Minds at Rest

Our friend Tess Brosnan filed this story on today’s historic neurosurgery decision for the facebook group Keep Neurosurgery in Dunedin. It is too good to hide only on facebook, so with her permission I’ve posted it here.  SM

A former Dunedin Neurosurgery patient, Casey Coombes, described her 8 years of recovery following surgery as an extreme and hellish battle to live, but today is overjoyed to be here to recount the experience. Her family are today elated and humbled at their little girl’s recovery, which they attribute to a fighting spirit.

Elation and joy, after tears, anger, frustration, and fear. Those who I have spoken to over the past few months on the topic of Neurosurgery have spanned the spectrum of anxiety.

Clinicians cite time and again the “Golden Hour” which cannot be negotiated, and the huge financial cost of care for a person permanently impaired by brain injury. Those who’s lives have been saved by the surgery spoke of their despair to think that others might not have their good fortune. Politicians spoke of a need for this to be a clinical decision, yet the historical impasse of Southern DHBs left the public feeling uncertain.

Indeed when the service at Dunedin Hospital seemed under threat, those who would never have contemplated “what would happen if..” were faced with the reality of that crucial golden hour. You trip over the cat. You find that the reason behind that fatigue you cant seem to shake is an egg-sized tumour behind your left eye. Toddlers fall over all the time, your baby rolls of the bed despite your best intentions. You cycle to work each day until….

The sheer unfairness of having Neurosurgery removed from Dunedin, leaving a what has been described as the dangerous and deadly scenario of ferrying the brain-injured to Christchurch, united southerners in an epic fight. It was clearly a fight that mirrored that of the brain-injured fighting to survive. Age and demographic became irrelevant.

55,741 signed the petition presented to parliament in support of retaining neurosurgery, 10, 000 marched in support in Dunedin, and when the panel attended public meetings in the south, many physically and emotionally struggled to tell the panel of their personal stories, living testament to the need to keep neurosurgery. Thousands joined the Face Book Page, including those who might never have ventured into the realm of social media, were it not for a desire to affect change and make themselves heard.

When I asked why this issue united the people of the South on such a great scale, surgeons, therapists, nurses, patients and head injury support workers all had a similar reply. It was that the thought of losing part of your brain, losing part of your identity, is universally terrifying to all humans. It was a long wait for the outcome of the panel’s review, and Casey Coombes, the former patient referred to earlier, speaks of sleepless nights, flash-backs and headaches as she anxiously awaited the review findings.
Today, the wait is over, and it was announced that a new, pioneering South Island neurosurgery service will forge ahead, and include a regional Dunedin Hospital service aligned with the University of Otago.  Acting Director of Health Andrew Bridgeman announced the new configuration at the Ministry of Health today, calling it a move from a struggling system to one which seeks to quickly become world class.

And with regard to all issues raised by clinicians and the public, the solution sounds promising indeed.

– The service will be built by an independent board chaired by the Head of Surgery at Melbourne Royal University, and comprised of combined Heads of Southern DHBs, a University of Otago nominee, a consumer advisor and Southern Iwi nominee.

– Dunedin will have at least three Neurosurgeons based at the Public Hospital, with one working specifically with spinal issues.

– The University of Otago will appoint and support a Professor of Neurosurgery and senior lecturer, and training and recruitment incentives will be of high priority.

At the Press Conference in Wellington Anne Kolbe seemed relieved, and happy to deliver the message so many will have been waiting to hear. I asked her how much influence the campaign “Keep Neurosurgery in Dunedin” influenced the panel- the march, the petition to Tony Ryall, the pages and pages of submissions, the personal stories at the public meetings.

Her reply was that while the panel took no political influence from the campaign, the submissions and in-person testimonials were extremely informative and without a doubt, highly valued by the panel.

She said the panel was there to look at clinical issues, not political ones, a crucial part of this was to look at the the needs of the community, while avoiding the “wants”. Kolbe stated that those needs were made crystal-clear to the panel in the numerous submissions and statements. She said they played a valuable role in “putting into stark reality some of the issues about geography, population, transport, and made us say hey, we need to look carefully at these things”. She said the submissions gave the panel focus, by informing them what issues those in the south cared about.

Kolbe acknowledged the effort made by neurosurgery patients to speak at the southern public meetings of their own personal stories, and expressed how she was “incredibly impressed by their willingness”. She acknowledged both the trauma and bravery involved in speaking up.

“We really appreciate the wonderful people who came forward to tell their stories, and people did that in such a respectful and pleasant way”.

She appreciated the acknowledgement from those who made submissions that the panel had an enormous task to undertake, and said that they stated their minds in an informative and beneficial manner. The panel head also commended what she called “the wonderful work undertaken by Dunedin Neurosurgeons over the years” and commended “the wonderful reverence in which Dr Sam Bishara is held”.

Bishara worked with Casey Coombes at Dunedin Hospital 8 years ago, and helped her recovery. Coombes was left in a 9 month coma with severe head trauma when the drunk driver of a car in which she was traveling hit a tree on Elgin Road. She was rushed to hospital within twenty minutes of the injury. She received her surgery within the golden hour, and of that says she is forever grateful. Coombes said today that the battle which began with her brain injury now feels like success, and is delighted that future brain injury sufferers will continue to have access to the surgery which saved her.

The final point of support of the Panel’s recommendations was that ” a review of this process take place in order to capture the generic lessons for the wider New Zealand Health Sector”.