NZ Doctor Column

Those of us that work in rural areas know the issues caused by our distance from medical support and social amenities and the challenges of working with rural people who are classically stoical, used to waiting,hard working or not working at all.

We know the need for us to develop extended skills to serve our communities, whether it be to help at the emergency on the roadside, or deal with a mental health issue when no-one else is available.

We know what we need to do to manage with limited resources and in situations of chronic workforce shortages. And we know how to do all this year in year out for many years.

Rural practitioners world wide are described by Prof.Roger Strasser as “extended generalists” – we provide a wide range of services, take high levels of clinical responsibility, for individuals and our communities at large in relative isolation. We know as rural nurses and rural doctors that we cannot perform in isolation, we work in inter-professional teams, sharing decision making and planning for the best possible care for patients, frequently working at the peak of our scope.

Rural communities that are lucky enough to have a small rural hospital available to them have the added advantage of being able to access hospital level services close to their home, but these services need to be staffed and supported by the health system in their region.

Rural practitioners are often instrumental in developing, driving and sustaining the services in their communities – they have developed skills in clinical governance, management and health service planning that are vital to the health service for their community.

Tudor Hart’s Inverse Care Law still applies – people who most need services are those least likely to be given access to them – and when the rural team stops working, services fail and communities suffer.

I was able this month to attend the WONCA world rural health conference, and heard how our experience in New Zealand is repeated world over.

What is exciting is that all over the world, and no less in New Zealand, the health and wellbeing of rural communities is vital for the health and wellbeing of nations.

There is nothing to be gained by setting rural and urban communities against each other, competing for resources for health services. It is mutually beneficial for us to aim for “equity” in health service provision across urban / rural boundaries.

Here we see ourselves as “number 8 wire” people, our heritage and national identity is embedded in the close community of our rural origins.Those of us that live in cities see rural areas as our place for leisure and a source of refreshment and vitality, we expect to be kept well when we are visiting them.

Perhaps even more importantly our country’s wealth relies on our primary industries, based in and reliant upon the health and wellbeing of the people who live and work in rural places.

One of the key international movements that was heralded at the Brazil Wonca conference was the development of “Rural Proofing” tools – our Ministry of Agriculture and Fisheries developed one 10 years ago – the NZRGPN adapted it to apply to the health sector 5 years ago.

The idea is to ensure that whenever any new policy is developed the impact on rural communities is considered and adaptions made if necessary so that unintended consequences do not follow.

Taking this step will have a slow but important effect on health and wellbeing in small isolated communities across the country. I am looking forward to advocating further for the development of “rural proofing’ in New Zealand, and to the support of the international family medicine community in seeing this become a reality here.