Weekly Update from the Bellingen Covid-19 Clinic: Dr Trevor Cheney

By September 21, 2020 In Focus, Other News 6 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire

21 September 2020

 

Sitting on a warm veranda in Gleniffer, it is the time of the firefly. It is also the time of the brooding bumbling thunderstorm – almost.   How often do we really take the time out to marvel at the wonder of these cycles of beauty? Cycles known and of great importance to the Gumbanyggirr people before and their ilk all over the continent. Cycles of vitality and survival. Rituals so easily drowned in the noise of “normal” modern living to which we are so desperate to return.

I must confess I did not find the time last year as we were already dry, under threat of fire, and seeing the air start to turn to 3 months of toxic soup.

I’m not sure when fireflies come out in Dorrigo, but I would expect that little miracle is also available to folk in Bellingen town and Urunga now, if you stop and look, and sigh.

It is also a marvel to hear Victoria’s Covid19 new case numbers down to only 11 today. As various media folk stack on and abuse the Victorian Govt it is helpful to recognise that the suffering in lockdown of our Victorian family has actually protected all of us! We should be ever grateful about how they have taken the hit and the restrictions so that the quarantine breakout has not (thus far) spread to everywhere else – including the gentle green Bellingen Shire. And they have done so with their health staff still struggling to get the PPE needed, to get the fitting of masks optimised, and with 80% of roughly 3500 health care workers also getting sick at work. Some needed intensive care.

Happily our local hospital management and health district have been actively rolling out education and mask fitting trials with staff for weeks.

We are still a bubble within a bubble.

And we still have no cases of Covid19 in the Mid North Coast.

It was so hard tonight listening to a certain radio presenter (who once was in parliament) raving on about impatience about the Vic/NSW/SA borders being closed, that we’re a federation and should be moving freely and not have State governments making decisions about the health and safety of their people!! As actual professional, professorial, economists keep telling us – the economy is very jaundiced when everyone gets sick. There is no economy if there is no health. There is no dichotomy of economy vs health.

Well, within NSW there will be lots of people moving freely from this weekend. A reminder for those who no longer have the delightful noise and chaos and smells of school kids in the house, the school holidays start this weekend and a lot of people will be desperate to get out of urban areas.

Overseas is out.

Rural wonderland is in.

So, please still be a bit careful, while welcoming visitors to our lovely Shire. Remember, and remind them, that distancing, hand sanitizing, and (in crowded spaces) masking are still really cool and desirable personal attributes.

We are still in the middle of the pandemic and fatigue with talking or thinking about it does not make that go away.

A quick glance outward before touching on a difficult topic.

Australia now has had >26500 Covid19 cases and 810 fatalities. I believe our numbers are reliable. Ironically, because we have been very lucky, there is minimal bureaucratic incentive here to down play or hide statistics. Hard to know what is happening in reliability in other countries of similar living standards as governments may stand or fall on their country’s results.

We have had roughly 31 fatalities per million population – this is a helpful benchmark to compare relative strategies. In one of my medical mags there is an Australian Doc living in Sweden who, with a group of Nordic colleagues, is outraged at the outcomes in that beautiful country and the fact that spin is now being put on their figures. Once again they have a population similar in size to NSW and a good advanced health system but did not have an aggressive strategy for Covid19. I understand they did not consciously seek to pursue “herd immunity” but that is how it has been labelled.

NSW has had just over 4000 cases and 55 fatalities. Sweden has now had >86000 cases and >5800 fatalities.   Sweden, USA, UK, Spain, Italy, Brazil have all had around 600 fatalities per million, so far! I am happy to suspend some freedoms till we have good treatments and well tested vaccines!!

On a rather different topic I would like to again warn about scamming. I have had some time off this month and consequently been at home a bit. I am astounded at the number of scam like calls we get – and this is a silent number!!

One was even a computer voice telling me that I was subject to a federal crime investigation and “just call the investigators on this number”. Please think through a strategy about how you will deal with unexpected and suspicious calls, and please talk with your older, less tech savvy relatives who grew up in a time when telephones were places of good manners and to some extent trustworthy tools.

Some scammers just want to lead you to say some critical words like “yes”, “go ahead”, etc to replay and impersonate you on voice recognition government or business websites. They hang up when you ask who they are.

Now the difficult topic. Maybe now is a good time as the risk is low and it doesn’t seem quite as morbid.

In the hospital system our health department has reminded us of the relatively low frequency of “living will” documents.

