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Photo: Getty Images
Photo: Getty Images

SocietyDecember 9, 2020

December 9, 2019: An intensive care doctor remembers Whakaari/White Island

Photo: Getty Images
Photo: Getty Images

A year ago today, the volcano on Whakaari/White Island erupted, leading to the death of 22 people and the injury of 25 more, many of whom suffered severe burns. Dr David Galler, a member of the team of intensive care and burns specialists at Auckland’s Middlemore Hospital, writes about that day and its aftermath.

As members of the medical profession we help others, but we are also helped. And occasionally, events occur that demand so much of us that we are changed forever.

I was reminded of that reading of the prime minister’s return trip to Whakatāne to follow up on her initial visit there on December 10, 2019, the day after the catastrophic eruption on Whakaari/White Island. Reports from that time speak of the empathy in her conversations with many who were involved in the rescue and initial resuscitation of those injured, and their subsequent triage and transport to different hospitals around New Zealand.

December 9, 2019 will long be remembered by the clinical teams from around the country that received and cared for those patients, an enormous mental and physical challenge complicated by the fact it was the first day of the new registrar rotation.

A view of the Whakaari eruption from a boat just off the island
A view of the Whakaari eruption from a boat just off the island (Photo: Michael Schade)

Burn injuries are unique: they are painful and disfiguring, and evoke emotions that are extremely confronting for those that suffer them, witness them and treat them. That psychological and physical horror is matched by the disruption they cause to their victims’ physiology; these patients are like no other and their care crosses the boundaries between many specialty areas. In situations like this the role of the intensivist is to resuscitate and stabilise the patient and coordinate and broker care across those specialty areas as needed. That’s what I did on that day.

As patients began to arrive at Middlemore we were still in a relative vacuum of information about who they were and how many were coming. Each patient was met by a team of people mobilised from our intensive care service, emergency and anaesthetic departments, and from the staff of the National Burn Unit. Each member of these teams did what they needed to by way of resuscitation, securing the airway in those who weren’t already intubated, inserting central lines, giving additional volume, starting inotropes, and making an initial assessment of their injuries.

As the evening and then the night flashed by, we were in our own state of shock but able to manage by relying on what we had rehearsed and practised together many times before. Our patients already resident in the ICU were managed by a dedicated group of senior nurses and one of our senior registrars, who that morning had started his rotation to Medicine but came back to help. His part was to assess and manage unstable non-burn patients admitted through the emergency department and from the wards. Other people appeared as intended, designated roles were filled, evidence-based guidelines were followed, all of these things happening in multiple locations for the entire night.

Each of the injured was accompanied by dedicated nursing and medical staff from the resuscitation rooms in the ED to the CT scanner, and from there to multiple operating theatres and finally to the ICU for ongoing organ support. On the way each of them had their injuries described and documented, and treatment begun with plans made for the next 24-48 hours. Still unidentified, each had been allocated a temporary “name” and assigned a unique national health identifier. I will never forget the first and most seriously injured person to arrive that day, a youngster who became known as “Unknown Blue”. He had thermal and chemical injuries the kind of which I had never seen before. They were so severe and extensive that despite his youth, good resuscitation, escharotomies and an early scrub down of his wounds in theatre followed by 24 hours of continuous dialysis, he never improved. He became our first fatality.

The next morning, a friend of mine, a retired radiologist from Middlemore, turned up as we were starting our rounds. He was looking for an American friend of his daughter, who was on her honeymoon in New Zealand and on Whakaari that fateful day. Luckily, we found Lauren with the first phone call we made; she was just up the road in the ICU at Auckland Hospital. Later we found her husband, also badly burned, he had been flown to Christchurch. That’s how it was, families separated in life and for some, in death too.

Middlemore Hospital in south Auckland. (Photo: RNZ)

The burn world is small. We will go out of our way to help each other if needed, so as all this was playing out, offers of help came from colleagues in Boston, San Francisco, the UK, Brisbane, Sydney, Melbourne and from other centres where we have close contacts.

