Movies and medicine have been my life. Friends and journalists often ask me which is the closest to my heart. I invariably answer that I am equally passionate about both cinema and general practice. The common thread is an abiding interest in people’s stories. I discussed this in this in an interview with Rob Olsen in the current issue of the New Zealand Rural General Practice Network News.
Read the interview in the current issue of the New Zealand Rural General Practice Network News
Almost three years on from receipt of the Wonca Foundation Award at the World Conference of Family Doctors in Cancun Mexico in May 2010, it is a good opportunity to take stock of the project and assess the steps required to ensure successful completion.
Whilst we started out working on the similarities with our project in rural Orissa, real progress has been achieved by looking at the unique problems which face rural Cambodia. The main point of difference has been the impracticability of the mobile open air clinics which were the cornerstone of our model for Orissa. I believe we now have an appropriate plan for the infrastructure of our device and we are anxious to put this into practice as soon as possible.
Changes in the economic climate have adversely impacted on the medical workforce, particularly in the voluntary sector and this has had a negative impact on our ability to deliver on our project goals. However, it is my sincere hope that increased funding from the proceeds of the recently announced charity premiere of Amiri & Aroha, together with a proposed IndieGoGo campaign, will help to secure a sustainable facility for generations to come.
Over the next few days I will be preparing a report for the World Organization of Family Doctors (Wonca) and will post my repost on this plog shortly.
I am delighted to announce that we plan to have a gala charity premiere for the Amiri & Aroha trilogy, the proceeds of which will go to support my project to develop family medicine in Cambodia.
I have highlighted the extreme need of the project community and the difficulty we have had in funding the project, despite the generous support of the World Organization of Family Doctors (Wonca). I mentioned in a previous post that we hope to use the experience I have gained with crowd funding for Amiri & Aroha to launch an IndieGoGo campaign for the Cambodia project. It is particularly rewarding to find a direct was for Amiri & Aroha to help the project through a gala premiere!
When we began developing the Cambodia project, the key element from the Orissa project that we wanted to replicate was the ability to reach as many people as possible with minimal set up costs. We planned open air mobile clinics which would provide the most accessibility to those in need without draining our precious resources.
This has proven particularly difficult to achieve in the project community in Cambodia. With the passage of time since the Orissa project, there have been many changes in the international medical workforce and particularly to the voluntary sector. We had hoped that the legacy of the Orissa project would be a sustainable model for other regions of extreme need.
So I am currently working with a group of Cambodian professors of general practice on a new model which will hopefully meet the community’s needs. We will need to look at new approaches to funding if the project is to be viable for the long term. I am planning to use the experience I have gained in crowd funding with my films and launch an IndieGoGo campaign to raise funds for the project.
The project community is amongst the most disadvantaged on our planet. It is hard to envisage a more deserving cause!
Our current priority in developing the Cambodia project is to accurately identify the health needs of the project community.
We have found significant differences in the morbidity pattern in the Samrong Tong area population compared with the Orissa community on which the project healthcare model is based. That is why it is vital that we have as many local health care professionals as possible in the field who can develop and shape our project model to truly address the health needs of the community. As previously reported, this has proved particularly difficult, especially in the current economic climate. We have a recruitment drive in progress and hope to redefine the project aims and structure with the input of the team in the field.
We feel a sense of urgency in progressing this work. The children of the project area are amongst the most disadvantaged on our planet.
A Cambodian girl contemplates her lot in life on top of a water buffalo.
I began the project to develop family medicine in rural Cambodia at the request of a group of professors of general practice in rural Cambodia who were keen to use the model we had developed in India. Initial research suggested striking similarities in the health needs of the project area in India and the proposed communities in Cambodia. Our plan was to again use open air mobile clinics to reach a maximum number of people with minimal set up costs.
Regrettably, many of the factors which worked so strongly in our favour in India are proving obstacles in Cambodia. Securing access to suitable sites for the mobile clinics and most significantly recruiting local medical staff is difficult. I have a great team of enthusiastic volunteers, but for the project to be sustainable, it is essential that the service is provided by local health professionals. We are working on incentives and a recruitment campaign so that we can address this issue.
The Samrong Tong region is one of the poorest in Cambodia with many children below the absolute poverty level. It is vital to improve the health and quality of life of some of the most disadvantaged people on our planet.
My project to develop family medicine in rural Cambodia is at an exciting stage. After a number of delays and false starts, I am eager to progress the project as quickly as possible. Unfortunately, we lost some key people early in the project who have been difficult to replace. I am now working on recruitment of a local team of health professionals to staff the fledgling project. Happily this is now starting to come together. The people in the project area are well below the absolute poverty level and their need is desperate. I do not want to lose any more time getting the work underway.
PRIME (Primary Response in Medical Emergencies) continue to on of the most challenging aspects of my work at Kurow, but also one of the most rewarding. There can be few situations where one has such an opportunity to make a difference to someone else’s life.
