Postcards from the edge #6

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This postcard comes from Emma Davey, a Rural Hospital Doctor and Clinical lead at Hawera Hospital. She is a convener on the Medical Specialities in Rural Hospital Medicine.

The cracks have always been there.  For those working in rural health they are more visible now.  We push forward for the sake of our patients, our rural workforce, our communities, flying the rural flag as we go.

COVID-19 has cracked the system.  Hacked it even.

Promoting rural health and rural hospital medicine in DHBs is a challenge at the best of times.  With COVID-19, war mentality has ensued and at every level: clinical, managerial, collegial.  Rural inequity greets us at the end of the pipeline.  Policies and procedures written for us without any rural context.  Limited resourcing to pull together our own.  Musings of traffic light areas in our small facility.  No resourcing for surge capacity.  Local GP services disappeared from view.  Patients along with them.

Although, amazingly, the strangest things have happened without even really asking for them.  Negative pressure rooms with something called an anteroom installed in a few days.  No-one really understanding why they were needed, which treatments they enable, how we communicate to the outside world whilst in these industrial spaces and who, if anyone, is coming to retrieve our COVID-19 contaminated people.

No-one really likes change in our rural hospital at the best of times.  COVID-19 forced it and the team have tolerated it to a certain extent.  There has been unrest on the floor.  Uncertain PPE restrictions.



We watch from a distance as our fellow rural hospitals around the country are affected by positive cases of COVID-19 and the impact on their workforce and their services.

Then, amongst the anxiety, comes a sense of gratitude.  We risk our health and the health of our families by working on the frontline but we have our jobs.  We are essential and we are vulnerable.  Our bubble larger than most.  A 2m distance difficult to maintain.  We should consider ourselves the fortunate ones whilst our rural community of small businesses may be compromised.  Wellbeing and mental health tested.

There is nothing like a crisis to re-evaluate the status quo.  Positive initiatives could assist in moving us forward, if we choose to continue them after COVID-19 comedown.  Increased efficiencies.  Complicated resuscitation scenarios simplified.  Flexible minds fine tuned.

The after effects of COVID-19 lockdowns are unknown.  We are here for the long game but undoubtedly the  cracks will remain but are hopefully connected around rural NZ until we can rise again.


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