33 avoidable deaths

28/11/2019

The death toll from measles in Samoa is now 33.

All but four of the deaths are children – under the age of four – including one who died in the past day.

About 200 people with the disease remain in hospital.

A mass vaccination campaign is underway and dozens of New Zealand nurses are in Samoa to assist. . . 

It’s likely the epidemic came from New Zealand :

. . . Ease of travel, particularly international, and immunity gaps within New Zealand meant the epidemic was not surprising, Immunisation Advisory Centre director Nikki Turner said.

In a report published in The New Zealand Medical Journal on Friday, Turner said more action was needed to ensure better protection for the community and the elimination of measles.

Some of those steps included resourcing a national campaign targeting adolescents and young adults; the adequacy of vaccine supply and accessibility including more use of pharmacies and pop-up clinics; and support for front-line workers. 

There was a risk to both New Zealand and Pacific populations and the epidemic indicated the country’s immunisation programme fell short. The health sector’s response needed to be strengthened, the report said. 

“With multiple imports and more than 12 recognised outbreaks in the first five months of this year affecting most regions, this should appropriately be called an epidemic,” Turner said. . . 

Otago University, Wellington Department of Public Health professor Michael Baker said the only way to contain an epidemic was to rapidly fill the immunity gap.

 It would be a “very responsible step” for the country to consider extreme measures that prevented the transmission of measles, particularly to the Pacific. . . 

The epidemics in New Zealand and Samoa and the deaths that have resulted were preventable.

It started when someone who was infected travelled to New Zealand and spread the disease here and a traveller probably took it to Samoa.

New Zealand’s immunisation rate wasn’t high enough for herd immunity and Samoa’s was far lower.

Europeans brought diseases to the Pacific Islands more than 200 years ago. They had the excuse that they didn’t know the dangers and they didn’t have vaccinations.

That excuse cannot be used in the 21st century, especially when a preventable disease has already cost 33 lives.


When politics of birth comes before its purpose

25/02/2019

Why would government officials try to discredit a critical piece of research that raised concerns about maternity care and why wasn’t it followed up?

In the months leading up to the release of a study which asked how safe it is to give birth in New Zealand, health officials were busy.

As a courtesy, researchers from Otago University had advised the Ministry of Health well in advance the study looking into maternity care outcomes would be coming out. Closer to the date, they provided an advance copy to the department.

The study found evidence to suggest all babies were not being born equal. Those in midwife-led care were at risk of poorer outcomes than babies in doctor-led care. The authors, Diana Sarfati and Ellie Wernham, were careful to point out their support for a midwifery-led system.

However, their conclusions were clear: the current way maternity care is provided in New Zealand is not as good as it could be.

“It may well be that midwife-led care is optimal within the context of well-organized systems,” the authors wrote.

At the very least this should have led to more research, but what did the Ministry do?

In the months they knew about the study – and the nine weeks they had a copy of it – ministry officials did little to suggest they would take its findings seriously.

Instead, an investigation by Stuff has found the ministry actively worked to try and obscure the results. Communications in the months before the study’s release show staffers worked on how to avoid “fallout,” and in one case shared plans to discredit the study ahead of its release with industry body the College of Midwives.

The ministry this week rejected suggestions it underplayed the findings of the study.

But documents obtained under the Official Information Act show attempts to spin the results of the study and avoid the spotlight on the safety of the system, into which 60,000-odd babies are born each year. These were met with stiff resistance from Otago University. 

But documents obtained under the Official Information Act show attempts to spin the results of the study and avoid the spotlight on the safety of the system, into which 60,000-odd babies are born each year. These were met with stiff resistance from Otago University.

Ministry officials took the unusual step of meeting with Professor Peter Crampton, then the head of Otago University’s Medical School and the pro-vice chancellor of health sciences. In an interview with Stuff,Crampton said it was clear the ministry felt the study was flawed. He disagreed, backing the university’s research. . . 

The Ministry felt? Ministries shouldn’t act on feelings, they should act on fact based thoughts and research but:

No further research was commissioned.

The study fell from the headlines; Sarfati went back to cancer research, and former midwife Wernham is in her last year of training to be a doctor.

But Crampton, who has had oversight of hundreds of studies in more than four decades in academia, can’t forget.

“I’ve never seen anything quite like it. The extent to which [the researchers] felt beaten up and traumatised by the experience was way outside of the normal,” he says.

“There should have been more high quality research set up to explore the issues that were raised, and we should have been doing this from day one. The chilling effect of the response to the results basically means this hasn’t happened.

“In my view, this was more about the management of a contentious issue than a policy engagement with important findings.

