Initial perspectives of New Zealand doctors: developing capacity and a training programme in the Cook Islands

ABSTRACT From 2012 to 2014, 18 New Zealand general and rural medical practitioners worked in the Cook Islands on a visiting programme to achieve the following objectives: (1) assess and assist with the capacity of the Cook Islands medical workforce; (2) assist with the infrastructure to improve clinical records and audit; (3) assist with developing a General Practice training programme for the Cook Islands; and (4) develop a training post for the Division of Rural Hospital Medicine in the Cook Islands. Each visiting doctor spent a minimum of 4 weeks in the Cook Islands. This study presents the results of a questionnaire undertaken to evaluate their experiences. There were challenges, but for most, the experience was overwhelmingly positive. There were synergies with rural practice in New Zealand. Working alongside local clinicians and being immersed in the Cook Islands health system led to better understanding of the Cook Islands perspective of rural and remote medicine. The findings provide insight into the early phase of an ongoing programme between the Cook Islands Ministry of Health and New Zealand, which has led to the development of a reciprocal training programme for generalist doctors.

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Introduction

Canadian Bulletin of Medical History ◽

10.3138/cbmh.513-022021 ◽

2021 ◽

pp. e513022021

Author(s):

Jennifer J. Connor

Keyword(s):

Newfoundland And Labrador ◽

Humanitarian Aid ◽

Medical Practitioners ◽

Narrative Approaches ◽

Theoretical Approaches ◽

Introductory Article ◽

Medical Reports ◽

Geographically Distributed ◽

Case Writing ◽

Clinical Records

This article provides context for three studies about early 20th-century medical cases in the geographically distributed humanitarian aid organization founded by Wilfred Grenfell in pre-Confederation Newfoundland and Labrador. It situates these studies within historiographical and theoretical approaches to case histories and their publication by medical practitioners, the background for research on the clinical records of the Grenfell organization’s main hospital, and the history behind specific case information for coastal patients. While the cases examined cohere through their organizational origin, the authors of these three studies reveal sometimes unexpected representations of the patient in text and illustration. In these ways, both this introductory article and the following three studies emphasize the enduring appeal of narrative approaches to case writing while also pointing to the evolving ethics of publishing medical reports for general readers and scholars. Together they invite renewed attention to the representation of medical cases in publications that increasingly are available globally in internet collections.

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The Illusory Trust Doctrine: Formal or Substantive?

Victoria University of Wellington Law Review ◽

10.26686/vuwlr.v51i2.6568 ◽

2020 ◽

Vol 51 (2) ◽

pp. 193

Author(s):

Mark Bennett

Keyword(s):

New Zealand ◽

Privy Council ◽

Cook Islands ◽

Trust Law ◽

Court Of Appeal

"A document is put before us. Does it or does it not create a trust?" This article considers the illusory trust doctrine (ITD) and claims that although the ITD has been criticised as doctrinally unfounded and therefore based in substantive, non-legal reasons rather than pre-existing law, there are formal reasons of trusts law to support it. It begins by considering Atiyah and Summers' concepts of form and substance, and then examines how they apply in the context of equity (in general), and then trusts law (in particular). It then briefly considers a number of recent decisions on the ITD: the four cases constituting the Clayton v Clayton litigation in New Zealand, Pugachev and the Cook Islands Court of Appeal and Privy Council decisions in Webb v Webb. Finally, it analyses these ITD decisions using the form and substance distinction, concluding that it is arguable that the ITD is grounded in principles of established trust law, as opposed to purely substantive reasoning.

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Acceptability and experience of a functional training programme (ReTrain) in community-dwelling stroke survivors in South West England: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-022175 ◽

2018 ◽

Vol 8 (7) ◽

pp. e022175 ◽

Cited By ~ 3

Author(s):

Meriel Norris ◽

Leon Poltawski ◽

Raff Calitri ◽

Anthony I Shepherd ◽

Sarah Gerard Dean

Keyword(s):

Controlled Trial ◽

Sampling Strategy ◽

Training Programme ◽

Careful Consideration ◽

Community Dwelling ◽

Definitive Trial ◽

Functional Training ◽

Framework Approach ◽

Training Post ◽

Randomised Controlled

Rehabilitation Training (ReTrain) is a group-based approach to functional training post stroke. ReTrain has recently been evaluated through a pilot randomised controlled trial.ObjectiveThis article reports on the acceptability of the intervention as described by trial participants.DesignA qualitative approach was undertaken. Of the 45 participants recruited into the trial, 23 were randomised to receive ReTrain. Following a sampling strategy, 10 participants undertook 1:1 semistructured audio-recorded interviews. Transcripts were analysed following a modified Framework Approach.ResultsSix themes were developed including exploration of: the physical and psychological impacts of training,the perceived mechanisms of change, the interaction of the group and approach of the trainer. A further theme considered the reported longer term impact of participation. Overall, the results indicated the acceptability of the intervention, but also key areas for potential modification in the definitive trial. These include a need to consider potential impact on both physical and psychological function, careful consideration of dosing and fatigue and the interpersonal factors that facilitate appropriate level of delivery, the trainer to participant ratio, and enhancing features that support continuation of activity postintervention.ConclusionOverall, this study supports the acceptability of ReTrain and the development of a definitive trial evaluation of this intervention to full.Trial registration numberNCT02429180.

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Rural midwifery practice in Aotearoa/New Zealand: Strengths, vulnerabilities, opportunities and challenges

New Zealand College of Midwives ◽

10.12784/nzcomjnl56.2020.3.17-25 ◽

2020 ◽

Vol 56 ◽

pp. 17-25

Author(s):

Rea Daellenbach ◽

Lorna Davies ◽

Mary Kensington ◽

Susan Crowther ◽

Andrea Gilkison ◽

...

Keyword(s):

New Zealand ◽

Rural Communities ◽

Social Services ◽

Health Professionals ◽

Rural Women ◽

Rural Areas ◽

Service Providers ◽

Rural Practice ◽

Midwifery Practice ◽

Adverse Weather

Background: The sustainability of rural maternity services is threatened by underfunding, insufficient resourcing and challenges with recruitment and retention of midwives. Aims: The broader aim of this study was to gain knowledge to inform the optimisation of equitable and sustainable maternity care for rural communities within New Zealand and Scotland, through eliciting the views of rural midwives about their working conditions and practice. This article focuses on the New Zealand midwives’ responses. Method: Invitations to participate in an online questionnaire were sent out to midwives working in rural areas. Subsequently, themes from the survey results were followed up for more in-depth discussion in confidential, online group forums. 145 New Zealand midwives responded to the survey and 12 took part in the forums. Findings: The New Zealand rural midwives who participated in this study outlined that they are attracted to, and sustained in, rural practice by their sense of connectedness to the countryside and rural communities, and that they need to be uniquely skilled for rural practice. Rural midwives, and the women they provide care to, frequently experience long travel times and distances which are economically costly. Adverse weather conditions, occasional lack of cell phone coverage and variable access to emergency transport are other factors that need to be taken into account in rural midwifery practice. Additionally, many participants noted challenges at the rural/urban interface in relation to referral or transfer of care of a woman and/or a baby. Strategies identified that support rural midwives in New Zealand include: locum and mentoring services, networking with other health professionals, support from social services and community service providers, developing supportive relationships with other rural midwives and providing rural placements for student midwives. Conclusion: Midwives face economic, topographic, meteorological and workforce challenges in providing a service for rural women. However, midwives draw strength through their respect of the women, and the support of their midwifery colleagues and other health professionals in their community.

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