Journal articles on the topic 'Midwives Victoria'

Substantial State Government funding has been committed in Victoria for the enhancement of maternity services. The funding is intended to improve the quality of care for women and meet consumer expectations for choice and continuity of care in maternity services. This paper reports on a mid-term review (the 'Review') of the Victorian Maternity Services Program, which was conducted by the authors on behalf of the Victorian Department of Human Services. Documentary analysis was conducted for the review, and workshops and key informant interviews were held throughout Victoria with midwives, medical staff and Department of Human Services staff. The Review found that there had been many gains as a result of the Maternity Services Program and identified directions for further development. Issues of change and facilitators of change processes in maternity services are highlighted in this article.

BACKGROUND:The use of complementary and alternative medicine (CAM) to manage pregnancy-related conditions is becoming increasingly popular. This article draws on a qualitative study that aimed to explain the processes midwives engaged when determining the role of these therapies for pregnancy care.METHODOLOGY:Our study used grounded theory methodology. Twenty-five midwives, who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semistructured interviews and nonparticipant observation of a subgroup over an 18-month period.RESULTS:Midwives’ attitudes and behavior toward the CAM was influenced by their professional ideology and knowledge. When participants considered the role of these therapies, they employed various strategies including aligning CAM with midwifery philosophy, using the therapies to increase women’s options, valuing diverse ways of understanding and seeking out professional knowledge.CONCLUSIONS:Although midwives do not reject conventional medicine, many value the opportunity CAM offers to individualize care and promote natural childbearing.

To address workforce shortages, the Australian Government funded additional nursing and midwifery places in 2009 pre-registration courses. An existing deficit in midwifery clinical placements, combined with the need to secure additional clinical placements, contributed to a serious shortfall. In response, a unique collaboration between Midwifery Academics of Victoria (MIDAC), rural and metropolitan maternity managers (RMM and MMM) groups and Department of Health (DOH) Victoria was generated, in order to overcome difficulties experienced by maternity services in meeting the increased need. This group identified the large number of different clinical assessment tools required to be being completed by midwives supervising students as problematic. It was agreed that the development of a Common Assessment Tool (CAT) for use in clinical assessment across all pre-registration midwifery courses in Victoria had the potential to reduce workload associated with student assessments and, in doing so, release additional placements within each service. The CAT was developed in 2009 and implemented in 2010. The unique collaboration involved in the development of the CAT is a blueprint for future projects. The collaboration on this project provided a range of benefits and challenges, as well as unique opportunities for further collaborations involving industry, government, regulators and the tertiary sector. What is known about this topic? In response to current and predicted workforce shortages, the Australian Government funded additional midwifery places in pre-registration midwifery courses in 2009, creating the need for additional midwifery student clinical placements. Victorian midwifery service providers experienced difficulty in the supply of the additional placements requested, due to complex influences constraining clinical placement opportunities; one of these was the array of assessment tools being used by students on clinical placements. What does this paper add? A collaborative partnership between MIDAC, RMM and MMM groups, and the DOH identified a range of problems affecting the ability of midwifery services to increase clinical placements. The workload burden attached to the wide range of clinical assessment tools required to be completed by the supervising midwife for each placement was identified as the most urgent problem requiring resolution. The collaborative partnership approach facilitated the development of a CAT capable of meeting the needs of all key stakeholders. What are the implications for managers and policy makers? Using a collaborative partnership workshop approach, the development of a clear project focus where all participants understood the outcome required was achieved. This collaboration occurred at multiple levels with support from the DOH and was key to the success of the project. The approach strengthens problem solving in situations complicated by competing influences, a common occurrence in health service delivery, and where unilateral approaches have not or are unlikely to succeed.

Objective Although home visiting in the early post partum period appears to have increased, there are limited data defining which women receive a visit and none that include Queensland. We aimed to investigate patterns of post partum home visiting in the public and private sectors in Queensland. Methods Data were collected via a retrospective cross-sectional survey of women birthing in Queensland between 1 February and 31 May 2010 at 4 months post partum (n = 6948). Logistic regression was used to assess associations between receiving a home visit and sociodemographic, clinical and hospital variables. Analyses were stratified by public and private birthing sector because of significant differences between sectors. Results Public sector women were more likely to receive a visit from a nurse or midwife (from the hospital or child health sector) within 10 days of hospital discharge (67.2%) than private sector women (7.2%). Length of hospital stay was associated with home visiting in both sectors. Some vulnerable subpopulations in both sectors were more likely to be visited, whereas others were not. Conclusions Home visiting in Queensland varies markedly between the public and private sector and is less common in some vulnerable populations. Further consideration to improving the equity of community post partum care in Queensland is needed. What is known about the topic? A recent paper found that most women from the public sector in Victoria and South Australia receive an early post partum home visit from a midwife or nurse. Queensland only recently implemented a program to increase post partum home visiting but who receives visits is still unknown. What does this paper add? No previous study has investigated which women receive early post partum home visits in Queensland, nor home visiting rates within the private sector. This paper also examines whether specific subpopulations of vulnerable post partum women are receiving home visits so that patterns of inequity or unmet needs can be identified. What are the implications for practitioners? Home visiting by nurses or midwives in the post partum period in Queensland was less common than in other Australian states, and varies markedly between the public and private sector. These differences highlight inequities in community post partum care that need to be addressed if women are to receive the most cost-effective and clinically appropriate care and support in the post partum period.

Purpose – Women from culturally and linguistically diverse communities face barriers to accessing perinatal mental health care. Victorian Transcultural Mental Health (VTMH) is a state-wide service in Victoria, Australia, that supports specialist mental health service providers to improve cultural responsiveness. VTMH provided training for perinatal health professionals in cultural responsiveness. The paper aims to discuss these issues. Design/methodology/approach – A curriculum was specifically developed based on a literature review, consultation forum, and input from members of an industry-based reference group. An Evaluation Tool was designed to collect participants’ feedback regarding the perceived relevance of the training content and its impact on practice. Responses were analysed using quantitative techniques and thematic analysis. Findings – Nine face-to-face training sessions were provided, in metropolitan and rural regions. In all, 174 professionals of various backgrounds (including midwives, mental health professionals, and maternal child health nurses) attended. In all, 161 completed evaluations were received and responses indicated that the training was of high relevance to the target workforce, that the training would have implications for their practice, and support was given for further training to be delivered using online methods. Research limitations/implications – First, an assessment of the cultural competence of participants prior to enrolment in the course was not conducted, and no matched control group was available for comparison with the participants. Second, generalisability of these findings to other settings requires further investigation. Third, the sustainability of the project is an area for further study in the future. Fourth, other methods including direct interviews of focus groups with participants may have yielded more detailed qualitative feedback regarding the effectiveness of the programme. Practical implications – To facilitate the sustainability of the project, following the face-to-face training, an online training module and a resource portal were developed, offering links to relevant web sites and resources for health professionals working in this field. Originality/value – The training addressed a significant unmet need for cultural responsiveness training for a diverse range of practitioners in the field of perinatal mental health. Online training can be adapted from face-to-face training and it is anticipated that online training will facilitate the sustainability of this initiative.

While collaborative, multidisciplinary teamwork is widely espoused as the goal of contemporary hospitals, it is hard to achieve. In maternity care especially, professional rivalries and deep-seated philosophical differences over childbirth generate significant tensions. This article draws on qualitative research in several Victorian public maternity units to consider the challenges to inter-professional collaboration. It reports what doctors and midwives looked for in colleagues they liked to work with ? the attributes of a ?good doctor? or a ?good midwife?. Although their ideals did not entirely match, both groups respected skill and hard work and sought mutual trust, respect and accountability. Yet effective working together is limited both by tensions over role boundaries and power and by incivility that is intensified by increasing workloads and a fragmented labour force. The skills and qualities that form the basis of ?professional courtesy? need to be recognised as essential to good collaborative practice.