“If this area is too hard to research, then this is a big problem.”

While all research was vulnerable to critique, the authors had been clear about the limitations of the research and to ignore the results was a mistake, he says.

“The [ministry’s] response implied a problematising of the research in a way I found very unusual and disquieting. They viewed the results as highly problematic, and my general sense was that there was a considerable effort to explain them away.” . . 

Why?

Birth is a highly politicised business.

Practices have quite rightly moved away from the old system where mothers-to-be lay back with their legs in stirrups, everyone did what doctors said and midwives were undervalued.

But the pendulum has swung too far to the opposite extreme where too often birth politics gets in the way of the safety of both mother and baby and those involved lose sight of the point of pregnancy – the safe delivery of a healthy baby.

Problems have been exacerbated by the exit of doctors from obstetrics and a shortage of midwives.

Problems with midwife shortages – particularly in rural and low-income areas – and an unsustainable working model for midwives which means long working hours, burnout, and insufficient pay have been long identified as issues.

Wernham and Sarfati’s study was the first ever to take an overarching look at the safety of babies within the current system. The differences she and Sarfati found were not small; across the five-year study of more than 244,000 babies, they found those in doctor-led care had lower chances of poor birth outcomes.

This included 55 per cent less chance of oxygen deprivation during delivery, 39 per cent lower odds of neonatal encephalopathy, and 48 per cent less chance of a low Apgar score, a measure of a baby’s wellbeing after delivery.

There was also a lower rate of stillbirth and newborn babies dying under medical-led care. This link was statistically weak due to the small number of baby deaths in the five years covered – 1.84 per 1000 births for midwife-led care (410 total deaths, from 20 weeks gestation to the first 27 days of life) and 1.31 per 1000 births for doctor-led care (27 total deaths) – but it was there.

Of course, comparing women with midwives as their lead maternity carer to those who have doctors is not necessarily fair.

After all, doctors – counting GPs and obstetricians – look after less than ten per cent of mums. It is very possible the types of mothers they see are different – mums who smoke might be more likely to see a midwife, while healthier mums might pay for a private obstetrician, for example.

The researchers knew these things could effect the results. So they used a mathematical model to account for factors like smoking, age, ethnicity, deprivation, and weight. “Women are not comparable, but the design adjusted for that,” says Otago University epidemiologist and emeritus professor Charlotte Paul, who has reviewed the research. “The authors restricted their population to women who were having single births and term births to make them more alike. Then they collected information on characteristics that differed between the groups and statistically adjusted for them. The results remained.” . . 

But the results didn’t fit the prevailing ideology and raising questions as this research did led to defensiveness rather than answers.

Independent policy analyst and researcher Dr Jess Berentson-Shaw co-directs think-tank The Workshop and is the author of A Matter of Fact: Talking truth in a post-truth world.

She says the midwifery-led maternity model was a major policy change which, like many in New Zealand, was never evaluated.

“We should always be exploring what models of care are working best for the people they are supposed to serve – mothers, babies, families – and that includes midwives themselves. We can’t shy away from it, shut it down, or pretend it doesn’t exist,” Berentson-Shaw says.

In maternity, with its historic power dynamics of a women-led profession fighting for autonomy, questions about the system were often not considered objectively. “There’s this feeling that you can’t critique maternity care without critiquing midwives. How has it got so unconstructive? How has this happened to the point that we cannot have a conversation about standards of care?

That the Ministry and College of Midwives appear unready to even have the conversation is a big part of the problem. The only bias either body should have is towards the health of both mothers and babies.

Sarfati doesn’t know what she could have done differently. “It was so draining and exhausting and seemed to have so little effect, and it was so stressful personally. It had a big impact on Ellie and me for quite a long time, and despite all our efforts it had no impact at all.

“All we were trying to do was evaluate this major policy change that had happened. We have a really unique system in New Zealand, and the research they use to support it is based on systems completely different to ours. It was an attempt to look at that.

“It suggested there were problems, which isn’t to say the entire system should be thrown away, but you need to address them like any professional group should.”

David Farrar calls this disgraceful behaviour by the MoH.

Stephen Franks gives due credit to the journalist in Great Michelle Duff journalism on MOH surrender to witchcraft

The latter isn’t a criticism of all midwives but it is a criticism of the system which has put the politics of birth before its purpose.


Rural round-up

28/10/2018

Farmers’ green efforts unrewarded – Hugh Stringleman:

New Zealand dairy farmers are world-leading in many aspects of sustainability but not getting international recognition for their efforts, Federated Farmers dairy group chairman Chris Lewis says.

