Sallies: Let’s build a better home for all

keep up with the sheer volume of people seeking help, and many of our clients report that they have days or even weeks to wait before financial assistance is given. The wage subsidy has been effective in helping keep many people in employment, but what happens after it ends, is an open question.

The housing crisis that saw more than 15,000 on the social housing register before this crisis even began, is set to intensify. People will need urgent support to meet their rent or mortgage costs. No one knows quite how this will affect the overall housing market.

A courageous and hopefilled programme of Government responses is needed to help us find a way through the tough times ahead together and come out of this crisis as a better place for all. A massive investment of billions of dollars in housing is essential. This will provide jobs and retain skills as more social housing is built, providing affordable and secure rental housing. A significant, progressive home-ownership programme for households with incomes of more than $60,000 is also needed.

Welfare support needs to be revamped to provide adequate incomes for the growing cohort who will rely on it for months, possibly years. Stronger controls need to be placed on consumer loans, along with an increased availability of financial mentoring services for those experiencing hardship.

People have gained a new appreciation of the value of the many vital support services provided by community organisations and NGOs such as The Salvation Army. But these times are testing the limits of volunteers and the scarce resourcing of so much of the paid and unpaid work done by people who do it because they care. Alongside those brave health workers fronting the pandemic response and the many essential workers in other services, let us recognise the value of work that is often unpaid or poorly paid. Let’s change the employment market to provide better paid work that contributes to our social and environmental sustainability.

The Salvation Army is calling on the Government to use the May 14 ‘‘Recovery Budget’’ as a chance to make these changes, for the benefit of all New Zealanders. We now know that, as a nation united, we can take on the Covid-19 threat. Let’s continue that work and build something better out of what is broken.

Thanks to television shows, movies, and books, many of us are vaguely familiar with intensive care units and how they take artificial control of failing bodies to save lives. But unless we’re very, very unwell, or know someone who is, we’re unlikely to set foot in one.

The sort of live-saving that goes on in ICU isn’t flashy or bold, it’s part of the job description. It doesn’t typically make headlines. Well, not until now. Life-and-death decisions are par for the course, along with working as part of a well-oiled team, and executing complex tasks in the correct sequence.

As a medical student, Dr Kate Tietjens didn’t get to spend much time in ICU. That’s something the intensive care specialist is working to change.

Last month, when presenting on behalf of the specialty to junior doctors, she rattled off a list of things she loved about her job. Varied workload; rewarding family interactions and communication; great colleagues; fast-paced and actionpacked; combines the best bits of other specialities. Plus, there are helicopters and a therapy dog who visits once a week. The negatives? Long hours and frequent overnight phone calls. She struggled to get through her list within the five-minute time limit.

But the coronavirus that became a pandemic late last year, and first reached New Zealand on February 28, has seen Tietjens’ line of work projected onto a much bigger, global stage.

Footage from overcrowded hospitals in the worst-hit countries shows dwindling stockpiles of equipment and doctors making impossible choices. Patients dying alone, and dying unnecessarily.

Meanwhile, in New Zealand, which has dedicated itself to going ‘‘hard and early’’ – in Prime Minister Jacinda Ardern’s words – to limit the spread of the virus, extensive work has been taking place to repurpose hospital buildings and prepare staff. The focus has largely been on ICU, where those with Covid-19 pneumonia and acute respiratory failure end up.

Tietjens, 40, is at home on a day off when we chat via Zoom. Her children – three boys aged 6, 4 and 2 – can be heard bouncing on the trampoline in the backyard.

This interview is specifically not about Covid-19. Yes, she’s been busy preparing for it. Yes, it’s the biggest disruption that’s happened in her career. But I want to hear what an intensive care specialist, or intensivist, does on any given day, and what it takes to become one.

Originally from

Christchurch, she’s been working as an intensive care specialist at Wellington Hospital for three years.

She and her husband, a general surgeon, work four days a week. Their nanny helps with childcare the other three weekdays. ‘‘We have to work our rosters to make sure we’re never on call at the same time, or never rostered on the same weekend.’’

Tietjens had to take time out to have her children and is now passionate about paving the way for both mothers and fathers to better fit parenting around medical training.

As chair of the Women in Intensive Care Medicine Network, she’s also working hard to improve the gender balance in the field.

The daughter of two maths teachers, she’s always been fascinated by ‘‘the maths of how the body works’’, she says. She was drawn to ICU when she first worked in the specialty in Hawke’s Bay.

‘‘Each day you turn up to work and you don’t know what you’ll find. You have medical patients, surgical patients, paediatrics. They’re the sickest patients of all the other specialties combined. So you work as a generalist, but on the cutting edge of things.’’

Tietjens rejects the word ‘‘stressful’’ and instead uses adjectives such as ‘‘exciting’’ and ‘‘interesting’’.

‘‘We’re really pragmatic people who look at the big picture.’’

They’re constantly having to re-evaluate what’s best for a patient, and work with what the patient and their family wants.

There are 24 beds in Wellington’s ICU, staffed by a team of 11 specialists, 18 junior doctors, and about 200 nurses and other staff (patients in ICU require one-on-one nursing care).

‘‘We have a really big but tight-knit team, providing highquality care for patients,’’ Tietjens says.

People would be surprised, she says, by the department’s mortality rate of just under 10 per cent. Meaning, of course, the vast majority of people who go into ICU come out, alive.

As her colleague, Dr Paul Young, wrote last month: ‘‘If you require ICU care in New Zealand you are less likely to die than almost anywhere else in the world.’’

On a typical morning, Tietjens is out of the house by 7.30am. Split into three teams, ICU staff review patients’ details before doing ward rounds, to