Background: Several state governments are once again reviewing policies for the provision of maternity care. This paper presents findings from a state-wide Victorian survey of recent mothers conducted in 2000 regarding women?s experiences of antenatal care. We also offer some reflections on the way in which results from this and earlier Victorian surveys have been used, somewhat selectively, to support the State Government?s new framework for maternity services, while other issues highlighted in the survey results have been overlooked. Design: Population-based postal survey mailed to Victorian women who gave birth in a 2-week period in September 1999, 5?6 months after childbirth. Results: 42% of women attending a public hospital clinic described their antenatal care as ?very good? compared with 73% of women attending a birth centre, 59% attending private practitioners for antenatal care but receiving public intrapartum care (combined care), 56% attending a midwives clinic, 53% receiving shared care and 84% of women receiving private maternity care. The social characteristics of women enrolling in different models of care do not explain these differences. Immigrant women were much less likely to be happy with their care in pregnancy than Australian- born women, with no improvement in ratings of care over more than a decade.

The physical environment has long been understood as a major determinant of health and well-being. In recent years, the relationship between health and the environment has become particularly pronounced, with the impacts of climate change identified as having the potential to reverse the last 50 years of public health advancement (Watts et al., 2015). Increasingly, professional bodies within health care are called upon to frame climate change as a health issue. Despite this, studies have found that nurses report feeling ill-equipped to respond to environmental changes and the resulting health impacts (Anåker, Nilsson, Holmner, & Elf, 2015; Lewis, 2018; Polivka, Chaudry, & Mac Crawford, 2011). This article recognizes some of the barriers facing concerned health-care professionals who wish to introduce climate mitigation activities within their sphere of professional operation. The Australian Nursing and Midwifery Federation (Victorian Branch) was approached by nurses, midwives, and carers, to become more involved in policy debates surrounding climate change and to provide stronger support to members in responding to environmental issues. The result is top-down and bottom-up responses working in synergy for climate change mitigation, by empowering nurses to make changes to their professional practice.

ObjectivesThere is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.DesignWomen having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding.SettingThree tertiary maternity services in Melbourne, Australia.ParticipantsOf 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey.OutcomesPrimary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding.ResultsMost women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving ‘any’ (95% CI 0.65 to 0.78) and 48% were giving ‘only’ breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR ‘any’: 2.69, 95% CI 1.29 to 5.60; ‘only’: 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR ‘any’: 2.48, 95% CI 1.05 to 5.86; ‘only’: 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR ‘any’: 0.36, 95% CI 0.13 to 0.98; ‘only’: 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR ‘any’: 0.26, 95% CI 0.11 to 0.58) with lower odds.ConclusionsBreast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.

Although midwives are the lead professionals for uncomplicated pregnancies and coordinators of maternity care in the United Kingdom (UK),1 they are not the default healthcare provider for women and birthing people in many areas of the United States (US).In this article, Victoria Pollack explores how midwifery in the US is thriving despite several challenges, some of which are unique to the US, and others that mirror challenges experienced in the UK.

Abstract Background Interventions to improve personalised and holistic care delivery by healthcare professionals are more likely to be effective if they target the factors influencing specific behaviours. This study reports on the development and testing of a questionnaire to identify perspectives of healthcare professionals’ personalised and holistic care behaviours based on the Theoretical Domains Framework. Methods The study was conducted in public health services in Victoria, Australia. The questionnaire was developed and pilot-tested with behaviour change researchers and healthcare professionals. Doctors, nurses and midwives were recruited via notices and email invitations from Safer Care Victoria's website and mailing lists of healthcare professionals and invited to completed the questionnaire online (hosted on Qualtrics). Health services administrators and allied health professionals were excluded from the study. Confirmatory factor analysis was undertaken to generate the model of best fit and group differences were tested using univariate tests. Results One hundred and four healthcare professionals from public health services in Victoria, Australia, completed the 39-item questionnaire focusing on specific personalised and holistic care behaviours. The final model consisted of 13 factors and 39 items, and CFA produced an acceptable fit, as well as adequate levels of discriminant validity and internal consistency (α = 0.60 to 0.84). Seven domains, “social influence”, “motivation & goals”, “environmental context and resources’, “skills”, ‘beliefs about consequences”, “behaviour regulation” and “nature of behaviour” were identified. Significant differences in the factors influencing these behaviours were found in groups with different years of experience and role seniority. These findings suggest that future interventions need to be targeted to specific groups. Conclusion This study identified the specific behaviours and the factors associated with performance of personalised and holistic care among healthcare professionals. The findings suggest several interventions and policy functions may be taken to improve personalised and holistic care.

Abstract Background Teamwork in the operating theatre is a complex emergent phenomenon and is driven by cooperative relationships between staff. A foundational requirement for teamwork is the ability to communicate effectively, and in particular, knowing each other’s name. Many operating theatre staff do not know each other’s name, even after formal team introductions. The use of theatre caps to display a staff member’s name and role has been suggested to improve communication and teamwork. Methods We hypothesized that the implementation of scrub hats with individual team members' names and roles would improve the perceived quality and effectiveness of communication in the operating theatre. A pilot project was designed as a pre-/post-implementation questionnaire sent to 236 operating room staff members at a general hospital in suburban Melbourne, Victoria, Australia, between November 6 to December 18, 2018. Participants included medical practitioners (anaesthetists, surgeons, obstetricians and gynaecologists), nurses (anaesthetic, scrub/scout and paediatric nurses), midwives and theatre technicians. The primary outcome was a change in perceived teamwork score, measured using a five position Likert scale. Results Of 236 enrolled participants, 107 (45%) completed both the pre and post intervention surveys. The median perceived teamwork response of four did not change after the intervention, though the number of low scores was reduced (p = 0.015). In a pre-planned subgroup analysis, the median perceived teamwork score rose for midwives from three to four (p < 0.001), while for other craft groups remained similar. The median number of staff members in theatre that a participant did not know the name of reduced from three to two (p < 0.001). Participants reported knowing the names of all staff members present in the theatre more frequently after the intervention (31% vs 15%, p < 0.001). The reported rate of formal team introductions was not significantly different after the intervention (34.7% vs 47.7% p = 0.058). Conclusions In this study, we found that wearing caps displaying name and role appeared to improve perceived teamwork and improve communication between staff members working in the operating theatre.

Abstract Gender Equality is vital for a peaceful, prosperous, and sustainable world for all individuals. Care- and help-seeking behaviour is strongly associated with health status, but, also gender, with women's health strongly correlating to that of the whole family and directly linked to the wellbeing of all members in our communities, and the resilience and sustainability of health systems. Health and social care delivery has been lacking a gender-centred approach, with a two-prong effect, on professionals/workforce (hierarchies and leadership imbalance) and on users/recipients/care seekers (lack of gender-sensitive care provision). The COVID-19 pandemic is a global health threat and societal challenge that has already exacerbated pre-existing structural gender inequalities. It is, therefore, imperative to rebuild a better, gender-equal society for the future. This crisis has highlighted the roles of women in the health workforce, incl. as informal carers for vulnerable adults and children. The increase in gender-based violence has also come to the spotlight, due to lockdown measures, implemented to combat COVID-19, resulting in serious physical and mental harm, as well as socioeconomic damages. Furthermore, sexual and reproductive health rights have been particularly affected due to pre-existing barriers across Member-States placing additional strain on individuals and systems. All these compounding factors also result in further limiting access to leadership positions for women. This roundtable aims to capture the perspective of our interdisciplinary panelists from leading European and global institutions to comprehensively map the needs, priorities, and key action areas of public health, in order to achieve gender equality and empower all women and girls across the globe. Objectives Assess the roles of women in the health workforce, to highlight gender inequalities, and to discuss regional differences across the European Region; Present and discuss the new Gender Equality Index 2021 (to be released end of Oct 2021), which will focus on health in relation to gender equality, covering mental health, sexual and reproductive health and pandemics of communicable diseases, and in particular of COVID-19; Combine the perspective of academia, multilateral bodies, practitioners and NGOs, for concerted action to combat the increase in sexual and domestic violence, and to Bridge disparities and overcome barriers to gender-sensitive health and social care services for all women, incl., migrant and refugee populations. The roundtable brings together for the first time EUPHA, WHO, UN Women, and of the European Institute for Gender Equality, in a joint effort for European and global public health, to support our workforce and safeguard the future. Mindful of the role women in health and social care, we also include panelists from the International Confederation of Midwives and from NGOs working in the field of combating violence against women. Speakers/Panelists Carlien Scheele European Institute for Gender Equality, Vilnius, Lithuania Alia El Yassir UN Women, Istanbul, Turkey Victoria Vivilaki International Confederation of Midwives, Den Haag, Netherlands Iveta Nagyova PJ Safarik University, Department of Social and Behavioural Medicine, Kosice, Slovakia Pille Tsopp-Pagan Women against Violence Europe Network, Vienna, Austria Key messages We need to join forces to fight sexual and domestic violence, as major public health threats globally, considering their worsening during the COVID-19 pandemic. Women account for the majority of caregivers and healthcare workers, especially nurses, explore the untapped potential of midwives, and step up efforts to strengthen protection and support.

