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As in 2020, participants remained concerned that the quality of housing, coupled with the costs to keep low quality housing warm and dry, contributed to health problems:

"A lot of houses are older houses, so they're under insulated and damp and cold. That's the main thing. Cold damp houses. "
"That has changed a bit though."
"There are a few families who are the same families every winter, they're always sick, their Whānau, because their houses are just so cold. And they get the firewood or get grants for wood but because it's old, floorboard, high ceilings, not double glazed, it's just really cold."
"I've got a house like that, but I can keep it warm because I just keep the fire running. I got a grant to get the floor and ceiling insulated. I got it re-roofed. It's kept it warmer."

Mental health problems, especially amongst younger people, were considered to be increasing within he Ohakune community. Amongst the adult population, economy uncertainty, compounded by the uncertainty with the ski fields, was noted as a key contributing factor.

"There’s been an increase in anxiety, in wellbeing. The school now employs a counsellor for two days a week who is very busy."
"Anxiety is massive amongst teens. I don't know whether that's just here or not, whether it's everywhere."
"It's amongst adults too right now, especially with our current situation, it's incredibly stressful. The instability and the resource that many of us live and eat off, being the Maunga. What's happening with it, but also what is happening with the economy in general. It’s a bit concerning that the only stability we see is agricultural pricing. But even that isn't great at the moment. So there needs to be a big focus on mental health in this region. Especially this region."

It was considered that mental health and other health services, were not consistently available. Concerns were held that where services were delivered by organisations who sent staff to Ohakune to deliver services instead of being delivered by local organisations, service delivery to Ohakune was not as good as it should be:

"I would have no idea, zero clue to where to go."
"There's someone at the Health Centre who is happy to talk to your kids but she's not trained, she's like a nice Aunty."
"Trying to work out who is available in this region and who services... it just, it seems to be very ad hoc."
"There used to be a counsellor come to the health centre. I don't know if she still does. It was set days of the week, I think. My observation of entities that are meant to cover our region for health don't necessarily do that. It's about holding them accountable to actually coming to our region. Fully supporting those roles that actually advertise those roles for people to actually live in the region and fulfil those roles. Because I don't think we get very good bang for buck when people are just travelling here for a set period of time."
"You have staff that may need help and I literally have no idea how do I drive them toward the right place?"
"I know of a few people who travel out of town to see therapists because there is nothing here. Or online. Virtual. To Rotorua, even. That's a huge cost especially at the moment."
"There are lines you can call like YouthLine, or LifeLine, and you get a qualified person on."
"One of the plans through the transformation plan was the Ruapehu Wellness Centre that was meant to be getting put into place and being located in Raetihi. Have you heard any updates on that? The whole idea was that there was actually money pegged aside from Whanganui DHB to start that and they started making plans, and the whole idea was that it was going to be what our community wanted and the whole message was that having an actual space where, if you had that person who is a counsellor who came here, that's where they'd meet, in that space. Where you could have a health centre operate from as well. Very holistic."
"I haven’t seen anything like that."

People from Ohakune generally accessed primary care/general practice in Raetihi. Some held concerns regarding waiting times, whereas others expressed satisfactory experiences. Relatedly, some participants felt that the standard of care was decreasing because the system was stretched. Participants described accessing health services through telehealth options:

