Issue 34 / 15 September 2014

IN the early hours of a cold wet morning, I was sleeping while something terrible was happening in my neighborhood.

In the park a few hours later, a fellow dog-walker told me that there had been a fire in the local shopping strip. As the day wore on, the news emerged that people were missing and, by the end of the week, we learned that three people, including a child, had died. The Sydney media monitored the unfolding catastrophe, and a pervasive sense of loss began its slow descent onto the surrounding streets.

On a global scale this was a small event but impactful to us because of its closeness. But modern communications and our desire for information mean that it is not unusual to watch from a distance as catastrophic scenarios unfold elsewhere.

One such crisis is the outbreak of Ebola virus in West Africa, which is the subject of an MJA InSight news story this week. There were several developments last week, including fears of a case in Queensland that were quickly assuaged.

While local cases are not impossible, we need to think beyond the need to protect ourselves, say experts writing in and talking to the MJA. This includes pitching in to a global effort to manage and prevent Ebola in the countries most affected.

It is about 20 years since endocrinologist Paul Zimmet first described diabetes as an “epidemic” but, the medical catastrophe of diabetes and its complications continues to unfold.

In another MJA InSight news story this week, we asked Professor Zimmet for his thoughts on a study published in the MJA that found one in four inpatients in Melbourne hospitals had diabetes. While he was too gracious to say “I told you so”, he did make an observation: “Most of us have been aware of these problems for many years and the need for hospital administrators to recognise the burden of diabetes within the hospital system”.

On an individual level, most of us have had the misfortune to partake in the unfolding catastrophe of a relationship breakdown. Two articles, published in the MJA, which explore the ethical and legal implications when that relationship is the therapeutic one between a doctor and a patient, are further explored in another news story this week.

The rising cost of health care has been seen in some quarters as an unfolding catastrophe, set to become “unsustainable” as the population ages.

Our comment articles this week, from three eminent physicians, touch on different proposals for maintaining quality while containing costs — Richard King looks at the obstacles that impede Australia’s progress in the worldwide drive towards “disinvestment” in ineffective or inappropriately applied practices in health care; Michael Gliksman takes aim at the AMA’s proposed amendments to the federal government’s unpopular Medicare copayment proposal; and MJA Editor-in-Chief Stephen Leeder explores the potential health benefits for people with chronic disease of a well designed managed care program for Australian medicine.

Sometimes catastrophes can’t be averted. The blow to my neighbourhood will run its course, although even in this case the community’s response will have some bearing on the healing process. But with many of the problems facing health and health care we have an opportunity to turn things around.

After all, who wants to watch a catastrophe unfold when we have the potential to avert it?

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight


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