A city's winter of discontent
Freezing temperatures, drafty quake-damaged homes, overcrowding and exasperation with the repair agencies will take a toll on the physical and mental health of Cantabrians this winter. BECK ELEVEN reports.
Winter officially starts on Friday but Jack Frost has already knocked on the door and wiped his feet on the welcome mat. The nights are cold, the mornings are frosty and it feels like you're never home in daylight.
Add that damp and dismal combination to our traditionally poorly-insulated homes (with extra cracks and drafts from quake damage), overcrowding due to lack of housing, creeping unemployment, frustration at the agencies tasked with fixing the city and a generally worn-down population, and the coming months are looking bleak.
Earlier this month, Canterbury District Health Board chief executive David Meates told a parliamentary select committee that the region's health system was "running on a knife edge", with population-based funding looking to take a $16 million hit this year because of an exodus after the quakes.
He told the committee there was "a real risk that parts of the system could fail".
"We still have broken buildings, capacity that was already stretched is on a knife edge and winter is coming," Meates said.
The CDHB has a yearly budget of $1.4 billion out of which it must juggle funding for 131 general practices, 116 community pharmacies, 109 dentists, 105 aged care facilities, 56 mental health providers, Princess Margaret and Christchurch Hospital.
The hospital is already running near 95 per cent occupancy, which gives little wiggle room for the peaks of winter - the international benchmark is 85 per cent.
It is down from 572 surgical beds to 541 and the challenge remains to complete repairs without impacting on services.
Canterbury is also the region with the largest ageing population in the country.
The health board's big push as Christchurch enters its second winter since the February quake is for people to stay warm, have flu shots, and see their GP early to make a health plan if they have a chronic ongoing medical condition.
Winter will also bring the usual nasties such as cold and flu. Low temperatures create cardiovascular stress, and people with chronic obstructive airways disease generally take up about two hospital wards (more than 50 beds).
Then there are the mental health problems.
Rosie, a 41-year old Christchurch professional who does not want to be named, says she already suffered depression for which she took medication but life took a dive following the September quake.
"It was like the last straw," she says.
"I was struggling at work anyway but, in the end, I couldn't even get out of bed. I was like a car that had run out of petrol."
She believed there was no way out of the emotional cul- de-sac and eventually confided in her sister that she'd been thinking about killing herself.
"I wasn't even aware I'd gotten to such a bad point. It sneaks up on you."
Her GP changed her medication and advised her to take time off work.
"It was the hardest email I've ever had to write but their reaction was really good."
In the February quake, Rosie was stuck in an inner- city office block for hours waiting for rescue.
"I became more anxious after that but I coped with the depression. The thing that gets me now is that I feel like my whole world has shrunk. I used to go to Lyttelton a lot. I don't even do that any more.
"I went to Wellington but I didn't enjoy being there so I won't go again. I used to travel once a year but I don't want to go to the Pacific islands, or anywhere earthquake prone. I wouldn't go to the West Coast and I certainly won't drive through the Southern Alps. The stupid thing is that I feel like Christchurch is the safest place for me because at least I know what quakes feel like here. That's so f..... up."
Christchurch clinical psychologist Dr Fran Vertue says there are a group of people whose mood deteriorates in the darker months. Known as Seasonal Affective Disorder (SAD), it is regarded as a type of depression related to lack of sunlight.
Vertue advises people to make sure they get a dose of sunshine as often as possible, whether that's a quick walk at lunchtime or a seat in the wintry sun.
"People need to take care of what I call the four cornerstones of health: sleep, nutrition, exercise and, the one that people often forget, pleasurable activities.
"The reward centres in the brain grind to a halt otherwise. You might even need to schedule them in - people need something to put a smile on their dial. If you can take care of these things, you are doing something to mitigate the effects of winter."
While anxiety-related problems appeared early on in the quake sequence, depression is now more prevalent in Christchurch.
"The unremitting nature of the stresses, from the aftershocks to insurance woes, means a larger number of us are heading into winter in a lower mood.
"When anxiety and stress continue over a period, you are on the royal road to depression. If people are experiencing a low mood or levels of agitation it might be related to the earthquake, it might not, but it makes sense to exclude the possibility.
"Particularly men, they have been stalwart for so long it sneaks up. Intellectually, they might say they are fine but they may feel tearful at times or that they are distancing themselves from their partner and family and cutting themselves off socially.
"To them I would say, go and have one session with someone, if that's not the problem, they can tick off that box."
Dr Caroline Bell works with the anxiety disorders unit and has been clinical head of a specialist mental health service since it was set up last winter.
She says more people are seeking help.
"It's the ongoing nature of difficulties, people relocating, travel is more difficult and all this contributes to significant changes in people's personal arrangements. All these changes are going on in a lot of people's home environment but they have to carry on working.
