CONTEMPLATING LIFE IN AOTEAROA

A. Roy Bowden

'A linked community' - Kororā (penguins) at Pukerua Bay - designed by village children

The boy with asthma

 

Now that Covid 19 is here the world is focused on the way health is protected and maintained in communities. I have been thinking about my own journey as a consumer of health services and as an allied health professional. In this reflection I trace events which affected my growing years and suggest health services need to be more connected. I am hoping consumers and those who practise in the primary health sector might plan towards establishing a more holistic environment.

The other night I felt unwell. Dizzy spells had me thinking, ‘What did I eat before bed?’ ‘I’m too busy to go to the doctor so I hope the nausea will be gone by morning’. I took an aspirin and eventually fell asleep. Physical symptoms were uppermost in my mind as I reached for medication and thought about visiting our nearby health centre. If I had a serious ongoing medical condition, had been traumatised, was recovering from surgery, managing a life-threatening illness, or in high level pain, it would make sense to focus on my body first. I was not seriously ill the other night, but somewhere I had learnt that when I feel unwell, physical symptoms are paramount, illness is likely to be confined to my body, and the only way to alleviate discomfort is to consult a medical or natural health practitioner. My doctor and the nurses are excellent but why did I decide promptly that only my physical self needed attention?

A divided self

I have been informed by childhood experiences. I had asthma from age five to twenty-one. Asthma is a condition affecting airways in the lungs, is very uncomfortable and sometimes requires urgent intervention. There are now inhalers which assist patients to breathe but these ‘inhaled corticosteroids’ were not available in the 1940s and 1950s.

When I was young our family doctor prescribed various medicines and gave me adrenaline injections to help me breathe. She advised my parents to keep me home from school when I had asthma ‘attacks’ and make sure I was warm. My mother and father appreciated the doctor’s treatment, but I remember sitting in the doctor’s waiting room wanting someone to pay attention to what I was thinking and feeling, as well as finding ways to help me breathe. I was told I was ‘an asthmatic’. It would have been more helpful to describe me as ‘a boy with sensitive airways’ and then I would have been interested in how my lungs worked. But there were no explanations and I was left to imagine what the unseen threat called asthma might look like.

When air is taken in and expelled from the lungs it is important to have space to breathe. It was not easy to relax in our home where it was difficult to find private spaces. When emotions peaked and disagreements lasted for days, peace did not come easily. After an asthma attack, I remained on alert even when there were good times and an abundance of love from proud parents. It was not long before ‘being on edge’ gave rise to shortness of breath.

I was anxious and confused. In that era there was no provision for relationship help so my feelings about family life were not shared. There was certainly no lack of affection at home but, had someone asked me, I could have described the fear that gripped me when my parents created distances between themselves. ‘Roy has asthma again’, was what people heard and that allowed me to collapse into lethargy and isolation. I did of course ‘have asthma’, but it was also true that ‘asthma had me’. It prevented me from enjoying a ‘normal’ childhood. My parents were told I was an ill child who needed to be excused from physical challenges, school outings and energetic times with friends.

Fortunately, my loving parents arranged for singing tuition and from an early age I looked forward to breathing exercises in a Roman Catholic convent where the lack of tension and the opportunity to be ‘on stage’ enabled me to forget I was ‘ill’. No-one noticed I found more than enough lung capacity to sing well every week. Singing had alleviated the symptoms, but I was not asked whether the lessons were making a difference to me or my illness.

Divided treatment

My parents did what many people do when mainstream medicine is unable to offer a lasting solution. They followed advice from well-meaning friends who said patients were being ‘cured’ by natural methods. Mother was advised to prepare a steaming bowl containing Friars Balsam and I breathed fumes from the mixture to clear my lungs. I would eventually feel exhausted and fall asleep, but I was restless and stressed. Sometimes as an adult I dream there is a cover over my head, and I wake to shift the pillow. There is a strange odour in my nostrils during that dream which takes me back to childhood. Friar’s Balsam partially addressed the symptoms, but no-one asked if it was helping, or wondered whether it might be anxious feelings that were restricting my breath.

During childhood I was afraid when asked to gather firewood from the wood pile under the house. My father had followed advice from a natural health practitioner who told him to attach copper wire to the house foundations. The wire was there to conduct moisture away from my bedroom. Those strands of bright copper wire seemed alive with danger whenever I crept around the foundation house piles towards the logs. My father had acted out of desperation because my ‘asthmatic condition’ prevented me being the ‘active sport loving chap’ which he had been in his younger days. The copper wire did not help, and the house remained damp. I would often take ages to get to sleep being afraid of those wires below my bed. It was all an attempt to reduce the symptoms, but the effect on me went unnoticed. The fear that built tension in my chest continued to restrict my breathing.