"That covers the Raetihi, Ohakune, Rangataua, maybe National Park. And it's not a big... sometimes they only have one doctor if you're lucky. Not a regular doctor, often just a locum, and sometimes there's not even a doctor there."
"The last appointment I had there I had to book a month in advance."
"I actually travel to Taihape to go to the doctor, but same again, two weeks in advance."
"And you have to tell the receptionist, kind of, what the issue is and they'll say, "Well I’ll make you a nurses’ appointment." It's quite awkward on the phone to be honest about what you want to talk about. Then they make the decision as to whether you're allowed to see a doctor or not."
"Or if they tell you just to harden up! Ha ha! We all know that person, wonderful! That's one tough Aunty!"
"I haven’t had that!"
"I have to admit yesterday I had an online doctor's appointment, not with our doctor because he, they don't provide that. But, and yes, it cost me more because I stay registered with Ruapehu Health, but it meant I actually had my appointment at the time that I had booked it. I booked it two days out, it took me ten minutes and boom! My prescription is at the pharmacy. For someone that works from home it just, I can't always find time. It worked."
"You can get phone consults, so make an appointment with a doctor and they will ring you. So I’ve had quite a few of those for my kids. Which is fine as long as it's not a .... you know, something that needs looked at."
"I find you almost feel like you’re inconveniencing them by actually being there (at the GP). We understand they're under resourced, we understand that. But you do have to find the pathway in order to get the assistance and then when you get it you almost feel guilty. The argument you'll get is, "Well, there's bigger problems than that." I don't know there are bigger problems than peoples’ mental health. When they can't cope with anything else... "

Low availability was also expressed in regard to some allied health services in Ohakune.

"The other thing is physiotherapy. Because we get lots of workplace injuries, it's a very labour intense region. The physiotherapists flip at the best every six months."
"I was terrified to move down here because I have (Redacted – health condition) and there's no chiropractor, no acupuncturists, no physio. There are all those things in Whanganui but it is an hour and a half. "

In terms of health services for school aged children, it was noted that public health nurses did provide services through Ruapehu College. Dental services were considered accessible and available for primary school children; however participants were uncertain if the same applied for secondary school students, and if, or how, this age group accessed free dental care:

"I don’t know if the college has… I was just thinking the other day that my son hasn’t seen a dental nurse the whole time he’s been at college. And whether that’s my fault or not, I don’t know?"
"I remember when my oldest was to enrol at secondary school for dental, and Ohakune Dentists wouldn't take any college kids. So I had to take them to Whanganui. So we have a whānau trip to the dentist now."
"The college students is a big gap. There's quite a lot of kids there. And it's a totally different scenario in their mouth compared to a four-year-old. There's a big gap between primary school and then going to the local dentist. I’m not saying the dental nurse is not good, but the difference is between your over twelve-year-old’s mouth is that they’re getting problems. If you miss that gap, she’s just going to have a look, but you go to a dentist in town and they’re taking x-rays and everything that you should be, which you don’t get at the dental nurse. There’s good dental here for under tens, and good dentist for adults who have the money but, if you don’t have the money and college kids, they’re not going to go for a check-up…"
"I would be willing to bet that most of the secondary school students would not go out of town to go to the dentist."
"There’s 240 students, if they’re going once a year, how is she going to see them? She doesn’t just cover Ohakune. All the little rural schools, Raetihi. Just covering primary school kids she is overloaded. And teenagers, they’re drinking and vaping. It’s quite scary what it’s going to be like in five or ten years. They’ll have no teeth by the time they’re 24 because they didn’t get the check-ups in college. "

Midwives were considered to be available for residents of Ohakune, although some concerns were held over recruitment and retention of midwives, and the common requirement to travel to Whanganui to birth.

"There used to be three midwives. It’s been a really fluctuating service. People come and go. It just fluctuates."
"There’s a current midwife leaving. They are trying to get, they are getting locum in to cover her. Hopefully they'll get someone permanently."
"People have their baby at home. Raetihi, only if there is a midwife on. And then they end up having to go to Whanganui. If there is no one on then you're not allowed to birth here. You just hold on, cross your legs. There are not enough people here for it."
"Say I have a midwife the whole time, then I have my baby on the weekend and it’s a random stranger. That’s not the plan! Which we all know, the plan doesn’t go to plan."
"Whanganui Birthing Centre is great. Apart from the hour and a quarter, drive, Oh! "

The distance to travel to health services in Whanganui, particularly to access urgent care, was also expressed as a challenge for people living in Ohakune:

"It’s a bit of a worry living here when you’ve got kids, if they break their arm it’s a one and a half our drive over to Whanganui. With no cell phone service. That’s a concern."

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