International Women’s Day 2023
As part of International Women’s Day (IWD) 2023, Te Whatu Ora is taking an indepth look at two of IWD’s key missions - to assist women to be in a position of power to make informed decisions about their health; and to forge inclusive work cultures where women’s careers thrive, and their achievements are celebrated.
Keen to join a supportive network of health sector women?
The Health Women’s Network is seeking membership from Manatū Hauora, Te Whatu Ora and Te Aka Whai Ora kaimahi The network is a platform to encourage all of our people to reach their potential and help our female leaders to advance their careers not only in our health entities but across the wider public service.
The Health Women’s Network operates under the Government Women’s Network, a professional employee-led network connecting women in agencies across the public sector.
If you’re interested in finding out more, or would like to join, email the network today
Is gender bias in health real?
Consultant Anaesthetist Dr Morgan Edwards tackles the prevalence of gender bias in health and encourages us all to do the same.
A disclaimer for this piece: I will be using the term female/women throughout for the purpose of being succinct but acknowledging that there are many people who have female reproductive organs, but do not identify as women or female. I am also aware of and want to acknowledge the significant bias in health, and society more widely, that affects gender diverse people, including transgender and nonbinary folks - and invite readers to also hold this in mind.
Is gender bias in health real? I’m not sure there’s plausible deniability at a population level. Examples litter our medical landscape:
• People with endometriosis still face a seven-year wait for diagnosis, despite the disease affecting 10 percent of the female population
• Females are three times more likely than males to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis, an autoimmune disease that attacks the central nervous system.
• Only 68 percent of women received bystander CPR, compared to 73 percent of men; with poorer long-term outcomes for women.
• Women with cancer consistently wait longer for a diagnosis after first noticing their symptoms – two and a half years longer than men.
• Women are less likely to be given pain relief than men. They’re likely to wait longer for pain management. They’re more likely to be diagnosed with psychosomatic pain.
Critically, in Aotearoa Māori women are most significantly affected; Māori women are more than twice as likely as non-Māori women to be diagnosed with cervical cancer, and two and a half times more likely to die from the disease.
So then undeniably we must go further than acknowledging that gender bias in health is real and accept that it costs the lives of wāhine in Aotearoa. We must address this bias and inequity; turning equity into life-saving. We must understand and address structural inequalities. We must insist on gender-responsive budgets and institutions, free from discrimination. We must embed these principles in our healthcare reforms.
Most importantly, at a personal level, we must examine our own bias in its many forms. Its insidious unconscious creep, and how it impacts our clinical relationships and decisionmaking. Further, we must take conscious steps to overcome long-standing barriers: having uncomfortable conversations with ourselves, and others. Because ultimately, it is only virtue signalling if you don’t actually believe in and deliver equitable healthcare for all genders.
Dr Morgan Edwards is a Consultant Anaesthetist at Waitematā Hospital, and the President of the New Zealand Society of Anaesthetists. She is passionate about using her vast knowledge to help pregnant people make informed choices without guilt and created Your Labour Your Way to give mothers and mothers-to-be an unbiased, factual overview of the most common pain relief options available during birth. Morgan has a strong social media following and became a critical voice during the COVID-19 pandemic in addressing misinformation and providing plain-English information to New Zealanders. Morgan has two children and lives in Tamaki Makaurau
Supporting our kaimahi through menopause
Our incredible Counties Manukau Occupational Health (OH) and Safety Services team recently opened a menopause clinic to support our kaimahi wāhine as they go thought this life-changing and often challenging biological transition
Menopause is something that affects half the population. This figure is further amplified here at Te Whatu Ora, where 79 percent of kaimahi are female.
Over the last few months, a new menopause clinic has been established in Counties Manukau to support kaimahi wāhine navigate this new phase of life alongside them, as they go through it.
Occupational Health Nurse Advisor Shaniza Masued and Occupational Health Physician Siobhan Gavaghan have been instrumental in getting the clinic off the ground.
The clinic provides staff with confidential advice and easy access to information about menopause and the options and strategies available for managing symptoms, and includes:
• Onsite and virtual consultations, available via self-referral.
• Information to help facilitate a discussion between the individual and their GP about treatment options.
• A menopause assessment summary that is sent to the individual’s GP.
• If requested, feedback to the individual’s manager on how to accommodate their needs and support them in their work environment.
• Access to a dedicated occupational health menopause intranet site for further information.
• Seminars for groups with limited access to the hospital IT system.
Those staff providing advice have also all completed the IMPACT Menopause module from the international menopause society.
