Yes, it has been a while since I wrote a post here.
The main reason is that on February 8th I got involved with campaigning against the Trans Pacific Partnership Agreement (TPPA or TPP) and I wanted to avoid ‘getting political’ in this blog. TPPA has been at the forefront of my mind for most of the last six months and this post attests to what I suspected… that it would be hard to leave it out of my writing.
But I’ve realised that ‘not getting political’ IS political! If you accept the status quo without question or comment then you’re actively supporting it. If I don’t tell you about the TPPA and how it will affect health in New Zealand then what kind of Future Focused Health is this?
The TPPA is a so-called “Free Trade Agreement.” I say ‘so-called’ because this agreement aims to lock in regulations that most of us would consider to be monopolistic; the complete opposite of what we expect ‘Free Trade’ to mean. New Zealand is in negotiations with eleven other Pacific Rim nations (Australia, Brunei, Singapore, Malaysia, Japan, Vietnam, Chile, Peru, Mexico, Canada and the USA) and this promises to be the biggest ‘trade deal’ in terms of combined GDP the world has ever seen.
So what? Well if it goes ahead there are several chapters which are going to spell some dire consequences for healthcare in New Zealand (and elsewhere). The first thing for New Zealanders to worry about as far as the health system goes is Pharmac. This is the government puchasing agency that because of its bulk buying capacity can negotiate really good deals so that we the consumer get cheaper medications. In doing so, Pharmac saves $30 million plus per year which pay for other health tests, procedures, services. Yes, Pharmac makes unpopular decisions sometimes because its budget doesn’t allow for subsidised access to some of the most expensive pharmaceuticals, and yes there is much that could be done to improve Pharmac. But that doesn’t change the fact that it is highly regarded and admired worldwide and keeps a tight rein on the cost to the country of pharmaceuticals. Hence the Pharmaceutical Industry would like to see Pharmac wither.
Big Pharma, with their bottomless pockets and high-pressure tactics, have put billions into lobbying on TPPA and are well represented in the 600 corporate advisers who have access to the negotiations. Bear in mind the people who are supposed to be represented by the negotiators (us) get no access and no information from our politicians. Most of what we know about the TPPA has been leaked. The Intellectual Property chapter was leaked and suggests patent life will be extended, meaning continued higher prices for pharmaceuticals, music, text books, movies etc. It also aims to cover medical procedures with patents, so the cost of healthcare will skyrocket. For the country, of course, but also for individuals. Expect to see more of those shortening waiting lists because people are being tipped off them “you don’t need a hip replacement anymore, we can’t afford it.” And for people in countries whose access to life-saving medications is already limited…
But that is by no means the TPPA’s only effect on public health. Have you heard about the Australian government being taken to court by Philip Morris Asia (tobacco) for plain packaging of cigarettes? This is possible because of what they call ‘Investor-State Dispute Settlement’ (ISDS) clauses in ‘Free Trade Agreements.’ This means a government can be sued in a secret offshore tribunal which is adjudicated by three lawyers whose day-jobs are working for transnationals (this is no joke!) if the complainant feels their future expected profits are going to be hurt by government legislation, such as plain packaging of cigarettes. No matter that this is a public health issue. No matter that smoking causes the country untold millions in health costs and deaths every year. And no, the government doesn’t have the same right to sue investors for costs such as these incurred by the state. We pay for those in our taxes and if the suing companies win, we pay their costs and reparations out of our taxes as well. Sound unbelievable? It’s happening all over the world right now. Funnily enough, Australia are staunchly rejecting the ISDS clause in the TPPA. These “arbitrary government actions” are known in Free Trade-land as ‘behind the border trade impediments’ and cover all aspects of life where a transnational corporation wants to sell you something. Regulations on sugary drinks? Forget it. Fast food? Haha! Environmental protection? Not if someone intends to drill, frack, mine, dredge or discharge.
So our impending diabetes epidemic will definitely be helped along by the TPPA, and when we need dialysis and transplants, we’ll have to pay for that through our noses, wishing we’d smelt the rat in the first place.
