Annette Milligan

In 2014 Nelson Youth Council conducted a series of interviews for Heritage Week 2015. They spoke with people involved in areas of health and medicine and this is one of a number of stories which was displayed in Elma Turner Library.

Annette Milligan  Nurse/Educator (RCpN BA FCNA (NZ)

One of Annette Milligan's many achievements is the founding of one of Aotearoa’s first Independent Nursing Practices (INP). Launched in 1989 this social and health based care service continues to be successful and necessary today. Milligan’s teaching background is put to good use to provide education about health.

The Nelson INP Medical Clinic is based on five underlying principles which aim to remove the restrictions on womens’ healthcare. The INP aims to provide sexual health support and advice to anyone; and be a forum for discussion of sexual issues outside of family planning and the traditional doctor-patient relationship. “There are just some things you can tell your GP and some things you can’t”.

Annette Milligan. Image supplied by author
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Annette feels it is important to educate in order to help people make decisions - “but never to make decisions for people.” The INP is all about partnership with people at a personal level” Today, the clinic provides contraceptive, STI, cervical smear, breast checks, infertility and sexual abuse services.

Prior to February 1989, there was a rise in controversy around healthcare in New Zealand. This included the 1988 ‘Unfortunate Experiment’, where women were unwittingly involved in a cervical pre-cancer study that withheld treatment to prolong their symptoms for research.  Annette teamed up with Mary Griffith and Flavia Goulding for their first meeting in August 1988. For the next six months, they single-handedly managed and worked towards launching their first nursing practice.  This was to be a trial, and paid for by the Government, and commenced in February 1989.

The practice began as a holistic approach to health, focusing on lifestyles, stress management and niche areas such as foot massages. These elements are still part of the practice. It was tough financially at first through the early 1990's, when working part-time developed into full-time work for two years with no form of payment. The resistance the practice needed to overcome was mainly doubt over the fragmentation of services; as prior to the INP the general public had had no alternatives to their traditional G.P..

The biggest challenge for Annette was in the complexity of personal relationships. This, along with confidentiality, was a large part of the learning process that existed outside of textbooks and training. It was not simply about ‘being really careful not to judge people’. Dealing with situations tactfully was a learning curve. Annette noted “you’ve handled the most intimate parts of their body and then you’re standing next to them in the supermarket”. Understanding the complexity of personal connections is especially important in a “small town like this”. There are pressures when you are in a position of knowledge to save lives at risk, however there are issues around confidentiality.

Annette Milligan and colleagues in the early days of the Independent Nursing Practice. Image supplied by author

The INP has always fostered mutual and external support and works on the premise that “there are always things you can do better.” To ensure this they use regular team Peer Review sessions as well as external auditors every few years.

An example of innovation in response to awareness of needs is the creation of Health Click Ltd. which Annette co-founded in 2000. This produces booklets and DVDs for those with learning disabilities, on hygiene, relationships and intimacy, using vibrant illustrations and large easily readable font sizes.

Annette feels strongly about the necessity of sexual education, and feels there is limited access to services and a culture which rejects adolescent sexuality. “We need more rural based clinics and, although New Zealand has definitely made progress in the cultural acceptance, we’ve still got a long way to go…The chlamydia, teen pregnancy and genital warts are statistics that are still nothing to be proud of”.

Annette approves introduction of the HPV vaccine, which has reduced the foot traffic of genital wart patients to the clinic. Annette stressed that there was not enough effective sexual education in schools and the need to “pitch different things at different levels”. Nelson Youth Council interviewers agreed recalling harrowing memories of birth videos, STI slideshows and embarrassed clinical teachers as their firsthand exposure to sexual education. Annette’s passion is in making things accessible, especially in providing for those with learning disabilities. “There’s still a lot New Zealand curriculum can work on”.

Annette has many things that continually inspire her. INP has carefully compiled scrapbooks that reflect how the practice has developed over the years.  The pages yellowed with age, are filled with milestones and letters of gratitude.

For Annette, working with the most intimate parts of someone’s life is the greatest privilege. “You’re taken into someone’s world that they don’t tell a living soul about”. “It’s moving and humbling. The personal intimacy is the gold - absolute gold”. She reflects on the people and countless journeys she has walked with them. “It really supersedes the hard stuff, when someone throws their arms around you”.

Annette Milligan was interviewed by Jackie Liang, Sophie Ross and Jethro Burr December 2014 ; interview edited by Debbie Daniell-Smith (edited July 2020)

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