Water notice piles more problems on cyclone-ravaged Tairāwhiti

Under the state of emergency, primary care have made a decision not to charge patients at all

An urgent stop water notice risked further disruption to flood-stricken Tairāwhiti just as medical practices got back up and running in the wake of deadly Cyclone Gabrielle.

The notice was issued to all Gisborne city residents to immediately stop using water late this morning.

Tairāwhiti Civil Defence posted on Facebook: “The Waipaoa back-up water treatment has failed. We are not getting any water into the city’s reservoirs. STOP NOW.”

This likely further limits primary care facilities, which started to open up yesterday as power and internet was gradually being restored to the region. Walk-in appointments only were available in general practice.

Tairāwhiti was among those regions hit hard by the strong winds and flooding caused by powerful Cyclone Gabrielle as it made its way down the east coast on Monday and Tuesday. Northland, Coromandel, Hawke’s Bay and Tairāwhiti, as well as Auckland’s west coast, were badly hit.

Eight people are now confirmed dead, but with thousands registered as missing it is expected the death toll will rise. Temporary morgue facilities have been set up at Ports of Napier and Hawke’s Bay Hospital in Hastings, police confirmed to New Zealand Doctor Rata Aotearoa.

In a statement, police said the facilities had been established as a precaution to ensure any fatalities can be managed with care and respect, and in accordance with Coronial processes. “They are held there before being taken to a mortuary.”

Jo Scott-Jones, Pinnacle Midlands Health Network medical director, said the stop water notice could limit services at some GP clinics.

Communication with clinics on the ground in Tairāwhiti are still patchy, Dr Scott-Jones tells New Zealand Doctor, but messages through WhatsApp and Facebook are coming through.

Doctors are “coping” and “doing the best they can in the circumstances”, he says.

“Te Whatu Ora is connecting the practices to the hospital, but quite a lot of that is driving around between places and passing messages because communication within the town itself is quite comprised.”

On the stop-water notice, he says hand sanitiser will help, but services could be limited, for example, due to the effect on sterilising equipment and the like.

“If you’ve no power and you’ve no water, it may be safer to actually deflect patients to other places that actually have those things,” he says. Navy vessels arrived today with materials to distribute, including water.

“The message from one of the GPs [to me] was, ‘we’re coping’, and the things that they’re facing are nothing [compared with] the loss of house, loss of life, that has disproportionately affected those most vulnerable in the community.”

GPs, urgent care clinics, hospitals and pharmacies are open today in both Tairāwhiti and Hawke’s Bay, Te Whatu Ora says. But power and communication are still patchy, especially in Tairāwhiti.

Elective surgeries, endoscopy services and outpatient appointments have been cancelled in Hawke’s Bay. Acute theatre continues as well as urgent radiology procedures.

In a Facebook post this morning, Te Whatu Ora Tairāwhiti said all scheduled GP appointments had been cancelled, and GPs were working on a walk-in/urgency-based system. It also warned that GPs may not have access to medical records, and advised people to bring their previous prescriptions, medications and NHI number when visiting any health centre.

“The hospital has enough staff and supplies to offer urgent care for the community,” the post says, but only essential appointments such as cancer, dialysis, fracture clinic, antenatal, ophthalmology and district nursing are operational.

“All other hospital appointments have been cancelled until further notice (unless you have been directly contacted in the last two days). We will call you to reschedule when possible.”

Pregnant women were advised to come to the hospital if they need urgent midwifery care.

Te Whatu Ora Hawke’s Bay said two dental clinics – one in Hastings and one in Napier – were open for children experiencing pain.

Also in Hawke’s Bay, Russell Twentyman, general manager at The Doctors Napier, says there has been close collaboration between The Doctors clinics and other local practices, GPs and pharmacists around how best to serve patients in their community.

“The Doctors Napier has opened its doors to provide as a hub base for multiple other local practices to operate out of from Thursday 16 Feb,” Mr Twentyman says in a statement provided to New Zealand Doctor.

“It means this practice is providing specialist GP services for the majority of Napier during this challenging time.”

