I attended a community meeting called to discuss a spate of vandalism at a car park and found myself in an episode of The Simpsons or a Brecht skit on Mussolini’s Italy. A local cop, all taser and trimmed moustache and shaving rash had been rapidly tapping the table with his notebook to show how busy he was before he suddenly pronounced that the police were now focused on catching baddies rather than hugging them. That was the directive and he was putting it into effect. Catching baddies is the thing, he repeated. Don’t worry, we’re onto them. The DOC guys looked like bush fairies and simply said they had no money to do anything. The council reps smiled a lot. The meeting of course, resolved nothing. A culture of totalitarianism has appeared, with bureaucrats competing to put the orders from above into practice. One of the main orders is to cut costs (I’ve heard they’re going through contracts to providers line by line). Another is to catch baddies and jail them. Another is for teachers to focus on essentials. Another is to give the unions a kick in the balls. It’s all about violence.
And then I had a further episode of a cold turning into ‘walking pneumonia’ so needed some antibiotics, which involved negotiating the local health system. Rumour had it that it was taking a month to see a GP, who are clogged up tending to the chronically ill (those with ongoing issues and ongoing medication), so I steeled myself for a visit to A&E as an acute walk in.
When the new local hospital Te Nikau was being designed we were promised a seamless service with the main local medical centre moving there, the pharmacy opening a branch, and then you’d have A&E, before you get to the wards. So, you go to the GP, she deals with you, if you need medication you can get it and go home. Or, if things are more serious and you need x rays or blood tests, you may advance to the A&E section, where these services are located and then, if you are seen as in need of secondary care it will begin to happen, with maybe you ending up in a ward. Meanwhile of course, ambulance patients enter via A&E but could, in fact be sent off to a GP if that is really the level of service required. It was sensible and aspirational, emulating what happens in a place like Poland or Cuba.
What has happened instead is that the GP practice (who are always short staffed) is overwhelmed with tending to chronic patients. Hence the 4 weeks wait. As well, it’s hard to find doctors. So that section becomes isolated and absorbed in its own crises.
The seamless concept has been transferred to the A&E section of the hospital which accepts walk ins. There are GPs there (usually locums), working from rooms attached to the waiting area. You are triaged and wait for however long it takes (at least put aside a morning). Eventually I saw a nurse practitioner who insisted on a chest x ray and blood tests. This meant entering through the portal to the A&E section. Eventually an X ray technician arrived (he didn’t seem very busy) and then an interminable wait for a blood test. There was only one patient and the staff seemed to be mooching along very comfortably and uninterested in anything much, despite prompting, so I went back to the triage desk and said I had to go. They protested that it was very busy in A&E – I suspect this is always the excuse. I explained that I just wanted a prescription for some bloody antibiotics, last time I’d done a tele call and the whole thing was over in 5 minutes. There were placatory noises and pleas to wait a little longer.
And then the shift changed and the nurses from Kerala arrived : gracious, very efficient, a blood test done in a moment, a swab, a bag of fluid to bring down my temperature, and then an antibiotic to take, and a script sent to the pharmacy for picking up. Now, you can go home. No cost for treatment or medication. With a few more GPs and a greater praxis it would be an efficient service.
But what about the GPs and the medical centre, with the four week waiting list? If there were continuity of care it may be worth it, but there isn’t. Nor do they keep an eye on people. At my age an annual check-up should be mandatory but I’ve never been contacted. I’ve got an optometrist request for a specialist opinion that I suspect will never be processed. And then there’s the Primary Health Organisation. What do they do? I’ve never come across them nor have I been aware of them in the local community.
I can see how the original model could have worked well, but it would require a greater number of committed GPS (rather than locums). We’ve got our nurses from Kerala, let’s bring in some doctors from Cuba.
Moving up the ladder (just a little), there’s the extraordinary interview with President Biden, arranged to reassure the public after his debacle in the first presidential debate. https://www.youtube.com/watch?v=0kpibhlagG0
The rest home candidate, after a few minutes of stuttering becomes animated when he talks about taking on Putin and expanding NATO and confronting China in the South, of capturing the production of semi conductors and of ‘running the world’ – for the US must remain the eminent power. And he’s the scout leader to do it. The nakedness of power is on show. It is an extraordinarily clear example of Hannah Arendt’s wonderfully apt description of ‘the banality of evil’. So, the American people have the choice between a cantankerous, self absorbed, cognitively compromised ‘Emperor’ and the unashamed criminal, Trump.
Before watching this I had caught an interview with the President of Grenada, a humble, erudite, civilised man obviously devoted to his community, lamenting the destruction caused by the recent early hurricane and the failure of the rich nations to address climate change. The poor, island nations are at the forefront. But where is the urgency? He was a despairing, tragic figure.
At a recent workshop at Kotuku the young climate action people there stressed their feeling of urgency in terms of the global order and their willingness to take direct action. It was obviously a visceral feeling and I understood the feeling.
It really is time to withdraw from the Empire.


