Sunday 20 June 2021

North East NSW tells it like it is to the Legislative Council Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales in Lismore on 17 June 2021

 

Ryan Park MLC
Janelle Saffin MLC

NSW Shadow Minister For Health Ryan Park and Labor Member For Lismore Janelle Saffin deserve the region's thanks for both their efforts to spread the word that the state’s north-east would have a chance to speak directly to the NSW Legislative Council Inquiry Into Health Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South WalesHealth Outcomes And Access To Health And Hospital Services In Rural, Regional And Remote New South Wales in Lismore on 17 June 2021, for lobbying to have a webcast of this public hearing and for their attendance on the day.


ABC North Coast, 17 June 2021:


A state parliamentary inquiry has heard some rural residents in northern New South Wales are being left "stranded" outside hospitals late at night with no way of getting home.


The NSW Upper House inquiry is examining the challenges people face in seeking medical care in remote, rural and regional areas.


Bonalbo pharmacist Sharon Bird told the inquiry some residents with chronic and complex illnesses are travelling more than 100 kilometres to access health services with virtually no public transport.


She said many residents "give up" on seeing a doctor because "it all gets too difficult".


"Many of my customers have had negative experiences when accessing healthcare in the referral centres," Mrs Bird said.


"Like being abandoned in Lismore in their pyjamas after an emergency ambulance trip with no way to get home again.


"[Many] are reluctant to seek help or call an ambulance again."


Northern NSW Local Health District chief executive Wayne Jones said steps had been taken to ensure such incidents did not happen again.


"Unfortunately we have failed in several of those occasions, but I can tell you it is not the standard of what we have tried to achieve," he told the inquiry.


"We have put memos out to staff reminding them we've increased our own patient transport vehicles locally, we have community transport contracts and we have a clear position that particularly after 8:00pm if people can't find a way home we need to find accommodation for them."


Residents need to 'schedule their accidents'


The inquiry heard the towns of Bonalbo and Coraki had struggled to attract general practitioners, often leaving residents with limited or no access to doctors.


Mrs Bird said Bonalbo had an X-ray machine but no staff to operate it and only one radiographer for two hours a fortnight, so residents would need to "schedule their accidents for that day".


The chair of the Ballina Cancer Advocacy Network Maureen Fletcher also gave evidence, talking about the dire need for increased funding for cancer care coordinators in the region.


She said many patients had "suffered needlessly" because they did not know what services were available before, during and after cancer treatment.


Ms Fletcher said there was one man who lost half his nose after melanoma surgery and felt socially isolated.


"He only found out that a prosthetic nose was available when a fellow patient in hospital asked why he didn't have it," she said.


Flow-on effects


The inquiry also heard from residents who spoke about the difficulties that arose from the region's reliance on south-east Queensland for specialist care.


Andre Othenin-Girard said he suffered on and off from atrial fibrillations and had been waiting almost three years to see a cardiologist on the Gold Coast, which was complicated by the Queensland border closure.


He said he had been hospitalised five times at Lismore Base Hospital while he waited.


The committee has been warned that the access to and availability of medical services could deter highly skilled people and businesses from moving to regional NSW.


Veterinarian Florian Roeber told the hearing he had to make at least 15 trips to the Gold Coast after being diagnosed with a neurological condition.


He said he moved to the state's north from Melbourne and believed he would have had better access to care if he had stayed in the city.


"I kind of regretted my decision to move to regional NSW because it led to a potentially worse outcome for me," Dr Roeber said…...


Problems are not confined to just the Northern NSW Local Health District. At Taree on the Mid-North Coast on 16 June the Inquiry heard the following.....


The Sydney Morning Herald, 17 June 2021:


A NSW hospital serving nearly 100,000 people has been relying on cleaners to look after dementia patients due to severe staffing shortages, a parliamentary inquiry heard.


Doctors, nurses and patients lined up to vent their frustration and despair as the inquiry into regional health travelled to Taree and Lismore for public hearings on Wednesday.


The inquiry heard that at Tamworth, "ghost" operating theatres are being used for storage and for staff to make quiet phone calls because the hospital is struggling to find specialists to use them.


