Bringing care to the furthest corners of the world

Otago Medical School alumni Dave Jenkins and Nick Laing have dedicated their careers to improving health outcomes in rural communities and providing access to care in some of the world’s most remote regions.

Nick moved to Northern Uganda 11 years ago, starting work in a church hospital. After raising $10,000 through donations and crowdfunding, he co-founded a network of nurse-led health clinics in rural, hard to reach areas. Today, 53 OneDay Health centres have treated 310,000 patients, and Nick plans to keep expanding the clinics.

On a surfing trip to the Mentawai Islands off the coast of Sumatra, Indonesia in 1999 Dave was shocked by the level of poverty and ill-health in the Islands. With fellow alumnus Andrew Griffiths, he co-founded SurfAid, a non-governmental humanitarian organisation dedicated to bringing medical aid to remote island communities, across the heartland of surfing in Indonesia and Solomon Islands.

Since inception, SurfAid has greatly improved mother and infant mortality and also provided disaster relief, notably after the 2004 and 2010 tsunamis. In the last year, the SurfAid field teams reached 47,680 people through their programmes, established 1211 clean water sources and trained 634 community health volunteers and midwives.

Dave was a finalist in the New Zealander of the Year Awards in 2010 and is currently advising Turanga Health Iwi in Gisborne on ways to help individuals make lifestyle changes to reverse diabetes. He is also researching new strategies to help prevent and reverse cognitive decline.

A surfing trip which led to life-changing healthcare

Q&A with Dave Jenkins (MB ChB 1982)

Firstly, can you tell us about your current roles and what you find most satisfying about your work?

I have a mixed consultancy practice, dedicated to optimising both individuals and community groups’ health, with a focus on metabolic and cognitive health. I am currently advising Turanga Health Iwi in Gisborne on using low-carb lifestyle protocols to reverse prediabetes and diabetes.

I find this some of the most satisfying work, especially when patients can come off medication and experience improved energy and a better prognosis for a longer life. We are exploring ways we can utilise technologies and AI to create a scalable model that holds great promise to help the thousands of patients who need these protocols and are willing to make the lifestyle changes.

Secondly, I have private patients who are suffering mild cognitive impairment and I use new strategies to help them stabilise their cognition and prevent further decline to Alzheimer's dementia. I have travelled to the Buck Institute for Research in Aging in California to study with Professor [Dale] Bredesen on reversing early cognitive decline. With a small group of other practitioners, we have published the reversal of 100 cases of early cognitive decline and Bredesen's Phase 2 trial has some very promising early results.

What motivated you to set up the humanitarian organisation SurfAid, after a surfing trip to Indonesia?

I was motivated by the opportunity to empower loving parents who did not understand why their children were sick and often died. When I analysed the underlying causes, I thought that if we could get very good at facilitating community-wide behaviour changes we could make a very large difference, especially as the key behaviours of hygiene, breastfeeding, a mosquito net, and using the widely available food differently were affordable.

So we set about to learn how to create change and SurfAid is proud of our results. For example, in one project of eight villages an average of 25 children were dying every year, which reduced to five per year after three years of our programme.

How did your career path develop after Otago, to take you to where you are today?

I became a rural GP and then was interested in the large gap in postgraduate opportunities for rural GPs, so was accepted for a job with the Goodfellow Unit facilitating new and improved educational opportunities for rural GPs.

Then in 2000 I took a surfing holiday to the remote Mentawai Islands off Sumatra and found the tragic situation was not being addressed by a struggling health system. And so I started SurfAid to address this and called on the surfers to help as they were the only people visiting the islands. Fortunately they did, as did the New Zealand government who remains our largest donor.

Back to the beginning of your career – why did you decide to study medicine at Otago? Tell us a little about your time there, any highlights, important friendships, influential programmes or lecturers?

I wanted a South Island experience rather than Auckland, and to learn to live without parental support. I loved my time there, both the academic aspect and the outside pursuits. It was in Dunedin I learned to surf and remain passionate about the sport and lifestyle, although the aging body demands more foam to enable wave-catching days.

Some of my favourite memories are hopping on the tramping club bus at 5pm Friday, only to start tramping at 2am in some remote mountain pass in Central Otago, returning late Sunday exhausted but ready for another rigorous week of academic life.

What do you value most about your time at Otago, and what did you take away from your time there that has continued to help or influence you?

I loved being in a University-based city where students were welcome and were always creating a buzz around town. I made many friends and look forward to our next reunion. The introduction to tramping and mountain climbing has been life-changing.

