Canterbury Charity Hospital Trust runs a day hospital that treats some of the many secondary elective patients who can’t access numerous types of secondary elective care at public hospitals in our region and who can’t afford private care. It’s run by a large number of volunteers and a skeleton staff, and is totally funded by charitable giving.(1) Because of serious under-resourcing of endoscopy services in Aotearoa New Zealand, and growing concern with high incidence of colorectal cancer (CRC) in our young population, the local District Hospital Board asked us to take over investigation of adults under 50 years of age, with monosymptomatic fresh rectal bleeding, which we’ve done by initial flexible sigmoidoscopy (FS). Between 2017 and end of 2023, we saw 1,389 patients and found: 1.1% had CRCs, 27.4% had colorectal polyps and 4.9% had high risk lesions. There were no international guidelines on which patients should have completion colonoscopy, based on FS findings, so we’ve published some,(2) and evaluated them.(3) With the Dept Engineering, Canterbury University we’ve evaluated different heart rate variability metrics for assessment of patient stress levels and vasovagal reactions during unsedated FS,(4) and completed an RCT on effects of an information video and patient-controlled Entonox inhalation on patient stress levels and clinical efficacy of FS.(5) 1. NZ Med J. 2022 Apr 1;135(1552):37-48. 2. Gut 2021 Feb;70(2):441-2. doi:10.1136/gutjnl-2020-321655. 3. Dis Colon Rectum. 2024 Jan 1;67:160-7. doi: 10.1097/DCR.0000000000002947. 4. Proc. ASME 2023 IDETC-CIE/MESA. Boston, USA. doi.org/10.1115/DETC2023-114621. 5. J Gastroenterol Hepatol 2023 Dec 6. doi:10:1111/jgh.164.