Background Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020. Methods We collected aggregated data on infected health care workers and outbreaks in health care facilities from all jurisdictions. Health care workers working solely in residential aged care and outbreaks in residential aged care facilities were excluded. Jurisdictions provided data on the number of health care setting outbreaks, confirmed cases, hospitalisation, source of infection, and health care worker role. We analysed data for two periods that aligned with two distinct peaks in the epidemic relative to 1 June 2020, referred to here as the first wave (23 January – 31 May 2020) and the second wave (1 June – 18 September 2020). Results Jurisdictions reported a total of 2,163 health care worker infections with SARS-CoV-2 during the surveillance period. Source of acquisition was known for 81.0% of cases (1,667/2,059). The majority of cases in the first wave were acquired overseas, shifting to locally-acquired cases in the second wave. The odds of infection in the second wave compared to the first wave were higher for nurses/midwives (odds ratio, OR: 1.61; 95% confidence interval (95% CI): 1.32–2.00), lower for medical practitioners (OR: 0.36; 95% CI: 0.28–0.47) and did not differ for ‘other’ health care workers (OR: 1.07; 95% CI: 0. 87–1.32). The odds of infection in the second wave were higher in a health care setting (OR: 1.76; 95% CI: 1.28–2.41) than in the community. There were 120 outbreaks in health care settings with 1,428 cases, of which 56.7% (809/1,428) were health care workers. The majority (88/120; 73.8%) of outbreaks in health care settings occurred in the second wave of the epidemic, with 90.9% of these (80/88) occurring in Victoria. Conclusions In the second wave of the epidemic, when there was heightened community transmission, health care workers were more likely to be infected in the workplace. Throughout the epidemic, nurses were more likely to be infected than staff in other roles.

Abstract Background Domestic and family violence (DFV), including intimate partner violence (IPV), sexual assault and child abuse are prevalent health and social issues, often precipitating contact with health services. Nurses, midwives and carers are frontline responders to women and children who have experienced violence, with some research suggesting that health professionals themselves may report a higher incidence of IPV in their personal lives compared to the community. This paper reports the largest study of DFV against health professionals to date. Method An online descriptive, cross-sectional survey of 10,674 women and 772 men members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch). The primary outcome measures were 12-month and adult lifetime IPV prevalence (Composite Abuse Scale); secondary outcomes included sexual assault and child abuse (Australian Bureau of Statistics Personal Safety Survey) and prevalence of IPV perpetration (bespoke). Results Response rate was 15.2% of women/11.2% of men who were sent an invitation email, and 38.4% of women/28.3% of men who opened the email. In the last 12-months, 22.1% of women and 24.0% of men had experienced IPV, while across the adult lifetime, 45.1% of women and 35.0% of men had experienced IPV. These figures are higher than an Australian community sample. Non-partner sexual assault had been experienced by 18.6% of women and 7.1% of men, which was similar to national community sample. IPV survivors were 2-3 times more likely to have experienced physical, sexual or emotional abuse in childhood compared to those without a history of IPV (women OR 2.7, 95% CI 2.4 to 2.9; men OR 2.8, 95% CI 2.0 to 4.1). Since the age of sixteen, 11.7% of men and 1.7% of women had behaved in a way that had made a partner or ex-partner feel afraid of them. Conclusions The high prevalence of intimate partner violence and child abuse in this group of nurses, midwives and carers suggests the need for workplace support programs. The findings support the theory that childhood adversity may be related to entering the nursing profession and has implications for the training and support of this group.

The following papers were presented to the Canadian Society of Church History in 2009, but were not made available for publication: Michael Friesen, “Draft Resistance and the Politics of Gender: A Life History Approach to Understanding Mennonites, Anti-Militarism and Masculinity in the United States during the Vietnam War”; Bruce Douville, “Spiritual Midwife? Liberal Christianity and the Origins of the Canadian New Left”; Marlene Epp, “Preachers, Prophets, and Missionaries: The dichotomous religious lives of Mennonite women in Canada”; William Klassen, “Pilgram Marpeck (1495-1556)”; J. Richard Middleton and David Belles, “Variant Eschatologies in the Great Awakenings and the Social Gospel: Case Studies in Jonathan Edwards, Dwight L. Moody and Walter Rauschenbusch”; Darren Schmidt, “Reviving the Past: Eighteenth-Century Evangelical Interpretations of Church History”; Stephen Fai, “St. Michael of Ponass Lakes, Saskatchewan: Icon, Architecture, and Material Imagination”; Iain Edgehill, “The Religious and Theological Elements in Caribbean Slave Revolts”; Brian Froese, “Contrasting Visions of Mission: Mennonite Social Activism and Mennonite Brethren Evangelicalism in Post-War British Columbia”; Andrew Eason, “The Salvation Army and the Sacraments in Victorian England: Retracing the Steps to Non-Observance”; and Donna Kerfoot, “Florence Nightingale’s ‘Way of Perfection’ in Nineteenth-Century England”; presentations by A.B. McKillop and Ian McKay on Richard Allan’s The View from Murney Tower: Salem Bland, the Late Victorian Controversies, and the Search for a New Christianity; and presentations by Linda Ambrose, Sam Reimer, and Robert Choquette on a collection of essays edited by Michael Wilkinson entitled Canadian Pentecostalism: Transition and Transformation.