What are your interests outside work?

I love music, both listening and playing, and spending time in the ocean surfing and diving. I hope to travel much more than I have and spend more time with my family who are scattered across the globe.

Building a community network to fill ‘black holes’ in care

Q&A with Nicolas Laing (MB ChB 2009, DCH 2012)

Can you tell us about your current role and any particular focus of your work? What do you enjoy most about it?

One hundred million Sub-Saharan Africans live in healthcare ‘black holes’, remote rural villages far from healthcare. When they get sick they don’t have a local GP, instead they are forced to choose between an expensive journey to a distant health centre, or an agonising wait at home. 

So seven years ago my good friend Emmanuel Ochola and I started OneDay Health in Uganda, a social enterprise which launches basic nurse-led health centres in these healthcare black holes, providing comprehensive primary healthcare for communities of 3,000-5,000 people who previously had poor access.

OneDay Health centres are operated by one nurse out of a two-room rental building, but can treat an impressive array of conditions comparable to a GP clinic in New Zealand. From acute conditions like malaria and pneumonia to chronic illness such as diabetes and hypertension, to family planning and pregnancy care.

We’re proud to have launched 53 OneDay Health centres which have treated 310,000 patients in remote rural areas, including 150,000 patients with the potentially deadly condition of malaria.

I never dreamed that medicine would lead me into public health and management, but I couldn’t be happier with my 11 years of work in Northern Uganda. I love the diversity of work, from hiring and training talented nurses, to writing clinical guidelines and of course working with communities and nurses to launch new health centres! I keep my hand in clinical medicine too, with a couple of mornings at a local clinic.

I can’t help but mention that about three years into us starting OneDay Health, an old friend from med school dropped me a line on Facebook asking if he could help out. He then dropped an insane donation of over $50,000, our biggest yet, which funded much of our first big expansion.

How did your career path develop after Otago, to take you to where you are today?

After finishing med schooI, I managed to knock off my $100,000 student loan in three years (rent was cheap back then), while I worked in Christchurch Hospital and upped my game with Diplomas in Paediatrics (Otago) and Tropical Medicine (London).

The road to specialisation seemed long and tortuous so I wasted no time in following my wife’s and my dream to move to Uganda where I started work in a church hospital, driven by a naive cocktail of passion [and] altruism, with at least a twist of saviour complex. 

In Gulu, Northern Uganda I first worked on a medical ward where I began to realise just how good our Otago education was. Lacking tests and scans, I learned from incredible Ugandan colleagues how to manage patients under challenging circumstances. Despite this, every day on average two people would die, often unexpectedly, which took its toll on all of us.

I was then asked to help manage 10 larger health centres operated by the Anglican Diocese of Northern Uganda. Here I learned the ability of talented and motivated nurses to diagnose and treat patients. As my good friend Emmanuel Ochola and I moved between these larger facilities, we met many people in healthcare ‘black holes’ along the way, who struggled to access healthcare.

After raising our first $10,000 through crowdfunding and generous churches, we launched our first remote health centres and OneDay Health was born.

Back to the beginning – why did you decide to study medicine at Otago? Tell us a little about your time here, any highlights, important friendships, influential programmes or lecturers?

After calculus was way too hard at high school, I couldn’t follow my original plan to become an engineer. I was fortunate to fall into medicine, a wonderful vocation where my natural social inclination and inquisitive mind found a natural home.

I was notoriously late for class but always made it in the end, slipping sheepishly into my seat close to the door. Lecturers like Helen Nicholson showed me that even anatomy could be laced with compassion and joy, while Prof [Peter] Schwartz pulled pathology from unintelligible to almost possible.

I also appreciated the School’s trailblazing pass/fail system, which stopped us from obsessing about grades every step of the way, as competitiveness was largely removed from the class and the pressure cooker lid was lifted just a little. Med school ain’t easy at the best of times.

What do you value most about your time at Otago, and what did you take away from your time here that has continued to help or influence you?

Dunedin and the uni were without pretence. Top academics came alongside and didn’t act like [they were] that. The top students would help average me when I struggled, without a second thought.

One truly influential time was Friday nights in first year, where for a time I stepped away from the obvious Otago activities, and joined a church group which ran a community dinner in South Dunedin. This showed me another side of life and helped me think more deeply about injustice, not only in New Zealand, but also all across our good earth. I also realised there was perhaps more compassion in me than I had thought, which set me up well for the future.

Playing rugby vs Josh Kronfeld in the ‘Medicine vs Physio’ game was also a blast!