A message from the frontline with Dr Joel Hissink

As the Northern Rivers community joins the rest of the world in adjusting to new lives, new routines and new values in the wake of COVID-19, we hear from Byron Bay GP Dr Joel Hissink about how both his work life and home life have changed in recent months.

The SARS-CoV-2 virus that causes the disease COVID-19 continues to wreak havoc and devastation across the planet. As a general practitioner in Byron Bay, the terrifying scenes emerging from China and Europe early this year filled me with dread.  There was every reason to think that the same would happen here, with our health system being overwhelmed and my patients suffering.

I found myself analysing the data every morning before work, trying to spot the first sign of even a minuscule flattening of the curve. Sometime in March I excitedly shared with colleagues an ever so tiny deviation from the frighteningly steep climb that we all feared would continue. There was a glimmer of hope that the changes that the people right across Australia were making to their daily lives were beginning to have an effect.

Behind the scenes in hospitals and medical centres all over the country health workers were scrambling to learn more about COVID-19, and establish procedures to manage large numbers of seriously ill patients. In many areas medical teams had to navigate their own way ahead as best they could and as a GP in a group practice the imminence of the crisis strengthened our collaboration.

Here in Byron Bay I’ve been asked by many people about my thoughts on the pandemic and about what it’s been like working on the frontline. The latter was not a question that I’d considered before as I had not felt that I was on the frontline. My first thought was that

I was fortunate to continue to have employment at a time when so many have had to suffer the shock of sudden unemployment, and then that I was even more fortunate to have a job that I loved.

On further reflection however, I began to think of how many times that I had been on the frontline, and even though this was different from the frontline of a conflict zone there were many similarities. To explain this, I need to go back a long way. Before I trained as a doctor and then worked as a Navy medical officer, I had a career in the Royal Australian Navy as a ship’s diving officer and an officer of the navigation branch.

As a junior officer, operational deployment was frequent, for example in East Timor in 2000, mapping beaches with South Korean special forces soldiers to facilitate the access of military landing craft, and shortly after that whilst serving in the guided missile frigate HMAS Newcastle, we were sent to Australia’s northern maritime border during the Tampa crisis. While on border patrol, we were informed of the 911 attacks and ordered to deploy to the North Arabian Gulf to enforce UN Trade Sanctions. As we arrived at our area of operations in the Gulf I recall feeling uneasy as we sailed silently at night under total blackout along a hostile channel approaching an Iraqi Oil Terminal, then shadowing and capturing ships smuggling oil. At each port we visited my diving team and I would leave the ship in small boats under the cover of darkness to dive along the wharf and seabed to ensure there were no explosive devices prior to the ship berthing. Late in that deployment the warship was called to ‘action stations’ as we manoeuvred in hostile waters to rescue a Navy boarding party from imminent capture and in danger of attack.

Several years later, then as a Navy doctor and with a wife and two small children safe in Sydney, I deployed to Pakistan with the first Australian Inter-agency humanitarian relief mission following the devastating 2010 floods. We established a medical centre on a sports field not far from the Afghanistan border. This was in a rural area of extreme poverty, and with so few people being educated or literate they were open to Taliban propaganda that we were there to do harm rather than good. There was a high risk of attack and remaining focussed on medical tasks was certainly challenging at times.

And now I’m on the General Practice frontline. In my surgery I’m not under risk of attack, and yet I am acutely aware of sharing the same frightening risk as everyone else. Of course this is quite different to being at the frontline in the Navy, yet I realise that I am on a frontline nonetheless, supporting the community against this known yet invisible and insidious danger. I know full well the risk of using military metaphors for a public health problem, but General Practice is THE frontline between our patients and community, and SARS-CoV-2. For many people, their GP is the person they turn to when confronted with a crisis in their health or personal life, so in that sense I feel part of the frontline everyday; all individual, unique, and very personal frontlines, but no less challenging nor less devastating to the person concerned.

These are the frontlines that often remain hidden in plain sight in society. They may be hidden from work colleagues, family and close partners. The pandemic has stressed every seam of work and family life, and hugely magnified the number of people who find themselves facing a crisis of relationship or finance. The loneliness of isolation, despite our online connectedness, has emphasised the importance of human physical closeness to our wellbeing. Right across the country rates of domestic violence, financial disadvantage, mental illness and stress have increased in direct relation to the virus and containment efforts. To be at the frontline of support and therapeutic endeavour, despite the absence of any silver bullet to cure the virus, takes us as doctors back to our most fundamental responsibility.

In Byron Bay I have been inspired by the resilience and perseverance of local business owners, and their skill in adapting to severe duress. Yet still they have the generosity to show gratitude to health care workers despite their own hardships: gifts and heartwarming words of thanks and kindness.

Despite the hardship, my wonderful community of patients have shown such heartfelt concern for me and my family. Many have also shared with me the silver linings of their time in isolation. These include the additional time spent with their children (ok, sometimes just a little too much!), slowing down from their usually busy routines, spending time walking together, and of course more time to read.

One of my favourite parts of the day has always been reading to my children each night, and as SARS-CoV-2 began to sweep across the globe I began seeing surprising parallels in the books that we were reading together.

In the early chapters of the wonderful novel that I’m currently reading to my nine-year-old daughter, The Girl From Snowy River by Jackie French, the story plays out against the backdrop of the influenza pandemic of 1918. There was the unconditional kindness of a young girl towards a homeless man in the story Mr Stink by David Walliams that I’ve recently read to my youngest son of five years old.

Later in the evening I’ve been weeping to the confronting Once series by Morris Gleitzman that I’ve been reading to my eleven-year-old and eldest son. Acts of great kindness shine amongst the unimaginable horror of the Holocaust.

In the fascinating novel The Overstory by Richard Powers, one story concerns the infamous Chestnut blight in the United States when a fungus was accidentally introduced from Asia around 1904. The infection resulted in the loss of four billion chestnut trees over 40 years and the devastation of industries that depended on them: it was one of the worst ecological and economic disasters in American history.

Thus my reading, and listening closely to my patients’ stories, has given me a heightened awareness of the symmetry between history and our lives.

Like most people, I have found that the changes to our day to day life has reinforced the importance of our individual daily rituals. These are the anchors that we create for ourselves and that secure us to familiar ground. I have found solace standing outside at night, gazing at the ‘wondrous glory of the everlasting stars’, and in watching the continuous and predictable continuity of wave swell and the tides. The citrus in our orchard continues to ripen, the Azure kingfishers continue to hunt along the creek, and while planes have deserted the sky it is busy as ever with soaring cattle egrets and flitting welcome swallows.

We must find hope amongst the anxiety that we all suffer, and the devastation that we see from around the world. The sense of shared responsibility and togetherness that we have witnessed has been heartening, and reminds me of the immeasurable power of community and the inspiring beauty of human kindness.

Byron Writers Festival