The Sunday Essay: On the Front Line
Emma Espiner on the relentlessness of this pandemic.
The Sunday Essay is made possible with the support of Creative New Zealand
Original artwork by Munro Te Whata
I don’t know what it’s like to be a doctor in a world without Covid. I was in my final year of medical school in 2020 when the first wave hit and we’ve been surfing it ever since. This week a patient coughed in the face of a colleague and we didn’t even flinch behind our breathing masks and goggles. The idea of doing this pre-Covid service without a mask makes me puke a little in my mouth.
Anyone working in the health sector who can hold a pen was approached to write a frontline account of the pandemic. The front line! What’s happening on the front line? ! People expect to attend all major national and international events, such as reality TV.
Three years later, we’re marching in our sleep, everyone is anxious, and before Russia invaded Ukraine, there was just this endless looping story. It seems impossible to plan ahead. Our aspirations froze in the face of relentless uncertainty. Our hearts and minds are fragile from the overexposure to social media, from condemning the muddled confusion of protesters littering the lawns of Parliament to hero-worship of stunningly beautiful Ukrainians defending their homes against Putin’s megalomania.
Sometimes the TV news has an update on our hospital before the communications team sends an update to my inbox announcing the latest “how are you” angle on the pandemic. I come home from work and try to massage my N-95 ravaged face back to its normal shape and see Michael Morrah standing outside the door I just walked out on the 6pm news. People message me saying they’re thinking of me on the front line, and I feel like a fraud because it sucks for everyone, and we don’t routinely thank someone else for their sacrifice, for simply doing their job or simply for surviving while the world is falling apart around them.
Right now, we’re hovering around the drain, held together by bonus payments, goodwill, and a refusal to let our colleagues and patients down. What happens next? When bonuses dry up, nurses keep their promises to quit and move to Australia, when paramedics remember they withdrew their strike and worked harder, for little extra recognition, and quit too? Whoever is left standing after all of this will face a mountain of remedial work.
While undoubtedly an acute and significant threat, Covid has done nothing more than expose the threadbare korowai of our healthcare system for what it really is: neglected infrastructure that didn’t make it anyway.
At the end of 2020, at a meeting of Maori doctors, Dr Rawiri Jansen spoke to a group of us at Tāmaki Makaurau. He warned us that it was not over, that another epidemic was imminent. I remember the urgency conveyed by him and other Maori clinicians, warning of the invisible threat looming post-Covid of delay in elective operations, cancer screening, childhood vaccinations, even seemingly tangential issues like the ability to obtain driver’s licenses that stop people, especially low-income people, from accessing the necessities of life and job opportunities. They hoarse over the inevitable inequity of rolling out Covid-19 vaccination for Maori if action is not taken urgently to target the program to our people. They told it to us in Turuki Healthcare’s meeting hall in Māngere and repeated it many times in other meeting halls, in the media, to anyone who wanted to listen.
The prescience and future of our Maori doctors today sticks like a rat in my throat. Because, despite our depression, our fatigue and our boredom, we must think about the future. There is a dark side to every heartwarming story of colleagues stepping in and taking extra shifts, helping where they can, hiding micron-sized cracks in our services and donating to immunization initiatives. for rural Maori communities. The impending fallout is tied to the total lack of redundancy in our healthcare system. It would be foolish to perceive the current problems as related only to the pandemic, to consider them as temporary and reversible in an imminent way. By the end of omicron, there will be an entire staff healthcare system, and only exhausted, overwhelmed employees to call on. There will be inequities that have not been corrected by delayed care, but are entrenched and compounded. Who will have the energy to take care of it?
In this context, we are also reminded that health care does not exist in a vacuum. Both major political parties are pivoting to respond to the truism that every election is fought on the battleground of the economy. The 2023 general election glistens on the horizon, backlit by poll results promising an edgy contest in which no one can take anything for granted. Over the past few weeks, Labor and the National have, in tandem, talked about the cost of living, inflation, petrol and benefits instead of rapid antigen tests, the team of five million of people and details of the global vaccine supply chain. Predictions of a recession are spreading across the economic and media landscape, pushing the high-level political narrative from Covid to post-Covid, even when we’re still in the throes of it.
I contacted our roster admin last week, told him I was exhausted, and asked him to cover a different set of shifts over the weekend. She said I was needed at night and she couldn’t give me any extra days off, but she would reduce one of my 2-hour shifts the following week to a eight hour work. I was pathetically grateful for the reprieve. We are seeing surgeries, clinic appointments and procedures drop due to understaffing, helping to streamline care, and we know delayed care is not going away, but is joining a growing discharge to be dealt with later. , by U.S. “Can the human body feel tired preventively?” I type on Google while queuing for a coffee.
“The plan to build back better is dead,” Forbes magazine reported in March. They were talking about Joe Biden’s disaster recovery plan for America, which put me off using the line here. Instead, I think we just need to view the post-Covid response as non-negotiable, the same way we saw the Covid response as such. The opportunity to learn from mistakes made during the pandemic is too important to ignore, especially when it comes to equity. For years, Maori health experts have attempted to explain the consequences of inequitable health care delivery – in the broadest sense of the word – without having a common understanding with the Five Million Team. It was easy for people not to know what was happening to the Maori, and from a state of ignorance there is only one step to indifference. We now have shared experience and, with the benefit of real-time, second-by-second, wall-to-wall coverage of the pandemic, eyes with which to see the effects of our health inequalities.
Maori death rates are higher than in Pākehā, our people have become sicker. Immunization rates lagged as central bureaucrats scrambled to secure resources for Maori health providers doing the heavy lifting with full support in the early days, our younger age profile and our higher comorbidity rates were considered unimportant; the results of these decisions are laid bare in the ongoing grim toll. You can overlay this template of inequity cut from the shortcomings of our health system onto almost any other health problem faced by Maori in the past and find the same patterns and results. You’ll also find clinicians and researchers shouting their evidence and outrage at injustice into a vacuum across generations. Surely this will be the last time our experts will be ignored.
The promise of the Māori Health Authority is simply that courageous decision-making will happen. That such decision-making is evidence-based and fair is beyond doubt; we have proven it collectively beyond even the sharpest criticism. There is no credibility in calls for “more evidence” on fairness. The very optimistic idea that getting rid of DHBs will solve everything (or whatever) means far less to me in the future than the opportunity we have with our best defenders in position at their own table at the Māori Health Authority .
They will not go unopposed. To some extent this is helpful – we are not immune to making mistakes and careful scrutiny should always be welcome. Less useful is the proximity of general elections; we have already seen the Act Party lead a proposed referendum on co-governance between Maori and the Crown, claiming unity through the erasure of differences like countless others before them. They won’t be the only ones to call fairness oppressive and there are, sadly, still votes in it.
In the hospital where I work, we have cared for those hardest hit by Covid, an unwelcome trophy that has everything to do with the inequalities we have ignored for decades in housing, employment, food environment and the provision of health care. Looking to the next year, we could do worse than examine our options from a health and equity perspective; even for those for whom economic concerns are paramount, they can surely recognize that productivity tends to struggle without a healthy population, and that the dead cannot buy your products.
Dr. Espiner writes in a personal capacity and does not speak on behalf of a district health board or hospital.
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