, is music to her ears.
“The current situation is inhumane,” she says. “It puts women through many unnecessary barriers at what can be a very difficult time.”
Throughout her 30-year career as a nurse, she has seen it all.
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“I have heard a lot of stories in those 30 years and I’m not going to sit in judgement on any women’s life,” she says. “With the best intentions in the world, sometimes things happen. For a long time, I have worked really hard to see that every child that comes into this world is a wanted child and comes into a situation where a parent or parents are able to support that child. In my experience all women give this an enormous amount of thought. Women are very capable of making those decisions.”
Milligan’s mother was a nurse, and during her childhood Annette alternated between nursing or teaching as potential career paths. She eventually picked teaching and worked in the United Kingdom, but when she returned to New Zealand at the end of 1979 she couldn’t find a single job.
“There had been a long shortage of teachers in New Zealand and the principals at the time had chartered a plane and gathered up unemployed teachers in Australia,” she says. “I came back to New Zealand a month and a half later expecting to have my choice and no one would take me.”
She moved to Nelson but couldn’t get a school to even take her name as a relieving teacher, so worked in the Bridge Street Delicatessen for a year slicing salami and making salad rolls. “Then, as now, working in Nelson wasn’t easy.”
Annette Milligan set up the Independent Nursing Practice 30 years ago. She recently sold the practice.
She was walking across Trafalgar Street one day when the thought suddenly struck her that she was going to be a nurse, and although it was too late for the intake at Nelson’s nursing school, she begged them to take her as a late applicant. At 29, she was an older student, but immediately loved it. The combination of nursing and education also worked well for her when it came to public health education.
“It’s been a feature of what I’ve done and I’ve always felt that having that solid background in education was really good for the type of nursing I pursued,” she says.
When Milligan opened the doors of INP on February 13, 1989, the world was quite different. The HIV/AIDS epidemic was in full swing. The first case in New Zealand hadn’t been registered until 1984, but by the close of the 1980s, HIV and AIDS notifications had spiked. Young Eve van Grafhorst had moved to New Zealand, and public health campaigns were in full swing. Yet it was a time of fear, misunderstanding, and prejudice.
New Zealand was a world leader in starting a needle exchange programme to reduce the incidence of HIV. But the argument against it was that if you made clean needles available young people would “go out in droves and start using”.
“It never happened and it wasn’t going to,” she says. “It was an amazingly successful intervention. I remember talking to an American woman in the early 1990s and her eyes filled with tears when she heard about it; she said ‘You have no idea how lucky you are’.
She remembers “several gorgeous young men” with HIV who came back to Nelson in the early 90s to end their days, and how hard they worked to get into schools and run programmes.
“I remember one young man who contacted us and he wanted to speak to all the Year 13 students to tell his story. I will never forget him until the day I die; how brave he was and how moving the students found that.”
After the introduction of antiretroviral drugs, she says that is another part of history we no longer have to experience thanks to improved healthcare. “I am so pleased to see the end of that; it was just a tragic time.”
Annette Milligan says the HIV epidemic was a tragic time.
There has been other amazing progress in the sexual health world since then. Access to contraception has dramatically improved for those under 22, and while in 1989 the contraceptive pill was the mainstay, the introduction of long-acting contraceptives such as Implanon and Mirena have made a dramatic difference to women.
“Long-acting contraceptives have made a tremendous difference to young people’s lives and the rates of unplanned pregnancy,” she says. In 1989, unplanned pregnancies were in the order of 35 to every 1000 women, and now the rate has dropped to under 20.
“I think that it’s really pleasing to see women delaying pregnancy a little longer. But it took a long time to get there.”
Anxieties and mythology about birth control still abounded, however. She still heard from women who were anxious about contraception affecting long-term fertility.
“Any evidence for that is extremely weak but young women are at risk because older women say things like ‘If you stay on the pill for too long you’ll become infertile’. Actually, nothing could be further from the truth. We are still having to suggest to women they talk to a medical professional rather than people who may not know so much about it.”
Another common anxiety is that the contraceptive pill increases the risk of breast cancer.
“If you want to prove that it is causative you have really got your work cut out; some studies say it is protective, some say it puts women at risk. There is no strong evidence.”
