Rural Recognition at 2022 RNZCGP: Awards and Honorary Fellowships

Thursday, July 28th, 2022 | claly44p | No Comments


Ma pango ma whero, ka oti te mahi (by black and red together the work is done).

Congratulations to Marara Koroheke-Rogers and Hone Taimona recognised with Honorary Fellowships to the Royal New Zealand College of General Practitioners. Ngā mihi nui ki a koe – huge gratitude to you on behalf of your Otago colleagues and the numerous rural medicine trainees and experienced doctors who have learned from you through our rural postgraduate papers, in partnership with Hauora Hokianga (@hokiangahealth).

In 2006, the Dunedin School of Medicine shifted the teaching of the rural context and Hauora Māori components of our rural postgraduate programme out of a Dunedin classroom and onto the Pa-te-Aroha Marae at Whirinaki in the South Hokianga. This was not just a change in location but a change in direction for the entire programme.

Marara and Hone, with Hauora Hokianga, have been partners since those early days. They occupy crucial roles that link the local health service, the community and the teaching.  Marara and Hone have also been active members of research teams and co-authors on publications.

“Marara and Hone are pioneers in delivering this type of postgraduate medical education. The knowledge they bring needs to be at the centre of all our rural health teaching and research” Associate Professor Garry Nixon, Department of General Practice and Rural Health.



Congratulations to Dr Jeremy Webber and Dr Sean Hanna who were honoured with Distinguished Fellowship awards. The Fellowship is awarded to GPs who have demonstrated sustained contributions to general practice, medicine, or the health and wellbeing of the community.

The next generation steps up. Dr Jeremy Webber was the first person to get a Fellowship in Rural Hospital Medicine the proper way, that is by doing the training programme and he has now turned that into a FDRHMNZ (Dist.)  Jeremy expanded his world view by spending time working in Australia before returning home and almost immediately taking on some important leadership roles, at Taupō hospital, in the Division of Rural Hospital Medicine as Chair of the Board of Studies and the first Clinical Director Rural Health for Hauora Taiwhenua. Thanks for your efforts Jeremy and the great way you approach the people and issues you deal with.  Jeremy is also the packhorse in any Godzone Team and the powerhouse in any packraft. Ngā mihi


Dr Sean Hanna is a Wellington-based general practitioner, who has been the medical educator for Otago’s Rural Medical Immersion Programme since its early days. He is highly respected for his work as a specialist general practitioner in Takapūwāhia Porirua, his commitment to delivering health care to young people, his advocacy for equity in healthcare and his contribution to education. He has also made a significant contribution to rural health both in his RMIP role and as a rural doctor in the Hokianga.




The Eric Elder Medal is awarded in honour of Dr Eric Elder, who was an inspired rural GP affectionately known as the grandfather of vocational training in New Zealand. The medal is generally awarded to a rural general practitioner.  This year the award has gone to Dr Nina Stupples – congratulations Nina!

Dr Nina Stupples has worked in her Westport community for 13 years, providing consistent and quality care to her patients and ensuring they have access to high quality hospital care when required. She has been instrumental in the developing Rural Hospital Medicine in New Zealand, being the Chair of the Rural Hospital Division from 2010 until 2014, laying the foundation for the first truly generalist training programme in the country. The key feature of this programme was combining both Rural Hospital Medicine and Rural General Practice into a single training programme, with dual fellowship being an option in both vocational scopes of practice.

Nina has mentored many registrars in Westport, alongside her day-to-day practice and involvement with the Division, and she also teaches students in the Rural postgraduate programme and Rural Medical Immersion Programme at the University of Otago.  New Zealand rural health has benefitted from Nina’s hard work and dedication to the profession.

The allied health workforce of rural Aotearoa New Zealand: a scoping review

Wednesday, July 20th, 2022 | claly44p | No Comments

Walker Sarah M., Kennedy Ewan, Nixon Garry, Blattner Katharina (2022) The allied health workforce of rural Aotearoa New Zealand: a scoping review. Journal of Primary Health Care.

