Mum and me on her 97th birthday
As a joke…. for many, many years in June and January, my mum has texted me to say “Well we haven’t made the awards honours list yet again.”
2023 has started in a very surprising way. After being a physiotherapist for 46 years, I have very unexpectedly received an Australia Day Award today – an Order of Australia Medal (OAM) – for services to the Physiotherapy profession.
To say I was shocked to receive the email notifying me of this is an understatement.
I always feel blessed and relieved that after working for so many years that I still love getting up each day and treating patients. I attribute this longevity to my love of pelvic health physiotherapy. It is intensely rewarding – Every. Single. Day. Who knows – maybe receiving this award will give me a platform to promote the value of every single person asking themselves: “Is it time to seek out a pelvic health physiotherapist and ask for help for those symptoms which are private, embarrassing and (in their own mind) so shameful?”
Of course my wonderful staff also make coming to work as I get older an absolute pleasure. Megan, Sam, Haleh, Amanda, Fara, Cristina, Katie, Arminah, Mette and Ashleigh. They are calm, happy, industrious and a pleasure to see every day. And they are passionate about what we all do – each and every admin staff, every physiotherapist and instructor (I am talking about you Ash King our dance instructor extraordinaire) give intensity to their job. The intensity of kindness, understanding, patience, humour and smiles – under those masks there are always smiles.
My Pelvis Story: Original commissioned artwork by Arabella Walker, Indigenous Artist.
For something so integral to our self – the pelvic floor muscles hold a lot of mystery for women and men. They hold secrets and they hold stress. They give pleasure and they can give pain. They control body functions and that is demanded from around the age of two or three and then has to hold true for a hellava long time (note to self: your mother is 97 and thriving – keep doing your pelvic floor exercises….it’s a forever thing literally.)
Arabella Walker, Artist and my commissioned artwork
You can see from my beautiful original artwork above by Arabella Walker that our muscles can also be injured by a vaginal birth (see the levator avulsion injury represented on the right hand side) and this can be a culprit if a woman is suffering prolapse and other pelvic floor dysfunction. For some women doing a pelvic floor muscle contraction remains a bewildering thing and that is where a good pelvic health physio can make the world of difference when learning how to do effective, regular pelvic floor muscle training.
I have said many times in my blogs that what pelvic health physios do is not rocket science. Good communication is critical and being a good listener when hearing the patient’s story is paramount. Getting some background to what work entails, about family relationships and friends – both great and toxic ones – all fills in the complete picture of what may be causing pelvic health systems to let us down. Urinary and faecal incontinence, other bladder and bowel issues and prolapse management actually rely on many common sense strategies (and some maths and physics), but the simple lifestyle modifications that are so vital in helping these conditions are sometimes hard to adopt for patients because our old habits become so entrenched that they are hard to break.
I have seen a lot of change over the past 35 years in the development of the stream of pelvic health physiotherapy. I first started in this area by taking antenatal physiotherapy classes with my friend and colleague Helen Beech, who to this day, is still volunteering by taking exercise classes for osteoporosis prevention. We would conduct the antenatal classes at night at the Mater Mothers Hospital – and at one stage I took a class at 38 weeks pregnant and then took the next one when Michael (my third baby) was just two weeks old. I had excellent ‘holding the fort’ support at home from Bob to to allow me to do this – as I always have over these many years. To this day Bob is the backbone of my practice because there would be no practice without him to iron out the daily technological issues (mostly Telstra), to format and organise my books and do all the staffing admin amongst a million other things.
Bob and I still love the beach, especially Sunshine Beach where we have been holidaying for 47 years.
Back in 1991 I also filled in for the beautiful Kim, the Head of Physio Department at QE2 Hospital, when Michael was just a couple of months old for just a 4 hours per week stint, while Kim had to attend a meeting. At that time, Margie Carroll, the physio who had been treating the Women’s Health patients at QE 2 was about to leave to set up her practice and I was asked would I be able to take up her position. This was the beginning of my lifetime love affair with Women’s Health Physiotherapy.
I started to see outpatient Women’s Health patients and took the relevant courses to learn the ropes. Lurlene Livingstone, Ruth Sapsford, Sue Markwell and Shirley Owen – pioneers in Women’s Health in Queensland – led the way for me and some became amazing mentors for me.
Shirley Owen a wonderful mentor Ruth Sapsford started my learning journey
Dear Shirley passed away in November 2020 – she was still actively communicating with me and giving encouragement and sending me comments to me about my blogs right up to the last few months that she was alive. A true inspiration!
After three years at QE2 and expanding the service from 10 to 20 hours per week, I then went on to work at the Mater Mothers Hospital in Outpatients and opened my own private practice. In those early years, the treatment of urinary incontinence, prolapse management and treating bowel dysfunction consumed most of my days, but in the last decade, the awareness that physiotherapy treatment of persistent pelvic pain is fundamental to the patient’s recovery has meant that we see many more of these patients every day at our practice. The complexity of our patients’ conditions has really escalated over the years since I first started out. Needless to say the stresses of modern life (yes I am talking about you COVID) has also impacted on our patient’s pain levels.
