Monday, 18 September 2017

Rural exchange in Balclutha, NZ

Each year, a Monash medical student based in East Gippsland for their second clinical year heads off to a New Zealand rural region and a student from Otago University takes their place here. James Davey reports on his experiences in New Zealand during the 2017 exchange.


Cold arrival


I was bursting with excitement as I left Melbourne destined for New Zealand to start my fortnight long exchange between Monash's School of Rural Health (East and South Gippsland) and Otago University's Rural Immersion Program (RMIP). Flying from Melbourne to Christchurch in the early hours of Saturday morning, I was treated to an amazing little look back on the Gippsland. As it was my first time visiting New Zealand my excitement only grew as I flew Christchurch to Dunedin. When I arrived it was dark, cold and rainy, but I was met at the airport by the warm smiles of my two new flatmates Dan and Grace. Their kind welcome instantly put any uncertainty I had aside as we headed out to for a dinner at the local pub over an exciting rugby game between the All Blacks and The Lions.

Sunday’s weather was again wet, cold, windy and rather miserable, but I dragged Dan and Grace out to brave the weather to explore some of the Catlins region. They were excellent tour guides and I was impressed with their depth of knowledge about the region, flora and fauna. We visited the Nugget Point Lighthouse to take in the rugged but beautiful coast, as we were hit with icy winds coming off the Southern Ocean. We ventured on to Cannibal Bay where I got to see sea lions play fighting on the beach. The water is a beautiful shade of blue though far too cold to swim, besides I forgot my "togs". That night we enjoyed a great dinner full of laughs with the Clutha Health First clinic’s administrator, my first introduction to Balclutha’s lovely small town hospitality.


Warm welcome - Clutha Health First
 

The following day I received an incredibly warm welcome to the Clutha Health First Clinic and a tour of the great facilities. Clutha Health First integrates a General Practice clinic, a fifteen bed inpatient ward, outpatient services for visiting specialists, a midwife run maternity unit, a medical assessment unity (a practice nurse run mix between ED and GP) and multiple allied health services like X-ray and a basic pathology service. Clutha Health First has an incredibly unique set up and an interesting backstory behind it. Balclutha originally had a hospital, but as Health Care Otago moved to retract funding from rural areas, it left the town with only general practice services. The dissatisfied community, rallied and marched in Dunedin demanding that their region have more. As a result, Clutha Health First opened in December 1998 funded and owned by the community of Clutha; an achievement that they are rightly very proud of.

My time spent at Clutha Health First during the first week was spent in a mix of general practice, outpatient psychiatry, the inpatient ward and the medical assessment unit. This gave me the opportunity to work with and learn from an incredibly multifaceted team in a hands on way.  Working with the team at Clutha Health First, I gained further insights into the challenges of rural practice in a smaller setting than I am used to, for example only having access to X-ray rather than a CT scanner. It was great to see the way that different areas of the clinic came together to handle some challenging medical problems. I really enjoyed my time in the Medical Assessment Unit with exposure to a great mix of GP and ED cases; I was really impressed that all of this was handled by incredibly capable nurse practitioners rather than doctors.

Exploring
 


During the weeks I spent my moments of free time making the best of the weather by exploring the town and surrounds. On sunny days I’d take a walk at lunch or in the evening through the main street of town or to check out the Clutha River (New Zealand’s largest volume river) and the Clutha River Bridge. When the temperature dropped, I’d be up early to take a walk through the frost and break frozen puddles as the sun rose over Balclutha. Although I got excited for snow a couple of times with freezing temperatures, we received no more than a minimal dusting, but got plenty of ice and sleet instead. Despite this my excitement over the ice and frost remained high and my flatmates jokingly likened me to a child as I continued to smile until my teeth literally hurt from the cold.

I celebrated the end of an amazing first week in Balclutha with with a fun filled Friday night at the Kaka Point Pub’s ‘open mic night’. My very talented flatmate Grace joined a number of excellent performances and we all had an absolute ball. I spent Saturday morning working alongside another fantastic nurse practitioner in the Medical Assessment Unit. On Saturday afternoon Grace and I left for Queenstown to go stay with some of the other RMIP students who are based there.  Despite stopping for a number of photos and needing to slow down for some icy roads, we made it in time for the final rugby game between the All Blacks and the Lions over dinner with some of the other students. It was great to hear about some of their experiences and challenges they were facing treating a population dominated by tourists.

Riding through a winter wonderland
 


On Sunday Grace and I set out exploring on an ambitious bike ride along the Queenstown trail which ran around lake Hayes, out to Arrowtown and back along the Kawara River. The scenery set to a backdrop of mountains was breath-taking, and I was in absolute awe! We rode through the most incredible ‘winter wonderland’ like thick frost coming into Arrowtown. Despite running relatively short on remaining daylight, we were confident in our riding ability so decided that making it home before sundown was still possible even if we took the longer scenic route. This would have been perfect had we not taken a wrong turn and added an extra 8km to our trip with a detour. We were still riding when the sun set and the temperature began to drop, we pushed on to eventually make it back to the car exhausted as the moon rose overhead.

Multidiscplinary week two


 Like my first week at Clutha Health First, my second was split with time across multiple disciplines and teams. I was fortunate enough to even spend some time parallel consulting with Dr Branko Sijnja who heads the entire Otago University RMIP program and Dr Rebecca Canner who runs the teaching for the RMIP students in Balclutha; both coming from an incredible wealth of knowledge that I had the privilege of learning from. I also got to spend some time with the Balclutha midwifery team and gained some valuable insight through discussions about the differences between a midwifery run centre with no theatre like Clutha Health First, and Sale with its large obstetric team. Additionally, I spent an amazing day with a GP in Milton, one of the small towns near Balclutha, gaining some exposure to the aged care system and having the opportunity to do some suturing. Although the presenting complaints and core medicine are similar, it has been interesting to see how the Australian and New Zealand health care systems manage patients slightly differently; something I will continue to reflect on in future practice.

I’m incredibly grateful to have been given this unforgettable and invaluable experience. Without hesitation I’d recommend this opportunity to broaden your perspective, gain insight and overall grow as a future doctor to everyone!! Throughout my journey I was generously welcomed and supported by so many incredible people! They all played a part in making this the enriching experience it was, I could never thank them enough for what they have given me!

I’ll definitely have to return to New Zealand real soon! Maybe even to spend some more time at Clutha Health First in the future.

 



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