Northland's mobile ENT clinic hits the road

For MAS Members Dr Richard Douglas and Dr David Waterhouse, providing quality, accessible healthcare to Northland is what drove them to set up the Tarāpunga ENT mobile clinic. Here, they share what inspired their medical mission and the challenges facing remote communities. 

We all know the tarāpunga: That familiar friend, the red-billed seagull, commonly sighted as it flies around our coasts. It’s also the name gifted by kaumatua to a new mobile medical van that will be weaving its way from east to west in Northland, bringing vital healthcare services to people in underserved areas. 

The van is effectively an Ear, Nose and Throat (ENT) clinic on wheels, brought to life by 2 MAS Members. It is a philanthropic initiative generously funded by University of Auckland surgery professor Dr Richard Douglas, and created in collaboration with Whangārei otolaryngologist surgeon Dr David Waterhouse. Thanks to Richard, the van has been fitted out to the highest standard and is able to provide hospital-level care even in the smallest towns. 

David explains how the idea was born. “I was originally Richard’s registrar, so we are friends from way back. In 2022, he gave me a call out of the blue and said he was keen to help the people of Northland. He’s a very altruistic person.” 

Taking inspiration from the past 

Richard’s concept for what could help came with a historical precedent. “This is an update of an old idea from the 1950s,” explains Richard. “It came from Sir Patrick Eisdell Moore, who was a medical officer with the 28th Māori Battalion in World War II. He learnt from his troops that the ear health of their kids was really poor, so after the war he built the first ear caravan. He put it on the back of his Land Rover and drove it to East Cape to check on all the kids. He then sent the children who had glue ear off to get grommets at Green Lane Hospital. He did that for a number of years, and there were various iterations of the idea, but over time it fell into oblivion. 

“A few years ago, I was talking with some doctors about the disparity in accessibility to healthcare, particularly if you live in a small, more isolated community,” Richard continues. “That made me think, why don’t we reestablish what he had done?” And that’s when the call to David was made. 

The healthcare challenges for rural communities 

Being born and raised in Northland, and working as a surgeon in Whangārei, David knows the situation in Te Tai Tokerau well. “Three generations of my family have worked in public healthcare here,” he says. “My grandmother was a nurse at Dargaville Hospital and my mum was a district nurse. I’ve got a huge family here and I’m very invested in this place, but it’s quite hard seeing the recent changes in healthcare. The regions are really struggling. We now have a centralised system that isn’t set up to understand the unique things happening in rural New Zealand.”  

David points to changes in farming, forestry and primary industries that have seen many people lose their jobs and move away from small towns. “As these places start going backwards, it’s much harder to recruit new people into rural hospitals. You can see it with Bay of Islands Hospital and Dargaville Hospital.”  

On top of that, economic factors like the cost of living crisis have taken a severe toll in the Far North. “These issues have disproportionately affected people living a long way away,” says David. “For a patient to come and see me in Whangārei from Kaikohe, for example, is a long trip. If it’s a child, they can’t come down by themselves, so that means a parent has to take the day off work, potentially take their other kids out of school, too, and the petrol to get here might be more than they would earn in a day. The economic factors are huge now and they’ve definitely got worse.”  

Then there’s the health issues themselves. “A lot of ENT conditions are related to deprivation,” David explains. “So there’s really clear evidence that ear disease is related to many different social deprivation factors. We could map where our highest need is, and currently it’s in the areas we’re not servicing that well.”  

Challenges with the healthcare system itself mean patients might also wait a year to be seen. “That’s a long time for these kids and there can be significant harm in delayed treatment, too. Basically, anything we can do to try and improve the service and make the care more timely is really good.”  

How the mobile ENT clinic works 

Enter Tarāpunga. Set up in a Mercedes Sprinter, the same model as most of New Zealand’s ambulances, the van is state of the art. The staff on board see a range of afflictions, from rhinology issues to cancer, ear disease and problems of the throat. “We’ve run over 50 clinics now, with patients aged from under 1, right through to 94. We do everything from routine check-ups to urgent cancer assessments.”  

To ensure the van delivers on its mission, Richard established a charitable trust which owns the van and lends it to Te Whatu Ora. “We didn’t want to run the risk that if it became hard to staff or maintain, it could fall into disuse. Instead we maintain it, insure it (through MAS), fill it with gas and look after the team while they’re in it. That way, it’s not a drain on the resources at all,” explains Richard. The plan now is for the van to be based in an area for 8 weeks, and then move on to the next.  

And the response from the people of Te Tai Tokerau Northland? “So far it’s been very positive from both the staff and the patients,” says David. “We’ll get people walking up just to say how stoked they are to have something like this in the community. There’s such a negative vibe around healthcare at the moment, but this has been a real breath of fresh air.” 

Richard’s hope for the future 

“It took us about 3 years to create this, but now we’ve got a great model and we know exactly how much it costs to the dollar, so if someone else wants to do one, they can. We could have another one on the road easily within 12 months, to serve a different area,” Richard says. “East Cape is another obvious one, but even in cities. Getting into a major hospital in Auckland is difficult and expensive, with paying for parking and taking time off work. Just in the same way that the dental vans go around, we could do this for ENT too.”