“Human beings are not born once and for all on the day their mothers give birth to them [...] life obliges them over and over again to give birth to themselves.” (Garcia Marquez 165) Introduction The refugee experience is, at heart, one of rebirth. Just as becoming a new, distinctive being—biological birth—necessarily involves the physical separation of mother and infant, so becoming a refugee entails separation from a "mother country." This mother country may or may not be a recognised nation state; the point is that the refugee transitions from physical connectedness to separation, from insider to outsider, from endemic to alien. Like babies, refugees may have little control over the timing and conditions of their expulsion. Successful resettlement requires not one rebirth but multiple rebirths—resettlement is a lifelong process (Layton)—which in turn require hope, imagination, and energy. In rebirthing themselves over and over again, people who have fled or been forced from their homelands become both mother and child. They do not go through this rebirthing alone. A range of agencies and individuals may be there to assist, including immigration officials, settlement services, schools and teachers, employment agencies and employers, English as a Second Language (ESL) resources and instructors, health-care providers, counsellors, diasporic networks, neighbours, church groups, and other community organisations. The nature, intensity, and duration of these “midwives’” interventions—and when they occur and in what combinations—vary hugely from place to place and from person to person, but there is clear evidence that post-migration experiences have a significant impact on settlement outcomes (Fozdar and Hartley). This paper draws on qualitative research I did in 2012 in a regional town in New South Wales to illuminate some of the ways in which settlement aides ease, or impede, refugees’ rebirth as fully recognised and participating Australians. I begin by considering what it means to be resilient before tracing some of the dimensions of the resettlement process. In doing so, I draw on data from interviews and focus groups with former refugees, service providers, and other residents of the town I shall call Easthaven. First, though, a word about Easthaven. As is the case in many rural and regional parts of Australia, Easthaven’s population is strongly dominated by Anglo Celtic and Saxon ancestries: 2011 Census data show that more than 80 per cent of residents were born in Australia (compared with a national figure of 69.8 per cent) and about 90 per cent speak only English at home (76.8 per cent). Almost twice as many people identify as Aboriginal or Torres Strait Islander as the national figure of 2.5 per cent (Australian Bureau of Statistics). For several years Easthaven has been an official “Refugee Welcome Zone”, welcoming hundreds of refugees from diverse countries in Africa and the Middle East as well as from Myanmar. This reflects the Department of Immigration and Citizenship’s drive to settle a fifth of Australia’s 13,750 humanitarian entrants a year directly in regional areas. In Easthaven’s schools—which is where I focused my research—almost all of the ESL students are from refugee backgrounds. Defining Resilience Much of the research on human resilience is grounded in psychology, with a capacity to “bounce back” from adverse experiences cited in many definitions of resilience (e.g. American Psychological Association). Bouncing back implies a relatively quick process, and a return to a state or form similar to that which existed before the encounter with adversity. Yet resilience often requires sustained effort and significant changes in identity. As Jerome Rugaruza, a former UNHCR refugee, says of his journey from the Democratic Republic of Congo to Australia: All the steps begin in the burning village: you run with nothing to eat, no clothes. You just go. Then you get to the refugee camp […] You have a little bread and you thank god you are safe. Then after a few years in the camp, you think about a future for your children. You arrive in Australia and then you learn a new language, you learn to drive. There are so many steps and not everyone can do it. (Milsom) Not everyone can do it, but a large majority do. Research by Graeme Hugo, for example, shows that although humanitarian settlers in Australia face substantial barriers to employment and initially have much higher unemployment rates than other immigrants, for most nationality groups this difference has disappeared by the second generation: “This is consistent with the sacrifice (or investment) of the first generation and the efforts extended to attain higher levels of education and English proficiency, thereby reducing the barriers over time.” (Hugo 35). Ingrid Poulson writes that “resilience is not just about bouncing. Bouncing […] is only a reaction. Resilience is about rising—you rise above it, you rise to the occasion, you rise to the challenge. Rising is an active choice” (47; my emphasis) I see resilience as involving mental and physical grit, coupled with creativity, aspiration and, crucially, agency. Dimensions of Resettlement To return to the story of 41-year-old Jerome Rugaruza, as related in a recent newspaper article: He [Mr Rugaruza] describes the experience of being a newly arrived refugee as being like that of a newborn baby. “You need special care; you have to learn to speak [English], eat the different food, create relationships, connections”. (Milsom) This is a key dimension of resettlement: the adult becomes like an infant again, shifting from someone who knows how things work and how to get by to someone who is likely to be, for a while, dependent on others for even the most basic things—communication, food, shelter, clothing, and social contact. The “special care” that most refugee arrivals need initially (and sometimes for a long time) often results in their being seen as deficient—in knowledge, skills, dispositions, and capacities as well as material goods (Keddie; Uptin, Wright and Harwood). As Fozdar and Hartley note: “The tendency to use a deficit model in refugee resettlement devalues people and reinforces the view of the mainstream population that refugees are a liability” (27). Yet unlike newborns, humanitarian settlers come to their new countries with rich social networks and extensive histories of experience and learning—resources that are in fact vital to their rebirth. Sisay (all names are pseudonyms), a year 11 student of Ethiopian heritage who was born in Kenya, told me with feeling: I had a life back in Africa [her emphasis]. It was good. Well, I would go back there if there’s no problems, which—is a fact. And I came here for a better life—yeah, I have a better life, there’s good health care, free school, and good environment and all that. But what’s that without friends? A fellow student, Celine, who came to Australia five years ago from Burundi via Uganda, told me in a focus group: Some teachers are really good but I think some other teachers could be a little bit more encouraging and understanding of what we’ve gone through, because [they] just look at you like “You’re year 11 now, you should know this” […] It’s really discouraging when [the teachers say] in front of the class, “Oh, you shouldn’t do this subject because you haven’t done this this this this” […] It’s like they’re on purpose to tell you “you don’t have what it takes; just give up and do something else.” As Uptin, Wright and Harwood note, “schools not only have the power to position who is included in schooling (in culture and pedagogy) but also have the power to determine whether there is room and appreciation for diversity” (126). Both Sisay and Celine were disheartened by the fact they felt some of their teachers, and many of their peers, had little interest in or understanding of their lives before they came to Australia. The teachers’ low expectations of refugee-background students (Keddie, Uptin, Wright and Harwood) contrasted with the students’ and their families’ high expectations of themselves (Brown, Miller and Mitchell; Harris and Marlowe). When I asked Sisay about her post-school ambitions, she said: “I have a good idea of my future […] write a documentary. And I’m working on it.” Celine’s response was: “I know I’m gonna do medicine, be a doctor.” A third girl, Lily, who came to Australia from Myanmar three years ago, told me she wanted to be an accountant and had studied accounting at the local TAFE last year. Joseph, a father of three who resettled from South Sudan seven years ago, stressed how important getting a job was to successful settlement: [But] you have to get a certificate first to get a job. Even the job of cleaning—when I came here I was told that somebody has to go to have training in cleaning, to use the different chemicals to clean the ground and all that. But that is just sweeping and cleaning with water—you don’t need the [higher-level] skills. Simple jobs like this, we are not able to get them. In regional Australia, employment opportunities tend to be limited (Fozdar and Hartley); the unemployment rate in Easthaven is twice the national average. Opportunities to study are also more limited than in urban centres, and would-be students are not always eligible for financial assistance to gain or upgrade qualifications. Even when people do have appropriate qualifications, work experience, and language proficiency, the colour of their skin may still mean they miss out on a job. Tilbury and Colic-Peisker have documented the various ways in which employers deflect responsibility for racial discrimination, including the “common” strategy (658) of arguing that while the employer or organisation is not prejudiced, they have to discriminate because of their clients’ needs or expectations. I heard this strategy deployed in an interview with a local businesswoman, Catriona: We were advertising for a new technician. And one of the African refugees came to us and he’d had a lot of IT experience. And this is awful, but we felt we couldn't give him the job, because we send our technicians into people's houses, and we knew that if a black African guy rocked up at someone’s house to try and fix their computer, they would not always be welcomed in all—look, it would not be something that [Easthaven] was ready for yet. Colic-Peisker and Tilbury (Refugees and Employment) note that while Australia has strict anti-discrimination legislation, this legislation may be of little use to the people who, because of the way they look and sound (skin colour, dress, accent), are most likely to face prejudice and discrimination. The researchers found that perceived discrimination in the labour market affected humanitarian settlers’ sense of satisfaction with their new lives far more than, for example, racist remarks, which were generally shrugged off; the students I interviewed spoke of racism as “expected,” but “quite rare.” Most of the people Colic-Peisker and Tilbury surveyed reported finding Australians “friendly and accepting” (33). Even if there is no active discrimination on the basis of skin colour in employment, education, or housing, or overt racism in social situations, visible difference can still affect a person’s sense of belonging, as Joseph recounts: I think of myself as Australian, but my colour doesn’t [laughs] […] Unfortunately many, many Australians are expecting that Australia is a country of Europeans … There is no need for somebody to ask “Where do you come from?” and “Do you find Australia here safe?” and “Do you enjoy it?” Those kind of questions doesn’t encourage that we are together. This highlights another dimension of resettlement: the journey from feeling “at home” to feeling “foreign” to, eventually, feeling at home again in the host country (Colic-Peisker and Tilbury, Refugees and Employment). In the case of visibly different settlers, however, this last stage may never be completed. Whether the questions asked of Joseph are well intentioned or not, their effect may be the same: they position him as a “forever foreigner” (Park). A further dimension of resettlement—one already touched on—is the degree to which humanitarian settlers actively manage their “rebirth,” and are allowed and encouraged to do so. A key factor will be their mastery of English, and Easthaven’s ESL teachers are thus pivotal in the resettlement process. There is little doubt that many of these teachers have gone to great lengths to help this cohort of students, not only in terms of language acquisition but also social inclusion. However, in some cases what is initially supportive can, with time, begin to undermine refugees’ maturity into independent citizens. Sharon, an ESL teacher at one of the schools, told me how she and her colleagues would give their refugee-background students lifts to social events: But then maybe three years down the track they have a car and their dad can drive, but they still won’t take them […] We arrive to pick them up and they’re not ready, or there’s five fantastic cars in the driveway, and you pick up the student and they say “My dad’s car’s much bigger and better than yours” [laughs]. So there’s an expectation that we’ll do stuff for them, but we’ve created that [my emphasis]. Other support services may have more complex interests in keeping refugee settlers dependent. The more clients an agency has, the more services it provides, and the longer clients stay on its books, the more lucrative the contract for the agency. Thus financial and employment imperatives promote competition rather than collaboration between service providers (Fozdar and Hartley; Sidhu and Taylor) and may encourage assumptions about what sorts of services different individuals and groups want and need. Colic-Peisker and Tilbury (“‘Active’ and ‘Passive’ Resettlement”) have developed a typology of resettlement styles—“achievers,” “consumers,” “endurers,” and “victims”—but stress that a person’s style, while influenced by personality and pre-migration factors, is also shaped by the institutions and individuals they come into contact with: “The structure of settlement and welfare services may produce a victim mentality, leaving members of refugee communities inert and unable to see themselves as agents of change” (76). The prevailing narrative of “the traumatised refugee” is a key aspect of this dynamic (Colic-Peisker and Tilbury, “‘Active’ and ‘Passive’ Resettlement”; Fozdar and Hartley; Keddie). Service providers may make assumptions about what humanitarian settlers have gone through before arriving in Australia, how they have been affected by their experiences, and what must be done to “fix” them. Norah, a long-time caseworker, told me: I think you get some [providers] who go, “How could you have gone through something like that and not suffered? There must be—you must have to talk about this stuff” […] Where some [refugees] just come with the [attitude] “We’re all born into a situation; that was my situation, but I’m here now and now my focus is this.” She cited failure to consider cultural sensitivities around mental illness and to recognise that stress and anxiety during early resettlement are normal (Tilbury) as other problems in the sector: [Newly arrived refugees] go through the “happy to be here” [phase] and now “hang on, I’ve thumped to the bottom and I’m missing my own foods and smells and cultures and experiences”. I think sometimes we’re just too quick to try and slot people into a box. One factor that appears to be vital in fostering and sustaining resilience is social connection. Norah said her clients were “very good on the mobile phone” and had links “everywhere,” including to family and friends in their countries of birth, transition countries, and other parts of Australia. A 2011 report for DIAC, Settlement Outcomes of New Arrivals, found that humanitarian entrants to Australia were significantly more likely to be members of cultural and/or religious groups than other categories of immigrants (Australian Survey Research). I found many examples of efforts to build both bonding and bridging capital (Putnam) in Easthaven, and I offer two examples below. Several people told me about a dinner-dance that had been held a few weeks before one of my visits. The event was organised by an African women’s group, which had been formed—with funding assistance—several years before. The dinner-dance was advertised in the local newspaper and attracted strong interest from a broad cross-section of Easthaveners. To Debbie, a counsellor, the response signified a “real turnaround” in community relations and was a big boon to the women’s sense of belonging. Erica, a teacher, told me about a cultural exchange day she had organised between her bush school—where almost all of the children are Anglo Australian—and ESL students from one of the town schools: At the start of the day, my kids were looking at [the refugee-background students] and they were scared, they were saying to me, "I feel scared." And we shoved them all into this tiny little room […] and they had no choice but to sit practically on top of each other. And by the end of the day, they were hugging each other and braiding their hair and jumping and playing together. Like Uptin, Wright and Harwood, I found that the refugee-background students placed great importance on the social aspects of school. Sisay, the girl I introduced earlier in this paper, said: “It’s just all about friendship and someone to be there for you […] We try to be friends with them [the non-refugee students] sometimes but sometimes it just seems they don’t want it.” Conclusion A 2012 report on refugee settlement services in NSW concludes that the state “is not meeting its responsibility to humanitarian entrants as well as it could” (Audit Office of New South Wales 2); moreover, humanitarian settlers in NSW are doing less well on indicators such as housing and health than humanitarian settlers in other states (3). Evaluating the effectiveness of formal refugee-centred programs was not part of my research and is beyond the scope of this paper. Rather, I have sought to reveal some of the ways in which the attitudes, assumptions, and everyday practices of service providers and members of the broader community impact on refugees' settlement experience. What I heard repeatedly in the interviews I conducted was that it was emotional and practical support (Matthews; Tilbury), and being asked as well as told (about their hopes, needs, desires), that helped Easthaven’s refugee settlers bear themselves into fulfilling new lives. References Audit Office of New South Wales. Settling Humanitarian Entrants in New South Wales—Executive Summary. May 2012. 15 Aug. 2013 ‹http://www.audit.nsw.gov.au/ArticleDocuments/245/02_Humanitarian_Entrants_2012_Executive_Summary.pdf.aspx?Embed=Y>. Australian Bureau of Statistics. 2011 Census QuickStats. Mar. 2013. 11 Aug. 2013 ‹http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/0>. Australian Survey Research. Settlement Outcomes of New Arrivals—Report of Findings. Apr. 2011. 15 Aug. 2013 ‹http://www.immi.gov.au/media/publications/research/_pdf/settlement-outcomes-new-arrivals.pdf>. Brown, Jill, Jenny Miller, and Jane Mitchell. “Interrupted Schooling and the Acquisition of Literacy: Experiences of Sudanese Refugees in Victorian Secondary Schools.” Australian Journal of Language and Literacy 29.2 (2006): 150-62. Colic-Peisker, Val, and Farida Tilbury. “‘Active’ and ‘Passive’ Resettlement: The Influence of Supporting Services and Refugees’ Own Resources on Resettlement Style.” International Migration 41.5 (2004): 61-91. ———. Refugees and Employment: The Effect of Visible Difference on Discrimination—Final Report. Perth: Centre for Social and Community Research, Murdoch University, 2007. Fozdar, Farida, and Lisa Hartley. “Refugee Resettlement in Australia: What We Know and Need To Know.” Refugee Survey Quarterly 4 Jun. 2013. 12 Aug. 2013 ‹http://rsq.oxfordjournals.org/search?fulltext=fozdar&submit=yes&x=0&y=0>. Garcia Marquez, Gabriel. Love in the Time of Cholera. London: Penguin Books, 1989. Harris, Vandra, and Jay Marlowe. “Hard Yards and High Hopes: The Educational Challenges of African Refugee University Students in Australia.” International Journal of Teaching and Learning in Higher Education 23.2 (2011): 186-96. Hugo, Graeme. A Significant Contribution: The Economic, Social and Civic Contributions of First and Second Generation Humanitarian Entrants—Summary of Findings. Canberra: Department of Immigration and Citizenship, 2011. Keddie, Amanda. “Pursuing Justice for Refugee Students: Addressing Issues of Cultural (Mis)recognition.” International Journal of Inclusive Education 16.12 (2012): 1295-1310. Layton, Robyn. "Building Capacity to Ensure the Inclusion of Vulnerable Groups." Creating Our Future conference, Adelaide, 28 Jul. 2012. Milsom, Rosemarie. “From Hard Luck Life to the Lucky Country.” Sydney Morning Herald 20 Jun. 2013. 12 Aug. 2013 ‹http://www.smh.com.au/national/from-hard-luck-life-to-the-lucky-country-20130619-2oixl.html>. Park, Gilbert C. “’Are We Real Americans?’: Cultural Production of Forever Foreigners at a Diversity Event.” Education and Urban Society 43.4 (2011): 451-67. Poulson, Ingrid. Rise. Sydney: Pan Macmillan Australia, 2008. Putnam, Robert D. Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster, 2000. Sidhu, Ravinder K., and Sandra Taylor. “The Trials and Tribulations of Partnerships in Refugee Settlement Services in Australia.” Journal of Education Policy 24.6 (2009): 655-72. Tilbury, Farida. “‘I Feel I Am a Bird without Wings’: Discourses of Sadness and Loss among East Africans in Western Australia.” Identities: Global Studies in Culture and Power 14.4 (2007): 433-58. ———, and Val Colic-Peisker. “Deflecting Responsibility in Employer Talk about Race Discrimination.” Discourse & Society 17.5 (2006): 651-76. Uptin, Jonnell, Jan Wright, and Valerie Harwood. “It Felt Like I Was a Black Dot on White Paper: Examining Young Former Refugees’ Experience of Entering Australian High Schools.” The Australian Educational Researcher 40.1 (2013): 125-37.

