A clear view of rural healthcare

Treating a man with an advanced cataract that had clouded his eye has given optometry student Cassidy Puttergill first-hand insight into the challenges of rural eye care. 

“He could only detect hand movements with that eye,” says Cassidy, an optometry student at Waipapa Taumata Rau, University of Auckland.

The man had already undergone cataract surgery on his other eye and was facing a lengthy wait for an operation on the second eye, she says.

Cassidy looked after the man while undertaking a six-week placement at a community optometry clinic in Kerikeri as part of Te Takapau Wānanga, the Hokianga-based Rural Health Interprofessional Programme (RHIP). The programme gives students practical experience in rural healthcare while living and working with peers from a range of health disciplines.  

For many Far North residents, Kerikeri and neighbouring Waipapa are the closest centres with optometry services. Patients often travel several hours for appointments, and flooding can isolate communities from healthcare services.

“Hearing first-hand accounts from patients has given me a much deeper appreciation of rural healthcare and the communities it serves,” Cassidy says.

“From the outside, the physical distance between communities can make rural life seem isolated, but these communities are strong and deeply connected to their whenua,” she says. “Their mana, aroha and manaakitanga create strong connections that bring these communities closer together, despite the distance.”

Cassidy encountered that manaakitanga at a local party.

One Saturday night, she headed to a colleague’s farewell but accidentally walked into the wrong house, where she introduced herself to a group of strangers relaxing on the couch.

She struck up a conversation with two women who, like her, were from South Africa.

After swapping stories, Cassidy realised the guest of honour was absent and that she had gatecrashed a stranger’s party.

Her new friends pointed out the right house and said she should return later “if the other party was dead”.

“In rural spaces, you enter as a stranger and quickly become family,” she says.

“The sense of community and manaakitanga is so beautiful, warm and welcoming that there's nothing quite like it.”

Cassidy has found the same camaraderie among the students she lives and learns alongside through the University’s RHIP.

Since 2012, the programme has drawn students from a range of health professions to rural communities such as Rawene and Whakatāne for supervised placements.

Cassidy is flatting in Ōhaeawai with other students.

“They are all like best mates,” says Dr Jaymie Rogers, Rural Optometry Academic Lead at the School of Optometry and Vision Science. “It warms my heart.”

Through New Zealand’s only professional optometry degree, the University of Auckland prepares students to meet eye health needs across the country, including in rural communities.

“Optometrists do much more than prescribe glasses,” Rogers says. “They can detect and manage conditions such as diabetes-related eye disease, glaucoma and cataracts.

“With optometry services concentrated in towns such as Kerikeri, rural clinical placements are essential for building the workforce and helping students understand how eye care fits within wider community health needs.” 

While learning about rural healthcare, Cassidy has continued to refine her approach to patient care.

An ADHD diagnosis two years ago reinforced for her that people process information differently.

“I try to make sure that patients feel comfortable asking questions,” she says. “Sometimes it only takes one extra question to make all the difference.”

She recalls treating a young autistic boy who found the bright, overhead lights overstimulating and approached the examination with trepidation.

But Cassidy earned his trust by slowing the exam, explaining each step, warning him before using bright lights, and asking how she could make it more comfortable for him.

“The kupu Māori for autism, takiwātanga, meaning, “in their own time and space,” beautifully encapsulates the approach I use with neurodivergent patients,” she says.

“Each person is different, and it's important to adapt to the patient in front of you. You need to slow down and listen. I remind my patients we’re a team and they can take a break whenever needed.”

Cassidy and fellow students gather weekly to learn about Māori and rural health, work with local people as well as contribute to community and hospital gardens.

Patients have urged her to return after graduation and asked to be first in line if she opens a mobile clinic, she says.

"This experience has reinforced my desire to work alongside rural communities.

“Northland has a special place in my heart.”