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Dealing with community despair in the time of Covid

Published by Anonymous (not verified) on Fri, 24/09/2021 - 4:57am in

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As the public health measures work to suppress the pandemic, community relations and connections are at risk. A sense of community, togetherness and mutual support is needed, now and in the long-term.

In the decades before the pandemic, Western countries experienced epidemics of opioid and substance use deaths, suicides, and alcohol-related liver deaths.

It took two US economists, Anne Case and Angus Deaton (2015 Nobel laureate), to label these deaths as “deaths of despair”. They argued the policies of capitalism were an engine of inequality and suffering — causing income inequality, workers’ disempowerment, outsourcing of manufacturing jobs, cuts in social services, mass incarceration, costly private health care and a paltry public health system. “Diseases of despair” had doubled in the US in 18 to 34 year olds and tripled in under 18 year olds in the decades before the pandemic.

All regions of the UK were also affected. Scotland had more “deaths of despair”, mainly from alcohol. Drug deaths occurred in early adult life, suicide in the middle years (predominantly males) and alcohol-related deaths in late life. In the US, mainly white men died from these conditions, reducing the overall life-expectancy of the whole population. Alcohol-related conditions increased by 37 per cent, substance use problems by 94 per cent and suicide by 170 per cent.

Australia did not suffer such increasing rates of “deaths of despair”.

According to Australian Institute of Welfare’s research, the rates during the two decades were stable at 23–25 per 100,000 persons. Australian men died from these conditions at three to 3.5 times more than women. These deaths peaked in 1997–1998 when suicide rates were at their highest. Suicide rates then declined but plateaued and increased in the most recent decade. Our social welfare, universal health insurance, primary health services and public health have shielded us from the worst ravages of globalisation and the market economy.

When people are economically dispossessed and rights trampled on — there is despair, desperare — down from hope — meaningless, hostility, loneliness and apathy. In turn, the ability to make personal choices, for the family and for the community is compromised. Whole communities, neighbourhoods and networks can be affected. The Senate Inquiry into Aboriginal and Torres Strait Islander Mental Health and Suicide found despair the root cause of their suicides.

Impacts of the pandemic

The pandemic has exposed despair, in the making, not of days, months, but years. The gulf between libertarians and social democrats has been revealed; the gulf between (the suffering) of those who labour their livelihoods (exposed) and the desktop workers; and between those who do the work others will not do, and those able to choose their work and environment.

The pandemic has led to border closures, restrictions on socialising and barriers to treatment dramatically affecting the use and trafficking of drugs, the consumption of alcohol, patterns of crime and the indirect effects on domestic violence.

However, overdose deaths have not increased so far in Australia, although use has shifted from heroin towards synthetic drugs. This experience is different from that of other countries, where illicit drug use has increased. Opioid deaths increased by 10 to 60 per cent in the US, blamed in part on fentanyl. The Foundation for Alcohol Research and Education (FARE) has reported that while calls for assistance with alcohol problems have doubled, multiple surveys have shown inconsistent results about the consumption of alcohol.

In NSW urban crime has fallen by 30 per cent to 50 per cent for reported incidents – thefts of all kinds, non-domestic violence and sex offences and drug possession offences have been stable (NSW Bureau of Crime Statistics and Research). Similar reductions in crime have occurred in the UK and, in the US, overall crime rates have fallen by 23 per cent and drug crimes by 65 per cent with inconsistent spikes in shootings and homicides.

Many women have reported the barriers preventing them from seeking help for domestic violence in a recent survey by the Australian Institute of Criminology. Two-thirds of women experiencing physical or sexual violence said violence had started or escalated during the pandemic. They reported the perpetrators used violence as a means of control and was commonly related to alcohol consumption. Much of this did not get into police records.

Suicides in the pandemic

When there is economic dislocation, disrupted care and a separation from valued relationships there is fear and anxiety which is made worse by fear of COVID-19. Front-line agencies and mental health organisations, from the numbers of people contacting them, warn of burgeoning mental health problems. They warn us of the likely increase in suicides.

Despite these warnings, suicides have not increased. Lifeline reported that suicide numbers fell in 2020 and they have not risen so far in 2021. Australia, Canada, New Zealand, Norway, Peru, Sweden and the US, high-income countries, have not experienced increased suicide rates. These data should be interpreted with caution as data on suicides are delayed and in the recovery period social stress can increase suicide risk.

During the two world wars suicide rates fell in many countries, including Australia. The falls in wartime have been attributed to social integration — “closing ranks in the face of common danger”. Even in the face of extreme threat, such as the Nazi labour and concentration camps and the Soviet gulags, suicide rates did not appear to increase. Hannah Arndt wrote of “an astonishingly rarity of suicide”. Victor Frankl, Alexander Solzhenitsyn and Primo Levi made similar observations.

When faced with a common threat, individuals form more closely knit relationships; and their misfortunes can be attributed to the threat rather than to themselves. In the face of psychosocial or existential despair the natural tendency is to socialise; and for some this gives them hope. It is hope of this kind which will enable affected communities to come through the pandemic.

Connectedness

As the public health measures work to suppress the pandemic, community relations and connections are at risk. A sense of community, togetherness and mutual support is needed, now and in the long-term.

This ethos was captured by the World Health Organization in the theme for suicide prevention “One World Connected” in 2014. What works to prevent suicide will also work for the “diseases of despair”. And the values implicit in these relationships — everyone’s entitlement to live a contributing life, in family, work, and society — are the bricks in the reports of National Mental Health Commission on the nation’s mental health in 2012 and 2013.

