Wednesday, July 9, 2008

We're all oppressors... at least I'm told so

The Kamatua ground his thumb on the table, his eyes locked onto mine "See that thumb, that's you white people, and all Maori are under it" his voice quavered as he said this, seeming to struggle to contain his righteous anger. Somehow dinner had turned into a confrontation between the head of the local Maori tribe and myself.

How exactly did I end up in a confrontation with the head of the local Maori tribe? Well, as part of our nursing training the graduating class had to spend a night on the local Marae. The goal of the visit was to discuss ways in which we could help Maori people feel more comfortable in the white world of modern medicine. We were learning how to make Maori patients feel more comfortable in such an alien envirnoment, how to meet their cultural needs.

The confrontation began innocently enough. The kamatua decided to sit with me at dinner, and as happens with a group of people sharing a table, sharing good food, a conversation soon ensued. "This is a special place" he began, glancing round at his surroundings, his eyes lingering on some of the Maori carvings. I nodded my head. "It effects everyone, even Pakeha people like you" he said, obviously referring to being on the Marae. Pakeha is the Maori word for people of European, or white decent. "What do you mean, people like me?" I had to ask as his wording almost seemed to border on insulting. It seemed as if this was just what the Kamatua had been waiting for he answered without hesitation "The people in charge, our oppressors."

I sat there in silence, too shocked to be angry. I briefly wondered what this had to do with nursing. I wondered how this would make me a more caring nurse, but came up blank. I didn't need this confrontation, not now at the end of my three years of training. I didn't need to be labelled as a stirrer, a trouble maker, or even a racist. I tried to be diplomatic "Well, I'm just here to help people, that's what nurses do. I'm not into all this politics and stuff" I replied. My response seemd to anger him as his eyes narrowed, his face deepend into a frown "Fighting for our land, our culture isn't politics" he then ground his thumb on the table "See that thumb, that's you white people, and all Maori are under it."

So that's how I ended up here, on the receving end of a Maori leader. But I wasn't going to do down without a fight.

"To be honest, I really don't think this has anything to do with nursing. I don't need to be told how to care for Maori patients, least of all by such an unpleasant host as yourself." By this time we had attracted a small crowd of onlookers, amongst them two frowning nurse tutors. But I hadn't finished.

"As I see it, I'll treat anyone, from anywhere, on an individual basis. If I have a Russian, Korean or even a bloody Martian, I'll base my care on their individual needs." The Kamatua's face was filled with rage, but I wasn't worth further time. He rose from the table and walked away without another word.

It was an interesting experience spending the night on the Marae. This part has now been stopped as too many students were complaining that it had nothing to do with nursing, and I happen to agree. The biggest shock of all was what I can only describe as hate from my hosts.

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Monday, July 7, 2008

Where's the racist?

My eyes practically bulged out of my head as I read that last phrase again "...nursing staff, medical staff and environment systemically racist." The letter was signed by Marore family which I had come to know very well over the last two weeks. Helen Clarke leant forward in her chair, her arms resting on her desk "You were Mr Marore's primary nurse, so we're talking to you first. Nothing much specific has been said, and no names mentioned, but perhaps you could explain why the Marore family has sent this letter."

I sat there in silence, my mind a complete blank. I want to be honest, but I don't think it will work. The family wouldn't send a letter like this for no reason, but that's just the problem, I couldn't think of a reason. I couldn't think of a single reason why the Marore family found the care of their recently deceased father racist. "Sorry Helen, I don't have a clue. I acutally liked Mr Marore, hell, he even requested me to be his nurse every time I was on. Maybe it's just the family grieving, I mean they knew he was eventually going to die, but still, that doesn't make it a whole lot easier. Perhaps it's grief talking." The words seemed to slip out of my mouth on their own, and it took me a few moments to digest just what I had said. The more I thought about it the more my suggestion sounded plausable.

Helen nodded her head thoughtfully, "Perhaps you're right, but are you sure you can't think of anything specific, any reason why they would send a letter like this?" I took another look at the letter, "Well, it does say here that they feel the hospital policy of allowing only two visitors in at a time prevents them from healing in a traditional family way" I noted. "And was that enforced?" asked Helen. "C'mon Helen, you know it's never followed, as well as the visiting hours that are never followed. We always make exceptions. Hell, the minimum visitors that Mr Marore had were two. I swear we've had all his immediate family plus every cousin in there sometimes." Helen managed a brief smile before her face turned somber "But these are very serious allegations, it still has to be dealt with." I shrugged my shoulders "Sorry, can't help anymore."

