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July 04, 2011

Bringing Rural Medicine to the Forefront

Rural medicine is general practice at its most challenging and satisfying, says Westport-based rural GP registrar Dr Amir Khan.

Dr Amir Khan attending to Paul Jeffrey from Westport at the Emergency Department at Buller Health, Westport.

Last year, the West Coast District Health Board opened the Rural Academic General Practice on the Grey Base Hospital site. As well as providing comprehensive primary health services to its enrolled patients both urban-based and in rural outposts, the practice provides rural clinical teaching and supervision for graduate doctors, nurse specialists and allied health staff.

The practice is one of a number of initiatives the DHB has under way as further demonstration of its commitment to getting health services on the Coast to the forefront.

Dr Khan was one of the first registrars at the academic practice and this month, started a six month stint with Buller Health.

Trained in Pakistan, Dr Khan spent several years in the United Kingdom before moving to New Zealand in 2006 and to the Coast in 2008.

His initial intention was to do his GP specialist training but following a move to the Coast and the recognition of Rural Hospital Medicine as a vocationally registered specialty, he decided to focus on hospital and community-based rural general practice.

He says rural medicine provides a satisfying challenge for both doctors and patients..

"I have just started this month at Buller Health, where the hospital has a two-bed ED (Emergency Department), an eight-bed ward and runs clinics and a general practice."

"When you are in a large hospital you might see someone in the ED but never know what the outcome is. In somewhere like Westport, you might see them in the ED, through to the ward and then in an outpatients clinic. You know, and are part of, the outcome."

Training in rural health means becoming almost a generalist specialist, he says. "You have to train to a higher level in a lot of things because you do not always have the specialist back-up available that there is in urban centres. When you're working as a generalist in a rural hospital you have to be able recognise the problem and deal with it or know when to refer the patient on.

"Simple diagnostic tests like x-rays might be hours away. So you need to be able to treat the patient relying on the history and examination , whereas in a large hospital you could be using a number of more advanced tests and examinations."

Another new initiative is training in Rural Hospital Medicine. This was recognised as a speciality by the Medical Council of New Zealand in 2008, with the standards for the specialty being set by the Division of Rural Hospital Medicine which is part of the College of GPs. This training is now offered by the WCDHB.

"Having Rural Hospital Medicine recognised as a speciality has been very positive," Dr. Khan says, "and has brought a lot of positive feedback from other specialists who are happy to lend their expertise."

The DHB also participates in the rural medical immersion programme , where fifth year medical students spend most of their final year (before gaining their basic medical degree) learning under the guidance and mentoring of experienced general practitioners, rural hospital generalists and tertiary hospital specialists while being based in a rural community.

Dr Khan says, "the immersion programme provides students with a great opportunity to broaden their experience. The responsibility is quite high but it can build their confidence in their diagnostic skills."

The Board's next move is a Rural Learning Centre, due to become fully operational later this year. The centre, at Grey Base Hospital, will deliver a training programme that combines rural primary and community care and rural hospital practice to produce nurses allied health professionals, and doctors who are competent to provide comprehensive rural health services.

The aim is to encourage health professionals into rural areas. Dr Tom Fiddes, an experienced senior doctor with a long involvement in medical education has been appointed to the part time position of academic director. He comments that these are exciting times for the development of rural health training and the WCDHB is well placed to further these aims.

DHB CE David Meates says the West Coast initiatives are aimed at strengthening and protecting rural health services on the Coast into the future.

"The provision of rural health services has suffered in the past through a number of factors, with a decline in the number of health professionals opting for the rural lifestyle, and a lack of rural health experience amongst health professionals.

"The learning centre will provide a rural setting for patient-centred learning and generalist rather than specialist learning experiences. We hope it will encourage graduates to work locally."

"Through the various initiatives the aim is to expose health professionals to the rural working environment at an early stage and train those interested in working in rural medicine in a rural setting", he says.

"We want to take rural medicine from being seen as a career backwater, to being seen as an attractive option for GPs, nurses and allied health professionals."

 

For further information please contact

Bryan Jamieson
Community Liaison Officer
West Coast DHB
PO Box 387
Greymouth 7840
Phone (DDI): (03) 769-7665
Mobile: 027 245-9595
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