This letter is written to urge you to intervene in this issue and apply rational common sense.
When I came to New Zealand in 1978, I became aware of hostility to the Otago Medical School, and even asked colleagues, many of whom were graduates of that establishment, the reason.
They could not answer apart from "they are too small and too big for their boots".
I became even more aware of this while climbing up the professional ladder, and found this sentiment at College of Physicians and Department of Health meetings.
Cat scanner
In 1980, I was registrar in neurology when the announcement was made that Otago would not receive funding for a Cat scanner, unlike Auckland, Wellington and Christchurch.
There was much alarm and dismay, and Dr Martin Pollock, head of neurology, was of the opinion that this would fatally damage the Medical School.
Urged on by colleagues, he embarked on a programme which raised sufficient funds to buy, maintain, and later improve a scanner. So much for the government of the day.
Dr Tony Hocken, physician, wrote a letter to the British Medical Journal, which is as appropriate today as it was in 1980.
He gave an elegant exposition of the issue, under the headings "Rivalry for facilities", "Setback to neurosurgery" and "Educational implications".
His final summary lists three issues:"(1) Dunedin is disadvantaged by a small population drainage area of 300,000 maximum.
To attract competent staff to maintain the standard of teaching, a full complement of services and technology needs to be maintained.
"(2) Christchurch is a vitally motivated business and industrial centre driven by ambitious local personalities, which drains a specialist area of 500,000.
"In Christchurch, there is a clinical medical school of the University of Otago, which only recently supplemented the service hospital.
"Is it possible that continuing ambition is to extend that role?"(3) New Zealand is a country of 3 million people whose living is mainly dependent on the cultivation of 60 million sheep. Technologically advanced hardware is not made from sheep There is a limited resource from which number three has to supply numbers one and two.
I wonder how Solomon would have handled this one?"There seems to be little change over 30 years, apart from fewer sheep.
School of Mines
The Otago School of Mines, founded in 1878, was moved to Auckland in 1986, but it did not last and those wanting to study mineral technology must now go to Australia.
Cardiac surgery
In 1997, the Ministry of Health decided to open the long-awaited cardiothoracic unit in Christchurch, and the Canterbury Cardiothoracic Surgery Unit performed its first operation on December 3, 1997.
The campaign to support that scheme was loud and ferocious.
A recent quote: "Ten years ago, South Island patients needing life-saving heart surgery had to travel all the way to Dunedin for treatment."
This was achieved by reducing cardiac volumes in Dunedin and transferring them to Christchurch.
There was some discussion about ceasing cardiac surgery in Dunedin as the reduced volumes threatened clinical viability of the service.
Paediatric oncology
Paediatric oncology services moved to Christchurch in 2000, quite appropriately in this case as one paediatric oncologist was due to retire leaving a sole specialist, which was not clinically safe.
The current neurosurgery issueThe effects on patient safety and disruption of their lives and that of their families have been well made.
Logic demands that the 4:2 model be used with local expertise on-call at all times, and collegiality and quality improvement undertaken by both centres together.
In the absence of an argument for increased quality of service and an overwhelming cost-benefit analysis, if these concerns are ignored, it suggests another agenda.
This is the elephant in the room and needs to be spoken about clearly.
Does Canterbury University, either directly or through its stalking horses, wish to dismantle the Otago Medical School and take over its pre-clinical as well as clinical teaching? Modern quality pre-clinical teaching demands competent clinical teaching.
Does the Ministry of Health wish to reduce Dunedin Hospital (and its services including outreach) to cottage hospital status, being able to provide low level acute services and stabilisation, with more serious cases transferred to Christchurch, and then transferred back for recuperation? This was suggested on introduction of the original population-based funding model when Michael Cooper was chairman of the area health board.
This was firmly rebuffed.
I commend the CEO of Otago-Southland for his decision to employ two neurosurgeons, and urge you to intervene in a timely manner to prevent delay.
Dr Caradoc-Davies is a retired specialist in rehabilitation medicine.
