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A scene from the infectious diseases Biocontainment unit at Middlemore Hospital (Photo by Hannah Peters/Getty Images)
A scene from the infectious diseases Biocontainment unit at Middlemore Hospital (Photo by Hannah Peters/Getty Images)

SocietyApril 11, 2020

David Galler: Life on the other side of a health crisis

A scene from the infectious diseases Biocontainment unit at Middlemore Hospital (Photo by Hannah Peters/Getty Images)
A scene from the infectious diseases Biocontainment unit at Middlemore Hospital (Photo by Hannah Peters/Getty Images)

With each new day, it is becoming increasingly clear that we cannot and should not return to the normality we have come to know in health, writes ICU doctor David Galler.

Over the past few weeks, our lives have been turned upside down and inside out in ways we could never have anticipated. Many of us are contemplating things that we have lost and are aghast at the easy complacency that allowed us to take so much for granted for so long; and now, all of a sudden, we wonder about what life could be like on the other side when the immediate impacts of this pandemic pass.

In this weird transition between a familiar past and an uncertain future, some still expect a quick return to the normality we have known, but with each new day it is becoming increasingly clear, even to them, that cannot and should not be the case.

For our leaders, the decisions they are making now will define their legacy forever. For each of us this is a time we will never forget and the way we respond will define us as individuals in the eyes of our families, and communities. How we behave, and how we continue to respond, will determine the nature of our immediate future – at best one where most of us remain well but living differently until there is a vaccine.

There are some, though, who continue to disregard advice and behave as though nothing has changed. Perhaps they should spend some time with us on the webinars with our intensive care colleagues in Italy, the US and UK to better understand the horror of what they are dealing with and then to know how their actions undermine our collective effort. The stakes are too high for that kind of arrogance and complacency.

I don’t know about you but with so much happening and so much at stake, I am working hard to stay sane. Like riding a roller-coaster, we can choose to fight every turn gripping the bar with white knuckles, or loosen our grip and roll with it. That’s where I have landed, grateful to be still alive and well in this blessed land, knowing that as part of a lucky generation I am not alone in feeling this sudden loss of liberty and luxury perhaps more acutely than those more familiar with such things. The people of Christchurch immediately come to mind, so too do many of my patients and their families whose lives have been cut short or derailed by illness and injury, and of course the experiences of my parents and their generation who suffered so much in the past in war-torn Europe.

At the end of the second world war, my parents were refugees finding their own safe havens on opposite sides of the world, before they found each other and moved to New Zealand where they made a new life. Once here, they were forever grateful to the fine people of this place who welcomed them so warmly. They often spoke of their feelings of wonder and gratitude at having washed up here on these shores, and I will always be grateful for what they sacrificed for me.

Gratitude is a grounding emotion and one that thankfully seems more prevalent in these feverish times. For my part, I am an intensive care doctor and like most people at the frontline of our healthcare services, I am deeply grateful to our government for their skilled, well-informed and expert management of this crisis that has dramatically slowed the spread of Covid-19 within our population, so far preventing the horror that is so evident in Italy, Britain and the United States. I am deeply grateful that New Zealand has a prime minister who respects science and acknowledges and follows the advice of experts. I want to thank my colleagues in public health and the public service for their tireless work.

As bad as this is in so many places, across the broadsheets of the world’s newspapers and on every radio programme, commentators everywhere are talking about a new and in many cases a better life on the other side of this, a future that is for us to imagine, design and build – yes, including for dolphins and fish in the canals of Venice, and less carbon in our atmosphere and nitrogen and algae in our waterways.

With all this happening on the eve of receiving the much-awaited review into our health and disability system led by Heather Simpson, many of us on the front line are talking about the future of healthcare and what we are doing differently now because of this pandemic, and how we might hold onto those things when we reach life on the other side.

Prominent in those conversations are a number of themes, including the need to rebuild capacity and capability in our public health workforce that has performed so admirably to date in helping suppress the spread of Covid-19, especially in my community of South Auckland.

That workforce, and its crucial role in providing a foundation for keeping New Zealanders well, was significantly eroded by the last government, who saw little value in the critical work it did. This crisis hopefully will help restore the mana of that important specialty group. Significant and ongoing resourcing should follow, to restore the capacity and build the capability of that workforce.

Much of its work should and must be directed toward a strategy for the primary prevention of disease, to decrease the appalling rates of harm to communities like mine in South Auckland from unhealthy food, tobacco and alcohol.

That community, like others in the Far North, Te Tairāwhiti, Porirua and elsewhere are particularly vulnerable to the impact of this pandemic. We know from other countries that this virus has a preponderance to kill those with chronic illness and now more and more evidence is pointing to a greater impact on the obese.

Sadly, most global calamities disproportionately affect the poor and those with chronic illness. In New Zealand, our Māori and Pacific populations make up a good proportion of those people and the greatest proportion of those in my area of South Auckland.

The appalling health status of so many here is a complex issue and not helped by poverty, overcrowding, poorly insulated houses, and an extremely high density of fast food outlets, liquor stores and pokie machines. All of my colleagues are deeply anxious that should this virus escape into the community of South Auckland, many will suffer, and our health services will be overwhelmed. Once we reach the other side, it will be time to develop and implement an evidence-based strategy to address the drivers of obesity and the other chronic health conditions that arise from it.

With so much attention diverted to prepare for the fallout from this pandemic, many other services have been put on hold, notably access to necessary, euphemistically called “elective”, surgery – there are few on a public hospital waiting list who don’t need their surgery urgently. This was the case too with the influx of seriously burned patients from the Whakaari/White Island eruption. We learned a lot from that disaster, liaising and working closely with other district health boards to match demand for services with supply regionally and nationally. Perhaps once we know more we will do that again here, such that those who most need an “elective” intervention will get it. I will be surprised if that doesn’t become part of the new mode for managing services on the other side of all of this.

Finally, a shout-out to the prime minister and director general of health for the manner in which they have kept the public informed of their plans and progress in combating this virus to keep people safe and save lives. Their communication has been exemplary; their openness and the transparency that they offer in all matters should reset the bar for public institutions in how they deal with the public. “Nothing about me without me” is a well-known catch cry of the quality in healthcare movement – perhaps when we get to the other side, it will become the norm for all of our health and social services.

Keep going!