Monthly Archives: April 2015

We’re a first world country . . . right?

Today’s news comes courtesy of SunLive, a local Bay of Plenty news service. I’m not sure if any major news services have picked it up, and if they have there hasn’t been much of a fuss made. It’s just that the government has decided that small town New Zealanders don’t have the right to clean water.

Oh, it’s not put like that, of course. It’s just the downsizing and eventual winding up of the Drinking Water Subsidy Scheme, which doesn’t sound like such a big deal really. Well, I guess it’s not, if you don’t live in one of the affected communities.

This means that there are small-town schools where kids can’t drink from a drinking fountain because the town water supply isn’t safe to drink and needs boiling before use. Maybe that’s not third-world – after all, the water at least looks clear most of the time – but it’s not good enough for a country that prides itself on being able to stand amongst the best in development.

The scheme subsidised towns with populations of less than 5,000 to bring their drinking water up to scratch. By the end of June all water supplies serving more than 100 people need to comply with the clean drinking water legislation, but in reality, it’s not happening fast enough and taking this funding away perpetuates the problem of poor quality drinking water for many poorer communities who cannot afford to upgrade their water to the legal standard.

We should not even be discussing the problem of undrinkable water in New Zealand. Between being ‘clean and green’ and being a developed, ‘first world’ country, it should just not even be a topic that needs to be tabled. Clean water is a minimum standard that every New Zealander is entitled to, and the government needs to step up to the plate and make this a reality. Every kid should be able to get in trouble for drinking straight out of the tap not because it might make them sick, but because that’s not what good children do!

Pride in never having been on the dole

New Zealanders have this odd fascination for saying “I was poor and struggling but I never took government handouts” with this glow of pride that says ‘I’m better than all those scum that take the dole when they’re broke’. It’s a shitty attitude, and it needs to stop.

People that are on government assistance come from all walks of life. They’re proud factory workers who have lost their jobs in hard economic times when everyone is ‘downsizing’ and have three kids and a mortgage to pay off. Are they lesser people for taking the social security that they have paid taxes to fund all their lives, the social security that is there for exactly this scenario? I would not put myself above those people if I had never been on a benefit.

They can be people who are chronically ill or disabled and unable to work. The security net is there for them as well, and they should not be shamed for using it. The way we treat our vulnerable members defines who we are as a society.

They can be people who have caught a temporary illness like campylobacteriosis which forces them off their food-handling job due to health regulations. Passing things like that on is nasty for all involved, and so they are simply not permitted to do the job that has been supporting them, so they’re on a sickness benefit until medically cleared. They have a job. They can’t do it. Does this make them lesser people?

There are many scenarios. The ones people really mean, though, is ‘long-term beneficiaries’ and sole parents. To be blunt, ‘long term beneficiaries’ is a group that’s vanishingly small – less than 0.1% of unemployment and sole parent beneficiaries are supported by the government for ten years or more. Less than three percent are on it for more than five. Those are small numbers, and judging the majority of beneficiaries by these few is unfair. It doesn’t matter that you know people that have never worked and have no intention to. The data says that they are an anomaly, not the norm.

Judging sole parents for taking the support meant for them is garbage. It’s really bloody hard to raise kids in an environment of few jobs and low pay, with few benefits like childcare included in any employment package. 71% of solo mothers have no more than a secondary education, with more than 30% having no qualifications at all. Jobs that including flexibility for mothers are generally those on the more-qualifications-needed end of the job scale, and realistically affording child care requires the more-qualifications-needed end of the pay scale. Childcare subsidies just aren’t enough when you’re on a minimum wage job and raising children.

Being proud of struggling along without using the social safety net means that you think you’re better than those who do use it, and that’s not something I would be proud of. Doing it hard but without help may be an achievement, but lording it over those who can’t or don’t is misguided.

Making good food choices

One of the themes that I’ve seen in the Ministry of Health literature that I’ve been looking at is the idea of healthy eating. It’s always framed as a choice – making good food choices for yourself and your family prevents obesity, protects their oral health, and promotes a healthy lifestyle. So why would anyone not make ‘good food choices’?

