Call the midwife. It sounds easy, but for many families living in remote rural areas, it's often anything but easy.

There is no doubt rural communities without district-wide connectivity across all platforms, struggle with delivery of all community health services.

The announcement of the permanent closure of the Manawatu Gorge and the lengthy wait before a new highway is built is adding even more to the pressure on the Tararua District's already stretched health services.

Added to the Gorge closure, the serious lack of connectivity via cellphone and internet in the district and the result is an untenable situation.


Unless there is government intervention to speed up the supply of rural telecommunications infrastructure, our district's health services will suffer even more pressure and the struggle to attract doctors, midwives and other health professionals to the area will become even more difficult.

Tararua Health Group chief executive Sharon Wards said the issues facing all the district's health services are becoming more challenging because of the inability to communicate via cellphone and internet.

"Our midwives often feel like rabbits down a hole when they head out to visit patients because within 5 minutes east or west of Dannevirke there is absolutely no reception at all," she said. "Short of standing on a fence post with an outstretched arm while endeavouring to raise one bar of reception, our midwives are literally working in the dark whenever they head out into our rural areas."

The Tararua District is the largest region under the MidCentral District Health Board's jurisdiction and its difficult geographical terrain and lengthy roading infrastructure mean services are often stretched to the limit.

"Rural people are entitled to the same level of care as anyone," Sharon said. "Our midwives and emergency service struggle so much because the Government sets policy which determines the way we operate. Because of the lack of connectivity many of these policies are impossible to implement.

"iPads are of no use, we can't Skype patients for virtual consultations, we are stretched to capacity on the ground and it's impossible to implement the policies which would enhance our medical services."

Tararua Health Group's lead for Maternity Services, Linda Shannon, said they struggle daily finding their way to points in the district where the lack of connectivity means a GPS is of no use and records held in files online cannot be accessed.

"All of us know where the points are on the map where there is reception but they are very few and far between," she said. "We are working together as a team to map connectivity for the Connect Tararua Governance Group to assist accurate mapping of cellphone and internet black spots.


"We want to provide a smoother integrated service but when our midwives are constantly up against lack of connectivity, our job is made so much more difficult."
Linda gave an example of postpartum visits where a young mother may have a newborn with jaundice.

"We need to be able to visit but while we're away on this call, we may have another client who is either in labour, or about to go into labour and the midwives all need to be able to be in contact with each other to ensure all cases are covered," she said.

The Tararua Health Group, on average, have 140 maternity patients a year and operate with four midwives.

"Without connectivity, the number of patients for four midwives really stretches resources because we may have two midwives attending a delivery while another is out doing calls.

When they can't communicate with each other it really puts the service under immense pressure," Linda said.

Local knowledge and awareness is paramount in sprawling rural districts and when locums come on board to assist with stretched services, they aren't familiar with the area and so the efficiency of service is compromised.

"The Manage My Health patient portal is a fantastic innovation in health care enabling the community to communicate with the nearest health centre," Sharon said.

"With patient approval, it allows doctors to upload personal health information from their medical centre's computer system, allowing the patient to access their personal health information from any internet device at anytime.

"The most important precursor for Manage My Health is connectivity - without it, it simply can't work. "Here we have a simple solution to a growing problem of stretched health services, but without good internet and cellphone coverage, it is rendered useless.

"Not only would Manage My Health be an efficient platform for improved health services, it would also mean that while we have a doctor shortage, our services would be able to cope far better because of virtual consultation."

Sharon said Manage My Health can eliminate some of the need for face-to-face doctor-patient consultations and having this added service in the Tararua District would help to mitigate the struggle to attract doctors to the district.

"This is all well and good and it is a fantastic innovation in health services, but it's of absolutely no use to us because such a large percentage of our rural patients have little or no cellphone or internet service."

Connect Tararua has identified that connectivity in New Zealand is based on population density and so large geographical but lowly populated districts such as the Tararua District, struggle to get their share of services.

"Imagine a midwife in the dead of night, without the aid of GPS tracking, no cellphone reception, no internet to access patient notes and with a patient to locate in a remote rural location that she's never visited before." Linda said.

"Knocking on doors of strange houses in the middle of the night in order to find the location of your patient is hardly ideal, or safe. We have a responsibility to make sure our midwives are safe at all times but this is not made easy with our lack of connectivity so we welcome the drive by Connect Tararua to bring our district's telecommunications services into the 21st century."