To find out more about the TPPA and its effects on health, visit
I have been pondering this topic for some time now. I don’t believe that we can address the inadequacies of the health system without also addressing poverty and housing issues, access to education and good food. All of these things are very much inter-related – hence the reason why Timebanking has so much to offer the health system.
As I write this, I have $140 to my name; total. $100 of this is in the shape of a cheque I received for Christmas from my Gran (thanks Gran!!) Yesterday I had to ask her to sign ‘please pay cash’ on the back so that I can pay my rent this week. My phone and credit card bills are overdue, and I’ve just got a $905 bill for (darn it!!!) scraping an Audi in a carpark after a night-shift – not insured, can’t afford it. Happily, and surprisingly, I’m not feeling too stressed out about my financial situation, although it is as dire as it has ever been!! But I’ve also run out of prescription meds and I can’t afford to see the doctor right now.
Lucky for me, not only will I be paid next week, but I live with friends who won’t see me starve. I have great support from my family and I know I am safe from destitution. Not only that, but I have no one else dependent on me and I own my own house(bus). It makes a big difference to know there is a limit to how bad it can get. But not everyone is so lucky, and for some, this is a constant state of affairs, through no fault of their own.
Imagine doctors visits are a luxury you can’t afford (not such a great leap for me right now!), the chances are you also have to buy the cheapest, most processed and nutrition-less food, and your house is damp and cold in winter. When you or one of your family gets sick, what do you do? I wouldn’t be the only ambulance officer to have ever asked someone in this position “Have you seen your doctor?” when the chest infection which could have been sorted by an early doctor’s visit now requires hospital care.
Timebanking can address these issues in multiple ways. Money can be saved by using the services of other Timebanking members; healthy food/vegetable co-ops are often one of the first off-shoots of local Timebanks in collaboration with Community Gardens; exercise and nutrition groups frequently spring up as well; gardening services and learning to grow your own food are easy through Timebanks; improvements to housing has been achieved with Timebanks; and where medical clinics have collaborated with Timebanking, health and access to healthcare has been improved.
The Rushey Green Medical Centre was the first in the UK to use Timebanking as part of its efforts to improve the health of the local community. Read more about what the Rushey Gree Timebank has achieved here: http://www.cihm.leeds.ac.uk/new/wp-content/uploads/2009/05/Rushey-Green-Time-Bank.pdf and here: http://timebanks.org/wp-content/uploads/2014/01/KeepingtheGPAway.pdf
According to Lou Reed, that’s what life’s like, without you. Yesterday Lou Reed left us. And so did Patrick, the husband of a very dear friend of mine. I had an odd day today, it could have been a Perfect Day, in many ways, were it not for the news about Pat. I hooked into building the chicken run, it was lovely and warm but not too hot, good friends, good food, and our ewe nearly had her lambs. Late, I know, it wasn’t planned, maybe they’ll come tomorrow…and that’s what life’s like, hey Lou? A mayonnaise soda.
I often head for lyrics. I used to write them out, listen over and over again to get them all, my cathartic process. I have a few scrawly hand-written pages tucked away. It was of course Lou Reed providing the soundtrack today ; ‘What’s Good’ over and over and ‘Fly Into The Sun’ (both worth a listen if you don’t know them – youtube!) So earbuds in, I ruthlessly slashed and chopped at bamboo to make the fence for the chicken’s new run.
It’s almost a year since I made the drop-everything-and-go dash to the funeral of another dear friend. And two more close friends have died within the last five years. I had a good bawl over the bamboo as they all came back to me. It’s what makes funerals such a uniting time, I guess, the commonality of our grief. It seems crazy to have had four contemporaries die of medical causes at my very spring-chickeny-type age. To give you a clue, a couple of mates were killed in skiing accidents when I was in my twenties. That wasn’t the clue. Here’s the clue; that was twenty years ago. It’s young, don’t you think? To have friends dying of cancer and diabetes and heart conditions?