During National Suicide Prevention Strategy, I saw local suicide prevention networks spring up across Australia in urban, regional, and remote areas. These networks were essential where suicides clustered and where suicide “hot spots” attracted attempters, especially in Aboriginal and Torres Strait Islander communities. To my mind, local networks of this kind are the key to building community trust and resilience in the face of adversity.

This is not a foreign idea in Australia. We have seen it before when Australia led the world in social reforms and antipoverty measures and in the rapid take up of public health programs. All these have demanded cooperation, unity, and connectedness.

That is what is needed now if we are to deal effectively with the social and health outcomes of despair, now and in the aftermath of the pandemic.

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How nurse practitioners have been shut out of the vaccine rollout

Published by Anonymous (not verified) on Wed, 22/09/2021 - 4:56am in

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Health

Privately practising nurse practitioners offer the best solution for vaccinated marginalised populations, but they have been excluded from access to Commonwealth emergency pandemic vaccines.

Nurse practitioners (NPs) have been established in this country for more than 21 years. The USA has been using NPs for more than 50 years. They are an accepted part of the public hospital system and are demonstrated to supplement, complement and improve existing services.

In the public sector, for example, NPs are demonstrated to prevent re-presentations to emergency departments and their expertise is drawn on significantly by the multidisciplinary teams.

In the private and community sector, they have established programs of work primarily for the underserviced and underserved.

Research evidence tells us that NPs provide quality care that patients are highly satisfied with, and that NPs have increased patient access to health services, particularly for marginalised populations in community settings, but that funding for their services continues to be an issue.

Privately Practising Nurse Practitioners (PPNPs) have had limited access to Medicare Benefits Schedule (MBS) funding since 2009, but their ability to be financially sustainable in the private and community sectors has consistently and persistently been blocked by both the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP).

One of the consequences of this exclusion is being clearly demonstrated right now.

In the middle of the COVID-19 pandemic, with Australia struggling with the delta variant and, up until recently, a shamefully sluggish vaccination roll out, PPNPs have been left out of the efforts to vaccinate all Australians.

Despite a growth in vaccination clinics across the country, the recent inclusion of pharmacists to deliver Covid vaccines, and states calling on health students to assist with vaccinations, PPNPs have not been included in these processes.

PPNPs offer the best solution for vaccination of marginalised populations across Australia. Yet PPNPs continue to be excluded from access to Commonwealth emergency pandemic vaccines and the funding to enable them to administer it. This is despite the fact that they are able to both prescribe and administer vaccines, and are already accredited to supply vaccines that are provided to them under the National Immunisation Program (NIP) to children and adults.

Examples of PPNPs in Australia and what they could do to assist

  • A nurse practitioner working in remote areas of Australia is the only contact point for the community, including the Aboriginal population, for general health care needs, and particularly for women’s health, sexual health, and family planning. A GP flies in to visit for a half day every 2–3 months. The nurse practitioner has the trust and engagement of this community, covering an area of approximately 500 square kilometres. Due to vast distances, the nurse practitioner regularly travels to the remote community, as well as holding regular clinics in several locations throughout the region. As a part of their usual service provision, vaccines are given. The nurse practitioner is clearly both the best engaged with the community to maximise uptake of the vaccine, and the most trusted and available qualified health professional to deliver it. Under existing arrangements, a GP will have to be flown in, and transported around to remote clinics.
  • A nurse practitioner in a large city works in their own clinic, and currently prescribes and administers vaccines under the National Immunisation Program. They also work as part of an outreach team visiting the homeless, addressing their primary health care needs, including vaccinations. Members of the outreach team are the only health professionals that visit the homeless in the city, and have established a high level of trust and engagement, with most of their clients refusing to enter clinics or hospitals due to fear or embarrassment. These people may never access a Covid vaccine.
  • A nurse practitioner working in a regional area visits four residential aged care facilities (federally funded). Of these, three are visited by general practitioners (GPs), although the nurse practitioner is the only one that visits after hours, or at short notice if a resident becomes unwell. The fourth has no visiting GP service at all. Following repeated delays, and several attempts to find a service that would attend and administer Covid vaccines, the nurse practitioner was able to obtain supply of the Covid vaccine for the elderly residents of the fourth aged care home, and worked several days vaccinating them without payment for his time or expertise.
  • An Aboriginal nurse practitioner in rural Australia manages both Indigenous and non-Indigenous groups suffering from end-stage renal disease, and has brought about significant and positive changes in their health. The need for this role was identified as a result of the rising number of people needing acute dialysis 24 hours a day. A retrospective study of the causes of this rise suggested that 80 per cent of the patients had risk factors that, if addressed early enough, would have prevented admission to the tertiary referral hospital for acute intervention. These risk factors were further examined and the diagnostic, clinical and referral skills required to address them were evaluated, and it was found that the scope of practice of a nurse practitioner met the requirements. The community renal nurse practitioner was able to develop and implement nursing models that integrated evidence-based clinical management with nursing advocacy for quality of life. This NP is ideally placed to provide vaccines and preventative care, for very vulnerable people, however, currently cannot.

NPs and the marginalised people who access NP care are being actively discriminated against and locked out of the ability to participate in the program due to the deliberately constraining MBS descriptors and the channelling of funds to individual GP fee for service billing items, rather than an “all hands-on deck” approach that could reach people in areas where GPs either can’t or won’t go, and communities are paying the price.