Interested in finding out more about this initiative, of keen to set up a menopause clinic in your area? Get in touch with Shaniza Masued or Siobhan Gavaghan to find out more.
Women’s heart health worthy of focus
We talked to Dr Tammy Pegg about the importance of women’s heart health, and how it differs from men’s
What is your role?
I am a consultant heart specialist/cardiologist with an interest in imaging the heart and heart failure. I work in Nelson Marlborough, but also part time for the Health and Quality Safety Commission as the clinical lead for Advance Care Planning and Shared Goals of Care.
What was your career path to get to this role?
I grew up in rural England in a relatively poor farming area. When I was motivated towards medicine after watching the relief programmes in Africa during the 1980 famines, my working-class family thought I was crazy. I studied medicine at the University of Leeds in the north of England and was drawn to cardiology as I worked in poor urban communities devastated by poor diet, poverty and cigarette smoking. I was interested in coronary artery disease and studied a PhD in cardiac surgery at Oxford University prior to moving to New Zealand. I completed my training in Wellington before moving to Nelson.
What do you find interesting about this particular area of medicine?
When the heart goes wrong suddenly it can be devastating and scary for the patient - so when you can fix it, suddenly that person is restored quickly and completely to their family, it is hugely satisfying.
Are there differences in the way men and women experience cardiovascular disease and heart attacks? What are they?
There are huge differences between heart disease in men and women. I was largely trained around the idea that cardiovascular disease was only a disease of men - I now know that not to be the case.
Women are relatively well protected from cardiovascular disease by our female hormones, so we tend to develop heart disease later after menopause. Also, our symptoms are often not the classical central crushing chest pain that we see on the heart foundation ads.
Most importantly, what I spend most of my time seeing is diastolic dysfunction (heart stiffening) in women, which causes progressive exertional breathlessness (shortness of breath).
Inactivity and weight are key factors and I believe there is a role in menopause unmasking the condition, but much more research is needed in this area.
Are there any particular warning signs women should look out for, that might be different for men?
We can present in many different ways, so I wouldn’t want to stereotype. For most women, we are very in tune with our bodies and are aware of changes - the problem isn’t recognising the change, its acting on it and being heard For heart attack, which is sudden, the biomarkers to detect heart muscle injury are so sensitive now that we are able to see damage early and the testing is so straightforward that if women make the step to get assessed for heart disease, it’s likely to be picked up.
For exertional breathlessness and diastolic dysfunction, the diagnosis is much more complex, but there is little medical treatment on offer for this condition. The treatments we do have centre around wellbeing - which I am a passionate advocate for. Simply put, we need to eat fresh not processed food, stretch our heart everyday otherwise it becomes stiff, and this doesn’t require a gym membership either. Just taking some time to look after ourselves, going for a walk at lunch instead of eating at our desk, running the stairs instead of the lift, these little things add up. There is also emerging evidence of the importance of strength training and maintaining muscle mass as we age naturally.
How do we make sure women receive equity of care when experiencing cardiovascular issues?
This is super complex, as gender bias is interwoven into cardiovascular medicine - from the low rates of women included into clinical trials, to a focus in clinical cardiovascular research on diseases that affect men - such as heart attack.
Heart diseases that affect women, such as stress related cardiomyopathy or Takotsubo cardiomyopathy (a fascinating condition where the heart suddenly fails because of bad news) and diastolic dysfunction, remain poorly understood.
As with all areas of health equity, we need to ensure that leaders, educators, researchers, clinicians and health care teams reflect the populations they serve, which requires increasing the representation of women in cardiovascular medicine. Women cardiologists are still in the minority in New Zealand and the training programme hasn’t always been as flexible as it could be to accommodate our needs - fortunately that is changing!
Do you think there is gender bias in healthcare?
Yes sadly, and similar to that for indigenous populations, it is complex, systemic and multi-level. Gender equity is probably more advanced in terms of achieving better outcomes right now, but there is still much to do to affect system changes (such as research and support for patients, and career development during child raising years for clinicians).
What can we do to make sure women receive the best possible healthcare?
We can recognise our biases introduced during our training, for example, that the classical symptoms we were taught at medical school are masculine stereotypical symptoms
What does international women’s day mean to you?
I would like to see a day where we don’t need International Women’s Day to highlight issues that affect half the people in the world. I have hope that International Women’s Day will inspire both men and women to challenge systemic issues and our own biases.
Shedding the stigma around gestational diabetes
Capital, Coast and Hutt Valley Clinical Nurse Specialist (Diabetes)
Julie Bate, helps demystify a health condition experienced by approximately 4000 women each year in New Zealand.
What do you do?
