Thursday, March 15, 2012

Words for a new year*

For last year’s words belong to last year’s language
    And next year’s words await another voice …
So I find words I never thought to speak
In streets I never thought I should revisit...

                                                         -T.S. Eliot Little Gidding

2011 was a year of continued discussion in Australia about the future of our health system, with movement towards more decentralised hospital care, the establishment of larger more formal primary care entities, and new interest in the efficiency of the way in which we spend the health dollar.  While the debate has been hot at times, it has not been anywhere near as bitter as that in the US over Obamacare.  Words have been chosen here with restraint even when discussions have been tense. 

But in the US, the polarised politics and the words used on each side of the political debate in general and in discussing the health reform proposals in particular are bitter indeed, contributing to, if not creating, a highly flammable social environment.

In Tucson, Arizona, at 10:11 am on January 8, 2011, a young man intruded upon a small group waiting to talk to their congress representative at a suburban Safeway supermarket.  He came up very close and shot Gabrielle Giffords, 40, a Democrat congressional representative holding the meeting, in the head. He then shot and killed six others and injured 13 before being disarmed by two by-standers. 

Through superb surgical care and intensive rehab, Ms Giffords is now walking with assistance and speaking in halting words. Revisiting ‘streets I never thought I should revisit’ on the Sunday evening of the anniversary of the shooting, she ‘led a crowd in the Pledge of Allegiance, her words ringing out across a cold Tucson night in a rare public appearance at a candlelight vigil. She limped to the podium, and (astronaut) husband Mark Kelly helped lift her left hand over her heart. After months of intensive speech therapy, Giffords recited the pledge with the audience, head held high and a smile on her face as she punched each word.’ the Huffington Post reported. She has now reappeared in Congress and attended President Barack Obama’s 2012 State of the Union address but has indicated that she will leave Congress shortly for more rehab.

On May 18th, Giffords had further surgery at Memorial Hospital, Houston, to replace the half of her skull that had been removed at the time of the shooting to allow brain swelling to occur without pressure on deeper brain centres.  Her surgeons used a custom-built plastic replacement, fashioned using CT imaging of the cranium on the opposite side.  Her husband, astronaut Mark Kelly was that morning docking the space shuttle Endeavour with the International Space Station. All up, the sun had risen on a hi-tech day in America.

The assailant, Jared Lee Loughner, has pleaded not guilty to 49 charges. He was assessed as incompetent to stand trial because of a mental problem, said to be bipolar disorder in several reports and  schizophrenia in others. He is now ‘forcibly medicated at a Missouri prison facility in an effort to make him mentally ready for trial.’ I wonder what he will choose as his words for this year.

Much thought and discussion, and some contrition, occurred at the time of the shooting about the virulence of political debate in the US and whether this had indirectly led to the attempted assassination of Giffords. She narrowly won re-election in November 2010 against a Tea Party candidate who virulently opposed her support for Obamacare.

Tom Zoellner, who worked on Giffords’ 2010 campaign, in a book about the event and its causes, argues that the killings were a product of ‘spiteful politics, a broken mental health system, wide-open gun laws and suburban alienation. A number of malevolent factors came together … I think it is flat-out wrong to say that Jared Loughner came from nowhere.’ 

Press reports said that Pima County Sheriff Clarence Dupnik blamed the vitriolic political rhetoric that has consumed the country, much of it centered in Arizona. "When you look at unbalanced people, how they respond to the vitriol that comes out of certain mouths about tearing down the government. The anger, the hatred, the bigotry that goes on in this country is getting to be outrageous," he said. "And unfortunately, Arizona, I think, has become the capital. We have become the Mecca for prejudice and bigotry."

Giffords had said previously. "For example, we're on Sarah Palin's targeted (mid-term election) list, but the thing is, the way that she has it depicted has the crosshairs of a gun sight over our district. When people do that, they have to realize that there are consequences to that action."  The media said that “Republican challenger Jesse Kelly held fundraisers where he urged supporters to help remove Giffords from office by joining him to shoot a fully loaded M-16 rifle. Kelly is a former Marine who served in Iraq and was pictured on his website in military gear holding his automatic weapon and promoting the event.”

"I don't see the connection," between the fundraisers featuring weapons and Saturday's shooting, said John Ellinwood, Kelly's spokesman. "I don't know this (Loughner) person; we cannot find any records that he was associated with the campaign in any way. I just don't see the connection.”

What relevance do these events in the US have to us in Australia?  Fortunately the acrimony and bitterness of American debate about health care have not infected our discussions.  But whatever one’s view about the causes of the Giffords disaster, ‘last year’s words’ and deeds about health reform and political life more generally in the US might serve as a lesson for us in our search for the voice that will lead to continued health reform in Australia. No health reform should be countenanced that does not endorse the values that underpin civilised living. While the dominating influence of the news cycle and political sound bites is felt everywhere, discussions about health care should surely have a distinctive, humane quality to them.  

The values of civility are obvious in any intensive clinical setting whether saving the life of Gabrielle Giffords or attending to the needs of the mentally ill.  Sometimes that is where they stop, not informing our policy thinking and our management. We do not say much about why we are seeking to improve the health system beyond the rhetoric of shortening waiting lists and creating more beds.  We have learnt phrases like “activity–based funding” without specifying the purpose and outcome of the activity. We stop short of telling the grand story of social achievement through health care. The extent to which these humane values are transmissible to today’s and tomorrow’s generations of health care professionals is in question.  But we can be reassured by the huge numbers of young people seeking meaningful careers in medicine and other health professions.  They get it.

The new words that we need to support changes in healthcare this year are ones that tell that story of health care, why we do it, why we pour money into it, why people spend their lives in it, not building monuments but providing care and giving service, a story that does not shy from compassion, concern, help, support, love and sacrifice.

There’s a new story to be told - or maybe an old one using words that have accumulated dust.    

*Published in RADIUS March 12 

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