People living in country areas are at risk of farming accidents and diseases spread by animals as well as the usual range of health problems. Isolation has always made access to health services difficult.
Rural doctors and nurses
The mainstay of the rural health system has always been the country GP. In the 19th century, these doctors regularly travelled long distances on foot or horseback to visit patients – as did midwives and nurses. Health Department district nurses included backblocks areas in their rounds from 1909.
It has always been difficult to attract doctors to rural districts because of the long hours, limited support, poor pay, and travel requirements. In 1941 government measures to provide more country doctors included paying mileage for patient visits, and appointing a doctor to rural areas too small to fully fund a medical practitioner.
Since 2001 the government has allocated more funding to recruit and retain rural GPs. In the early 2000s the New Zealand General Practice Network provided support for GPs and doctors working at rural hospitals. There was also a Remote Rural Midwives Support Scheme.
The first New Zealand hospitals were in the main towns, so country people needing urgent surgery could face a long, painful journey. Gradually more hospitals and maternity homes were set up in the regions, often part-funded by local contributions or rates. In 1885 the country was divided into hospital districts, each controlled by a board. These districts multiplied, and at one stage there were 47. In the 1960s the number was reduced, and some smaller general and maternity hospitals closed.
Health reforms in the 1980s and 1990s also led to the demise of some small rural hospitals, and surgical services were cut at others. In 2001, 21 district health boards were set up, and the smallest rural hospital board districts disappeared. In 2008 there were 36 rural hospitals in New Zealand.
Paying a visit
In Littledene (1938), H. C. D. Somerset described how the women’s toilets in the country town of Oxford incorporated Plunket rooms for the visiting nurse. Women and children went there on market day, while the men were at the stock sales. The nurse’s salary was subsidised by a fundraising luncheon on ewe-fair day.
Rural health initiatives
The Plunket Society was established in 1907 to provide baby-care advice and support for new mothers. It soon became widespread throughout New Zealand, and branches were set up in rural districts. Local people paid the visiting Plunket nurse’s salary through subscriptions and fundraising. In the early 2000s, Plunket was still active in country areas.
From the 1920s country children were bussed to city clinics for free dental care. Dental clinics were also attached to some country schools, and a dental nurse travelled between them. There were mobile clinics, and in some areas the nurse treated adults as well as children.
Public health programmes
Diseases passed from animals to humans were a special threat to farming people. Bovine tuberculosis and hydatids were major problems in the 19th and 20th centuries. The Public Health Department and local authorities ran campaigns to raise awareness of these diseases. The Hydatids Act 1959 established a regime for inspection and treatment of dogs, and in the 1960s the Dairy Board, Meat Producers’ Board and Wool Board gave money towards hydatids research.
By the early 2000s, both diseases were well controlled in animals and no longer a risk to human health in New Zealand. But leptospirosis was a serious concern, and Rural Women New Zealand was fundraising for further research into the disease.
In 1918 Dr Doris Gordon was locum for a medical practice at Stratford in Taranaki, and was called to an emergency at Whangamōmona. The trip – now an hour’s drive – took her half a day by car and then horse-drawn gig over treacherously muddy roads. Despite the doctor’s best efforts her patient, a two-year-old child, died.
Air ambulance services
From the 1960s, aircraft helped transfer critically ill people from isolated areas to hospital. Helicopter services provided a more flexible air ambulance service from the 1970s.
Mobile surgical bus
In 2002 a surgical bus began visiting small rural hospitals, so local people could have day surgery without travelling long distances to larger hospitals. The bus carries the latest medical equipment, and doctors can contact colleagues elsewhere for advice during operations through an interactive video link.