In the National Covid Vaccine Campaign Plan, Lieutenant General John Frewen identifies that the only three groups with unrestricted access to all aspects of immunisation in all jurisdictions are medical practitioners, nurse practitioners and nurse immunisers. Of these three groups, PPNPs are the sole group who do not have access to the Covid vaccine. States and territories have specifically stated, in their pandemic-related legislation changes, that NPs can be used during the pandemic (and in most cases can supervise and/or have other health professionals reporting to them).

Nurse practitioners could have been funded at a federal level to provide mobile and in-clinic services to the general public, leading teams of nurses, and ensuring disadvantaged people are not left out.

The Australian College of Nurse Practitioners (ACNP) and all the key Australian nursing organisations have been seeking access for PPNPs from government for months, but this has still not happened. There is no legitimate reason why this should be the case. We are of the view that this relates to ongoing “turf” concerns. Michelle Grattan, writing in The Conversation, asks these salient questions in relation to the late utilisation of pharmacists, and the very same questions could be asked about PPNPs:

  1. Why, way back when, did the government put so much weight on the doctors in delivering the early months of the rollout?
  2. How much did doctors’ lobbying influence the initial shape of the rollout? What clout did they have with senior health officials?

Why and how much indeed? Far more than we could even have imagined, given the developments of the past week in relation to the introduction of what seemed (at last) to be an opening to “enable” PPNP access to the Covid vaccine.

With only one day’s notice, the ACNP and other key nursing groups were invited to a webinar by the federal Health Department to learn how PPNPs were to be given access to Covid vaccines.  Despite the short notice and work demands, there were about 140 attendees.

What we learnt was that instead of PPNPs being able to access the same MBS item number to administer Covid vaccines as doctors and pharmacists, they would need to make a request for tender (RFT) under a new scheme entitled VAPP — the National Vaccine Administration Partners Program panel.

The 25-page document explained that the lodgement closing date for phase one of this three-phase process would be September 24 at 2pm (so move quickly whilst working full time in your own practice) but the final phase would not be until December 3, which would effectively mean that PPNPs would not have access to the Covid vaccine (were they to be successful) until just before Christmas.

The RFT itself was released on September 14 with an enquiry cut-off date of September 17, so three days to resolve any queries.

Furthermore, the average IProvider (immunisation provider) is required to have the capacity to deliver 500 doses per day, unless exemptions were granted for rural and remote IProviders. But as the examples above demonstrate, many NPs even in the inner city have small vulnerable populations who still require vaccination.

To say that PPNPs are disappointed would be an understatement.

Many are outraged.

They have vulnerable patients who desperately need to be vaccinated against COVID-19 and they are in the perfect position to provide those vaccinations.

Yet now they have to jump through another series of hoops not required of other health care providers.

And let us be really clear. The majority of Covid vaccinations in this country are being administered by nurses, at state, territory and federal level. At state and territory level these nurses are remunerated by the state and territory governments. At federal level the remuneration goes to the doctors and the pharmacists, even if they then employ a nurse to give the vaccinations.

It seems that there is an unwritten determination at federal level that seeks to avoid giving a recognised regulated group of health care providers (who are already qualified immunisers) access to MBS as a means to enable them to care for their underserved communities.

In a previous paper in P&I, I used the word “perverse” to describe the decision of the MBS review taskforce to reject all 14 recommendations of its own nurse practitioner reference group. That perversity continues and it will be the vulnerable patients of nurse practitioners who are the victims.

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Covid on the inside: A Sydney doctor’s perspective. I can face tomorrow

Published by Anonymous (not verified) on Tue, 21/09/2021 - 4:57am in

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Caring for COVID-19 patients in a Sydney hospital through the city’s latest outbreak, a doctor reflects on the impact the pandemic is having on our healthcare system and the people who work in it.

I cannot

I cannot be more resilient
I cannot manage anything else
I cannot be too honest
I cannot watch the news anymore
I cannot imagine
I cannot sleep
I cannot let my team down
I cannot think about more than one day at a time
I cannot keep going

A calling

Someone asked me last week if I would have chosen this path if I knew I had been signing up for this.

I was exhausted, slumped over a desk with my head in my hands when I took a deep breath through my surgical mask to answer.

“It pains me to say it but I still would have done this. I cannot imagine doing anything else,” I sighed. “It is still a privilege to do what we do.”

I was almost rolling my eyes at myself, cringing at expressing something so cliché, but amidst much uncertainty I knew this to be fact. I was resigned to it. Does this privilege come with a price? How would I feel if any health care worker across our state, our nation, could not withstand the immense pressure they were under right now.

The answer? Devastated. Angry. Crushed.

Colleagues

It is not everyone, and it is not all the time, but the majority pull together when needed. This period has seen more collaboration and sharing of information, experience, and expressions of support across multiple hospitals than ever before in my career.

We humbly exchange successes and failures over Zoom, Skype, Microsoft Teams — if we remember to unmute ourselves.

We gather outside where we can physically distance and remove our masks to enjoy a coffee and a quick chat in patches of sun or shade.

These brief, shared moments of light and darkness feel precious. They help one go on.

Communication

Everyone I know is struggling with communication at the moment.

You do not say much. You frantically text in your breaks, letting typos fly while emojis do the talking. Sad face. Tired face. Laughing crying face.

Sometimes you speak but the words are all jumbled. Sometimes there is random, hysterical laughter which is almost as contagious as the virus itself. The next moment, you are confronted with the fear of a patient or their loved ones, who cannot visit or help them. It is unimaginable.

Some health workers are looking after patients from parts of Sydney they have never heard of, let alone been. This provides important insights into how different pockets of society function.

