Dialogue: No use saying healthcare is okay when it isn't

By CHRISTINE RANKIN

For a second time in a few weeks I feel hugely frustrated by the public health system. Since commenting on the cases of women in some parts of the country who required a mastectomy because radiology services were overloaded, I have received letters from many women telling of their plight and their fears.

It doesn't make for happy reading, especially as I prepare for my annual mammogram.

While my feelings about this have intensified, public reaction has dissipated and the minimal media coverage amazes me. It is as if these are personal and private matters that we all know go on but would prefer not to know unless they affect us.

The most frightening aspect for these women is being presented with few, if any, choices and the indignities foisted upon them.

The most distressing stories have been from older women, who seem to be the most reluctant to complain or question the suggested treatment or the lack of alternatives offered. One woman, in her late 70s, believed she had her breast removed needlessly. She was distraught at the lack of understanding, discussion and choice.

She had been told she had the most invasive type of cancer and that there was no choice but to have a mastectomy. After the operation she was told that she had actually had the least invasive type of cancer and that her lymph glands, which had been removed (because in Auckland, she says, they cannot afford to go back in), were healthy.

Her continuing pain and the distress of her disfigurement as she described it made me feel very angry and terribly sad.

Another correspondent, badly burned from the radiation therapy she eventually received, told of enormous continuing pain with a rock-hard breast and the apparent inability to have this corrected.

She is a beneficiary and has no extra money for doctors' fees. She is afraid to complain for fear that it will make someone angry and affect her access to treatment.

One of the common themes of the various stories is the women's fear of bad consequences if they protest. They feel, rightly or wrongly, that they are at the mercy of those who make the decisions.

The stories are not limited to breast cancer. One woman had to wait 26 weeks for an appointment to discuss a prolapsed vagina. That must seem to most people, and certainly to me, unbelievable.

I can almost hear the defensive reaction of our leaders. "If you write a newspaper column on a subject like this you will inevitably receive a stream of hard-luck letters, which do not represent the mainstream of women's experience."

For every awful story the spin doctors of health could no doubt provide an instance of success and assert that unfortunate examples ignore the many good things going on.

But we ought to be able to take that for granted. It's what hospitals are there for. The health system in this country is a promise, a social contract and should not be failing people in such numbers.

What really gets to me is the apparent lack of honesty that is emerging. Staff are being asked to cover for a system that is creaking at the joints.

The approach to political management of the health system appears to be to demand that an already depleted system provide even more care for less money and continue the fiction of high-quality healthcare for all.

The effect is that staff become more and more pragmatic, doing what they can, narrowing the choices, protecting themselves. It's as if we have run out of ideas and the only good thing we can say is that it's the same for everyone. And even that's not true.

I don't blame the staff. Who wouldn't be disgruntled and unhelpful under these circumstances - a system at breaking point. There is not enough money in the system. It's as simple as that.

Either more public money is required or we will have to begin paying for more ourselves and as a community facing up to what that might mean.

Don't we have to re-examine the promise? Don't we have to face up to the fact that we will, each of us, have to take greater responsibility for our health, including financial responsibility? For some reason we want to perpetuate the fiction of high-quality healthcare for all when it simply can't be delivered.

What we need is more honesty and an end to pretending that it's okay - because it's not.