Te Mana Hauora O Te Tairawhiti
27 February 2016
Physicians Intesar Malik and Joanna Wojciechowska say coming to Gisborne was their destiny. They talk about why they travelled across the world to build a nest in a small city in New Zealand. (photo: Liam Clayton, Gisborne Herald)
Joanna Wojciechowska and Intesar Malik are feathering their nest. It’s the first time in their lives the couple have had the time, energy and inclination to put down roots anywhere.
It’s ironic that the two physicians, one from Poland and the other from Pakistan, who met in Scotland, have chosen a small town on the other side of the world as their home.
In fact Joanna and Intesar (known as Inte) say Gisborne chose them.
"It was our destiny to come here," says Joanna.
"In Scotland we both worked incredibly long hours doing consultancy, ED work and being on call every other day. There were very few junior doctors there and it was very tiring. We had no free time and no work-life balance."
After seven years of this, they had reached the end of their tether so in February 2014, they decided to look around for other jobs, starting with Australia and then New Zealand.
Their CVs just happened to land on the desk of the clinical director at Hauora Tairāwhiti (Tairāwhiti District Health) at precisely the time the hospital was looking for two specialists with the exact qualifications and experience possessed by Inte and Joanna.
Joanna has a special interest in diabetes and Inte in gerontology and diseases of the elderly.
"We were interviewed by phone at midnight in Poland while on holiday there and a few days later, we received a formal job offer," says Inte.
"We couldn’t believe our good fortune to find the two positions we were looking for in one hospital in New Zealand. We were ecstatic," says Joanna.
Months of red tape followed — gaining New Zealand Medical Council registration and fulfilling immigration requirements — but there were no major obstacles and the process went smoothly.
The pair arrived in Gisborne at the end of November 2014 and started work on December 8, just 10 months after they first began looking at their options.
"It was meant to be," says Joanna beaming.
"We are so comfortable and happy here. It’s the first time I have wanted to establish a nest," she says showing me around their beautiful new home which she is "feathering" with the help of an Auckland interior designer.
During her nine years working in the UK, Joanna’s goal was always to return to Poland.
"So everything around me was temporary and I didn’t ever own anything. I feel at home here . . . and we are even applying for permanent residency.
"We finally have a healthy work-life balance where we are on call one in six days so we can go away for weekends, socialise with friends, go to the Wine Centre and generally enjoy life.
"And we get along very well with our colleagues which is crucial in a small hospital like Gisborne."
Joanna and Inte are part of a "United Nations" contingent at Gisborne Hospital with doctors and specialists from the UK, US, South Africa, France, Sweden and India.
Joanna, a third generation doctor who also holds a PhD in cardiology from Silesia University in Poland, as Inte proudly tells me, is deeply concerned about the prevalence of diabetes in the district, especially among the Maori population.
"We have the highest incidence of Type 2 diabetes in New Zealand," she says showing me Ministry of Health statistics which place the Tairāwhiti region at the top of the table with 8.3 percent of the population affected by the condition.
"Diabetes is associated with hypertension (high blood pressure), high cholesterol, strokes, heart attacks, amputations, blindness, kidney problems and in extreme cases, it can cause death.
"Too many people, including the very young, are dying from diabetes-related illnesses here," she says.
"And yet it’s entirely curable by reducing the level of glucose in the blood through weight loss, a change of diet and exercise and by taking regularly prescribed medications.
"It’s all to do with excess fatty tissue concentrated in the abdomen," she says.
"Some of my patients told me it’s their destiny to have diabetes — their parents and grandparents had the disease so they expect to suffer from it too.
"I had never come across this before. It is frustrating seeing so many overweight youngsters and strokes and heart attacks in very young patients. It shouldn’t be happening here in New Zealand," she says.
It seemed like "mission impossible" so Joanna, who is passionate about diabetes education, visited Tairāwhiti medical centres to discuss how the hospital and GP teams could work more effectively together. Several GP practices have launched their own diabetes improvement services with positive results starting to show. Joanna and the diabetes team have been there to support, educate and advise. Joanna, the specialist nurses and dietitians are available to the practices and are holding clinics at the hospital.