Braden Fastier
Annette Milligan has seen many changes in health over her career.
On the other hand, the evidence that drinking alcohol increases your risk for breast cancer is “as clear as a bell”.
“If people are worried about young women’s rate of breast cancer can we please focus on alcohol rather than the contraceptive pill? In 1989, alcohol was less freely available and young women actually weren’t a target of the alcohol industry; we didn’t have alcopops and other drinks packaged up specifically with young women in mind. A high consumption of alcohol is a real concern.”
Another treatment that’s changed dramatically in those three decades is that for sexually transmitted diseases (STDs). In 1989, genital warts, a side effect of HPV, were very common.
“We didn’t have very good treatments and I remember young women coming in several times a week to have warts painted by a nurse.”
It was an “undignified and humiliating procedure” that took several visits to clear up. It could also mean annual smears and/or colposcopies (a cervix examination and sometimes biopsy). “Treatments that no woman would put their hand up and say they wanted”.
Better treatments came in, but the one that has had the biggest impact by far is vaccination with Gardasil. Sadly, it’s been more effective in Australia than in New Zealand.
“From my point of view having seen the Cartwright Inquiry [into mishandling of cervical cancer cases at National Women’s Hospital], the establishment of regular cervical screening, and then the opportunity to eliminate this completely – I could see at the time that this could mean the end of cervical cancer.”
A recent study in the UK shows rates of cervical cancer have plummeted since the introduction of the Gardasil vaccine.
“The numbers of women and young men who are coming in with cases of genital warts has also plummeted and almost disappeared since the arrival of the HPV vaccine,” she says. “Of course, Nelson has been slow on the uptake for all sorts of reasons; we seem to have a high level of resistance to vaccinations.”
But when it was first introduced, the same arguments against the vaccine were used as those made against providing safe needles back in the days of the HIV crisis.
“Amidst all the concern about the HPV vaccine, some of it was based on an anti-vaccination philosophy but more of it was based on a philosophy that young women having the HPV vaccine will then go out and become madly promiscuous and ‘lose control’. It is just ridiculous. Words fail me,” she says.
“Of course no such thing happened, and I have had to sit and watch statistics from Australia about how colposcopies etcetera have plummeted because all girls have the vaccine in Australia.”
In New Zealand, it has taken longer. “It is really tragic that it has taken us this long to get our heads around the HPV vaccine being an amazing opportunity to eliminate a viral-borne cancer in our society.”
Braden Fastier
The development of an HPV vaccine gives Milligan hope that a virus-borne cancer can be eliminated.
Abortion reform is also well overdue, she says; there is now a chance to reduce the harm that barriers to abortion access have done to women. In Milligan’s view, a woman’s decision to have an abortion should be between her and her health provider.
“And no-one else,” she says. “There is no place for it in the Crimes Act at all, and removing it and making it a less torturous process for women to navigate is a good thing. I’m very supportive of the move – though I’m not quite sure it will go far enough.”
The bill is in dramatic contrast to what is happening in the United States, with legislation steadily stripping abortion rights from women.
“It is just heartbreaking,” she says. “All I can think is that nobody has listened to the stories of the women. I don’t understand cruelty and I don’t understand why we feel the need to interfere in other people’s lives and other people’s decision-making.
“I get very angry with the claiming of the term ‘pro-life’; I am pro-life too. I am pro 16-year-old girls having the right to have a life too. And women who are 45 and find themselves unexpectedly pregnant; I have seen situations in which not being able to access an abortion was catastrophic. How dare anybody inflict that on another human being.
“Women will not be stopped from having abortions; they will be desperate and do desperate things and will get hurt and will die.”
As for the clinic’s future, Milligan says the time is right for it to have “a breath of fresh air” and she is pleased to hand it over to nurse practitioner Jessica Irvine and registered nurse Lucy Halsey. “I’m thrilled it’s still a nurse-led service.”
Meanwhile she plans to continue her community involvement; she is the chair of Safeguarding Children Initiative, a Nelson trust educating people on the care of children; is on the board of Light Nelson; and involved with fundraising for the Brook Waimarama Sanctuary.
“I don’t want to be doing nothing. It’s been the most wonderful 30 years. You are seeing people often at the worst times in their life, and it’s been an absolute privilege to help.”