Mobile surgery brings health to rural New Zealand

QUICK FIX: Surgeons operate on a patient in the mobile surgery in Waikari, North Canterbury.
QUICK FIX: Surgeons operate on a patient in the mobile surgery in Waikari, North Canterbury.


Westport, Balclutha, Te Puia, Takaka and Dannevirke are not places one would expect to find a state-of-the-art operating theatre.

Over the past few decades, these and many other rural New Zealand towns lost surgery facilities for their residents.

In early 2002, private company Mobile Health Solutions spent $5.2 million to build a specially designed 20-metre long, 39-tonne truck to show there was another way to provide day surgery to people living in rural areas.

The country's only surgical bus has since treated thousands of people by giving them access to hundreds of specialist surgical procedures not otherwise available in their towns.

It visits 23 rural towns during a five-week cycle, stopping in each place for a day and offering whatever surgery is most in need in that area or whatever procedures the available surgeon can do.

Since the February 2011 earthquake, Ashburton has been added to the list while earthquake-strengthening work is being planned for its hospital's operating theatres.

"It was a real prototype because nothing else really had been built like it in the world," Mobile Health Solutions general manager Mark Eager said.

Some people were skeptical of the bus when it first opened, but fears it could not be hygienic and patients would end up suffering from infections had long been disproved, he said.

The bus, which was funded by the Ministry of Health, now delivered about 1 per cent of the country's annual surgical workload - the same as an average operating theatre.

Eager believed the service was the "true" version of the Government's health catch-cry - "better, sooner, more convenient".

Health professionals could sometimes spend years trying to decide a new piece of expensive technology should go, but given New Zealand's small population, having one machine that could be moved as needed was the most efficient way to use it, he said.

Eager said the bus covered whatever the needs were in the town it was visiting, although they were limited by what district health boards were willing to pay for.

"Some DHBs won't do any hernias at all and others will."

Paediatric dentistry was a big need for Northland communities, while Takaka received a range of services and colonoscopies were in high demand in the Buller district.

In the small North Canterbury town of Waikari, general surgery such as hernia repairs are the target when The Press visits.

Four years ago, Waikari's then-practice manager Deb Howell walked a few metres out of her office, underwent hand surgery and was back in her office two hours later.

Her surgery was for trigger finger - a condition affecting the tendons in a finger or thumb, limiting its movement.

"It was a bit alarming you know, I think because I'd been at work before the operation, then suddenly you're lying on the operating table."

Howell found the process "much nicer than having to go to hospital" though and she has seen how the bus had benefited other people in her community, too.

"It's just been an amazing thing. Some people live an hour further away from Christchurch to here and for them to travel down to Christchurch for day surgery, it's not easy. We're lacking a lot of services out here."

Patients wanting to be treated on the bus first have to be referred to a specialist by their doctor, who can put them on their district health board's waiting list.

The Waikari stop catered for patients from as far away as Kaikoura and Hanmer Springs, and made having day surgery a less stressful thing for them, Allan said.

Waikari practice manager Wendy Allan believes some of the bus' patients would be waiting much longer for their surgery if they had to go to Christchurch for it.

While the problems faced by the patients were not life-threatening, they were life-altering - particularly the hernia repair operations.

"It's been really limiting for them; they can't actually work. Then they [have the surgery] and go back to being fully functioning members of the community."

Despite the often life-changing surgery, Eager believed the biggest "footprint" the bus left was the training of local health professionals.

"Some nurses in these rural towns are saying they're now getting better education than they were in the big hospitals, because they're not just hearing from the local people."

Nurse educator Steve Smith said local district and practice nurses were used to flesh out the operating team at each stop, giving them the chance to do work they would not otherwise get to do.

The company also made use of interactive digital video equipment to upskill local health professionals and allow them to collaborate with their peers in other parts of the country and overseas.

"It's not just about us turning up and doing the surgery and driving away. [We're] involving local health professionals and leaving them better skilled to deal with a range of situations."

The rural communities appreciated the difference the service made, Smith said.

"It's a very enjoyable thing to be involved in. It's just about restoring the services to rural communities."

The Press