And I look at all of them and I wonder if anything could have been done… if anything would have changed the outcomes? And I’m not sure. I’m really not sure. I watched a documentary the other night about a young (my age-ish) mother with terminal breast cancer. She bravely admitted that she became a bit complacent with her treatment and the relentless monitoring for changes, which probably led directly to it becoming inoperable. And I know that more than one of my friends could have fallen into that category. But it must be so hard, so tiring, such a godawful drag, the continual vigilance and management of a recurring or chronic
condition. They say the cure’s worse than the disease with some of those things, hey?
I don’t have any answers, particularly. I do have ideas, but they can be so easy to spout, and they sound great… but there are such deep-rooted changes that need to occur; deep in our very psyches.
I don’t know. All I know is I wish that Adrian and Kelly and Mark and Patrick were all still here.
But not fair at all.
So I was chatting to someone in the ambulance bay yesterday and I realise there may be a few things that are not abundantly obvious that I probably need to make that way.
To all busy full-time ambulance officers:
you are not the people I am thinking of when I suggest Timebanking. That’s not to say you can’t join a Timebank, of course, but this plan is not specifically designed with you in mind. Sorry.
Except that I hope this will make a difference to you in the future in terms of work load. I am thinking of you when I am thinking of creating management plans for those frequent, inappropriate ambulance users which will address the root causes of their repeat calls.
Addressing inappropriate use of service
When St John, GPs and Timebanks can all work together to pull isolated people back into their communities by utilising their skills, those people may have less need to call an ambulance for their social interaction. You know what I’m talking about… you may not want a hand crocheted scarf yourself, but I’m sure you’d think it was great if the person who could make you that scarf started teaching the skill to young kids who wanted to learn to crochet… for example, and stopped calling the ambulance every week because now she has purpose in her life and distraction and social interaction.
Taking the stress off St. John
There are lots of our jobs where Timebanking could help relieve the stress on our resources. It isn’t necessarily short term stuff, but with the growing future issues – you know the list; aging population, increasing expectations, increase in chronic illnesses and so on – we have to start implementing some long-term strategies. Timebanking can help with education and transferring knowledge to communities. We could pay people in time credits to attend first aid courses and healthy living courses and courses specifically for living with particular chronic illnesses. Yes, I know we make money that we need to run operations from delivery of first aid courses, but the cost of them excludes a whole section of society from gaining those skills, and if we have a goal to have a trained first aider in every home (we do) then we have to find ways to deliver that training so that people can afford it. Otherwise we perpetuate the inequalities in health care delivery. (See Peter Bradley’s blog on The Hub “An Envelope For Every Occasion” October 4th 2013)
So when I envisage this project for St John members, it is busy full-time working parents who are also volunteer ambulance officers I am mainly thinking about. So that they can actually gain time with the hours they already put in. I’ll explain how this doubles and can even triple the value of what they do (which is real cool maths that I like, and I don’t say that everyday about maths) in another blog ….
There are already 30 Timebanks in NZ and more popping up all over the place. There’s a new one in Nelson and a new one in Queenstown. So there is plenty of scope for hooking up St John volunteers in various parts of the country with their local Timebanks. It’s not available everywhere and hence not for all volunteers yet but with St John endorsement I reckon funding for Timebanks will be much more forthcoming while understanding of what they are and what they can do will spread like wildfire and within the next couple of years there will be a fairly consistent coverage throughout the country. That’s my prediction.
When I first connected the idea of Timebanking and St John Ambulance in my head, it was like a lightening strike and I have to admit, I do assume that everyone will experience it like I did. But no. So it took me quite a while to realise that even after I thought I had explained things in perfect detail, the ins and outs were not completely obvious, and to be fair, I have been consumed with this for nearly two years!
So to fill in a bit more detail, here is how I see it actually running from here…
The implementation process for this project is a long-term strategy. It would start in the places where Timebanks already exist as the plan is to link St John with local Timebanks, not to start or operate any Timebanks ourselves.
Timebanking is new in New Zealand, most people that I speak to about it have never heard of it. Our Timebanks are in varying states of development, and it is currently very difficult to get funding for Timebank co-ordinators. Although many Timebanks manage to run on nothing, like everything else they need resources, and full-time co-ordinators get a Timebank up and running quicker and more effectively than without. So while we do have about 30 Timebanks in varying stages of operation across the two islands, relationships between them and their local St John Area Committees will take time and energy to initiate and build.