In my last post, I commented on how well family medicine and film making have worked together for me. Perhaps more universally acknowledged is the link between literature and medicine, with many physicians having made their name as writers.
That illustrious list includes A J Cronin, who was a significant influence in my desire to become a doctor. I was particularly inspired by his novel The Citadel, the story of a mining company doctor's struggle to balance scientific integrity with social obligation. This book was directly responsible for the change to a health care system which was available for all, with the inception of Britain’s National Health Service.
Getting down to work on the novel of Amiri & Aroha is now a top priority for me. I have mapped out the structure in my head, including a number of intriguing story lines that I was unable encompass in the films. I must organize some protected time to develop these ideas and write the novel!
As proof positive that family medicine and film making complement each other perfectly, a house visit to a patient this week resulted in a new scene for Amiri’s Child. My visit was to the Campbell Park Estate at Otekaieke, some 15 km from Kurow. As I approached this majestic stately building, it reminded me of Hatter’s Castle in the A J Cronin novel. There was an eerie, mysterious quality to this elegant mansion, isolated in the middle of nowhere. This would make wonderfully atmospheric location for my new film.
As I drove home from the visit, images flooded my mind. The young Arapeta, the main character in Amiri’s Child, is playing with his childhood friend Miriama. Out on a walk one day they come across this seemingly deserted mansion and start to explore the grounds. But who is this mysterious figure hidden in one of the attic windows? And why does he send his henchmen to scare Arapeta and Miriama away? Why is Arapeta’s aunty so angry when she discovers he has been playing there? Why are the local people so frightened by the madman who live in the castle?
This promises to add a dramatic and powerful layer to the story of Amiri’s Child.
Interestingly, the Campbell Park Estate has previously hosted film units and was the base for The Lion, the Witch and the Wardrobe during the shooting at the nearby Elephant Rocks.
We had decided to make the Peer Group meeting at the Otago Peninsula into a family weekend in Dunedin. As we indulged in some retail therapy at the Meridian Shopping Mall on Sunday morning, the snow suddenly start to fall and the northern motorway out of Dunedin was closed. In an amazingly short space of time, the snow brought Dunedin to a standstill and the roads impassable.
With this came the realization that we would be unable to get home and we were forced to spend another two nights in Dunedin. But every cloud has a silver lining and Ooy, Mark and Rebecca had a wonderful time playing in the snow!
I belong to a rural Peer Review Group and we meet by teleconference every month. This is a tremendously important for rural general practitioners, providing professional and collegial support. In addition to our teleconferences, we have face to face and social meetings and today we met at Penny Kagan’s house on the Otago Peninsula. This provides an opportunity to get to know each other and our families.
After a Continuing Medical Education (CME) session on domestic violence we had a shared lunch and an energetic walk oner the Otago Peninsula to Lanarch Castle with Penny as our guide.
It is a beautiful setting and the views from Penny’s house are magnificent.
My life over the past couple of years has been taken over by production of my film Amiri & Aroha. Now that the film trilogy is nearing completion, it is time to progress my project to develop family medicine in rural Cambodia.
Things have been going on in the background during my hectic shooting schedule. I have been in email contact with key team members in Cambodia and have been video conferencing with the Cambodian professors of general practice who will be leading the project. Our next task is to develop a time frame for the project. The first stage is to develop a network of mobile community clinics to enable immediate access to those in greatest need with minimal set up costs. I will be reporting on progress over the next few weeks.
One of the excitements - and challenges - of my new work at Kurow is responding to PRIME (Primary Response in Medical Emergencies) calls. No amount of training can prepare you for the adrenaline rush when the PRIME pager goes off!
Today we had two PRIME calls, both requiring the rescue helicopter. I was called to a boating accident at the Kurow bridges where a boatsman had crashed into the bridge and sustained chest injuries.
I am most grateful to Wonca for supporting this project to develop family medicine for an area of extreme need in Rural Cambodia.
The project developed following my previous work in rural India, which was also supported by a Wonca Foundation Award.
Following successful completion of the Orissa project, a number of Cambodian professors of general practice approached me about using the same model for Cambodia. We developed an infrastructure for family medicine in Orissa, starting with open air clinics to reach a maximum number of people with minimal set up costs, which we believe will also be an effective starting point in Cambodia.
This “podcast” will bring you regular updates on the project and through photos, video and audio I hope it will provide a true flavour of our work!
I have had a magical week working at Palm Springs Medical Centre in Papamoa. I have been working here part time over the past few weeks, in between completing my film Amiri & Aroha, developing the Wonca Cambodia project, RNZCGP Council in Wellington and all the other commitments which my life so interesting!
This week at Papamoa has been so special because Mark came with me and we had such an awesome time together. Christmas shopping at the Bayfair Centre after clinics and Mark was Father Christmas - and life and soul of the party - at the Medical Centre’s Christmas party this evening!