"What is presenting is a kind of 'worn down-ness' and fatigue. High levels of stress and juggling balls that are not in your control over such a prolonged period makes your body tired. People swing between good days and bad days. They feel so tired so they think there must be something physical wrong.
"Keeping connected and talking to people helps immensely. Local activities do make a big difference so people can see the Christchurch they once loved is still here."
There is no denying the region reached for the bottle to cope with stress. Bell says the instant gratification of alcohol and takeaways helped initially but, without vigilance, these things become the norm.
"We lost our structure, people felt like there weren't any places left to go. The beaches were shut, hill walks were shut but so many of those things have re-opened and regaining those habits takes effort.
"No-one is perfect and slipping is perfectly fine but you have to know when to pull yourself in again."
Canterbury District Health Board member Andrew Dickerson fears that while suicides dropped in the aftermath of the quakes, the number will rise.
"I have lived in the eastern suburbs for most of my life and while poverty was always evident, I have never seen it before on this scale. My perception is the situation is worse. I expect to see more people accessing health services as the months go on. I also fear we may see a rise in suicides.
"I never thought I would live to see some of the conditions people are living in. Some still don't have working sewerage and are living in garages. It doesn't sit well with me.
"Most people have coped remarkably well. Now we're seeing ongoing stress, not only because of aftershocks but because of interaction with the agencies that are supposed to be helping us recover.
"People feel down and demoralised and powerless because of terrible bureaucracy. Badly damaged homes and chronic health issues are a very dangerous combination to be going into a Christchurch winter in."
Dickerson says he is proud of the performance of the CDHB and the public health sector but believes CERA and EQC are failing.
"These stress levels have very little to do with an act of God any more. The single worst thing since the quakes has been EQC giving highest priority to houses in the least affected areas.
"When I hear about people's houses being fixed when they have minimal damage or their holiday home in Akaroa being done while people live in squalor, I have to question the morality and the integrity of the people who are allowing this to happen."
The link between housing conditions and health is the speciality subject of Professor Philippa Howden-Chapman from the Department of Public Health at the University of Otago, Wellington.
Howden-Chapman says the death rate should be indifferent to seasonal change but an estimated 1600 more people die during New Zealand winter.
Her group, He Kainga Oranga, the Housing and Health Research Programme, will release an evaluation next month, with early results confirming the relationship between insulation, warmth and reducing premature deaths in older people.
It also shows homes with insulation and heating provide a "significant improvement" in health and days off school in children.
"And it is really important for Christchurch because so many houses are already hard to heat and in a bad state of repair.
"It's not a way to bring up babies and people coming home from hospital shouldn't have to stay in bed just to keep warm.
"There's no way people can stay warm and sleep properly if they're in an overcrowded house or a garage while maintaining their privacy and relationships."
While much of the health focus is on the more vulnerable demographics of the very young and the elderly, youth health physician Sue Bagshaw warns it will be dangerous to forget teens and young adults.
She is seeing under-25s using alcohol and drugs.
"You can't ignore this group of people because the damage will be done. They won't be OK as adults because the brain is still developing and you can't throw alcohol at it."
Another concern is their ability to pay for a doctor's visit, especially as youth unemployment has crept higher since the quakes.
But despite concerns, CDHB chief medical of health Dr Nigel Millar says the ideal is still to keep people out of hospital.
"We're not trying to deprive people of hospital but we don't want to bury money in the hospital when we have services such as GPs, rest homes, community nurses to take care of. Often, when people are in hospital, their kids might be thinking 'thank God they're in hospital' but the people themselves don't think that, they want to be home.
"Well, that is the dream. Martin Luther King said he had a dream, he didn't say he had a wonderful plan and a cost-balanced benefit."
The board has created programmes to assist people in homes before they need hospitalisation or to help them after an early release.
A drift west and drop in population is a point of concern because while the CDHB is doing a good job remaining "on message" in terms of spreading the word on vaccinations and keeping warm, one CDHB insider says people continue to be dropped from waiting lists, which will result in a deterioration of faith in the system.
"The GP might refer a patient to a specialist but the specialist simply refers them back to their GP.
"The GP thinks it's not worth sending them back and expectation slips because the patient doesn't care about their own health either. It's the trickle-down effect.
"And what about people who don't even live in houses? We've got people living in cars and a transient population, many of whom no longer have permanent addresses and are unable to be traced by their local GP."
The source said it was all very well the board having plans and flow charts but they did not translate into a practical situation.
Millar says frail, older people become insensitive to temperature and might benefit from a thermometer in their living room so they can keep the room at 18 degrees Celsius. And under-18s now qualify for a flu vaccination, so they should make sure to get the shot.
Planning and funding manager Carolyn Gullery says financial forecasting is "almost impossible" in an environment of such fluctuating populations, but with a reasonably gentle influenza situation in the northern hemisphere they are not panicking yet.