Reintroduction of bonding for trainee doctors and nurses would improve the health services in rural communities.

This was among ideas forwarded when poetry-writing doctors, Art Nahill and Glenn Colquhoun, stopped off at Ōpōtiki last week.

The doctors’ Hīkoi for Health was hosted locally by Ōpōtiki Community Health Trust members, including chair Lyn Riesterer and members Muriel Smith-Kelly, Emily Gill and Colleen Walker. Toirāwhiti representative, Jodi Porter, Green party representative Ilmars Gravis, businesswoman Carol Wheeler and several others also spoke.

“When I became a teacher, I was paid to train, not a huge amount but my hostel and tuition were paid for,” Ms Riesterer told the visitors.

“Upon graduation, I owed my country service equaling the years that I’d taken to become qualified. It’s something we could do again, especially for our medical staff. It wouldn’t matter how many years they took to qualify – they would pay that back in service to communities like ours.”

Ms Riesterer expected the reintroduction of bonding could now gain bi-partisan political support and widespread public approval.

Her suggestion was in the context of describing unique health needs at Ōpōtiki.

“One of the problems is that we are lumped in with Whakatane statistics wise, which makes our statistics look a lot better,” she said.

“The powers that be in Te Whatu Ora don’t realise that we are 50 percent of the Bay of Plenty coastline, a long district. For people to travel to Ōpōtiki can take two hours, let alone another 45 minutes to Whakatāne.

“Often our maternity people are then placed in an ambulance to go to Tauranga, from there they can be placed in a helicopter to go to Waikato.

“For women and babies, it can be a very adverse experience and although Whatu Ora states there have been no adverse birth outcomes here, what about the emotional adverse effects? These are quite problematic for our people.”

The Hīkoi for Health culminates at Parliament today, where the two doctors plan to present their collection of stories about people’s experiences with healthcare access. These will include system failures, successes and ideas for change.

The doctors and their supporters have been touring in “The Vanbulance”, a vehicle decorated for the hīkoi by Dunedin painter Nigel Brown.

Dr Nahill is a hospital physician who recently left work because of burnout, but has not stopped believing there are better ways to deliver healthcare.

“I left because I felt I was being made to choose between my own health and wellbeing and working in a system I knew was broken. I was angry about the choice I was being forced to make. Glen and I had known each other for years through writing poetry.  This hīkoi idea came from a conversation we had during Covid – on how we can steer healthcare reform into productive directions.

“A core aspect of poetry is that poets take multiple points of view as they walk around their topic. They look at it from left, right, above and underneath – so it creates this restless way of looking at things. You’re not locked into one way of thinking.

“That carries into health – so it’s like, ‘why are we doing what we are doing’ . . . if you practice creativity, you practice asking questions all the time of orthodoxies. Medicine is an orthodoxy so that’s probably where the poetry comes in.

“In poetry you can’t write the ending before the poem tells you where it wants to go. Likewise, on this hīkoi, although we have ideas for reform, we’re not here to tell you about them. We want to hear what reform ideas are bubbling up in Ōpōtiki. We’re hearing from people who are already seeing a need, gathering and filling it.”

The two received an overwhelmingly positive response in all towns they  visited.

“We’ve obviously tapped into some significant feelings, frustration and anger at the state of the health system. People are happily speaking up - there’s been some fabulous ideas and lots for us to contemplate.”

The material would be written up into a publication in the three or four months following the hīkoi, he said.

Dr Colquhoun is a GP who has taken annual leave from his job to participate in the hīkoi.

“We didn’t know what to expect at every town and have learned to just roll with it. We’re getting very personal stories of need through to stories about systems failures and everything in between. We’re hearing from everyday citizens as well as people who work in the health system and for everyone who shows up to the van there are 10 to 20 making submissions on our website https://healthreformnz.org/stories.”

“Ideas of how the system can be improved and stories – both the good and the bad - of how it has treated people are coming in via face-to-face conversations, posted letters, emails, voice recordings and videos.

“Our aim is for communities to take back control of their health system but ultimately to do that people must talk to one another.  There are pockets where excellent programmes are in place. They need to tell others in their community what is being achieved or what they want to achieve, then self-organise to overcome those divisions. There’s power in unity, power for change.”

The challenge was to get all the health providers together, calm them down so that they stop being rivals, “and just focus on patients”, he said.

“Each community wants best outcomes for their people; it’s necessary to start with them, building a new system from the bottom-up rather than from the top-down.

“Above all, the best efficiencies are never in a health system; they are in preventing poor health and promoting a sense of balance in a person’s life. It’s making sure there aren’t things in society that knock us off balance like poor relationships to food or to alcohol, or trauma in families. Health starts with warm dry safe homes, decent transport networks and employment opportunities.

“We need to help people maintain a sense of balance even if they have a physical or mental illness. If there’s a sense of balance they don’t have to be defined as having something wrong with them. It just becomes a challenge they can work around.

“So, in all our conversation we don’t want to just talk about what the system must look like once you’re unwell. Let’s imagine what the system could be in terms of keeping you well, keeping you balanced.”