Postcards From The Edge

We are bringing you a ‘Postcards from the Edge’ series: short reflections from rural/remote settings around NZ and the region, which will make up the LOFP blog leader during the Covid pandemic. Our hope is that these will keep the rural remote voices loud and all of us connected and uplifted.

Instructions for those wanting to submit

Please send your reflections +/-photo for our Postcards from the edge series to rural.postgraduate@otago.ac.nz

We are looking for geographical and creative diversity to cover a broad swath of rural and remote health care in NZ and the pacific.

Maximum word count 400 , wll be strictly adhered to.

Please attach a photograph and/or artwork with your submission (or it might be your piece).

NB: it is unlikley that all submissions will be able to be published: please don’t be offended if it doesn’t make it.


Postcard from the edge #10

2020-05-20 08:47:53 milro13p

This postcard comes from Sara Gordon, who is a GP and Rural Hospital Registrar who is currently completing this programme at Taranaki Base Hospital.


Suddenly the apprenticeship is shifting gear; business as usual comes to a full stop. At the pointy end of training, fellowship is a blink away. My intention to do a bit more cardiology and respiratory medicine is now an irony. Our new negative pressure rooms feel as far away from anywhere, and patients cannot have their usual plethora of tests. I’m more ok with this than my colleagues.

Generalist rural training turns out to be excellent preparation for this community response

Introspection: COVID–19 is the disaster that follows you home. In most disasters there is a safe haven, there’s a safe place to retreat. The disaster is a usually a tragic tale to tell friends and family about, not one they are characters in.

Once upon a time is still now, adventure has exited the stage, leaving an uncertain future, as we build the plane we are flying it. The invisible particle that has taken the breath from our nation is dubbed the ‘Ebola of the rich’ and will be the COVID–19 of everyone; even those who hide their faces in the sand like hypoxic orange flamingos. Like the disease itself, the ramifications of a pandemic pervade every organ of our carefully structured, safe system.

COVID–19 is kicking down the sandcastle we have just built.

Developed nations are acting like newborns. Narratives prompt pragmatic action with inspiring commonsensical speed. Connections are light speed and real. This train left the station months, years ago and we woke up on it.

If there is a station, would you get off?

 

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Postcard from the edge #9

2020-05-17 08:55:23 milro13p

Margaret Fielding is a GP at Queenstreet Practice in Wairoa and Clinical lead at Wairoa Hospital.


Seven weeks down the track and we are on our way out of Level 3 into Level 2.

A sigh of relief as we are itching to go fishing, hunting, cruise around Bunnings and Farmlands, have a meal in a restaurant and visit the pub in Mahia.

Living under Covid restrictions has not been easy but as we look back over time we marvel at the positive changes both in Wairoa Hospital and Queen Street Practice (QSP), who are housed together in one large building with the Laboratory, ward, midwives, outpatients, public health, mental health, District Nurses, the kitchen, all sprawled around like spokes of a wheel, also under the same roof.

Covid has been a great leveler in the community as we all queue together respectfully, keeping our social distance and chatting away with Mongrel Mob, Black Power and others while waiting to be allowed into New World to buy our groceries. The strangest masks and gloves hide people’s faces and hands.

The Mahia Dairy puts out free bread and milk on a Thursday and announces it is time to “come and fetch” on our social page. Young people run around doing Meals on Wheels as the elderly are at risk of performing this function.

People have been kind to each other in a myriad different ways.

We have all increased our awareness of Infection Control which will stand us in good stead coping with mundane things like the Flu and MRSA. Donning gloves, masks and funny looking gowns is now second nature and sadly we no longer hug and kiss our patients.

QSP and the Hospital have worked closely together, lending or giving each other PPE, depending on who is running out, ordering PPE from a common site. The CBAC has been manned by a team of hospital, practice nurses, and community dental nurses. There has been a blurring of Private and DHB boundaries and the Clinical Nurse Manager even has her own named coffee mug in the practice drawer as she meets frequently with QSP staff.

QSP and hospital nurses practice weekly emergency “sims” together along with all the doctors.

