Tangipo Ryder has to travel seven hours each way for a face-to-face consultation with her GP. Photo: Peter de Graaf/RNZ
Kaitāia residents are being forced to drive as far as Auckland - and in one case all the way to Tokoroa - to see a doctor amid the town's acute GP shortage.
Kaitāia's GP clinics stopped enrolling new patients years ago, which means people moving to the top of the Far North have to stay registered in their former home towns - or try their luck registering elsewhere in Northland.
Tangipo Ryder returned home to family land in Hihi, in Doubtless Bay east of Kaitāia, just over a year ago.
She was working full-time but a serious health condition meant she needed to be enrolled with a doctor and have regular check-ups.
"I've made every attempt to get registered with a medical centre and get a GP, and it's been very difficult. It's just not happening. I'm really concerned, because I have health issues that need to be addressed. So I find that very, very difficult."
Northland suffers shortage of GPs
In the meantime she was still enrolled with her doctor in Tokoroa.
He was able to send her prescriptions to a pharmacy in Doubtless Bay, but a face-to-face visit meant a drive of about seven hours each way.
Ryder said she was also concerned for others in the Far North, where hardship and poor health were common.
"I think there's going to be a lot of risk to people's lives. For me, it's been a year, but I know for others, it's been a lot longer."
Unfortunately, Ryder's situation is far from unique.
Thousands without a registered GP
A study carried out for Kaitāia's ANT Trust found about 3500 people did not have a GP, or were registered with a clinic elsewhere in the country.
RNZ has spoken to people living in the Kaitāia area who are enrolled with doctors in Whangārei, Dargaville, Kāeo, Kerikeri, Auckland, and even Westport.
Some residents of Kaitāia, in the Far North, are forced to drive five hours to Auckland to see a doctor. Photo: Peter de Graaf/RNZ
Sally and her husband Peter, who did not want their surname used, were until recently registered at a clinic three hours away - despite Peter's diabetes and a complex, life-threatening health condition.
"We now have a GP in Kaitāia, but only because both of us ended up in hospital and were adopted by different medical practices through the emergency department. Our daughter's moved in with us, but she and her two children are still registered in Dargaville because there isn't anywhere up here," Sally said.
While her husband was now enrolled in town, every six months he had a new GP - always a locum, or short-term doctor, from overseas.
"So there's no continuity of care. It's really difficult."
In Pamapuria, south of Kaitāia, Deirdre Ahu said she was desperate to register her mokopuna, a one-year-old and a newborn.
If they fell ill, all she could do was take them to the hospital's emergency department, or try home remedies.
"That's put a lot of strain on the family. We're having to dash into A&E and sit there for four to six hours, sometimes even being turned away and told to come back the next morning. You just can't get in to see a doctor or anything."
Ahu believed Kaitāia's distance from the main centres meant it was out of sight, out of mind.
"It feels like Kaitāia is just a dot on a map. We don't really matter to anyone. We're up here in the Far North. It's okay. It's pushed away. It's hidden right up the top," she said.
GP shortage not new
The biggest medical practice in the area is Te Hiku Hauora, which has 12,000 registered patients and clinics in Kaitāia and Cooper's Beach.
Medical and dental general manager Cheryl Britton said the GP shortage was not new, and not limited to Northland or even to New Zealand.
Studies published decades ago had warned about the country's ageing health workforce, but little had been done - apart from some initiatives such as a voluntary bonding scheme and increased medical school intake.
Of Te Hiku Hauora's six permanent GPs, three were approaching or over retirement age, she said.
"So this is certainly not a new problem, although everybody thinks it is. We've known about it for a long time. But there haven't really been any active steps to solve it," Britton said.
Te Whare Oranga is a nurse-led clinic aiming to fill a gap amid Kaitāia's primary healthcare crisis. Photo: Peter de Graaf/RNZ
Kaitāia also faced the extra challenges of recruiting staff in a high-needs, rural area, where doctors did not have access to resources or equipment - such as a CT scanner or even five-day-a-week ultrasound scanning - available to their colleagues in the main centres.
Single doctors could be reluctant to move to the Far North because of the isolation, and those with families could struggle with a lack of work for their partners or limited educational opportunities for their children.
"It's that whole wraparound package that needs to be attractive for a person to choose to come here, when they can go anywhere in the world."
Britton said the clinic was often asked to start signing up new patients again.
"People say, 'Why don't you just open your books to everyone?' Sure, any practice can open their books. The issue is the ability to service the patients that you enrol. And I feel it would be unethical to continue to sign patients up when we don't have the clinical capacity to provide even a basic service, let alone really good healthcare that's safe and ensures that we're actively looking after them."
Options other than a doctor
One of the attempts to ease Kaitāia's healthcare crisis has come from the ANT [Aupōuri Ngāti Kahu Te Rarawa] Trust, which has previously focussed on social services.
Chief executive Hone Harawira, a former Te Tai Tokerau MP, said the need became apparent during the Covid pandemic, when people started turning to the trust for testing and vaccinations.
"During that time we found out a lot of our people didn't even have a doctor. We got somebody to do a proper study and they came back with a figure of 3500 people in Muriwhenua alone, that's just in the very Far North, who didn't have a doctor, or their doctor was in Auckland, or Whangārei or Hamilton or Wellington. It was ridiculous. So we decided we wanted to do something about it."
Just six months later, in July 2023, the trust opened Te Whare Oranga, a Māori nurse-led clinic with support from a virtual GP service.
Harawira said the clinic had signed up 1000 of the 3500 people who had been without primary healthcare.
"We have to stop people thinking they have to see a doctor every time they're sick. They just need to get quality medical advice, and they can get that from good nurses and from health assistants, people who can advise them intelligently," he said.
Harawira said it was vital that everyone could access health care, especially in an area at the bottom of the socio-economic ladder.
"People up here don't have a lot of money, they don't have a lot of employment opportunities. We just want to try to make sure that at least they can be healthy and start making healthy the decisions for themselves and their whānau."