Keryn Densem 31, is fundraising for a hysterectomy after being rejected twice for an assessment in the public system.

New Zealand has a world-class public health system, but for some people accessing care can be a long, painful journey. OLIVER LEWIS reports.

Keryn Densem wants a hysterectomy – but she's having to fundraise to get it.

The 31-year-old, who has lived with painful gynaecological issues since she was 16, was referred twice to the Canterbury District Health Board (CDHB) for an assessment this year. She wanted to discuss the hormone therapy drugs she had been taking for the past seven years and what her options were, but was declined both times.

"I felt absolutely hopeless," Densem says. "I was at the point where I was so depressed about it that I just didn't know what I was going to do."

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When the Christchurch woman managed to see a private gynaecologist in December, he gave a frank assessment: "There is little point in my writing to Christchurch Women's Hospital at the moment as the door is firmly shut on all new referrals."

STACY SQUIRES/STUFF Christchurch woman Keryn Densem was referred to CDHB gynaecology services for an assessment twice in 2019 but was declined both times.

Each year, thousands of New Zealanders try and fail to access hospital-level care. Their GPs refer them for specialist assessments, and for whatever reason – they don't meet the threshold, or maybe the service they need is swamped by demand – they get rejected. What that means is they wait, often for a long time, and often in pain.

Densem has been taking hormone therapy drugs to medically induce menopause for the last seven years. When she was 16, a scan revealed a large cyst on her left ovary. She had it surgically removed, and was later diagnosed with polycystic ovary syndrome. Densem experienced heavy bleeding to the point where she required a blood transfusion when she was 21. She also had to have regular iron injections.

In 2012, she was also diagnosed with adenomyosis, a condition where the tissue that normally lines the uterus grows into the muscle wall. Densem didn't hesitate to try hormone therapy.

"I was just desperate to have the bleeding stop and to not have to keep having iron and blood tests and all sorts."

When her treatment was reviewed in 2017, Densem expressed a desire to have a hysterectomy, but was told it was not appropriate. She was still in pain, and was referred to Burwood Hospital's pain clinic.

This year, again experiencing symptoms, Densem was referred for a gynaecology outpatient assessment twice. The first referral took place after she was admitted to hospital experiencing pain and nausea, which Densem says doctors attributed to a suspected burst cyst. It was declined. A GP at her practice tried again. This was also declined.

ALDEN WILLIAMS/STUFF When Keryn Densem managed to see a private gynaecologist in December, he said there was little point referring her to Christchurch Women's Hospital.

Densem says she had wanted to talk to an expert about the hormone therapy drugs, and what options she had. They had killed her libido, she says, making it hard to have a relationship. She was also still experiencing pain, which the private specialist later told her could be a result of undiagnosed endometriosis.

In reply to a letter from Densem, the clinical director of gynaecology at the CDHB said the service was only able to see a limited number of patients, mainly those referred with concerns regarding cancer risk and other acute events. A gynaecologist could provide advice to the GP Densem was seeing, the letter said.

After the rejections, Densem managed to secure funds for a private assessment. On a benefit and unable to afford to go private, she says the advice she received – that a hysterectomy was a good option for her – has given her renewed hope she can have a better quality of life, but to get the procedure she has had to resort to fundraising. Densem was told it would be about $20,000.

"If there's no uterus then there's no pain," she says.

"It's a lot of money to get together, and I'm relying on a lot of people to be generous, and I find that very, very hard and very uncomfortable."

STACY SQUIRES/STUFF Diane Clyma's right hip has "completely collapsed", causing debilitating pain and compromising her quality of life. (Video first published December, 2019)

In its annual review, the CDHB revealed it received 4179 referrals for a first specialist assessment in gynaecology in 2018-19. Of these, 453 were declined because there was no capacity. One GP told Stuff they no longer bothered making referrals to the department unless a patient was particularly acute.

CDHB chief executive David Meates said the health board completed an average of 172 acute and elective gynaecological procedures per month in 2018-19. Several factors had affected planned care, including reprioritising operating theatres for acute demand – responding to the March 15 attack, for instance – flooding of the new outpatients building and operating in constrained facilities.

Meates said vacancies in the gynaecology department had now been filled. "As a result wait times have improved recently, although we still have a small number of patients who have been waiting up to six months. However, this is due to their personal circumstances."

Densem believes there needs to be more support available to women through the public system.

"I hate to feel there's so many women out there feeling so alone, and stuck and lost with this."

WAITING IN PAIN, BY THE NUMBERS

- About 1 in 10 referrals for first specialist assessments are declined.

- DHBs carried out about 200,000 elective surgeries in 2018-19.

- About 1.4 million people in New Zealand have health insurance.

- 11,305 people had been waiting longer than four months for a first specialist assessment, September reporting shows.

- 7312 people had been waiting longer than four months for treatment, September reporting shows.