August 2015

The Medicine

Society’s safety net

By Karen Hitchcock
When social services are cut, hospitals are left to fill the holes

All my writer friends say, “You’re so lucky to have a real job, which has a real effect, in the real world.” They say it with an existential sigh. “You actually help people.” I usually just nod, my counterarguments too huge to mount.

I’ve fallen back into my dream of running away, to a place like rural Maine in winter, where you sit inside by a wood fire and watch coyotes dive for mice in the snow. Where you’re living so deep in the woods there is nothing and no one and nowhere else. I want to be snowed in, for a very long time.

I had a friend at university who ran away to join the Carmelites. One minute she was a vegan painter and the next she was in a closed order: cloistered, silent, with all day to read. Though I’m not a believer, it sounded almost as good as the snow.

Then a few years ago I moved house and my new next-door neighbours were nuns. My nuns are not like my friend. They wear normal clothes. They work in women’s refuges and soup kitchens, and support refugees. They organise Centrelink and medical appointments, and comfort those dying alone. They leave early in the morning – I watch them through my study window – and work their guts out till it’s dark.

I met Sister Agnes when the real-estate agent first showed me through my house-to-be. When I told Agnes I was a doctor, she gripped my forearms, threw an unshackled laugh into the wind and said, “Thank God.” On auction day, people crowded the street, as if it were a festival. The sisters sat in their front room, holding hands, praying I’d win.

Their order used to inhabit my house too, and they moved between them through a door in the fence. But then, like endangered birds, they started to die out. The few who remain – Sisters Agnes, Maria and Christina – are all in their 80s. Maybe another doctor will take their place when they die.

One day I bumped into Sister Agnes in the street. She looked as if she might cry. I asked her if everything was OK, thinking of Maria’s joints, Christina’s heart. “They’ve defunded the House of Welcome,” Agnes said. St Mary’s House of Welcome is a meeting place for the homeless, lost and chaotic that’s been operating in the Melbourne suburb of Fitzroy since 1959. The House provides meals, showers, company and assistance for hundreds of people living in the margins, those excluded from or unable to access other services. There are no inclusion criteria, no forms to lodge or automated telephone services to negotiate. It is the House of Welcome. “Where will they all go?” Agnes said, her hands covering her mouth. I stood there thinking of snow and closed orders, knowing where they will go: to the hospital.

When you work in a public hospital it takes a great deal of denial, repression, alcohol or convoluted self-justification to remain dispassionate about bad public policy. The hospital is society’s safety net, and it hovers 2 centimetres from the ground. If you have no bed, no shoes to stop your feet from getting all cut up and infected, no food, no medicine, no one to help you get to the toilet, if you want to die and have fallen through the chasms between our community resources, it is the grand old public hospital that will take you in.

I recently looked after a young woman with pneumonia. She was covered in bruises and living in her car. At the last women’s refuge her wallet and most of her clothes were stolen. She was on the years-long urgent-category waitlist for public housing. In between hacking coughs, she said, “I might have to go home.”

I’ve visited one of the nuns’ secret houses for women who have been kicked out – or repeatedly kicked in the face – by their husbands. It’s a light and airy house, full of women and children cooking and singing in a communal kitchen. There’s a garden and an aviary, and it all sits safely behind a huge brick fence and funding that is not government dependent.

Medicare is unsustainable. Welfare is unsustainable. Education is unsustainable. We hear statements like this all the time. Community services are being slashed like it’s harvest time. Welfare organisations that have grown from the particular needs of specific communities are being closed down, tendered and bound into large private companies who will “deliver services” more efficiently. Apparently, these are the sacrifices “we” have to make for “our” children’s and grandchildren’s futures.

My dad’s favourite saying was “Bugger you, Jack. I’m all right.” He’d say it when someone cut him off on the road, or when my brother and I stole the last pack of biscuits. It’s a fair summation of our current government’s social policy. You can even imagine the Ironman, with his this-is-all-a-big-joke smile, chanting it three times in a row while Madam Speaker nods her pristine bun and bleeding lipstick, aping Thatcher.

