Friday, December 8, 2023

Community at heart of rural practice

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Canterbury doctor Sue Fowlie is driven by a clear ambition to provide the best care for a growing rural community.
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Dr Sue Fowlie says the rural health workforce has been neglected for years and the covid outbreak hasn’t helped the situation. Photos Annette Scott

A love of the land and a passion for rural health have brought together the dream lifestyle for rural health facility owners Dr Sue Fowlie and husband Colin Steven. They talked to Annette Scott.

Canterbury doctor Sue Fowlie is driven by a clear ambition to provide the best care for a growing rural community.

The clinical director and practising general practitioner is at the helm of the Rakaia Medical Centre, where she started GP practice in New Zealand five years ago.

In April 2020 Sue and her husband Colin Steven purchased the rural medical centre, formerly run by the Rakaia Community Trust since its inception in 2000.

Brought up on a mixed farming property in Aberdeenshire in the UK, Fowlie’s love of the land goes back to her childhood.

Her career as a GP took her to the Highlands of Scotland, where she worked in a rural practice.

“I am well used to rural work and the challenges that come with it,” Sue said.

Husband Colin also grew up in a rural community on an arable and Angus farming property in Scotland.

They had both visited NZ on separate occasions.

“Colin fancied living here, I thought maybe, it’s not too bad,” she said.


The couple came out together in 2015 and stayed with a friend in Canterbury as they looked at lifestyle and career options.

Meanwhile, Fowlie worked as a locum GP at the Rakaia Medical Centre.

“It was back to Scotland (that) I decided I was quite at home in Canterbury,” she said.

“I loved being a rural GP, it is all I know.”

“I knew by now she was sold (on Canterbury),” Colin added.

A phone call back to the friend cemented the deal.

“By the end of a Zoom with the community trust I was offered the job,” she said.

The couple sold up, packed up their life in the UK and moved to NZ in 2016, buying a rural property in Greendale, near Rakaia, where Colin also established a rural contracting business.

The Rakaia Community Trust was always intended as a custodian to keep rural health services available to the rural community.

“The whole idea was that people did not have to travel for health care,” she said.

“We decided we liked it in Rakaia, then the opportunity to buy the practice came along and in April 2020 we became the owners, buying it from the community trust.”

And they were owners with a clear goal.

“The goal is to provide the best care for our community into the future,” she said.

“Providing services that allow patients to access them without having to travel too far matters – peoples’ health and welfare matters, wherever you live.”

The Rakaia Medical Centre is more than just a GP practice.

“We are a primary care practice; where you go to hospital from an urban practice we deal with more injuries and provide emergency services,” she said.

The medical team includes two GPs, a nurse practitioner, three practice nurses, a practice manager, an administration team and an onsite physiotherapist.

Several visiting specialist services operate on a regular basis from the centre.

With the demand for rural health services continually growing, Sue and Colin have big plans to extend the practice, the centre and its services.

“When I arrived here in 2016 the practice had 1800 registered patients, now it has 2800 and it’s only going to keep growing,” she said.

Sue says the rural health workforce has been neglected for years and the covid outbreak hasn’t helped the situation.

She acknowledged making a living as a rural GP is a challenge, to start with funding is based on per capita.

“And while that is the case, rural folk have the same right to access good health care services within their community,” she said.

“NZ is short of GPs, particularly in rural areas and we have got to look at ways to make it attractive.

“The way they (GPs) are trained is down the middle.

“Rural is very different – rural GP is not for everybody, income is less and workload is more, urban you are more likely to work 9 to 5 and be paid more.”

There is a constant push for a more fitting funding model for rural areas.

“We have to look outside the box as to how we can work – this is what’s needed and how can we do it?

“We have to make sure the work environment, while challenging, is not stressful, it’s making sure we spread the load.”

The rural immersion scheme is one way to encourage new doctors and staff to rural centres.

“We have hosted medical students on one-year placements and the idea is they see, work and enjoy the lifestyle,” he said.

“It’s great if they are young; they are likely to even meet someone in the local rural community and stay.”

Hosting nursing students is another option.

“It’s all about attracting people into rural areas and them finding reason to stay,” she said.

Providing more and improved services for the local rural community is the goal for Sue and Colin as they embark on the medical centre’s extension that will see it almost double in size.

“Service provision for the community is key – health in general. How do you reduce the barriers to care, and travel is one of them, and with improved health outcomes? That’s the main driver,” she said.

Managing a rural medical practice is about keeping focused on core business.

“It’s a mixed model business. I like to be proactive, keeping people well rather than waiting until they are not well and trying to fix them,” she said.

While farmers’ priority is their farming business, they are encouraged to keep themselves well.

“If you are not well, you can’t look after your farming business or your family,” she said.


Sue urges farmers to have regular general health check-ups.

“Remember it’s okay to not feel well, physically or mentally, don’t put off getting a check-up,” she said.

“It’s horribly common to put it off and something horrible goes wrong.”

Taking health checks to the farm gate has proved rewarding for Sue who, in recent years, has worked with the farming community to organise wellness check-ups for farmers in their own setting, or the setting of livestock sales, fields days and shows.

Checks include blood pressure, weight, pulse and oxygen saturation.

“We also chat to them about being proactive and looking after their own health,” she said.

“I want to continually be involved in that, I really enjoyed the connections and the satisfaction in that work.

“It was different, there was really positive feedback, it felt like really making a difference and it’s the only way to get to some farmers.”

Shaping the future of rural health will see a significant period of change with both the implementation of the NZ Health reforms and the NZ Rural General Practice Network proposed transition to Hauora Taiwhenua, Rural Health Network.

“The health reforms are still a minefield, PHOs may be going,” she said.

“Rural GPs need to make sure we have a real big voice as so much of NZ is rural.”

The immediate concern is a possible rural covid outbreak.

“We are a small team, we have no wriggle room, the real concern is how do we look after these people,” she said.

The community care programme is based around wellbeing and social support to help people who are isolating at home.

The difficulty is how that is going to happen in rural areas, who is going to coordinate it, how it will be funded and how people will be supported in rural areas.

“We don’t have the allied services and extra support, but we do have a community that looks after its people,” she said.

“Rural communities come together, they appreciate what we do and it’s a real team feel how everyone looks out for each other.”

In the meantime Sue, Colin and their nine-year-old son Ben have recently moved to their new lifestyle farm in Leeston, where they are currently fattening Angus cattle.

With his new role as project manager for their Rakaia Medical Centre development extensions, Colin sold the contracting business on leaving Greendale.

“With Sue working full-time, I will have more time at home with Ben and to look at more options to diversify on our new property,” Colin said.

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