6.3 Health
One of the areas of greatest change and continuing impact of that change has been that of health. Access to health services is a key indicator of living standards. In the 1980s threatened closures of hospitals and health services received continuous attention from the media, and helped provoke a strong community response in places such as Taihape and the mid-Rangitikei. Health is a high priority in the area
In 1986 Community Health Watch Committees were set up to act as watchdogs on health, and to liaise between the health board and the community. In the mid-Rangitikei there was an initial successful committee which prepared the ground for the later establishment of the Taihape Community Health Group which has had to deal with the major health reform. The work of this group, through much effort, can be counted a transition success story:
The Taihape Community Health Group consider they have won an essential point – "that rural services are different" and they want such a recognition factored into all planning.
The group has been active in promoting, and complementing health professionals’ efforts to establish, in 1988, the Taihape Rural Health Centre, the first such centre to be established. Essentially it was a change from a focus on ‘the hospital’ to a centre of services - all under the one roof.
Essentially it is a model based on "integrated health care. The culture of the whole place changed", and is still changing. Though a number of hospital beds were lost gains included a five day week district nurse, plus day care for the elderly, a multidisciplinary team of physiotherapist, occupational therapist and an x ray service concentrated in the one place. There is also a free outpatient service provided by visiting specialists such as orthopaedic, paediatrician, psychiatrist, psychologist, obstetrician and gynaecologist, surgeon, physician and an ear nose and throat specialist; a dietitian and diabetic nurse educator, an asthma educator and podiatrist.
There is an air ambulance service available for emergencies; general practitioners have days in attendance at places such as Hunterville and Mangaweka but there are no pharmacies at either place. Prescriptions are delivered by courier, [ this service is being questioned in regard to safety issues ie carrying of drugs] neighbours or friends. Mental health services are considered patchy; one person suggested "it was unwise to become mentally ill except between 9 and 5 Monday to Friday" though there is a crisis line in operation, and services are available, "if accessed appropriately, ie through the GP".
The group learnt how to work in tandem with health professionals. Many had in fact been health workers in the past. They learnt, quickly, what to do in negotiating with government departments, CHEs, bureaucrats, business people- local and ‘outside’, and learnt how powerful a community group can be when it works to a common goal.
There are a number of opposing ideas about whether there is a good cross section of the community involved. [ members have a general interest in health as well as specific interests in Maternity/Early childhood; La Leche League, Plunket; youth issues, care of the elderly, medical, surgical and nursing; primary and public health; mental health, disabilities, home care, ambulance, road safety] There is no iwi representation, no high risk representation, eg people from lower socio economic groups, and no elderly persons involved.
The group recognised that they had to be the advocates, or get people onside who could be their advocates, for "this was not a task for professionals who were likely to be placed in an ambiguous position and who were mostly too busy". They also learnt "to have perseverance even when the odds are against you", and to negotiate for long term plans which are viable, for the local community. 450 people attended a public meeting on health issues in Taihape in 1989.
In doing this work, group members said they "had to learn a new terminology in order to converse with officials". They lobbied, challenged, spoke with Ministers, their own MPs, and did constant research – "we were very aware of always needing to back everything with facts - needed to substantiate the claims". They recognised they had a better chance of success if they concentrated on real needs and principles; and were constructive, gained trust and showed sound understanding of issues.
They attributed their success to such factors as commitment, lateral thinking and vision.
"We knew we were going to succeed." "We were unbeatable because we stuck up for each others’ arguments." "The energy resilience and stickability has been a group attribute - there has always been someone to balance despondency with enthusiasm to keep the group motivated and on track about important issues."
There are a number of key players in the area of health promotion and delivery. Some are volunteers who are acknowledged locally for the effort, energy and hours spent on researching, arguing and presenting issues. Some are current health professionals.