I see this happening with personal presentations to the Area Committees, volunteers and paid staff in each locality where a Timebank is already operating. Discussions and explanations about the ways in which Timebanking can advance the goals of the St John strategic vision, give service back to volunteers and even reduce our workload will help our people decide if they want to become a Timebank member.
In Lyttelton, the relationship with St John and the Timebank has begun, but this first one, and all the rest will need to be looked after in order to grow. Volunteers will need to hear about and understand how it can work not just for them and their families, but for the community and their patients as well. As stories emerge about things that have happened through Timebanking, they need to be shared, so that others get the hang of the possibilities. And where frustrations arise they will need to be addressed, reflected upon, solutions found and actioned.
The Timebanks in Dunedin, Wanaka, Queenstown, Gore, Christchurch and Nelson will already provide plenty to do in building and nurturing those relationships, but with St John Ambulance acting as a champion for the philosophy of Timebanking, momentum will gather and funding will be more forthcoming for Timebanks in a virtuous cycle as they proliferate.
And then the real magic happens. When Timebanking becomes a household name partnerships between St John, GPs, and Timebanks will foster the community support needed for people living with chronic illness; our old folk living independently in their homes; or those recovering from illness or injury.
The goal of this project is to make a serious difference to the ambulance workload in places like Auckland and to address the crisis facing the health system by providing solutions at ‘the top of the cliff’. Timebanking gives us unlimited opportunities to do that, and a brilliant example is in Lower Hutt, where the local Timebank decided to provide five home-cooked meals a week to the very young women and their children at a school for teenage mums. The availability of healthy food in early development has lifetime effects, so you can imagine that this one beautiful project is having long-lasting benefits for them and cost-benefits for our health system.
And this is just the start. Health is only one area where Timebanking can be a worthwhile tool – education, youth justice, housing, emergency planning and management are the areas in which Timebanking has a proven record…but the full list is as long as your imagination.
Timebanking is a tool that knits communities together, and tighter communities have less crime, better health and more fun than fractured ones.
It’s really easy to generalise about people and like others, I have been guilty of doing this about our patients.
When I talk about this idea of initiating collaboration between St John Ambulance and Timebanking, in order to help people understand my vision, I quite often say that we have ‘lots of’ patients who call us because they are lonely. This is something that people can understand and there is a bit of a stereotype about ambulance crews going round just to make cups of tea for people! While it does happen, there are all sorts of reasons why Timebanking could be of benefit to our patients, and many, many patients that I am thinking of when I am spouting off about this plan.
People who are recovering from illness or injury could benefit from Timebanking, even those with lots of friends and family support. Sometimes it is the friends and family who may need the Timebanking support! When you suddenly have to look after someone who can no longer do things for themselves, even short-term, the pressure can be palpable. Being able to call on someone in your community to cook a meal, or take the kids to rugby practice or whatever can be an immense relief.
Having suffered with depression for many years myself, I know that isolation can be both an ease and an aggravation to the illness. But getting out and doing stuff, particularly helping others is pretty much always a balm. When mental illness is really bad, it can be hard to hold down a ‘proper’ job, but if you end up on a sickness benefit, sometimes the way out becomes more and more difficult when there is less that you have to do. It can be a very vicious cycle. Timebanking allows people suffering from mental illness to build up their contributions to others at a rate that fuels their recovery without burning out. It feeds the soul by building confidence, connections and a sense of belonging and being needed. Stretching out into the community widens the experience of both of the trading parties, and can lead to new support and friendships.
Our elderly people often feel more secure when they know more people in their community. Of the people who ‘call the ambulance because they are lonely’ I think elderly women would be most likely to fall into that category. My mum and grandmother grew up in a time when women had really only one choice – motherhood and homekeeping. They have lived through vast societal changes and now these generations of women can find themselves widowed and with their children and grandchildren spread all over the world. Who wouldn’t feel lonely?! But if their enormous array of skills and experience was tapped into by the community, their sense of purpo
se and usefulness would return, as would important endangered arts like knitting and mending and preserving.
