Rural healthcare workers and other first responders had always done their best when dealing with medical emergencies in extremely trying circumstances.
Trevor Walker, who died in April of this year, was working as a rural GP in the mid-1990s, when he wondered if rural emergency care could be improved.
Could the severely injured car crash victim have fared better? Could the farmer who nearly died when his tractor rolled have had a better outcome?
Could the woman with the heart attack who lived in the remote cottage have been better served? The list went on.
The underlying question Dr Walker asked was: could first responders be better trained and equipped to work together to provide acute accident and emergency care in time-critical situations, often in challenging environments outside of a general practice or hospital?
The Southern Regional Health Authority was similarly concerned and advertised for someone to investigate the matter.
Taking advantage of a quiet Fiordland practice in winter allowed Dr Walker to accept the three-month health authority contract to answer the question posed.
He toured the length of the South Island meeting as many first responders as possible.
His kind, welcoming and disarming persona, along with his intense diplomatic skills, meant he was the right person for the job.
Dr Walker noted potential issues.
Emergency services often used different protocols and guidelines. Service co-ordination was at times poor. Police, fire and ambulance personnel reported to different control centres. Ambulance services could be fragmented. Patients were not always directed to the most appropriate hospital.
Dr Walker set out to improve the system. He enjoyed this type of challenge, and the potential gains for healthcare were enormous.
After much hard work he designed and set up the now highly regarded pre-hospital care system called Primary Response in Medical Emergencies.
The logophile liked the name and the catchy acronym Prime. Dr Walker simultaneously developed the training programme which was vital if the scheme was to be a success.
The Prime service got under way in the South Island in 1998, and in the North Island two years later.
Primary healthcare practitioners were now effectively co-responding with other first responders when dealing with emergencies in rural and remote areas. Prime became a major success.
It is impossible to overestimate its importance.
It has survived multiple governments — politicians know a good thing when they see one.
No exact figures for the number of lives saved has been published but the Royal New Zealand College of General Practitioners says the training for rural healthcare providers in Prime has saved and will continue to save the lives of many across Aotearoa.
The lives saved can in part be attributed to Dr Walker’s dedication, intellect, leadership and teamwork skills.
Prime was only one example of Dr Walker’s love of and involvement in rural health services.
He was a founding member of the first national rural general practitioner lobby organisation — the NZ Rural General Practice Network. His deep understanding of rural health inequities, and his strong desire to improve services, led him into the fields of rural and general practice education at the University of Otago. Dr Walker also helped develop rural strategies with the health funding organisations.
Born in Hull, Yorkshire, in 1946 and brought up in the austerity of a post-war society demanding a more just and equitable world, Dr Walker developed a strong notion of wanting to help others and of wanting to pursue public service.
His state grammar school education along with his many additional responsibilities such as head boy and school rugby captain prepared him well for his future medical career and for the many leadership roles that would follow.
A fiercely intelligent young medical student, Dr Walker won a Royal Air Force cadetship which helped finance him through the prestigious Cardiff medical school.
After qualifying, work with the air force exposed him to a vast array of postgraduate medical experiences in many countries including Germany during the most tense moments of the Cold War.
Dr Walker’s continuing sense of adventure led him and his young family to the other side of the world. After completing training in general practice in Invercargill, Dr Walker was lured to Te Anau where he spent a wonderful 20 years caring for his ever-appreciative patients.
Rural general practice is tough, but Dr Walker threw himself into it wholeheartedly, becoming a stalwart of the community. He was involved in many search and rescue missions, often being winched in and out of helicopters.
Again, he wanted to improve things, so he developed a comprehensive local disaster plan.
His energy was not confined to medical issues. He spearheaded fundraising for a new Te Anau library — his beloved childhood library had taught him the importance of such public institutions.
Community awards from the Southland District Council and the Rotary Club among many others were bestowed and accepted with his usual humility. The softly spoken Yorkshireman was never one for "getting above himself".
Dunedin was his next port of call where he began an ongoing and changing portfolio of work.
Dr Walker spent a brief spell as an adviser to the Southern Regional Health Authority where he again championed rural health. This was followed by a position at the University of Otago where the now legend of rural medicine was warmly welcomed into the Department of General Practice.
Dr Walker was able to further dedicate himself to improving rural health. He was instrumental in organising rural placements for medical students, many returning with a glowing appreciation for rural primary health and many eventually deciding to work rurally. His enthusiasm for his passion truly rubbed off on the students.
Dr Walker also set up simulated general practice clinics where an actor would be given the role of a patient and be interviewed by a medical student. The idea was not new but Dr Walker, always the logician, set up systems to evaluate how safe and effective the students were.
Patients were asked to assess the student’s performance. These Safe and Effective Outcome or SECO clinics were perennial favourites for students as were the visits Dr Walker organised to the local fire station to see how crews dealt with motor vehicle accidents.
While in Dunedin, Dr Walker continued to work as a part-time GP, most notably over a 14-year period at the Otago Polytechnic Student Health Service, where again he set out to improve processes and systems. Staff recall him as a kind, compassionate and wonderful gentleman.
Dr Walker also worked with the Best Practice Advocacy Centre in Dunedin where his communications skills came to the fore. His educational articles aimed at GPs were clear and concise and set a new standard in medical education and communication. Peers were eager to learn from him.
Dr Walker spent time as a medical adviser for the Accident Compensation Corporation where his extensive medical knowledge was much appreciated. Members of staff were impressed by his modesty and again could be heard saying, "What a gentleman".
After 17 wonderful years living in the Dunedin suburb of Port Chalmers, and following the death of his beloved wife Jo, retirement found Dr Walker moving up the coast to Karitane where new interests and hobbies were found.
A keen crossword solver, he started to compile cryptic crosswords, which was an ideal pursuit for his intellect, guile, humour and love of wordplay. He would beaver away for hours and hours and every fortnight he would submit an intensely clever, but fair, puzzle to New Zealand Doctor.
His inquisitiveness was never-ending. A visit to the local museum introduced him to Dr Crocome, the first European doctor to reside in Otago. Dr Walker’s interest was piqued, and he spent several years researching Dr Crocome’s life from his upbringing in England to his settling in Otago. He turned this research into a work of riveting historical fiction.
Dr Walker’s extensive professional achievements could not have been possible without the love and support of a close family. He enjoyed nothing more than being with his family. They were avid travellers, would explore the rugged outdoors, ski, sail and ride horses. Italy was a family favourite destination and learning the Italian language became a competitive exercise.
Meals were a particularly important time for the family. Updates were given; stories told.
Dr Walker’s strong moral philosophy would filter down to his children.
Later in Port Chalmers, his family would take it in turns on a Friday night to cook the most wonderful meals.
Then there were grandchildren and more latterly great-grandchildren. Dr Walker was so proud of all their achievements and would often be the first port of call for any problems that arose.
Dr Walker will be sorely missed by his family, extended family, partner, and by the many professionals he worked with.
He will be remembered as a man of great intellect, extreme compassion, competence, courage, kindness, humour and modesty who spent his life trying to make things better and trying to help people reach their full potential. — Supplied.