I read through the complaint letter again, but it didn't help anymore. "Look Helen, the only specific thing they've complained about is the offical numbers of visitors allowed, the rest vague, it doesn't acutally complain about a specific person, just everyone. Perhaps you should request something specific from them, perhaps word it in such a way that you want their input so to make the system better."

Helen was in agreement and let me head back to work.

Over the next several weeks everyone in the department was questioned, and everyone came up blank. It caused a lot of stress and left a sour taste in everyone's mouth. Helen was no further ahead and did send a letter as I had suggested.

We'll hear the reply to that letter in a future blog.

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Wednesday, July 2, 2008

An Unusual Argument/View on an old topic...

Cough, splutter, cough, "I..... need some more..... oxygen" gasped Mr Jones. He couldn't have any more oxygen because too much of the stuff would kill him. He knew this, it had been explained many times before, but it didn't stop him desperately desiring enough oxygen to stop his breathlessness. Instead he had another nebuliser with room air pumping though the mask.

It was Mr Jones' third admission in five months, which was not bad for him. He had a run the previous winter when he had come in once a month for five months on end. It almost seemed that Mr Jones spent as much time in hospital as out. We knew him, he knew us, he knew the respiratory ward better than his own back yard (he no longer could walk in his own back yard as he got short of breath and had to go back on his oxygen after the exertion).

Ten minutes later the nebuliser was finsihed. "Could you... wheel me outside for a fag" his gasping wasn't quite so bad as he mananaged a sentence with only one pause for breath. I shook my head, "Ah, no Mr Jones, oxygen and a lit cigarette really don't go that well together" I replied. He managed a brief chuckle "Got away with it... all these years". I knew better than to argue, and he knew better than to try asking again.

Mr Jones was eventaully admitted to his second home, the respiratory ward. I went home, but stopped off at the local for a quick drink and catch up with a couple of friends, but didn't stay long as the smoke in the bar was so thick.

It may seem my point has been made, but I'm not done yet...

Over the next week the news was filled with those against and for banning smoking in all public places. Anong the various arguments against the ban was that they were being discriminated against, human rights etc.

Let's jump to Mrs Smith

Mrs Smith was sent to hospital because her family doctor was concerned about a lump in her arm. He was pretty sure it was just a lipoma. It was her first time ever in hospital as she is normally a healthy person who doesn't happen to smoke. The doctor there said it looked like a harmless lipoma as well, but she would need a biopsy, just to make sure. He also said it wasn't urgent.

What he didn't say to Mrs Smith but to myself (the attending nurse) was that if he had the time, or the hospital had the money, we'd get it done now, instead of letting her wait another month or more before she had the biopsy. She ended up going to her family doctor again who did the biopsy as it was quicker this way. (It was a harmless lipoma)

You know where I'm going with this yet?

Mr Jones the smoker is an extreme example of a smoker using up thousands upon thousands of pounds of health care over and over again, every time he is admitted to hospital. Most smoker's will at some stage cost the health service money because of their habit.

Mrs Jones has been admitted only once, and in need of a rather minor procedure, her visit a rather cheap visit compared to most, but she didn't get the ideal treatment because of cost.

So, for those diehard smokers who complain about their right to smoke, their right to sit and relax over a pint and light up at their local, especially on a rainy day, I have no sympathy, even if they have are old enough to have fought for their home and country.

Mrs Smith has a right to healthcare. She's not a regular, she doesn't get her money's worth out of the health service, but she does pay for the Mr Jones' of this world to get the best healtcare available to prolong his sufferring.

Don't get me wrong. I'm not heartless and going to deny the Mr Jones' the right to healthcare. I like people like Mr Jones, there's almost something comforting seeing the familiar face of Mr Jones as he's wheeled through the hospital doors. Then there's the banter back and forth over a very serious subject to look forward to. I want to help. All I'm doing is supporting the ban of smoking in public places.

PS As of July 2008, there are 250,000 fewer smokers in the UK since the ban started. In the long term, that's a huge amount of money saved, although it isn't seen in the short term.

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