Timebanking offers a cost-effective method to implement ‘buddy’ schemes for people living with chronic illness. Self-management of chronic illness can be difficult even with the right education. Support from a fellow sufferer can make all the difference and good self-management has been shown to reduce ambulance call-outs and hospital admissions.
People whose calls to the ambulance are frequent and inappropriate are usually those who suffer most from social isolation. Management plans can be enacted by GPs and ambulance, but it doesn’t really get to the core of the problem. Timebanking does. It acknowledges that all people have skills and can be assets to their community. Providing the conduit to be that asset pulls people into their communities. I remember placing my stethoscope on a woman’s back to listen to her lungs and thinking… ‘I bet this is the only human touch she has had since the last ambulance came…’ People need people. With Timebanking we can start to crochet our communities back together.
This is to give you an idea of the scope of Timebanking in enhancing health and well-being in our communities. It’s just a snippet, because the scope is enormous and when other people’s imaginations are added into the mix it just gets bigger. There isn’t a day that goes by when I am on-road that I don’t encounter someone who I think… ‘now there’s a likely Timebanking candidate…’ What I hope to see in the not-too-distant future, is me passing that on to the next Health Care Provider or the patient’s GP who will start the conversation with the patient; no one will have not heard of Timebanking; and we will turn the corner from our Sickcare system into Health & Care Street!
Have you heard of a thing called Timebanking? I have been working on an idea for St John to partner with Timebanks in New Zealand for the last couple of years as I believe it would have amazing benefits for us in St John for many reasons.
Tonight I went to Lyttelton and together with Wendy Everingham from the Lyttelton Timebank, we convinced the Lyttelton St John Area Committee to join the Timebank. This will mean volunteers who chose to join their local Timebank (Lyttelton or any other) will be able to have their hours aknowledged and ‘reimbursed’ in time credits. This is the first Area Committee in New Zealand to join a Timebank, so we have the ball rolling!!
It takes a while to understand the possibilities of Timebanking, especially when related to something like St John Ambulance. Although the ideas and concepts themselves are quite easy to grasp, there seems to be a psychological leap required to ‘get’ it. And because the possibilities are literally endless – limited only by peoples’ imaginations -it is hard to fully explain. But once people start to ‘get’ it a little bit, they can at least see that there are no downsides. The only downside is trying to clearly impart all of the upsides!
So Lyttelton St John Area Committee will be able to earn credits by renting out their rooms, giving first aid training (for which they can also pay people credits to attend), sharing health knowledge with the community and whatever other ideas they may come up with. (The local kindergarten earns time credits from the children drawing pictures which get used as wrapping paper and cards – so when we say possibilities are endless, it’s because they really are!) But it must be remembered that ledgers don’t have to balance with time credits. If the Area Committee ‘pays’ out more hours than they earn, it really doesn’t matter, the ‘debt’ in time is not the same as a money debt. But it is better that there is a circular nature to the transaction. Before tonight, the two Lyttelton St John volunteers who had joined the Timebank were being paid time credits from the community chest. By being an organisational member, the Area Committee aknowledges those hours very deliberately themselves (although there is no need for extra paperwork – the volunteers will make the transaction themselves online) and they can also more closely engage with their local community. There become more ways that the community can give back to St John whilst not necessarily becoming a member of St John. And if the first two Timebanking volunteers became St John volunteers because of the incentive of earning time credits (as they apparently did) then the chances are that others will be encouraged to become volunteers because of it, too.
I search and read and watch a lot of cool stuff on this topic nowadays and I’ve just realised that this is the place to store it all. (sorry, I haven’t figured out how to do the neat and tidy hyperlinks that are the words in your sentence yet… room to improve for sure!)
I frequently confront self-doubt, especially because this vision is so expansive and relatively left-field (especially for the health system) and I am so seemingly underqualified in this arena but the things that I am reading and watching everyday – inspirational, clever, driven people, who see it the way I do – often make me pick back up and keep on going.
