ABC’s Keep­ing Aus­tralia Alive of­fers a fas­ci­nat­ing snap­shot of the health­care sys­tem over a 24-hour pe­riod

The Weekend Australian - Review - - Television - Graeme Blun­dell Keep­ing Aus­tralia Alive

new mum Shay-Lee holds baby Monique for the first time, in­set; bariatric sur­geon Justin Greenslades, below

For most of us, our con­tact with health ser­vices usu­ally in­volves lit­tle more than a visit to the lo­cal doc­tor or phar­ma­cist, but as a com­plex new sev­en­hour ABC doc­u­men­tary se­ries re­veals, th­ese ser­vices are part of a much broader and in­tri­cate net­work that’s as hard to visualise as any­thing the cre­ators of Utopia could dream up. Think “gov­er­nance and sup­port mech­a­nisms that en­able the pol­icy, leg­is­la­tion, co-or­di­na­tion, regulation and fund­ing aspects of de­liv­er­ing qual­ity ser­vices”, a de­scrip­tion that might have been writ­ten by Rob Sitch.

ITV Stu­dios Aus­tralia ex­ec­u­tive pro­ducer Karen Dewey, with the help of 100 cam­eras and her crew, gives us an ex­tra­or­di­nary snap­shot of what hap­pens over a sin­gle day in this med­i­cal ecosys­tem, stretch­ing across the con­ti­nent. “Film­ing over a 24-hour pe­riod — one sin­gle, ran­dom day — al­lowed us to high­light the in­cred­i­ble breadth and depth of our health sys­tem,” she says. “This was an ir­re­sistible op­por­tu­nity to ex­am­ine some­thing so vi­tal to all Aus­tralians, and to present a vivid and hu­man por­trait of a com­plex and sprawl­ing sys­tem.”

In that sin­gle day — Dewey gives us an at­trac­tively in­sis­tent dig­i­tal count­down graphic — more than 800 ba­bies were born, 400 Aus­tralians died and more than 1000 peo­ple were treated across the coun­try in hos­pi­tal trauma de­part­ments. There was a lot to cover and, as al­ways, the the­atri­cal­ity of sur­geons in white gowns in the heat of the op­er­at­ing theatre fight­ing for some­one’s life of­fers se­duc­tive view­ing.

Dewey is no stranger to fac­tual med­i­cal shows: she pro­duced Med­i­cal Emer­gency (filmed at the Al­fred Hos­pi­tal in Mel­bourne) and Mak­ing Ba­bies (cre­ator), an ob­ser­va­tional doc­u­men­tary se­ries for the Seven Net­work that fol­lowed 12 cou­ples from preg­nancy to birth; she was also re­spon­si­ble for RPA (filmed at Syd­ney’s Royal Prince Al­fred Hos­pi­tal) and Young Doc­tors, an ob­ser­va­tional doc­u­men­tary fol­low­ing res­i­dents at the John Hunter Hos­pi­tal in New­cas­tle, both for Nine.

But Keep­ing Aus­tralia Alive is al­to­gether dif­fer­ent. Her pro­duc­tion notes re­veal seven fran­tic months of pre-pro­duc­tion for the one-day shoot, in­clud­ing ne­go­ti­at­ing ac­cess to all the hospi­tals and clin­ics — more than 80 in all — and more than 1000 con­sent forms. (“How do you eat an ele­phant?” she says. Bite by bite.”)

Then there were four months of post-pro­duc­tion. The footage was filmed, she says, us­ing a mul­ti­tude of cam­eras, with no op­por­tu­nity for se­cond takes, re­sult­ing in 550 hours of raw footage. Units were de­ployed in 10 dif­fer­ent emer­gency wards, some surg­eries re­quired cov­er­ing two sep­a­rate pa­tients (“There was a risk that if a pa­tient had a tem­per­a­ture or was not well they wouldn’t go ahead with surgery and we would miss the story”), and film crews were on standby in ma­ter­nity wards in two states.

“The story de­vel­op­ment list was ex­ten­sive — we wanted to en­sure we had all an­gles cov­ered,” Dewey says. “We had to cre­ate a bal­ance of sto­ries: metropoli­tan to ru­ral to re­gional to re­mote, pub­lic to pri­vate, from birth to death, from far north Queens­land to south­ern Tas­ma­nia, from east to west, from sur­gi­cal to clinic to home care.”

Al­lowance was made for seven sto­ries per episode, plus emer­gency room se­quences, and then an­other 10 to 15 re­serve sto­ries were al­lo­cated, in case some dropped off on the day.

“We wanted ev­ery story to hit at least three of our key themes: love and sac­ri­fice, qual­ity of life, tyranny of dis­tance, com­pare and con­trast, the in­dige­nous health gap, pri­vate ver­sus pub­lic, the fu­ture of medicine, age­ing pop­u­la­tion, cost of health­care, pres­sure points in the sys­tem,” Dewey says. Her in­ten­tion is to con­front and sur­prise us with the real sto­ries of what makes up Aus­tralia’s ex­ten­sive sys­tem of care and ser­vices — which, as her ex­tra­or­di­nary pro­duc­tion re­veals, we of­ten take for granted.

