Rakaia, Aotearoa New Zealand

"I absolutely love it, and I love the challenge of learning new skillsets"

It took a year of careful planning before Extended Care Paramedic (ECP) Stuart Cook joined the medical team at Rakaia Health Centre on Aotearoa New Zealand’s South Island.

A seasoned clinician with more than 25 years’ experience and a Professional Advisor with Te Kaunihera Manapou | Paramedic Council, he had long wanted to work in primary care. In 2013, while studying at Auckland University of Technology, he wrote a postgraduate paper on community and remote area paramedicine and the models of care adopted overseas.

“I absolutely fell in love with the idea of paramedics being in primary healthcare and how that could look,” he said.

Around the same time, he was undertaking short-term contracts as a Flight/Remote Intensive Care Paramedic with Australian-based Aspen Medical. While he was working in an emergency response capacity, he progressively began spending more time in the clinic. It was another lightbulb moment.

“It wasn’t typical paramedic work, and I ended up really enjoying it. It was like, ‘That's where I want to go and let's see how we can figure that out’.”

Although he was eager to move into the primary healthcare space, other life priorities took over until 2020.

His attendance at the Australasian College of Paramedicine’s 2022 Rural Outback and Remote Paramedic Conference solidified his resolve, and he and his wife agreed that “we need to head back into this space”.

“Basically, from then I was working towards where I am now. I went out on an oil rig to get primary healthcare experience and then approached another rural clinic who put me in contact with the [Rakaia] clinic that I'm at now, where I’m absolutely loving it.”

The town, home to fewer than 2000 residents, sits on the southern banks of the Rakaia River on the Canterbury Plains, about an hour from the nearest major hospital. Rakaia Health Centre, which serves the local community and outlying areas, has three GPs, two nurses, a nurse prescriber, a healthcare assistant and, with the addition of Stuart, one paramedic.

“It's an interesting dynamic given we often serve patients from a lower socioeconomic background, at times with poor health literacy; then in stark contrast we serve very affluent, highly educated patients and everyone in between. It’s a real melting pot of health inequities and understanding - a community I feel privileged to assist.”

Stuart worked with Rakaia Health Centre Clinical Director and practice owner Dr Sue Fowlie for a year before he came on board.

“I had approached Sue and said would you consider an ECP working there, and she said yes, I don't know how it'll work but I can see it working, let's talk. That's basically how the conversation started, and it took us about a year for that to happen. We had to navigate how I was going to work under standing orders and what funding was going to be claimed.

“My job is changing all the time, which keeps me on my toes. My job description seems to change weekly based on how I can best support the clinic to improve health outcomes for our patients and the wider community.”

He is now an ensconced member of the Rakaia Health Centre team, working four days a week undertaking a range of tasks that have added to his professional growth and taken his career in new directions.

On Mondays he operates an acute care clinic, where patients can book appointments with him and where he is able to treat and discharge patients. On Tuesdays he does triage in the mornings and acute clinic work in the afternoon.

“In the morning, patients who need to be seen on the day or acutely come through me and I allocate them either to myself, the nurses or the doctors.”
He also handles patients who call up asking for prescriptions and “doing the legwork for the doctors” to make sure they're still on their medication or are not trying to get more medication than they need.

On days when there is no GP in the clinic, he works with a nurse prescriber, a healthcare assistant, a practice nurse, and a tele-doctor, and is supported in making more independent decisions for his patients.

Stuart works under Aotearoa’s national ECP guidelines, with some additional standing orders, such as immunisations.

“So, within my standing orders, I can make a clinical diagnosis and safely discharge the patient. I have a set criteria where I can effectively supply half of the treatment course to the patient to see them through the acute phase, then I write a recommendation that the doctors can audit and sign-off. The GPs then complete the course of medication by prescription. This allows our patients to be treated faster.”

He is also able to do long-term wound care, which is an area of growth and learning.

“I’m very well supported by the nursing team as they help guide me to supply immunisations, immunotherapy and wound care. Support is also there in that I can make a referral to the community nursing team for more complex wounds.”

His work is a world away from his life on the road and in the air.

“Previously when I was working on an ambulance or helicopter, I’d drop people at the ED and I’d be gone, and that was that, whereas now I'm on this journey with our patients, and it's really cool to see those kids I’ve treated who have responded well. It's that whole continuity of care; it's exciting and a lot of fun to be a part of a community.”

There are currently more than 3,000 patients on the clinic’s books, presenting with a range of conditions, from chest and ear infections and minor wounds to chest pains and acute health issues. Having a multidisciplinary healthcare team enables patients to be treated in the community who could otherwise end up in hospital.

“We're able to see patients and discharge them. We've dramatically cut down the appointment wait-time for our community and we can see a lot of things on the same day.

“Sue has lots of plans going forward with regards to how I can support both the clinic and the community.”

For now, Stuart continues to add value to Rakaia Medical Centre and is excited to become more involved in chronic disease management and in supporting the team.

“I absolutely love it, and I love the challenge of learning new skillsets. I'm glad it's taken me 10 years to get to be where I am. Any paramedic who is interested in primary healthcare should explore all options that are available.”