Tamworth has the busiest non-metropolitan emergency department in NSW.


Three senior doctors delivered a scathing assessment of the state of affairs in Taree on the state's mid-north coast, which is serviced by Manning Base Hospital.


"Houston we have got a problem and the problem I'd like to talk to you about is workforce," said Dr Simon Holliday, a rural GP with three decades' experience and a staff specialist at Manning Base Hospital.


He said less than 5 per cent of Australian-trained doctors were choosing to practise in rural areas which was a "disaster" for people living outside capital cities.


Dr Holliday said overseas-trained doctors from developing countries were stepping in to fill the void which was tantamount to "reverse foreign aid".


He said there was an epidemic of burnout among the foreign-trained doctors, who were having a "horrific time" as they were used as "cannon fodder" in understaffed facilities.


Dr Holliday was critical of the Australian Medical Association for refusing to endorse medical conscription, where doctors are made to serve in regional and rural areas.


"Australia needs to start providing Australian-trained workforce for rural areas," he told the upper house committee.


"Today you've heard about the pain and anguish in our community, as in many other regions' communities, and you have the weight of our expectations on your shoulders."


Dr Seshasayee Narasimhan said chronic underfunding had rendered Manning Base an “exhausted and severely downgraded hospital” that was “not appealing for new recruits”.


No one wants to come here,” he said.


The Taree region has only one cardiologist serving a population of nearly 100,000 people and the worst cardiovascular outcomes of anywhere in regional Australia.....


President of the Manning Great Lakes Community Health Action Group Eddie Wood said the hospital's dementia ward had been shuttered without any consultation with the community.


"The cleaners on the ward have been asked to monitor and sit with the dementia patients," he said. "Dementia patients deserve the same level of care as anyone else ... it's horrendous."


Marion Hosking OAM later told the inquiry her son had been present at the hospital when the gardener was brought in to sit beside a troubled dementia patient.


But Mr Wood said assurances from the hospital administrators and local health district that there was no staffing problem further incensed the community.


You say that to the ... first year graduate nurse who is put in charge of a ward,” Mr Wood said.


Mr Wood said only half of the 18 beds in the emergency department were funded and staffed......


When you see your hospital and your staff demoralised and leaving, it’s atrocious,” he said.....


Friday 18 June 2021

A statement from some of the health experts who first told Australians that the AstraZeneca COVID-19 vaccine (ChAdOx1-S) was perfectly safe to administer to all adults, then 'modified' that assurance to safe for all adults 50 years of age & older and now announces that it is only safe for those adults 60 years of age and older

 

Australian Technical Advisory Group, statement excerpts,,

17 June 2021:


A statement from the Australian Technical Advisory Group on Immunisation (ATAGI) on the AstraZeneca COVID-19 vaccine in response to new vaccine safety concerns.


Summary


The Australian Technical Advisory Group on Immunisation (ATAGI) recommends the COVID-19 Pfizer vaccine (Comirnaty) as the preferred vaccine for those aged 16 to under 60 years. This updates the previous preferential recommendation for Comirnaty over COVID-19 Vaccine AstraZeneca in those aged 16 to under 50 years. The recommendation is revised due to a higher risk and observed severity of thrombosis and thrombocytopenia syndrome (TTS) related to the use of AstraZeneca COVID-19 vaccine observed in Australia in the 50-59 year old age group than reported internationally and initially estimated in Australia.


For those aged 60 years and above, the individual benefits of receiving a COVID-19 vaccine are greater than in younger people. The risks of severe outcomes with COVID-19 increase with age and are particularly high in older unvaccinated individuals. The benefit of vaccination in preventing COVID-19 with COVID-19 Vaccine AstraZeneca outweighs the risk of TTS in this age group and underpins its ongoing use in this age group.


People of any age without contraindications who have had their first dose of COVID-19 Vaccine AstraZeneca without any serious adverse events should receive a second dose of the same vaccine. This is supported by data indicating a substantially lower rate of TTS following a second COVID-19 Vaccine AstraZeneca dose in the United Kingdom (UK).


