The geography of medicine

Yesterday, looking at comments on an article on Facebook about the intensifying fight between supporters of vaccinations and foes. I saw that there were some who seemed to honestly not understand how the dispersal of these diseases works. And I wondered if a lesson in how epidemiology was founded, coupled with a brief foray into medical geography would assist.

I am reminded of a lesson in medical geography that I took when I was at University of Canterbury. Medical geography looks at the temporal and spatial distribution of illness, the environment that causes that distribution and ways of addressing it. The lesson looked at an example from 1850’s England when there was a cholera outbreak. It was a very localized outbreak. English physician John Snow, who had conducted research into the disease became interested. He looked at the distribution of instances by talking to local residents and ascertaining which wells they were using. Once it was established that rates were particularly bad in an area around Broad Street, he looked at where the water was being sourced from and noted that it was being drawn from a polluted section of the Thames River. He established that the deaths from the cholera outbreak were concentrated around a particular well, and employed a dot map to show this.

In a modern society with vehicles and aircraft able to give people a local mobility that simply did not exist 100 years ago when the Influenza pandemic that was spread by soldiers returning from World War 1, only one person needs to be infected to establish an outbreak in a new location. Soldiers living in absolute squalor in the front line trenches where hygiene was effectively non-existent became incubators for a particularly virulent variation that would go on to affect 500 million people world wide; kill nearly 100 million people and devastate families and communities alike. With an aircraft flight able to cover reach any major New Zealand town within two hours a case that originated in Auckland may have infected someone living in Dunedin before the day is out.

In African countries Ebola is a disease that was discovered in 1976 and is thought to be hosted by fruit bats. Currently afflicting western African nations, Ebola has an average mortality rate of about 50%, though this can vary anywhere between 25% and 90% in individual outbreaks. It spreads from contact with fruit bats, chimpanzees, gorillas, antelope, porcupines and monkeys found dead in the forest.

The virus is spreading in Africa because of a chronic underfunding of health care and education. Basic hygiene levels are very poor, which means humans who have had contact with patients are becoming potential incubators of it themselves. The symptoms start to show between 48 hours and 3 weeks after the contact with the body or body fluids of a person who has died.

But New Zealand is not like Africa. Aside from much better education, medical care and planning for such diseases, our authorities are much more transparent in terms of what information they hold and how they use it. Yet we have an escalating problem with vaccination caused by people who are either wilfully ignorant or not educated to understand that the science behind vaccinations is well grounded and with the best intentions. Thus decades of hard work trying to eradicate Measles Mumps and Rubella from our fair land is being undermined.

As far as I know there is no geographical field that can understand the the temporal and spatial dispersal of wilful ignorance.

Scrap National Certificate of Educational Achievement

I have never been a fan of National Certificate of Educational Achievement. Whilst it was intended to replace a system that did not work for many students I think that there are remedies that with a bit of tweaking would adequately fill in the short comings that existed.

The major short comings in N.C.E.A. are:

  1. That some of the courses, such as Year 11 English and Mathematics were 100% assessed on the last exam. Despite having numerous assessments throughout the year, they did not account for anything, and were only used in the event that a student could not sit the School Certificate examination (which I think should simply be called Year 11 Maths.
  2. Unit Standards were intermixed with more conventional assessment methods on traditional courses like history, which I believe were better assessed using conventional methods – my experience on this is based on consecutive years failing Year 12 history in part because of the emphasis on Unit Standards in a subject I honestly did not believe was suited to that.
  3. A Unit Standard has an overly simplistic marking regime – one can FAIL/PASS or be NOT YET COMPETENT. This was perhaps my biggest gripe as that tells me nothing about my overall performance. Did I do really well and get the equivalent of 90% or something like that? Did I get a bare minimum 51% or was it a total catastrophe in the order of 30% or less?

My solution is not new. But it will provide a robust assessment regime for all students and give those who might not be so strong at exam time an opportunity to show their ability through assignment work and tests.

I recommend going back to to the old framework which will be renamed Year 11, 12 and University Certificate. All courses will have a 1/2 internal assessment component that will test their ability to through practical and theoretical tests as well as examinations. The old scaling system will be removed. What you score is what you get. The only cross marking that will happen will be to make sure all students get subject to the same rigour of assessment.