I educate women about diabetes and its management while pregnant, working very closely with them throughout their pregnancy and up to 6-weeks post-delivery. This involves monitoring blood glucose levels, medication and insulin use, support and mentoring and developing management plans. We encourage a balanced diet, gentle physical activity (if safe), mental well-being, and breastfeeding.
What made you decide on this particular career path?
I first developed an interest in diabetes while working in primary health as a Practice Nurse It can affect all ages of the life span and can also have a huge impact on individuals and families. I wanted to increase my knowledge of diabetes and its management and was fortunate to be offered a position as a Diabetes Nurse at Wellington Regional Hospital. I have always had an interest in women’s health, and after becoming a Nurse Prescriber in Diabetes, I moved into the area of diabetes in pregnancy. I am very passionate about my role because we can make a huge difference to maternal and foetal outcomes.
What do you enjoy most about your role?
I love working in a multidisciplinary team (MDT) with my diabetes colleagues alongside the obstetric team, midwives, nurses, dietitians, and healthcare assistants. We are all passionate about maternal health and achieving excellent standards of healthcare. I enjoy building rapport with the women I work with and helping them to feel safe and supported at a time when they can feel very worried and overwhelmed.
How do we, as the health sector, best support women going through gestational diabetes?
Diabetes in pregnancy is an extra stress for our women. It can be overwhelming, but our MDT approach promotes equity, access, engagement, communication, support, consistent advice and education, and expertise to our women and their families.
What makes you particularly passionate about women’s health?
Pregnancy is an incredibly special time for the women and their families. I feel very privileged to be part of this time and this journey!
How do we make sure there is equity of care for all women diagnosed with gestational diabetes?
We embrace diversity and are inclusive. This is a journey of partnership and our aim is to empower women to achieve the best possible maternal health outcomes Accessing resources and support through other key providers to ensure equity is important – for example, translators, the Sign Language Service, Whanau Support, Pacific Health Unit, Taeaomanino, Vaka Atafaga, social workers and mental wellbeing support.
The use of technology and recent innovations for people with diabetes, such as insulin pumps and Continuous Glucose Monitoring Systems (CGMS) also aids equity, however funding for these remains a significant equity issue.
Are there any misconceptions about, or stigma attached to, gestational diabetes?
Yes, women who develop gestational diabetes often feel guilty or that it is their fault We reassure all of our women that this is not the case. There are a lot of misconceptions and
stigma regarding insulin use in the community, but it is the gold standard treatment for diabetes in pregnancy. Insulin is safe in pregnancy because it doesn’t cross the placenta to the baby. Having information like this is important, knowledge is empowering!
Is it a common condition, or has it become more common in recent years?
Gestational diabetes affects around 4 - 8 percent of pregnancies in New Zealand. This seems to be fairly stable according to our hospital statistics. However, because diabetes outside of pregnancy is increasing, we are seeing more women in our clinic with existing diabetes. These pregnancies are more complex.
Have you seen improvements in the way gestational diabetes is diagnosed, treated and managed in your time in your role?
The biggest change from my perspective has been around the management of type 1 diabetes in pregnancy, delivery and postnatally. The use of technology has increased (insulin pumps and CGMS) and I have seen improved maternal outcomes and fewer neonatal unit admissions during my time in this role.
What does international women’s day mean to you?
International Women’s Day is a global day celebrating the achievements of women and gives us the opportunity to reflect on our progress to date and look to the future. The future for me is to embrace the movement promoting equity for women worldwide.
What would you like to see the future of women’s healthcare look like? Equity - through excellent health outcomes for all our women and their families.
Prioritising self-care when your job is to care for others
We know that wellbeing is essential to thriving at work. Self-care is just one piece of the puzzle, but it can have a huge impact on how we feel in the workplace We talked to two Te Whatu Ora wāhine about what self-care means to them and provide some further tips below.
What is self-care to you?
Dr Joanna Sinclair –Anaesthetist and Clinical
Wellbeing Lead, Counties
Manukau and Clinical Lead for Employee Wellbeing, Te Whatu Ora
The biggest thing I have learnt over the past decade is that the way we see ourselves impacts our wellbeing. I am the first to admit that, despite being in a position to offer guidance to others about what they could do to improve their wellbeing, I am not so good at finding time for doing those things for myself due to a very hectic work schedule and a busy family life. When you are busy, it is easy to start telling yourself that you are not good enough because you are not
doing everything “the way you should”, even if the truth is that there are not enough hours in the day to actually do all the things you have to do, perfectly.