Whenever I visit Rotorua where sulphur rises from hot pools, I remember a time when I felt close to death. Around the age of eleven I travelled with family members to sing in competitions in a city where steam is all around, creating a rather mystical environment. A health practitioner advised me to breathe in as many sulphur fumes as possible. I spent the first day doing just that, and in the morning, I had to be driven to the top of nga maunga Mamaku because I was extremely short of breath. I recall thinking I might die in the moments before my uncle’s Morris Oxford came to a sudden halt and fresh air from the mountains filled my lungs. The practitioner had focused only on symptoms, the recommended treatment was life-threatening, and no one asked what it had felt like as sulphur burnt my throat before settling in my lungs.

A particularly frightening experience happened whilst seated in a leather chair in the darkened room of a colour therapist. My parents were told the light emanating from colours would heal my emotions and the chosen treatment would be linked to chakras in my body. The therapist attached wires to my wrists, left me on my own for fifteen minutes, then returned to show me various colours and ask questions. Interestingly none of the questions explored my emotions. I waited another fifteen minutes before being released down a dingy corridor where my mother waited with an expectant look on her face. My health issues did not abate, I remained fearful, and worried I might have to re-visit the strange man who held coloured wires in his wrinkled hands.

One night I woke wheezing loudly and mother thought I might not breathe again. She phoned a taxi from the telephone box on the street corner and summoned our doctor urgently. The doctor’s adrenaline injection made me feel as if a large balloon was deflating inside me. That was accompanied by a floating feeling in a strange world of colour and immense pleasure. I thought the symptoms might disappear for ever. They eased, but they often reappeared. I didn’t know what the word ‘adrenaline’ meant and concluded it was something to do with what was inside the ‘magic needle’.

No one told the doctor I was seeing natural health practitioners and the doctor did not enquire about life inside or outside our home. I wonder what would have happened if all my health advisers had called everyone to a meeting where we shared insights into ‘Roy the boy with asthma’. I also wonder whose voice would have prevailed.

We attended the Methodist Church and in my adolescent years I played the church organ. I never felt asthmatic in church, even when the minister preached sermons about the atom bomb, which he said would send us all to heaven long before we were due there. Theology, a sense of belonging and church music made me feel strangely safe as they offered me a way to start believing in myself.

Integration

After being employed as a clerk, a salesperson, and a heavy vehicle driver, I was encouraged to challenge myself by entering Trinity Theological College as a resident divinity student. College life demanded my full attention. I was philosophically engaged and close to twelve young men who expected me to be healthy, rebellious, studious and creative. There was no room for lethargy, no-one was over sympathetic when I felt low, and the tutors expected us to be self-motivating responsible adults. To my great surprise I topped the class on occasions and passed papers towards my university degree. The boy who had been told he would not achieve because of his illness was somehow released from low self-esteem. From 1962 to 1966 there was no recurrence of my asthmatic condition. Perhaps my lungs were stronger as a young adult. Perhaps my body passed through changes I was not aware of. Perhaps leaving home meant leaving asthma behind. Perhaps I needed a break from well-intentioned loving parents. Perhaps I had discovered my ‘self’.

Raising my own family triggered asthma on occasions and it was significantly present when each of my parents died but I did not have symptoms in early adulthood.

In the mid-seventies when ‘encounter’ groups were popular I attended a ‘rebirthing workshop’. Group members pushed on cushions until I felt ready to be ‘re-born’. Whilst under the cushions I became asthmatic and was sure someone else was there in the ‘womb’ with me. My mother later confirmed there was another foetus present and I asked myself the obvious questions: Did the birth process cause my asthma? Did the presence of another baby affect me physically? Perhaps both had an effect. There are theorists who promote the view that what happens in utero is of continuing psychological significance. I believe there can be no evidential proof for that and of course the recurrence of asthma whilst I was under heavy cushions is not surprising. The information gave me a family history perspective but did not change the way I viewed my journey.

For four years I was the on-site, part-time staff counsellor at the pharmaceutical company, Glaxo, in Palmerston North. Their main product was Ventolin inhalers which were designed to assist with breathing. I was intrigued by complex processes which ensured ethics and protection during manufacturing. I was also interested that whilst the word asthma was used daily, research focused on the way breathing was assisted and videos were played showing children in distress, I did not have asthma while I worked in the company and did not need medication.

Asthma returns in a mild form when I am highly stressed. It can be triggered by cold, a ‘closed in’ environment, fear, and relationships that lie fractured for too long. It is now clear to me that everything I am, all that I have been, and every experience I’ve had would have to be gathered together in order to explain why I am asthmatic on rare occasions.

When I became a psychotherapist, I discovered psychodynamic interpretations which might have explained my ill health and subsequent recovery. Some theories helped me examine important links between emotional, familial and physical development but an inclusive approach, developed by a colleague in New Zealand, was the only one that took the many-faceted narratives of my life story into account. In 2020 bicultural and multi cultural frameworks for therapeutic interventions are attending to wider perspectives which take our Aotearoa environment into consideration. Health is gradually being considered in a much broader context within professions that offer individual, family and group therapy.

