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In August of 2018, I was honoured to be elected by my peers to the College presidency. I had been on College Councils and committees since 2007, and on the College Board since its inception since 2014, so it was a question of stepping up to the top job or stepping off to make way for others coming through.

In 2018, I officially became President Elect in Perth at the AGM at the ASM, the meeting where all but one of ACEM’s 11 Presidents, including our founding president Tom Hamilton, stood on stage. I wondered how on earth I was going to be able to emulate the feats and achievements of my eminent predecessors. In 2019, in Hobart, I was privileged to be gifted by Tainui Kaumatua and Kuia to the College for my presidential term, on stage with College dignitaries.

I was, and am, deeply honoured to be the first President of our College to be elected from Aotearoa New Zealand to represent you all, on both sides of the Tasman. It has indeed been an incredible honour to serve you in the last two years.

However, for reasons we all know, it has not quite been what I expected. In March and April 2020, the incredible uncertainty began when we watched the pandemic take its terrible toll in the Northern Hemisphere. 
It was then that we rolled our sleeves up in our EDs to meet the expected onslaught and began our new world of Zoom and other virtual meetings and knew that we had a real challenge before us. But rise to this challenge we did.

Each of us have had our own journeys over the last 20 months. We have all been locked down in our own states, towns, neighbourhoods, and homes at various times for various lengths of time, with occasional flashes of freedom. All of us have had to reappraise how life was to be lived, with the real personal risk of catching this infection and taking it back to our families.

Our work in Emergency Departments changed too, and it challenged us in different ways. But we rose to this challenge, with hot and cold zones in our EDs, PPE, and, as always, inexorable access block weighing upon us. 

In addition to this, our trainees have had the added pressure, and the weight of uncertainty, of sitting examinations in altered conditions something that continues even now. I am so proud of our College as we have successfully run our examinations with over 3000 candidate exam episodes in the last 13 months, without significant complications that have, at times, beset others.

Our College staff have been substantially out of their offices for 20 months, in the most locked down city in the world. The College staff are absolutely part of our team of over 6000 (members and trainees) – supporting the work of our College and clinicians at the front line of the pandemic, advocating, making exams happen and supporting the membership.

For three months from April 18th to July 16th I was able to get across the Tasman to meet some of you in person, to come to your EDs, and experience your worlds firsthand. I was privileged to get to Melbourne, Sydney and NSW Central Coast, Canberra, Tasmania, Adelaide, Alice Springs and Darwin, before Delta shut down visits to WA, Queensland and central NSW.  Unfortunately, planned trips around regional Aotearoa NZ have now too been shut down.

Other than that brief window it has been virtual connection, but connect we have. Some days I have virtually met with people at a dozen different locations right around Aotearoa NZ and Australia, in one day. 

We have continued to discuss the important issues we are facing, issues that I am deeply committed to, and that include the sustainability of the healthcare system, resource stewardship and choosing wisely and culturally safe care. Also supporting trainees, addressing workforce issues – including geographical maldistribution – and finding solutions to access block, the wicked problem that affects our ability to provide timely acute care to emergency patients.

What struck me during my virtual and in-person meetings is that, while challenges might be different, there are many similarities. The pressures of access block and staff distress were universal issues across Australia and Aotearoa New Zealand. What I also noticed is that, despite the duress, there was – and is – so much to take heart from: the presence of strong leadership, determination and camaraderie among ED staff that enables and supports people to get through.
 
That is what we do when times are tough: we band together, support each other, and we help our patients.

 We are trained to deal with the direst of situations, whether in our resusc rooms, in our EDs – or in our healthcare systems.
 
As President, I have done what I can. Now, I feel happy to be handing the presidential reins over to my good friend and colleague, Dr Clare Skinner. I know that ACEM is in very good hands. Clare, I wish you every success as you embark on this next chapter of your life, and the life of the College.
 
So now, as I step into the role of Immediate Past President, please know I will still be there, working in ED, advocating, and standing shoulder-to-shoulder with each of you to do our best for our patients, and our colleagues.
 
I have some thoughts and wishes I want to leave you with:
 
Firstly, please try to see some positivity in the future. The tail end of the pandemic, ongoing access block and climate change looms large in each our minds, but there is much to be thankful for in the oases that are our beautiful countries, Aotearoa New Zealand and Australia. We can survive, and we can thrive, in the face of adversity.
 
Please join with me in efforts to promote equity and sustainability sustainability in our healthcare system and that of our planet. 
 
Please don’t waste this rare and precious healthcare resource that we have by over-testing, over-diagnosing or over-treating.  Choosing Wisely means choosing equity: more care for those who need it, and less for those who don’t.
 
Please, as we move towards living with COVID, let us not catastrophise or fixate on unrealistic predictions of calamity. Instead, let us rise to the challenge, as we have in the last 20 months – and as we always do – to look after our communities. 
 
Lastly, please don’t forget compassion: for our patients, for our colleagues, and for ourselves.
 
To finish, thank you. Thank you to all ACEM members and trainees – our emergency medicine team of 6,000 – who have continued to give so much, while navigating so many difficulties. Thank you to the College staff, led by a dedicated CEO and executive leadership team, who have provided such vital and dedicated support – while subject to so many disruptions and uncertainties in the most locked down city in the world.
 
Thank you to the Presidents who have come before me, from our inaugural President Dr Tom Hamilton to my immediate Predecessor, Dr Simon Judkins. Theirs have been enormous shoes to fill and I hope you all feel, as I do, that I have made every effort to live up to their Collective legacy, in truly challenging circumstances.
 
And, thank you to my wonderful family – my wife Ulrika and my children Nick and Eva. They have seen a lot more of me than they were expecting in our home bubble, and I could not have done any of this without their endless patience, support, and advice.
 
Ka kite ano,
 
Dr John Bonning
ACEM President

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