As the days passed some of the most serious patients were transferred from the regional burn units to us while we triaged some of our regular intensive care work to Auckland and Waitematā; our rosters changed to ensure we all had periods of rest, but the work continued. Ongoing organ support in the ICU, trips to the operating theatres every few days to ensure the burn wounds were clean and temporarily closed with cadaver skin and then the long slow process of skin grafting. It’s roughly two days in the acute part of the hospital for each percent burn; with most sustaining burns of greater than 50% of their total body surface area, all of these people required in-hospital treatment for months. Weeks later, two more of our patients died, a husband and wife, leaving three small children behind. It was an intense time.

Most of our patients were tourists from far off lands: India, Holland, the UK, the United States, some from New Zealand too. One morning I went to visit Lauren, the American friend of my radiology colleague’s daughter. She had been transferred to us and after several weeks was discharged from the ICU across the corridor to the National Burn Centre. There she was, looking good, sitting up in bed swathed in bandages, her parents in the corner reading, while occupational therapists were working on each of her hands. By then we had got to know each other reasonably well but before entering I stood at the door to take it all in. Seeing me, Lauren and her parents beckoned me in and began to talk about what I had just been observing: the meticulous nature of the care that Lauren was receiving, delivered by these two lovely engaging people who are part of our team. They saw that too and were extremely grateful for it, saying that they couldn’t imagine that they and their daughter would have been so well cared for in the health system in their own country.

Although all of these people have now been discharged, we hear from them or of them from time to time. For some their survival seems miraculous, the result of a convergence of so many things that have carried them through, lifted them up and kept them up. Some say the experience has made them better versions of themselves and more aware of the vital nature of life and the importance of their family and friends. Wherever they are, we know that their lives will have been changed forever.

Prime Minister Jacinda Ardern hugs a Whakatāne first responder who helped those injured in the Whakaari/White Island volcano eruption the day before on December 10, 2019. (Photo: DOM THOMAS/POOL/AFP via Getty Images)

I am proud of the work we all did and in awe of those first responders and the team at Whakatāne Hospital. It is a great credit to them and many more that most of these badly injured people did so well. I will never forget that first day nor will those who were there at the outset. That was evident nine months later when Jacinda Ardern returned to check in on those who so bravely responded to that evolving tragedy, and the town that has been so deeply affected by it. The raw emotion is still there; you can feel it bubbling close to the surface. “It will take time to process the trauma of what you have been through,” said Ardern. She is right about that.

There is no turning the clock back on the events of that day but out of this trauma and suffering must come a better understanding of how we might avoid a similar tragedy in the future. I hope that is the prime intention of the action taken by WorkSafe and the ongoing investigations by the coroner. While their charges will cause anxiety for many, it is important to know whether or not agencies and individuals have been derelict in their duties, or whether they should have been better coordinated in their decision making. These issues will inevitably form part of what is to follow in what will be a stern test of our new health and safety legislation. Time will tell whether this approach will have a positive impact on work place health and safety in New Zealand. I certainly hope it does.

An earlier version of this article appeared in New Zealand Doctor|Rata Aotearoa

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Members of the public in front of the Christchurch High Court during the last day of the sentencing of the March 15 shooter (Photo: SANKA VIDANAGAMA/AFP via Getty Images)
Members of the public in front of the Christchurch High Court during the last day of the sentencing of the March 15 shooter (Photo: SANKA VIDANAGAMA/AFP via Getty Images)

SocietyDecember 8, 2020

With this report on the Christchurch terror attacks, is NZ now ready to face its demons?

