ENT surgeons Richard Douglas and David Waterhouse in the newly donated mobile ENT clinic.
Photo: Supplied

A surgeon from the legendary Māori Battalion has inspired a mobile clinic designed to bring health services to the remotest corners of Northland.

The new ear, nose and throat (ENT) clinic on wheels has been paid for by Richard Douglas, an ENT surgeon and professor at Auckland University.

Douglas said the concept for the mobile clinic was not new.

“The guy who initiated it was Sir Patrick Eisdell Moore, who was the medical officer of the 28 Māori Battalion in World War II.

“When he came back he worked in Auckland as an ENT surgeon, but he was aware that the children of his soldiers had poor ear health, so he put together with his own hands the original ear caravan. It was literally a caravan that he put on the back of his Land Rover. He used to drive down to East Cape and see children down there, diagnosing them with glue ear or other ear problems.”

Those children would then have their treatment at Greenlane Clinical Centre in Auckland.

Douglas said the new version of Sir Patrick’s ear caravan was fitted with state-of-the-art equipment and digital technology, which meant clinicians working in it had access to the same records and information as if they were working in a major hospital.

“And so what it really means is that outside the confines of the hospital, you are able to run a clinic with the same efficiency as if that clinic were within the hospital walls,” he said.

The idea to follow in Sir Patrick’s footsteps came up at a conference four years ago, during a discussion about the difficulty of ensuring equal access to health facilities for people who lived in rural New Zealand.

Sir Patrick Eisdell Moore with a young patient in the 1960s.
Photo: Supplied

Douglas designed it with Whangārei ENT surgeon Dr David Waterhouse, who was using the van one day a week to see patients while it was parked outside Whangārei Hospital to make sure everything was working as intended.

Douglas had not met Sir Patrick personally, but the generation of ENT surgeons who trained him had been trained by Sir Patrick.

“And they spoke of him with huge reverence.”

He had chosen to focus on Northland because its “tricky geography” meant some patients there were as far from a major hospital as virtually anyone in New Zealand, but also because his colleague Waterhouse immediately saw the benefits for the region.

Waterhouse said mobile ENT clinics had been around for many years, but until the advent of digital technology they were limited in their ability to assess patients.

“So this van was really set up to be able to provide the same level of care that we do in our Whangārei and Kaitāia hospitals. It’s been a very, very generous donation from Richard and his family, and we’re been pretty grateful for that.”

Waterhouse said they had worked together on the project for three years, had the van blessed in October, and held the second trial clinic last week.

“Our plan is to rotate the van in areas of really high need. At the moment we don’t really service the Mid North and Dargaville particularly well. Those patients have to travel quite a long way to see us in Whangārei, so our aim is to take the van to Kawakawa and Kaikohe and Dargaville, on an eight-week cycle, and provide a service closer to home.”

It was scheduled to make its first trip to Kawakawa on 10 January.

Unlike earlier ear caravans, which focused on children’s ear health, this one catered to anyone.

“We have a huge waiting list of patients across our whole specialty, so we’re targeting our long waiters and our urgent patients. But we’ve also had some walk-in patients already,” Waterhouse said.

Waterhouse said Northland’s ENT service was good at seeing urgent patients, particularly those with cancer, within a few weeks. However, patients with routine or semi-urgent conditions often had to wait six to 12 months to be seen.

“Some of our patients with tonsillitis or sinus disease or conditions of the external ear canal, conditions that really affect people’s lives but are maybe not life threatening, they definitely wait longer than we would like. There’s lots of factors for that – it’s certainly got worse since the issues with healthcare over Covid, and the significant changes the public health system’s undergoing – but this is one thing we’re hoping will make it a bit better.”

Waterhouse said as well as paying for the van – named Tarāpunga, after the native red-billed gull – Douglas had set up the Tarāpunga Trust to cover its ongoing operating costs. If successful, the service could be expanded to other parts of the country, such as East Cape.

Douglas said his dream for Tarāpunga was simple.

“What I would like is for the communities in the more distant parts of Northland to have this feeling that if they have a problem with their ears, their nose or their throat, the mobile clinic’s going to turn up in a few weeks’ time and it’ll be really easy for them to go to. And all of the things that one could have done in Whangārei Hospital will be done very close to their home, and they’ll have confidence that in eight weeks the van will turn up again.”

The mobile clinic was built in Hamilton and based on a Generation 3 Mercedes Sprinter van, with plenty of headroom and space for not just the patient and clinicians but also the patient’s family.

The Tarāpunga Trust will loan the van to Health NZ Te Tai Tokerau without cost.

All procedures performed in Whangārei Hospital’s ENT clinic can be carried out in the van, such as ear drum grafts, head and neck skin biopsies, endoscopy, vertigo manoeuvres, treatment for chronic nosebleeds, and hearing loss and thyroid abnormality investigations. Grommet insertions can be performed on adults only because children need to be anaesthetised in an operating theatre.

According to Health NZ, almost 40 percent of all Northland children waiting for an initial specialist appointment are waiting for ENT – more than double the figure for adults.

Nearly 60 percent of patients waiting more than four months for an ENT appointment in Northland were children.

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