Who am I, and why should someone subscribe?

Do you like stories about medicine, science, healthcare, and the social determinants of health? Want a better understanding of health science and the medical issues of the day? Have a passion for public health and working towards a healthier society? Want to fight against privatisation and preserve the things that make our society stronger — like public education, public healthcare, public housing, and essential public services?

Me too. Come read my stuff. We can fix things.

— Dr Gary Payinda

A little bit about me:

I am an emergency doctor. It’s who I am. It’s not just my job.

I’ve lived and worked in Whangarei, in Northland, New Zealand for the past 18 years, with my wife and two kids.

But let’s start from the beginning:

I was born in New York, and raised in a very small rural town in the Adirondack mountains. My father, who immigrated to the United States from Afghanistan as an 18-year old, got educated and eventually worked as a chemist. He died when I was six years old, after years of occupational illness ending in liver failure, leaving my mother and I alone. Unfortunately, my mother developed nasopharyngeal carcinoma (a bad kind of head and neck cancer associated with smoking) not long thereafter my father’s death.

My early memories are of accompanying my mother to doctor’s visits for surgery and radiation therapy. She lived through a disease that is usually fatal thanks to modern medical care. The doctors’ care was a life-saver, even if the radiation treatments to her head and neck did eventually leave her disabled. Even more unfortunately, the American healthcare system left her financially gutted. She had survived but we had nothing.

We were very lucky to be able to get welfare and food stamps. Government social programs kept us going. As a disabled immigrant widow with a 6th-grade formal education and a child to take care of, my mother knew that higher education was the best way out of poverty for me. From about the age of 12 or so, I understood that it was quite possible she wouldn’t be around to take care of me, and that I had to get independent and get educated and start taking care of myself, so as not to be a burden on her.

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I loved learning everything, read voraciously, and did very well academically in my small rural public schools, doing 2 years in one then skipping a year, entering university a few years early, at age 16. I received need- and merit-based scholarships which allowed me to go to Johns Hopkins Univeristy in Baltimore. I graduated with a Bachelor’s degree in biology. Then I did a Master’s degree in science writing. I had a love for science communication and medical journalism from an early age. At 19, I met me wife while doing medical research Johns Hopkins Hospital. I went to medical school at the University of Chicago alongside her, and we married the day after our medical school graduation.

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Together we did our residency training at Los Angeles County Hospital, after my first year in general surgery at Harbor-UCLA Public Hospital. LA County was a wild, hairy experience. Los Angeles was coming to the end of crack epidemic, and LA County was a hotbed of penetrating trauma, critical illness, and overwhelming patient numbers. We put around 180,000 patients through that emergency department every year. It was an enormous public hospital built during the Great Depression as a public work to keep people employed, and it’s mission was to care for people who had nowhere else to turn.

It was a great place to learn how to practice emergency medicine. A crucible. During those years, I was chosen by my peers to represent them at the Southern California, then the National level, of the public union for doctors-in-training. The United States’ largest doctors’ union: JCIR-SIEU.

I take pride in the fact that we achieved some big wins: the country’s first law limiting the number of working hours a doctor could work: 80 hours a week. It may seem crazy, but getting working hours capped at 80 hours a week was a huge victory. Having worked between 56 and 126 hours a week, every week through 4 years of surgical internship and then emergency medicine residency training, I thought this was a great achievement for trainee doctors and the patients they looked after. The change in the work-hours laws came too late to help me, but at least I helped make things better for those that came after me.

Providing health care to patients based on their need, and not on their ability to pay was always extremely important to me. After residency I worked in a small rural town in northern California for a few years, practicing community emergency medicine.

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In 1997, my wife and I decided to take our two toddlers to New Zealand, for a 6 month working holiday visit. We loved it so much that we stayed forever. There seemed to be a social conscience that New Zealand had—a willingness to take care of its people, a decency, a real sense of community, of a whanau that was bigger than just one’s nuclear family, that I valued greatly.

My wife and I have continued working in Whangarei, in Northland New Zealand, the entire time. 17 years and counting.

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After a few years in New Zealand I was elected to the Northland District Health Board where I tried to make things better for patients and the community. It was hard, if I’m being honest. There was little scope to make the system more efficient and effective. It was a bureacratic fiefdom that was resistant to any change of direction. Good people were disempowered and good ideas just stagnated.

I learned Northland had for the better part of 50 years been a “safe National seat”. I learned what a “safe seat” really meant: Northlanders had always voted for the same government, National, for virtually all of those years, and as an indirect result, had always been forgotten about.

It had among the worst numbers for poverty, the worst roads, the worst hospitals, the worst schools and the unsurprisingly, the worst health outcomes. After 9 years under a National government, and 3 of those on the NDHB, I knew none of this would change, and so I went back to just practicing emergency medicine, happy to treat my wonderful, long-suffering, but nonetheless deeply appreciative Northland patients.

