Doctors’ experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study

Thursday, December 8th, 2022 | claly44p | No Comments

Hedman MDoolan-Noble FStokes T and Brännström M. 


Back in 2018 the Department of General Practice and Rural Health hosted Dr Mante Hedman – rural GP from northern Sweden – for his PhD research on rural health care in Sweden and NZ. His NZ research has now been published and is OPEN ACCESS:


Objective To explore rural hospital doctors’ experiences of providing care in New Zealand rural hospitals. Design The study had a qualitative design, using qualitative content analysis. Setting The study was conducted in South Island, New Zealand, and included nine different rural hospitals. Respondents Semistructured interviews were conducted with 16 rural hospital doctors. Results Three themes were identified: ‘Applying a holistic perspective in the care’, ‘striving to maintain patient safety in sparsely populated areas’ and ‘cooperating in different teams around the patient’. Rural hospital care more than general hospital care was seen as offering a holistic perspective on patient care based on closeness to their home and family, the generalist perspective of care and personal continuity. The presentation of acute life-threatening low-frequency conditions at rural hospitals were associated with feelings of concern due to limited access to ambulance transportation and lack of experience. Overall, however, patient safety in rural hospitals was considered equal or better than in general hospitals. Doctors emphasised the central role of rural hospitals in the healthcare pathways of rural patients, and the advantages and disadvantages with small non-hierarchical multidisciplinary teams caring for patients. Collaboration with hospital specialists was generally perceived as good, although there was a sense that urban colleagues do not understand the additional medical and practical assessments needed in rural compared with the urban context. Conclusions This study provides an understanding of how rural hospital doctors value the holistic generalist perspective of rural hospital care, and of how they perceive the quality and safety of that care. The long distances to general hospital care for acute cases were considered concerning.

Recruiting for Professional Practice Fellow – Rural Health

Friday, November 25th, 2022 | claly44p | No Comments

The Department of General Practice and Rural Health, Dunedin School of Medicine, invites applications for the part time (0.3 FTE) position of Southland/Central Otago Regional Convenor (Senior Professional Practice Fellow) to join their Rural Medical Immersion Programme (RMIP) team.

We also welcome applications from suitably qualified candidates seeking a more formal academic role at Senior Lecturer level (teaching, research and programme development). This is part time position (0.5 FTE) with additional duties including a leadership role in the RMIP programme, contributing to research as well as community and university service.

Closing date is Sunday 18 December 2022

For further details & application click here

Understanding the context of hospital transfers and away-from-home hospitalisations for Māori

Wednesday, November 23rd, 2022 | claly44p | No Comments

Cormack D, Masters-Awatere B, Lee A, Rata A, Boulton A. Understanding the context of hospital transfers and away-from-home hospitalisations for Māori. The New Zealand Medical Journal. 2022 Nov 11;135(1565):41-50.

In this paper, 10% of acute hospital admissions, transfers and arranged admissions for Māori are to hospitals outside of their home domicile which increases with higher levels of deprivation.  With around 25% of Māori living rurally the burden of travel is even greater.  Let’s hope Te Whatu Ora & Te Aka Whai Ora make this a priority in addressing health disparities.




 In Aotearoa New Zealand, people regularly travel away from their home to receive hospital care. While the role of whānau support for patients in hospital is critical for Māori, there is little information about away-from-home hospitalisations. This paper describes the frequency and patterning of away-from-home hospitalisations and inter-hospital transfers for Māori. Data from the National Minimum Dataset (NMDS), for the 6-year period of 1 January 2009–31 December 2014, were analysed. Basic frequencies, means and descriptive statistics were produced using SAS software. We found that more than 10% of all routine hospitalisations constituted an away-from-home hospitalisation for Māori; that is, a hospitalisation that was in a district health board (DHB) other than the DHB of usual residence for the patient. One quarter (25.19%) of transfer hospitalisations were to a DHB other than the patient’s DHB of domicile. Away-from-home hospital admissions increase for Māori as deprivation increases for both routine and transfer admissions, with over half of Māori hospital admissions among people who live in areas of high deprivation. This analysis aids in understanding away-from-home hospitalisations for Māori whānau, the characteristics associated with these types of hospitalisations and supports the development and implementation of policies which better meet whānau Māori needs. The cumulative impact of the need to travel to hospital for care, levels of poverty and a primarily reimbursement-based travel assistance system all perpetuate an unequal cost burden placed upon Māori whānau. 



Defining rural in Aotearoa New Zealand: a novel geographic classification for health purposes

Wednesday, October 26th, 2022 | claly44p | No Comments


Jesse Whitehead, Gabrielle Davie, Brandon de Graaf, Sue Crengle, David Fearnley, MicHelle Smith, Ross Lawrenson & Garry Nixon

NZMJ, Vol135, No 1559. Published August 5, 2022:

You’ve heard about it!  Now read in detail on how the Geographic Classification for Health in Aotearoa NZ was developed. A game-changer for rural health policy and delivery.


