Guest blog by Dr Tammy Pegg, Nelson Marlborough District Health Board cardiologist and advance care planning advocate
Advance care planning has the potential to build bridges between you and your health care team at a time when COVID-19 is destroying them.
This virus has re-imagined our world, but in Aotearoa for the last 18 months we have lived in our own bubble of 5 million in the South Pacific quite separate to the reality of this disease and the real experiences of our partners and friends around the world.
But our time may have arrived; we must be humble before Aituā (atua of disasters) as he can rain a fierce storm of this pandemic down upon our people.
Vaccination is certainly the best way for our communities to prepare but even with vaccination rates approaching 70 percent of our population, 1.5 million New Zealanders are left unvaccinated and vulnerable to this deadly and disabling disease. Watching the UK with similar vaccination rates, and following its current rates of 250 deaths and 40,000 new cases each day, presents sobering statistics for all of us; and although the UK is more populated (60 million compared with 5 million here), 25 deaths and 4,000 cases per day remains a frightening prospect.
The reality of an overwhelmed health service
The reality of a health service becoming overwhelmed with COVID-19 patients is dawning upon health care workers. We are worried, but most of us are already protected from the virus by vaccination so our fears are different to those in 2020; we are not worried about ourselves or succumbing to the virus – we are worried about you and the impact of the virus on our ability to look after you and your whānau. Importantly this is not just about COVID-19 infection; you may also be protected by vaccination, but as our health services become overwhelmed you may not be able to access treatments, surgeries or your GP like before. You may already be experiencing this reality arising from the impact of previous lockdowns. We are just understanding that it may take years to catch up.
Access to health services is not the only thing affected; your health care team will be stretched, stressed and tired, and in these situations we tend to default to a battle mentality. Our empathy diminishes by the constant demands on us and the repeated experiences of tragedy. But more than this, our increased use of digitial technology and telehealth creates a virtual barrier between us, which, like mask-wearing, has left human connection sacrificed at the altar of slowing the spread of the virus.
Advance care planning in 2021
Doctors, nurses, midwives and other health care workers need reminding of you as a person, the person that sits underneath your health conditions, your āhua, essence and needs beyond health. What are your goals, priorities, worries? What helps you through tough times and what are you prepared to endure for the possibility of better or more? This is advance care planning in 2021.
An advance care plan is a way for people to think about, talk about and share what matters to them now in case someone needs to speak for them in the future. Advance care planning has been around for 30 years and its focus has previously targeted those who need to plan most – those near end of life. In our rapidly mobile communities where connection with the health care team is fragmented, you have to repeat your story so many times to so many people. But advance care planning has evolved as a tool for you to communicate rapidly to many about what matters to you for your health care journey.
Advance care planning builds bridges between you and your health care team
Advance care planning has the potential to build bridges between you and your health care team at a time when the virus is destroying them. Advance care planning brings you alongside in your own journey. Doctors and nurses often struggle to talk to patients about what is important to them, what may lie ahead in this illness and what the other side may look like. No time is more important for this conversation than now as COVID-19 hospitalises people for months and those with long COVID require months of rehabilitation. Advance care planning gives you the ‘in’ to guide your health care team as to how you want to be treated and what you want the future to look like after this episode. It also gives the doctor or nurse the ‘in’ to give you an honest assessment of the possibility of that.
The proverb ‘The best time to plant a tree was 20 years ago, the next best time is now’ has application here. Advance care planning was best done well ahead of this emerging crisis, but the next best time is now as part of our preparation as a country, as a community and as a person for what may lie ahead. Go to www.myacp.org.nz for more information.