A trainee intern, who was here before Covid in the practice, and had her overseas elective cancelled, is coming back for 2 months to do her stint in Wairoa Hospital. Maybe a budding rural GP?

So – for us,

 

“Covid Time has rocked”.

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Postcard from the edge #8

2020-05-14 08:53:49 milro13p

Robin Chan is Australian Trained Rural Generalist and creator of islanddocs.com.au.  She works in Taupō across hospital and community settings. She likes to dance.


They say it aint over till the fat lady sings but my “Corona Rhapsody” playlist has never had so much airtime and isolation has seen a surprising surplus of Cake and Quarantini’s.

Did we miss a bullet? Was our overnight transformation to virtual general practice for naught? Do our hospitals owe the catalogue of in-actioned surge plans to a decisive pre-emptive strike from Sista J?  Perhaps, but the truth is something way better.

The choice Kiwi’s made every day for the past months, to trust the information that their government was broadcasting, that this virus was real, it was deadly and transmission was preventable through physical distancing measures, was a gift that they gave each other and ultimately themselves.

We healthcare workers put ourselves on the front line at 10 times the risk of contracting COVID19 in our duty to care for our community. Although there have been infections, we are mostly safe because through trusting the physical distancing messages, our community cared for us.  Kei runga noa atu Taupō, well done.  I would wrangle a pandemic with you any day.

P.S. don’t forget to wear pants on zoom.

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Postcards from the edge #7

2020-05-13 10:10:25 milro13p

After two number 5’s and a break here comes the next postcard from Wilson Mitchell who is a medical student in the Rural Medical Immersion Programme (RMIP).


It was a year I had been eager to undertake ever since I had learnt of it in my second year of medicine. Like many, the Rural Medical Immersion Programme (RMIP) encapsulated different aspects of life that thoroughly appealed to me; integration into New Zealand’s rural communities, hospitals that are dominated by friendly faces (not endless corridors) with the freedom and independence to learn on my own terms, in my own time. My first four weeks had been some of the best I had experienced in medicine so far.

However, merely two days after returning to Blenheim we were all faced with the reality of a national lockdown and unprecedented, uncertain times ahead. This was a necessary decision that had undoubtedly saved lives and prevented widespread community transmission; with this in mind, it became a little easier to forget about the red stags roaring in the seaward Kaikoura range I had encountered on a tramp the week before.

During this time it has been a privilege working with my fellow students as they have used their differing backgrounds, knowledge and experience to ensure that others are not left behind in their learning. The friendly and uplifting atmosphere has been invaluable.

I was nonchalantly perusing Facebook the other morning when I stumbled across the following quote:

When asked if my cup is half-full or half-empty, my only response is that I am thankful I have a cup. ­– Unknown

Not normally someone to find meaning in white text overlaid on a stock image, this sentence seemed to weigh on me, given the current events. In the face of adversity and irreversible social change, I still had much to be thankful for.

That I, and those in my bubble were still in good health, alongside other family, friends and social networks.

That this lockdown had given me the time to work on myself and develop skills I’ve neglected for a time. A mission to see how many laps I could run around the block turned into a marathon. My homemade bread recipe has been tweaked, improved and reengineered. Kneading dough is a somewhat cathartic experience I have discovered.

Although seemingly successful, we have not had an optimal medical response in this pandemic, with concerns regarding resource allocation and management. However, I’m also thankful for the collaboration and initiatives in the rural health sector in recent weeks. In such trying times, to see such widespread cooperation, advocacy and adoption of new technological practice in the sector is encouraging and opens many new possibilities for the future of healthcare provision in rural New Zealand.

Being able to find positive lights in such a dauntingly uncertain era will certainly not lift the darkness, but might make it just a little bit easier to see the way out, and what the future can hold.

Sunrise from Mt Fyffe Hut (Seaward Kaikoura Range) a week before the lockdown announcement.

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Postcards from the edge #6

2020-04-29 14:49:08 milro13p

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.

Confusion.

Fear.

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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Any views or opinion represented in this site belong solely to the authors and do not necessarily represent those of the University of Otago. Any view or opinion represented in the comments are personal and are those of the respective commentator/contributor to this site.

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