ŌPŌTIKI-born Carlton Irving says he’s not “an army of one”, but a member of “the coalition of the willing”.

As of December 7 last year, he is addressed as Dr Irving, having graduated with a Bachelor of Medicine and Bachelor of Surgery from the Otago Medical School after having put in 16-hour days for six years.

He and his wife, Jaime, who works as a police prosecutor, have seven children and Dr Irving now works part-time as a junior doctor at Hawke’s Bay Hospital.

However, working as a medical doctor was never the destination, but “a why”.

“If your why is big enough, it’s surprising what you can achieve,” Dr Irving said.

With more than 20 years’ experience in the health sector, he was a critical care paramedic before moving into healthcare leadership and medical practice – he is the Director of Māori Health and Consumer at Te Tāhū Hauora Health Quality and Safety Commission.

For the last year of his medical studies, Dr Irving wanted to get practice at a rural hospital through the medical school’s Rural Immersion Programme.

“Being keen on rural health, I wanted to go on that programme – but there were no kaupapa Māori health providers that you could go and work at,” he said.

“So, I said to them, what I really want to do this year is set it up for other students – so they can go to kaupapa Māori providers if they want and get exposure to the Māori model of health work.”

Thanks to the “coalition of the willing”, the rural project is expanding.

“Across the country, we now have Wairoa, Dannevirke, Masterton, Kaikoura, Clutha, Queenstown Lakes, West Coast, Northland, Auckland and more,” Dr Irving said.

“They are increasing in number. We have this idea that if we want to have rural doctors, we have to train rural doctors.”

Dr Irving said he had achieved his ambition, doing his final year with a rural kaupapa Māori provider – Te Taiwhenua o Heretaunga.

“Sometimes you have to volunteer and be the guinea pig,” he said.

For graduates, there were not yet any full rural-immersion post-qualifications as they had to be attached to a base hospital.

“Regional hospitals like Whakatāne you can go to, but you couldn’t work in a rural clinic in Ōpōtiki or Te Kaha,” Dr Irving said.

“It’s about supervision and stuff, but over time, I think we’ll find a way to get there.”

The question was how to make a rural community a medical student’s base, from where they would sojourn to a hospital to do their mandatory hospital time of six months in the first two years – instead of having the hospital as the base.

Dr Irving said these distributed models, which could have a kaupapa Māori component, were “not radically opposed”, but that it was more about working out the logistics to support them.

Having been the inaugural chairman of the Paramedic Council since June 2020, Dr Irving said he had now resigned from that position, but remained a council member for a year.

“I feel the chairman of the Paramedic Council should be a paramedic, not a doctor,” he said.

It’s this why-driven sentiment that has seen Dr Irving come to the fore in many areas.

Starting as a paramedic in South Auckland and seeing the poor outcomes of Māori and Pasifika whānau in the healthcare system was a key motivator for him to jump into his medical studies.

“Studying medicine over 40 with a family is difficult – you get only two years of student allowance,” he said.

“But things need to change and you have to be a doctor to change some of it, have a clinical perspective.”

Not having done well at school, including dropping out of high school, Dr Irving has now made learning one of his main activities.

He said that learning, itself, was a skill that could be learned.

“If you master how to learn, you can learn anything,” he said.

“We need to have more Māori doctors and nurses.”

His plan is to carry on working to improve public health outcomes for everyone, including working on models of primary care.

“The model we have been working with has hit capacity,” Dr Irving said.

“We have been living with the doctor-nurse model for a long time, but there are different and other models in other countries.”

One idea was to train rural people to make diabetics foot assessments.

“Treating early reduces both the suffering and the cost of treatment.”

Dr Irving said he’d also been studying how earthquake vulnerabilities and the effects of climate change could affect rural healthcare.