 Open Access

 Great to see a focus on rural allied health professionals (AHP) who are often under-appreciated when we consider optimising health outcomes in our rural communities.  The lack of published material will not be surprising to AHP living and working in rural/remote Aotearoa and I applaud Sarah and colleagues for starting this narrative and highlighting important areas for research that could address rural AHP workforce capacity, capability, recognition and career progression.



Introduction: The allied health workforce is a crucial, if at times poorly visible, component of modern healthcare systems. The services provided by allied health professionals may be particularly important for underserved populations, including rural and remote communities.

Aim: To determine what is currently known through research about the allied health workforce in rural Aotearoa New Zealand.

Method: A scoping review of diverse sources of literature from Aotearoa New Zealand was obtained from seven databases (July 2011–July 2021).

Results: Eighty-nine articles were identified, of which 10 met the inclusion criteria; nine empirical studies and one narrative review. The included research fell into two main categories: geographic workforce distribution (n = 8), and the role of the rural allied health workforce (n = 2).

Discussion: The paucity of research that meets the criteria for inclusion makes it difficult to draw conclusions about the allied health workforce in rural Aotearoa New Zealand. There is a focus in both the international rural allied health literature and the Aotearoa New Zealand rural medical and nursing literature on: measuring geographic workforce distribution; and rural-specific training. This suggests that these issues are important to the rural workforce. Similar research is needed in Aotearoa New Zealand to inform policy and ensure the rural allied health workforce reaches its full potential in improving health outcomes for rural New Zealanders.

Congratulations to Rural Health Researchers!

Friday, July 1st, 2022 | claly44p | No Comments

Our shining stars, Dr Rory Miller and Assoc Prof Garry Nixon are among 22 University of Otago researchers to receive Health Research Council funding in the latest round.  Check out the full report. – well worth it for the photos! 

Awesome to see rural health research being supported!

“Dr Rory Miller, of the Department of General Practice and Rural Health, will assess a pathway to allow patients who develop chest pain to remain closer to their communities and whanau by accessing blood testing technology which is as accurate as those available in urban emergency departments.”

“Associate Professor Garry Nixon, of the Department of General Practice and Rural Health, is seeking to better understand the impact of rurality on health outcomes and healthcare delivery.  Aotearoa has not undertaken much research into the health status of rural communities, so he wants to find out how rurality, ethnicity and socioeconomic status interact to impact on health outcomes and access to health services for New Zealanders, how people move between urban and rural areas when they become unwell, and how much public healthcare rural New Zealanders consume, in dollar terms, compared to their urban compatriots.”


26th July 2022 – CME Webinar: Bare Bones of Flaming Joints

Wednesday, June 22nd, 2022 | claly44p | No Comments

Want to know the latest on inflammatory arthropathy? – well tune in on the 26th July at 730pm and I think we will answer most, if not all of your questions!
Register in advance for this meeting:

After registering, you will receive a confirmation email containing information about joining the meeting.

For more information contact Dr Lucinda Thatcher, Rural CME Convenor

Dr Branko Sijnja named as 2022 recipient of Peter Snow Memorial Award

Friday, June 10th, 2022 | claly44p | No Comments

Influential GP Dr Branko Sijnja has been named as the recipient of the Peter Snow Memorial Award for 2022.

Branko was nominated for his service and dedication to rural health for over 40 years.

He is well known in the South Otago town of Balclutha and by many students at the University of Otago (UoO) for his leadership, commitment and inspiration.

Branko began his health career as a medical officer in 1974 and moved overseas for a couple of years to work in Scotland in the orthopaedic unit at Bridge of Earn Hospital and in Obstetrics and Gynaecology in Perth Royal Infirmary.

In 1980, Branko moved into working in General Practice. He became involved in the forming of Clutha Health First, a bespoke healthcare provider offering hospital, community and general practice services in Balclutha.

