Dr Gary Payinda Profile picture
Emergency doctor. Interested in how poverty & politics shapes society and healthcare. Opinions are my own.
jennblevin Profile picture 1 added to My Authors
Jul 24 9 tweets 2 min read
costr.ilcor.org/document/cab-o…

"Two manikin RCT studies were identified in the review that demonstrated ventilations were only delayed by 5.7-6.0s with a compression-first strategy compared to ventilation-first.[Marsch 2013 w13856; Sekiguchi 2013 1248] There is only indirect evidence to support a ventilation-first strategy.
Jul 23 5 tweets 2 min read
The original law proposed was sensible and respectful of suffering patients' autonomy and wishes; with "a grievous and irremediable condition"

Because of scaremongering it got watered down to a whole series of hurdles a patient has to jump through. i.stuff.co.nz/national/polit… Now we've got the situation where terminally ill patients are told they don't qualify because they might live longer than 6 months. Regardless how bad their symptoms are.
If you can't get a doctor to write that you're likely to die within 6 months, no access to assisted dying.
Jul 23 18 tweets 5 min read
#Monkeypox action, coming soon to a town near you.
1/

theguardian.com/world/2022/jul… GPs and nurses can expect some cases to look like a flu-like illness.

Fatigue, muscle ache, shivering.

2/
Jul 23 7 tweets 2 min read
really interesting question. will take a minute to answer.
so-called natural immunity vs vaccine-induced immunity.
some studies have suggested a combo of both creates a better immune response, other studies have shown that infection can weaken your subsequent immune response.
1/ immunity from getting covid obviously means you're taking a hit from the infection. some will end up sick, hospitalised, at increased risk of clots, etc, or with chronic symptoms. so "just getting it over with" is not a good idea. plus, the reinfection risk is still there.
2/
Jul 22 6 tweets 2 min read
The reality no one really wants to talk about, is that it would take Billions to rebuild our hospitals to a professional standard, and hire enough staff to appropriately take care of patients. Image We all know what the end result of this will be: wealthier people moving onto private health insurance. And the public system getting starved for funds.

Some honesty needs to happen. One is an appraisal of what we will, and won't, try to achieve.
Jul 21 4 tweets 2 min read
Boosters markedly reduce the chance one will end up hospitalised or dead.
Most studies show an approximate 65-90% reduction. That's massive.
Avoiding hospitalisation is important. sciencedaily.com/releases/2022/…

Avoiding hospitalisations is good for the patient for obvious reasons, but also good for everyone, since (unnecessary and booster-preventable) admissions mean fewer available staffed beds for all other types of patients...meaning delays and missed care.
Jul 5 6 tweets 2 min read
Dr Hackney, Ohio:
"I am going to have to tell her that her baby has a lethal condition, and she is going to have to carry a pregnancy to term against her will. It might be tomorrow. It might be weeks from now. But this is going to happen, and I cannot stop it. This patient will go through her third trimester visibly pregnant. Strangers in the grocery store will congratulate her. She will have to explain her story over and over again to friends, neighbors and co-workers.
Jul 4 10 tweets 2 min read
Feel sorry for the RMOs (doctor-in-training), who are working 70 hour weeks covering all their colleagues' sicknesses. Little known fact: some (? most) DHBs have no real sick cover. 'Leave relievers' cover annual leave, but not sick leave.
When if your colleague is sick, you come in on your day off, or their shift goes unfilled and the team (and patients) are understaffed.
Jun 28 62 tweets 13 min read
NZ Emergency Doctor Describes Crisis Caused By Lifting COVID Public Health Measures

scoop.co.nz/stories/HL2206… The World Socialist Web Site recently spoke with Gary Payinda, an emergency doctor in Whangarei in Northland, one of the poorest areas of New Zealand, about the out-of-control spread of COVID-19 and the crisis in public hospitals.
Jun 22 6 tweets 3 min read
UK now has #polio being found repeatedly in its wastewater.
Now's a good time to review your family's vaccination status. Whooping cough, tetanus, measles, mumps rubella, varicella, etc.
If it's going to be a return to the bad old days make sure you're prepared. The reason I say this, is that vaccination rates are dropping in communities everywhere. #NewZealand rates are atrocious.
There will likely be more #measles outbreaks this year. 1/1000 kids who get it will die, 1000 will be brain damaged. It's vaccine-preventable.
Jun 22 5 tweets 2 min read
Vaccine mandates mean your doctors and nurses and midwives are vaccinated. It's literally the least they could do.

