Dear Bellingen Shire
31 August 2020
The end of Winter. Time of sun. Beloved of bush fires.
Some quick-fire learning issues :
127 days with no Covid 19 cases in our region. The cases on the news are still in the greater Sydney area. Our Local Health District Staff continue to actively hone our preparation. The latest being how to ensure the PPE that we use works to its best protective capacity.
And this leads to a little personal comment. Sometimes institution concepts like “the Government”, “The Health Department”, “The Shire” get thrown around in our hot political debates like dirty blobs of unfeeling machinery. It is so easy to forget that all our institutions are actually us. We play a part in them by physically engaging with them, or even when we angrily attempt disengaging. The work of such institutions is done by our daughters, sons, brothers, sisters, and old school friends.
Why is this suddenly personal? Because on the news tonight was a little report that today about half of all the Covid19 infections in Victoria are Health Care workers, working in institutions or for the government, and at least 70% got their infections from work. Too many are still in ICU. This mirrors the story in Europe with thousands of health care workers amongst the mortality numbers. As many of us in GP-land are over 50, and quite a few of us tripping over 60 we are face to face with what it is like to be in the high risk group. An “existential threat”! So when seeing the other sad news bulletin of protesters marching in certain European cities arguing against pandemic action and claiming yet again it is just a mild flu, or some bizarre conspiracy to raise panic, yes, it feels personal.
3808 cases registered in NSW now and 54 succumbed. We are so far still doing very well. It is unfortunate to see cases rising in Qld like the spot fires of last summer. Again we can’t be cocky, and again, and again we have to keep telling ourselves this is a long haul. We must keep looking for strategies to sustain our carefulness for the whole community. It won’t be over this year.
Still, on the good news side – we still are not seeing ANY influenza – a great lesson on the power of not sharing germs! Our local testing clinic is only finding lots of rhinovirus – a common winter cold that is a bit heavy for some, but minor for most.
Some more good news- in the latest edition of the Medical Journal of Australia is an inspiring article on the very serious preparations that national indigenous bodies and Aboriginal Health Services have been making.
They copped the worst toll in the 2009 influenza epidemic – hospitalised at a rate 8 times the rest of the population and needing ICU at 3 times the rest of us. So they have been actively learning from that event, and from watching what is happening around the world. Careful control of access to remote communities, rapid access to testing, rapid redesign of clinics and very busy communication with their people has all been well coordinated. Given that most of us in Health feared that our First Nations people would suffer terribly if Covid19 hits their communities, it is uplifting to hear that, so far, they are also doing pretty well. In terms of coordinated responses we may end up learning more from them.
Once again I mentioned the long haul. How do we work though prolonged discomfort, in a new threatening social situation? In fact Humans have been dealing with change and threats forever. I make no claims to formal teaching qualifications. However when I worked as instructor and logistics manager for the Australian Outward Bound School (Outdoor education pioneers), we were required to study lots of educational resilience theory, from John Dewey right back to Plato and Aristotle. This arose again as a medical student when part of the course touched on the concepts of resilience and hardiness. (They might not be identical but are closely related concepts – you can look up a definition). 2 key issues recurred in modern literature and the philosophy of the ancients. Some perception of control over one’s destiny, and the power of the process of ongoing learning. There is a classic study called the White Hall Project that shows susceptibility to disease follows gradients in these parameters
With a colleague at the end of medical school we mounted a research project to see if we could trace a similar response locally, by monitoring the reported sickness of long term unemployed people in training courses and those not. The simple result was that people undergoing learning seem to get sick less. Despite the urging of our lecturer we did not publish – final year of 6 year (and 2 preschool kids) … there were a few of other priorities!
Anyway, the literature still suggests that a factor of resilience is gained by learning. Anything, everything, but to learn – do so consciously, vs tick-a-box. Right now, and again when we do have local covid19 cases requiring a local lock down again. Many of us did the Netflix thing last time – next time consider the power of learning.
Family have passed on a true story of a fellow in the capital who was living effectively alone. In January he took up a cooking class. He had never meaningfully cooked and had lived the old stereotype that it was not a man’s job. He studied well and in early July invited 4 ladies – neighbours – for what they described as a magnificent chef’s meal. He was very proud. Even learning new life skills left him empowered. He is 93.
A wise person once told me that when you stop learning is when you start to die.
On the fire front: tomorrow is back to bush fire season, as well as thunderstorm asthma season. During last year’s pall of smoke Dr Fields, the wonderful Emergency Specialist at Macksville hospital, pulled together a literature search on advice for how to deal with prolonged smoke from eucalypt forests. There is virtually none. Eucalypt smoke is not benign, containing some powerful toxins that even koalas have to limit in their ingestion. Eucalyptus oil is therapeutic in tiny amounts. The best advice she could find is to please check in with your GP, do spirometry if they suggest it, and make sure your management of asthma, bronchitis, COPD, heart disease is up to date.
Also on fire and learning, a personal confession. I admit that I had a fire incident last weekend. Did the warning, did the prep, checked the weather, mounded the stuff, then a funny little gust of wind – and spot grass fires popped up all around me. Terrifying! The wonderful Rural Fire service came to the rescue just in time. No one was harmed except a chunk of paddock and someone’s pride. Lets not forget the mighty service these people provide, while we have other distractions. Looking for a new activity?…
On reflection the process was SO like the Covid19 breakouts. This is why some leaders use the analogy in their press conferences.
So what to learn? Fire breakout is quick and all around if you are not well enough prepared. So is Covid19 infection. Keep vigilant. Know the strategies. Now is fire time, allergy/asthma time, and maybe Covid time. So take care while clever people in funny white coats, or Intensive Care staff, or Infectious Disease doctors, or staff in the Health Department and researchers, working through hundreds of current treatment trials, keep learning how to keep it out.
Dr Trevor Cheney
Please remember this is one person’s update and observation from a professional experience perspective. Please check with your own GP.