Most Northlanders have no idea that behind the scenes in the General Surgery Department at Whangārei Hospital, a team of surgeons, registrars and trainee doctors conduct nationally and internationally recognised research helping to improve the health of our people.
At the helm of this research is colorectal and general surgeon Mr Chris Harmston.
Chris trained in general surgery in the West Midlands and undertook a fellowship year at the John Radcliffe Hospital in Oxford. He migrated to New Zealand in 2015 to work at Northland DHB after six years of consultant practice in a large university hospital in the United Kingdom.
After seeing that only small amounts of research and well-designed clinical audits were being performed in Whangārei, he set about building them into the General Surgery Department.
He also helped set up and sits on the expert advisory group for Surgical Trainee Research, Audit and Trials Aotearoa (STRATA). The group's objective is to establish a New Zealand- based collaborative of future surgeons designing and undertaking research, audit and clinical trials.
Under Chris's guidance, the research undertaken in the General Surgery Department sits under three project areas – local, regional (Northland and Auckland) and national.
He uses his experience to help decide what research topics are investigated.
Junior doctors in the Department are encouraged to participate in international collaborative studies. These have included assessing the impact of COVID-19 on outcomes in general surgery and studies into analgesia post colorectal surgery, to which many patients in Whangārei contributed and made an impact internationally.
The Department also hosts Masters Degree candidates for a 12 to 18 months to complete their Research Masters. The students spend half their time working in general surgery and the remainder performing research to deliver their thesis.
Chris encourages candidates to develop research topics they are particularly interested in. For example, the first Research fellow, Dr Brodie Elliot, led a national study on appendicitis and the differences in outcomes between rural and urban populations. The second Fellow, Dr Matthew McGuiness, was interested in chest trauma and led the RiBZ study, which focused on improving outcomes in patients with chest trauma and broken ribs.
Chris said both of their manuscripts were exceptional, and he is confident current Masters student Dr Henry Witcomb-Cahill's study on provision and barriers to patients receiving bariatric surgery in provincial centres will also be.
Last year, the University of Auckland recognised Chris's leadership and research accomplishments by awarding him an associate professorship. He said this had enabled him to forge a stronger relationship with the University and broaden what his team can do here.
His primary goal is to develop a research unit in Whangārei to benefit the community and draw medical staff to the region.
Chris noted that often data that informs guidelines isn't relevant to Northland. Therefore, it's vital to perform local studies to ask questions and get answers to guide quality improvement and improve outcomes for our population.
"For instance, in a colorectal study, we looked at the time on the pathway. We didn't find a difference due to rurality or ethnicity. If we had, we would have been able to provide targeted intervention in that area. However, in the paediatric appendicitis study, we found that rural children did worse and did a qualitative analysis asking why. We are hoping to use the answers from that qualitative analysis to help us do some intervention in that area.
"In the RiBZ study, we found that the rate of pneumonia in patients over 55 was higher than it should be. So, we designed a specific pathway for rib patients in the Hospital to try and improve outcomes.
"Local research allows us to ask a question and target intervention."
The Department also contributed to an international study, OPERA, run by a group called Tasman in Australia with centres worldwide. OPERA looks at opioid prescribing post most surgery, and Whangārei is the third most significant contributor to that study.
Opportunities to be part of studies like this attract a high calibre of people to Whangārei. Chris believes a research facility will draw better candidates across a range of jobs and encourage connections with other academic institutes.
"We've become more lucrative to a group of junior doctors because we offer a research-type environment, which allows us to attract students, registrars, and consultants. We have Pῡkawakawa, our intern programme, and we get medical students here. But I believe we can strengthen our relationship with the University of Auckland because we have a lot to offer."
Currently, all this research is done on a shoestring budget. Chris and his colleagues do a lot of work in their own time, and he said they often self-fund because they find it rewarding and a worthwhile investment, "Every dollar you invest in research, you get it back and then some. So even if you don't get it back from that study, the bubble around that research moves things forward – even giving people the skills to perform research and audit is useful."
He acknowledged Northland DHB for allowing registrars to do the work and allocating him time to provide supervision. He also thanked the Auckland Medical Research Foundation for funding specific projects. However, to develop a recognised Research Unit and body in the Hospital with a structure,
Chris said they need to secure a whole extra level of funding.
He believes the way to do this is to engage our local population to support research projects through benefactors.
"It's an under-tapped and unused resource, and I'd like to work with people to work out how we set up a research fund and engage the local community to get behind this – I think we'd be surprised at how engaged the local community would be with it."
Although research in New Zealand has tended to be concentrated in a small number of institutions, Chris wants to show that a peripheral centre can lead and perform collaborative national studies.
"Whangārei is one of the few regional units with Masters students and the ability to run a proper research programme. I believe we have demonstrated that it's feasible.
"A research unit will bring together the body of people performing research and move us on to the next level. In General Surgery, we are there and have a pretty well-structured programme. Now it's about moving to the next level by bringing other areas, enrolling patients into studies in Whangārei, and celebrating that. I think we're almost there. We just need some investment. Then we can say ‘let's do this’."
"The goals we are trying to achieve in General Surgery are to investigate our local population to provide answers to clinical questions, enable early years researchers, and enrol patients in clinical trials. We are unlikely to conduct laboratory-based research or lead large randomised clinical trials here. But we can get people started on their research and audit pathway and give them the skills and tools they need to move on and perform independent research to continue their research careers, and the word is out that this is the place to come."
The Strategic Projects team are investigating the development of a clinical training centre on the grounds of Whangārei Hospital that would incorporate a research unit, pre-university, undergraduate and post graduate programmes and clinical laboratories for simulation training.