While coronavirus has forced people to isolate in their own communities, in their echo chambers, we providing healthcare are not able to do that. I hope we will be the better for it.

Compromise

Conflict and compromise occur in hospitals daily. From the front door to the top floor. Consensus in meetings is akin to reaching Nirvana — unattainable for most. This is not unique to the health sector.

The discomfort of being faced with this possibility that we might have to compromise on the care we provide is palpable. Of course, we are privileged that this is not something we are faced with every day.

Complain

I should not complain because we will not face anything like China, Italy, the US or UK have faced from this virus.

I should not complain because so many colleagues return home to loved ones including unvaccinated children, or to care for elderly relatives.

I should not complain when the nursing and junior medical staff constitute the majority who are providing “around the clock” care for coronavirus patients in our hospitals.

It is hard, maybe impossible, to use words to describe the gut-wrenching anguish many feel on their way home. The vague nausea of exhaustion and dry lip-smacking, for titrating water and coffee intake with the challenge of doffing personal protective equipment (PPE) to use the bathroom is a fine balance indeed.

Then a slowly typed text to family or friend that you are off the ward and on your way home. This journey is one of processing what you have done today, often fixating on what you missed or should have done better.

Assaulted on the outside by the noise of news, modelling and mayhem, I often switch to music, embrace the endorphins of singing. A small smile may creep up when “Danger Zone” by Kenny Loggins comes on seemingly by chance.

Then the work façade is replaced by the home façade. What can you say and share? Who can you be vulnerable with? The energy taken to shift between these fronts can be almost as hard as the work itself.

Clean

Most hospitals are using terminology like “hot” and “cold” zones, or even “dirty” and “clean”, in an attempt to clearly communicate areas where coronavirus patients may be transported and where certain PPE is necessary. We are familiar with these terms which are often used in surgical procedures where sterile zones are needed, but no one thinks the term “dirty” is really acceptable.

It helps focus the mind on the stigma of this and other diseases. Remember when you could cough without someone turning to glare at you?

If you are not working in coronavirus care, you cannot possibly know how good showering can be.

Perhaps if you have reached the summit of Mount Everest you can appreciate the sensation I describe. From the anxious, painstaking peeling off of one’s gear to the fearless frolicking in warm water, scrubbing from head to toe once, then again. Maybe just one more time. It is a strangely joyful climax at the end of a long, hard… day.

Celebration

When life returns back to something we recognise as “normal”, it will be a great relief.

But it should not be a relaxation into past oversights, assumptions and errors. The coronavirus pandemic has exposed some of the biggest disparities across Sydney in the way we interact with healthcare and the media.

It has also exposed crucial access limitations for rural communities. I feel confident that we as healthcare workers can embrace these lessons when we recover. I hope others will follow our lead.

I can

I can help patients and their families at this difficult time
I can swallow some of my frustrations
I can listen
I can lean on colleagues, friends and family
I can ask for help
I can feel good about my work
I can feel proud of my team
I can be grateful
I can face tomorrow

 

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Genocide by big pharma. Millions will die

Published by Anonymous (not verified) on Mon, 20/09/2021 - 4:58am in

Big pharma is fiercely opposing measures to scale up production and distribution of COVID-19 vaccines around the world. This corporate genocide must be named. Stop protecting crooks.

The crimes of big tobacco, oil and asbestos recede into shade compared with the contemporary genocide perpetrated by big pharma: deliberately limiting vaccine supply, by refusing to share technologies, in order to maintain prices and further inflate existing megaprofits (and dividends and bonuses).

The World Health Organization (WHO) asked pharma to share COVID-19 vaccine technologies in March 2020; pharma sneered and the G7 confederacy supported their refusal.

When Covax was designed, big pharma was party to the decision to limit Covax to supplying only 20 per cent of the needs of its clients, partly in order to prevent the emergence of a large monopsonic purchaser with significant pricing power.

Blessed are the rich in securing vaccines

Now, while Europe and the US are headed towards 80 per cent double dose vaccination, Africa has only enough supply to vaccinate 2 per cent of its eligible population. Will pharma be held accountable for the avoidable deaths that are even now taking place?

Far from it. The South African and Indian proposal for a limited term waiver of relevant intellectual property provisions in order to disseminate and scale up production is being fiercely opposed by pharma with the outright support of the EU and deferral and delay by the rest of the “liberal democracies”.

It seems that the racism which normalised slavery (in Europe and North America) remains alive and well.

Pharma has form. In the late 1990s pharma was selling AIDS medicines in South Africa for $10,000 per treatment year while Indian generics were selling for $350 per treatment year. A high margin for the well-off would yield more profit than a thin margin for ordinary folk. The fact that the death rate among ordinary folk would be thus inflated was immaterial.

The shameful global vaccine apartheid in 10 images

South Africa passed a law enabling the purchase and importation of medicines from other countries, where prices were lower, but in 1997 39 pharmaceutical giants, supported by the Clinton-Gore administration, took the South African government to court, alleging they were in breach of their trade commitments.

There was a massive protest campaign with street marches in South Africa and solidarity actions around the world, including in the US.

Finally, in 2001, the US withdrew its support, concerned at the damage that was being done to the Gore presidential campaign, and the pharma case collapsed.

It was international revulsion which arrested pharma in 2001. Corporate genocide must be named. Stop protecting crooks.

Nobody is safe until everybody is safe.

