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Rehabilitation Conference
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Queenstown, 22 July
2009
Nga mihi mahana, ki a koutou katoa
Warm greetings to you all, especially to our Australian
visitors.
It is an honour to open this combined conference of the
Australasian Faculty of Rehabilitation Medicine, the National
Institute of Rehabilitation Research, and the New Zealand
Rehabilitation Association.
I love your Conference theme -
"Working together across the lifespan - an interdisciplinary
approach to rehabilitation". I was captivated by the
wonderfully evocative conference photograph of a man with
outstretched arms, standing on a boulder by the sea, embracing the
sun bursting through the clouds. Notice how his hands are
open, with his palms facing upwards.
It's hard to work together with closed fists … Yet
metaphorically that is what we sometimes see in the health sector,
when providers from different specialties work in isolated
fiefdoms. It's interesting that we use the term "handover" when
care is passed from one team to another in hospital - yet all too
often we see incomplete handover of information leading to a
breakdown in communication and care. And we see the same thing when
patients are transferred to community providers.
To my knowledge, New Zealand is the only country in the world
that has a legislated Code of Patients' Rights that specifically
includes the legal right "to co-operation among providers to ensure
quality and continuity of services". You'll find it in right 4(5)
of the New Zealand Code. It's one of the areas where care most
often breaks down, leaving patients to fall through the cracks. So
it's very encouraging to see the emphasis on an interdisciplinary
approach to rehabilitation that runs through so many of the
conference sessions over the next three days.
It's also good to see so many presentations focusing on the
needs of the individual patient. Last night, in the light rain, I
walked back from town with one of you, a fellow in spinal
rehabilitation from India, currently working in Australia. I asked
what's the main determinant of successful outcomes in spinal
rehabilitation? The patient, came the swift reply.
All the technically superb, well co-ordinated rehabilitation
services in the world will fail if the patient is not fully engaged
in their own recovery.
Over the years, I have always been fascinated by the insights of
patients who have written accounts of their rehabilitation - in
particular when doctors have learnt what it is like to be a
patient. Many of you will have read the fascinating book by
neurologist Oliver Sacks, "A Leg to Stand On". Sacks, recovering
from a devastating injury to his left leg - a rupture of the main
tendon - writes of his alienation and despair. He turns to the
scriptures when he can see no reason to hope: "Thou, who hast
shewed me great and sore troubles, shalt quicken me again, and
shall bring me up from the depths of the earth". Sacks writes of
the "quickening" of his limb, the turning point when he "remembers"
how to walk, and of the return of function and sensation with the
help of music.
Australian surgeon and rehabilitation specialist Tony Moore
recounts his personal journey of recovery after a horrific motor
vehicle accident in his 1991 book, "Cry of the Damaged Man".
Temporarily disabled and emotionally devastated, Moore records how
he learned "many things about illness which no amount of abstract
sympathy could have achieved and no textbook ever mentioned". He
writes: "Technology now ensures physical recovery for many who
would have died. But having survived severe damage, where is the
therapeutic equivalent of intensive care units for the emotional
wounds which can leech themselves into a lacerated body'. … Have we
understood that the spirit must accompany and assist this
retrieval?" [p.142]
American bioethicist Bruce Jennings entitles his 2006 essay on
traumatic brain injury and the goals of care, "The Ordeal of
Re-minding". He states that the real tragedy of TBI occurs if we
allow the physical damage to objectify the person, reducing them to
their impaired body and altered behaviour.
I salute all of you here today for choosing to research and
practise in such challenging fields. One of the great things about
conferences is the opportunity to refresh oneself, to get new
ideas, to reconnect with professional colleagues and meet new ones.
You have a rich menu of presentations over the next few days.
Reading the abstracts, some of what you will learn will be
sobering. In New Zealand and Australia inadequate resourcing of
rehabilitation facilities means that we lag behind some other
countries. In 2003, John Gommans and colleagues reported in the New
Zealand Medical Journal that only one of 48 hospitals in New
Zealand have a dedicated inpatient stroke rehabilitation facility.
They concluded that most New Zealanders do not have access to
stroke-specific, organized, inpatient stroke rehabilitation.
But you will also learn about exciting new initiatives, such as
ACC's early intervention service for TBI clients in the Auckland
area, with stunning results, described as a "phenomenal shift".
This morning, we will hear the results of the inaugural AROC
report on benchmarking rehabilitation outcomes in New Zealand. I am
greatly heartened by this development of a standardized set of
benchmarked data, starting with 10 of 35 rehabilitation units in
New Zealand. Health and disability services in Australia and New
Zealand are awash with data, but there is a woeful lack of
meaningful benchmarked data available to services, funders and
policymakers - and ultimately to the public. I regard collection
and publication of good quality comparative data as critical to
improvement in the quality of rehabilitation services.
Let me draw these opening remarks to a close. I am keen to hear
Harry McNaughton deliver the George Burniston Oration. Six days ago
I had the privilege of delivering the Kirby Oration (in honour of
Australian Judge Michael Kirby) on "Regulating for Compassion?", to
the first conference of the new Australasian Association of
Bioethics and Health Law. My talk on that occasion explored the
yearning for compassion in health care - but I queried whether we
can legislate for the gift of compassionate care, which must come
from the heart of the practitioner.
Doctor and anthropologist Cecil Helman, in his book "Suburban
Shaman, Tales from Medicine's Frontline", writes of the strange
paradox at play in modern society. We "pay lip service to
individualism while at the same time reducing individuals
themselves to standardised, impersonal … entities".
We need to avoid this trap. In the words of the 12th
Century Jewish philosopher physician Maimonides, "May I never
forget that the patient is a fellow creature in pain. May I never
consider him merely a vessel for disease".
I wish you well for your conference.
Kia ora tatou katoa.
Ron Paterson
Health and Disability Commissioner