When I started in pelvic health physiotherapy, I joined the peak organisation for continence promotion called the Continence Foundation of Australia. I have been a member of CFA for 30 years and have been involved in the Queensland Branch Committee in various roles for many of those years. In 2020 I co-chaired the Scientific Committee of NCOI20 conference with Dr Peta Higgs, a urogynaecologist at the Sunshine Coast. This of course was the start of the pandemic and we had to pivot through the year from a face-to-face conference to a fully online conference. This was an exhausting, but fulfilling and satisfying experience – especially working with Peta and having contact with so many brilliant presenters. It was a success and attracted a larger than expected audience (in view of the new untested format) across two weeks (for three nights per week). Ah COVID you have given us some challenges over the years!
With the changes to complexity of patients comes the increasing need to do ongoing continual professional development. I suppose that when I was 32 and starting out on this journey I would never have expected that 34 years later, I would still be attending international conferences, doing regular workshops and other professional development (PD) opportunities to keep up-to-date with best evidence-based practise. If anything, with the advent of Zoom education thanks to COVID, we are all doing more than ever. (And the bonus is we can do the PD in our PJ’s and I don’t have to try and find my way and inevitably get lost driving to Eight Mile Plains for the Australian Physiotherapy Association Qld Branch meetings.)
I had a big moment in 2011 when I had a weekend contemplating my own potential health drama and I made a vow that I needed to fulfil a long-term dream to write a patient-directed book on what to do pre and post gynae repair surgery. There was a good outcome to the investigations, but I took that as a sign to knuckle down and across the next eight weekends I wrote Edition1 of Pelvic Floor Recovery: Physiotherapy for Gynaecological Repair Surgery.
Spreading the word about how to treat pelvic health problems started in 2011 with my first patient-directed book Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery
Over the next 12 years, I have written four editions of this book, four editions of my second book Pelvic Floor Essentials and translated Pelvic Floor Recovery into German – called Beckenbodenrehabilitation – with help from my great friend, pelvic health colleague and previous co-worker, Alexandra Schafer, who has since returned to Germany with her family after 13 years in Australia. Alex has gone on to set up her brilliant private practice there and she is thriving back in her homeland bringing high level evidence-based pelvic health physiotherapy to German women and men. Go on Instagram to learn lots about Alex (Becken-Balance-Physiotherapie).
Alexandra Schafer Beckenbalancephysiotherapie
2011 also saw the creation of my blog which now has over 380 blogs on pelvic floor dysfunction, as well as other aspects of my life, my musings about things good and bad happening in Australia and most importantly, trips to Italy. My blog has been an important place for me to promote the value of physiotherapy in the assessment and treatment of bladder and bowel dysfunction, prolapse management and persistent pelvic pain and to disseminate free information to women and men across the world. Of course my introduction to the virtues of social media (SoMe) – Facebook, Twitter, Instagram and more recently TikTok – happened in this same year and I have continued to use SoMe as a medium to spread the word about the value of physiotherapy.
In 2015 I took the big step into employing staff to help me in my practice. My grandson was born in Melbourne and I wanted to be able to go down to see him without closing the doors of my practice. Fortunately Kate and Jane, the first two physios who came to work with me, eased my nerves about ‘the letting go of full control’ and teaching others the things that I felt were important for my patients. Jane went on to be with me for over 6 years and was a joy to have as a colleague to work with. Since then I have had up to 15 employees at any one time and this has been a wonderful thing to work with so many lovely, talented staff members.
Some of my closest amazing and fun pelvic health colleagues: Annie, Sue, Nat, Taryn, Fiona
Pelvic health physios are generally very fun people. (See example above). They are down-to-earth and have learned how to stay relaxed and comfortable when talking with their patients about personal subjects such as bladder and bowel problems, sex and prolapse. I have had a lot of fun as well as earnest learnings with pelvic health physios at conferences over the years, but they have also acted as great support when the patients problems are so complex that we feel ‘stumped’ as to what to do next to help the patient. Having clever colleagues to bounce ideas off and brainstorm with is such a bonus.
To the left of me Professor Hannah Krause, to the right is Professor Judith Goh
Over the years I have worked with some extraordinary people, but two of the greatest have been Professor Judith Goh (AO) and Professor Hannah Krause (AO). These two urogynaecologists go quietly about their business – helping numerous women in Australia solve their complex pelvic health problems – and then during their ‘holidays’ head off overseas to disadvantaged countries to do their incredible volunteer work, operating on women who have suffered shocking birth injuries called fistulas.
A fistula is a communication between the vagina and the rectum or the vagina and the bladder when the labour has failed to progress. Without any medical help, the baby passes away and the tissues die leaving the young girls (some are as young as 12) with fistulas, which results in faecal matter and urine continuously passing from the vagina. They become outcasts in their village and are usually abandoned by their husbands.