Clutha Health First opened in December 1998 and transformed the healthcare delivery to the Balclutha community.

To this day, Branko is still involved in the governance of Clutha Health First and sits on the Board of the Clutha Community Health Company Limited. Alongside this, he worked every Monday in the clinic for 12 hours.

Over his career, Branko has become well-known for delivering hundreds of babies in Balclutha. His wife says he is known throughout the community for his unwavering dedication which has often seen him work incredibly long hours doing home visits, followed by night shifts and then running a full clinic the next day.

In 2009, Branko’s career transformed when he became the Director of the Rural Medical Immersion Programme at UoO. Through this programme, Branko mentors fifth year medical students as they spend a year working and studying in rural New Zealand.

Since stepping into this role, Branko has taken advantage of the opportunity to share his passion for rural health and his wealth of experience. He is a natural teacher, and this has meant he often goes above and beyond to ensure his students succeed.

New Zealand Rural General Practice Chair Dr Fiona Bolden says Branko has always supported the Network.

“Whenever he comes to the conferences you can always spot him as he’s the one with the crowd of young doctors around him who know him through the training scheme- he’s usually telling them tales and there’s always lots of laughter,” she says.

It is no surprise that Branko has become a well-known and respected leader during his time as the Director. His commitment to encouraging and empowering the next generation of rural doctors is reflected through his work to expand the programme and produce educational outcomes that are equivalent to urban centres in New Zealand.

In 2021, Branko was awarded Distinguished Fellowship of the Royal New Zealand College of General Practitioners, which recognises Fellows of the College who have made sustained contributions to general practice, medicine, or the health and wellbeing of the community.

Branko currently works part time at the University and will be retiring from his role as Director at the end of June 2022. He plans to continue working at Clutha Health First for three days a week.

Reflecting on his time at the University Branko says, “I have really enjoyed working with the students, it’s been good for me too and I will miss them.”

The New Zealand Rural General Practice Network believes that Branko’s dedication to inspiring the future health workforce is what make him a deserving recipient of the 2022 Peter Snow Memorial Award.

About the award

The Peter Snow Memorial Award was set up to honour the life and work of Dr Peter Snow who passed away in March 2006.  Dr Snow was a rural general practitioner based in Tapanui. As well as caring for his patients, Peter was Past-President of the Royal New Zealand College of General Practitioners and was a member of the Otago Hospital Board and District Health Board. He was enthusiastic and active in seeking knowledge to improve the health and safety of rural communities. His work contributed to the identification of the chronic fatigue syndrome and he was influential in raising safety awareness on issues related to farming accidents.

Previous winners include:

Inaugural winner Dr Ron Janes (2007)
Nurse Jean Ross and Dr Pat Farry (2008 – jointly awarded)
Dr Garry Nixon (2009)
Dr Tim Malloy (2010)
Dr Martin London (2011)
Nurse Kirsty Murrell-McMillan (2012)
Dr Graeme Fenton and NZIRH CE Robin Steed (2013)
Kim Gosman and Dr Janne Bills (2014)
Dr Katharina Blattner (2015)
Dr Ivan and Leonie (RNS) Howie (2016)
Drs Chris Henry and Andrea Judd (2017)
Dr Keith Buswell (2018)
Dr John Burton (2019)
Mātanga Tapuhi (Nurse Practitioner) Tania Kemp (2020)
Dr Grahame Jelley (2021)



Wellbeing and health in a small New Zealand rural community

Friday, May 27th, 2022 | claly44p | No Comments

Chrystal Jaye, Judith McHugh, Fiona Doolan-Noble, Lincoln Wood,
Wellbeing and health in a small New Zealand rural community: Assets, capabilities and being rural-fit. Journal of Rural Studies, Volume 92, 2022, Pages 284-293, ISSN 0743-0167

A nice paper that’s well worth reading,  A ‘healthy’ reminder about what actually matters.  Healthcare doesn’t figure that highly when rural dwellers consider health. Place is much more important, both the geographic and the social. There are no prizes for guessing the community!