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Three unjustified problems with the Queensland euthanasia bill

Published by Anonymous (not verified) on Mon, 20/09/2021 - 4:52am in

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Health, Politics

The Queensland Voluntary Assisted Dying Bill goes too far in trampling on the rights of those who want nothing to do with it in the last stages of their own life or in their long term relationships with their patients and residents.  This is a new area of law and policy, and we should step carefully being attentive to the rights and sensibilities of everyone.  The Queensland Bill does not strike the appropriate balance.

The Queensland Parliament, like the Victorian Parliament four years ago, is committed to legislating for voluntary assisted dying (VAD). The Queensland bill being considered by the one chamber Queensland Parliament this week basically follows the contours of the Victorian legislation. But there are three major new developments proposed in the Queensland bill which are very worrying in this new field of social experimentation.

First, under Victorian law a registered health practitioner is not allowed to initiate the discussion about voluntary assisted dying with a patient or resident to whom they are providing health services or professional care services. If they do, they are guilty of unprofessional conduct within the meaning and for the purposes of the Health Practitioner Regulation National Law. Of course, they can provide all necessary information and opinions once the patient or resident initiates the conversation.

Under the Queensland bill the registered health practitioner is allowed to initiate the discussion. They can even make an unsolicited suggestion of VAD provided they tell the patient about other options, including palliative care. The last thing that aging, sick people need is a cast of evangelising health practitioners prompting them to consider VAD. The Victorian law precludes that; the Queensland bill encourages it.

Second, under Victorian law a doctor is able to buy out of all aspects of VAD simply informing their patients that the doctor has a conscientious objection to being involved in VAD. Back in 2008 when legislating on abortion, the Victorian Parliament conceded that a doctor might have conscientious objections particularly to late term abortions. But the Parliament insisted that the doctor with conscientious objections refer the patient to another doctor prepared to perform the abortion. The rationale was that the patient might otherwise be stranded in an emergency situation.

When it came to legislating for VAD, the Victorian Parliament saw no need to insist that the conscientiously objecting health practitioner provide a referral. There would be other ways to provide the patient or nursing home resident with the time and opportunity to engage someone to assist with VAD. The Victorian Parliament acknowledged that the doctor with conscientious objections to VAD, perhaps even viewing it as assisted suicide, should be left in peace, not having to provide a referral.

The Queensland Parliament is proposing that the provider who views VAD as morally unacceptable must provide the patient with information about another provider ‘who, in the practitioner’s belief, is likely to be able to assist the person with the person’s request’.  This extra clause not found in the Victorian law risks trampling unnecessarily on a health provider’s conscience.

Meanwhile, unlike the Victorian law, the Queensland bill specifically states that “a person’s freedom of thought, conscience, religion and belief and enjoyment of their culture should be respected”. Give us a break!

Third, under Victorian law and practice, hospitals and nursing homes can maintain their principled objections to VAD giving notice to all patients and residents that VAD services are not provided on their campuses whether for religious or other reasons. The Queensland bill provides access for consulting VAD practitioners to facilities which do not provide VAD. It provides that all and any steps in the VAD process can take place on these facilities, and it allows the consulting and/or coordinating VAD practitioner, and not the facility’s own admitting clinicians, to decide whether transfer of the patient will occur.

There have been no reported problems in Victoria where Catholic health and aged care services from day one have made it clear:

“Our staff have always had open discussions with patients, residents and families, about their treatment and care at the end of life. That will not change. Each of our services has a system in place that will respond respectfully and compassionately to any questions about ‘VAD’. This includes coordinating transfer of care to other providers if a patient/resident wishes to seek ‘VAD’. We will not impede access to the provision of ‘VAD’ elsewhere.”

The three novel suggestions in the Queensland bill will upset some nursing home residents who would prefer to be left in peace, violate the consciences of some of Queensland’s finest health practitioners, and interfere with the smooth operation of some of Queensland’s finest hospitals and aged care facilities. If any of these suggestions are to be adopted, Queenslanders should first be told what is the specific Victorian problem that each proposal is designed to solve.

This article first appeared in The Australian.

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Anxiety is good for you

Published by Anonymous (not verified) on Fri, 17/09/2021 - 7:42am in

Said no-one ever. But it’s what, I suggest, government thinks. Unless we are anxious and worried, we, their electorate, allegedly, do not strive for better things…. ….in, of course, a personal endeavour, for, supposedly, the benefit of all society. A bit like Adam Smith’s invisible hand. It is not true – and since most government... Read more

‘Everybody did it’: wealthy doctors’ lobbies ride JobKeeper gravy train

Published by Anonymous (not verified) on Fri, 17/09/2021 - 4:55am in

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Health, Politics

JobKeeper for dentists? Fair enough. But more public subsidies for doctors’ lobby groups? Callum Foote reports on Australia’s medical colleges refusing to pay back millions in JobKeeper payments.

Australia’s specialist medical colleges already rake in enormous government funding. The bulk of college revenue comes from doctors’ membership fees, and doctors continued to pay them during the pandemic — people continued to “visit the doctor”. Then there is the enormous system subsidy, some $24 billion spent by Medicare annually.

On top, there is the cherished charity tax status of these wealthy colleges — such as the Royal Australian College of Physicians (RACP) and the Australian & New Zealand College of Anaesthetists (ANZCA) — and further state and federal government subsidies given to the colleges directly.

Many doctors were hit by the pandemic individually, particularly the wealthier doctors, but not their lobby groups and professional associations.

Diagnosis: greedy

When Michael West Media asked why they took JobKeeper when they did not suffer the requisite fall in income to deserve it, a general refrain from medical lobby groups was that everybody was taking it. The “others were taking it too” explanation reflects exactly the rationale expressed in corporate Australia, a rationale which led to the largest transfer of wealth in history from ordinary Australians to wealthy Australians.

