Tag Archives: Book Review

A reflection on Rising from the Rubble

Nine years ago in my office above the main entrance to Christchurch hospital I was hiding under my desk pushing back at furniture on wheels (whoever thought that was a good idea in New Zealand!) and generally avoiding flying objects. This weekend we remember that February day in which an earthquake cost many their lives and many more their health, their homes and their livelihoods. All who live in Christchurch know that the events of that day and the days afterwards still are with us today. For many of us our homes are still broken. Sadly, many have had their mental health suffer too. When I extracted myself from the office and got down stairs, I watched as the first of the injured arrived in cars and on the back of the utes. As the staff of the health system geared up, I, merely a scientist, wandered off home avoiding the liquefaction and inspecting broken buildings on the way. Recently, I have had the pleasure of reading a book written by a scientist and an emergency physician that has opened my eyes more to the incredible system and people who work in it that we call the Canterbury’s health system.

Rising from the Rubble: A health system’s extraordinary response to the Canterbury earthquakes, has been written by Professor Michael Ardagh, an emergency physician, and Dr Joanne Deely, a scientist. It is published and available through Canterbury University Press.

Rising from the Rubble is indeed an extraordinary story.  It is written in a very engaging manner – purposely with anecdotes and quotes from interviews, but not without athe science and facts and figures to back them up.  The authors’ aimed for the book “to be not only a public record of the Canterbury health system’s response, but a celebration of it.”  They have certainly met that aim.

The book covers a very broad range of response, both in the immediate aftermath of the quakes, but also the ongoing dealing with the myriad issues the quakes threw up for the health system and those involved.  

You will read of courage and heroes (have your tissues ready): 

“We were scared … We were running out and we were hit by a wave of people running in to the building [Princess Margaret Hospital]! They were all staff.  I couldn’t believe it”

You will read of competence and professionalism: 

“speaking calmly and quietly she directed resources to where they were needed”

Dr David Tolley, President of the Royal College of Surgeons, Edinburgh who was in the ED on 22/2 speaking of Dr Jan Bone

You will read of what can be done when it has to be done:

“So we just gave him [a builder son of a GP] the work credit card and he got reticulated water going to about 12 or 13 of the practices in the east and south areas of Christchurch”

You will read of leadership

“He [Dr Nigel Miller, Chief Medical Officer] said, ‘ What are you going to do?’ And I said, “Well we already know what we are going to do.  We are going to get everybody [needing dialysis] out”

Dr David McGregor, Clinical Director, Nephrology Department

You will read of collaboration

“The friendships, connections and collaborations that were forged during the period of integration between Canterbury Health Laboratories and MedLab staff will remain.”

Kirsten Beynon, GM, Canterbury Health Laboratories

You will read of aroha:

“I asked the Maori community if we could include the Asian and migrant communities because they would be outside, to which I got an immediate agreement”

Sir Mark Solomon, Te Rununga o Ngai Tahu

Of course, there is much more.  We were truly blessed by a health system that was so well interconnected and replete with individuals prepared to do what it takes.  While, the consequences of the earthquake remain this book is a reminder of what was and what can be done by people with the right motives and skill.  Dr David Meates, CDHB Chief Executive speaks not of recovery, but of transformation.  This book will be a record of a time of rapid transformation as well as a tribute to all those involved. Do read it.

The Treatment of Kidney Failure in New Zealand

I am delighted to introduce a guest post from Dr Kelvin Lynn. Dr Lynn worked as a Nephrologist at Christchurch Hospital for 35 years and retired in 2015.  He is the lead author for a book just published:

The Treatment of Kidney Failure in New Zealand

Authors: Kelvin L Lynn, Adrian L Buttimore, Peter J Hatfield, Martin R Wallace 2018

ISBN PDF – 978-0-473-45293-3

Available at no charge at www.kidneys.co.nz/Kidney-History from 16 October 2018.

Dr Kelvin Lynn and his fellow editors tell the history of the treatment of people with kidney failure in New Zealand; beginning in the early 1950s this story encompasses remarkable experiences of patients and their families, and of the contributions made by dedicated health professionals. It also reveals the challenges and ethics of meeting an ever-increasing demand for treatment.