Looking back on a graph of those years economically, I see what was happening. Even though those 9 years were booming economically, the proportion of GDP going to Health NZ was actually shrinking. It didn’t just ‘feel’ like things were being neglected during those years. In our hospital, the windows were literally falling out of the walls due to “deferred maintenance”, another name for neglect. It would take years to undo that damage, but before it could be undone, Covid struck.

Deaths were coming fast and furious in Italy, then London, then the US. NZ locked down and waited out the worst of it. While millions died in the US and UK and elsewhere, a handful of countries rode our the storm and got all their people vaccinated while the first strains of Covid were at the worst. Those few countries suffered almost no deaths (compared to other developed countries): Taiwan, Singapore, Australia, and New Zealand. The US and the UK had more than four times the death rate that we had here in New Zealand! We were able to close our borders, wait for a vaccine, and vaccinate almost all our people before the virus swept over us.

Medical colleagues in the UK and US were intubating people and watching scores of their patients die for the first two years, while NZ avoided the worst part of the first 2 years of the plague. By the time the much weaker Omicron came around, Kiwis were understandably sick of lockdowns and reeling from a worldwide economic crash, but understood that NZ had made it though Covid having saved roughly 20,000 New Zealanders lives.

I am thankful that while I worked through the entire Covid pandemic, I never had to intubate anyone nor pronounce anyone dead due to Covid. I’m thankful for that, and for a public health and government protections that kept 20,000 more New Zealanders alive through those two years. 20,000 people that would have died had they lived in almost any other developed country in the world in 2020 and 2021.

But these years were also the years of misinformation and intentional disinformation, combined with for-profit social media corporations that literally created profits by fomenting rage and hate. It took its toll on social cohesiveness and diminished our ability to and act together for our nation’s benefit.

The world has been greatly diminished by spread of disinformation, and worst of all, the corporations that benefit from it are still monetising outrage and harm. I don’t expect that to change until governments begin holding companies like Meta and Google responsible for the damage they amplify and directly profit from.

With the ascendancy of corporate ownership of media, and the defunding of public interest media, we are in for tough times for the foreseeable future. Unless community awareness is raised, and the levers of power are taken from the hands of corporations and governments full of corporate lobbyists.

As things worsen for the person on the street, its my hope that people realise what’s happening and insist on change. It will have to be grassroots though. One conversation at time. Corporate power is strong, but peoples’ voices will hopefully prove stronger.

—

In all my years in healthcare, I have always chosen to work in underprivileged areas, and always with high-acuity (ie, very sick) patients. I went into emergency medicine to help people facing the worst day of their lives get through it. And to this day, 25 years after first becoming a doctor, I am still doing that.

My academic interests are in critical care, trauma, ultrasound (I’m a DDU sonologist with a specialty interest in emergency ultrasound), and pre-hospital and retrieval medicine. I worked part-time in South Auckland as a doctor on board the Westpac Rescue helicopter one week a month, for a few years, which I’ve recently stopped. I have served as the Medical Committee Chair for the International Life Saving Federation and currently serve as National Medical Director for Surf Life Saving New Zealand, after years volunteering as a lifeguard.

I also sit on the New Zealand Resuscitation Council, the standard-setting body for resuscitation, CPR, and first aid in New Zealand. And when I can, I volunteer with NZMAT, the NZ Medical Assistance Team, which sends nurses and doctors to respond to international disasters.

My sideline into medical writing started even before medical school, as a way of educating and informing people, and of organising my thoughts and reflections on what is an interesting and at times challenging job. For many years, I had a question-and-answer medical column in New Zealand newspapers, then online, where I responded to people’s medical questions. I love talking about medicine, and explaining things to patients and readers alike. That hasn’t changed. I love medicine, and I love talking about science, health, and social policies that improve the health and wellbeing of the public.

Over the past 10 years, I’ve become more involved with end-of-life issues. Because I believe that terminally ill patients shouldn’t be forced to suffer prolonged and needless suffering — when they may want to choose a gentler, peaceful, medically assisted death — I work with the NZ Assisted Dying Service. It’s been a perfect counterpoint to emergency medicine, no time pressure to see an endless flow of ED patients, but rather as much time as is required to talk about what a good life, and a good death, might look like to them as patients.

It’s a privilege to talk to just one patient at a time, talking about what’s really important to them in the time they have remaining, and how we as doctors can help them have gentle, peaceful, painless deaths at home, surrounded by loved ones, if cancer or another terminal illness has left them with nothing but untreatable, interminal, unavoidable suffering. The reduction of needless suffering is one of the unalloyed social ‘goods’ that medicine can provide. When death is inevitable, having the option of a gentle death is, quite simply, humane.