Background


The Australian COVID-19 vaccination program has the overarching goal of protecting all people in Australia from the harm caused by the novel coronavirus SARS-CoV-2.


On 8 April 2021, ATAGI recommended that Comirnaty was the preferred vaccine for people under the age of 50 years due to local and international reports of thrombosis and thrombocytopenia syndrome (TTS) following COVID-19 Vaccine AstraZeneca.


Based on available international data at that time, the estimated risk of TTS was 4-6 per million cases following a first dose of COVID-19 Vaccine AstraZeneca. Given the ongoing risk of COVID-19 outbreaks, low vaccine coverage, and increasing rate of severe COVID-19 outcomes in older individuals, it was considered that the benefits of COVID-19 Vaccine AstraZeneca outweighed the risk in those over 50 years. As such, no preferential recommendation for either vaccine was made in this age group. This advice was reinforced on 23 April 2021 and has been reviewed weekly by ATAGI since then.


Principles underpinning the revised recommendations


In making the decision to revise the previous recommendation, ATAGI has considered several factors that have been monitored closely, including:


  • The potential risk of severe illness and death from COVID-19 over the coming months

  • Minimising harms to people due to adverse events following immunisation

  • Australian data on the age-specific risks and severity of TTS following COVID-19 Vaccine AstraZeneca

  • The expected vaccine supply over the months ahead

  • The impacts of any change in recommendation on the COVID-19 vaccine program……


The risks of TTS after COVID-19 Vaccine AstraZeneca


From early April to 16 June 2021, 60 cases of confirmed or probable TTS have been reported in Australia. This includes an additional seven cases reported in the past week in people between 50-59 years, increasing the rate in this age group from 1.9 to 2.7 per 100,000 AstraZeneca vaccine doses. The revised estimates of risk associated with first doses of COVID-19 Vaccine AstraZeneca are listed in the table below.



TTS is a serious condition in a proportion of individuals who develop it. The overall case fatality rate in Australia (3%; 2 deaths among 60 cases) is lower than has been reported internationally. This is likely to reflect increased detection due to heightened awareness, as well as early diagnosis and treatment. A spectrum of severity of illness has been reported in Australia, from fatal cases and those with significant morbidity, to relatively milder cases. TTS appears to be more severe in younger people.



There are different ways in which the severity of TTS can be measured. The US Centers for Disease Control and Prevention (CDC) defines “tier 1” cases as clots involving unusual sites, such as the veins of the brain (cerebral venous sinus thrombosis) or abdomen (splanchnic thrombosis); these are generally more severe and may potentially lead to long term health complications. In those under 60 years, 52% of TTS episodes are occurring in tier 1 sites compared with 28% in those 60 years and older. Other markers of severity include the requirement for intensive care (33% of TTS in those under 60 years; 15% of TTS cases in those 60 years and older), and fatal cases (both occurring in those < 60 years)……


Second dose recommendations for COVID-19 Vaccine AstraZeneca

ATAGI supports completion of a two-dose schedule with COVID-19 Vaccine AstraZeneca, based on current evidence. The risk of TTS following a second dose of COVID-19 Vaccine AstraZeneca is much lower than the risk following a first dose. The UK has reported 23 TTS cases in 15.7 million people after receiving a second dose, an estimated rate of 1.5 per million second doses (compared to a reported risk of 14.2 per million first doses in the UK).


People of any age without contraindications who have had their first dose of COVID-19 Vaccine AstraZeneca without any serious adverse events should receive the second dose.


Recommendations


  • ATAGI advises that Comirnaty is preferred over COVID-19 Vaccine AstraZeneca from the age of 16 to under 60 years. This is based on recent data regarding TTS cases in Australia and a reassessment of current age-specific risks and benefits of vaccination.

  • ATAGI considers the benefit of vaccination in preventing COVID-19 with COVID-19 Vaccine AstraZeneca outweighs the risk of TTS in people aged 60 and above. For this age group, the benefits of receiving a COVID-19 vaccine are greater than in younger people. The risks of severe outcomes with COVID-19 increase with age and are particularly high in older unvaccinated individuals.

