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Quality of housing and overcrowding are seen to be a significant determinant of health for the residents of Ohakune despite new housing standards. Housing, employment, and income pressures are viewed as detrimental to the community’s mental health.

“You don’t tell on the landlords (when there is a problem with the house), because then you lose the house. But there is a lot of damp houses. So you see the respiratory (diseases) in the kids. It’s pretty damp here. A bit of infectious disease with overcrowding but nothing ridiculous. But the more families you have crowded into an area the quicker it spreads. And it’s the same with the mountain, they’ll just get a wave of people who get sick.”

The participants strongly felt that there was a lack of access to children’s mental health services. It was strongly felt that mental health issues within the community were exacerbated by their isolation.

“Mental health is a big factor. Your mental state. They see it at school. And here you’re isolated from services, from counsellors. It’s really hard. It’s a big factor. It comes into everything. It can be a cycle, if your mental health is not good your physical health goes down the drain, and you can see it and it all comes in with income as well, and employment, housing. And the travelling to access help is a huge barrier.

“In the schools there are services but they don’t see them often enough. It’s just not frequent enough. There is a nurse one day a week but by the time they get up here that one day is just three hours. Her job description is not mental health, but it’s more (physical) illnesses. There is an alcohol and drug counsellor who is at school for 2 hours max a week, but if something comes up it’s a fortnight. So the school has employed a counsellor for one day a week because we are just not getting the support up here to help the students and the families. And even if they take them to Whanganui it’s the process of getting them in front of the right people and the families just end up giving up because it’s just too much of a battle”

“You’re isolated from services, from counsellors. It’s really hard…travelling to access help is a huge barrier.”

Service provider boundaries were found to be confusing and frustrating. Some feel they are forced to access their specific DHB services despite other DHB health options being closer. A participant trying to access x-ray services for their daughter, had to wait 5 days for the local service with a broken foot, despite Taumarunui hospital only being an hour away.

“We also fall on the borders of boundaries for different services. For the District Health Board we are with Whanganui, but for Te Oranga Tamariki we are with Taumarunui. For the Truancy Services we are with Marton. So you know, we are dealing with different… it just seems crazy. We are split with Taumarunui. So potentially things could link and join, but you need some people from there, and some people to Whanganui, so you are talking to different groups in different directions. We need one back line, not several.”

There was notable concern regarding access to primary, secondary and emergency health services.

Emergency services, such as ambulance, are perceived as having to expand their scope of practice beyond emergency services to address a lack of access to primary care, particularly outside of business hours.

“Because there’s a gap a lot of more minor things that normally a GP could deal with, antibiotics, a couple of stitches, there’s nowhere for people to go. And not everybody has transport. There is a shortage of GPs.”

“If you rang at 8:30 they have two available spots each day so if you need something urgently you ring at 8:30 and you hope like hell you’ll get one of them otherwise you have to wait. Two weeks. So people just ring the ambulance.”

In terms of emergency transfer participants felt there was good coverage by helicopters due to the fortunate location of Ohakune on the cusp of three helicopter coverage areas.

“Another thing that’s important here is definitely a chopper. We have to have access to a chopper… we do get serviced pretty well. They seem to be good. St Johns is good. It’s only the doctors there’s a problem with.”

Travel to Whanganui to access secondary services is seen as arduous, impersonal and a financial barrier for many. Participants noted that Ohakune residents delay seeking health care due to accessibility challenges.

“Ohakune has quite a few older members of the community but many are moving to be closer to health services.”

“So since we’ve been here I’ve stopped going to the GP because you have to repeat yourself to all these people and it’s very private personal stuff and you have to repeat it over and over and Occupational Therapists – 18 months was how long he had to wait […] and it was very, very, hard and isolating to come to this town and not have the support here.”

The additional costs of travel and time are seen as barrier to accessing health care as is the process of claiming travel costs, which is complicated especially for those with literacy or comprehension issues.

“I’m a pretty good person at admin, and finding things out and working things out by talking to people and I found it so hard to deal with the hospital staff and ACC that I never put that claim in. And I was thinking the whole time, what about people who actually can’t afford this? So you have to get it after you’ve done all your hospital visits, you’ve got to go back to the hospital staff and go to different departments. It was so discouraging.”

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