Making Connections

My journey highlights disconnections in primary health services. Doctors consulted in my growing years applied their skills in surgeries separated from practitioners with knowledge about children and families. If I share feelings with therapists these days my medical history is of importance, but my general practitioner is not necessarily consulted. If a doctor refers a patient to a therapist there is no guarantee there will be follow-up communication between those professionals. Natural health practitioners point people to methods for alleviating specific symptoms but informative public health records and patients’ complex stories are not necessarily accessed.

There are a growing number of therapists, doctors, natural health practitioners, counsellors and psychiatrists who establish close working relationships in order to focus on an inclusive and expansive view of health. They function in a more connected and holistic way but there is no formal requirement to do so. In 2020 some community-based health centres with multi-disciplinary teams monitor a wide range of influences that impinge on health. Resident practitioners from different disciplines share their knowledge in cooperative settings where consumers are offered ‘wrap around’ services. Nurses, midwives and allied practitioners contribute their valuable perspectives. 

Whanau Ora is creatively pioneering health services based on connection, belonging, whakapapa and influences that are present long before birth. A number of primary health organisations are also including allied professionals in their teams. These innovative facilities promote an all-inclusive approach to health, but they are not yet accepted as fundamental to the health system. Professionals in health-related associations are also talking with the Ministry of Health about ways in which multi-disciplinary services can be established but support for these policies will need strong encouragement from consumers as well as policy makers.

 

🎭 Changes we can make as consumers >>

 

 

🎭 Consumer action

As consumers of health services, we have a role to play by encouraging health professionals to consult with other practitioners we have seen or perhaps should see. Instead of expecting one doctor, nurse, therapist or allied practitioner to heal us it is important we have a more inclusive view of influences affecting our health. We are sometimes inclined to dismiss approaches that don’t meet our particular needs and we often prefer our layperson’s assessment of treatment. There are also occasions when we choose our own medicinal solutions without pausing to consult wide-ranging inclusively focused research.

A more constructive approach would be to give health professionals permission to work together on our behalf. The phrase, ‘My doctor or my therapist says’ could be replaced with, ‘My health team advises’. As patients or clients, we can assist health professionals by telling them more about our complex history. We have a good sense of what might be relevant in any given circumstance but we often expect health practitioners to make discoveries without hearing enough from us. We can also isolate professionals by deciding they are not competent because our health did not improve or because they didn’t attend to us in the way we expected.

We know everything we do and are affects our health but our tendency is to seek a cure for each separate symptom. A consumer-driven movement is needed to support the view that ‘holistic health’ has no meaning unless all elements are woven into a colourful cloak which tells the complex story of a person’s life.

Multi-disciplinary cooperation

The primary health care system in Aotearoa offers a range of high standard services. There are limited resources in some regions and not everyone has easy access to facilities, but policy is directed towards ensuring good health. Now is the time for our skilled health professionals to work together. It is also time to address territorial imperatives that keep medical professionals, physiotherapists, psychologists, psychotherapists, psychiatrists, social workers, counsellors and natural health practitioners practising in isolated settings. Competition for recognition and funding has helped each profession build a strong knowledge base in separate forums but we are now in a climate where it is urgent that we share our combined knowledge.

Each discipline supports the view there is no separation between body, mind, spirit, emotion, relationships, community and cultural belonging. It is time that view was reflected in practice by establishing more connections between professional groups, arranging interdisciplinary seminars, and funding shared research. It is important to search for the causes of illness and well-founded multi-disciplinary research is crucial. Accordingly, research findings built on wide-ranging inclusive data bases are needed to inform treatment in all health practitioner settings.

Health policy

I’m aware a connected primary health system would require alternative ways to allocate funds, a review of training opportunities for health professionals, and an agreement to establish shared pathways between professional associations. These are significant challenges. However, it may be that community hubs and a team approach to consumers are, in the end, less costly and it is also highly likely more people would be saved from having to live with ill health.

Currently we continue to fund specialist agencies which focus on different aspects of ill health. These agencies gather data to build excellent frameworks for practice in addiction, abuse, family violence, child protection, poverty, youth, mental health, disability and disadvantage. While they enable specialist knowledge to be applied to practice, they too exist in isolated arenas, competing with each other for resources and recognition. The disconnected agency sector would certainly benefit from a combined approach to people in need.

Regular reviews of the health system have examined each sector many times. Whilst there has been progress, nothing significant has changed largely because services and professions have been supported as separate entities.

It is important to acknowledge that serious and life-threatening symptoms need to be separately targeted with medicinal and surgical precision and in these hospital-based situations focused health professionals, working in teams, save lives daily. They also take care when returning us to communities by suggesting targeted rehabilitation.

More support is needed for a connected view of health in the primary sector. Our tendency is to treat each symptom and each ‘condition’ as if it is self-sufficient, self-generating and able to be healed without reference to all the elements which pertain to healthy living. When our many symptoms and all our experiences of life are acknowledged as woven together, health services will be truly holistic. It is easy to agree with that view but very difficult to convince ourselves, health related organisations, and those who fashion policy, that change is well overdue. 

A. Roy Bowden August 2020

https://www.healththerapylife.com