Thursday, November 30, 2023

Caring for the rural community

Neal Wallace
An endless appetite for work is a feature of many young farming couples, but as Neal Wallace discovers, by any measure Southlanders Jono and Kayla Gardyne have shown an exceptional commitment to their futures – albeit in different areas. The tribe of magpies chose the wrong time to invade the Gardyne property.
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An endless appetite for work is a feature of many young farming couples, but as Neal Wallace discovers, by any measure Southlanders Jono and Kayla Gardyne have shown an exceptional commitment to their futures – albeit in different areas.

The tribe of magpies chose the wrong time to invade the Gardyne property.

A shotgun resting against a wall was evidence Kayla could no longer handle the disruptive noise and activity outside her home office window, as she studied for her medical degree.

The pests progressively came off second best with six magpies dispatched, reinforcing that not only were they unwelcome, but that Kayla needed to focus on her studies.

“They (magpies) got cunning and knew when I was moving and going to have a pop at them. I had to be prepared,” Kayla said.

Several rabbits that attacked her prized vegetable garden as she studied suffered a similar fate.

The small dent in the local pest population is symptomatic of a hectic past six years for the Gardynes.

As Kayla, 29, studied medicine, husband Jono, 31, was cementing their partnership in a large complex family livestock and arable farm near Waikaka, about 30km north of Gore.

The Gardynes farm 550ha, with Jono’s parents John and Joanne, on which they run 3000 ewes, winter 2000 dairy cows, grow cereal and winter feed crops and finish between 6000 and 7000 lambs a year.

Their farm is run in conjunction with Jono’s sister and brother-in-law’s nearby property of a similar size and diverse mix.

It is a complex and busy business.


From left, Michael Hall, Jessica Hall, Georgia Hall (in front),

Joanne Gardyne, John Gardyne, Kayla Gardyne and Jono Gardyne. Photo: Heidi Horton.

The 480ha cropping business is based on core crops of oats, autumn and spring-sown feed barley and feed wheat, fodder beet and kale, but they have grown other crops, such as canola, on the home farm, as well as under contract on neighbouring properties.

In addition, they run a contracting business to utilise their two harvesters. Last season they harvested 1100ha.

“Cropping is a large part of our year,” Jono said.

Lamb trading is an additional busy activity.

They aim to have their own lambs killed by February and then buy replacement store lambs which are finished and killed, with the last gone by the end of April.

For the past six years, Kayla has had an additional focus.

Since 2012, she was working as a nurse at the Gore Medical Centre but was keen to advance her career.

She started postgraduate study to become a nurse practitioner, which involved a Master’s degree.

A postgraduate degree would provide Gardyne with new skills to increase her nursing scope of practice and ultimately could have given her a choice of pursuing a more advanced clinical or research career.

But Gardyne realised this could create job security challenges locally, but also the timeframe for the qualification was similar to that for medicine.

“It became obvious that medicine was the better choice for me,” she said.

And that is what she did.

Jono and Kayla Gardyne

Jono and Kayla Gardyne. Photo: Heidi Horton.

“I was incredibly well supported by my medical centre colleagues and of course by Jono, family and friends as I undertook this major career change.

“I could not have made it this far without so many of these wonderful cheerleaders.”

Kayla saw on a daily basis the struggle rural practices have recruiting general practitioners (GPs), many surviving by recruiting predominantly foreign locums.

Although short-term locums have been a regular feature of rural general practice, Kayla says they often only provide temporary solutions to long-term staffing issues.

She says information from the Royal College of General Practitioners Division of Rural Hospital Medicine highlights the perilous state of rural New Zealand practice, with an impending GP workforce shortage.

“Rural areas are likely to be disproportionately affected,” she said.

Last year, half of GPs working in rural-based practices obtained their first medical degree overseas, compared with 34% of GPs in urban-based practices. 

She says around 10% of New Zealanders depend on rural hospitals for their healthcare and half of rural hospital doctors also work in general practice, reflecting the diverse and dual training pathway for those choosing to specialise in this area.

Despite the pressures of working in rural medicine, data supplied by the Royal College has found 80% of rural hospital doctors say they are likely to recommend it as a career, with only 5% saying they were unlikely to do so.

However, succession planning for rural hospital medical staff is crucial given more than 25% intend retiring in the next five years and a further 18% in six to 10 years’ time.

“The medical staff shortage really adds importance to my decision to undertake further study and into the Nursing Council’s development of the Nursing Practitioner’s role,” she said.

“I do think it (the Nursing Practitioner’s role) is filling a healthcare gap and providing nursing pathways to upskill and extend practice scope.

Tractors work the ground

Tractors work the ground on the Gardyne family farm in Southland.

“I think the value of Nursing Practitioners is being increasingly realised. 

“Medicine alone won’t fix the workforce issues, with shortages of almost all allied health professionals being a very real reality in rural areas.

“We all need one another to provide the best care.”

For five years Kayla spent Monday to Friday predominantly living in Dunedin while studying at the University of Otago Medical School, then she would return home to the farm and help out as she was needed, shifting stock or doing other farm chores.

“At weekends it was back to being a farmer’s wife,” she said.

To stay focused, she treated her studies as a job, devoting specific times when she would hit the books.

