The emergence of the contagious delta variant and associated rolling lockdowns with border restrictions across much of Australia are testament to that. Thoughts and best wishes are with all colleagues contending with, and affected by, these short-notice arrangements.
We continue to confront the reality that our best hope for more COVID-normal existence is to bolster vaccination coverage across our two countries. To this point, disappointingly, things have not moved as quickly, or smoothly, on that front as they should have.
This must change, and change quickly, if we are to collectively give ourselves the best possible chance of withstanding the emergence of current and further new variants, impacts on our health systems, and disruptions to our communities and lives.
In Australia, reasons for the sluggish rollout have been multifactorial. Clear, consistent messaging has been lacking, aggravated by logistical, supply and systemic issues. This has not been helped by public narratives from multiple sources, some of which have disproportionately focussed on the potential for extremely rare, although potentially serious, side effects, rather than the fact that overwhelmingly safe and effective vaccines are now available to eligible members of the public.
Noting the Australian National Cabinet’s recent announcement of a ‘four-phase pathway’ out of the pandemic, this must serve as a catalyst to bolster vaccination uptake across the country, along with more streamlined efforts from Commonwealth and state/territory jurisdictions, to promote vaccine access and uptake.
While clear timelines and targets are still lacking, the bottom line is we need more people vaccinated to provide better protection from COVID-19, and its associated disruptions. Collective efforts in both of our countries must be focussed on achieving that goal as quickly as possible.
Whilst vaccine hesitancy or complacency is common, even amongst some healthcare people – and no doubt exacerbated by various systemic frustrations – we as a College are liaising with government, their advisory groups, and other medical colleagues as we seek to work collaboratively to strongly endorse and encourage vaccine uptake.
While we push to expedite vaccine roll outs, our emergency clinicians on the ground continue also to confront the bi-national scourge of extreme and dangerous access block in our emergency departments. In recent weeks our College’s efforts to highlight and draw public and government attention to these major issues has continued, with some success.
While we must continue to highlight these issues, and are committed to doing so, our focus is also on influencing those with ability to enact meaningful change, by engaging constructively and presenting solutions.
As a recent article published by the Medical Journal of Australia, co-authored by myself and colleagues Dr Clare Skinner and Dr Simon Judkins, highlighted, not all of these are straightforward.
Nevertheless, we must continue striving for the collaborative, whole-of-system healthcare reform necessary to address access block and other major issues.
Another major piece of work on that front is the College’s pursuit of a new set of nuanced, tiered and targeted hospital access targets that we shall aim to have incorporated into the next Australian National Health Agreement (2025). Our advocacy efforts are progressing, with more to come. You can find out more here, and we will continue to keep members and trainees updated and involved.
Since my last blog, I have also had the opportunity to return to Australia and visit colleagues in Tasmania, Victoria, South Australia, and the Northern Territory to date, albeit in a constrained fashion due to the unpredictability of arrangements associated with COVID-19.
The overwhelming messages are similar everywhere; whilst the pandemic is “inconvenient” and the vaccine stroll-out “frustrating”, access block is harming us and our patients more than ever before, and governments and health system managers continue to present frustratingly unhelpful narratives.
In Tasmania it has been overtly stated that the system will prioritise electives over acutes, despite unprecedented access block in all EDs across the island. Whilst tomorrow’s elective patient knows who they are and waits patiently, petitioning their elected representatives, tomorrow’s acute patient does not know who they are, and does not know that it might be their elderly relative or themselves languishing on an ambulance ramp, or for 24+ hours in an ED corridor. It is an equity issue. Acute patients must not be treated as second-class patients.
The South Australian Faculty have been left increasingly frustrated, puzzled and angered at the apparent lack of willingness from their Minister and SA Health leadership to take ownership of the urgent issues in that state, and drive improved hospital flow and efficient function. We are working on advocacy strategies to address these issues.
Though difficult circumstances prevail in emergency departments across Australia and New Zealand, I have felt very fortunate to meet with colleagues in person, to hear their perspectives and consider what more can be done to improve circumstances on the ground.
Despite the challenges, the camaraderie and support for each other is evident. It has been inspiring to witness, first-hand, the skill, commitment and perseverance of our emergency medicine family across both of our countries.
As we collectively consider what more we can do to improve the situation for emergency clinicians and our patients, it is reassuring to reflect on the fact that we can and will get through the multitude of challenges together. You are doing an excellent job and deserve every support to do that job to the best of your abilities.
As a College, we will continue pushing that right, and the rights of our patients to receive the highest possible standard of emergency care, when and where they need it.
For now, my plan remains to stay in Australia for the coming weeks and – COVID-19 settings permitting – visit further jurisdictions to discuss key issues on the ground. I hope to continue meeting, in person, with as many of you as the still-changing circumstances allow. I will keep you all updated.
This week also marks NAIDOC Week 2021, which began on Sunday 4 July 2021 and will run to Sunday 11 July 2021. The 2021 theme – Heal Country! – calls for all of us to continue to seek greater protections for our lands, waters, sacred sites and cultural heritage from exploitation, desecration, and destruction.
The week is an important opportunity to embrace First Nations’ cultural knowledge and understanding of Country as part of Australia's national heritage, and to pay respects to the culture and values of Aboriginal and Torres Strait Islander peoples. You can find out more about activities in your area via the NAIDOC website.
Thank you, as always, for the work that you do. Don’t forget compassion: for your patients, for your colleagues, and for yourselves.
Kia kaha,
Dr John Bonning
ACEM President