A Sick, Sad, Sinking Feeling

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Aboriginal, Aboriginal & Torres Strait Islander Peoples, Australia, bureaucracy, genocide, Indigenous Australians, Indigenous People, Institutional racism, nationalism, policy, Public health, racism

Learning about some subjects in Australian public health is pretty confronting. In particular the health of Aboriginal and Torres Strait Islanders.

• The relative risk to health if you’re indigenous compared with non-indigenous is not reducing. The gap is not closing, no matter what the government would like to say.
• When you match by disease condition, indigenous people get 40-60% of what non-indigenous people get.
• There are a lot of bullshit policy and “plans” around with no definable actual plans, money or measurable outcomes attached to them. Content-free policy indeed.
• Let’s not get started on the institutional racism, intentional genocide, discrimination that are ongoing
• Oh and then there is the bullying, discrimination and internal sabotage that happens in Australian institutions in general if you try to change something or complain about something.

Overall, this is very depressing. Just the lack of progress. Things can definitely be done. There are multiple studies that show huge benefits from simple interventions. But these things need funding, community consultation and a sensible approach. Things which are completely lacking in Australia.

People like me are slowly making a difference but seeing as we’re starting these changes in 2013, it will take at least a generation for the institutional culture to change enough to be dynamic and less bitchy. We can make incremental changes, and some of these things do snowball into big effects on the community, but for the most part we actually need a change from the top. Or a big, earth shattering disruptive event that forces things to change, the way that the invention of the printing press, the discovery of relativity and the end of apartheid in South Africa did.

I swing from feeling energetic and positive to feeling despondent and depressed and angry.

I have some plans, but I’m scared it will be hitting my head against a brick wall. I need help with all of this.

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Pulling Strings

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Australia, corruption, doctors, emergency, Health, hospital, politicians, Public health

Something happened that really, really gave me the shits. Essentially I made a mistake. I caught up with a friend(ly acquaintance) of mine (a healthcare student) whose sister happened to call asking for advice as she was possibly unwell. It turned out to be a good description of a severe allergic reaction so I told her to go to emergency urgently. They stuffed her around a bit and so given the urgency I asked a friend if anyone we knew was working in emergency that night (answer: no). In the end she was okay and got seen by someone who knew what they were talking about and went home safe and sound.

Fast forward to a few days ago when aforementioned individual’s significant other has a broken nose. And I get a couple of text messages and a missed call asking me to pull strings to get them seen in emergency faster.

A broken nose is an accident but it’s not an emergency. It’s painful, unpleasant and ugly but it is not life or limb threatening and the surgery for fixing it is usually done a few days later, not even on the same day.

Pulling strings is a form of corruption. Really speaking, I should never have done it in the first place- my only justification can be that not intervening in a potentially life threatening situation would have been a worse evil. Pulling strings is a common thing in Australia. So much is about who you know. You know someone connected to the head of a big company? Let’s arrange an internship. Your father went to school with someone who is the head of department in a hospital? Instant research opportunity. A politician’s or staff member’s family member is in emergency? Let’s fast track surgery.

Who knows which other patients were in emergency when they walked in with a broken nose? Someone with chest pain? Someone with a stroke? Someone with appendicitis? There is a cost to every string you pull. There is always someone who loses out. I knew a couple of junior doctors who used to bribe the bookings clerks with chocolates and coffees to get their unit’s scans done faster. Who was missing out on an urgent MRI or CT as a result? Someone with an acute stroke? A patient with bowel contents leaking into their abdomen? Someone who had been hit by a car?

The scarcer the resources and the more underpaid the people on the receiving end of bribery, the more susceptible society is to corruption. Additionally, the less it is policed by independent bodies with the power to investigate and prosecute, the more likely people are to get away with things. In the hospital setting this means rigorous auditing procedures and systems analysis.

In the end I politely declined to intervene and explained my reasons. By the time I’d gotten the messages in the first place it was too late. They were already making a complaint to the health minister.