It’s a show premised on life’s big ques­tions, and there are many to which she at­tempts to find an­swers in the very hu­man sto­ries of joy, fear, ter­ri­ble un­cer­tainty and hope on the part of pa­tients and staff.

What are the in­equities be­tween pub­lic and pri­vate sys­tems, be­tween east and west, be­tween coun­try and city? What spe­cific chal­lenges do we face with a struc­ture that needs to cater for ev­ery­thing from the most re­mote in­dige­nous com­mu­nity to the busiest city hos­pi­tal? What hu­man dra­mas un­fold ev­ery day within it, and what do they tell us about our­selves?

The first episode takes us from cra­dle to grave. On the day, 35 ba­bies are ex­pected to be born with fer­til­ity as­sis­tance. In Syd­ney’s West­mead Hos­pi­tal we find Chrissie and Rob, who have been try­ing to have a baby for many years. They have com­pleted an­other ex­pen­sive in­vitro fer­til­i­sa­tion cy­cle and now des­per­ately hope for a pos­i­tive re­sult to a preg­nancy test. It’s a big day and it may be heart­break­ing. Mean­while, Vanessa, who has three chil­dren, is do­nat­ing her eggs to a child­less cou­ple who sought out a donor on Face­book. “I’m happy to help,” she says. “It’s a real hon­our.”

On Bri­bie Is­land, 79-year-old Rita Kok is a home carer, one of thou­sands of “un­paid sol­diers of the health sys­tem”, as her doc­tor calls them. Rita’s hus­band El­bert has ad­vanced de­men­tia.

“He hasn’t for­got­ten me, he’s for­got­ten the re­la­tion­ship,” she says. The per­son she fell in love with is no longer there. More than a mil­lion of us care for some­one with de­men­tia.

Forty-one-year-old mother-of-four Lisa Clark col­lapsed at home near Bal­larat. She’s been rushed to the Royal Mel­bourne Hos­pi­tal with a rup­tured brain aneurysm. As the trauma team works ur­gently, ev­ery minute counts. Then an­other emer­gency aneurysm pa­tient ar­rives: a farmer sadly given lit­tle hope of sur­vival. In Aus­tralia some­one suf­fers a stroke ev­ery 10 min­utes; one in six of us will suf­fer one. The speed of treat­ment is crit­i­cal to the out­come.

Ru­ral med­i­cal gen­er­al­ist John Douyere works in the small com­mu­nity of Lon­greach in Queens­land. He de­scribes his pa­tients as his friends and his friends as his pa­tients. To­day he has a dif­fi­cult con­sul­ta­tion with an old mate who has skin can­cer. “We’ll just have to see how we go here; this could be a bit emo­tional for me,” Douyere says to cam­era. The pa­tient and his wife are stoic, brave and funny.

It’s a beau­ti­ful-look­ing and sound­ing pro­duc­tion un­der the guid­ance of di­rec­tor of pho­tog­ra­phy Ian Peter­son and head of sound Tony Clunes, who briefed more than 130 pro­duc­ers, cam­era oper­a­tors and sound recordists across the coun­try at “boot camps” for crews in Mel­bourne, Syd­ney, Perth and Bris­bane.

“The vi­tal part of boot camp was to en­sure ev­ery­one was aware of the shoot­ing style and se­ries mis­sion,” Dewey says. “We wanted to en­sure they cap­tured the hu­man sto­ries, the heart — we en­cour­aged them to ask ques­tions of con­trib­u­tors about how they feel, what they’re afraid of, what their fu­ture holds.”

The se­ries is visu­ally grip­ping, the im­ages slid­ing back and forth be­tween high pho­to­graphic styli­sa­tions and vis­ceral hand­held cam­era im­me­di­acy, shift­ing at­trac­tively be­tween film modes and styles in cov­er­age, not only be­tween se­quences but within them.

There’s a fast cut­ting rhythm in the edit, mon­tages of fast and slow mo­tion be­tween the main sto­ries, be­speak­ing a fran­tic med­i­cal uni­verse, each se­quence pre­ceded by the rhyth­mi­cal click and crunch of a cam­era shut­ter that adds to the feel­ing of be­ing hur­tled through this ex­tra­or­di­nary day.

We’ll have to wait un­til the day is up to know how many ques­tions this re­doubtable team is able to an­swer, but there’s no doubt­ing its prob­ing and com­pas­sion­ate en­gage­ment with the re­al­i­ties of health­care, and the joy, sad­ness and the oc­ca­sional mo­ments of wry hu­mour are af­fect­ing.

There are won­der­ful, of­ten in­spir­ing mo­ments of char­ac­ter in the show that re­ally cap­ture the essence of hu­man drama by show­ing mod­est, unas­sum­ing he­roes who work hard to bring peace of mind to peo­ple with per­plex­ing med­i­cal prob­lems.

8.30pm, ABC.

from Tues­day, March 15,

A scene from Keep­ing Aus­tralia Alive;

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