The option for six subjects will be available to the most able students in Years 11 and 12 if a parent/teachers meeting recommends it. There will be partial scholarships (half annual fees) available to students who get a B average or better (325/500 (5 courses) or 400/600 points (six courses))and full scholarships (full annual fees) for those who achieve an A average or better (400/500 (five courses) or 480/600 points (six courses)).

Perhaps alongside this for those who want to go through a private system, those schools able to afford it might offer their students the opportunity to sit Cambridge or Oxford examinations for high performing students. The Cambridge International Examinations programme is offered at a range of schools in New Zealand by the Association of Cambridge Schools in New Zealand Inc.

Most important to me though would be ensuring that all students in this system or N.C.E.A. are able to participate and not held back by the financial situation of their family.

The looming teacher mega strike

So, it is finally here. On Wednesday teachers and principals across the primary and secondary education sectors will come together for a mega strike. This will be a strike on a size not seen before in New Zealand and which points to grave issues across the broader pre-tertiary education system.

I will not comment on the reasons for the strike as I have addressed these in prior articles, and I have little more to add. What I will say however is that it might be fortuitous for the Government that both the primary and the secondary education sectors are striking simultaneously. It could be seen through opportunistic eyes as an opportunity to talk about the expectations that the two sectors have of each other when dealing with Year 8 students that are about to make the transition from intermediate to high school. Is this even something that they discuss?

It is about time though that the community gets real as to what we realistically expect of teachers, and what teachers can realistically expect of students and their parents. At times I wonder whether some sort of contract between the parents of the student and the school about common expectations other than having a willingness to learn and behave properly. Except it really should not have to be coming to this.

In low socio-economic areas, I can understand that parents/caregivers might struggle to provide things such as breakfast to ensure the child starts that school day on a full stomach. I can understand it if sometimes stationery or uniforms are hard to afford – when I was at school it was pens, pencils, exercise books, rulers and rubbers, and most other stuff was extra. Now it is electronic devices. Across the course of the school year we had to pay up for the annual class camp, and a couple of school trips such as to see a production of The Nutcracker (which I did in Primary School), or go to Science Alive (an interactive place where children and adults could learn about science), the Antarctic Centre or Orana Park Wildlife Refuge.

Given the relative lack of change in incomes in the last two decades it makes me wonder how much a parent on a 1995 income could afford now in terms of kitting out their son/daughter for school – a time when a pie and Coke from the tuck shop cost not more than $3.50. It also makes me wonder how much of what we require for our children’s education is really necessary, whether there is not some better way of teaching with less material.

But how much can the school realistically provide? How much SHOULD the school realistically provide? There comes a point where the school knows its budget simply will not stretch any further and that if it does somehow manage to find a few more dollars, they will be in high demand for other uses.

The looming mega strike will be largely about pay and conditions, but I am sure that on Wednesday when the strike happens we will see that the teachers have other issues in tow as well.



Cannabis reform coming – But is it enough?

Reform of the laws around the use of cannabis is coming to New Zealand. Minister of Justice Andrew Little has announced there will be a referendum in which people will be asked a simple yes/no question about the legalization of cannabis in New Zealand.

I support reform for a range of reasons. New Zealand society sees and deals with the effects of cannabinoids every day. New Zealand Police see and deal with the aftermath of cannabinoid related emergencies each day as do the emergency departments at our hospitals. An unknown number of families are despairing as they watch loved ones become consumed by the effects of synthetic cannabis, which is many times more powerful than ordinary cannabis.

I wonder what the socio-economic cost would be if someone tried to add up the money spent on rehabilitation, Police and hospital time and resources, the cost to individual families and finally to the public at large – in a twelve month period in Auckland alone St. John Ambulance was averaging 20 synthetic cannabis related call outs a day.

At one end of the spectrum, I hope to see cannabinoids:

  • Legalized for medicinal purposes
  • Of the synthetic ban them completely
  • Restricted to age 21
  • Subject to strict controls on nationwide cultivation of it

However cannabis is only part of the problem. Much worse drugs are making their way into the market both in New Zealand and abroad. In the United States, fentanyl is currently the drug causing alarm bells to go off, as part of an opioid epidemic. As I see it unless we address these other drugs as part of a comprehensive plan involving both the authorities  and communities, there will not be a meaningful gain in terms of reduction of harm.

