Saturday 27 November 2021

On Public Health

 The NZ public hospital system is in crisis. The predicted massive surge of Covid infections, with vulnerable people and the unvaccinated forming the bulk of those needing hospitalisation, could easily tip it into chaos.

If you need any sort of diagnostic procedure or are in need of some sort of elective surgery that is deemed to be non-urgent – and if you don't have insurance or the cash to pay the huge fees of the private sector – you may just have to continue to suffer.

If you are unlucky enough to have a heart attack, a serious accident etc you will be entering a system which has inadequate ICU provision even without a mass of critically ill people with Covid.

THIS is the primary reason for the controls. 

Ardern's government inherited an inadequate public health system and we cannot reasonably blame it for not reversing all the trends of the past forty years – especially not given it has been dealing with a global pandemic for most of its current term – and was hamstrung by a rightwing coalition partner in its first term. 

It's not possible to build, equip, and staff primary health centres and new hospitals in the middle of a global pandemic.

But imagine if all the money that has been poured into wage subsidies, vaccines, tracking systems, PPE etc had been invested in the creation of a proper NHS. One in which there are primary health hubs with a full range of diagnostic equipment and trained staff, a range of auxiliary services, and GPs employed by the NHS, not a privately owned practice with an eye on profit margins. Primary health centres which engage with community health issues, health promotion and disease/injury prevention. 

Well, an old advocate of a socialised, holistic health system can dream.

So this government gets a bit of a pass – but only a bit and none of those which preceded it do. And let's not forget, National has governed for most of the past forty years of neoliberal asset-stripping and diversion of state funds into private pockets.

That Covid-sceptic, Christian doctor up north who claims to care so much about his community – owns the practice, ie it's a business first, health provider second. He cares so much about his Māori community, his practice doesn't even employ a te reo speaker.

So he, and all like him, can sod off with his posturing in the robes of a defender of democratic freedoms, as can all the other medical people who are choosing, not just to be unvaccinated, but who are trying to persuade others to do the same.

Vaccination is one part of the wider approach to managing this virus. The vaccine gives degrees of protection against the Delta variant but it won't necessarily stop you getting it or passing it on. Nor will it stop other vaccine-resistant variants from emerging.

The biggest danger to the public health strategy is that among the vaccine-resisters, there will be a higher proportion of people who are sceptical about the dangers of the virus, and with that about the need for other infection-prevention and control measures, such as masking, hand washing, social distancing, scanning, etc.

Unvaccinated people are statistically more likely to catch the virus and pass it on, including to people who are highly vulnerable because of known or unknown vulnerabilities.. All the evidence points to the fact that an unvaccinated person is more likely to catch and to transmit the virus, to become extremely ill, to need ICU treatment, and to die. It might be their choice, but their choice may well adversely affect other people.

The greatest irony in all this is that the main reason for mass vaccination and control measures like mandates, is the parlous state of the NZ health service. This is not a phenomenon that can be blamed on the Ardern government alone - the erosion of the already compromised principle of free health care (I'm looking at all those self-interested doctors who refused to participate and have leapt on every opportunity since to make money out of the contract culture) – can be laid at the door of successive governments which have enabled the encroachments of the private sector and under-funded the public sector.

Treatment of people with Covid in hospital is massively resource intensive – not just in the ICU – and puts already over stretched and stressed hospital workers at far greater risk of harm. 

Covid-sceptics in Canterbury should be aware that when there is the predicted mass wave of infections as Auckland borders open for the summer exodus – we will see an upsurge down here, not just of mildly sick people, but people ill enough to need to be hospitalised and to be rated in ICU – in a DHB which has now formally closed its waiting lists for any and all non-urgent procedures.

The Canterbury DHB has been upping its triage game over the past year - refusing all diagnostics to anyone not considered by them to be an urgent / acute case. Pretty much the only way into Christchurch public hospital now will be via an ambulance or for life-saving treatment.

And, if you have a heart attack or a serious accident, be prepared to enter a system that will be diverting massive amounts of resources into treating critically ill people with Covid - a high proportion of whom will be vaccine-resisters. A large number of people with Covid will be left to isolate at home and we will see yet more deaths in that scenario. 

So for all those who will now try to blame this government for what is about to happen – if you have never bothered to engage with any of these issues in the past; if you stood by and watched a two-tier health system develop; if you pocketed profits from the sale of publicly owned assets or excused that happening; if you have refused vaccination and/or not taken other infection control measures seriously–-I very politely request that you sod off with your cynical, sceptical, or stupid claims about defending democracy.

US justice - what is it good for?

However hard Jesse Singal tries to spin the outcome of the Rittenhouse trial, using extant state and federal laws, it’s impossible to remove race or class from this situation. 