Abstract Background Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live births. As Uganda strives to achieve sustainable development goals, appropriate antenatal care is key to reduction of maternal mortality. We explored women’s reported receipt of seven of the Uganda guidelines components of antenatal care, and associated factors in hard to reach Lake Victoria island fishing communities of Kalangala district. Methods A cross sectional survey among 486 consenting women aged 15–49 years, who were pregnant at any time in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January–May 2018. Interviewer administered questionnaires, were used to collect data on socio-demographics and receipt of seven of the Uganda guidelines components of antenatal care. Regression modeling was used to determine factors associated with receipt of all seven components. Results Over three fifths (65.0%) had at least one ANC visit during current or most recent pregnancy. Fewer than a quarter of women who reported attending care at least four times received all seven ANC components [(23.6%), P < 0.05]. Women who reported receipt of ANC from the mainland were twice as likely to have received all seven components as those who received care from islands (aOR = 1.8; 95% CI:0.9–3.7). Receipt of care from a doctor was associated with thrice likelihood of receiving all components relative to ANC by a midwife or nurse (aOR = 3.2; 95% CI:1.1–9.1). Conclusions We observed that the delivery of antenatal care components per Ugandan guidelines is poor in these communities. Cost effective endeavors to improve components of antenatal care received by women are urgently needed. Task shifting some components of ANC to community health workers may improve care in these island communities. Trial registration PACTR201903906459874 (Retrospectively registered).

