The monumental District Health Board data hack

As many as 913,000 patients may have had their records accessed in a massive data breach of New Zealand District Health Boards. The hack, which is thought to have also affected Public Health Organizations, was concentrated on the Tu Ora Compass’s computer system. As officials try to contain the damage, it raises – yet again – some damaging questions about the cyber security of Government agencies in New Zealand.

I have long thought that New Zealand has been too slack with data security in Government agencies. It is a recurring problem that has at some point or another affected Inland Revenue Department, Accident Compensation Corporation, Department of Work and Income, to name just a few. All of these agencies have been breached in the last decade, with some of the breaches involving thousands of files being misused or misplaced.

But back to what I think might be one of the biggest data hacks in all New Zealand history. Whilst it is good that the Chief Executive has apologized, it is not enough and there are major failings. Glaring questions need to be rapidly answered by the Ministry, the Chief Executive and those responsible for the maintenance of the data. Very quickly the Chief Executive must find out what steps can be immediately taken to tighten up the security of M.o.H. systems and equally quickly the M.o.H. system administrators must action those recommendations.

The breach appears to affect the lower North Island, particularly people in Wellington, Kapiti CoastĀ  and Wairarapa. 648,000 are thought to be affected, but given the data goes back over a decade and includes people who have deceased, the number of affected patients might be close to 1 million people.

Ministry of Health have to own this incident. If they cannot, Chief Executive Martin Hefford should hand his resignation in, for it was his responsibility to make sure M.o.H. had the correct procedures and personnel.

New Zealanders should be short onĀ  patience with Government agencies treating cyber security so poorly as to let this happen. But I have the feeling that after a brief burst of indignation, people will merely shrug their shoulders and life will carry own as if it never happened. The agencies will heave a sigh of relief and say “we got through that one – I am sure we will be fine in the future”, instead of holding those who failed in their roles to account.

It is this kind of resigned behaviour, touched with a bit of “She’ll be right”, implying things will sort themselves out instead of New Zealanders ensuring that the situation before them improves that prevents this nation getting better. We can be a lot better at these issues, but until we start dragging officials over the coals for indiscretions there will not be any progress.

Get private companies out of University accommodation

A few weeks ago, a student was found dead at the University of Canterbury. The discovery of the 19 year old who was estimated to have been dead for 8 weeks. It has kicked off a storm about whether profit-making companies should be in the business of managing tertiary accommodation.

Many students in halls are young people away from homes for the first time in their lives. Many will be nervous, and have no friends. They will not be in familiar environments and will be feeling stressed at having to fend for themselves all the while getting their studies underway.

In a country with an on-going mental health emergency, it seems that one of Christchurch’s biggest employers, the University of Canterbury has failed to heed the message: looking after student mental health is essential. It seems that Campus Living Villages has failed in its primary duty of care to the people that inhabit the villages it is responsible for looking after. And its Chief Executive has not helped things by saying:
“IF something needs to change…”.

No “IF’s”, “BUT’s” or “MAYBE’s” mate. Your company mucked up. Your company can fix up.

Then it can leave the tertiary accommodation sector.

I see no place for private companies in tertiary accommodation. If there need to be, they should be New Zealand companies operating to New Zealand law. A foreign company operating under a minimalist management model where the ratio of Residential Assistants was kept to a bare minimum – 54 students for every R.A. More importantly the two R.A.’s were only working part time, which further reduces the amount of contact time they had with their charges.

It is the culture that should be truly alarming. A human being dead for weeks would have been entering a horrible state of decomposition by that point – how could someone not have noticed the smell or perhaps other biological indicators such as ants or flies or maggots(!)? Why did no one from his courses contact the halls to see where their student had gone or to see if he was even still going to University – eight weeks is a full term plus mid-semester holidays and maybe a week longer?

And to the poor parents who thought their boy was going to be safe at the University that presumably he had chosen to study at and begin what for me was the most exciting chapter of my academic life, how do you explain what happened? CAN you explain what happened? I am not sure one honestly could.

Simply conducting investigations is merely the beginning of a much bigger process if University of Canterbury wants to recover the portion of its reputation that is now decomposing. It needs to boot out the Australian company. Its New Zealand replacement needs to have very clear terms of engagement set down including minimum full time staffing levels, a 24/7 help line, a supervisory panel making sure that all parties are compliant with their responsibilities.

How lucky I am that I live in the same town as where I went to University. I only had to cycle in or catch the bus. I knew from the outset numerous people there from Burnside High School and made more friends fairly quickly in Geography and Geology. The staff there were great and if I or another student was struggling they would pull us up to make sure we were okay.

Not everyone has that fortune. For some life at University can be very lonely. It does not need to be like this.

And if we want to stop another death, nor should it be.

The case for a cannabis referendum

I personally support a referendum. I think it would be too divisive to pass legislation without first knowing whether that is even what New Zealanders want. And given the propensity of New Zealand politicians for partisan politics, I might reasonably hazard a guess that if such legislation DID get passed through any backlash would be seized upon as New Zealanders objecting to cannabis.