I only recently read Judith’s book called Mamitu: A Life in Ethiopia which she wrote in 2003. It chronicles the life of three women who suffered horrific birth injuries at very young ages but then went on to become instrumental in helping other women in Catherine and Reg Hamlin’s dedicated fistula repair hospital.
Professor Judith Goh’s book written in 2003
It is such a beautiful book – very moving (I promise you there will be tears) and it makes you realise that while women definitely do experience birth trauma in Australia – thankfully rarely do they experience a fistula. The wonderful thing about Dr Catherine and Reg Hamlin (who have now passed away) and Judith, Hannah, Dr Barb Hall and Dr Neroli Ngenda is they teach doctors and nurses in these third world countries how to do the work and how to try to prevent the birth injuries. If you would like to donate to their work – where 100% of the money goes to funding their trips to Uganda and other countries – here is the link.
Finally my beautiful family has been instrumental in encouraging and supporting me throughout my career as a Physiotherapist. My kids have heard a lot of ‘vagina’ talk over the years and never once said ‘Mum stop…enough!’ (not that I heard about anyway). They are well-educated into the perils of bladder and bowel dysfunction and the girls even tolerated me speaking at their schools to their peers. They have always understood that my work is my passion and not begrudged my desire to continue working long and hard and for this I thank them.
On this day I am thinking that my father Neil would be immensely proud that this has happened – he would probably be as amazed and shocked as I am. My mother obviously has been waiting for this to happen because her words were: ‘About time’ <insert smiley emoji>
Mum/Marie &Dad/Neil – Neil would have been a happy man today. He died almost 13 years ago to the day.
Now on a less happy note.
Today is 26th January.
As you know, it goes by a number of names.
While I have many amazing positive emotions about the recognition that receiving an Order of Australia medal brings today (and no Sue – you didn’t get a medal because you are still working after 3 years of the this crazy pandemic – even though there are times when you felt you may have deserved one) – one of the not-so-pleasant emotions is that today, Australia Day 26th January, for First Nations people is one of sadness, anger and a feeling being perplexed. Perplexed about our nation’s desire to want to continue to celebrate its National Day on a day that in history is so triggering and traumatising for indigenous people.
Aboriginal Australians have lived in Australia for more than 65,000 years. It is the oldest continuous culture on earth. This country was not devoid of a race, of a nation. It was inhabited by people with traditions, languages, culture and history. You can learn more about this by reading The Uluru Statement from the Heart which is an invitation to the Australian people from First Nations Australians. It asks Australians to walk together to build a better future by establishing a First Nations Voice to Parliament enshrined in the Constitution, and the establishment of a Makarrata Commission for the purpose of treaty making and truth-telling.
I have written for many years about the strange phenomena of continuing to celebrate Australia Day on a day which represents the day when Aboriginal culture and identity was changed forever. First Nations people call Australia Day Invasion Day, Survival Day or Mourning Day for a reason. And rightly so. I repeat again there is an injustice in celebrating our Australian identity day on this date. Seriously, it could be ANY other date in the year.
It will be helpful if we can all learn more about the proposed Referendum. An extensive education programme will start soon in February. An important concept is that currently our Constitution does not recognise Aboriginal and Torres Strait Islander people.
For those who are not aware, the draft question is:
Do you support an alteration to the constitution that establishes an Aboriginal and Torres Strait Islander voice?
Voters will be asked to answer YES or NO.
We will all understand more as the months go by and hopefully the referendum will pass (meaning the YES vote will win).This will allow the mechanics of The Voice to Parliament to be debated and legislated by all politicians in the Parliament.
Then another date of significance can be chosen (perhaps if the referendum passes, that historic date could become the holiday and the day of celebration). We do need to stop this ongoing trauma of our First Nations People every 26th January.
To finish about the Referendum. What can you do? What can we all do?
Not feel threatened. See it as just basic good manners to recognise our First Nations people in the Constitution (and also the pain and trauma that Australia Day represents for our them).
Read up everything you can so you can understand it and tell others about it and pitch it in an intelligent, calm way – not an “I’m going to be deliberately malicious and negative about this so it will fail” way.
Here are some links to start the learning process.
What are we doing as a family today?
I wanted to gather the family together on this day to celebrate their contribution to my Order of Australia Medal, but of course I was sworn to complete secrecy about this honour, so have been unable to tell them about it. However my son’s girlfriend – the beautiful Lou – celebrates Lunar New Year this week and I so wanted to celebrate her special time of the year, as she is away from her family. So we are gathering to wish her Happy Lunar New Year, eating lots of lovely dishes and I am sure everyone will be as surprised as I was by my revelation.
We will not be celebrating Australia Day.
We are in the majority because I heard some statistics on Monday that 68% of Australians wish Australia Day was on another date.
We will wait patiently (and impatiently) for the appropriate change of date. And we all grieve in solidarity with our First Nations People who find this day offensive.
Uluru Statement from the Heart