Working and Discussion Paper Series
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Item Understanding the registration experiences of overseas-trained medical doctors in Aotearoa New Zealand : a snapshot(Institute of Development Studies, Massey University, July 2024) Thomas-Maude, JohannaThis working paper provides a snapshot of findings from a doctoral research project that aimed to understand the experiences and outcomes of practising and non-practising overseas-trained medical doctors in Aotearoa New Zealand. This research addresses a knowledge gap by exploring the relationship between the experiences of these international medical graduates (IMGs), professional outcomes, and their designated pathway to registration. An exploratory sequential mixed methods research design was employed, consisting of semi-structured interviews of IMGs (n = 24) and local experts (n = 9), an online questionnaire of IMGs (N = 80), and a document analysis of historical policies, grey literature, and media reports (N = 370). Overall, the research found that IMGs experience differential processes and outcomes when seeking to practise medicine in Aotearoa New Zealand, depending on the country of their medical training and their designated medical licensing pathway. In general, doctors who trained in high-income countries tend to experience smoother pathways to registration. This results in unrealised potential for many IMGs who trained in low- or middle-income countries and are often already residing in Aotearoa New Zealand, with delays in registration exacerbating national medical workforce shortages. Compiling recommendations for change from research participants from diverse backgrounds, the paper argues that change is needed to create more equitable registration processes for IMGs in Aotearoa New Zealand.Item “Nobody should talk about it”: Fijian health system resilience and the COVID-19 pandemic(Institute of Development Studies, Massey University, June 2023) McLennan, Sharon; Movono, Apisalome; Thomas-Maude, Johanna; Siliasau, Isoa; Vosanibola, ApolosiIn April 2021 Fiji made international news with stories of ‘horrific’ health care conditions, including hospital staff and patients without food, hospital operating theatres out of service, and shortages of beds, medicine, equipment, and blood. While Fiji appeared to be relatively well-prepared to respond to COVID-19 and had successfully avoided a major outbreak in 2020, a rapid increase in the number of cases in 2021 quickly overwhelmed the public health system. In this working paper, we draw on the health systems resilience framework of tangible hardware, tangible software, and intangible software to explore the impacts of COVID-19 in Fiji, the underlying causes of the resulting crisis, and the response of the Fijian health sector. We contend that the 2021-22 crisis was no accident, but that over two decades of political instability, multiple smaller crises, chronic under-resourcing, and neglect left the system with limited ability to cope with the pandemic, and potentially insufficient resources to enter a recovery phase post-pandemic. However, this research also highlights the role of intangible resources, including the adaptive practices, collective labour, and sacrifices of health workers drawing on solesolevaki and communal cultural values. We argue these were not only vital to the Fijian pandemic response but may offer a path towards resilience-building in the health system, and for the radical innovation and adaptions necessary to provide a healthy environment and best quality care for Fijians both in ‘normal’ circumstances and in the face of future crises.