What Is the Reality of the Reality? When the Roads Closed, Relationships Stayed Open

Behind every rural health service is a story worth telling.

What Is the Reality? is a storytelling series from Hauora Taiwhenua Rural Health Network, sharing the people, partnerships and communities that shape rural healthcare across Aotearoa. Through real experiences, we explore the challenges, innovation and resilience that define rural health.

This month, we visit Kaikōura to discover how an integrated rural health team responded when severe flooding cut their community off from the rest of the country.

What happens when every road into a rural community closes, helicopters can’t fly, and patients still need care?

For Kaikōura Health Te Hā o Te Ora, the answer wasn’t found in emergency plans alone. It was found in years of building relationships, preparing together and knowing that, when disaster strikes, rural communities rely on each other.

As torrential rain cut Kaikōura off from the rest of the country, the healthcare team continued caring for patients, supporting evacuees and adapting services to meet the community’s needs. While the flood made headlines, the real story was what happened behind the scenes – and what it revealed about the reality of rural healthcare.

Angela Blunt, recently retired Health Services Manager at Kaikōura Health Te Hā o Te Ora, says “Relationships are key in an emergency.”

“If you know your fellow responders well, it’s much easier than if you’re trying to start from the beginning.”

It is a lesson that has been reinforced time and again in Kaikōura.

The community has lived through the 2016 earthquake, significant wildfires and now another major flood event. Each emergency has strengthened the partnerships between healthcare, emergency services, local government and community organisations, creating a response built on trust long before it is ever tested.

For Health Services Manager Nienke Itjeshorst, the flood became an unforgettable introduction to both her new role and the realities of delivering integrated rural healthcare.

Having spent 18 years working in local government, including senior leadership roles in emergency management and civil defence, Nienke arrived in Kaikōura with an understanding of how communities prepare for emergencies.

She officially began her role on 8 July – just as the flooding event was unfolding.

“It was definitely the deep end on all counts,” she says.

Yet despite the circumstances, one thing immediately stood out.

“Those networks start working very quickly,” she says. “You’re tapping into council, regional teams and Health New Zealand. Everyone already knows how to work together.”

That coordination wasn’t accidental.

For years, Kaikōura’s first responders have met regularly, trained together and worked through emergency scenarios. Police, Fire and Emergency New Zealand, Hato Hone St John, Health New Zealand, council, Red Cross and other agencies all understand each other’s roles before an emergency occurs.

Even everyday programmes help build those relationships. Through PRIME responses, local doctors and nurses regularly work alongside police and fire crews, creating trust that becomes invaluable when larger emergencies arise.

“People take it for granted,” Angela says. “But they become a community of responders. When something happens, you already know who to call.”

That preparation meant the focus could remain where it belonged – on supporting the community through a coordinated rural health response.

As floodwaters threatened the town centre, the local pharmacy was forced to close. Rather than allowing access to medicines to become another challenge for the community, Kaikōura Health Te Hā o Te Ora was able to provide space within the health centre so medications could continue to be supplied to the community.

For the team, it wasn’t viewed as innovation. It was part of ensuring continuity of care.

“We always ask ourselves, ‘How do we continue delivering healthcare during an event?'” says Nienke. “We have emergency plans, extra medication and supplies, and we plan for how services can continue, even when circumstances change.”

At the same time, the health centre’s wellbeing team worked alongside the Emergency Operations Centre, supporting people who had been evacuated to local welfare centres and ensuring those most vulnerable were identified and cared for.

“We support others, “That’s how it works.”

For both Angela and Nienke (second and third from right, first row), those wellbeing services represent one of the defining features of rural healthcare.

In Kaikōura, where many specialist support services available in larger centres simply don’t exist locally, the health centre has intentionally built a multidisciplinary wellbeing team to meet the community’s broader needs.

“In rural healthcare, you play so many more roles than just being a nurse or a doctor,” Nienke explains.

“We’re the only go-to,””Having those services here isn’t an extra – it’s essential.”

Yet alongside these strengths lies one of rural healthcare’s greatest challenges: isolation.

When roads closed and helicopters were unable to fly because of the weather, clinicians were faced with a reality familiar to many rural practitioners. Patients needing specialist care could not be transferred immediately, despite everyone knowing they required higher levels of care.

“You can prepare for almost everything,” says Nienke. “But sometimes you simply run out of options because transport isn’t available. That’s a real source of stress for our clinicians.”

Angela agrees.

“Our teams are trained for situations like this, but it’s still incredibly stressful when you have patients who need specialist care and you can’t move them because the weather won’t allow helicopters to fly.”

For rural clinicians, distance is more than geography. It can influence every clinical decision, every transfer and every hour spent waiting for weather to improve. It is a pressure that many people living in urban centres rarely have to consider.

Despite those challenges, neither Angela nor Nienke define the flood by what went wrong.

Instead, they talk about what worked.

They talk about responders who already trusted one another.

About staff calmly adapting as circumstances changed.

About wellbeing teams supporting vulnerable residents.

About emergency managers coordinating behind the scenes.

About years of preparation quietly paying off when the community needed it most.

Following the event, agencies came together to review the response. There were lessons, as there always are, including exploring additional four-wheel-drive capability to help transport staff during future events. But overall, the reflection confirmed that the systems, partnerships and planning had stood up under pressure.

For Angela, that reinforces an important point about rural healthcare.

“We often think about rural healthcare in terms of its disadvantages,” she says. “And yes, we have challenges – our isolation, our vulnerability when roads close and not having access to every service a larger hospital has. But we’re also advantaged in many ways.”

“The same sort of response we had here wouldn’t necessarily happen in a large urban centre because people don’t work alongside each other every day like we do.”

As the floodwaters receded and life gradually returns to normal, the event left behind more than damaged roads and disrupted travel. It reaffirmed something those working in rural health already understand.

The reality of rural healthcare isn’t defined solely by distance or isolation. It’s defined by the relationships built over years, the preparedness developed long before an emergency, and the unwavering commitment of people who continue caring for their community – no matter what lies beyond the end of the road.

Know a story worth sharing?

We’re always looking for stories that showcase the people, innovation and realities of rural healthcare across Aotearoa.

If you know an individual, team, service or community with a story to tell, we’d love to hear from you.

Write an email to communications@htrhn.org.nz to get connected with our team.