Small government. Personal responsibility. Have a go. Down with the leaner. I’m beginning to think that the bedrock of the political conservative is his belief that everyone’s just like him. As if they think that guy on the street corner with a hat between his knees could, if he really wanted to, get up, comb the grease and the hallucinations out of his godforsaken hair, and run for parliament.

There’s something missing in this belief system. The kind of imagination necessary to generate empathy, perhaps. A knowledge of history. And step by step, our rich country moves towards precipitous inequity.

Hospitals and doctors are good at treating diseased organs, and yet we now spend a rocketing amount of our time trying and failing to patch up social catastrophes. Forty thousand dollars ripped off the street becomes millions in the hospital.

I leave my house to ride to work, where there is no time for daydreams. But when I get home I plan to ask Agnes if she ever dreams of the snow.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

There is nowhere quite like The Monthly. We are told that we live in a time of diminished attention spans; a time where the 24-hour-news-cycle has produced a collective desire for hot takes and brief summaries of the news and ideas that effect us. But we don’t believe it. The need for considered, reflective, long-form journalism has never been greater, and for almost 20 years, that’s what The Monthly has offered, from some of our finest writers.

That kind of quality writing costs money, and requires the support of our readers. Your subscription to The Monthly allows us to be the home for the best, most considered, most substantial perspectives on the state of the world. It’s Australia’s only current affairs magazine, an indispensable home for cultural commentary, criticism and reviews, and home to personal and reflective essays that celebrate and elevate our humanity.

The Monthly doesn’t just comment on our culture, our society and our politics: it shapes it. And your subscription makes you part of that.

Select your digital subscription

Month selector

From the front page

Kim Williams seen through window with arms half-raised

The interesting Mr Williams

At a time when the ABC faces more pressure than ever before, is its new chair the right person for the job?

Exterior of the Department of Treasury, Canberra

Tax to grind

Tax reform should not be centred on what we want, but on who we want to be

Rehearsal for the ABC TV show ‘Cooking with Wine’, March 13, 1956

Whose ABC?

Amid questions of relevance and culture war hostilities, the ABC’s charter clearly makes the case for a government-funded national broadcaster

Tony McNamara in New York City, January 2024

Pure things: Tony McNamara

How the Australian screenwriter of ‘Poor Things’, who cut his teeth on shows such as ‘The Secret Life of Us’, earnt his second Oscar nomination

In This Issue

Process of recognition

The constitutional recognition of indigenous Australians requires meaningful consultation

Hallo spaceboy

Icon as exhibit at ACMI’s ‘David Bowie Is’

Greek tragedy

Former finance minister Yanis Varoufakis on Greece’s economic crisis

Politics and power

Why we keep watching ‘The Americans’, ‘Veep’ and ‘House of Cards’


Online latest

Osamah Sami with members of his local mosque

In ‘House of Gods’, Sydney’s Muslim community gets to be complicated

Plus, Barnaby Joyce shines in ‘Nemesis’, Emma Seligman and Rachel Sennott deliver ‘Bottoms’, and Chloë Sevigny and Molly Ringwald step up for ‘Feud: Capote vs. The Swans’.

International Film Festival Rotterdam highlights

Films from Iran, Ukraine and Bundaberg were deserving winners at this year’s festival

Two women on a train smile and shake hands

‘Expats’ drills down on Hong Kong’s class divide

Plus, Netflix swallows Trent Dalton, Deborah Mailman remains in ‘Total Control’ and ‘Vanderpump Rules’ returns for another season

Image of a man playing music using electronics and the kora (West African harp)

Three overlooked albums of spiritual jazz from 2023

Recent releases by kora player John Haycock, trumpeter Matthew Halsall and 14-piece jazz ensemble Ancient Infinity Orchestra feel like a refuge from reality