Although many of their members, working doctors, were appalled at the cash grab, many “royal colleges” did not to bother to respond at all.

The Royal Australian College of Physicians (RACP) pulled in the most in JobKeeper at up to $4.9 million in 2020. The college’s JobKeeper haul contributed to a $3.8 million surplus that same year.

RACP refused to engage with questions put to them by Michael West Media as to whether the college would consider repaying the subsidy.

After RACP, the three highest JobKeeper earners were the Royal Australian College of Surgeons at $4.4 million, the Royal Australian College of General Practitioners at $3.7 million and the Australian and New Zealand College of Anaesthetists (ANZCA) at $3.4 million. They each made millions in surplus.

ANZCA is a standout, having grown its surplus from $310,000 in 2019 to $6.3 million in 2020 with the aid of its JobKeeper take. Many anaesthetists themselves have queried the legitimacy of their college’s JobKeeper earnings.

A member of ANZCA asked the college’s leadership in an annual general meeting whether the $4.4 million would be paid back now that “the dust has settled”. The response at the time was that the college would be doing what other similar organisations were doing.

The ANZCA has since confirmed that they would not be repaying their JobKeeper, with a spokesperson saying: “The college’s 2020 financial position was due largely to a temporary reduction in operating expenditure with many costs deferred, and increased returns on investment income.”

So much for leadership

If the anaesthetists were waiting for leadership from their fellow colleges, or from similar bodies such as the Australian Medical Association (AMA), they would be waiting a while.

An AMA spokesperson responded to questions put to them by Michael West Media by saying, “JobKeeper’s role in other organisations is a matter for them”.

Of the 25 specialist colleges operating in Australasia, only the Royal College of Pathologists of Australasia has informed Michael West Media it did not apply for nor receive JobKeeper. Just as well, the pathologists were very busy.

No college came forward to return their JobKeeper take and many refused to respond to questions put to them.

While lockdowns did significantly affect the income of Australian doctors, according to the ANZ–Melbourne Institute Health Sector Report it is not clear that this extended to the colleges themselves.

According to the report, “20 per cent of GPs and 42 per cent of other specialists reported losses in income of 30 per cent or more, while 20 per cent of surgeons and anaesthetists reported their income had fallen by 50 per cent or more”.

However, it was the richest doctors, particularly GPs, who were hit hard, “GP practices in the wealthiest areas were hardest hit in terms of income losses and fall in patient numbers, most likely as a result of the substitution of bulk-billed telehealth consults in place of the usual full-fee face-to-face consults,” the report states.

Beyond their JobKeeper take, Australia’s specialist medical colleges are already significantly reliant on government funding. The bulk of college revenue comes from doctors’ membership fees, significantly subsidised by the $24 billion paid out by Medicare annually, while state and federal governments provide further millions in grants to the colleges directly.

Currently, independent Senator Rex Patrick, Labor and the Greens are demanding the Australian Taxation Office reveal which organisations were paid JobKeeper. A total of $4.6 billion dollars from the program is believed to have flowed to firms that saw revenues rise in the first three months of JobKeeper according to new data published by the Parliamentary Budget Office.

This article was first published by Michael West Media.

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The Nine Cent Taxis of Rural South Korea

Published by Anonymous (not verified) on Wed, 15/09/2021 - 6:00pm in

Three great stories we found on the internet this week.

Where ya headed?

Some taxis don’t want to pick you up if you live in the middle of nowhere. These cabs are meant for exactly that — and they cost nine cents a ride.

In South Korea’s Seocheon County, population declines have led to public bus service cuts, stranding residents who don’t own cars, many of whom are older. So, rather than subsidize the mostly empty buses to keep them running, the county government came up with a cheaper, nimbler solution: the “100-won taxi.” 

Seocheon County, South Korea. Credit: Insung Yoon

More a policy than an actual taxi service, the scheme lets rural residents of Seocheon call taxis and pay no more than 100 won — or about nine U.S. cents — per trip. The government pays the rest of the fare, and anyone who lives more than 2,300 feet from a bus stop is eligible for the perk, which has quickly become very popular. According to the New York Times, the policy is revolutionizing how people in South Korea’s small hamlets get around, and has been so successful that the national government is helping other counties copy it.

“The taxi now drives me all the way to my doorstep,” said one 85-year-old Seocheon resident. “You can’t imagine what it was like in older days when I had to haul my shopping bag all the way from the bus stop to my place. It killed my legs.”

Read more at the New York Times

Against the grain

In the U.S., school lunches are awash in tater tots, fish sticks and white bread — foods produced with cheap yet nutritionally deficient refined flour. Now, one California school is doing something unexpected: not just buying whole grain flour, but milling it itself.

RTBC contributor Hannah Wallace reports for Civil Eats that, with a grant from the California Department of Food and Agriculture, Shandon Elementary in San Luis Obispo County will become America’s first public school to make its own flour on site. For the next two years, every slice of pizza, taco shell and spaghetti strand served at the school will be made from nutritious whole grain. Until 2023, the grant will cover the cost of the mill and the ingredients, and training for the cafeteria staff, many of whom say they’re excited to try something new. 

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Additional grants will allow two neighboring districts to buy their own nutrient-dense whole grain foods from local farmers, ensuring that hundreds of central coast students will be eating healthier lunches for years to come. The broader goal is to adapt the kids’ palates to whole grains so they’ll make healthier food choices for life. “We know all about school budget deficits and challenges,” said one of the people involved. “But we also know what’s possible with a lot of creative thinking and community-building.” 

