Pepsi and Cupcakes

【Rippi/リッピ】

fuzzy bugs series

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I used to work as a live-in nanny for a pediatrician.

Now, the thing about hospitals in my country is that they are massively understaffed and massively underfunded. This is especially true outside the major cities. The staff are worked to the bone and receive little to no help in things like finding accommodation or childcare, making working in rural areas a very uninviting prospect; staff come out here, get lumped with the work of three people (because there's nobody else to do it), burn out under the workload and leave, meaning that those remaining have even more work because that person is gone. It's unsustainable and the medical staff are doing their best to sustain it, because people die if they don't, so to the higher-ups it looks like everything's getting done and therefore everything is fine.

My friend (and boss) worked one week on, one week off, swapping out with another pediatrician. This was necessary because it would not be physically possible for one person to handle the workload for longer periods of time. The one single pediatrician had to hold up the entire pediatrics ward, which was not only the only public hospital pediatrics ward in our town, but also the one that served all the towns around us for a few hours' drive in all directions. I regularly saw her go to work sick, aching, tired, or with a debilitating 'I can barely make words or see' level migraine, because if she took a day off, twenty children didn't get healthcare that day, and some of these kids' appointments were scheduled weeks in advance. She'd work long hours in the day and then be called in a couple of times overnight for an hour or two at a time (she was on-call at night too, because somebody had to be), and then go in the next day. Sometimes she would be forced to take a day off because she physically could not stay awake for longer than a few minutes at a time, meaning she couldn't drive to work.

Cue my niece's second birthday coming up in Melbourne. I'd been working for her for about 3 years, and she (and the hospital) had plenty of advance warning that I (and therefore she) needed one (1) Friday off. That's fine, we'll find someone to work that Friday, the hospital said. Right up until the last week where they're like "oh, we can't find a replacement; you can come in, can't you?"

No, she tells them; I don't have anyone to watch my kid that day.

Oh, surely you can hire a babysitter for this one day, they say. Think of the children! We really really need you to work that day. I know we said it'd be fine but we need you now, there's no one else to do it.

There are no other babysitters, she told them. Unless you can find one?

That's not our responsibility, they said.

But I'm not changing my plans, she's got plans by now as well, the hospital knew about this one day weeks in advance, and with absolutely no reserve staff they're forced to reschedule all pediatrics appointments for that Friday. Not a huge deal, it happens on the 'physically too overworked to get out of bed' days too. I go to Melbourne, she goes back to her home in Adelaide for her recovery week, all should be on track.

My niece gives me Covid.

This was way back in the first wave of the pandemic, and there were no Covid vaccines yet. The rules were isolate, mask up, hope. I had Covid in the house, and it would've been madness for my friend and her toddler to come back into the Covid house instead of staying in Adelaide. There was absolutely no way that a pediatrician could live with someone in quarantine due to Covid and go to work in the hospital with sick children every day. And no support existed for finding another babysitter, or temporary accommodation, so the hospital was down a pediatrician.

The other pediatrician wasn't available to do a three-week stint. They were also trapped in Adelaide on their well-earned week off.

Meaning that the only major pediatrics ward within a several-hour radius had no pediatricians. They had to shut down and send all urgent cases to Adelaide for the week. To the complete absence of surprise of any of the doctors or nurses; of course this would happen, this was bound to happen, it presumably keeps happening. But probably to the surprise of the higher-ups. After all, the hospital was doing fine, right? Of course all the staff were complaining of overwork and a lack of resources in every meeting, but they could always be fobbed off with the promise of more help sometime in the future; the work was mostly getting done, so the issue couldn't be too urgent.

Don't stretch yourselves to the breaking point to keep doing as much as possible, and don't cut corners where customers/clients/patients/patrons won't notice. Say out loud, "Due to low funding/staffing, we can no longer do X," where X is something visible but not mission-critical.

In the library world, this is usually a small reduction in hours: we lose an employee position, we stop being open on Sundays, or we close an hour earlier every day. (And we put up signs saying exactly why, and to whom patrons can complain.)

If you say "this isn't enough resources/we're understaffed/we can't go on like this," but then you continue to go on like this? You've just proved that you can indeed go on like this.

Of course, not everyone is in a position where you can make decisions like this--reducing hours, or suspending a particular service; the reason we learn this in library school is that we usually have a clear bright line between operational management and funding. However, you can still ask. Management says, "For now this store is going to have to get by with 6 employees instead of 7," you say, "Okay; what are we going to stop doing, to make that work?"

And if the answer is, "Nothing," you just...let the problems happen. Someone gets sick, and they really need you to come on your day off? Sorry, but you made plans that you can't break (even if those plans are "lay in bed and eat ice cream"). But they can't open the store if you don't come in? Sounds like the store isn't going to be open. Hopefully we'll be able to get up to full staffing before this problem comes up again!

In the story above, the COVID quarantine situation was, of course, unpredictable, but if management had taken the lesson any of the times when appointments had to be cancelled because a doctor called off due to physical exhaustion, perhaps they would have had some options when both of their pediatricians were unavailable due to a global health emergency; who can say?