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From testing times, some positive changes and lasting lessons

Introduction by Croakey: As 2020 nears its end, we think of the 1.7 million people who have died from COVID-19 this year and their loved ones, the 44 million who’ve recovered, and the many millions more still dealing with the infection.

We think of the billions whose lives and livelihoods have been disrupted, and we think especially of those groups who’ve been hardest hit.

One in every five state and federal prisoners in the United States has tested positive for the coronavirus, a rate more than four times as high as the general population. In some states, more than half of prisoners have been infected, according to data collected by The Associated Press and The Marshall Project.

And we also think of the commitment, solidarity, creativity and sheer hard work that has been on display this year in all sorts of places and all sorts of ways, as Marie McInerney reports below.


Marie McInerney writes:

For one former prisoner, the “miracle” of the Federal Government’s coronavirus supplement meant still having food in the fridge at the end of a week.

For another it was being able to put money away for emergencies. One paid all her debts and bills.

Another former prisoner – also a client of the Samaritan Foundation in Newcastle, north of Sydney – talked about the mental health boost from having a haircut and new clothes and no longer feeling embarrassed about how he looked.

Others used the extra money to be able to relocate closer to family. Some saved up and bought cars or got decent places to live in “for the first time in their lives”. Many got their driver’s licences.

The regular $550 fortnightly supplement helped one woman to get a rental contract, putting her out of danger of family violence and the risk of breaching her parole because she didn’t have stable accommodation.

For all the challenges of the coronavirus pandemic, it was seeing the transformation that a decent, liveable income can make in people’s lives that stood out most this year for Helen Fielder-Gill, the post-release coordinator with the Samaritan Foundation in Newcastle, north of Sydney, who works with up to 300 former prisoners at any one time.

She admits to having had a fleeting worry, when the supplement was announced for income support payments like JobSeeker, that some of her clients struggling with addiction might use the extra income for drugs or alcohol.

But “that was far from the truth”, she told Croakey. It’s been fundamentally so good for them, including the change in the way they feel about themselves.

“It meant they could live like a normal human being for a little while.”

No fairy tale

Like many other advocates, Fielder-Gill is deeply worried now that the supplement, described as “a social policy fairy tale”, likely won’t have a happy ending.

Having already dropped down to $250 a fortnight, from 1 January it will be paid at $150 per fortnight, with plans for it to end on 31 March 2021, and it’s telling that the news is no great shock to Fielder-Gill’s clients.

“That’s the other terrible thing,” she says. “They’re really used to disappointment. We think it’s not fair but they’re like, ‘well, we were lucky to have had it for a while’.”

Like prisoners and former prisoners across Australia, Fielder-Gill’s clients are among those who have been most at risk in the pandemic, in and out of prison.

Most suffer chronic health conditions, many from the ill effects of having used ice “which takes a huge toll on the body”. Many in Newcastle and elsewhere had already struggled during 2019-20 bushfires that burned nearby. “The smoke was really shocking here and people were sick from it,” she said.

To protect everyone, the Samaritans had to stand down all of their volunteers and move most support services online. That was hard initially for those who didn’t have phone data access or other IT issues, or had relied on the Samaritans being a ‘drop in’ place for years. One had been popping in for breakfast for about eight years.

Some struggled with the isolation and boredom or with supporting their kids through online school if they didn’t have the literacy skills to help.

But as a group, Fielder-Gill says, her clients mostly proved very adaptable and resilient in 2020, joining online fitness classes and forging new connections. A Facebook Messenger group set up by some of the women has led to a ‘women’s only’ day each week at the service now.

Her concern now is with the return to normal — normal services, yes, but also back to paltry levels of income support and to poor housing options for ex-prisoners, who often end up homeless or couch surfing because of stigma and unaffordability.

Just as the coronavirus supplement had helped financially, so too had the concerted effort from housing authorities to get people off the street during the lockdown.

“It’s amazing what we can pull out of a hat when we have to,” she said.

Clients of the Samaritan Foundation in Newcastle. Source: Samaritan Foundation

Positive changes

In the remote Kimberley region of Western Australia, Dr Lorraine Anderson has seen much heartache from the coronavirus pandemic this year, where regional lockdowns and ongoing community closures have kept people separated and unable to attend funerals.

Overall, however, Anderson believes the region has seen “more positive outcomes from this pandemic than we have negative”.

That’s due, she says, to strong Aboriginal leadership, new partnerships that have broken down many silos in services, and revolutionary healthcare changes like telehealth and Point of Care testing that were rolled out in weeks rather than the usual years that such reforms can take.

Anderson is a Palawa woman with family links to north-western Tasmania who has worked as a remote GP over the past 12 years in the Kimberley, Pilbara and the Indian Ocean Territories.

She is now medical director at Kimberley Aboriginal Medical Services (KAMS) and is “ecstatic” at how successful the region has been in managing COVID-19, and at the success of other Aboriginal and Torres Strait Islander communities and health services.

The number of cases among Aboriginal and Torres Strait Islander people was six times lower than they would be if the population was affected at the same rate as the rest of Australia, according to figures released on 14 December.

It looked bad in the early days in the Kimberley, with a worrying cluster of 17 COVID-19 cases that came via the Ruby Princess in Sydney and spread among non-Indigenous health workers. But by year end, there has not been a single positive case of any Aboriginal person in the Kimberley nor a single case in a remote community in the region.

“We didn’t know a huge amount about the spread in the early days,” Anderson told Croakey before heading off on long-awaited leave. “But what we did know was that if it spread into our remote Aboriginal communities, we were going to be facing quite devastating results.”