Read more at Civil Eats

Friends and family rate

Imagine if all that separated you from contact with your loved ones was the jacked-up price of a phone call you couldn’t afford to make. This is reality for many Americans in prison, where the cost of phone calls is often outrageous, topping $10 for a 15 minute chat in half of all U.S. states.

Now, an array of legislation — much of it spurred by pandemic lockdowns that prevented in-person visits — is allowing incarcerated folks to make calls for little to no money. The federal government recently capped long-distance call rates at 12 cents per minute from prisons and 14 cents from jails, and some states have chosen to go further. In June, Connecticut, which until recently had the highest per-minute rates in the country, joined New York City, San Francisco and Los Angeles in offering free video calls and emails. Meanwhile, video conferencing startup Ameelio has signed contracts to pilot its free software for incarcerated people with the state prison systems in Colorado and Iowa.

For those in prison, the calls are more than comforting. Research shows that incarcerated people who maintain regular contact with friends and family during their sentences have better housing and employment outcomes after they’re released. “We’ve hit a tipping point,” said the founder of one group fighting commercialized incarceration. “The ball isn’t fully rolling yet, but we’re starting to roll.”

Read more at Bloomberg CityLab

The post The Nine Cent Taxis of Rural South Korea appeared first on Reasons to be Cheerful.

A house divided against itself cannot tame the pandemic

Published by Anonymous (not verified) on Wed, 15/09/2021 - 4:56am in

Tags 

Health

St Matthew tells us that Jesus was at pains to teach his disciples that, “A house divided against itself cannot stand”. The truism comes to mind as one looks in vain for the United States of Australia, an entity essential for our taming of the Covid pandemic.

It’s infuriating, foolish and certainly counterproductive not to have a national plan to help us emerge from our Covid crisis that is agreed to and championed by all our governments. In general Australians are a remarkably homogeneous lot. We are not like the United States where states are not united and where Texas and Texans are very different from New York and New Yorkers. However at the moment division rather than mutual cooperation characterises our interstate relations.

The truth is that with the exception of a vaccination target with which all agree, there would seem to be little appreciation of the urgent need to have nationwide uniformity in the development and application of the non-vaccination strategies that will be essential for us to live, together, more enjoyable and productive lives despite the continuous presence of the SARS-CoV-2 virus.

We deserve better than to have state premiers bickering with each other and the prime minister, who some argue is politicising the distribution of vaccines. Controversy is swirling as documents obtained by Labor suggest that the Morrison government neglected an opportunity for Australians to benefit from the Pfizer vaccine before the end of 2020. History may well report that the offer from Pfizer was not pursued because of confidence of an abundant supply of the AstraZeneca vaccine which was far cheaper than the Pfizer and could be manufactured here by our CSL. The rare but serious side effects of the AZ vaccine were not appreciated at that time.

Real world modelling

We are awash with modelling from universities and Institutions all with somewhat different imperatives for shaking off the yoke of the Covid pandemic. For us at this moment, far more important than these learned predictions are the actual happenings in the rest of the world where a number of countries have actually reached 70 to 80 per cent vaccination rates.

The message for us is very clear, unless vaccination success is complemented by continuing adherence to a range of public health initiatives, then the incidence of COVID-19 can still surge among the unvaccinated and 10 to 15 per cent of those who are vaccinated.

The UK, with almost 70 per cent of the population vaccinated, declared “freedom” from restrictions in July and today hospitals are under siege. With around 35,000 new infections per day hospitals are admitting more than 1000 Covid patients a day and a seven-day average of more than 130 deaths a day.

Singapore was living with Covid comfortably as vaccinations and restrictions had seemingly tamed their epidemic. A secure Covid bubblewas proposed with Germany. Such plans have been abandoned just this week as with the easing of restrictions a new wave of delta infections is again sweeping the country.

Other countries with high vaccination rates such as Canada and Israel are experiencing surges in new cases and appreciating the need for a long term partnership between vaccination and measures to facilitate the need to keep away from each other.

So what will acceptable co-existence with the coronavirus look like? The steady state we seek will feature numbers of new infections that our contact tracers can contain and the capacity to provide hospital and intensive care for those who need it without compromising our capacity to provide the same necessary care for non-Covid illnesses. Indeed the integrity of our hospital services must be the bottom line imperative for living with Covid.

There are three major elements to achieving these goals. Two are within our control, the maintenance of high vaccination rates and high levels of immunity among the vaccinated and community acceptance of long term crucial public health restrictions. The third requires the taming of global infections as we have no choice but to engage with the international community.

Vaccination

Our experience with the available vaccines tells us that about 90 per cent of those vaccinated will be protected from serious illness and death from COVID-19, that immunity wanes about six months after vaccination, booster doses six to eight months after a second dose will be required, so-called break through infections among the vaccinated are to be expected and vaccination reduces the carriage of virus in one’s respiratory tract but still allows for many vaccinated to be infectious.

These facts need to be considered as plans for vaccination passports are developed. My passport may not be as reassuring as your passport if my immunity is waning. The vaccinated who are carriers of virus can infect the vaccinated who are not.

There is general agreement that vaccination of 80 per cent of Australians over 16 will not achieve herd immunity. Twenty-five per cent of new infections in NSW are in children who are far more likely to become seriously ill now that the delta variant is predominant. As soon as possible (probably March/April 2022) we must vaccinate children from five years of age to protect them, better protect the rest of us and deny the virus a cohort for the development of viral mutations.