Members of the public in front of the Christchurch High Court during the last day of the sentencing of the March 15 shooter (Photo: SANKA VIDANAGAMA/AFP via Getty Images)
Members of the public in front of the Christchurch High Court during the last day of the sentencing of the March 15 shooter (Photo: SANKA VIDANAGAMA/AFP via Getty Images)

Aotearoa’s challenges are clear, but it is incumbent, too, on the Australian government to launch an inquiry of its own – the society that shaped the terrorist and the failure of its own intelligence services, writes Anjum Rahman.

My first impression on reading the report of the Royal Commission of Inquiry into the Terrorist Attacks on Christchurch Mosques was a feeling of being underwhelmed. To be fair, I haven’t had time to read the full report, nor to digest it fully.

One of the initial things that stood out for me is the history of family violence in the life of the terrorist. He was abused by a partner of his mother, to the extent that an “apprehended violence order was taken out” to protect him. In so many cases of mass murder and terrorist attacks, we find family violence featuring in the history of the killer, who has also very often committed violent acts against intimate partners.

This is borne out by the research, as is the fact that misogyny is a feature of “lone actor” attacks. The question is, what are we going to do about this? Adequate resourcing to support children who have suffered violence is still not available. The institutions set up to protect these children have been found sadly wanting. Attempts to counter misogyny are often vigorously resisted.

Who will lead change in this area? The report suggests the Ministry of Social Development lead the work on social cohesion, with strong input by communities, civil society, local government and the private sector. A community empowerment approach is recommended, which means handing over decision-making power to communities.

A second aspect of the report is that the closest relations of the terrorist – his mother and sister – were concerned about his views and his mental state. His sister stated that she began to have concerns in early 2017. His mother reported feeling “petrified” about his mental health and increasingly racist views. Who could these women report their concerns to, and how?

In order for close family members and friends to report concerns, they would need to feel assured that there was a system with the capability and resources to treat their relative with care and compassion. They would need to be aware of whom to report to, and understand the consequences of making that report. They would want to be sure that the reporting would lead to positive change for the individual concerned without infringing on their social and political rights.

At the time these two women felt concern, they had no awareness of the terrorist’s planned massacre. They just knew that something was wrong. We, as a society, needed them to raise those concerns with someone.

The Royal Commission report mentions a “see something, say something policy”. Like previous campaigns on family violence, it is a campaign that asks the public to report any concerning behaviour they might witness. Such a policy does not, though, take into account the historical and structural discrimination in society.

From overseas experience, we see so many incidents of innocent people of colour having the police called on them as they are going about their normal business. Simply because they are in a place where privileged members of society believe they shouldn’t be. People of colour report being stopped more often by police.

In this country, research by JustSpeak confirms racism in the justice system, from the likelihood of being charged to conviction and incarceration rates. In a system with known bias, a “see something, say something” policy can lead to unfair and unjust results, which are counter-productive in reducing extremist violence. In particular, it may mean that white supremacists are not reported, but innocent people of colour are reported in high numbers. For Black Americans, that kind of reporting can and has resulted in death.

What this indicates is that the success of any new systems is dependent on eliminating racism and discrimination both within government and wider society. The question is whether or not New Zealand is ready to face its demons, and do the mahi required of us. Perhaps we finally are ready to have the difficult conversations of sharing power, tino rangatiratanga under the Treaty and constitutional change.

In a year that gave us the heartbreak of the Covid pandemic and the power of the Black Lives Matter marches, in the reflections since the mosque attacks, perhaps we are ready to have those conversations in a constructive way. Perhaps we are ready for change.

A final thought on this report: the terms of reference constrained the commissioners so they were unable to look beyond the New Zealand government. The terrorist grew up in Australia – that is where he formed his thinking and that is the society that shaped him. It is incumbent on the Australian government to conduct its own inquiry into what could and should have been done to ensure he had the kind of support that might have arrested his path to radicalisation and terrorism.

There were multiple incidents and points where that support should have been provided. There may well have been points where his activities should have raised concerns. He had not “been identified” by the Australian Security Intelligence Organisation, but we need to know if he should have been. Only the Australian government can set up an inquiry to answer that question.

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