New Zealand doctors were early adopters of new dialysis technology. The first peritoneal dialysis (PD treatment in New Zealand occurred at Wellington Hospital in 1954. Two young doctors tried a recently reported treatment using homemade equipment – classic Number 8 wire technology. Dr Neil Turnbull was a medical registrar in 1954 when he admitted a pale, vomiting, dehydrated 24-year-old woman who had not passed urine for the past nine days. Fifteen days before admission she had tried to terminate an unwanted pregnancy by infusing a Dettol solution into her cervical canal. In spite of rehydration with blood and five per cent glucose she became comatose. It was then that pathology registrar, Dr Dave Reid, suggested trying PD, which he had recently read about in the New England Journal of Medicine.  After mixing 20 litres of a glucose solution in sterilised glass bottles they had to stop as the solution had caramelised. They supposed the autoclave (steriliser) had been too hot and were proved right when after the autoclave temperature was reduced the new glucose solution remained clear. This was not the end of their technical problems, however, for after running two litres of the solution through the polythene tube that they had inserted into the right iliac fossa with a trocar and cannula, there was no drainage. Undeterred, they pulled the tube out and established good drainage by pricking holes in the tubing with a hot 22-gauge needle. After three days of peritoneal dialysis the patient began passing increasing volumes of urine and then regained consciousness. When last seen by Turnbull in 1992, she had normal renal function.

This book recounts the contribution of doctors, nurses, technicians, and patients and their families to the story of kidney treatment in New Zealand. Social and political changes in our country since the 1950s have critically influenced the development of treatment services for New Zealanders with kidney failure. The improvements in technology and community expectations regarding access to treatment over the past 50 years are discussed as well as the issues for patients and families coming to terms with kidney failure and its treatment.

This story is illustrated with many anecdotes and historical photographs.

  • The experience of living a life with kidney failure is recounted from patient interviews.These stories are a testament to the bravery and determination of these individuals. Rob Brydon’s story demonstrated what ordinary people were able to do in the face of kidney failure.

Rob began home haemodialysis on 31 August 1976 just after getting married. After two failed transplants, the second from his brother Nev, he remains on HHD over 40 years later.  Most of this time, he worked full-time. Following redundancy in 1993, he started his own painting business which he ran for ten years until he had both legs amputated below the knee, bringing this to an end. Rob had a profound anaemia as the result of having both his kidneys removed to control his high blood pressure. He built his own house while his haemoglobin concentration was only 40 to 50 g/L, and subsequently Rob was one of the first patients in New Zealand to benefit from erythropoietin treatment for renal anaemia. Rob remembers the burden of having to reuse dialysers and blood lines and the unpleasantness of using formalin for sterilisation. His advice to other dialysis patients is to “try to keep your life as normal as possible.”

  • There are chapters devoted to the professional development of renal nurses and dialysis technicians who have played a key role in the progress made in kidney treatment. Nurses were important members of the early clinical teams who pioneered dialysis treatment. Now renal nursing is an established nursing specialty. Hospital technicians who maintained the early dialysis equipment quickly took up clinical roles, particularly in training patients for dialysis at home.
  • There is an account of the trends and statistics of dialysis treatment in the past and a chapter discussing where dialysis treatment may go in the future.

The first home dialysis machine used in New Zealand Drake Willock 4011 1972

Enquiries to kidneyhistory@gmail.com

 

Toms River

TomsRiverToms River is a mystery. Not a mystery about the missing apostrophe, though that does warrant a thorough investigation. Rather, Toms River is a forensic mystery, an intrigue of science and health, of the marvels of chemical manufacturer and of the mischievousness of chemical pollution, and finally of that old conundrum of correlation verse causation. The writing flows like that of a well written novel – good enough that one forgets at times that it is not fiction, but a story about real people and real events. At the nub of the mystery is that so human of all questions, “why?” Why does my son have cancer? The answer provided in Toms River is neither sensational nor simplistic. To try and get near an answer the author must explore the histories of dye manufacture, cancer biology and epidemiology. In that way he provides the skeleton around which the flesh of the events of Toms River throughout the past few decades is built. He does this in a way that is accessible to anyone with a modicum of curiosity. No math needed! Yet the author doesn’t shy away from talking about the difficulties of epidemiology, modelling of water flow, and cell biology.

Some of what you read will shock you, some will enlighten, some will inspire. Five stars.