Forging bonds in splendid isolation

• A new practice, Whakaihu Taiora, began holding fortnightly clinics at Parihaka in Taranaki in April.
• The doctor, Kiri Wicksteed, is based at Ōpunake Medical Centre, a 10 to 15-minute drive away.
• Pinnacle Midlands Health Network is providing funding to ensure consultations are free.

If COVID-19 has an upside, it’s that when things get really quiet, they can also get that much more personal.

And places don’t come much quieter than Parihaka, despite its deep, historical resonance. Even in the best of times, it isn’t a place you pass through on your way to somewhere else, and a pandemic is definitely not the best of times.

Which only makes Kiri Wicksteed’s Whakaihu Taiora practice all the more aptly named.

Literally, the name refers to the prison ships that carried away those arrested after the constabulary stormed the community in 1881. Metaphorically, it talks of difficult journeys and being carried on tides of wellbeing.

Which pretty much sums up the months since the practice opened in April.

“I feel very lucky to have been invited into this community at this time,” says Dr Wicksteed (Tūhoe, Whakatōhea, Tūwharetoa). “It’s a beautiful place full of generous people, and it feels so good to have been accepted. This has been a special time.”

It has also been a time of restrictions, only survivable because of the bulk-funding arrangement with Pinnacle Midlands Health Network. The village, which is home mostly to kuia and kaumatua, locked itself down to reduce the risk of infection.

The anniversary of the Parihaka attack on 5 November, 1881 always attracts a crowd, but the 140th iteration was limited to residents and those who attended at least eight of this year’s monthly community meetings.

Despite new patients being thin on the ground, Whakaihu Taiora took on 46 new whānau in eight months and sees up to 16 patients at each of its fortnightly clinics.

The practice model was co-designed with the community: patients do not have to be enrolled. Dr Wicksteed estimates they would have seen about 100 individuals to date.

When not at Parihaka, she is based at Ōpunake Medical Centre, a 10 to 15-minute drive away. Being close by helps with continuity of care.

Pinnacle’s long-term funding commitment also means consultations are free, which Dr Wicksteed says has an obvious impact.

“I’m biased, but I would say [the lockdown] has created closer ties with our families here, and I’m seeing them more regularly than I think I would at a normal practice.”

In part, it’s because the care is free, but she also has mums coming in with questions they probably wouldn’t ask otherwise. “That connection seems to be growing, which is really cool,” she says.

“I’m also seeing people for minor stuff they wouldn’t worry about if they had to pay: ‘I’ve never had a smear and I’m ready to do that now’ or ‘can you check my blood pressure?’ So, I think there is increasing awareness of general health and wellbeing from us being here.”

Dr Wicksteed wants to see whether this is backed up by research. A fourth-year medical student is looking at how other small practices operate and will talk to patients enrolled at Whakaihu Taiora about their experiences.

Pinnacle deputy chief executive Justin Butcher says the PHO is pleased with the practice’s results during a difficult year.

“It always takes time to get something like this off the ground, but having someone like Kiri on board has been amazing,” Mr Butcher says.

The PHO is exploring other marae that could host a small practice and, at Parihaka, adding social work and mental health services if that’s agreed with the Parihaka Papakāinga Trust.

Dr Wicksteed has also been meeting with providers and iwi trusts about better coordination between services. More accurate data is needed.

“Twenty per cent of our most vulnerable people aren’t registered anywhere, and we need to find a way to reach them,” Dr Wicksteed says.