Abstract Background Nurse and Midwifery Unit Managers (NMUMs) play pivotal roles in quality patient care, nurse and midwife satisfaction and retention. NMUMs are expected to be both leaders and managers simultaneously, which may create role tension. This study aimed to explore the understanding and experience of NMUMs regarding their role; to explore what barriers and facilitators NMUMs identified to achieving the goals of their clinical area; and to explore NMUMs’ career plans. Methods Set in Victoria, Australia, this study was guided by naturalistic inquiry using a qualitative descriptive approach. Thematic analysis was used to inductively develop core themes, which facilitated the motivations, experience and meanings underlying the data to be elaborated. Results In all, 39 interviews were conducted with NMUMs across four hospitals. Two overarching themes were identified from the data; system challenges and influences on people and each theme had three sub-themes. In relation to system challenges, participants spoke about the structural challenges that they encountered such as financial stressors and physical infrastructure that made their work difficult. Participants felt they were unprepared for the NMUM role and had limited support in the preparation for the role. Participants also related their frustration of not being included in important decision-making processes within the hospital. Regarding their career plans, most did not envisage a career beyond that of a NMUM. Conclusions This study of contemporary NMUMs uncovered a continued lack of investment in the orientation, professional development and support of this critical leadership and management role. There is an urgent need for targeted interventions to support and develop capabilities of NMUMs to meet the current and evolving demands of their role.

Abstract Background Maternal immunisation is an essential public health intervention aimed at improving the health outcomes for pregnant women and providing protection to the newborn. Despite international recommendations, safety and efficacy data for the intervention, and often a fully funded program, uptake of vaccines in pregnancy remain suboptimal. One possible explanation for this includes limited access to vaccination services at the point of antenatal care. The aim of this study is to evaluate the change in vaccine coverage among pregnant women following implementation of a modified model of delivery aimed at improving access at the point of antenatal care, including an economic evaluation. Methods This prospective multi-centre study, using action research design, across six maternity services in Victoria, Australia, evaluated the implementation of a co-designed vaccine delivery model (either a pharmacy led model, midwife led model or primary care led model) supported by provider education. The main outcome measure was influenza and pertussis vaccine uptake during pregnancy and the incremental cost of the new model (compared to existing models) and the cost-effectiveness of the new model at each participating health service. Results Influenza vaccine coverage in 2019 increased between 50 and 196% from baseline. All services reduced their average cost per immunisation under the new platforms due to efficiencies achieved in the delivery of maternal immunisations. This cost saving ranged from $9 to $71. Conclusion Our study demonstrated that there is no ‘one size fits all’ model of vaccine delivery. Future successful strategies to improve maternal vaccine coverage at other maternity services should be site specific, multifaceted, targeted at the existing barriers to maternal vaccine uptake, and heavily involve local stakeholders in the design and implementation of these strategies. The cost-effectiveness analysis indicates that an increase in maternal influenza immunisation uptake can be achieved at a relatively modest cost through amendment of maternal immunisation platforms.

