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The Kakahi community viewed health problems, such as rheumatic fever and diabetes as commonplace, thought to be due to the likes of uninsulated and overcrowded housing and poor diet. In addition to these physical ailments, participants were concerned with the state of residents mental health and wellbeing. The community has concerns around a lack of access to support services for those living with mental health issues in the community. Participants felt that the lack of early intervention and mental health support is leading some to self-medicate.

“Among children, rheumatic fever and the aftermath, children with heart problems. And those children have to have a really nasty injection every month. There’s a clinic at the hospital if they can get there. Or else the District nurse has to get to their home. And I think a lot of this comes from housing. Poor housing, in uninsulated and cold housing, and overcrowding”

“There used to be a psych nurse in Taumarunui but now that’s closed. If there’s a problem in terms of mental health, you now have to call Hamilton. And now when there is a mental health crisis, some of them are being put into police cells and they shouldn’t. And it’s really sad that the psych nurse that was in the community and knew the community, and it worked. And now it’s gone”

As with other northern Ruapehu townships, accessibility, distance and waiting time, to access both primary and secondary services is a major cause of concern. This is especially challenging for elderly in Kakahi, as patients have been discharged at night, outside of hospital bus hours, with no way to get home.

“And elderly people, they get transferred to Hamilton and they’re discharged with no transport to get back. I was taken by ambulance one night and was told in the middle of night and the middle of winter and it was frosty, and I was discharged in the middle of the night. And I said, ‘But I have no car.’ And she said, ‘Tough’. And I said, ‘For god’s sake!’ and stood up for myself and she came back and said I could stay for the night. But what if it wasn’t someone who could stand up for themselves? And that’s the sort of thing that goes on.

Those with chronic or serious conditions requiring secondary care were particularly disadvantaged by the cost and time of travel to Waikato Hospital, but noted that specialists did sometimes offer services from Taumarunui Hospital. Residents that are aware of assistance via travel schemes are grateful however note that not everyone is made aware of assistance that is available to them.

“At the beginning I had to do a lot of travelling between Kakahi and Hamilton to get all the tests done and see the necessary specialists but that was maybe a year of going backward and forward for all the assessments. But once it’s done it’s done. And I’m currently going through that now with my daughter, having to travel back and forward … because it’s not available here in Taumarunui.”

“One of the best pediatricians in the country has a clinic at Taumarunui. He comes sometimes, he says as much as he’d like to do everything here, I still have to go through to Hamilton. But they help with petrol vouchers, the travel schemes. I didn’t have a clue about all that but I have learnt what to do now.”

Community members are also concerned by the lack of back up for the single Plunket nurse and midwives.

“But the midwives here have very little back up. In terms of New Zealand, the East Cape is worst and we are the second, in terms of lack of back up. If (my friend) was a midwife here she said would find it really scary.”

“There’s only one Plunket nurse these days. And she’s stretched too thin. I saw her only three times. I had to use the Plunket helpline a few times. And they talk constantly about dropping the Plunket service.”

“And the mother will have her baby in the maternity unit and be breastfeeding so they have good rates, but the midwives say because of the lack of follow up they go home and there is drop off. For a lot of women there is really good whanau input but for a lot of women there is not.”

Despite logistical challenges, community members feel stress levels are low. Participants acknowledged that there was great benefit to living in a small tight-knit community in that they kept an eye out for anybody in need. The local shop is also central to community resilience. The shop has been fitted with a defibrillator and trainings are carried out by St Johns.

“That’s a benefit of living in a small community… when something happens, they’re there. It makes you feel… quite safe when I’ve been sick and people in the community have stepped in.”

“The stress levels are good, you don’t feel that pressure and that hustle and bustle. Fresh air.

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