  • COVID-19 Vaccine AstraZeneca can be used in adults aged under 60 years for whom Comirnaty is not available, the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.

  • People of any age without contraindications who have had their first dose of COVID-19 Vaccine AstraZeneca without any serious adverse events should receive the second dose.

  • ATAGI reinforces the importance of providing clear communications to people who have received or are considering COVID-19 Vaccine AstraZeneca, and notes guidance documents for consumers, for primary care and for hospitals are being continually revised to accommodate this new recommendation.....


Read full statement here


It is noted that of the 60 cases (29 men and 31 women) to date with confirmed and probable adverse reactions to the AstraZeneca vaccine resulting in thrombosis with thrombocytopenia syndrome (TTS):


  • the majority of people diagnosed with TTS are over 50 years of age - only 6 people aged under 50 years had a TTS diagnosis; 


  • 23 of the 60 individuals listed were diagnosed with the most severe forms of TTS (CDS classification Tier 1);


  • 6 of those with the most severe forms of TTS were aged in 60-65 age group through to the 80+ age group; 


  • Across all age groups, from under 30 years upwards, it was the 70-79 age grouping which had the highest number of TTS diagnoses at 19 cases (comprising Tier 1, Tier 2 & unclassified), with an est. risk rate of 1.8 TTS cases per 100,000 AstraZeneca first doses; and


  • There were 12 new confirmed and probable cases of TTS attributed to the AstraZeneca vaccine in the week of 11-17 June 2021 in Australia, with 5 of those cases being in individuals over 60 years of age and 7 cases in individuals below 60 years of age.


Thus far in 2021 Australia appears to be averaging one woman dying a violent death at the hand of another person every 8.73 days

 

As of 15 June Destroy The Joint's Counting Dead Women project has recorded 19 women violently killed in 2021.














This project relies on media reports for its data and at the moment these 2021 reports show that violent deaths are averaging one every 8.73 days.


On 9 July 2020 the Australian Bureau of Statistics (ABS) released Recorded Crime - Victims, Australia covering the calendar year 2019, with data based on police records. 
This is the latest release available to date. ABS data for 2020 should be released on or about 24 June 2021.


In 2019 there were 416 homicides, manslaughters and attempted murders recorded in Australia. Up 39 victims on 2018 figures.


An est. 125 of these victims were female and the majority of the violent deaths and near deaths appear to have been the result of family and domestic violence.


In that same calendar year Counting Dead Women recorded 61 women who died violently at the hands of another person..

Thursday 17 June 2021

G7 Summit June 2021 confirms aim to eliminate unabated international thermal coal power generation from global power generation mix by 2030


Recognising that coal power generation is the single biggest cause of greenhouse gas emissions, and consistent with this overall approach and our strengthened NDCs, domestically we have committed to rapidly scale-up technologies and policies that further accelerate the transition away from unabated coal capacity, consistent with our 2030 NDCs and net zero commitments. This transition must go hand in hand with policies and support for a just transition for affected workers, and sectors so that no person, group or geographic region is left behind. To accelerate the international transition away from coal, recognising that continued global investment in unabated coal power generation is incompatible with keeping 1.5°C within reach we stress that international investments in unabated coal must stop now and we commit now to an end to new direct government support for unabated international thermal coal power generation by the end of 2021, including through Official Development Assistance, export finance, 14 investment, and financial and trade promotion support. This transition must also be complemented by support to deliver this, including coordinating through the Energy Transition Council. We welcome the work by the Climate Investment Funds (CIFs) and donors plan to commit up to $2 billion in the coming year to its Accelerating the Coal Transition and Integrating Renewable Energy programs. These concessional resources are expected to mobilize up to $10 billion in co-financing, including from the private sector, to support renewable energy deployment in developing and emerging economies. We call on other major economies to adopt such commitments and join us in phasing out the most polluting energy sources, and scaling up investment in the technology and infrastructure to facilitate the clean, green transition. More broadly, we reaffirm our existing commitment to eliminating inefficient fossil fuel subsidies by 2025, and call on all countries to join us, recognising the substantial financial resource this could unlock globally to support the transition and the need to commit to a clear timeline.” [CARBIS BAY G7 SUMMIT COMMUNIQUÉ, Our Shared Agenda for Global Action to Build Back Better , 13 June 2021, excerpt]