The SARS-CoV-2 virus has been hard at work seeking model improvements that increase its chances of long-term survival. Enter mu. In the last few weeks scientists have watched a new variant, labelled Mu, pop up in Columbia and take of on its travels. It has so far been detected in 40 countries and 49 of the states in the US. The World Health Organization (WHO) regards it as a variant of interest along with eta, iota, kappa and lambda variants. There are no data suggesting that any of these will displace delta but all need to be monitored carefully.

Noting these developments it is important to again emphasise that the gross inequity associated with the distribution of Covid vaccines is not just abetting the ravaging of the poor by COVID-19 but is also perpetuating the conditions for unfettered experimentation by the SARS virus. Less than 0.2 per cent of vaccine doses have been delivered in our poorest countries.

Things may improve if recent developments see the removal of the intellectual property rights vis a vis vaccines currently protected by manufacturers. It was gratifying to see Australia join more than 100 other countries signing onto the WHO’s campaign for this to happen.

Nationwide preparation for the restrictions that must complement vaccination

While we continue our vaccination program, with wiser and united leadership Australia would now, with a sense of urgency, be investing in a myriad of non-vaccination imperatives to maintain, and in the case off NSW, Victoria and the ACT, return to a cautious but acceptable lifestyle.

Productive, enjoyable, economically imperative freedom of movement around our nation will require all people in all states and territories to metaphorically sign a social contract wherein adherence to evidence based restrictions will maintain that freedom. Masks when one uses public transport, physical distancing indoors, spacing in public arenas, etc. The restrictions the NSW government plans to maintain after we have 70 per cent of the adult population fully vaccinated will, I believe, need to be maintained even if we have 80 per cent of adults vaccinated. But to move freely and safely around our country, the entire country must accept and maintain those restrictions.

There is some good news re better controlling this virus. Better vaccines are being developed and particularly interesting is progress with the development of vaccines that can be administered as a nasal spray. These would produce antibodies in our respiratory secretions that should stop the vaccinated from spreading the disease. Good progress is being made in the search for drugs that if given soon after infection would stop disease progression.

Our government should now be planning an economic stimulus package to address inadequate ventilation in schools and offices, a major issue for cross infection with the SARS virus. Similarly we need to plan for the near future, distribution of rapid antigen testing kits to households so that respiratory symptoms could be quickly assessed for SARS causation. This is already happening in Singapore.

Our prime minister is insisting that with 80 per cent of people over 16 vaccinated we are opening up. If that is a come what may figure we will be sentenced to the same unacceptable outcomes experienced by other countries who tried to do the same. The percentage is only important if it delivers the desired product ie our ability to control this Covid epidemic.

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Go hard, go early. But the PM prefers a go slow on key issues

Published by Anonymous (not verified) on Tue, 14/09/2021 - 4:58am in

Tags 

Health, Politics

The Treasury advice to government at the time of the Global Financial Crisis was to “go hard, go early” with counter-measures, and that has since become an accepted model when confronted with an unexpected, major, crisis.

Although applied in some areas in dealing with the COVID-19 crisis, the unwillingness of the prime minister and his ministers to follow that model in key areas has worsened our situation.

The fiscal and monetary response to the pandemic has followed the “go hard, go early” model, and succeeded in limiting the extent of the economic recession. Targeted income support measures helped to limit the distressing economic consequences for many, but not all, individuals and businesses. As the crisis has dragged on and in the latest delta wave, however, the government has been slow to extend those measures.

Such quickly designed measures do run the risk of making errors, such as compensating those not needing support – as the JobKeeper “rorts” illustrate. It also remains to be seen whether the interest rate subsidies provided to banks via the RBA’s Term Funding Facility led to lower borrowing costs for business or simply bolstered bank profits. But the errors pale compared to those of not acting quickly and adequately.

The state premiers also understood the benefits of going hard and early. Lockdowns and other restrictions on social and economic activity proved successful in suppressing the virus in the earlier stages. Unfortunately, a tougher enemy in the form of the delta variant, combined with hesitancy of the NSW premier (apparently supported by the PM) to repeat the model, and a lack of widespread vaccination has seen the approach’s efficacy diminish.

The current awful situation can be partly traced back to the failure of Prime Minister Scott Morrison to adhere to the go hard, go early model in addressing the public health issues – with one exception. That exception was the closing of the international borders – something he perhaps found easy given his past callous behaviour on his way to the leadership in the “stopping the boats” saga, and resulting in inhumane detention of refugees.

Also a failing was the casual approach to the building of new quarantine centres. Hotel quarantine clearly didn’t work well, and state premiers had to wait an inordinate amount of time for the PM to make decisions on what the federal government would support. Now, hopefully this pandemic will be suppressed before they’re usable!

But where he really failed was in not going hard and early to ensure an adequate supply of vaccines, as the recent exposure of (lack of) dealings with Pfizer have illustrated. Of course there may have been a risk of committing to purchase too much vaccine – but what a nice problem to have! Any surplus could have been provided to other, poorer, countries, bolstering our flagging reputation as a humanitarian nation.

Also a clear failure was his pronouncements that “it’s not a race” – when “go early, go hard” sounds very much like the instructions for a runner in a sprint for survival. The precise consequences of those pronouncements are hard to identify, but the slow take-up by the populace of available vaccines is consistent with them wrongly accepting that “it’s not a race”.

And then, there’s the greatest challenge of our time – dealing with climate change. Our PM apparently prefers to go late and casually. In the race for survival of our planet, “go hard, go early” is the only option – although it may be too late.

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