Shall we talk about how expensive it is? Fatty mince can be picked up for $8 a kilo – good lean mince can be up to $14. Chicken wings and drumsticks are much cheaper than lower-fat breast, and fatty chops are cheaper than steak. A good quality sausage will set you back $13/kilo, while crappy precooked horrors are less than $8. Just looking at meat, ‘good food choices’ are expensive, at out of reach for struggling families.

Spuds and onions are cheap, but peppers and tomatoes and greens can be very expensive. Eating a wide variety of vegetables just isn’t practical. Apples are often cheap enough, but that’s not a great variety on the fruit front. Maybe oranges for a change? If they’re in season, that is.

Milk is expensive, but coke is cheap. Cheese is expensive, but chips are cheap. Lean ham is expensive, but luncheon meat is cheap. Good food is expensive, but crap is cheap.

Personal tastes also come into it. If a kid is going to refuse broccoli and throw it on the floor, it’s a waste few poor people can absorb. Better to feed them food they will eat than waste the food we can’t afford, is the (very logical) thought going into this.

It’s not always about making good choices. It’s about making the choices you can with the resources you have.

Improving the care of people with non-fatal suicide attempts

Part of the National Suicide Prevention Strategy is to improve the care of people with non-fatal suicide attempts. This is a noble goal, and one that needs some attention. Why? Because suicide attempts are often treated pretty bloody poorly.

Suicide attempts are treated as a waste of time, a waste of resources, a waste of energy. If you want to die, the attitude often runs, then do it properly and don’t waste our time. One in two will give it another go, and one in ten will ultimately take this unspoken advice and go on to complete suicide. So much of this could be helped with good post-survived attempt intervention.

The Strategy talks about improving after-care and support, but it does’t address the underlying attitudes that are brought to the emergency room by the staff. I don’t know if there’s a lot that can be done to change that. empathy with people suffering debilitating mental illnesses just can’t be taught. A better level of professionalism might help, but the way people really feel has a way of bleeding through to people they don’t respect in any way.

It’s even worse for self-harmers, who are treated dreadfully. They’re looked at as the ultimate waste of time – people that want to hurt themselves (no matter what complex psychological processes are going on to cause that self-harm) have no place in a department set up for those who are in medical crisis. What? Self-harming that leads to hospitalisation is a medical crisis? Naaah. It’s just a waste of time.

People seeking help before the crisis gets too bad aren’t treated that terribly much better. Emergency department staff can be more sympathetic, because you’re at least trying not to clog up their resuscitation rooms with failed suicide, but mental health unit staff sometimes don’t have much respect for people who aren’t in complete crisis. They don’t have the space or the time or those who aren’t suffering the absolute worst they can endure. If you can still ask for help, you’re not at the point of total disaster, and therefore you’re not really ill enough for the unit.

Perhaps I’m speaking from my own, rather shit, experience. I’m not alone, though, and I know people who have had similar experiences. Surviving a suicide attempt only to be treated roughly and harshly is a cruel experience. The follow-up is often perfunctory – a harassed mental health worker will come and chat for five minutes, and sign you out with little in place to follow up – perhaps an outpatient appointment three weeks into the future that gets ignored or forgotten. The missing patient is written off as a no-show, and that’s it, good luck with your life, and there’s a fifty percent chance that we’ll see you again.

I feel like this isn’t very well written, and such a topic deserves better. Maybe I should revisit this when I’m not suffering new-medication blues and public holiday chaos.

Side Effect Hell, part dear god how many of these have I done?

Today is day 3 of amitriptyline, a word I can now spell correctly thanks to the University of Google. I have to say, I’m less than impressed.

I’m not really sleeping better, or at least not yet. But I am exceedingly grouchy, and struggling to not take it out on the people around me. Being really grouchy is fantastic right now, given that it’s my three-year anniversary today. Sigh. I spent the day snapping at people then apologising and crying. not winning.