Would a black kid have had supporters who could quickly raise $2m for bail, and an undisclosed amount for a top flight legal defence

 US history does way more than suggest that a 17-year-old black kid with an assault rifle who shot three people, killing two of them, would not only NOT have been cleared on all counts, but would most likely have been incarcerated for decades. 

 

The skin colour of his victims is irrelevant because they were deemed to be left-wing / troublemakers / mentally unstable young men who contributed to their own demise by a) being there with a presumed ill-intent, and b) chasing an armed man.

 

The fact that Rittenhouse cried and vomited when he turned himself in as logically attributable to the after effects of high levels of adrenaline and fear of what would follow if he were jailed - as it is to remorse. 

 

Those who want to cast Rittenhouse as a Disneyfied, soft-focus, citizen-vigilante, too young to make good judgements, caught up in a terrifying situation and genuinely in fear of his life at the hands of those he saw as the enemy of all he holds dear …. are also logically and ethically obligated to oppose the insanity of laws and a mass popular culture which allows cognitively immature people to legally own, and carry in public, military grade weapons. 

 

A society which has a mass culture that promotes and legitimates the presence of heavily armed citizen-militias, which incarcerates more of its (poor and black) citizens per capita than any other country in its prison-industrial complex, which could house, feed, educate and keep healthy its entire population with the money it wastes on its military-industrial complex.... is a fundamentally flawed society. 

 

The side of US society that Rittenhouse identifies with, sought to protect – the side he inserted himself and his assault rifle into - is also the side that created, and which perpetuates that toxic culture.

 

I’m of the opinion that he should have been found guilty of manslaughter by virtue of his age,  been barred from owning or using a gun for the rest of his life, and been entered into some sort of rehabilitative programme rather than the hell-hole of a US prison - but such a verdict only becomes just if all other neurologically immature US citizens in similar situations, irrespective of race and/or class, could reasonably expect such a response from the courts. 

 

They can’t. And as things stand, they won’t. 

 

And a bit closer to home while we are on the subject of miscarriages of justice  – a  young man, also aged 17, also white and middle class, who drove a powerful car at speeds of up to 180 kph in city streets, who ran into and killed a 19 -year-old Chinese student, who fled the scene and conspired with his mates to lie to the police about his car having been stolen; who, when dobbed in, expressed racist views and sought to deflect from his culpability by suggesting the young woman should not have been in NZ - was charged with, and pleaded guilty to, manslaughter even though his actions were so reckless they met the criteria for murder. He “used his car as a lethal weapon” and “drove at insane speeds”-  the Judge’s words – but got a five year sentence, and was out in under two.


The reason for the charge of manslaughter was he was white, middle class, driving a car, and deemed by the cops to be too young to fully comprehend the consequences of driving in that fashion so no jury would convict him of murder.


Second scenario involves five young brown, poor people, the oldest 17 and youngest 12 - who staged a classic horizontal crime of robbing a pizza delivery man, also ethnically Chinese. They hit him on the head with a baseball bat, robbed him; took him back to his car unaware that he had a brain bleed, and because no one nearby came to his aid or called for help, the poor man died.


Utterly tragic on every level.


But did the police or the courts consider that those young kids might have been incapable of fully understanding the consequences of their actions – especially in a society in which kids are assailed constantly with images of people being bashed on the head with no resulting brain damage or death? Were they that much more culpable than the car driver that their actions constituted murder?


Aggravated robbery – causing bodily harm or death in the commission of a robbery always carries a heavier tariff because our society places such a high value on protection of property. 


Causing injury or death by dangerous driving is often treated more lightly because of the high social value our society places the right to drive, a value driven by the lobbyists  pushing the huge economic interests of the car and petro-chemical industries. In the neo-liberal era, there is a greater need to drive because of the erosion of public transport and growth of satellite communities.


It was no accident that those kids were Māori and poor. Nor was it an accident that the media talked up the crime shamefully lurid, tub-thumping, amygdala-exciting terms.


Similarly the trial of Lipine Sila. His reckless actions caused immense harm and ended two young lives, but I have no doubt that had Sila been the scion of a white, affluent Christchurch family and his victims been two working class brown girls, the charge would have been manslaughter plus ABH and he would have got a lighter sentence than life with a mandatory non-parole period of 18 years.  Nor would we have had the local newspaper covering the prosecution case in terms that eventually drove the judge to order them to tone it down – in time for the defence case.

 

Rittenhouse is a victim in a sense. He’s a kid who has bought into the American dream and constructed a scenario in which the angry young people drawn to antifa are his enemy, while heavily armed, right-wing militias are his patriotic allies.