This paper will discuss the way in which the creative component of my thesis Hannah’s Place uses a style of neo-historical fiction to find ‘good’ narratives in (once) ‘bad’ women, keeping with the theme, here paraphrased as: The work of any researcher in the humanities is to…challenge what is simply thought of as bad or good, to complicate essentialist categories and question passively accepted thinking. As a way of expanding this statement, I would like to begin by considering the following quote from Barthes on the nature of research. I believe he identifies the type of research that I have been involved with as a PhD candidate producing a ‘creative’ thesis in the field of Communications. What is a piece of research? To find out, we would need to have some idea of what a ‘result’ is. What is it that one finds? What is it one wants to find? What is missing? In what axiomatic field will the fact isolated, the meaning brought out, the statistical discovery be placed? No doubt it depends each time on the particular science approached, but from the moment a piece of research concerns the text (and the text extends very much further than the literary work) the research itself becomes text, production: to it, any ‘result’ is literally im-pertinent. Research is then the name which prudently, under the constraint of certain social conditions, we give to the activity of writing: research here moves on the side of writing, is an adventure of the signifier. (Barthes 198) My thesis sits within the theoretical framework of postmodern literature as a new form of the genre that has been termed ‘historical fiction’. Although the novel breaks away from and challenges the concept of the traditional ‘saga’ style of narrative, or ‘grand narrative’ within historical fiction, it is no less concerned with events of the past and the idea of past experience. It departs from traditional historical fiction in that it foregrounds not only an imagined fictional past world created when the novel is read, but also the actual archival documents, the pieces of text from the past from which traditional history is made, and which here have been used to create that world–‘sparking points’ for the fictional narrative. These archival documents are used within the work as intertextual elements that frame, and, in turn, are framed by the transworld characters’ homodiegetic narrations. The term ‘transworld character’ has been attributed to Umberto Eco and refers to any real world personages found within a fictional text. Eco defines it as the ‘identity of a given individual through worlds (transworld identity)…where the possible world is a possible state of affairs expressed by a set of relevant propositions [either true or untrue which] outlines a set of possible individuals along with their properties’ (219). Umberto Eco also considers that a problem of transworld identity is ‘to single out something as persistent through alternative states of affairs’ (230). In Postmodernist Fiction, Brian McHale also puts forward a number of definitions for ‘transworld identity’. For my purposes, I take it to mean both that defined by Eco but also the literary device, as defined by McHale, of ‘borrowing a character from another text’ (57). It is McHale who elaborates on the concept as it relates to historical fiction when he states: All historical novels, even the most traditional, typically involve some violation of ontological boundaries. For instance they often claim ‘transworld identity’ between characters in their projected worlds and real-world historical figures (16-17). Interestingly for the type of fiction that I am attempting to write, McHale also takes the idea into another area when he discusses the ontological levels of the historical dimension that transworld identities may undergo. Entities can change their ontological status in the course of history, in effect migrating from one ontological realm or level to another. For instance, real world entities and happenings can undergo ‘mythification’, moving from the profane realm to the realm of the sacred (36). For transworld identities, such as those within my novel, this may mean a change in status between the past, where they were stereotyped and categorised as ‘bad’ in contemporary newspapers (my intertext elements), to something in the present approaching ‘good’, or at least a more rounded female identity within a fictional world. The introduced textual elements which I foreground in my novel are those things most often hidden from view within the mimetic and hermeneutic worlds of traditional historical fiction. The sources re-textualised within my novel are both ‘real’ items from our past, and representations and interpretations of past events. The female transworld characters’ stories in this novel are imaginative re-interpretations. Therefore, both the fictional stories, as well as their sources, are textual interpretations of prior events. In this way, the novel plays with the idea of historical ‘fact’ and historical ‘fiction’. It blurs their boundaries. It gives textual equality to each in order to bring a form of textual agency to those marginalised groups defined by PF Bradley as the ‘host of jarring witnesses, [of history] a chaos of disjoined and discrepant narrations’ (Bradley in Holton 11): In the past in Australia these were lower class women, Aboriginals, the Irish, the illiterate, and poor agricultural immigrants whose labour was excess to Britain’s needs. Hannah’s Place – A Brief Synopsis Six individual women’s stories, embedded in or ‘framed’ by a fictional topographic artist’s journal, recount ‘real’ events from Australia’s colonial past. The journal is set in 1845; a few years after convict transportation to Australia’s eastern states ceased, and the year of the first art exhibition held in the colony. That same year, Leichhardt’s expedition arrived at Port Essington in Australia’s far north, after 12 months inland exploration, while in the far south the immigrant ship Cataraqui was wrecked one day short of arrival at Melbourne’s Port Phillip with the drowning of all but one of the 369 immigrants and 38 of the 46 sailors on board. Each chapter title takes the form of the title of a topographic sketch as a way of placing the text ‘visually’ within the artist’s journal narrative. The six women’s stories are: New South Wales at Last (Woman on a Boat): A woman arrives with a sick toddler to tent accommodation for poor immigrants in Sydney, after a three month sea voyage and the shipboard birth, death, and burial at sea of her baby daughter. Yarramundi Homestead, as Seen from the East: An ill-treated Irish servant girl on a squatter’s run awaits the arrival of her fiancée, travelling on board the immigrant ship Cataraqui. In the Vale of Hartley: In the Blue Mountains, an emancipist sawyer who previously murdered three people, violently beats to death his lover, Caroline Collitts, the seventeen-year-old sister of Maria, his fifteen-year-old wife. She Being Dead Yet Speaketh: In Goulburn, Annie Brownlow, a pretty 24-year-old mother of three is executed by a convict executioner for the accidental ‘murder’, while drunk, of her adulterous husband. The Eldest Daughter: The isolated wife of a small settler gives birth, assisted by Lottie, her eldest daughter, and Merrung, an Aboriginal midwife. On Wednesday Last, at Mr Ley’s Coach and Horses Hotel: In Bathurst, a vagrant alcoholic, Hannah Simpson, dies on the floor of a dodgy boarding house after a night and a day of falling into fits and ranting about her lifetime of 30 years migration. Historiographic Metafiction Has been defined by Linda Hutcheon as ‘Fiction which keeps distinct its formal auto-representation from its historical context and in so doing problematises the very possibility of historical knowledge… There is no reconciliation, no dialectic…just unresolved contradiction’ (106). Unresolved contradiction is one of the themes that surfaces in my novel because of the juxtaposition of archival documents (past text ‘facts’) alongside fictional narrative. Historiographic metafiction can usefully be employed as a means of challenging prior patriarchal narratives written about marginalised women. It allows the freedom to create a space for a new understanding of silenced women’s lives. My novel seeks to illuminate and problematise the previously ‘seamless’ genre of hical fiction by the use of (narrative) techniques such as: collage and juxtaposition, intertextuality, framing, embedded narrative, linked stories, and footnote intertext of archival material. Juxtaposition of the fiction against elements from prior non-fiction texts, clearly enunciated as being those same actual historical sources upon which the fiction is based, reinforces this novel as a work of fiction. Yet this strategy also reminds us that the historical narrative created is provisional, residing within the fictional text and in the gaps between the fictional text and the non-fictional intertext. At the same time, the clear narrativity, the suspenseful and sensationalised text of the archival non-fiction, brings them into question because of their place alongside the fiction. A reading of the novel questions the truthfulness or degree of reliability of past textual ‘facts’ as accurate records of real women’s life events. It does this by the use of a parallel narrative, which articulates characters whose moments of ‘breaking frame’ challenge those same past texts. Their ‘fiction’ as characters is reinforced by their existence as ‘objects’ of narration within the archival texts. Both the archival texts and the fiction can be seen as ‘unreliable’. The novel uses ex-centric transworld characters and embedded intertextual ‘fragments’ to create a covert self-reflexivity. It also confuses and disrupts narrative temporality and linearity of plot in two ways. It juxtaposes ‘real’ (intertextual element) dates alongside conflicting or unknown periods of time from the fictional narrative; and, within the artist’s journal, it has a minimal use of expected temporal ‘signposts’. These ‘signposts’ of year dates, months, or days of the week are those things that would be most expected in an authentic travel narrative. In this way, the women’s stories subvert the idea, inherent in previous forms of ‘historical’ fiction, of a single point of view or ‘take’ on history that one or two main characters may hold. The use of intertext results in a continued restating of multiple, conflicting (gender, race, and class) points of view. Ultimately no one ‘correct’ reading of the past gains in supremacy over any other. This narrative construct rearticulates the idea that the past, as does the present, comprises different points of view, not all of which conform to the ‘correct’ view created by the political, social and economic ‘factors’ dominant at the time those events happen. For colonial Australia, this single point of view gave us the myth of heroic (white male) pioneers and positioned women such as some of those within my fiction as ‘bad’. The fictional text challenges that of the male ‘gaze’, which constructed these women as ‘objects’. Examples of this from the newspaper articles are: A younger sister of Caroline Collit, married John Walsh, the convict at present under sentence of death in Bathurst gaol, and, it appears, continued to live with him up till the time of her sister’s murder; but she, as well as her sister Caroline, since the trial, have been ascertained to have borne very loose characters, which is fully established by the fact, that both before and after Walsh had married the younger sister, Caroline cohabited with him and had in fact been for a considerable time living with him, under the same roof with her sister, and in a state of separation from her own husband (Collit). Sydney Morning Herald, April 27, 1842, The Mount Victoria Murder. About twelve months after her marriage, her mother who was a notorious drunkard hanged herself in her own house… Sydney Morning Herald, April 27, 1842, The Mount Victoria Murder. And when we further reflect that the perpetrator of that deed of blood was a woman our horror is, if possible, much augmented. Yes! A woman and one who ought to have been in as much as the means were assuredly in the power of her family-an ornament to her sex and station. She has been cut off in the midst of her days by the hands of the common executioner. And to add to our distress at this sad event she to whose tragic end I am referring was a wife and a mother. It was her hand which struck the blow that rendered her children orphans and brought her to an ignominious end… The Goulburn Herald, October 20, 1855, Funeral sermon on Mary Ann Brownlow. His wife had been drinking and created an altercation on account of his having sold [her] lease; she asked him to drink, but he refused, when she replied “You can go and drink with your fancywoman”. She came after him as he was going away and stabbed him…..she did it from jealousy, although he had never given her any cause for jealousy. The Goulburn Herald, Saturday, September 15, 1855, Tuesday, September 11, Wilful Murder. She was always most obedient and quiet in her conduct, and her melancholy winning manners soon procured her the sympathy of all who came in contact with her. She became deeply impressed with the sinfulness of her previous life… The Goulburn Herald, October 13, 1855, Execution of Mary Ann Brownlow. [Police] had known the deceased who was a confirmed drunkard and an abandoned woman without any home or place of abode; did not believe she had any proper means of support…The Bathurst Times, November 1871. It is the oppositional and strong narrative ‘voice’ that elicits sympathies for and with the women’s situations. The fictional narratives were written to challenge unsympathetic pre-existing narratives found within the archival intertexts. This male ‘voice’ was one that narrated and positioned women such that they adhered to pre-existing notions of morality; what it meant to be a ‘good’ woman (like Mary Ann Brownlow, reformed in gaol but still sentenced to death) or a ‘bad’ woman (Mary Ann again as the murdering drunken vengeful wife, stabbing her husband in a jealous rage). ‘Reading between the lines’ of history in this way, creating fictional stories and juxtaposing them against the non-fiction prior articulations of those same events, is an opportunity to make use of narrative structure in order to destabilise established constructs of our colonial past. For example, the trope of Australia’s colonial settler women as exampled in the notion of Anne Summers of colonial women as either God’s police or damned whores. ‘A Particularly rigid dualistic notion of women’s function in colonial society was embodied in two stereotypes….that women are either good [God’s police] or evil [Damned whores]’ (67). With this dualism in mind, it is also useful here to consider the assumption made by Veeser in laying the ground work for New Historicism, that ‘no discourse imaginative or archival, gives access to unchanging truths or expresses unalterable human nature’ (2). In a discussion of the ideas of Brian McHale, Middleton and Woods acknowledge McHale’s point of view that readers do recognise the degree to which all knowledge of the past is a construction. They make the claim that ‘the postmodern novelist answers that sense of dislocation and loss…by wrapping ruins of earlier textualities around the narrative’ (66). This to my mind is a call for the type of intertextuality that I have attempted in my thesis. The senses of dislocation and loss found when we attempt to narrativise history are embodied in the structure of the creative component of my thesis. Yet it could also be argued that the cultural complexity of colonial Australia, with women as the subjugated ‘other’ of a disempowered voice has only been constructed by and from within the present. The ‘real’ women from whose lives these stories are imagined could not have perceived their lives within the frames (class, gender, post coloniality) that we now understand in the same way that we as educated westerners cannot totally perceive a tribal culture’s view of the cosmos as a real ‘fact’. However, a fictional re-articulation of historical ‘facts’, using a framework of postmodern neo-historical fiction, allows archival documents to be understood as the traces of women to whom those documented facts once referred. The archival record becomes once again a thing that describes a world of women. It is within these archival micro-histories of illiterate lower-class women that we find shards of our hidden past. By fictionally imagining a possible narrative of their lives we, as the author/reader nexus which creates the image of who these transworld characters were, allow for things that existed in the past as possibility. The fictionalised stories, based on fragments of ‘facts’ from the past, are a way of invoking what could have once existed. In this way the stories partake of the Bernstein and Morson concept of ‘sideshadowing’. Sideshadowing admits, in addition to actualities and impossibilities, a middle realm of real possibilities that could have happened even if they did not. Things could have been different from the way they were, there are real alternatives to the present we know, and the future admits of various possibilities… sideshadowing deepens our sense of the openness of time. It has profound implications for our understanding of history and of our own lives (Morson 6). The possibilities that sideshadowing their lives invokes in these stories ‘alters the way that we think about earlier events and the narrative models used to describe them’ (Morson 7). We alter our view of the women, as initially described in the archival record, because we now perceive the narrative through which these events and therefore ‘lives’ of the women were written, as merely ‘one possibility’ of many that may have occurred. Sideshadowing alternate possibilities gives us a way out of that patriarchal hegemony into a more multi-dimensional and non-linear view of female lives in 19th Century Australia. Sideshadowing allows for the ‘non-closure’ within female narratives that these fragments of women’s lives represent. It is this which is at the core of the novel—an historiographic metafictional challenging by the fictional ‘voices’ of female transworld characters. In this work, they narrate from a female perspective the might-have-been alternative of that previously considered as an historical, legitimate account of the past. Barthes and Bakhtin Readers of this type of historiographic metafiction have the freedom to recreate an historical fictional world. By virtue of the use of self-reflexivity and intertext they participate in a fictional world constructed by themselves from the author(s) of the text(s) and the intertext, and the original women’s voices used as quotations by the intertext’s (male) author. This world is based upon their construction of a past created from the author’s research, the author’s subjectivity (from within and by disciplinary discourse), by the author(s) choice of ‘signifiers’ and the meanings that these choices create within the reader’s subjectivity (itself formed out of their individual cultural and social milieu). This idea echoes Barthes concept of the ‘death of the author’, such that: As soon as a fact is narrated no longer with a view to acting directly on reality but intransitively, that is to say, finally outside of any function other than that of the very practice of the symbol itself; this disconnection occurs, the voice loses its origin, the author enters into his own death, writing begins. (142) When entering into the world created by this style of historical fiction the reader also enters into a world of previous ‘texts’ (or intertexts) and the multitude of voices inherent in them. This is the Bakhtinian concept of heteroglossia, that ‘every utterance contains within it the trace of other utterances, both in the past and in the future’ (263). The narrative formed thus becomes one of multiple ‘truths’ and therefore multiple histories. Once written as ‘bad’, the women are now perceived as ‘good’ characters and the ‘bad’ events that occurred around them and to them make up ‘good’ elements of plot, structure, characterisation and voice for a fictionalised version of a past possibility. Bad women make good reading. Conclusion This type of narrative structure allows for the limits of the silenced ‘voice’ of the past, and therefore an understanding of marginalised groups within hegemonic grand narratives, to be approached. It seems to me no surprise that neo-historical fiction is used more when the subjects written about are members of marginalised groups. Silenced voices need to be heard. Because these women left no written account of their experiences, and because we can never experience the society within which their identities were formed, we will never know their ‘identity’ as they experienced it. Fictional self-narrated stories of transworld characters allows for a transformation of the women away from an identity created by the moralising, stereotyped descriptions in the newspapers towards a more fully developed sense of female identity. Third-hand male accounts written for the (then) newspaper readers consumption (and for us as occupiers of the ‘future’) are a construct of one possible identity only. They do not reflect the women’s reality. Adding another fictional ‘identity’ through an imagined self-narrated account deconstructs that limited ‘identity’ formed through the male ‘gaze’. It does so because of the ability of fiction to allow the reader to create a fictional world which can be experienced imaginatively and from within their own subjectivity. Rather than something passively recorded, literature offers history as a permanent reactivation of the past in a critique of the present, and at the level of content offers a textual anamnesis for the hitherto ignored, unacknowledged or repressed pasts marginalised by the dominant histories. (Middleton and Woods 77) References Bakhtin, Mikhail. The Dialogic Imagination: Four Essays. Trans. Michael Holquist. Ed. Caryl Emerson. Austin: U of Texas P, 1981. Barthes, Roland, and Stephen Heath, eds. Image, Music, Text. New York: Hill and Wang, 1977. Eco, Umberto. The Role of the Reader: Explorations in the Semiotics of Texts. Bloomington and London: Indiana UP, 1979. Holton, Robert. Jarring Witnesses: Modern Fiction and the Representation of History. New York: Harvester Wheatsheaf, 1994. Hutcheon, Linda. A Poetics of Postmodernism: History, Theory, Fiction. New York: Routledge, 1988. McHale, Brian. Postmodernist Fiction. New York and London: Methuen, 1987. Middleton, Peter, and Tim Woods. Literatures of Memory: History, Time and Space in Postwar Writing. Manchester and New York: Manchester UP, 2000. Morson, Gary Saul. Narrative and Freedom: The Shadows of Time. New Haven: Yale UP, 1994. Summers, Anne. Damned Whores and God’s Police. Ringwood Vic: Penguin Books, 1994. Veeser, H. Aram. The New Historicism. London: Routledge, 1989. Citation reference for this article MLA Style Lowes, Elanna Herbert. "Transgressive Women, Transworld Women: The Once ‘Bad’ Can Make ‘Good’ Narratives." M/C Journal 8.1 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0502/04-herbertlowes.php>. APA Style Lowes, E. (Feb. 2005) "Transgressive Women, Transworld Women: The Once ‘Bad’ Can Make ‘Good’ Narratives," M/C Journal, 8(1). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0502/04-herbertlowes.php>.