Taihape Rural Health Centre: the CEO here is known for her abilities, negotiating skills, openness, and her forward thinking. She suggests that for any community watchdog group to be powerful they must have:
- access to inside information
- a background knowledge of the subject
- an excellent communication network
- trust and respect for all those involved in health service delivery
- a sense of humour
- an ability to be a team player and not form your own crusade.
Obvious gains have been achieved - the Taihape Rural Health Centre has a three year contract with the RHA whereas most have only a one year contract.
Isolation, distance and time involved in travelling, are constants. One of the GPs who has been in the area for 7 years suggested two critical issues are recruitment and retention of rural GPs, and claims that the biggest single factor is the isolation and effect on families. As with teachers, a number of health workers spoke of the professional loneliness.
Midwives - one of whom was still on a party line in February 1997 [ the party-line system in this area was finally upgraded to individual lines in mid 1997] , say their bureaucratic workload has increased. They have responsibility for doing their own statistics, their own accounting and cost recovery. They have not, as yet, got a computer, though they do have access to one in the clinical area.
Economies of scale are always going to be a major difficulty in rural areas, particularly one where there is a low density of population. For example: the Workbridge programme has been moved from Marton to Wanganui. Because public transport is virtually non-existent potential participants are limited in how to attend such programmes. Specialists can be reluctant to travel to see 2 or 3 patients when, by remaining in Wanganui, they can see 10 in the same time period. Human rights issues are at stake here, alongside principles of equitable access.
There is a concern about the continuing non-understanding of rural isolation and needs from health professionals based in urban areas. We want them to transfer patients to the Health Centre, so their discharge planning can be prepared locally. [For example] they have no idea how far it is to the end of the Kawhatau Valley and therefore how difficult it is to both monitor and give support to the patient’s health needs.
Mental health: there are many issues here that need addressing. Most are common to urban situations as well. Some matters do not necessarily ‘fit’ primarily within the health portfolio but involve education, attitude change, relationship training. Comments such as "I’ve yet to meet a man who will ask for help with his anger" were common, often in conversations about the handling of stress. There was concern too, that men, and women, hesitate to enrol for courses or counselling, partly because it needs real commitment and money to get there.
"It’s difficult to make that commitment when you have little self esteem and you don’t think you’re worth it...[and you think] I shouldn’t be spending the family’s money on counselling - it’s seen as an indulgence."
Family violence: a number of professionals spoke of their knowledge and experience of this, both adult/adult and parent/child. Matters to do with family violence are hinted at, spelt out on occasions, but need further research, uncovering, education and action in this area. It was suggested that not even the tip of this problem is being addressed. "For well-off people in violent situations the wife will take a holiday, separation under a different guise. What else would women do - if they left their standard of living would drop. Most would not consider leaving. Both sexes see the farm as his."
Bullying is named as a major problem at a number of schools. One staff member suggested they had poured all their resources into it "but it still won’t go away".
Sexual abuse: this is seen as a major issue. Incest is both denied "this is a village environment - everyone knows what happens so they’d be too scared"; and acknowledged. One health worker said: "there’s an increasing amount of sexual abuse- almost every case is incest".
Problem drinking: there was an ambivalence about alcohol. Some said that drinking is seen as a "social outlet for a lot of males. At the Otaihape [club] it’s the accepted norm of behaviour. [Men] have worked hard all week…" - yet this causes another stress particularly if they haven’t got the income to sustain it. Then there is the category of social drinker - the male who "has to get really pissed before he can enjoy himself... at the O... Ball they have a 2 hour session on bubbly because no one dances when they’re sober".
However others, including key health professionals, see "drink as a major problem. This is an alcohol based society". The rural drink drive campaign is seen as having an impact, and making a dent on the rural macho idea that drinking and driving is acceptable: "a number of key people in this town have been caught - it’s been really helpful".
Contact for Enquiries
Rural Affairs Coordinator
Sector Performance Policy
MAF Policy
Ministry of Agriculture and Forestry
PO Box 2526
Wellington
NEW ZEALAND
Phone: +64 4 894 0675
Fax: +64 4 4 894 0745
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