Sunday, October 30, 2011


 Words cannot describe this beautiful, intoxicating, idyllic South Island justice so I am going to document most of this trip with pictures but I will have to write about some parts as we had some great adventures that we want to share. We headed out of New Plymouth and drove South to Wellington to catch a car Ferry that would take us to the South Island. Going to the South Island has been at the top of our "to do list" so we were super excited about this road trip. 

Interislander is the New Zealand ferry service that crosses the Cook Strait between the North and South Islands of New Zealand. The 92km , 3 hour journey between Wellington and Picton is one of New Zealands Iconic tourist experiences  and one of the most spectacular cruises in the world. The Ferry  reminded me of a small cruise ship. It had restuarants, bars,  private cabins, gift shop, Movie Theatre, and a play ground.

Marlborough Sound

 Our first stop on this journey was Nelson. Nelson is known for it's glistening golden sand beaches, turquoise crystal clear water, alongside alpine meadows and snowy mountain ranges. It is also a a short distance from 3 of New Zealands spectacular national parks and it is the sunniest region in all of NZ. I have heard Nelson compared to a mix of Napa, Santa Barbara and Santa Cruz. There are Vineyards everywhere and Apple and Pear orchards as far as they eye could see. 

Being a family of 5 we have out grown one hotel room, so a great alternative is Book a Bach. These are kiwi vacation homes that can be rented. They range in cheapo to deluxo. I spent hours finding us bach's to rent on this  road trip, but it was well worth it as we stayed in some amazing places that added to the excitement of being in the road. This one was a quirky little bach that we stayed at for 3 nights in a town just west of Nelson called Mapua. It had two bedrooms and a great loft for the little ones. It sat on about 6 acres and the family had sheep, chickens, cats, a trampoline and swings. It was great, nothing fancy but lots of personality and activities for the kids. 

Wharf at Mapua, which reminded us of somewhere on the coast of New England. It had some fun shops, a great brew pub and tons of character.

The Abel Tasman National Park (named after the mid-17th century explorer who was the first European to site New Zealand) crowns the top of the South Island with lush green mountainsides that sprout tree ferns everywhere. It's coastline curves in and out around points and bays, protruding like gnarled knuckles on a fist, and several islands with seal colonies rise up in tree and rock covered humps. It is New Zealand's smallest national Park, and offers picturesque sea kayaking and is known for its World famous Abel Tasman Coastal Track. 

Kaiteriteri which is the closest town to Abel Tasman Park and location of the water taxi pick-up for trips into the park. 

The playgrounds in this country do not disappoint and this one had an awesome flying fox that the kids  played on for hours.

The National Park is only accessable by boat or hiking. We felt that Owen and Skyler were too young for Sea kayaking but not too young for a day hike on the Coastal Track (it takes 3 days to hike the whole Abel Tasman Coast Track). We had the water taxi drop us off at Torrent Bay, which is right in the middle of the Park and we hiked for 6.5 miles along the most stunning trail with breathtaking views of the granite coast and lush gullies of Manuka and fern trees back to our designated pick-up point. It was a long day of hiking for the kids (it took us about 4 hrs.) but they did not complain once. Mother Nature was our entertainment for the day and she put on one hell of a show!! The yummy Sweets that we brought along also came in handy, nothing like a little sugar buzz to help with the last few miles of the hike. 

Water Taxi
Start of our hike
A longest swinging bridge we had ever been on (until later in the trip)

Cleopatra's Pool -a great side hike that we managed to talk the kids into and was worth the extra 30 minutes. 
Owen looking out at our Pick-up spot for the Water Taxi

After our full day of hiking we decided to go and treat ourselves at the Local Microbrewery and try some of their famous tacos. It was Friday night and the locals were out enjoying the lively band that was playing at the Wharf. The place was packed but I somehow managed to get us a table. As we were sitting down there was a gentlemen off to the side that looked like he needed somewhere to sit and eat his tacos. We scored a big table but because the kids were outside collecting crabs Brad and I were only using 2 of the chairs. I asked this gentlemen if he would like to share our table and he quickly sat down and struck up a conversation. He and Brad quickly started talking Rugby and then we started to tell him about our road trip and where we were headed. We told him how much we were enjoying Mapua and that we wanted to stay another night but the bach we were renting was not available and I had yet to book us somewhere else to stay. Well this kind gentlemen, David, owned a B&B and offered us to come and stay with him the following night. He is seperated from his wife and he just sold the B&B, and was moving out the following week. But because he had 3 extra bedrooms that were not being used and we had a family of 5 with no where to sleep he offered his place to us free of charge. So the next morning we drove over to David's B&B, which was called Rosie's Grove to check the place out. HOLY MOLY, was this place awesome. David had 623 olive trees on the property as well as lemon trees, almond trees, and walnut trees. He had a pond with a family of ducks and 2 chickens. At our previous place the kids were not encouraged to pet or hold the animals. Well once Owen saw David's "chooks" (a kiwi term for chickens) his eyes lit up and he asked David if he could hold one. And, David's response was "Only If you can catch one mate, and I will give you a buck." So not 5 minutes later Owen appears with a HUGE smile on his face and a chook under his arm!!  David  then told us about a Cafe that had wild eels that the kids could feed and they served a delicious breakfast. So off we went to find the eels and explore the area of NZ called Golden Bay.
The View from David's Porch.

