Community can fix hospital's problem

We have a problem in our hospital. Our obstetricians are desperately over-stretched. As they and management describe the matter, the OB service has been functioning at the edge of collapse.

Last week DHB management presented a plan, largely the work of obstetrics chief Mark Stegman, which proposes to transfer 400 "at risk" pregnant mothers-to-be to Palmerston North for delivery. For a meeting preceded by public protest, this one was restrained and civil, but the underlying emotions were palpable.

An immediate issue raised from opposite ends of the political spectrum - by Councillor Hamish McDouall of Labour and by the former mayor - was whether this was to be a pro forma consultation process or a real one. Personally, I'm going to accept the assurance of DHB chair Kate Joblin that it's a real one, while remembering Ronald Reagan's maxim: Trust but verify.

That's because the outcome of this process is the elephant just outside the room. It risks not only a dismantling of the OB service but the domino effect of further erosion to paediatrics and eventually the whole hospital. Many are persuaded that the train is leaving the station. Will the two ministerial MPs who represent this community plus mayor and council be willing to put their bodies in front to stop it?

Of the public's comments at the meeting, the most compelling came from two mothers who detailed their fears over their experiences. One woman had been through a delivery necessitating such a transfer and described herself as overwhelmed and treated as a stranger in a an unfamiliar city without support of her family. A successful birth was marred by a lingering effect of the trauma.

Credit is due to the former mayor for his insistence that any proposal be preceded by presentation of factual data, statistics to define the degree of risk inherent in maintaining the present service, compared to others nationally. While assertions were made that the obstetric service as it exists is unsustainable, in danger of collapse and inherently unsafe for patients, the urgency for immediate solution is belied by the fact that, as everyone acknowledges, the situation has been ongoing for a decade.

The problem, then, is of long standing. It has to do with issues endemic to this hospital and others. It can't provide the best possible service, because it hasn't got the staff.

The difficulty is recruitment of senior staff, which in turn, is intertwined with the failure to attract adequate numbers of registrars or junior staff. The hospital has not been able to shape itself into a place where those who wish to learn speciality medicine or those who could potentially teach speciality medicine would want to come.

Yet the proposal to shift patients 72km to Palmerston North places the burden for solution largely upon the patients. They will be exposed at a time of personal stress to even greater stress of travel to a different city, for care from unfamiliar hands, absent support from family members who may not have the means for travel and accommodation involved, thus turning a celebratory experience into one of potential feelings of abandonment.

There has to be a better way to solve these problems.

Doctors are people too. Our present ones are over-stretched. Prospective new doctors, whether consultants or registrars, and those already here want the same things that patients want: safety and caring. In the doctors' case they want a safe place to learn and to work and a caring place for a family. As a community we can offer that if we have the will.

Kate Joblin describes the proposal to shift patients as a stopgap measure, in effect a Plan B, in case the present OB programme fails or collapses. What is needed is Plan A.

We need to act together as a community in an effort geared at solving the problem of recruiting junior and senior staff. Our hospital needs to create real teaching and mentoring opportunities. We need to make clear provision for incoming staff to be received like family and assured of a place in our homes, in our community, in our hearts.

My stepson Jason rides his dirtbike through rough terrain. When asked how he avoids the dangers he says: "Don't focus on the obstacles; look to where you want to go."