Mobile Health Has Come a Long Way

dr stuart gowland


Stuart Gowland, who founded the travelling mobile surgical bus 15 years ago, stepped back from his role as managing director of the Mobile Health company last week. He spoke with Gabrielle Stuart


So where did the surgical bus start?

We started working on the idea when I was a surgeon at Christchurch Hospital in the 1990s. At that time a lot of funding issues were going on, similar to what is going on now.

But in the midst of all that a new treatment for kidney stones came out. It worked similar to a loudspeaker, but it could focus sound waves on a stone and shatter it, so it was like no-touch surgery. Before, you would need surgery, then a week in the hospital, then weeks off work after that, but this completely changed that. So we wanted a machine. And we decided the best way to get one was as a mobile machine, so the cost could be shared.

The kidney stone bus has been going for 22 years now, going up and down the country between hospitals.


170817 stuart gowland christchurch star 400So that was one kind of treatment – how did the surgery bus develop?

It was the same principle: If something's expensive, always look at a way of sharing it. But the surgical bus was different, nearly twice as big with a lot more technology, so it was much more difficult to start – we began working on it around 1998, and it was in 2002 we organised the Government partnership.

The brief was to do low-risk elective surgery in rural towns, with about 22 or 23 of them in a circuit. And to train up local nurses to do the work. We bring a driver, a clinical nurse leader and a technician, then there are four from a local hospital, two to work on the bus and two on recovery.

That does two things. It means people in small towns can get surgery and care afterward in their own communities. And it gives medical teams in those towns exposure to procedures they may not otherwise see. A lead clinical nurse in a small community might not experience that kind of work otherwise, but they could be the first to come across a car accident in the community, where that knowledge could help to save a life.


If it took years to get off the ground, that must have been pretty demoralising – what kept you going?

You've got to have good colleagues, the people around me were all quite motivated, and you've got to have a good wife, too. We eventually did it, although it took a while, there is always politics around this kind of thing. I think the politicians finally said yes, we'll do it, because they got sick of hearing from us. Although I have to say the politicians at the time were actually really supportive.

Annette King was in Parliament at that time, and she was fantastic at pushing the bus, so to speak.


Tell me how you first got into medicine?

I don't have a chance, actually, because however many Gowlands ahead of me had done it, both here and in England, so I didn't have a chance, for better or worse.


So were you pushed into it?

I wouldn't say pushed, but I had grown up knowing so much about medicine and so many people involved in it. But I always wanted to leave home and go study in Dunedin, so I was very eager for that.


So what were your student days like? You weren't down on Hyde St?

No, but I was in a flat which was fairly infamous, which they called Toad Hall. Just because it had a willow tree outside it.


So where was your first job?

After I graduated I worked in Wellington, in house surgery, and then in Dunedin in the anatomy department, which generally then was something you had to do if you wanted to work in surgery. After leaving Dunedin I spent a few years working overseas, in Australia and South Africa and London and Los Angeles.


How different were the hospitals over there?

The most amazing thing was to meet names you've read about, very skilled people and often multi-talented, and to see why they got where they are. When I was head of urology at Christchurch my view was don't apply for a job unless you've been in places like Europe, because you have to reset a lot of your values, it makes you reset your thinking.


And you've been working in Christchurch ever since?

Yes, for 20 something years. I was able to keep working while we got the kidney stone bus going, but when the surgery bus got going it was like having a tiger by the tail, to get it going I had to work on it full-time. That's when I retired from the public system.


Do you miss working in the hospitals?

There are things I miss. But the thing that makes a difference when I do is working with incredibly passionate people here. No one is here just to watch the clock.


Has anything gone badly wrong?

Well, the main complaint really has been that people didn't like walking out of the bus to the recovery rooms in their gowns – which is fair because they're open at the back. But what we do is low-risk day surgery, and anything higher-risk is done at a hospital. So we're very careful about the cases we take and, touch wood, it's all gone well for 16 to 17 years so far.


What have you enjoyed the most?

I always thought it was important we kept close to the public, and that's what I've appreciated most: The unabashed enthusiasm from people. The great thing about rural people is that they often have a tremendous sense of humour.