When Doctors Turn Right Wing

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Australian Labor Party, Health, Julia Gillard, Liberal Party of Australia, Private healthcare, Public health, right-wing, Tony Abbott

I always find it weird when doctors start spouting ideology that is counter to the ideals of public health, education and social services. More than 90% of doctors support public services for a reason. There is strong evidence that social services, healthcare and education are paramount to improving overall health outcomes. Scratch that – it’s not “strong evidence”, it’s fact.

So when doctors start spouting extreme right wing ideology, I wonder why. Are they stupid, wilfully ignoring the evidence because they are selfish or just evil?

I don’t really know. Some of it is picking and choosing – I don’t really blame those who don’t like Julia Gillard or the Labor Party, and I can understand a desire to liberalise the economy. There are things that are broadly considered “right wing” such as globalisation that are, I feel, necessary and good and have no negative impact on basic services.

What I don’t like is supporting cuts to services while promoting overpriced private healthcare and education. Charging patients excessively. Promoting private schools and full fee places at medical school. Claiming that Tony Abbott will be some sort of saviour for the nation given his atrocious, immoral job as health minister.

I suspect it’s mainly selfishness and greed that drives some people. And some people think that the pursuit of “success” in the form of money is the good and right thing to do (à la the “American Dream“) and that not doing this is morally inexcusable and that such people don’t deserve anything. In which case punishing the poor or unemployed is necessary even though it has the side effect of making everyone worse off due to inefficiency (treatment is far more expensive than prevention) and lack of resources in the health sector.

Additionally, people such as myself who wish to work almost exclusively in the public sector, for lower pay overall, are then losers and enablers, thus also evil and not worthy of any of the prestige that public hospital positions hold.

A similar line of argument is pursued by those who don’t believe that fat people, drinkers or smokers should have public healthcare. Which is a good topic for another post.

Related articles

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• Doctor ‘advised medical students to act less overtly gay’ to pass exam (telegraph.co.uk)
• The Bad Idea That Doesn’t Go Away: Cutting The Ounce of Prevention (forbes.com)
• Why are doctors silent? [SciencePunk] (scienceblogs.com)
• NHS changes ‘risk to sexual healthcare’ (bbc.co.uk)

Australian Propaganda Against Indigenous People

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Aboriginal & Torres Strait Islander Peoples, Australia, Australian Bureau of Statistics, Education, Health, Indigenous Australians, media, mental health, nationalism, propaganda, Public health, racism, social welfare, Stolen Generation, substance abuse

Television and newspapers and radio and magazines in Australia are full of the most amazing horseshit when it comes to certain topics.

Aboriginal and Torres Strait Islanders, but particularly Aboriginal people are portrayed in the media as stupid, lazy, drunk, violent druggies with a sense of entitlement. They are shown as a class of destitute no-hopers whose main ambition in life is to sniff petrol on the dole while resisting all attempts of Australians to bring in the comforts of civilisation. They are shown as savages who choose to be the bottom of the heap and who can’t be trusted to make decisions and were better off being taken away from their parents. Oh, and of course they have extra rights compared with more deserving Aussie battlers. Ungrateful sods.

Just like a lot of the political commentary in Australia, this is a lie.

The Stolen Generation actually happened, sheeple. Children were taken away from their own parents and often abused by their new families or treated as servants. No surprises then that PTSD, depression, anxiety, substance abuse are major problems. That’s right, due to the mass child abuse and cultural genocide that White Australia proudly perpetrated and continue to perpetrate. In the name of saving them from themselves.

How is the current “intervention” anything different? They’ve taken away indigenous representation (ATSIC etc) and instead continue to take people’s money and quarantine it and take their children away. The propaganda supports this abominable “cause” in exactly the same way they did the first Stolen Generation. Or worse, ignores it, making everyone think it’s stopped and everything is hunky dory.

Of course there are poor people and people with drinking problems. But when you age adjust, Indigenous people have the same high rate of heavy drinking as the general population – 15%. Yes, this is a problem. And yes there are communities where this is especially true. However the scale of the problem is vastly exaggerated. And if 15% is a national tragedy then it’s a national tragedy for the entire nation, not just for “the abos“.