Jamilah Bin Omar (L) working with Dr Lorraine Anderson for a Community COVID-19 FAQ video. Photo via KAMS

KAMS was ahead of the curve from the start, mindful of the toll on communities from the 2009 swine flu outbreak. In excellent timing, it had in 2019 developed a pandemic plan and employed an infection protection and control nurse, who sounded the alarm in January when stories began to emerge from Wuhan.

KAMS immediately placed “a massive order” for personal protective equipment (PPE) and made an early decision to isolate remote staff when they were back in Broome, as the remote communities began locking themselves down to all but essential workers — well before the WA Government declared a State of Emergency.

It brought its mobile dialysis unit, often used to support people attending funerals on country, into the renal service centre in Broome, so it could separate patients with symptoms, “recognising very quickly that if we got COVID into one of our dialysis units, there would be close to 100 per cent infection and death rate”.

Anderson says managing all this has been a major logistical exercise and a crash course for her in emergency policy and procedure across the three tiers of government.

Even working out how to define “essential” healthcare in a lockdown that has gone on for most of the year was complex. She gives podiatry as an example — not a service you need in an emergency, “but you really don’t want your diabetic patients going more than three months without seeing a podiatrist, so once you hit the three-month mark their status goes up and you have to rethink the plan”, she said.

COVID-19 testing was another big logistical exercise in the early days, and a big toll on community members. Symptomatic people had to travel to Broome — for people from the Balgo community in the Western Desert this could mean a three-hour Royal Flying Doctors Service flight, for example. They would need accommodation, food and other supports while they stayed in isolation for the standard five-day turnaround on a COVID-19 result from Perth.

Now that remote Point of Care testing is available in community, not only are results back in 45 minutes, but services can also test as quickly for other infectious diseases such as sexually transmitted infections chlamydia, gonorrhea and trichomoniasis — and will soon be able to test for other respiratory viruses.

The rollout of telehealth to all remote Kimberley communities — “a five-year plan squashed into about three months” — means KAMS can now limit the number of medical staff going in and out of communities in the pandemic, and also now provide better healthcare in wet seasons when staff physically can’t get to them.

Finally, Anderson said, the pandemic has generated an “unbelievable” level of collegiality in the Kimberley between professions, communities, sectors, services and agencies, across health and non-health sectors like housing and justice, who have broken out of silos that constrained them more than they had known.

“So if we’ve got a positive case in a remote community this afternoon, we know exactly what we’re going to do. You’re not just phoning ‘the police’, you’re phoning the [police officer] that you now know really well. Instead of having a meeting when there’s a problem, now we’ve got regular meetings to stop the problems in the beginning.

“It’s all just very collegial and we all feel as though we’re probably going to be able to maintain that post COVID as well. It’s been a real high point.”

Area covered by KAMS

Phases of crisis

Leading public health specialist Adjunct Professor Tarun Weeramanthri has crossed Australia back and forth this year, working on high level state and national responses to COVID-19 and the climate crisis — and earning himself two stints in hotel quarantine.

Weeramanthri, formerly Chief Health Officer for the Northern Territory and Western Australia and now president of the Public Health Association of Australia, started 2020 working on the final report for the year-long Climate Health Western Australia Inquiry — billed as the world’s first statutory inquiry into climate and health.

“Then COVID came along, and some of the team got asked to help with the response,” he told Croakey.

Weeramanthri was first asked to assist WA’s Department of Premier and Cabinet to work with different business and industry groups to manage their risks and develop COVID-safe plans.

Liaising with “everyone from mining and resource companies, to beauticians, judges and café owners”, his major takeaway was that “businesses and industries really do know their own customers best and are in the best place to plan for and manage their own risks, while government’s best role is to provide principles, guidance and sign-off”.

In June he was part of an expert panel that reviewed the response to COVID-19 in remote Aboriginal communities in WA, “as it had been such a success, and WA’s Minister for Aboriginal Affairs wanted to capture the lessons learnt”.

He then spent three weeks in Victoria, as it began to grapple with its tough second coronavirus wave, invited to work “inside the engine room” at the Department of Health and Human Services on policy issues, multicultural engagement, and then contact tracing, as case numbers climbed.

Associate Professor Tarun Weeramanthri in hotel quarantine in Perth, after working on the National Contact Tracing Review.

Back in WA, he was part of another expert panel asked to work with the public sector and stakeholders to test various COVID outbreak plans, with a continuous improvement focus rather than as a series of formal reviews.

This didn’t involve any kind of ‘gotcha’ process, he said. Rather it used ‘appreciative inquiry’ techniques that involved asking questions like: What are the assumptions here? Are there any gaps or risks that are not covered off? What still keeps you up at night?.

This approach meant “that key decision-makers and stakeholders are fully engaged and make appropriate process changes as we go”.

“It is literally ‘continuous improvement’,” he explained.

Weeramanthri then had a seven-week stint with Chief Scientist Alan Finkel on the National Review of Contact Tracing, which “earned me a trip round most capital cities and consequently a second lot of hotel quarantine for the year”.

(His tips for hotel quarantine? “Routine, not too much work, bit of exercise, gratitude meditation!”)

And he ended the year with the WA Government committing to establish a Health Sustainable Development Unit as part of the WA State Climate Policy – a recommendation from his Climate Health WA Inquiry final report that was finally released last month.

Asked what had been the most useful book for the year, he told Croakey it was “by far” one he has had for years: ‘The politics of crisis management: public leadership under pressure’.

He said it “discusses crises in phases – making sense, making decisions, making meaning, termination and accountability, and finally learning. Each of those phases has come into play during COVID.”

Back now in Perth, Weeramanthri says he is feeling “generally positive” about what’s to come in 2021.

“[2020] has been such a difficult year, but it’s been the first experience that literally everyone in the whole world has shared, and there are opportunities for change revealed by how we have responded,” he said.

Croakey acknowledges and thanks donors to our public interest journalism funding pool for supporting this article.

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