Sunday Essay Munro te Whata Feature image

The Sunday EssayApril 10, 2022

The Sunday Essay: On the frontline

Sunday Essay Munro te Whata Feature image

Emma Espiner on the ceaselessness of this pandemic.

The Sunday Essay is made possible thanks to the support of Creative New Zealand

Original illustrations by Munro Te Whata

I don’t know what it’s like to be a doctor in a non-Covid world. 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 into the face of a colleague and we didn’t even flinch behind our respirator masks and goggles. The thought of doing this ward round pre-Covid without masks makes me vomit a little in my mouth.

Anyone who works in healthcare and can hold a pen has been approached to write a frontline account of the pandemic. The frontline! What is happening on the frontline?! People expect to sit in on every major national and international event like it’s reality TV.

Three years in, we doom-scroll in our sleep, everyone has anxiety and, prior to Russia invading Ukraine, there has only been this one story looping endlessly. It feels impossible to plan ahead. Our aspirations have congealed in the face of unceasing uncertainty. Our hearts and minds are brittle from over-exposure to social media, lurching from condemnation of the confused muddle of protestors soiling parliament’s lawns, to hero worship of the improbably good-looking Ukrainians defending their homes from Putin’s megalomania.

Sometimes the television news has an update on our hospital before the communications team sends an update to my inbox announcing the latest “this is fine” angle on the pandemic. I get home from work and try to massage my N-95 ravaged face back into its normal shape and see Michael Morrah standing outside the door I just exited on the 6pm news. People send me messages saying they’re thinking of me on the frontline, and I feel like a fraud because this sucks for everyone, and we aren’t routinely thanking anyone else for their sacrifice, for just doing their job, or simply surviving while the world disintegrates around them.

Right now we’re circling the drain, held together by bonus payments, good will and a refusal to let our colleagues and patients down. What happens afterwards? When the bonus payments dry up, the nurses act on their promises to resign and move to Australia, when the allied healthcare staff remember they withdrew their strike and worked harder, for scant additional recognition, and they resign too? Whoever remains standing after all that will be faced with a mountain of catch-up work.

While undoubtedly an acute and significant threat, Covid has done nothing more than expose the threadbare korowai of our health system for what it really is: neglected infrastructure that wasn’t coping anyway.

Late in 2020, at a Māori doctors’ hui, Dr Rawiri Jansen spoke with a group of us in Tāmaki Makaurau. He warned us that it wasn’t over, that another outbreak was imminent. I remember the urgency conveyed by him and other Māori clinicians, warning of the invisible menace looming post-Covid from the lag in elective operations, cancer screening, childhood immunisations, even seemingly tangential problems like the ability to get driver’s licences that stop people, especially people on low incomes, accessing the necessities of life and work opportunities. They talked themselves hoarse on the inevitable inequity of the Covid-19 vaccination rollout for Māori if steps weren’t urgently taken to target the programme to our people. They said this to us in the meeting room at Turuki Healthcare in Māngere and went on to say it repeatedly in other meeting rooms, in the media, to anyone who would listen.

Our Māori doctors’ prescience and future-focus at that hui sticks like a RAT in my throat. Because, despite our depression, fatigue and boredom, we need to think about the future. There is a dark side to every heart-warming story of colleagues stepping up and taking on extra shifts, helping out where they can, papering over omicron-sized cracks in our services and donating to vaccination initiatives for rural Māori communities. The pending fallout relates to the complete lack of redundancy in our health system. It would be foolish to perceive the current issues as relating only to the pandemic, to consider them temporary and imminently reversible. At the end of omicron, there will be an entire health system to staff, and only exhausted, stretched employees to call upon. There will be inequities which weren’t fixed by delayed care, but entrenched and worsened. Who will have the energy to attend to this?

In this context we are also being reminded that healthcare doesn’t 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 shimmers on the horizon, backlit by poll results promising an edgy contest in which nobody will be able to take anything for granted. In recent weeks Labour and National have, in tandem, swung to talking about the cost of living, inflation, petrol and benefits instead of rapid antigen tests, the team of five million and the minutiae of the global vaccine supply chain. The predictions of a recession are creeping across the economic-punditry landscape, nudging the high-level political narrative from Covid to post-Covid even when we’re still in the throes of the thing.

I contacted our rostering administrator last week, told her I was exhausted and asked to cover a different set of shifts over the weekend. She said I was needed on nights, and she couldn’t give me any extra days off, but that she’d reduce one of my 14-hour shifts the following week to an eight-hour shift. I was pathetically grateful for the reprieve. We are watching the decline of operations, clinic appointments and procedures due to staffing shortages, participating in the rationalisation of care, and we know that the delayed care doesn’t disappear, but joins a growing landfill to be dealt with later, by us. “Can the human body feel preemptively tired?” I type into Google while waiting in line for a coffee.

“The Build Back Better Plan is Dead” announced Forbes magazine in March. They were talking about Joe Biden’s disaster recovery plan for America, which dissuaded me from using the line here. Instead I think we simply have to see the post-Covid response as non-negotiable, in the same way that we saw the Covid response as such. The opportunity to learn from the mistakes made during the pandemic is too significant to ignore, particularly when it comes to equity. For years, Māori health experts have tried to explain the consequences of the inequitable provision of healthcare – in the broadest sense of the term – without having a shared understanding with the team of five million. It was easy for people to not know what was happening for Māori, and from a state of ignorance it is only a short walk to indifference. Now we have a common experience and, with the benefit of wall-to-wall, second-by-second real-time coverage of the pandemic, eyes with which to see the effects of our health inequities.

Māori death rates are higher than Pākehā, our people have gotten sicker. The vaccine rates lagged as central bureaucrats scrambled to get resources to the Māori health providers doing the heavy lifting with bugger all support in the early days, our younger age profile and higher comorbidity rates were brushed off as unimportant; the results of these decisions are laid bare in the grim accounting currently underway. You can overlay this stencil of inequity cut from the gaps in our health system onto almost any other health issue experienced by Māori historically and find the same patterns and outcomes. You will also find clinicians and researchers screaming their evidence and outrage at the injustice into the void down the generations. Surely this will be the last time our experts go unheeded.

The promise of the Māori Health Authority is simply that courageous decision-making will happen. That such decision making is evidence-based and just is without question; we have collectively proven this beyond even the most pointy-headed of critiques. There is no credibility in calls for “more evidence” on equity. The highly optimistic idea that getting rid of the DHBs will solve everything (or anything) means far less to me in looking forward, than the opportunity we have with our best advocates in position at their own table at the Māori Health Authority.

They will not go unopposed. To some extent this is helpful – we’re none of us immune from making mistakes and thoughtful scrutiny should always be welcome. Less helpful is the proximity of the general election; we have already seen the Act Party leading out a proposed referendum on co-governance between Māori and the Crown, claiming unity through erasure of difference like countless others before them. They will not be alone in characterising equity as oppression and there are, sadly, always votes in it.

In the hospital where I work, we have looked after those hardest hit by Covid, an unwelcome trophy that has everything to do with the inequities we’ve been ignoring for decades in housing, employment, the food environment and the provision of health care. Looking ahead to next year we could do worse than look at our options through the lens of health and equity; even to those for whom economic concerns are paramount, surely they can recognise productivity tends to struggle without a healthy population, and dead people can’t buy your products.

Dr Espiner writes in a personal capacity and does not speak on behalf of any district health board or hospital.

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