And here would be where the politics start. Let us suppose that that is what happened: a law gets passed through Parliament, catching most people unawares, someone finds out and goes to the media full of indignation about it. The legislation itself might be perfectly fine, but the fact that a party is attempting to force it through Parliament without going to “we the people” has suddenly caused a major ruckus. Being a small country, within a short time the whole of New Zealand knows that cannabis laws are being pushed through Parliament. One major party or the other is demanding a referendum to force the issue into the open where everyone can see it.

Before the referendum, we would need to have a formal debate about it where someone speaks for those who support cannabis and someone to speak for those who are against it. A medical practitioner, legal practitioner, a police officer and a Member of Parliament would would be my preferred composition of the panel to talk about the issues that society might be faced with.

The referendum would need to address some thorny issues, such as what forms of cannabis are going to be voted on. What will the question be? Will it be a simple majority of 51% vs 49% or will there need to be a super majority to ensure the vote is clear of any obstacles?

Some people might question the timing of a cannabis referendum. I do not. It is very clear to me that the “War on Drugs” both here and abroad has failed to achieve its goals and that the only responsible thing to do is to wind it up. It is also clear to me that the support for medical cannabis has swung substantially in favour of allowing its use for purely medical reasons. In saying that, we need to acknowledge the hugely damaging consequences of synthetic cannabis which is causing major problems both in New Zealand and abroad.

But the movement in New Zealand is growing. I personally am not sure whether legalization or decriminalization is better and to what extent it should happen. In the United States the number of people going to jail for being in possession of small amounts of cannabis has led to a burgeoning jail population. Minor criminals end up meeting major league players and becoming hardened criminals, some with a vendetta against society who come out more dangerous than they went in.

Video clips on Youtube of people who have been destroyed by synthetics show zombie like beings in weird postures, completely oblivious to what is happening around them, are disturbing. Sure there is a growing problem with synthetics in New Zealand as well, but for someone completely trashed on synthetic cannabis, a jail cell or – as would potentially happen in Singapore – execution is not the answer. A rehab clinic is. There is no place for executing people and the jail cells should be spared for the chemists (the ones who make the synthetics), the importers, the dealers.

But if we agree that a referendum on cannabis should only deal with low powered product that might induce a brief high, but nothing else, then I see a case for a referendum around it.

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.

Vaccination wars: Vaccinating the Anti-vax bug

Every year in March or April a notice goes at on the notice board at work telling I and my colleagues that our employer is providing free influenza vaccinations. A sheet next to it with provision for name, work roster hours and allocated time slot is put up next to it – after a week or so the sheet is handed to a registered vaccine provider to provide the shots.

I normally visit my local medical centre and get a nurse to do it. I accept that for a few unlucky people there will be the risk of a reaction to flu vaccinations. I know that they happen because I get a slightly heavy arm after each flu vaccination, but just as the nurse administering the vaccination says each time, wait 20 minutes to see if there is going to be a reaction. The heavy arm sensation recedes within 36-48 hours.

Since 2016 vaccinations have declined in New Zealand after reaching a peak in 2012. This has concerned health officials following the start of the current measles outbreak in New Zealand. Measles had been eradicated in New Zealand in 2012. But in 2019 there have thus far been 723 known cases resulting in people being admitted to hospital.

Not all of my colleagues believe in vaccination, and as a person who has a long term medical condition, that has led me to be more wary in terms of monitoring my own symptoms. Various reasons have been given for not trusting vaccination – one or two do not believe in the science, another doesn’t vaccinate for reason of personal beliefs. With hypertension and having mild asthma that can be aggravated by cold or dusty condition, I have to be more careful about the working environment in the rental car yard wash bay that I work in.

Whilst respecting individual beliefs, I believe that anyone with a child should at the very least because of their highly contagious nature get vaccinated against Measles Mumps and Rubella. They should until they reach age 18 be required to get a flu vaccination as well. My brother had mumps in 1989 before we were vaccinated – the timing was fantastically bad since I had just days earlier been diagnosed with hypertension. Parents who fail to should be made to declare with any school their children are attending that they have not been vaccinated.

As the global human population explosion – 200 years ago it was just over 1 billion, having taken 200,000 years to get that far and reached 7.75 billion this year – and continuing growth in air travel combine to ensure the need for vaccinations was never greater, the resistance to vaccinations seems to be growing. As a plane can move hundreds of people around halfway around the world in 12 hours, and hundreds of flights taking off and landing all the time, the potential for someone with a contagious bug to slip through undetected is very real. Influenza and M.M.R. are just a few. Those in tropical countries where mosquito borne viruses such as Malaria are also countries with poor socio-economic situations where education about hygiene and disease prevention, coupled with low investment in health and rapid population growth, are particularly prone.

M.M.R. is one that has had a controversial history with opponents of vaccinations claiming it has been linked to autism, despite the link being disproven by multiple pieces of research. It continues to be controversial in the United States partially as a result of a disgraced British doctor named Andrew Wakefield who authored a thoroughly discredited paper against vaccination. Mr Wakefield visited the United States just as parents of Somali Americans refused to vaccinate their children claiming it was linked to autism.

I think a New Zealand wide education campaign with the facts inserted into full page adverts in the major newspapers is necessary to make clear that getting vaccinated and making sure ones children are vaccinated is necessary. If the Government has to dip into the coffers to fund the advertisements then so be it. But the idea that