In addition to her weekly diabetes clinics at the hospital, six months ago Joanna and her hospital diabetes team launched an initiative whereby the team, including specialist nurses and dietitians, visit GP practices to upskill staff on best practice management of diabetic patients.
The diabetes team is also visiting shops and dairies on the East Coast, educating owners about diabetes.
"Some shops stock only white bread because no one buys brown bread," the owners say.
"We are encouraging them to provide lean meat, wholegrain, high fibre bread and low-fat options — to save their customers’ lives," Joanna says.
"At my clinics, I show patients a very realistic model of how cholesterol narrows the blood vessels causing insufficient blood supply. That helps people understand."
Inte says the diabetes team’s approach is pioneering and Joanna is pleased to see outstanding results for the people attending the hospital clinics.
Inte’s work focuses on patients who have suffered strokes, Parkinson’s disease, osteoporosis and general medicine relating to ageing.
The Scotland-trained consultant physician originally from Rawalpindi in Pakistan, says the district has many problems in these areas of medicine because treatment has been variable.
"Since I arrived thirteen months ago I have seen all local Parkinson’s patients. This gives people continuity of care and avoids the need for visiting Parkinson’s specialists or trips out of town for patients.”
"The most important thing with Parkinson’s is diagnosis. It’s not hard to diagnose but other conditions do mimic it.
"There is no scientifically proven cause and no known cure but there have been advances in drug treatment and new techniques like deep brain stimulation in main centres like Auckland."
While the incidence of Parkinson’s Disease is generally the same everywhere in the world, the stroke patients he is seeing here are far younger than in the UK due to the high rate of diabetes and high blood pressure.
Inte has approached this in several ways.
"Six months ago we established a new stroke review clinic at the hospital where once a month we see between four to seven patients who have been discharged from hospital after a stroke.
"It’s a wrap-around service where patients are seen by me, a nurse, physiotherapist, occupational therapist and speech-language therapist.
"We address all the problems like assessing blood pressure, taking an ECG to look for irregular heartbeat, conducting blood tests including cholesterol and providing lifestyle advice such as how to give up smoking. This backs up the advice people are receiving from their GP.
"If a person has had one stroke, he or she is more likely to have another within the first year after so the condition must be treated aggressively.
"We look at social, financial and housing problems, and refer patients on to the appropriate services.
"We also do a driving assessment and give advice about when it is safe to start driving again," he says.
"I’m happy with the way it’s going so far and will do an audit at the end of the first year of operation to assess whether we need to increase capacity."
Inte’s third area of consultation, osteoporosis or thinning of the bones, is under-diagnosed here compared with the UK.
"In the next few months we are launching an initiative where I will see patients at a clinic at the hospital, arrange scans and start treatment and therapy with a physio who has a special interest in osteoporosis.
"The scan results will determine whether drugs or injections are the right course of action.
"All patients will attend an exercise programme aimed at strengthening the bones. The exercises will be different for those with osteopenia, early signs of bone weakening, and osteoporosis.
"The exercises are designed to reduce the incidence of fracture of the neck of the femur, or hip joint, which is very common in older people.
"The physio will also work with patients to enhance their balance and strength so the chances of falling and breaking a bone are less."
He says the service will be available to GPs from March this year.
But it’s far from all work and no play for Joanna and Inte these days.
The couple, along with Joanna’s 13-year-old daughter Magdalena who lives with them, have done some touring around the North Island and are planning a South Island trip next.
They have also had time to make presentations to the U3A history group about their respective countries, and even learn a new sport.
"We have never been very sporty types but we are learning to play tennis," says Inte.
Looking back, Joanna says a powerful factor in their decision to come all the way to New Zealand was a job satisfaction survey they came across while in Scotland.
The survey found that emigrant doctors in New Zealand have far higher job satisfaction than their UK-based counterparts . . . and few ever want to return.
"The predominant reason for staying in New Zealand is a preference for the wonderful lifestyle here," she says.
"We are living testament to that."