Centralisation leaves rural health

Centralisation is now a fact of life, but focus is needed on how to meet the ensuing shortfalls for rural areas, says Margaret Pittaway, RWNZ South Island board member and a retired nurse.

She says rural people are coming under real stress because they do not have the same access as urban people to district nursing, mental health and other medical services.

“Mental health services is a big issue for rural New Zealand, with rates high for younger men in farming communities,” Pittaway told Rural News, outlining some of the issues raised at a recent RWNZ seminar on rural health.

Rural Support Trust members and others working with people in strife often report that though they can get clients an initial assessment for clients through a GP, often a 10 - 20 day wait may ensue before they can get help from intervention services.

“That is a long time for a person who is suicidal or deeply depressed,” Pittaway says. “It is unacceptable.”

Another issue is emergency services rely hugely on volunteers.

“Hats off to the volunteers who give up personal and family time to commit to giving services to rural people,” she says. “But many of us are about three hours from a base hospital. We talk about 'golden hour': it is recognised that unless [during that hour] you stabilise a patient who is critically injured or ill, the chances of a good outcome start to diminish.

“Our rural volunteer services get put under pressure once services start to be centralised. It takes time to get a crew into an ambulance station when they are based at home. Weather and road conditions can affect them, winter conditions can put the crunch on helicopters flying… so life-saving or rehabilitation outcomes come into question.”

Closure of smaller hospitals in rural areas has affected maternity services and rural surgery patients who previously would have got a few days respite care in local hospitals. This suited the main hospitals because it freed up beds and gave patients time to recover.

With maternity services, she says she recently spoke to a young woman in Te Anau who said the nearest available midwife is about 90 minutes away and the backup midwife even further. Midwives who were closer had full caseloads and were not taking more clients.

“We are faced with a town that is remote; it is a tourist town so it has a growing younger population. There are no opportunities there for young women to have ante natal classes; they probably face lengthy travel to have ultra-sound scans to monitor the progress of their pregnancy and their nearest maternity hospital is in Lumsden, 77km from Te Anau. It is under threat of closure but has been given another year.”

Because of closure threats women are opting to give birth at bigger centres, taking them away from home often at busy times such as lambing or harvesting. That throws extra pressure on families.

She is also concerned the young women are not getting the six-seven post-natal visits available once they go home. It is not a reflection on the midwife service but often the mother must drive to see the midwife.

“That may be fine unless she has had a caesarean and can’t drive. In the middle of a busy farming season it becomes well-nigh impossible to make those visits at a time when it is critical to observe both the mother and the growth and wellbeing of the new babe. That’s imposing huge pressures and we don’t know how it affects the long-term wellbeing of these children.”

Any government should use the rural assessment tools when forming policy to assess the effects on rural people. Often it is not until submissions – RWNZ submits on a number of issues – that they realise how policy will impact.

“If they looked at how it might affect rural areas initially there would be a lot of time and angst saved for everybody."

Definitions of rural are often vague and inaccurate, with some data systems inaccurately putting rural statistics into urban areas, Pittaway says. So the figures that health services and budgets are based on are “widely inaccurate”.

Recently they asked health services for the differences between urban and rural for the rates of cervical cancer and the uptake of preventative vaccinations, and the figures were not available.

“There is no definition of the difference between what is urban and what is rural. That affects the funding and outcome of health services.”

It is known internationally that health outcomes for people living in rural areas are below those in urban areas.

Often treatments are only available at larger hospitals which can be three hours drive away for appointments and follow-ups. Patients having chemo or radiation therapy often have to stay at their own expense or stay with family or friends.

“That is huge if the patient is the farmer and breadwinner. It places huge stress on these people, puts them under pressure and is not conducive to a good family situation.”

The budget of the district nursing service does not allow travel to more remote areas for after-surgery care. Sometimes respite care can be arranged for the very elderly, but most others from remote rural areas must make their own arrangements.

“There’s lot of things putting rural people on the back foot when it comes to health services.

“We have a shortage of rural GPs, and an ageing and tired GP workforce from the hours they are working, so there are lots of things compounding.”