We *should* require up-to-date vaccination: Covid boosters and flu.

Spreading infection to patients unnecessarily, preventably, is not acceptable. Some will die. If you are vaxxed and boosted you avoid 90% of hospitalisation and death risk.
You are less sick, for shorter, and less infectious to others because of it.
Unvaxxed are an unnecessary risk for immunocompromised, elderly, infant, pregnant and vulnerable patients.
Jun 22 7 tweets 4 min read
I'll be participating in a free online debate, for anyone interested in: #lifeguarding #FirstAid, #firstresponder #Lifeguard #CPR #C-spine #trauma #BLS The International Life Saving Federation is having a medical talk (actually, a debate amongst several international doctors, researchers, and paramedics) on **C-collar use** and **Hands-only CPR**. Should be fun.
Jun 21 17 tweets 3 min read
This story wholly missed the mark of healthcare worker staffing issues, I feel.

Background:
EDs were unable to meet demand even before Covid, with ED pts occasionally waiting altogether too long: ie, 24 hours for a ward bed. This is happening again.

nzherald.co.nz/business/the-s… It's not due to a lack of backpackers.
Our most senior and experienced nurses are deciding, wisely, that it's a good time to retire, leave, or do other work.
Jun 21 8 tweets 2 min read
Monkey pox will usually spread through close skin to skin contact, like sleeping in the same bed with someone or having sex with an infected person. But it can also be spread by respiratory droplets. Close exposures. It started off in Africa; 20 years ago there were a batch of cases in Wisconsin, spread by handling imported pet Gambian rats, etc.
Jun 21 8 tweets 2 min read
NZers missed out on losing family members to gruesome Delta.
Everyone was scared when people were dying of respiratory failures in the ICU and Italy in the UK. NZ missed this.

But chronic health symptoms from recurrent Omicron infections are just not very motivating. Meh. Most people will not notice if they lose 1% of their lung or heart function with every COVID reinfection. The odd PE here and there.
They'll just call it aging, or shortness of breath, or forgetfulness and not trace it back to infection.
Jun 21 4 tweets 2 min read
One could:
Subsidise housing for nursing students.
Make books and learning materials public access.
Change medical school so it doesn't prioritise test taking and high grades, as much as demonstrated clinical competence, communication, and caregiving.
Institute living wages. ...living wages tied to capitals gains taxes, redistributive taxes on the rich, and wealth taxes.
... cut down medical school duration, eliminating it's focus on irrelevant science trivia, and increasing clinical science education.
Jun 20 5 tweets 1 min read
We need a public health service paying living wages, reimbursed modestly but appropriately, with adequate staffing resources and facilities.
Instead we'll get more private insurance/doctors/hospitals hoovering up taxpayer subsidies. rnz.co.nz/news/national/… It's long past time for all public GPs to be salaried: paid fair wages, and receive continuing medical education, and benefits like any other public doctor.
Jun 20 11 tweets 6 min read
This is insane:
Only 54 percent of district health board staff have had the flu vaccine! Nelson Marlborough District Health Board: just 39 percent of workers had been vaccinated against flu. If you can prevent infection with something (the flu) that harms kids, older people, pregnant women, and others...and kills some people every year, how can you be a health care worker and not bother getting vaccinated..to keep your patients safer?

Of course it should be required
Jun 19 5 tweets 1 min read
Let's say an average ED had 30 beds. Fairly busy day.
5 beds are blocked with pts waiting for a bed 'upstairs', coming up on 5-10 hours. 10 more await inpt assessment, 2-6 hours after ED assessment.
Not many beds left for anything else. The low acuity fast track GP type stuff can still get churned through chairs in fast track.
The real and fundamental problem is you've locked up and blocked half of the ED for the entire shift, or whole day.
Jun 19 4 tweets 1 min read
I was once surprised by this...no longer.

I looked at the rates of Maori voting in Northland...they were so atrociously low that it essentially silenced their contribution.

Disenfranchisement and disengagement favor conservatism and the right wing. There's one group that votes at a fantastically high rate: the elderly. This means our politicians get strongest support from this largely socially conservative and religious group.
Jun 19 5 tweets 1 min read
Our emergency department is fantastic with n95 use and masking.
We've had much less COVID than average despite working around infected patients. Workers: you too can have fewer Covid sicknesses, fewer weeks off sick. Less ongoing symptoms.
(Wear a mask.)

Employers you too could have fewer worker shortages due to Covid illness.
(Wear a mask.)