Indigenous people are dying of diabetes, heart disease, strokes, vascular disease, kidney failure and suffering from mental illness. 25% of them don’t even have access to a hospital for crying out loud. Healthcare, education, money and fresh food are essentially being withheld from the population that needs it most. The excuse is that they “don’t want” services or “refuse to have people come in” or supposedly attack and destroy things. Has anyone asked Indigenous people if they want health, education, fresh food and running water? Funnily enough, they do want services and most of them trust their doctors. Perhaps once again we are being lied to? Hmmm.

Is it any surprise that they’re angry? I’m also angry!

Both major parties in Australia lack honesty. Their own government department, the Australian Bureau of Statistics has created a wealth of data that disproves a great deal of what they mindlessly parrot. Data that they are more than aware of and is clearly ignored.

Aboriginal and Torres Strait Islanders are used as a political football while being slowly killed off.

An Impoverishment of Aspirations

Tags

birth defects, child abuse, Education, mental health, neglect, nutrition, poverty, Pregnancy and Birth, Public health, social determinants of health, substance abuse, teenage pregnancy

For those who think “the abos” are responsible for living in a destitute state, it will probably amaze you to find out that there is a significant underclass of non Aboriginal (mainly white Anglo-Saxon) Australia that live in the same conditions, with however marginally more empathy due to not being “the abos”.

Did you know there are people living in Melbourne and Sydney with no running water or sanitation?

The cycle of poverty goes like this. A teenager gets pregnant. She may or may not get kicked out of home. Same with school. She probably won’t have adequate nutrition and may smoke or drink during her pregnancy. She is less likely to receive adequate antenatal care. Due to her age she is at a higher risk of premature labour and birth defects. The foetus is already at significant risk of intellectual and physical impairment before even being born.

The child is born. It’s quite possible that the young mother doesn’t get enough social support looking after the child. She may drop out of school or work. She may be struggling to make ends meet and not physically have enough time in the day. She may not have the maturity or ability to parent appropriately either. The child may experience neglect or even an abusive or chaotic home life. With such little money around they will get fed bad quality food and fast food.

School is a struggle. The child may or may not be bullied. Everyone around tells the kid (and new younger siblings) that school is pointless and worthless because they never completed school either. University is for weirdo nerds. And neither will get you any money anyway – better off quitting and working. Anyway what’s way more important is a nice house and a big wedding and kids. No-one reads to the children. They are functionally illiterate. So even if they wanted an apprenticeship, they can’t get one. Sex education just doesn’t happen and no one cares or teaches anything about how to organise your life.

With no hopes or aspirations or career options, what is there to do? Home life is awful. There’s alcohol and smokes and drugs and sex for a distraction. You can’t move out with the pittance that the dole is. Not even with rent assistance. Centrelink is unintelligible anyway. And eventually someone gets pregnant, usually before they turn 16, sometimes accidentally, sometimes on purpose. Because that’s what everyone else is doing. You don’t have a kid? What’s wrong with you? Don’t you want the baby bonus? Maybe then you could move out of the overcrowded hovel you share with your mother and her boyfriend and his friend that tries to grab your breasts and with your siblings.

And so the cycle repeats.

Where can we intervene? Give people a sense of agency in their own lives. Better role models than the “stars” of Jersey Shore. Show them life can be better. Teach them to read. Compulsory sex education and access to contraception. Early and intensive social work intervention and support. Better infrastructure. Change the message in the media to support education and reading. Provide 2 decent meals at school. Make it easier to get access to drug and alcohol services and mental health services, and GPs. You know, for free like they should be. Without 2 year waiting lists. Increase the dole. Build far more community housing. Improve infrastructure in the country. Supplement bread, cereals and other foods with vitamins. Make vaccinations and child health checks compulsory.

That took all of 2 minutes to come up with and in many countries this cycle of poverty has been largely broken. It honestly cannot be that hard. However when we have a culture of ignoring what doesn’t exist directly under our nose it is impossible.