Postcards from the Edge #3

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This postcard comes from Brendan Marshall, a rural doctor on the Westcoast.

On Wednesday night I finished War and Peace. It’s a book I’ve always wanted to read and had finally got round to getting started at Christmas. I couldn’t help musing how the world of work and indeed so much we take for granted had changed in that three month period.  Part of the book’s beauty is watching the characters endure extreme experiences and emerge at the end as changed people. It has felt, needless to say like many of us on such a journey ourselves.

Across the country you will have caught up with the news that it was Greymouth Hospital where the first COVID death has occurred.  So what lessons can we add for those of you across the country holding the rural health system together.

  1. Trust your intuition. COVID was suspected on admission in the Greymouth patient The case was de-escalated on the basis she didn’t meet case definition) and would “be an unlikely index case” following advice from ID in Christchurch.
  2. Remember the old adage in rural health. You know more than anyone else about your patient ‘at that moment’ because you are the one providing the care, whether they are in your clinic room, hospital or ED.
  3. Have your COVID environment ready to go now! We’d ‘planned’ and talked about it but were falsely reassured as we only had one positive case and often feel ‘isolated’ on the coast. Well guess what happened to the second case!!
  4. Practice PPE. Practice PPE.
  5. Not just intubations or arrests but the patient journey from front door to back.
  6. Keep communication pathways clean to avoid duplication and mixed messages.

We will emerge from this crisis.

As a network of rural clinicians we must be heard and be the advocates for our patients and health services.

In Tolstoy’s epic there is a strong message about leadership. It’s not necessarily going to be about us leading our teams with a logical plan, but adapting to the flow of events and thinking on our feet. None of us can control much outside our immediate sphere at the moment. But as rural practitioners we can remain connected. All the while we’ll continue to serve our patients, look out for our peers and ensure those we hold dear are kept safe and feel secure in uncertain times.

Keep safe everyone.

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