During her first year of medical studies when Kayla sat and had to pass the competitive Health Sciences course to progress to medical studies, it dawned on her that she could be without a job locally, as her role had been filled, if she did not make the grade for medical school. 

She passed and for three years continued to work one day a week either at the Gore Medical Centre or West Otago Health at Tapanui, relying on recorded lectures to maintain her medical studies.

Kayla has enjoyed exposure to rural medicine, which included spending five weeks of her elective assisting on the Mobile Surgical Unit, which tours rural communities around the country performing day surgery.

rural medicine immersion programme

Last year she was placed at Clutha Health First in South Otago, part of the University of Otago Medical School’s rural medicine immersion programme.

“I spent a whole year there. It was so good because I was hands-on,” she said.

“On the first day, I was suturing up and treating patients.

“I had people looking out for me when they had interesting patient presentations, giving me the opportunity to see and practice what I had been taught.”

This year Kayla is based at Southland Hospital in Invercargill under the supervision and direction of senior consultants.

As an intern she says working in this centre provides variety, enabling her to rotate through various specialties every four to six weeks, gaining knowledge, experience and helping her decide if she wants to specialise in one area of medicine.

“It gives me a taste of every specialty,” she said.

She also gets more opportunity to practice her skills sooner than if she was assigned to a larger hospital, where hands-on patient care is shared among multiple students.

Kayla says knowledge, confidence and patient interaction gained from her nursing background has helped her.

“My nursing has come into its own during my clinical work,” she said.

“It has made me a much better and hopefully more practical clinician.”

Having to soon start applying for jobs, she hopes to continue working at Southland Hospital as a new graduate doctor for a few years before determining her specialty.

Headers at work

Headers at work on the Gardyne family farm in Southland.

Options include working either in a regional hospital such as Invercargill, a rural hospital such as Balclutha or Gore, in which case she will be a generalist doctor, or working in a GP practice.

In a bigger hospital such as Southland, she is surrounded by specialists who can provide advice and access to quickly turned around blood tests and imaging.

As a generalist in a rural hospital or remote practice, she may be largely on her own, able to seek advice over the telephone, but left to make key diagnosis and decisions and, in serious incidents, keep patients stable while waiting airlift to a larger hospital.

“I’m not 100% sure where I will end up. I love emergency departments, hospitals and especially women’s health. Everything really,” she said.

Jono says having Kayla commute an hour’s drive to Invercargill is also easier on family life. When she is on night or late shift she stays with family in the city.

Having a rural upbringing makes Kayla different from many of her fellow Otago medical students, even though they all have placements in rural health centres as part of their studies.

Getting them to commit to a rural practice is complicated.

Many come from an urban background and the vast bulk of training is done in urban centres, both as under graduates and during specialty training.

The longer they stay in an urban centre, Kayla says their lives become connected to the city as they meet and need to consider their partners, have children and become entwined in urban life.

“I think considering working rurally at that stage is really tough, uprooting partners and families,” she said.

“Many consider Dunedin too small, therefore the idea of working in the likes of Invercargill might seem too much of a contrast to other big cities.

“It’s a real shame, as these smaller centres are often overlooked.

“My experience is that they are fabulous places to learn and grow as a clinician and put down long-term roots.

“They are often highly supportive, collegial and frequently have better work-life balance.”

Ewes and lambs

Ewes and lambs graze rolling Southland hills on the Gardyne family farm.

Kayla’s family moved to West Otago from Tauranga in 2001 to milk a newly converted dairy farm at Heriot, so her roots are well and truly with rural communities.

She loves farming and the rural lifestyle, but also the ability for rural doctors to follow families through their lives.

“You get continuity of care, seeing patients and families grow and change, seeing babies, school-age kids, teenagers, parents and grandparents,” she said.

“I find that quite satisfying that it’s possible when part of a small community.”

That degree of connection also gives rural doctors a better understanding of their influence on a patient’s health and an understanding why some treatments would not work for everyone.

“So many things in rural life intersect, playcentres, schools and community events,” she said.

Although uncertain exactly what medical route she will pursue, Kayla intends to continue contributing to the family farming business as she can.

Most roles in the business are shared but Jono tends to manage the livestock, harvesting and compliance, while his father looks after crop care, the drying and dressing of grain and movements in and out of the grain plant.

Last season feed wheat yielded about 12 tonnes a hectare, feed barley about 9t/ha, oats 8t/ha.

The cultivation work is shared.

Joanne oversees the bulk of the paperwork and shepherding.

“There is a lot going on. It’s a matter of being organised,” Jono said. 

He says the biggest immediate challenge is keeping track of environmental and broader Government legislation.

The 2019 winter was especially stressful when animal welfare critics travelled throughout Otago and Southland looking for images of stock on crops to publish.

“I worried the cows were going to get out into a wet area and I’d be on the news,” he said.

He did not, but it is symptomatic of the increasing amount of his time spent assessing their practices and systems comply with new environmental rules.

“It’s a challenge to keep up with the paper trail to prove we’re doing the right thing,” he said.

Waterways are fenced, sediment traps installed and dairy cows grazed on a flat, dry and free draining area.

The past six years have been busy for the Gardynes and the pace is unlikely to ease in the next few between their increasingly busy farming business and Kayla establishes her medical career.

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