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Over these 17 years I’ve seen a lot of things change in NZ. I’ve watched it all unfold. Our politicians are doing what rightwing governments everywhere do: rewriting the laws and the tax code to help the very wealthy become extremely wealthy. Our public services are being defunded, destabilised, and privatised at a roaring pace.

Meanwhile politicians distract the public by telling us it’s the poor, immigrants, women, and the disabled and benficiaries who are stealing our tax money. All while the supermarket, electricity and gas companies, the banking monopolies and private health companies rob us blind. With a refusal to build more houses, townhomes, and apartments in our cities, housing has become wholly unaffordable to first-time home buyers (while the government gives $2,900,000,000 a year in taxpayer money to landlords in the form of tax deductions), and our politicians sell off our public assets to private developers. All so we can eventually end up renting our roads and hospitals and schools from corporations for profit.

I’ve been watching this all play out from the role of an emergency doctor: seeing issues of poverty, low-paying jobs, and the defunding and destablising role of ‘for-profit’ governments on public services. I’m watching privatisation corrode a society from a front-row seat, and I realised I have to do more as a doctor than just pick up the pieces. I’ve got to try to prevent the damage. Hence this Substack, the interviews, the podcasts, the rallies, the hikois, and all the rest.

Perhaps like me, you have the feeling we are quickly becoming squatters in our own nation. We’ve lost any chance at affordable housing for our kids. Soon we will not own the very roads we drive on. Our government is selling off, and selling out, our nation.

Our infrastructure: highways, schools, prisons, and hospitals will be rented from corporations. As our elders age, they face the horror of not being able to afford aged care. The issues we thought we eradicated long ago, such as abject poverty for our children and our elderly, and bad working conditions for everyone else, are back with a vengeance. This government has killed off the Fair Pay agreements and union protections that protect Australian workers. Our workers are left more vulnerable than every, during a cost-of-living crisis that has benefitted millionaires and billionaires. 180,000 low-wage women have had their pay equity cases cancelled. They might have made between 2 and 5 dollars more an hour, and government wouldn’t even allow them that. But it found, under urgency (without public notice or debate), 200 million for the gas companies, 216 million for the cigarette companies, and 2.9 billion for property investors. Who was National’s largest donor last election? A landlord.

Regular New Zealanders are suffering. But not everyone is suffering. The ownership class of corporate owners, property investors, bankers and financers are absolutely thriving. It’s a bad time to be an “average working-class person” in New Zealand, but it’s an incredible time be a corporate director.

The glory days are gone with nothing to show for it, because all the money and the assets have flowed uphill, to the rich. Having impoverished and hollowed out the middle class, the corporate rich are now coming for the public services: piggy banks they can empty out into the private sector.

New Zealand now has the worst wealth inequality it’s had in the past century. While the extremely rich have wealth that is growing faster than ever. Record profits for some, record poverty for others.

That must change, because it is damaging to our society. It cannibalises public ‘goods’ like public housing, public hospitals, and public schools…selling them off for private profits.

We are facing the challenge of a generation: to fight back against the degradation and diminishment of New Zealand into a country of Haves and Have-nots.

The assets of the extremely wealthy continue to grow by obscene amounts, while wages and essential public services have stagnated or reversed. Worldwide as the very wealthy have evaded and avoided taxes, the middle class class has been steadily disappearing. While the mainstream media tells you its the poor, the disabled, the gays, and the marginalised that are to blame, it’s actually the wealthiest corporate owners that have ensured they avoid taxes and accrue assets and wealth, along with tax benefits the working class can only dream of.

I hope people galvanise to action. To imagining a different story than just the inevitable ‘For-Profit’ destruction of society.

It’s time we dreamed of simple things: hospital that work, schools that work, housing that works. The taxpaying public has been looted for long enough by privatisation. It’s time to get the country back from the the passive investors and corporate owners that don’t actually do any of the work, but still accumulate nearly all the profits.

I’ve always fought for the regular person: whether in the emergency department or in community roles. I cannot think of anything better I would rather be doing than helping people live better lives, and trying to build stronger a stronger sense of community. We are each others’ strength.

As we enter a era of unprecedented challenges, we will need unprecedented strength and unity.

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Well, that’s my story. So far.

— Dr Gary Payinda, Substack

If you want to support these things, send me a message, meet me at the rallies, follow and share my writing online, share my interviews in the newspapers, and consider subscribing to my Substack. If you want to just to a one-off donation in support:

https://buymeacoffee.com/drgarypayinda

My time and the money this Substack makes is going to things like audio and video equipment, tech help, a megaphone or two, signs, and supplies for rallies. If you can’t afford a subscription, let me know. If you want to show your support and can afford it, please subscribe. If you want to bring a story to my attention, just comment or reply.

If we all work hard, we may be in a more hopeful place in 18 months. If we neglect to fight back, we will be in a position where recovery will literally take decades or generations. Once a decent society is lost, it is not easily rebuilt.

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