Thursday, December 7, 2023

Passion to serve rural NZ

Neal Wallace
Wilson Mitchell is a young man on a mission. The University of Otago medical student is passionate about rural communities and the health and wellbeing of those who live there. Wilson Mitchell attributes the hours spent crutching and drenching sheep over weekends and school holidays for helping fuel his desire to work in rural health.
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Wilson Mitchell is a young man on a mission. The University of Otago medical student is passionate about rural communities and the health and wellbeing of those who live there. He spoke to Neal Wallace.

Wilson Mitchell attributes the hours spent crutching and drenching sheep over weekends and school holidays for helping fuel his desire to work in rural health.

The satisfaction of an honest day’s physical toil is one reason for his infatuation but more so mixing with rural people and observing the dynamics of their communities.

He may just be 23 years old and five years through his studies, but Wilson’s commitment to rural health has already extended beyond good intentions.

Born and raised on the Taieri Plains, south of Dunedin, he is the current co-chair of Students of Rural Health Aotearoa (SoRHA), which represents students across all health professions and aims to promote jobs in rural health.

Mitchell is also involved in a proposed new body, Hauora Taiwhenua, a merger of the NZ Rural General Practice Network (NZRGPN) and the Rural Health Alliance Aotearoa NZ, which will act as an advocate for rural health.

“We are all different groups with the same aspirations, but we want to have consistent messaging, a joint, strong voice … whether it is health, GPs, nurses or rural communities,” Wilson said.

“That will allow the Ministry of Health or the Government to consult with one body if they want to know something about rural health or to find out something within the organisation.”

Additionally, Wilsonl helped organise this year’s National Rural Health conference in Taupō, which attracted 50 medical, nursing and public health students.

From an early age, Wilson wanted to be a doctor but his upbringing was always going to be centred around farming and a rural lifestyle

His dad Garth is livestock buyer for Silver Fern Farms and his mum Debbie is a nurse, but farming has also been in their blood.

“Debbie and I were both off farms and we wanted to wait until we owned land before we had children,” Garth said.

“We wanted them to have a rural upbringing.”

Wilson and his brother Jordan were raised on a 140ha farm on the slopes of the Maungatua Hills, and because their parents worked full-time, school holidays were spent working on the farm, which was enjoyable while instilling a work ethic.

They also accompanied Garth on livestock buying visits to clients and stock sales where they met farmers, which ultimately led to them being offered holiday and weekend farm work.

“We would go to the Mt Benger cattle sale and I would give them a programme to keep track of prices,” Garth said.

“All the farmers got to know them and still ask what my two sons are doing.”

From these relationships farmers would recruit Wilson and Jordan to work for them.Mitchell 4

One year Garth was involved in a weaning draft, which Wilson tagged along to and decided to take his handpiece. He spent the morning crutching lambs.

Even today the two boys run a firewood business and help out on the family’s 12ha holding, which the family recently downsized to.

At school Wilson enjoyed science, especially biology, and was one of five in his class to move to medicine in 2016 and pass the first year Health Sciences course, required to move to medical studies.

After five years of studying medicine towards his goal of being a rural GP, he has taken a year off to do a Bachelor of Medical Science honours degree at the university’s Cancer Genetics Laboratory in the Department of Biochemistry, where he is helping with research into new stomach cancer drugs.

“I want to undertake a year’s study to get a better grasp of science, how to read a paper then write it up while learning from people who have a lot of knowledge,” Wilson said.

It is enjoyable work.

“There are a whole lot of new skills required to work in a laboratory growing cells, testing different and new drug combinations then interpreting the results,” he said.

There is a very real and practical reason for his interlude year, which potentially includes implications for the delivery of health to rural NZ.

“There is a real need for us to know what is happening to the health of rural communities as this has been difficult to quantify,” he said.

What there is, is predicted on the urban population, an anomaly he wants to address.

“There is anecdotal evidence that some health outcomes for rural people are worse than for those in cities, but there is no hard data to support this,” he said.

His cancer research experience could provide skills and knowledge that can help accumulate data on the state of rural health, but also assist should cancer treatment be extended to regional hospitals such as Dunstan in Central Otago.

The rural immersion part of his medicine training took Wilson to work at Wairau Hospital and Kaikoura in Marlborough and rural GP practices in Hanmer Springs and Rotherham in North Canterbury.

It confirmed his career choice was correct, in part because it ticked all the boxes he wanted ticked.

He also found that being posted to smaller hospitals rather than at a large-base hospital, he was able to put into practice the theory he had learnt at university.

“It was a good opportunity to get hands-on and develop my own skills, so I found myself more confident out there doing it and interacting with people,” he said.

Some of those early-in-a-career tasks included suturing a badly cut leg and inserting lines and administering pain relief to a patient with a suspected broken back.

In addition to working as a rural GP, he is considering acquiring the skills for the next level of care to work in regional hospitals.

“By having general research skills, it can apply across all fields of the health of the rural population, identify issues and be able to provide treatment or advocate for communities and get research funding,” he said.

Part of Wilson’s future training could include having a Primary Response in Medical Emergency (PRIME) qualification, which will allow him to deliver emergency care and stabilise patients while waiting for an ambulance.

It also reflects the flexibility and upskilling needed by rural health professionals.

Wilson Mitchell

Wilson Mitchell and his brother Jordan operate a firewood business in their spare time.

“With rural health medicine you have to treat anything that comes into the practice,” he said.

“You either treat a patient or stabilise them so they can get to a base hospital.

“It is also recognition of the fact rural communities are underserved and it takes a lot of skills to work in these practices.”

His leadership role has highlighted to him the perilous state of the rural GP workforce.

Surveys have shown 49% of NZ’s GPs intend to retire within the next decade; 39% of rural GP practices have vacancies and 46% of GPs in rural practices were trained overseas.

“There is a massive looming crisis coming within the GP workforce,” he said.

Foreign GPs are underpinning rural health but Wilson says they often work limited term locum contracts to provide temporary relief to short-staffed rural practices.

That has a significant impact on the quality of care, as the turnover of GPs means patients are seen by different doctors with different ideas and approaches to treatment.

“Having a sustainable rural workforce across all fields of nursing (or) physiotherapy, makes all the difference for patients,” he said.

Wilson sees a solution in targeting potential graduates from rural high schools and colleges with information on health sector careers, opportunities and a pathway to study.

“The evidence is that those who come from rural areas are most likely to go back to those areas, stay there and serve their communities,” he said.

The NZRGPN is seeking funding from the Ministry of Health to take that message to rural high schools.

The other required element is central support and funding for rural GPs, such as having sufficient staffing to evenly share the after-hours on-call requirement and adequate funding for fundamental services such as maternity, so rural people do not have to travel vast distances.

Not long after Wilson started secondary school at John McGlashan College in Dunedin, he was asked to write down three work goals.

He wrote: doctor, farmer and pilot.

“If I work in a rural hospital I potentially could be involved in aerial transfer of patients. I also want to own a farm, so I could achieve all three,” he said.

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