My blood pressure has been a little kinky, so occasionally I’ll stand up and fall right back down again. I’ve been lucky so far, in that I’ve been getting out of bed and just fallen straight back down onto it.

My tongue tastes like I’ve been licking a nine-day-old corpse. It’s awful. It’s not all the time, just when I eat, and for about an hour after. Did I mention I suddenly have this overwhelming urge to snack on things? Is the universe cackling away back there while rubbing her hands together evilly?

I’ve been through so many side effect hells that I’ve actually forgotten what number I’m up to, and it doesn’t get any nicer. I’m fed up. Not much for it but to persevere and hope it gets better, and talk to the doc if it doesn’t, I guess. Now, if you could excuse me, I’m off to have my corpse-flavoured anniversary dinner with my husband and my daughter (no babysitter available = no romantic dinner for me!)

Dental care – the great gap in our subsidised healthcare system

I live in a good place when it comes to health care access. Most things are either heavily subsidised or free. One of the glaring omissions, however, is dental care. It’s a huge gap in our system, one that’s costing us in terms of quality of life, as well as in the economic terms to loved by the government. Poor dental health has been linked to heart disease, diabetes, dementia, and more, things which make people pretty miserable as well as costing our free health system a tidy pile of cash.

Basic dental health care is provided through community-based clinics for children up to age 13, and through private dental practices until age 18. Other than these provisions, special dental services like those for cleft palate are provided free of charge for life, and emergency pain relief and extractions are available for people on low incomes. ACC provides for dental services as a result of injury, and in some lucky places, the DHB funds basic dental services for low-income adults.

What all that means is that dental care for adults is patchy. If you’re in an accident then you’ll be ok (usually – ACC can be a bit odd at times). If you’re in absolute agony the hospital will see you – but only for pain relief and extraction, and you may have to pay a part charge. I’m not sure what the services are like in the DHBs that fund basic adult services, but I assume they’re similar to the providions for under-18s – cleaning, fillings, extractions. It’s not a huge range, but it’s covering the basics, and that’s a huge step up from the nothing offered in other areas.

Dental issues are painful. They impact severely on quality of life. Constant pain makes it hard to eat and hard to concentrate. It puts you on edge and wears away your patience. It’s unpleasant for you, and can make you unpleasant to other people. It’s a pretty big social cost, and one that’s pretty unnecessary. Basic dental health care is as important as good primary health services – it should be part of the primary health care package.

Dental treatment is far too expensive for low-income families. When you’re so poor that taking the kids to the doctor is often out of reach, preventative dental treatment is way out. WINZ offer a dental grant of $300 per year for urgent dental treatment, and this is useful for a dental crisis, when the pain gets so bad that it can’t be endured. It’s just about enough to get a tooth pulled. but it’s well short of what you’ll need to save that tooth with a root canal.

I would think that, given the extra health costs associated with dental ill health, it would be a cost-effective intervention to provide free basic dental care for all low-income adults. Something along the lines of ‘if you have a community services card it’s free’. I would want to extend that to everyone, but in the interests of keeping the bean-counters happy, low-income people are a good start. Less heart disease, fewer diabetes complications, less dementia – these will all save the government money and help fund the programme. Or at least, it would work that way in my ideal world.

I feel very wrong justifying the basic right of free dental care by appealing to other cost savings. We acknowledge that health care is a basic right, why not dental health care? Why is dental care still the preserve of the well-off? New Zealanders deserve better.

Medication hangover

For the first time in ages, I’ve started on a new medication. We’ve been gradually reducing my medication load, but removing one has had some shitty effects, including cancelling my subscription to a good night’s sleep. So we’re trying something new, because the drug I came off was my nemesis, olanzapine, and I would rather not sleep than take that stuff again.

So, to play with sleep a bit, we’ve started amytriptiline. It’s an old antidepressant, which is apparently pretty good but makes you really drowsy. That’s what I’m after, right? Right. A full night’s sleep, without waking up a couple of times for hours at a time.

Last night was the first dose. This morning? Holy hell, turn the sun down, swaddle the world in cotton wool, I have a stupidly nasty hangover. I’ve not have one like this since, well, ever. My keyboard is just a bit loud for comfort, at least until painkillers kicked in a wee bit and took the edge off.

