GP and poet Glenn Colquhoun: 'Every week I hear at least one story I thought was not possible.'
I am a GP. I work for a youth health service in the Horowhenua. The area I cover passes from just north of Foxton to just south of Levin and reaches inland to the foothills of the Tararua Range. About 30,000 people live in the area and almost a third of these are under 24 years of age. There are three main high schools and two alternative education providers. Maori are 20 per cent of the population and 20 per cent of the population are older than 65.
The median income is $18,500, and 52 per cent of people in the area live in the bottom three socio- economic deciles. The main industries are farming and horticulture.
We have high rates of domestic violence and youth crime and youth pregnancy. We are young and old and white and brown and small-town and rural and relatively poor, but the sun still rises and sets. You can get a good home for $200,000. The Tararuas blanket in snow every winter. We have great vegetables, an excellent range of second-hand shops, the best A&P show in the country and a fabulous Christmas parade.
You can get RJ's Licorice at knockdown rates and people love their children but sometimes get stuck.
It can be difficult to see a doctor where I work.
There are lots of reasons for this. One is that people cannot afford it. Many of the young people I work with don't have $5 for a prescription, let alone $30 or $40 for a consultation. They especially don't have the $60-plus they would need for an after-hours appointment. When the median income of a region is $18,500, the money left to households after bills such as rent and power and phone-lines are paid is often less than $100.
There are not enough doctors to go around, so that those who are there are full and close to overwhelmed on any given day and need to create obstacles to seeing people. "You'll need to speak to this person who'll need to speak to this person who'll need to speak to this person" screens the less persistent out. People often owe doctors money, which means they cannot be seen or are too embarrassed to be seen. Those who are acutely unwell struggle for an urgent appointment because these appointments are taken by those who are chronically unwell. If you do manage to see a doctor, it might not be the same one you saw last time or the time before that because we are reliant on locum doctors to cover the gaps.
Doctors of course have a degree of complicity in all this. We are among the highest-paid beneficiaries in the country. Our patients have spent a quarter of a million dollars educating us – the equivalent of someone being on the sickness benefit for 10 years – but often this means we simply leave the country to ply our trade somewhere else, or shift out of the communities we work in, so that the medicine we practise is bussed in from more affluent suburbs instead.
It can be easy as a GP to become locked into a death spiral. There are not enough of us and we are busy and our patients are complicated. We do not have the time to ask the questions we know we should, and something in us flies away. All that is left to make the job slide down more easily is to be paid more. But this means that we need to see more patients to justify our wages, which means spending less time with them. Slowly but steadily we begin t price ourselves out of the caring market. In order to cope we consider ourselves consultants and introduce our patients to nurses who are cheaper, and we become more unhappy because in all of this it is our patients who look after us but we don't slow down enough to connect to them.
The young people I see come to me for many reasons. They are worried about their skin. They have sore ears or throats or stomachs or knees. Sometimes they wheeze or cough. They might want to ask me about contraception. Often they are sad and in trouble. Mostly I listen.
Every week I hear at least one story I thought was not possible.
Listening to someone's story is not a benign activity. David has lived in a bus stop. No matter how removed he is from that life now, he tells me he still wants to bring his children up in the same schools he went to. Not because they will give them greater opportunity, but because he knows they will learn to fight there and become fearless. Fearlessness is an important value where he comes from.
George was placed in the custody of seven different caregivers between the ages of three and four, a disruption that still haunts. Left alone in the house from 10 to 14, Aroha was continually abused by her stepfather. Stephanie's dad buys synthetic cannabis with the allowance he gets for looking after her. There is no food in the fridge.
Colin was abducted by men in a van at the age of seven and Sonia was raped at 10 by three men in a park.
These stories are real and relived and only a small fraction of those I have been told in the last few years. They are always central to the health of my patients and they are always open-ended and unfinished. They are rarely volunteered without some sacrifice and pain, and they often leave the teller raw and vulnerable. In short, they are sticky.
Medicine requires me as a GP to assess and refer these storytellers and sometimes to give them medicines, but more often than not they do not take the medicines and more often than not they do not get to appointments I referred them for. If they do get there, then many times they do not know what happened when they did. They acquire labels they don't understand, tell their stories to people they rarely see more than once or twice, and return to me less certain that big people have any idea what they're doing.
More tragically, they return thinking things haven't worked so they must be the problem.
Societies are a collection of shared symbols and beliefs. They don't work otherwise. We agree that the law is the law. We agree that money has a certain value. We agree that people own things: televisions, cars, property. We agree that performing a certain job should earn you a certain wage. We agree that the country is the country and the government is the government. All of this floats on a cloud of assumption that over time has come to be unquestioned and forgotten.
Poverty in New Zealand is not really like poverty in Africa or in India and so it often ends up being argued about. In New Zealand poverty is really another word for inequality. And the problem with inequality is that it is a risk factor for disengagement.
If you don't think you have a shot at those things everyone else has a shot at, then why bother? In the young people I see who don't go to school any more and who roam the streets at night and who huff butane or smoke cannabis or drink themselves rotten every weekend, it is this disengagement I fear most.
Because it will damage them and it will damage you and me who still believe that the country is the country when one day the brick in the wall they beat their head against is ours.
Extracted from Late Love: Sometimes Doctors Need Saving as Much as Their Patients, by Glenn Colquhoun (Bridget Williams Books, $15).
- Sunday Magazine