Rural dwellers in New Zealand often have fewer locally available health services. Health inequities are particularly salient for rural dwellers who are older and/ or Māori, yet the focus on these inequities has resulted in a deficit view of rural. There has been little attention to considering health and wellbeing through positive frameworks such as the Assets and Capabilities approaches. This project aimed to explore what can be learned from one small rural community about wellbeing and health; including sources of wellbeing and health. A combination of qualitative methods was used to collect data from 17 adults living in a small South Island rural community. All participants were interviewed and given the option of taking photographs to illustrate what wellbeing and health meant to them. Most participants reported that they were satisfied with their access to primary healthcare services, while acknowledging service gaps, particularly in mental health and emergency services. Health was described primarily in terms of wellbeing, and participants referenced concepts of wellbeing and health against local assets (place, community support networks, livestock, rural lifestyle and values), and a suite of capabilities adapted to the demands of the place in which they lived. The high value that rural dwellers place on the assets of their rural community and the contribution of these to their wellbeing and health may mitigate the disadvantages of distance to health services. This balance is mediated by capabilities that may be rural specific, particularly mobility and physical functioning.

COVID-19 impact on New Zealand general practice: rural–urban differences

Monday, May 23rd, 2022 | claly44p | No Comments

Eggleton K, Bui N, Goodyear-Smith F. COVID-19 impact on New Zealand general practice: rural–urban differences. Rural and Remote Health 2022; 22: 7185.

This paper performed serial surveys in general practices across 4 countries and demonstrates something that many of us intuitively know – rural general practice is different: adaptable and resilient – in response to COVID-19 anyway. We agree with Kyle and his team that further efforts are required to define and understand NZ rural general practice – and would extend that to include all rural health providers.  



In countries such as New Zealand, where there has been little community spread of COVID-19, psychological distress has been experienced by the population and by health workers. COVID-19 has caused changes in the model of care that is delivered in New Zealand general practice. It is unknown, however, whether the changes wrought by COVID-19 have resulted in different levels of strain between rural and urban general practices. This study aims to explore these differences from the impact of COVID-19.


This study is part of a four-country collaboration (Australia, New Zealand, Canada and the USA) involving repeated cross-sectional surveys of primary care practices in each respective country. Surveys were undertaken at regular intervals throughout 2020 of urban and rural general practices throughout New Zealand. Five core questions were asked at each survey, relating to experiences of strain, capacity for testing, stressors experienced, types of consultations being carried out and numbers of patients seen. Simple descriptive statistics were used to analyse the data.


A total of 1516 responses were received with 20% from rural practices. A moderate degree of strain was experienced by general practices, although rural practices appeared to experience less strain compared to urban ones. Rural practices had fewer staff absent from work, were less likely to use alternative forms of consultations such as video consultations and telephone consultations, and had possibly lower reductions in patient volumes. These variations might be related to personal characteristics of rural as compared to urban practices or different models of care.


New Zealand rural general practice appeared to have a different response to the COVID-19 pandemic compared to urban general practice, illustrating the significant strengths and resilience of rural practices. While different experiences from COVID-19 might reflect differences in the demographics of the rural and urban general practice workforce, another proposition is that this difference indicates a rural model of care that is more adaptive compared to the urban one. This is consistent with the literature that rural general practice has the capacity to manage conditions in a different way to urban. While other comparable countries have demonstrated a unique rural model of care, less is known about this in New Zealand, adding weight to an argument to further define New Zealand rural general practice.