NZ is an echo chamber in which environmentalists and farmers hear themselves repeatedly, often without an international perspective or frame of reference.

“We think that if we solve our problems we are solving the world’s problems but we are a long way ahead of most countries.” . . 

On Farm story: sheep beat dairy temptation – Annette Scott:

North Canterbury sheep and beef farmer Ben Ensor planned to take a year out after leaving school then head off to university. He hasn’t got there – yet but who knows what might happen, he says. Meantime, he’s passionate about the challenges of farming in the close-knit rural community of Cheviot. Annette Scott visited him to learn what drives him.

Ben Ensor grew up farming in the Cheviot district where the family name is synonymous with the small rural community in North Canterbury.

On leaving high school he looked forward to a year out of study before heading to university but that year grew to several as he first worked with a shearing contractor them worked his way around New Zealand on sheep and beef farms, climbing the ladder to stock manager status.

Then with a couple of years overseas and university fallen by the wayside Ensor returned to the family farm in 2000 as managing director of the sheep and beef business. . . 

Guy Trafford looks at our current struggle with mycoplasma bovis and compares that with how others have tackled other major animal disease outbreaks:

If anyone needed reminding about the importance of bio-security, then the report that Britain has had a reactor animal for BSE (mad-cow disease) should capture all‘s attention.

Found in the Scottish region of Aberdeenshire, the surprising thing that came out of the report, from this commentator’s perspective, is the regularity of these outbreaks.

This is the first since 2015, but over the last decade 76 animals have been identified over the UK. Given that in the UK 4.4 million animals were destroyed during the 1986 outbreak it shows the difficulty in getting rid of diseases that get a hold within a resident population. . . 

New device helps farmers to identify crop viruses faster – Stacey Bryan:

A new agri-tech innovation could help New Zealand farmers to diagnose crop viruses, according to an expert in molecular diagnostics.

An international team of scientists, including Jo-Ann Stanton from Otago University, have invented a hand-held device that can sequence a viruses genome so farmers can quickly identify the disease without leaving the field and act to mitigate it.

Dr Stanton, who is a senior researcher specialising in molecular diagnostics, said the technology was easy to use and had reduced the time farmers in Africa had to wait for diagnoses from six months to just four hours. . . 

On the farm: what’s happening around rural New Zealand:

What’s happening on farms and orchards around Aotearoa New Zealand? Each week Country Life reporters talk to people in rural areas across the country to find out.

A lot of the North Island is crying out for rain and farmers are checking the rain radar to make sure wet weather forecast for the weekend is still planning to arrive.

In Northland around Dargaville, the dry conditions have been ideal for planting kumara but now they need a drink as does the grass. The stock market is okay but would be a lot better if it rained. Next week Dargaville is hosting its spring cattle fair. There will be 1500 cattle to sell over two days and stock agents are hoping Northland buyers will be joined by others from around the North Island. . . 

Ag graduates’ innovation key to industry’s future:

 New Zealand’s agricultural graduates need to back themselves and the sector needs to welcome their insights in order to navigate the changing demands of farming, according to Massey agricultural alumni award winner, Bridgit Hawkins from .

Bridgit Hawkins spoke to over 250 graduates, industry partners, and educators at Massey University’s 25th Agricultural Awards Dinner, held in Palmerston North on Friday evening, before herself receiving The Massey Agriculture Alumni Achievement Award in her role as founder and Chief Executive of New Zealand agritech company Regen.

Raised on a Reporoa sheep and beef farm, Ms Hawkins completed a Master’s Degree in Agricultural Science in 1989. Now a leader in Agricultural technology, Regen provides technology for solutions for farmers to manage effluent and irrigation, taking the guesswork out of farming and reducing their impact on the environment. . .


$50m children’s hospital gift

10/07/2017

Wellington benefactor Mark Dunajtschik will build and gift a new $50 million children’s hospital for the region.

A media release from Health Minister Jonathan Coleman says:

The announcement was made this morning at Wellington Hospital where a heads of agreement was signed between Mr Dunajtschik and Capital and Coast DHB.

“Mr Dunajtschik is a very successful businessman with a very big heart and his offer to build a new children’s hospital for Wellington is extraordinarily generous,” says Dr Coleman.

“While gestures on this scale are not unheard of, they are extremely rare.

“Mr Dunajtschik has said his philosophy is that people blessed with a sound mind and body can look after themselves, but those born with or suffering illness and disability need our support.

“Although he has been a substantial benefactor in the areas of health, sport and education for forty years, this latest act of ‘giving back’ is unparalleled.”