Effects on sleep so far? Well, there was no feeling of drifting off to sleep last night, nor of slowly waking up. It was just awake, and then suddenly awake again. It’s a really disconcerting feeling. And . . . I woke up three times in the night, worse than most nights, for about the same amount of time, and I woke up an hour to an hour and a half earlier than usual. I’m not sure what kind of state I’ll be in this afternoon. It may be a nap kind of day.

This all isn’t unexpected. Starting a new med is always nasty. I’d just forgotten what it was like, after being on stable meds for so long.

The voice of privilege speaks on college and travel and debt

Today’s post is brought to you by a chef names Alton Brown, who I had never heard of until today. I understand he’s pretty good though, explaining things in everyday ways rather than throwing a French dictionary at his watchers. That kind of everyman approach is pretty cool. What’s not so cool are his remarks on college (university) and what people should do there.

What he says just reeks of privilege. All the while, he claims that he was completely broke in college, but then he says that every college student should travel abroad while studying. This may be possible for the privileged ones with money backing them, but for the less well-off, travel is just a dream. Just earning enough money to eat at the crappy job they work is too much of a struggle sometimes, never mind dropping several hundred on spring break in Mexico or several grand on a jaunt to Europe. It’s something every student should have the opportunity to do, but in reality it’s way out of reach for some.

A little later, he says the biggest piece of advice he can give college students is “don’t go into debt”, to drop out before they start incurring debt. This is perfectly reasonable . . . if you have money backing you. If you’re poor, what then? Don’t go to college? Don’t try and get a good job? I know that the American student loan business is a horrific sea of loan sharks, but for many people it’s the only possible way out of poverty, and even going to community college is going to incur some debt. A pronouncement like this can only come from someone who’s never experienced poverty, nor needed to climb out of it somehow.

Even if you’re awarded a scholarship, college can incur debt. You’ve still got to eat during that time, and buy textbooks if they’re not included, and pay rent, and all these things that require money beyond what you can earn part-time at Papa John’s. So a scholarship is not a magic bullet for poor people to get through college debt-free.

It is interesting to see how Brown sees himself as poor, given what he considers essential for a college kid’s refrigerator – eggs, butter, herbs, hummus, cheese, and wine. Cheese? Butter? Are you kidding? What about ramen and rice? That’s more like it when it comes to being actually poor.

This guy is probably a good guy, but he’s so out of touch with what poverty is and what it means for kids trying to pull themselves out of it. For so many good jobs, you need a degree. Any degree will do, a lot of the time, as long as you have proven that . . . well, whatever a degree proves. I’ve just completed one, and I have no idea. Still, it’s what you need for so much – corporate, government, even mid-range management requires one. Putting yourself through college, as opposed to having someone help you through, is expensive and requires sacrifices that he just doesn’t understand.

The needs of state housing applicants

Yesterday a wee article came up in the Boy of Plenty Times. It’s a smallish regional newspaper, and there were some big stories yesterday, so it just slipped under the radar a bit. It’s important, though. It talks about the issues facing applicants for social housing in Tauranga and the Western Bay of Plenty, and those issues are a big deal for those on the waiting list.

Many of the applicants are very vulnerable groups – single parents with multiple children, people with long-term health issues, homeless people – and the issue is bad enough that the government, amidst plans to sell off social housing, is looking to purchase 90 more houses in the area to accommodate people.

Those purchases are just plans for the next two to three years at this stage, and with winter looming the problem is more immediate than the government proposal will deal with. 139 applicants are on that list, and many of them are living in the homes of relatives or friends in overcrowded conditions, or in their cars, or on the streets. Winter means the risk of illness increases in these situations, and for many of these people illness is a crisis.

Single-parent families have enough to deal with without the problems that the illnesses that winter and overcrowding can bring. It’s worse, though, for people living on the Supported Living Payment. These people are have serious long-term illnesses, and getting sick can be catastrophic for them.

