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Becoming a doctor during a pandemic

Emma Espiner starts her career as a doctor later this year, and she doesn't want to be reflecting years down the track on a post-Covid health system that continues to favour some ethnicities over others. Brave decisions must be made now, she writes. 

At the beginning of all this my friend sent me a text “You’re training to be a doctor in a once in a lifetime pandemic!” and that felt like something big. 

The outpouring of love and support from friends and family was a bit embarrassing. Sure, we were frontline-ish. Most of our cohort of final year medical students was allowed to stay in the hospitals and in general practices around the country while the students in the years below us were pulled out and sent home. But our continued clinical education was on the proviso that none of us were to be involved with patients who had Covid-19. We were hero-adjacent. 

In the hospital we were just as addicted to the daily briefings as everyone at home, although the responses were different. For example, a colleague was shocked when I told her about the collective thirst for Ashley Bloomfield. “That guy?” she said, looking slightly ill. 

As we started to turn the corner on the number of cases, watching the worm trend steadily down while our testing numbers increased, the discussions in the hospital were less about preparing our ICUs, wards and emergency departments for the influx of coronavirus patients, and more about preparing for what comes next. I realised we might be training to be doctors during a pandemic but we would become doctors during the long Covid-19 hangover. 

I saw an interesting Wall Street Journal opinion column from 2019 resurface on Twitter last week, like detritus drifting on the tide. It was written by an American physician who was enraged by the inclusion of (a tiny amount of) teaching on social justice issues in modern medical schools. The snappily titled “Take Two Aspirin and Call Me by My Pronouns” says “At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness.” As if illness occurs in isolation. This person is clearly not across the literature that consistently demonstrates that social justice issues like inequity contribute to disease. Perhaps he enjoys practising medicine ineffectively, ignoring the fact that his patients have a context that exists outside of the clinic room.

The social determinants of health have been forced to centre stage by Covid-19. It has been revelatory watching local and national government respond to previously intractable social issues. It will be even more instructive watching them respond to what comes next, as the framework for what’s possible has been irrevocably altered. 

Before Covid-19, I had seen people discharged from hospital without homes to go to. It felt like our apathy as a nation towards homelessness was impossible to budge, because it only affected the people who were homeless. During a pandemic, however, if we release someone into the community without a home, they might put others in danger. So their needs are prioritised not for their own sakes but because they might cause harm to the rest of us. 

We managed to feed the hungry. Just like that, in my city, Auckland Council diverted its resources and just fed everyone who needed it. 

Iwi were ‘permitted’ to exercise tino rangatiratanga in establishing community checkpoints, exemplifying a truly Māori public health intervention focused on protecting community. For all the cries of vigilantism and attempts to stir anti-Māori fear from some commentators, the checkpoints were unproblematic for those who encountered them, and our low rates of transmission among Māori and in these communities point to the initiatives’ success. 

Unconfirmed plans to potentially prioritise Māori and Pacific patients for elective surgery among the Northern Region DHBs, explored in depth by Nicolas Jones at The Herald last week, raised the usual ‘special privilege’ arguments among the usual suspects. I wish those people were equally vocal when our ‘special privilege’ goes in the other direction, leading to reduced life expectancy and increased morbidity. I’d like to present them with a different question - how is it that they are happy to see ethnicity-based provision of health services that favour non-Māori, non-Pacific patients? Because that’s what the data tell us that we have currently. It’s not logically consistent to be okay with this, and yet be outraged by an intervention that aims to correct this imbalance.

Decisions about equity in the post-Covid world represent the true frontline of healthcare in this country. Pending some final assessments and exams, I will start my career as a doctor later this year and in 20 years' time, I don’t want to be reflecting on a health system that continues to perpetuate ethnicity-based inequities. Covid-19 can be the circuit breaker, but brave decisions need to be made now. They will not all be well-received, but they are necessary if we’re serious about providing world-class healthcare to all New Zealanders - to everyone in the team of five million who sucked it up, and did the hard yards when it mattered for the good of us all.

It always makes my guts clench to see an article like the one in The Herald because I can anticipate the ugly responses. I’ve come to accept that there are people who will resist every meaningful action on equity with vague threats about ‘slippery slopes’ and ‘race-based policy’. This overlooks the fact that we already have a system that prioritises some ethnic groups over others, and all we’re asking is that this be corrected, for fairness.

Sometimes when I’m feeling hōhā about having to explain the blindingly obvious reasons to act for equity, again, I wonder if it would be better to just sit this one out and work quietly in the background. But then I think of one of my medical tuakana, a truly terrifying woman, who went through a phase of randomly sending me Audre Lorde quotes. “Your silence will not protect you” is one of my favourites. 

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