Healing and kneeling

ROSEMARY MCLEOD – THE SUNDAY PROFILE
Last updated 05:00 06/11/2011
willswide
KEVIN STENT/Fairfax NZ

DR RUSSELL WILLS: He divides his time between being commissioner for children and a practising paediatrician.

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A childhood accident offers a clue to the way Children's Commissioner Dr Russell Wills connects with kids who are isolated and vulnerable.

I mean no slight to the new commissioner for children, Dr Russell Wills, when I say he may be almost hyper-normal, an advertisement for what could happen if every child had benevolent parents from benevolent extended families, in which children, quite naturally, came first.

Possibly he is himself unaware of how rare that is, and why I hesitate to call his upbringing normal, though in his role as a paediatrician he has seen a great deal of unnecessary suffering.

He seems the very kind of person who should work among families with severely sick children. He radiates a natural, benign optimism, a calm belief that parents really do want what's best for their kids, however much poverty, addiction, overcrowding and violence might get in the way. Wills is not a big man and it seems a little ironic that he sports the white ribbon on his jacket lapel of the men who take a stand against violence against women. He has, of course, never raised a fist against anyone in his life.

"I win all my fights by 100 yards," he jokes – but he knows what other men are capable of, because he has seen it. The difference between him and most of us is that he still doesn't judge, and so he earns trust, the first step towards co-operation.

That background: "Mum was a physiotherapist and Dad was a chemist. When I was little I had a fractured skull and had a lot to do with paediatricians, so that's probably what influenced me in my career choice. With Mum and Dad there was a tradition of service, and my wife's parents are the same. My grandfather was a bank manager involved with the Napier Cathedral, and Nanna was in women's groups and Plunket so Mum was, too, and Dad was involved in Jaycees and Lions." Wills' wife, Mary, has two master's degrees and also works in the health sector. They met at university.

"I was the eldest of three children, Church of England and Sunday School from the very beginning. The family was pretty ideal, I was pretty lucky. Mum and Dad are 75 and 72, still together and still with us; they live opposite us. We spend a lot of time together. Our boys, Dad and me will be chopping wood, three generations together. That's nice." He admits this is hardly ever what he deals with in paediatrics: "I've been with poorly resourced and supported parents all weekend."

WILLS WAS the head of paediatric services in Hawke's Bay before he took on his new job in July, and still works part-time there seeing children who are acutely unwell and hospitalised. One weekend in seven he is in charge of acute admissions on his home turf, and he's on call there one night a week. Plainly, he loves the work.

"The commonest things are respiratory problems and infections. Three-quarters of admissions are children under five, and three-quarters of them are Maori and Pasifika, the bread-and-butter of paediatrics.

"This [respiratory illness] is not genetic. When you take the effects of poverty away the problem almost disappears – and with Pasifika people there's also the effects of crowding – poverty, crowding and cigarette smoking. The rate of chest infections among Pasifika children in Hawke's Bay is nine times the European rate, all at under one-year-old."

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But this isn't just about the specific illness. Wills and his team take a wider approach to their work, finding out what affects the safety and welfare of their small patients and their families, like asking about insulation and heating in their homes, and referring them to available help. He says his was one of the first district health boards to ask about cigarette smoking at home, and dispense nicotine replacement medicine to parents direct from the ward. "It's highly successful," he says. "People love their children. And that's a good time to tell them they never want to have their children in hospital again, and neither do I. You hardly ever get a defensive response from a parent late at night with a sick child. Eighty percent of [smoking] parents are given a nicotine patch there and then so they can stay with their baby. Even if they take it off when they go home, you've still done them a favour. Maybe 25% will stay off cigarettes."

This team will also ask about domestic violence in the family, and refer mothers to refuges or CYF for help. "Mothers don't mind you asking so long as you're sensitive and you take time."

