Month: January 2014

Rural Resilience

opotikigp Uncategorized , , ,

“He taru kahika” – Walk on, it is only summer rain falling – (Maori Proverb about resilience.) 

Resilience and sustainability are going to be the “buzz words” of 2014 I suspect. 

Rural communities in the 21st Century need to build resilience and as rural health providers can be powerful contributors to that work. 

They need resilience because they are facing the challenge of climate change.

They need resilience because they are facing economic pressure. 

They need resilience because they are getting smaller.

They need resilience because they are politically marginalised. 

They need resilience because no-one else is going to be there when push comes to shove. 

 

The New Zealand primary system in rural areas particularly depends on small businesses owned and operated by GPs – this competitive model of providing care is prone to inefficiency and reduces resilience as what is right for a business is often not what is right for a community. Competition between providers may result in “lean” businesses, but people’s needs are often sacrificed and long term planning and development takes second place to profit and short term gain.

PHOs and DHBs mainly show little or no regard for the long term future of primary care services, and time and time again we hear of practices closing, amalgamating, or struggling from locum to locum with little or no help or support from the system that is supposed to be responsible for the care of the community. 

As a profession we take responsibility for the whole person, we walk the talk when we adopt the bio-psychosocial model of care – we approach the individual and their family in a holistic way and address their physical, emotional, and spiritual needs to enhance their sense of wellness. Increasingly we need to do this for communities as well – people need communities to live and work in, and an unhealthy community makes life worse for everyone. 

It may seem too hard to begin to embrace the task of developing sustainable, well connected communities in which our patients can live – the good news is that it starts with ourselves as a community of rural providers. 

Small towns and communities may have rosy reputations as “rural idylls” but those of us that live in them know the truth that many small communities are exclusive, self absorbed, toxic to change and intolerant of difference. Financial sustainability of small business in small communities is marginal and a competitive business model adds stress into an already stressed work environment. Rivalries are not diluted by the sense of anonymity and distance that can be achieved in larger places, individual and generational grudges can develop and tend to be sustained. 

Health workers are not immune to these failings, we can develop professional jealousies and anxieties that make us inaccessible to others, and cut us off from our fellow health team members. 

However there are great examples of how we can do better.

In preparation for the upcoming conference in Gramado (http://www.woncarural2014.com.br/ingles/index.php) the Wonca Working Party for Rural Practice has been discussing the role of rural hospitals in communities and disaster preparedness. It is heartening to see initiatives like Arran Resilience (http://www.arranresilience.org.uk) showing how it can be done – if you have “the spark!” (http://www.globalfamilydoctor.com/News/RuralRoundupItsallaboutthepeople.aspx) 

It is also important that rural providers, despite being intensely busy day to day, become involved in national networks.  We bring a unique perspective to these tables and without our involvement our communities will be less visible, by being involved we can help make the people who have power focus on the resilience of our communities. This is what the New Zealand Rural General Practice Network (http://www.rgpn.org.nz/) is all about, linking together rural providers nationally and in combination with the Rural Health Alliance Aotearoa (http://www.youtube.com/watch?v=qHBcZV6Lzdg) bringing communities of interest together to keep rural health and wellness on the agenda. 

It doesn’t have to be so hard. Ask yourself – how often do you sit down with the other health providers that work in your area and share a cup of tea? There is a wealth of expertise in your neighbours that can be learnt from and built on, and you have a shared experience of care and can support each other in your work. Make 2014 the year to take advantage of your networks, put aside past grievances, pull up your big boy / girl  pants and get together for a chat.  

First Post -Truth develops over Time

opotikigp family medicine, general practice, Healthcare, rural , ,

Don’t shoot the messenger.

The purpose of taking this step into bloggersphere is to provide another outlet for my own opinions about the state of healthcare, in particular how rural communities, and in particular rural communities in New Zealand, fare.

I suspect that when Don Berwick and his colleagues delivered their Don Berwick’s report for the UK NHS they felt a bit like Phiddepides the apocryphal first marathon runner.

Phiddepides bore bad news of invasion, and of the failure of the government of the day to respond.

Berwick et al told the bad news to the UK government of the need for systematic and widespread change to address the failures of the health system, to develop a culture of learning and patient safety, and the letters he wrote, to management, staff and the public exhort a response. They not only challenge the system in England, but internationally. Have we responded?

Famously Phideppides died at the end of his courier run, conveniently I suspect, since the bearers of bad news often did not fare too well in ancient times.

Many bearers of bad news are still “shot down” at least metaphorically, and perhaps in an effort to avoid this people who challenge the status quo will couch their approaches as “solutions” spinning the bad news to assuage the anxieties of leading political parties.

The problem is it is almost impossible to keep everyone happy all the time whilst maintaining the feeling of freedom of expression.

I have been told that you need to play the game if you are to have influence, to treat the powerful like they are children in a sandpit, fighting for the bucket that makes the sandpies.

It seems to me that a regular personal viewpoint, expressed clearly and with the acknowledgement that it is often through expressing ideas and debate that opinions form, could help to get the message through to the children in the sandpit.

Here’s hoping they don’t shoot….