This development will benefit the 4,000 children and their families admitted to child health services at Wellington Regional Hospital each year, as well as over 5,000 children who attend nearly 38,000 outpatient appointments.

While many details are still to be confirmed, the new hospital is expected to be around 7,000m², and is likely to be three floors. It is expected to include 50 inpatient hospital beds, as well as space for families to be together.

Existing child hospital and outpatient services will move into the new hospital. The services and staffing levels are expected to remain the same.

Mr Duanjtschik and his team will now work alongside DHB clinical teams to design a fit for purpose, family centred hospital for the region’s children.

The new hospital will be situated in the Wellington Region Hospital campus, and is expected to begin construction early next year and will take around 18 months.

When we were in Houston a couple of months ago a local told us the city doesn’t really do much for tourists. With the space programme and health precinct it doesn’t need to.

The health precinct covered several blocks and included the The University of Texas M. D. Anderson Cancer Center . It was established by the University of Texas which funded half the cost, the other half came from the MD Anderson Foundation.

New Zealand health has benefitted from the generosity of  philanthropic people before, for example the T.D. Scott Chair of Urology at Otago University was established when a $1m donation from Trevor Scott was matched by the same amount from the Government’s Partnerships for Excellence Programme.

The $50m donation for the children’s hospital is a very generous one and it comes from a man of whom most of us have never heard.

 


Pre-loading’s the problem

25/01/2014

Pubs have known this for a long time – people are drinking, and often drinking a lot, before they get to them.

It’s called pre-loading.

Bars can lose their licences and staff face stiff fines if they serve drunks.

It must be hard enough to keep track of what customers drink when you’re serving them, bar staff can have no idea what people might have drunk at home if they aren’t showing signs of being drunk.

If they do suspect they’re drunk they can refuse to serve them and ask them to leave.

Hospitals can’t do that even though dealing with drunks costs them a lot of time and resources and pre-loading is a big part of the problem:

“We knew there was a problem with people turning up to our department with alcohol-related problems; this has confirmed that and it’s even shown that we’re underestimating it,” says professor of emergency medicine at Otago University Dr Mike Ardagh.

The study found alcohol contributed to almost one in three attendances at the hospital’s emergency department between 11pm on Saturday nights and 8am Sunday.

The median number of drinks consumed across alcohol-affected patients was 14 standard units -that’s about two bottles of wine or more than a dozen cans of beer.

The study also found that just 30 percent of that alcohol had been purchased at bars and clubs, with the overwhelming majority – 70 percent – bought at off-license premises such as supermarkets and bottle stores. . .
Dr Scott Pearson has worked in Christchurch Hospital’s emergency department for 15 years. He says alcohol related admissions place an enormous strain on the department – particularly on Saturday nights. . .

“We’d like to see a real public effort to try and reduce the number that are coming here because we’d like to spend that money on other things – things that can contribute to the public’s health in general.”

Increasing prices for at off-licence outlets is one suggestion but that imposes costs on the majority of people who drink moderately.

One problem with existing liquor laws is that people who serve drunks can be charged but the drunks don’t usually face the same risk.

Making drunks who cause problems and costs face the responsibility and be liable for their actions would be a better place to start than increasing taxes.


Lack of money or learning?

26/04/2012

The Christchurch Health and Development Study, by Otago University has found that poverty doesn’t lead to increased rates of crime or mental health problems in later life.

The study’s leader, David Fergusson, says low income appears at first glance clearly associated with crime and mental health problems.

But he says poverty is also connected with a lack of parental care, and that is what seems to be the real culprit in these adverse effects.

Poor parenting isn’t confined to poor people but the study, which has observed the development of about 990 people from birth over 30 years, did show a link between family income and the child’s later educational success and earning power.

But is the cause a lack of money or lack of learning? Is it being poor or the fact that poorer people are likely to have less education – and sometimes less regard for education – that handicaps their children?

This doesn’t apply to all poor people, some understand that education is the key to a better life and work hard to ensure their children have opportunities they didn’t have.

But some parents don’t recognise, or don’t care about, the importance of education and don’t give their children the help and encouragement they need to succeed.

That could be a contributing factor to their poverty and the poorer chances for their children in which case education could be at least part of the answer.

There’s more on the study here.


Things to do with 30 spare hours . . .

25/10/2010

. . .  and 600 metres of tinfoil:

The art of procrastination has taken on new meaning with students at an Otago flat spending 30 hours tinfoiling a friend’s entire room, just days out from exams. 

Hamish Chang, a third year accounting student, was the unlucky victim of the time-consuming prank, which used 600m of tinfoil and took several days.


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