Cigarettes also feature as a cause of glue ear. The rate of glue ear in the region's decile one schools runs at 30%; in some schools at 50%. Rather than inserting grommets, which are often ineffective, into the ears of new entrants, Wills advocates giving teachers the small, no-hands mikes used by singers, coupled with speakers in every corner of their classrooms. He says even the children with good hearing benefit from the result, with an overall improvement in language and literacy. It's this kind of careful and thoughtful approach by teams working with Wills and his colleagues that has led to a two-thirds drop in child admissions to hospital in his area from non-accidental injury. It's the kind of practical approach he's advocating for everyone who works with children at risk, and you can see why it would impress politicians. "It doesn't need to cost a lot. A lot is fixable through not smoking, and clinicians asking the hard questions."

It's also about breaking down barriers so that there's information-sharing between the various agencies working with children. Wills is conscious that he may be advocating turning privacy law upside down, but there is precedent in New South Wales when it comes to the care and protection of children and young people.

"A very few skilled people who talk to each other often can make huge changes happen. I've seen kids who were just feral transform their behaviour when a small team has a single plan."

Wills seems to have a gift for cutting to the chase, and for turning questions upside down. "Some people talk about people being hard to reach. I take the view that it's not families that are hard to get to, it's us. You've got to deliver service to people where they are – in schools, marae, kohanga. Families are changing, and you've got to keep up. If all we did was administer antibiotics and send our patients home, we'd be missing the point, and missing an opportunity."

SOMETHING PROMPTS me to return to the mention of the fractured skull in his childhood. It happened, he explains, when as a three-year-old he watched his father hammer a nail into their garage wall. With his father's back turned, three-year-old Russell clambered up with the hammer to do the same, but fell back onto the floor. Four years of total deafness followed. His mother had to fight to have him accepted into mainstream schooling, and he remembers being strapped on his first day at school for being in the toilet and not hearing the bell signalling the return to class. "She [the teacher] knew I couldn't hear," he says, without apparent bitterness. His hearing was restored following neurosurgery when he was seven.

Four years of a silent world, but strangely, Wills can't remember what it felt like to suddenly hear again. He puts that down to having a loving and supportive family, and therefore a strong sense of security. "You pick up the clues as you go along," he adds, explaining how he would copy what other children were doing, and learnt to lip-read – luckily he already had a good vocabulary when the accident happened. He doesn't read much into this childhood experience, but it seems to offer a key to his approach with children in his care. He knows a bit about what it's like to be isolated by difference, and believes implicitly that with good will, all children can have a better life. Right now he is seeking feedback for the government's Green Paper on vulnerable children, and for his suggestions for change.

He is new to Wellington, big-picture politics, and the corridors of power – hopefully he'll be a fast learner.

"If you were to photograph me at work I'd be on my knees," he says, explaining that this is how paediatricians get onto a level to communicate with their patients.

Now 47, he admits that all that kneeling is starting to hurt.

BIOGRAPHY

Lives: Hastings with his wife Mary and two sons.

Education: Trained at the University of Otago Medical School in Dunedin and Christchurch. Began paediatric training in the United Kingdom, then gained a Master of Public Health degree, in Brisbane.

Career: Returned to New Zealand and took up the roles of national paediatrician for Plunket, senior lecturer at the Wellington School of Medicine and community paediatrician at Wellington Hospital. Back in Hawke's Bay, he became a general and community paediatrician at Hawke's Bay Hospital. He was head of the paediatrics department before becoming children's commissioner.

THE GREEN PAPER FOR VULNERABLE CHILDREN

A Green Paper is a document a government produces when it wants feedback from the public before it decides on policy. New Zealand was rebuked by a United Nations committee in February this year for our "staggering" rates of child abuse and poverty. Our rate of child abuse is among the highest in developed nations, and one in five Kiwi children is defined as living in poverty. "Despite hundreds of millions of dollars invested across health, education, the benefit system, Child, Youth and Family and the justice system, public services have too often failed the children who need them most," Prime Minister John Key says on the first page. "Just throwing money around will not improve the lives of these children." The Green Paper lists areas of the government's concern, and outlines some proposals for improving services to vulnerable children, including improving care and protection services, and access to early childhood education. The deadline for feedback is February 28 next year.

- © Fairfax NZ News

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