View the gallery of pictures from the Christmas party!
Whilst I am taking four months away from medicine to make my new film “Amiri & Aroha”, I am doing some part locum work to keep my hand in (and to help finance the film!) in between leaving Te Karaka and starting at Kurow.
It has been a great pleasure to work at Greerton Health in Tauranga over several weeks. Greerton Health is a modern family practice with a great practice team and I have really enjoyed working with them. Having worked in one practice for over 15 years, it is especially interesting to see how another practice works and copes with the day to day issues of family practice. I have learnt so much from Greerton.
After fifteen years at Te Karaka, today was my last working day at the Waikohu Medical Centre. It has been a tremendous privilege to live and work in the Waikohu Community and I am so grateful to everyone who has made my family and I feel so welcome and so much a part of this wonderful community.
It was inevitably a very sad and highly emotional day as I had to say goodbye to so many people who have been so much a part of my life over these fifteen years. The community held a farewell party for me at the Te Karaka Fire Station this afternoon, which was a moving and very touching ceremony.
In my valedictory address to the people of Te Karaka, I recalled my very first morning at Te Karaka, on 1st May 1995. Each successive patient that morning addressed me in French: “Bonjour docteur!” “Comment allez-vous?” I began to think I had stumbled on a small outpost of French Polynesia when one patient thankfully said: “Would you mind awfully if we continued in English?” I later discovered that the locum who had worked at the clinic before I arrived had mistakenly told them that I was French!
This little anecdote for me sums up so much of what is wonderful about Te Karaka. A community that would take the trouble to learn some French just to make their new doctor feel at home, that is something very, very special.
Click here to view all the photos from the farewell parties at the Te Karaka Fire Station and the Bushmere Arms
After fifteen wonderful years at Te Karaka, it is time for new challenges.
Leaving Te Karaka has been a very difficult decision, but the opportunity to pursue two projects that are both very close to my heart has proved to great to resist.
I have secured funding through the World Organization of Family Doctors for my project to develop family medicine in a rural part of Cambodia. This work promises to make a real difference to some of the most disadvantaged communities on our planet.
I have also promised myself that I will have another film in the can by the end of 2010. Since my teenage years, film making has been an integral part of my life and I have been a prolific independent film maker over the years. Yet life has been so hectic that it is some years since my last film.
So I am thrilled to be back behind the camera, shooting a distinctly New Zealand story set in the beautiful East Cape which has been my home for these fifteen years.
I am indeed fortunate to be able to realize these two projects which I have dreamt about for so long.
I plan to spend the next six months working on these two projects. The pre-production planing for my new film Amiri & Aroha is almost complete and am currently working on the casting. I hope to start shooting in mid September, shortly after finishing work at Te Karaka. The principal location, the Rere falls, is close to Te Karaka and I am hoping that many of my former patients will be “extras” in the film.
The Cambodia project is also taking shape. I am working with a number of professors of family medicine in Cambodia and hope to progress the work of setting up community clinics in the rural areas of most extreme need by the end of the year.
On completion of these two projects, I am planning to return to rural practice and am currently looking at Kurow, the practice in South Canterbury which first awakened my love of rural practice.
It has been a tremendous privilege to be the doctor at Te Karaka for the past fifteen years and these have proved some of the happiest and most challenging years of my professional life. Both my children were born during my time at Te Karaka and we have always felt a part of the local community. I extent my most sincere and heartfelt thanks to the people of Te Karaka for making us so welcome.
It was a tremendous moment for me to receive the Wonca Foundation Award in support of my project to develop family medicine in rural Cambodia at the Wonca awards ceremony at the Cancun Conference.
I had previously won a Wonca Foundation Award in 1998 to support my project in Orissa state in India. The project proved very successful in bringing family practice to an area of extreme need.
I feel extremely fortunate to have secured funding for the two projects closest to my heart, this project with the chance to make a real difference to a community in Cambodia and my new film Amiri & Aroha.
We had a two day meeting of the Wonca Working Party on Rural Practice immediately prior to the 19th Wonca World Conference of Family Doctors in Cancun, Mexico.
It was wonderful to catch up with so many old friends and hear their stories and their journeys in rural family practice.
The Working Party is an amazing group of committed family physicians, with a single vision to “change the world” by improving the health status of rural communities worldwide.
Since my project to develop family medicine in rural India, I have received many requests to work on similar projects, particularly in South East Asia. I have done some work with a group of professors of family medicine from Cambodia about a project in Samrong Tong, an area of extreme need in Northern Cambodia. My work as Deputy President of the RNZCGP has not allowed me time to pursue this further, but now that my term of office with the RNZCGP is concluded, I would like to progress this work.
My work in Orissa was supported by a Wonca Foundation Award and today I am getting a proposal together for the Samrong Tong poject.