So, it’s important to do things like remind yourself that you are managing a lot and doing the best you can, which is all anyone can ask of you; ask for help; and learn to say no to things to create space for yourself.
On top of this, healthcare workers hold themselves to very high standards and often default to attributing bad outcomes to their own failings, whether or not that is factually correct. I’ve learned that it is important to check the stories I am telling myself about myself - my colleagues are very supportive of me if there is a bad outcome despite my best efforts, why should I not be forgiving and kind to myself too? Self-compassion is really important and the foundation of compassion for others.
Sarah Majeed – Dental Therapist, Capital, Coast and Hutt Valley
As healthcare workers it is easy for us to put our own needs behind our day-to-day work without realising. We have to look after ourselves, so we can look after others. It's also important not to sweat the small stuff, we can only do our best and we can't control what the rest of the world will bring. I like to unwind by catching up with my friends and going for walks outside in the fresh air. I also enjoy having a quiet weekend now and again to make sure I have caught up on everything I need to do to make the week easier.
Self-care tips
Self-care is not about adding more to your already full plate, small steps towards self-care can be weaved into your work day and habits can be created over time. Self-care is also highly personal, so what works for one person may not work for another. The ‘at a glance’ opposite and the further suggestions below are a good starting point:
Cut yourself some slack - when the weight of accountability or perfectionism kicks in, ask yourself: “What would I say to a colleague or friend in the same situation?” By keeping your internal critic at bay, you can create the right psychological conditions to move through periods of rumination or self-doubt more quickly.
Value your time - Throughout the day, others will ask for our time or resources. Try setting aside 5 minutes first thing each morning to jot down the three things you hope to accomplish
that day, and if you can, consider the impact others’ requests have on your ability to achieve your priorities before saying yes to them.
Take a victory lap – as a team, take a look back at the previous week or month, and remember what went well or what felt particularly satisfying. This kind of debrief can help you and your team stay connected to each other and your purpose.
Surround yourself with good people - healthy and supportive relationships are critical to selfcare. Take notice of who feeds your energy and who drains it. Invest in those who inspire and support you. Take a minute to talk to loved ones during breaks and carve out plenty of time outside of work to nurture your relationships.
Recharge and reboot - Stay attuned to your energy levels, take your designated breaks while at work, and make the most of your time off by doing what you love with the people you love, and staying off your work device (if you have one).
Above excerpts have been taken from the Harvard Business Review
A conversation on self-care with Dame R. Nadia Glavish
Watch Dame R. Nadia Glavish describe the importance of self-care, so that we may care for others.
Bowel cancer rates high for New Zealand women
While breast cancer may be the most common cancer affecting New Zealand women, bowel cancer comes a very close second in terms of both incidence and mortality. Find out how the National Bowel Screening Programme is working to make a difference in detecting bowel cancer in all New Zealanders.
Aotearoa New Zealand has one of the highest rates of bowel cancer in the world. It is the most commonly reported cancer and the second
highest cause of cancer death in the country, with approximately 3000 cases and 1200 deaths each year respectively
Among women, colorectal cancer is the second most common cancer (after breast) for both incidence and mortality, and a recent study also showed that colorectal cancer rates in New Zealand women are higher than for women in any of the other 32 countries within the international cancer screening network.
The National Bowel Screening Programme (NBSP)
The National Bowel Screening Programme was rolled out across New Zealand in a phased way and has been offered throughout the whole country since May 2022. A campaign promoting bowel screening began in July 2022. The programme is offered to people aged 60 to 74 years (and aged from 50 for Māori and Pacific people in some areas), who are eligible for publicly funded healthcare. More than 835,000 people are invited to take part in the National Bowel Screening Programme every two years.
As of November 2022, participation rates were 59.4 percent for women and 57 percent for men, with a target of 60 percent participation across the board. There are a number of initiatives in place aimed at increasing participation levels, particularly for Māori and Pacific people who generally have lower participation rates.
The importance of regular screening
Bowel screening every two years can save lives by helping find bowel cancer at an early stage, when it can often be successfully treated.
Since it began being rolled out over five years ago, the bowel screening programme has detected cancers in about 1800 New Zealanders. About a third of these cancers have been early stage and treatable. People who are diagnosed with early-stage bowel cancer, and who receive treatment early, have a 90 percent chance of long-term survival.
Find out more at https://www.timetoscreen.nz/bowel-screening/
Supporting resources
• https://www.internationalwomensday.com/Resources
• https://gwn.govt.nz/learning-events/events/iwd-2023/
• https://www.parliament.nz/mi/get-involved/features/celebrate-international-women-sday-2023-with-a-new-zealand-parliament-suffrage-tour/