The crisis in India and the devastating scenes we see unfolding there daily are further reminders that the pandemic is far from over. Our thoughts are with colleagues and communities in India, and others around the world who are still contending with the horrible impact.
Certainly, the latest recent lockdown in Western Australia, ongoing hotel quarantine issues and the delays, disruptions and recalibrations of vaccination programs, tell us our nations still face risks requiring attention. Unfortunately, the theme for 2021 is seemingly, “it isn’t over yet”.
Nevertheless, our relatively fortunate position has afforded a return to some semblance of pre-COVID life. This has included the establishment of the trans-Tasman bubble, albeit it perhaps a somewhat tenuous one, which allowed me – for a brief few days in late April – to visit Australia for the first time since the world as we knew it, changed drastically in March 2020.
While I have been in regular contact with many colleagues across our two countries over the past year, I have truly missed the additional connection that in-person interaction can provide.
During this brief trip, I welcomed the opportunity to visit several EDs in Melbourne, western Sydney and the Hunter and Central Coast regions to see and discuss in person some of the distinct issues and experiences facing our colleagues.
Eight EDs and three social events in three days. I would have liked to have covered more ground, however, COVID-19 arrangements permitting, I plan to return to Australia in late June, for more comprehensive meetings and visits to jurisdictions and sites across Australia.
Despite time constraints, the visits I did manage were telling. While challenges might be different, there were many similarities; indeed, worsening access block and staff distress are universal issues across Australia and New Zealand. It was, however, also very clear in the places I visited that, despite the duress, the presence of strong leadership and camaraderie in ED staff is serving to enable people to get through the current situation.
In reality, we are all aware that our EDs, hospitals and healthcare systems are struggling. Struggling under the pressure of steadily increasing demand. Demand that has been increasing predictably for years, with issues of widespread systemic, staffing and under-resourcing occurring across entire hospital systems – all resulting in access block and immense pressures on frontline staff.
In our public advocacy we have emphasised this is not simply ‘a blip’, nor can it be put down to ‘a post-pandemic surge’. We are experiencing a continuation of trends we have been seeing for years – presentation numbers going up and up, inefficient hospital admission and discharge processes and other systems issues, all compounding in unsustainable bottlenecks in our EDs. This is frustrating but entirely predictable, and we have been calling on governments and administrators to act. We have now reached a ceiling in terms of the care we are able to provide to the steadily increasing numbers of people who are turning to our EDs for acute care.
Politicians and system leaders, to varying degrees, are acknowledging things need to change – health ministers accepting we need more bed capacity and RACF spaces, so the message is getting through. Our mission is to build on this momentum to secure the genuine whole of system improvements that are required.
We cannot accept any more excuses or blame shifting between jurisdictional and national governments, nor the false public narrative that ‘GP-type patients’ are to blame. The root systemic causes of the access block – so dangerous to the patients we care for, and morally harmful to ourselves and healthcare colleagues – must be addressed.
Urgently, we need government, healthcare system and hospital leaders – at every level – to step up, and to work with us on necessary systemic solutions, support and planning.
I am very aware of the significant personal and professional toll the current situation, in the aftermath of 2020, continues to take. Amid these challenges, it is also important to look for hope, emphasising that there is so much to admire and take heart from in the work carried out daily in our specialty of emergency medicine, where the vast majority of our patients get world-class treatment and great outcomes and are grateful to us for doing what we do.
We must continue our advocacy work, research work, education and support work, which is all aimed at improving our systems, our collective understandings, seeking solutions, improving the care we provide to patients, and training the next generations of emergency physicians.
Across our increasingly mature and sophisticated specialty and College there are many resources available. Among the most valuable is the experience of our members. We are always eager to find ways to ensure that this wisdom, strength and expertise is imparted and shared.
To that end, I am pleased to confirm the College will be launching its Mentor Connect mentoring program this year, which will aim to connect members and trainees with an emergency medicine colleague outside their immediate jurisdiction or place of employment.
The College is currently seeking expressions of interest from potential mentors ahead of plans to open applications to mentees in stages throughout this year. This is an excellent opportunity for collaboration and additional peer support. By embracing mentoring, we can also seek to support healthy workplace cultures, leadership and professionalism in emergency medicine.
This is just one of many opportunities and ways to get involved with the life of our College. ACEM is what our members and trainees make it. By working together, supporting each other and promoting kindness – to ourselves, each other and our patients – we are all stronger for it.
Our workplaces, healthcare systems and communities are still facing stormy seas for now. But we navigate them together, knowing there can be smoother sailing ahead.
Remember compassion, and thank you, once again, for all that you do.
Dr John Bonning