As we age (ie over 30), there are 4 documents that are really, really important.

Everyone knows you should have a will – to determine what you wish to happen to your possessions and maybe other stuff, should you die –expectedly or otherwise.

There is also a document called Power of Attorney. This is really important if you have an injury or illness and are unable to deal with critical business or life issues – the trusted person you appoint can pay your bills etc.

Then we strongly advocate nominating an Enduring Guardian. This is not the same as power of attorney although you might nominate the same person to be both. Again a trusted person who knows you well and knows your wishes if you should be unwell and unable to communicate with someone like me. Remember I only have a right to give you treatment with your expressed consent or in an emergency. If it’s not an emergency, and especially if one is incurably ill, then we need someone to give, or withdraw, consent for medical treatment.

And then there is the Advanced Care Directive. Some people call this “Living Will”. It is a personal document in which you specify what your living values are and, in the event of a seriously life threatening illness, how much you want to be treated.

This came about when patient groups challenged the status quo that we as doctors and nurses go to any lengths to save lives and resuscitate all comers. Some people with already terminal illnesses, advanced age, and the like actually don’t want saving, especially if it means living in body but not mind. So there has been a 2 decade campaign to reset our medical attitudes, to allow people to have a say, now that we are all living longer. Much of the campaign has been led by a local Coffs Harbour academic.

So, in this time of pandemic where we will work hard to save lives in the hospital, we also really want you to think about these 4 documents and discuss them with your family, and be confident in the trust you place on the person or persons to speak for you if something happens and you can’t speak for yourself. It is vital that all members of your family are aware of your wishes. I have seen terrible conflicts erupt in a hospital setting – especially if there is a prodigal son or daughter – when everyone is stressed or upset or frightened.

Please discuss this with your GP and your lawyer. In fact your wishes are respected in Hospital.

These documents are relevant to everyone – esp over 30, and should be updated regularly as life changes. For example we no longer have dependent kids. They are adults and quite capable of making their decisions, and some for us if needed. So our documents from 10 years ago are well out of date. Of course the pandemic, and being on the front line, and over 60, now sharpens ones mind to survival issues!!

Stay safe, enjoy spring, have a fire plan and set it up, keep your masks clean.

And of course remember all the above is one opinion, so check anything with your own GP.

 

Dr Trevor Cheney

 

 

6 Comments

  • WITH TESTING ALREADY HAPPENING IT WOULD BE ADVANTAGEOUS TO SIMULTANEOUSLY TEST FOR VITAMIN D3 & IODINE LEVELS TO SEE WHO MIGHT BE IMMUNOCOMPROMISED…

    dr. mark borsuk
    APPROPRIATEHEALTH.COM.AU

  • Jaki says:

    Thanks again Trevor for leading the charge in keeping us informed and safe. Sad that Victoria’s strategists are so hounded and the important message can get so lost: the Victorians proved it – the restrictions WORK!
    And so sobering to read of your colleagues in Sweden. Thanks to all for your ongoing vigilance and encouragement to support the community’s health and welfare.

  • Leigh Emery says:

    So good to read news and opinion from one of our local medical professionals who is really ‘on the front line’ with Covid-19. We are so lucky in a small place like Bellingen to have such a great hospital and so many dedicated, caring and efficient doctors, nurses and allied health workers in the shire. They are much appreciated. Get really sick or go to ED and you’ll find out why

  • Libby Park says:

    Thank you Trevor for speaking in such a positive and supportive way about the strategy that Victoria has had in place to manage their COVID outbreak. I have been very distressed to see all the political mileage that our political leaders have been attempting to gain. We should be very grateful to the Victorians for the leadership they have shown and their determination to stick to their plan despite criticism and pressure.

  • Joseedemooy says:

    Thank you Trevor for this uplifting writing. I am great full that you bring up the conversation of the will, ACD, Enduring Guardianship, this is a important conversation and people need to think and discuss it. I have organised all this, at the surprise of my GP, who mentioned he was impressed with my thoughts and actions. He actually said that I was a bit young (63 then) to do it. I feel like you, everybody should have it organised, we all are going to die, we just don’t know how and when. In the meantime enjoying life and nature around us, especially in our area, we can count our blessings. Stay safe and thank you again for this writing. Cheers Josée

  • John May says:

    Thanks again, Trevor….

    …..how lucky we are that you, and all who support you, live here

    I absolutely agree with your observations about Victoria and the Victorians! – we all owe them so much….the abuse and harassment they have had to endure is shocking and unconscionable

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