As the article says, the government needs to be thinking very seriously about the amount being paid to beneficiaries, so that they can afford to get into private rentals. Or it needs to provide adequate state housing so that those it pays so little to can live in a house rather than their car or a tent. That those are real situations that people find themselves in, rather than silly hypotheticals, is shameful in a country where we have enough resources to house everyone.

There also needs to be a willingness to make state housing work for the people that need it. The standard three-bedroom state house will not work for everyone, particularly those living alone and those with disabilities that need modifications to their homes to make them accessible. One-bedroom state houses should be more common where need dictates, and the government needs to be really responsive to the needs of people with various disabilities. A wheelchair fit-out isn’t cheap, but in a world where people can’t afford their own homes to modify, and getting an accessible private rental is near impossible, the state needs to step up and care for these people.

State housing is a disaster in the current political climate, where sell-offs are king. It creates an environment in which people with serious needs are failed with alarming regularity. We can do better.

Free GP visits for under-13s? Well, mostly.

One of National’s big promises this past election was free doctor’s visits for all children under 13. This is a pretty big deal for people in poverty, whose children often stop going to the doctor for anything less than an emergency department visit after they turn six. Free visits for under-13s has the potential to reduce diseases of poverty such as rheumatic fever, with early intervention preventing serious consequences.

Today it was revealed that this promise is being broken. Yes, there will be ACC funding for injured children. No, it won’t be enough to cover everyone. Perhaps 90% of injured children will be covered by the $24 per injured child of funding, but that still leaves 10% having to pay a co-payment for their care. Incredibly, Health Minister Jonathon Coleman suggests that if your child is injured and your doctor’s receptionist states that they ask for co-payment, you should take your injured child on down the road a couple of hundred yards to the next doctor’s practice. I shit you not, that’s what he said.

There are a few issues with this. First is the rural issue. If you’re in a smaller town, you don’t have the option of waltzing down the road to the next place. There is no next place. You take what you get, and you deal with it. From that perspective, this is an incredibly privileged townie idea. It denies the reality of rural and small-town life. Many poor people live rurally or in small towns, making money when shearing time or the grape harvest comes around, and living on very little in the meantime. These people often live an hour or more from the nearest emergency department, so primary care is very important in this setting.

Then there’s the issue of having a regular GP, one that has known your child since they first came in for immunizations at six weeks old. Not only do they know your child and hold al their medical records, but you are also enrolled as part of their PHO, and if you go to another practice that’s not an urgent care clinic, you risk having your whole family deregistered. Which brings me around to the next problem . . .

Trying to find another GP to take you on is next to impossible. In small towns there’s no-one else. In cities the waiting lists are horrendous, to the point where some people don’t have GPs and have to cobble together care from urgent care clinics, youth one-stop shops, outreach clinics, and emergency services. Even if you’re just looking for a one-off appointment with a doctor, rather than enrolling with them, it’s likely to be hard. Doctors are crazy-busy, and they’re likely to be filled up with their own patients.

Finally, there’s the ridiculousness of having an injured child and being told at the clinic that they don’t do free visits, and taking your child, who is in pain, and cruising off to the next place to try again. Who’s going to do that? Well, people who really don’t have any money available will have to. Yeah, you should probably know before the crisis what your GP charges, but for people that don’t go very often that’s not necessarily assumed knowledge.

Funding 90% of ACC visits isn’t that terribly bad, in that most children will be subsidised, and it is likely that most urban poor will be covered. I don’t know what it’s going to be like for those outside the main cities, though. I remember rural GP care being quite expensive when I lived rural, and I wouldn’t be terribly surprised if it’s clinics in the middle of nowhere, as well as expensive town clinics, that impose a co-payment.

Something that hasn’t been raised that interests me is that this is talking about ACC funding. What about non-ACC stuff? Is that going to be funded? Where will that funding come from, and who will it cover? I would love to know. And prescriptions were supposed to be free. Is this happening?

This is a broken promise, and one that has the potential to keep kids that desperately need primary care intervention locked out. New Zealand kids deserve better.