Hydroxyurea Interference in Point-of-Care Creatinine and Glucose Measurements

Tuesday, May 17th, 2022 | claly44p | No Comments

Shane A. Betman, Eldad A. Hod, Alexander Kratz, 57: Hydroxyurea Interference in Point-of-Care Creatinine and Glucose Measurements, American Journal of Clinical Pathology, Volume 143, Issue suppl_1, 1 May 2015, Page A030,

Spurious iSTAT POC creatinine (and glucose) results with hydroxyurea

Many of us rely on iSTAT POC bloods some, or all of the time. We had a recent experience of an elderly patient who had a iSTAT POC creatinine of > 200 micromol/L and who we managed as AKI overnight. The next day his creatinine done in the main lab was 70 micromol/L.  Repeated tests  done on both the iStat and in the main lab using the same samples kept returning a similar  large disparity in creatinine levels. The problem in the end turned out to be the hyroxyurea that patient was on – which falsely elevates iSTAT POC creatinine levels. The manufacturers advice when an patient is on hydroxyurea is ‘use another method’ to test the creatinine. And it looks like the hyroxyurea has the same effect on the iSTAT glucose reading and parcetamol (not at therapeutic levels but potentially in an overdose) might have the same effect of falsely elevating the iSTAT creatinine. Might be worth keeping this in mind.



Background: Measurements of creatinine and glucose on the i-STAT point-of-care testing (POCT) device are known to be elevated in the presence of hydroxyurea. This interference can lead to differences between creatinine and glucose results reported from the i-STAT and samples analyzed with other methods. We sought to characterize the extent of this interference and to compare results with the epoc, a POCT device similar to the i-STAT.

Methods: Patient serum samples with known creatinine levels were pooled to create three standards – normal range (NR), high (H), and very high (VH) creatinine. Serial dilutions of hydroxyurea were added to aliquots of each standard, resulting in final hydroxyurea concentrations between 0 and 2,000 μmol/L. Each aliquot was tested with the i-STAT, epoc, and Olympus platforms.

Results: Creatinine and glucose measurements on the iSTAT showed a dose-response relationship with the concentration of hydroxyurea in the sample. Disregarding data points outside the reportable range (output from i-STAT “>20.0” or “***”), the creatinine data fit linear regression models with slopes of 0.0138 (R2 = 0.994), 0.0127 (R2 = 0.995), and 0.0163 (R2 = 0.978) for the NR, H, and VH standards, respectively. The glucose data fit linear regression models with slopes of 0.104 (R2 = 0.999), 0.102 (R2 = 0.999), 0.111 (R2 = 0.998) for the NR, H, and VH standards, respectively. Creatinine and glucose showed no correlation with hydroxyurea levels when tested with the epoc or Olympus. All other analytes tested were unaffected by hydroxyurea levels.

Conclusions: Hydroxyurea causes linear dose-dependent elevations of creatinine and glucose results from the i-STAT POCT device. Based on our linear model and pharmacokinetic data, using the i-STAT following a typical dose of hydroxyurea could result in a creatinine level that is falsely elevated by 6.15 mg/dL on average and a glucose level that is falsely elevated by 46.09 mg/dL on average. Other platforms tested did not show interference by hydroxyurea. As the operators of POCT devices are unlikely to be familiar with the limitations of the testing methodology, it is important for laboratory professionals to keep them informed of appropriate practices.

© American Society for Clinical Pathology

NOTE: 6.15mg/dL (from the conclusion) = 543 umol/L and 46.09mg/dL glucose = 2.5mmol/L

Podcast: Our Changing World – Closing the heart health equity gap

Thursday, May 12th, 2022 | claly44p | No Comments

Hi everyone

This is a RNZ podcast with Dr Anna Rolleston (University of Auckland) about inequities in heart health for Māori and Pacific people and some of the factors that need to be taken into account when doing research with Māori.

Listen here to Our Changing World – Closing the heart health equity gap

One of the main causes for the life expectancy gap between Māori and non-Māori is heart disease. A new Centre of Research Excellence: Pūtahi Manawa | Healthy Hearts for Aotearoa NZ, led by Dr Rolleston aims to close this gap by trying new research strategies.

Read more here