Aim: Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality. Method: Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications.  Results: The GCH is a technically robust and heuristically valid rurality classification for health purposes. It identifies a rural population that is different to the population defined by generic Stats NZ classifications. When applied to New Zealand’s Mortality Collection, the GCH estimates a rural mortality rate 21% higher than for residents of urban areas. These rural–urban disparities are masked by the generic Stats NZ classifications. Conclusion: The development of the five-level GCH embraces both the technical and heuristic aspects of rurality. The GCH offers the opportunity to develop a body of New Zealand rural health literature founded on a robust conceptualisation of rurality.

Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand

Wednesday, October 5th, 2022 | claly44p | No Comments

Gurney J, Whitehead J, Kerrison C, Stanley J, Sarfati D, Koea J. Equity of travel required to access first definitive surgery for liver or stomach cancer in New Zealand. PLoS One. 2022 Aug 11;17(8):e0269593. doi: 10.1371/journal.pone.0269593. PMID: 35951652; PMCID: PMC9371338.


This recent study focuses on travel required for patients to access surgery for liver or stomach cancer in New Zealand, particularly for Māori. Gurney et al. find that that Māori on average travel twice as far for cancer surgery compared to Europeans. A substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori. This research has important implications for rural communities – which have a higher proportion of Māori residents than urban areas – and there are likely to be similar situations with other essential health services. To help address these inequitable travel barriers to access cancer care, it is recommended that additional support is provided to Māori patients, including financial support, and that Te Whatu Ora consider localising as much service provision as possible. (J.Whitehead)



In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007-2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09-2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.

Pacific doctor awarded rural health medal

Thursday, September 15th, 2022 | claly44p | 1 Comment

A Pacific doctor and Otago postgraduate student based in the Cook Islands, has been awarded the Dr Amjad Hamid Medal at the 2022 National Rural Health Conference held in Christchurch this month.

Dr Ruonamakin Rui Mafi (known as Dr Makin), who is practising medicine in the Cook Islands, says, “I’m so honoured to receive this award and for having been given the opportunity to study at the University of Otago by the Cook Islands Ministry of Health (Te Marae Ora).”

Dr Makin completed all her Otago study while based in the Cook Islands.

The Dr Amjad Hamid Medal is awarded to the student who achieves the highest grade in the University of Otago’s Cardiorespiratory Medicine in Rural Hospitals postgraduate paper.

The medal honours the memory of Dr Hamid, who was tragically killed in the 2019 Christchurch mosque attacks. It is awarded by the Royal New Zealand College of General Practitioners’ Division of Rural Hospital Medicine.

Dr Makin was born, raised and schooled in Kiribati and did her medical training at Fiji National University. During her internship she met her (now) husband, Dr Vakaola Mafi from Tonga, at Lautoka Hospital in Fiji. After her internship, Dr Makin worked in the ophthalmology department at Lautoka Hospital. In 2013, the couple decided to move with their young family to the Cook Islands to work and explore opportunities. In the Cook Islands, Dr Makin worked in a range of areas, including emergency and medical wards and obstetrics/gynaecology. She is currently working in primary care, emergency care and medical ward work when required, and also doing some work for the Cook Island Family Welfare Association.

The Cook Islands GP training programme, which includes University of Otago distance taught rural papers as the academic component, was established in 2016. Dr Makin started the rural programme papers in 2019 and has completed the Postgraduate Certificate (Rural and Provincial Hospital Practice). She is now undertaking her third paper (Medical Specialties) and is aiming to complete the Postgraduate Diploma in Rural and Provincial Hospital Medicine. Her ultimate goal is to combine clinical work and research.

Dr Makin says, “Further study has enhanced my clinical knowledge and skills in order to improve the management of our people in the Cook Islands, as well as the wider Pacific community…. A huge thank you to the University of Otago staff, my colleagues and family for their support.”

University of Otago Associate Dean Pacific (Christchurch) Dr Kiki Maoate says, “I congratulate Dr Makin on this wonderful achievement. It is also a great achievement for all the partners in the programme, in particular the Cook Islands Ministry of Health, and for Dr Makin’s family, for all their support….Juggling postgraduate study, especially distance learning, while working as a doctor can be demanding, but hopefully Dr Makin’s success will encourage other Pacific doctors to take this step.”

Note: Dr Makin’s husband, Dr Mafi, was the first Pacific Island-based doctor to be awarded the University of Otago’s Postgraduate Diploma in Rural and Provincial Hospital Medicine. See earlier story

Kōrero by Andrea Jones


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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