Generators had enabled The Doctors Napier and The Doctors Greenmeadows to open both general practice and pharmacies, he says. The Doctors Greenmeadows was also supplying a generator for the neighbouring homeless shelter to provide lights and cooking facilities.

Mark Peterson, a specialist GP at Taradale Medical Centre in Napier, says the “collegiality between practices has been great”.

Speaking to New Zealand Doctor this afternoon, Dr Peterson says: “The ability to work together has been fantastic, so that’s a positive about this, is how people can work together in a crisis.”

Practices with large generators had opened their rooms to GPs from practices without generators, he says, as “all of Napier really doesn’t have power”. Others – like his Taradale practice – were operating with limited services.

“Under the state of emergency, primary care have made a decision not to charge patients at all, so patients are not being charged for any medical care at the moment and we will have a discussion with the Te Whatu Ora people about how we can continue to do that and funding for that.”

The biggest issue for general practices now back up and running in Hastings was the large number of displaced patients and their need for medication.

Rural areas are “still really cut off”, he says, which is a challenge.

Numbers turning up to general practice have been small, he says, as most people seem aware that booked appointments would be cancelled and that power outages would cause disruption.

However, pharmacies have been much busier – as people who were forced to flee their homes left without vital medications.

Urgent care is being provided by City Medical in Napier, with all doctors in the city contributing to the 24-hour roster.

Te Whatu Ora has also extended its summer telehealth initiative to include all general practices impacted by the cyclone, Hauora Taiwhenua Rural Health Network says in a newsletter today.

“This means that general practices can direct their patients to Whakarongorau where a GP is available 24/7 to provide clinical telehealth,” the network says.

The HMNZS Manawanui reached Tairāwhiti this morning, the New Zealand Defence Force says in a statement. The ship dropped off food and much-needed clean water to Tokomaru Bay and Waipiro Bay, before anchoring off Gisborne.

HMNZS Te Mana sailed from Auckland for Napier at 6pm yesterday, with 26 tonnes of stores and equipment on board, such as humanitarian assistance and disaster relief (HADR) equipment, food, water, fuel, shelter and generators.

A C-130 Hercules brought a reverse osmosis water treatment trailer to Gisborne, to help with providing clean water. And two more C-130 flights are planned to facilitate a changeover of oxygen bottles in Gisborne, after delivering 45 bottles yesterday.

New Zealand Red Cross is among the agencies in the cyclone recovery effort, with its welfare support volunteers working alongside emergency management agencies and providing psychosocial support.

Volunteers have also been deployed to Northland, Auckland, Tairāwhiti and Picton, while teams are on stand-by around the country ready to move into the worst affected areas, a spokesperson says in a statement to New Zealand Doctor.

An appeal for donations has reached more than $500,000, to go towards essential supplies such as stretchers, blankets, bedding and hygiene kits, deploying satellite phones, generators and other equipment.

Pasifika Medical Association has also deployed a medical response team, which will first travel to Napier, before moving to Gisborne on Sunday.

In a media statement, chief executive Debbie Sorensen says it’s important to work quickly to understand the types of support needed on the ground.

“We're expecting there will be a high need for medical and mental health support,” Mrs Sorenson says. “We have a wide range of health professionals who are experienced in emergency response and we're ready to provide the necessary assistance.”

The association’s subsidiary, Pasifika Futures, donated $50,000 towards the support of recognised seasonal employees and the Tongan community in Hastings.

Urgent clinics:

City Medical at Napier Health Centre is open (24-hours)

Urgent care clinic at Hastings Health Centre (until 7pm tonight)

General practices:

Napier

Maraenui Medical Centre (10-12pm)

Taradale Medical Centre (9am-midday)

Greendale Medical Centre

Carlyle Medical Centre (limited hours)

The Doctors Napier 8am-9pm

Greenmeadows Urgent Medical Care

Hastings

Medical and Injury in Hastings

The Doctors Hastings

Totara Hastings

Hastings Health Centre

Totara Flaxmere

The Doctors Gascoigne

Hauora Heretaunga

Rural

Tukituki Medical Centre

The Doctors Waipawa

New Zealand Doctor tried to contact Ngati Porou Hauora, without success. Wairoa Health is uncontactable, with calls redirecting to Hastings Hospital.