This is Rebecca E. Onie http://healthleadsusa.org/video/rebecca-onie-tedmed/ speaking at TEDMED, she is an amazing woman who has set up an organisation called Health Leads which helps patients sort out the ‘upstream’ problems that are causing their illnesses. She’s got volunteer college students to advocate for these patients so they can get their heating turned back on, or get food, or get the mould irradicated from their damp appartments.
And I got on to Health Leads, after reading this http://blog.ted.com/2013/06/05/investigating-the-root-causes-of-the-global-health-crisis-paul-farmer-on-the-upstream-doctors/ Paul Farmer’s review of what sounds like a very good book called The Upstream Doctors by Dr. Rishi Manchanda. They are talking about social medicine. Social Medicine. So it has a name!
Otago University teach a course in Preventive & Social Medicine.
The other guy I’ve just watched on TED is Eric Dishman http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html and http://www.ted.com/talks/eric_dishman_health_care_should_be_a_team_sport.html both very good talks. He’s a great speaker and a very clever man with great ideas. And like all of them, he is saying unequivocally; our system of ‘health’care is completely broken and outdated. We must change it.
I don’t necessarily think it is the job of ambulance to change it, but if we can help to move it in the right direction, then shouldn’t we do that? And we do all need to get involved and engaged, we can’t keep waiting for someone else to do it for us.
I’ve just been writing a submission to the EPA against the proposed black sands mining on the Taranaki Bight, so this is on my mind:
I think we are trapped in a world-view that encourages us to not care about the environment or people by adhering to the idea that money will save everything. We are forced to pit the economy against the environment as if they are two beings battling for supremacy. We are often shown the Venn Diagram of ‘sustainability’ which shows sustainability as sitting where the economy, environment and society intersect. A nice little green niche which some can occupy if they wish.
But sustainability isn’t like this at all. This diagram suggests that the economy and society live completely outside and independent of the environment. It treats the economy as if it is equally important to the other two, rather than as a tool designed to serve society. The economy doesn’t exist without human society, in the same way that human society cannot exist without the environment.
But this is the view through which we interpret our world at the moment. And this view allows us to play off the needs of society and the environment with the ‘needs’ of the economy. We believe what we are told about economic growth being vital so that money will ‘trickle down’ to the most deprived in society and that the more we make, the more there will be for us to spend on ‘protecting the environment’.
However, money doesn’t follow the laws of nature. Its tendency is not to ‘trickle down’ but to ‘flood up’ to those for whom this view suits best. So when I think about the mining of black sands on the North Island’s West Coast, or deep-sea oil drilling in New Zealand’s waters, I am sure that the economic argument of how much we have to gain is fundamentally flawed.
I hesitate to liken the exploitation of the natural environment to rape – I have never been raped and I don’t imagine I have any capacity to really understand how that could feel – but from the perspective I have of current events, I feel that the Police attitude towards the young victims of the ‘Roast Busters’ was not dissimilar to our regard of our natural resources – if it’s going to go flaunting all that beautiful stuff, what do you expect?
This world-view allows us the capacity to care less about people and planet than about other peoples’ money. Which relates directly back to the health system. Caring for people is not a huge profit making exercise (unless it’s the wealthy elderly) so we have had to manipulate it to suit the economic system. We have created this ‘Fee-For-Service’ model which concentrates on sickness rather than health, turning treatments into commodities and patients into consumers. Hence you better be a fast-talker cos your GP only has seven and a half minutes to spend with you.
But the demands on the health system are becoming too great to bear. This world-view encourages all sorts of health-depleting behaviours (the cheapest food is the most nutritionless, working longer and longer hours etc) and a nonchalant attitude towards the health of the environment so its easy to see why so many people take such little responsibility for their own health.
A better, more realistic view is that the economy is totally dependent on society and the environment. Degrading either of these two reduces our potential for long-term economic output and enhancing them raises that potential. Environmental and societal health should be at the top of our agenda, because a healthy society reduces all sorts of other costs to us; of course health system costs, but even crime, civic care, education and more. The way this looks in a Venn diagram is like this. The economy is our servant, not the other way around.