Wednesday 16 June 2021

Alleged 70 per cent hazard reduction burn over two days planned for the biodiverse Billinudgel Nature Reserve in June 2021


Echo NetDaily, 11 June 2021:


Local Minjungbal Indigenous leaders are asking the National Parks and Wildlife Service (NPWS) to consult with them over a planned hazard reduction burn at Billinudgel Nature Reserve but a scheduled meeting was cancelled by NPWS. 

Billinudgel Nature Reserve where the hazard reduction
burn is planned by National Parks and Wildlife Service.




The hazard reduction burn was originally scheduled for the Billinudgel Nature Reserve on 3 June with neighbours being informed by letter on 2 June.


We got notification that Billinudgel was going to have a hazard reduction burn which gave me time to get in touch with NPWS to discuss some options and ask them to sit down with traditional owners to look at cultural issues in the reserve,’ said Rachael Cavanagh, a Minjungbal woman and traditional owner that covers the Billinudgel Nature Reserve.


Rachael said a meeting was originally set up but was then cancelled by the NPWS who said that they would only speak to the Tweed Byron Aboriginal Land Council (TB ALC).


They are not the traditional owners,’ Rachael pointed out. ‘Everyone deserves a voice. We are on the Native Title claim for the Five Rivers and the Tweed Bundjalung people. We are the traditional owners who hold the cultural knowledge on the land values. We still have fire law that has been continued in our family,’ she told The Echo. 

Billinudgel Nature Reserve.



NPWS legislation states that they need to engage with traditional owners and knowledge holders. By their own legislation they are supposed to meet all registered parties.’


Rachael has been a fire fighter for 20 years with the Queensland National Parks and Forestry Corporation and is engaged with the Firesticks Alliance Indigenous Corporation.


I am in a senior leadership team for National Fire Sticks Alliance. We support and build capacity with Indigenous groups nationally to support cultural fire practices and traditional land management for people on country. We look at the whole picture.’


Having been denied the option to meet with NPWS Rachael told The Echo that their lawyer has now sent a letter to NPWS to seek a meeting between the traditional owners and NPWS in relation to the burn.


Pretty much our family are fighting to be at the table and be part the discussion,’ she said.


They are planning to for a 70 per cent hazard reduction burn over two days which means it will be very hot, raging and overall health of the forest and the cultural values will be at risk, the understory will be and the canopy will be scorched, the animals will have nowhere to go to.


Regardless of whether it is Billinudgel or Cudgen. I will be fighting to have a say over the management of Minyungbal Country.’


Regardless of whether it is Billinudgel or Cudgen. I will be fighting to have a seat at the table.’…... 



BACKGROUND


Billinudgel Nature Reserve was created in April 1996. It's current size is 789 ha. Approximately 75% of the Reserve is within Byron Shire with the remainder in Tweed Shire in the NSW Northern Rivers region.


The Reserve protects the following features

· a large tract of natural lowland coastal vegetation, a significant remnant in an otherwise highly modified environment; 

· an extensive wetland containing Melaleuca swamp forest; 

· a diversity of habitat which supports a wide range of fauna and flora including rare, threatened, significant and migratory species; 

· Aboriginal sites and landscapes of significance; and 

· features of scientific interest. 


In the 2016 Byron Coast Comprehensive Koala Plan of Management the North Byron Koala Management Area encompasses an area of approximately 2,814ha located to the north of the Brunswick River and includes the Billinudgel Nature Reserve along with the localities of South Golden Beach, Ocean Shores and Billinudgel.

localities of South Golden Beach, Ocean Shores and Billinudgel as indicated by Figure 3 of the


Northern Rivers Region Billinudgel, Marshalls Creek, Jinangong, and Brunswick Heads (north) Nature Reserves Fire Management Strategy (Type 2) 2016 at: