Salute to the Pōhutukawa and the West Coast.

It’s Christmas. I’m touring the north Island with family in tow.  Blooming pōhutukawa line the Coromandel coastline.  I’m curious about its evolution, uniquely suited to the landscape, shaped by millennia of slow and steady adaptations.  Courageously reaching for the coral sea.

The New Zealand Christmas tree.  I wondered how many versions of the Christmas tree there are the world over, more fitting to the cultural context in which they find themselves, serving precisely the same purpose well enough. Absurd that the Germanic Lutheran tradition should be the standard by which all others are compared.

As we pass by Thames hospital, Im reminded of another rural hospital, Greymouth, my West Coast colleagues and the recent storms they have weathered in the name of system level change.  The West Coast DHBs endorsement of a new sustainable model to support the unique needs of its community has come under fire in the press.

Rural generalist medicine programmes are being established or developed in several countries as part of an integrated response to rural health and workforce concerns. The West Coast District Health Board has endorsed a model adapted from a successful Australian rural Medical workforce solution. Which, at its heart, acknowledges the need to prioritise primary health care services whilst maintaining essential secondary services.  The challenge for rural communities everywhere.

Although the medical union response warned that the West Coast stands to lose services, endorsing a rural generalist model is a strategic DHB decision to sustainably maintain essential anaesthetic and obstetric services whilst opening the door to other advanced skills that rural generalists may bring in the future.

Rural hospitals nationally looked on. Most already meet the needs of their community without onsite anaesthetic, surgical or obstetric cover through a combination of Rural Hospital Medicine Specialists and reliance on larger referral centres. The proposed use of procedural rural generalists imagines a future where more procedural care can occur locally, reducing transfers away from home. If the changes at Greymouth are successful, this precedent may increase services to many rural communities through advanced rural skills delivered by specialists in rural medicine.

As we evolve to find a uniquely New Zealand rural health model, stones will be thrown. Some will damage ego’s, some will cost jobs. Perhaps these are only the casualties of change, or perhaps they are the predictable and unfortunate consequences of medical tribalism. Where specialists fight to protect their own turf at the cost of the overarching goals of the health service.  

The future is not clear.  But it is Christmas. The pōhutukawa teach me to embrace cultural relativism in all its wonders.  The evolution of a system built to meet the unique health care needs of the West Coast deserves our curiosity and humility. If it is successful, Rural communities across New Zealand stand to benefit.

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