At the other end of the spectrum, there needs to be a quite different response:

  • Dealers, importers and cooks of methamphetamines, cocaine, heroin and so forth should have all assets and money illegally made from the business confiscated and the proceeds put forward for rehabilitating addicts
  • Aforementioned dealers, importers and cooks be given 20 year starting sentences
  • A nation wide drug education programme that everyone must go through at high school
  • Have fentanyl classified as a licenced GP administered drug only to reduce availability and prevent abuse of it

In terms of communities, people in New Zealand need to step up with perhaps a confidential line that people can call if they have concerns about someone’s drug use. It would be monitored by the Police and give people a way of ensuring no harm is done whilst at the same time making sure they are not harmed themselves. Community leaders need to work with the Police and start having regular meetings, work out a strategy and integrate it with other local communities.

Because the results of failing to do so can be in clips on Youtube and having viewed a couple, I can say right now they are NOT General Audience viewing.


Teacher’s mega strike about more than money

It seems inevitable. A massive – this one possibly one of the largest in N.Z. history – teachers/principals strike is now nearly certain. With the territory comes the accusations that teachers are simply being greedy and wanting all the money they can get. What many people seem to forget is that the strikes have not been entirely about getting a bigger wages, or more money. Often the strikes are about things such as:

  • working conditions
  • how streamlined the bureaucracy is
  • special needs students
  • managing troublesome or otherwise problematic students

The first problem is the environment in which our teachers work. Working conditions are often the biggest gripe after pay. Not being a teacher, but knowing several in the profession I am guessing that on top of the teaching day there is 2-3 hours preparatory time of teaching material, paper work and marking assessments. My guess is that whilst a school teacher might have a teaching day from 0830 to 1500 hours, the above mean that they are not really finished for the day until 1800 hours at night where upon they have time for dinner, maybe 2 hours relaxation before it is time to clean up and go to bed.

The second issue is bureaucracy. It is a word we hear all the time. It is the state officialdom that takes the every day operating decisions out of the hands of elected officials and put them in the hands of regular civilians. In the New Zealand education system it is agencies such as the New Zealand Qualifications Authority, the Ministry of Education and so forth who are responsible for administering the education through the Tomorrow’s Schools framework, the assessment regimes, making sure New Zealand is compliant with its international obligations, among other things.

New Zealand teachers have a huge workload. I described an average day very briefly above, but what I did not mention was the challenges that bureaucracy pose. Getting to know each student, their characteristics, learning interests and any special needs are just part of it. Obtaining approval for activities, special needs support staff, resourcing among other things are just a small range. I am talking about all levels of bureaucracy right down from the Ministry to internal administrative needs at each school.

The third issue is special needs students who, through no fault of their own, pose particular challenges. Integrating one into a class room setting sometimes works well, but other times can be a complete disaster. How a student with particular conditions such as autism are mentally wired can be quite contrary to how they would be expected to function. Would they and their classmates be safe? How would they react in an emergency? What help would they need and who could supply it? These and a huge range of other questions all come up.

When I was a student I had speech impairment and hearing loss. I had hand to eye co-ordination issues. The speech impairment is pretty well gone, and the hand to eye co-ordination is pretty good, but I am still hearing impaired. I still come across as different, even though I hold down a full time job, have a social life, participate in human rights activism and can travel on my own overseas. So, how a developmentally impaired student worse than myself will cope in a system that is very different from the one that assisted me will be interesting to see.

The fourth and final issue I see is how to manage disruptive students. Some of the answers are glaringly obvious and are just waiting for the right trigger to become something that can be implemented. Many children for example come to school on an empty stomach, not having had breakfast. Right before the school day even starts, there is a certainty of some disruption – the causes of the lack of breakfast could be many:

  • No money for breakfast
  • Dysfunctional family where properly feeding the children is not a priority
  • A time poor house where parents both work long hours

It could simply be that the child has learning or behavioural issues that are fuelled by a toxic family environment – violence, excessive drinking, anti social or otherwise inappropriate behaviour. These two causes and others can lead to any range of problems – fights, wilful damage of property, assault, bullying and so on. And a failure to arrest the problem in its early stages will teach the child that this is okay conduct. The teacher has limited options for dealing with it. And they run the risk of being groped, spat on, assaulted as well, which only serves to worsen the situation.

So, whilst sad I am that it is has come to this, the demands we place on a teacher these days are massive. They are often made to be a whole range of things that they are simply not trained to deal with. When will we step up and accept that teachers are overworked and sometimes work in a horrible environment?