Call the midwife? But she's 100km away

by Virginia Larson / 16 October, 2017
Opinion.
As the election campaign wound up, it was Labour’s proposed water charge and our overburdened health system that brought out the street protesters and Checkpoint text-bombers.

Morrinsville made the news when placard-waving farmers rallied there to protest the water tax. And John Campbell’s lines ran hot on his Radio NZ show, after he exposed the “slow-motion train crash” at the Southern DHB, including the revelation that 10 prostate-cancer patients waited seven months for surgery at Dunedin Hospital. Canterbury and Counties Manukau DHBs were the next to be scrutinised, with stories of long waiting lists and underfunded services.

It would be easy to dub the water tax a “country” issue, which helped paint those rural seats blue after votes were counted on September 23. And you could assume hospital waiting lists are a “town” problem, especially for people without health insurance. So maybe Labour’s pledge to convert National’s promised tax cuts into extra funding for health and education influenced the clusters of “red” seats in poorer urban areas?

In fact, the rural-urban divide was not as it seemed. Election data shows Labour made gains in rural areas – even in Waimakariri, Selwyn and Rangitata, the heart of irrigation-dependent farming. The electorates where National stood its ground or increased its party vote were nearly all urban – and mostly in Auckland.

As for who’s most affected by diminishing access to health care, how many townies give a thought to rural New Zealanders? If it’s tough getting elective surgery, a specialist appointment or a mental-health assessment in a major centre, think what it’s like for a farming family on a high-country sheep station or remote North Island forestry block.

Imagine being pregnant for the first time and living somewhere like Te Anau. Actually, Margaret Pittaway doesn’t need to imagine that situation at all. She’s a board member for Rural Women New Zealand and makes it her business to gather such stories. The young woman she talked to from the Southland town said her nearest midwife was in Tuatapere, a distance of more than 100km. (Pregnant Auckland women simply hope they don’t go into labour at rush hour.) There are no ante-natal classes in Te Anau, and the nearest birthing unit is 77km away in Lumsden.

Pittaway says it’s threatened with closure, like a number of birthing units throughout the country. Many women in remote parts of Southland are choosing to have their babies in Invercargill, where they feel confident there will be a maternity department when they need it. 

Assuming all goes well with the birth, the new mum from Te Anau is entitled to seven post-natal visits, which may in fact mean she has to visit the clinic. If she’s had a caesarean section, she’s not supposed to drive for six weeks. And for farming couples, too bad if the baby’s arrival coincides with lambing or harvesting, when scheduling a number of 200km round-trips for mum, baby and driver – be it her partner, a friend or neighbour – would be challenging.

“Midwives have also reported on the difficulties of using ambulance services to transport women in labour who are having difficulties,” says Pittaway.

“The irony is, if you break a leg on a ski-field attempting some manoeuvre beyond your capabilities, there are no questions about the need for a helicopter.”

That’s just a snapshot of maternity services as they play out for many rural New Zealanders. Mostly, births and well-baby checks are happy encounters with the health system. However, for people living in remote areas, an accident or cancer diagnosis, for instance, can present all kinds of problems – from accessing post-surgery care after discharge from hospital to getting to chemotherapy sessions. Pittaway says she knows of rural women with breast cancer who have chosen more aggressive treatments so they can get home to their families sooner.

We have a 620,000-strong rural population. “Our second largest city, effectively,” says Pittaway. Well, in a virtual-reality sense. But she’s right that, as a sector, it’s not well-served for health, among other government services. And younger doctors aren’t replacing ageing rural GPs. Pittaway says 25 per cent of rural general practices are seeking a full-time doctor, and more than a third of pharmacies are having trouble with recruitment.

I ask her about mental services for rural people – and can sense her shaking her head, at her home in Cromwell. “You know we have a very high suicide rate in our farming communities, especially among men in their early 20s?” she says.

Yes, I’ve heard. Also that NZ Young Farmers have launched a series of mental-health initiatives for rural youth this year. It certainly puts a two-hour wait at an Auckland after-hours medical clinic into perspective.             

 

This was published in the November 2017 issue of North & South.

 

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