Wendy Fraser loved walking: she would do at least one 10km hike every week and had walked the Milford and Routeburn tracks.
But the Dunedin grandmother will not be accompanying her family in a about fortnight when they set out to walk the length of New Zealand along the Te Araroa track. Mrs Fraser died in 2019 after a harrowing 17 hours in Dunedin Hospital following a pulmonary embolism.
‘‘She would have loved to have come along to look after the kids. She just loved the kids to bits,’’ her daughter Tania Henwood said.
‘‘She would have also loved to have had an adventure with me, and I also imagine that she would join me for bits of it and would have been very keen to see how she would play a part.’’
Mrs Fraser was nothing if not intrepid. She once travelled from Balclutha to Piano Flat, where the Henwoods were camping, in the rain, to deliver them a pavlova.
However, Mrs Fraser’s indomitable spirit was doused after a series of missteps, misapprehensions and misunderstandings meant that Dunedin Hospital clinicians opted to wait and see whether her condition might improve, rather than immediately start the thrombolysis treatment that might have saved her.
How her doctors mishandled Mrs Fraser’s case was the subject of a stern report from the Health and Disability Commissioner released earlier this year, and legal action against the former Southern District Health Board concerning how its processes and procedures failed Mrs Fraser is imminent.
The former board offered a full apology to Mrs Fraser’s family and vowed to immediately improve its systems.
Mrs Henwood was at Mrs Fraser’s bedside and it was she who pushed the alarm bell when she noticed that her mother had fallen into her final unconsciousness.
‘‘She had just said ‘it’s not working’, referring to the opiate they had given her, and then her eyes rolled back in her head, her jaw clenched and she arrested.
‘‘Her body just couldn’t fight any longer.’’
As the numbness of grief wore off and recognition of the unfortunate chain of events which led up to Mrs Fraser’s death emerged, Mrs Henwood resolved to find a way for her mother’s death to help others.
The HDC report depicted a cloud of confusion around Mrs Fraser’s bedside, as doctors failed to assess her condition accurately and were unable to clearly pass on vital information to colleagues starting a new shift.
‘‘There were obvious signs that Mum was deteriorating ... and I knew that there [were] missed opportunities there,’’ Mrs Henwood said.
Through the investigation Mrs Henwood discovered Korero Mai, an initiative piloted at Waitemata DHB for a patient, family and whanau-led escalation system for deteriorating patients.
Essentially, doctors and nurses there decided to try putting into their practice the adage that family knows best, and allow a person’s loved ones a role in monitoring their wellbeing.
The Health Quality and Safety Commission assessed the Waitemata DHB and other follow-up pilots, and the HDC ultimately recommended that the SDHB consider its findings and whether implementing Korero Mai could improve patient care.
For Mrs Henwood, Korero Mai offers the chance to clear the fog away from the ward and allow for clear communication and effective care.
When she, husband Jason and their children Briar and Nikita leave from Cape Reinga, they will be spending six months as ambassadors for Korero Mai, stopping at every hospital along their route to give their own, intensely personal perspective on how patient care could be improved.
‘‘It has taken a good couple of years to get to this point, and I was pretty angry initially,’’ Mrs Henwood said.
‘‘But, ultimately, we want something good to come out of all that has happened. I know I’m not going to get my mum back but I would like change to happen because otherwise the fact that we have the health and disability commissioner means nothing.
‘‘This is the bit that I can affect; the rest is up to the hospitals to make those changes.’’
The HDC process could have been a difficult one for Mr Henwood, an anaesthetist for Te Whatu Ora — Southern, but he was wholly in support of an investigation which could have lasting consequences for colleagues.
However, he has found considerable support, and the organisation has helped Mr Henwood so that he can play his part in the Henwood hikoi.
‘‘They have given me the time off, which is absolutely unbelievable,’’ he said.
‘‘On the walk I would like to engage with hospitals and discuss how Korero Mai can function and become part of their culture, and conveniently the Te Araroa trail has a lot of hospitals on it.’’
Mrs Henwood has labelled the family walk the ‘‘Hikoi of Healing’’ and created special ‘‘Bridging the Gap’’T-shirts which depict the bridge which spans the river at Balclutha, her and her mother’s home town.
‘‘In any health system the patient is the vulnerable one and it is up to those less vulnerable to bridge the gap and communicate,’’ Mrs Henwood said.
‘‘I may not have known what was best for my mum but I knew my mum best, and as a health professional you might be the best cardiologist in the world but you don’t know your patient as well as their family does.’’
As well as walking and talking, the Henwoods will also have to teach: Briar and Nikita will be enrolled with the Correspondence School for the duration of the walk, their teachers reasoning that the hikoi will be an unparalleled learning opportunity for them.
‘‘They have their packs and they are quite excited about walking the length of New Zealand,’’ Mrs Henwood said.
‘‘I’m not saying that we’re going to make it, we might not be able to make it to 90 Mile Beach, but we’re going to give it a crack.’’
Now matter how far the Henwood family travel they have already gone on a journey together, and for Mrs Henwood a long walk seemed the best way to personalise what they had experienced.
‘‘After everything that happened I just wanted to get away and walk because there is something cathartic about getting away and walking,’’ Mrs Henwood said.
‘‘From that came this dream and this method by which we can raise awareness, and it is something that we can do as a family to heal together.
‘‘I have been in the health system long enough to know that it takes a long time for things to change, but a part of me thinks if we walk the length of New Zealand and you still don’t engage with families, I can’t do any more to raise awareness than that.’’