We found the sign for The Jester House that says "Cafe and Tame Eels."  We crossed a footbridge and got a glimpse of the slithering, sleek things in the stream below-dozens of them intertwined and flopping about. My kids were totally enchanted with these eels and not the least bit grossed out. Lindsey ran to buy a cup of eel food (chopped up raw chicken), and I went to find us a table. The Cafe is set in a garden that looks lifted from a children's story book, with play things such as oversized chessboards and teeter-totters. One table was inlaid with a hand carved Chutes and Ladders game, but it pictured eels instead of chutes. Brad and I have noticed as we travel around NZ that this country caters to kids. The playgrounds are amazing and many of the cafe's have playgrounds or some other activity for children to engage in. I love it that the concept of play structures at resturants has spread beyond McDonald's in New Zealand. I went down to the stream to watch the kids feed the eels. Lindsey and Skyler were luring the eels like snake charmers by using the food on the end of the stick. Sure enough, these fish squirmed out of the water, opening and shutting their mouths in a silent motion. They looked like evil sock puppets dipped in slime.

So after the excitement of the eels we got into the car and headed north to an area of New Zealand called Golden Bay. Golden Bay is nestled into the South's north-west corner. A chain of steep and rugged mountains cuts it's fertile river plains and valleys from the rest of the island. Unless your a migrating whale, you don't go past Golden Bay on your way to anywhere. The lifestyle of Golden Bay has always been "alternative"-a hideout for hippies, musicians, and artists. 

The view on the drive over. Notice the mtns. in the background, it was beautiful!!
I was trying to be artsy fartsy in this photo, and I think it worked!!
The kids loved these "rock" tunnels. 
We did not get to see any penguins in Golden Bay, but they are common in the area. 

The Golden white sand was a nice change from the Black beaches of Taranaki. 

These two pictures are of the Te Waikoropupu Springs (try and say that 10 times as fast as you can). This is the Largest Spring system in the Southern Hemisphere, and the clarity of the water is second only to the Weddell Sea in Antarctica. Brad and I have noticed that the trail system in this country are second to none. We are continually amazed at how well maintained the trails are kept. 
Next we are headed to the Wild West  Coast to explore places like Pancake Rocks, and Buller Gorge and then head over  to Arthur's Pass to Christchurch, and then back up the coast to Kaikoura. 

Friday, October 14, 2011

Taranaki Base Hospital

People have been asking me what is health care like in New Zealand so I will attempt to provide my initial impressions formed over the past three months.  While there are multiple factors that apply to health care, I find New Zealand's system more fair and makes far more sense than what we have in the states.  Here it is more about providing care to people than it is about running a  business and there is not this titanic political battle over how to go about providing it like in the US.

Medical care in New Zealand is provided by a relatively extensive system of public hospitals that treat citizens or permanent residents, including visa holders like ourselves, free of charge.  The care is managed by district health boards which run the hospitals with all of the funding coming from the government.   I work for the Taranaki District Health Board and staff the ED at Taranaki Base Hospital in New Plymouth and occasionally cover shifts at a smaller Satellite hospital in Hawera in south Taranaki.  Around 75% of all health care expenditures here come from the government with the remainder provided by a secondary market of health insurance organizations that fund treatment and operations for their members privately and I believe that they even have their own private hospitals.

When you show up at a hospital due to illness or injury there is no attempt to get your co-pay or your insurance card.  There is no worry that this hospital or doctor will not take your insurance and you will be saddled with an exorbitant bill.  You show up, get treated get admitted or go home and there will never be a bill.

The DHBs also are mandated to focus on the overall health of their communities through Primary Health Organizations which provide a general practitioner (GP) for all New Zealanders.  These are strictly non profit and I believe there are incentives for people to sign up for them.  There is some cost to see the GP but your income status is accounted for and if you are referred to a specialist of any kind there is no payment.  I believe that more effort is spent here on health and prevention of disease than on treatment.  New Zealand spends about 25% of what the US does on health care per capita, Kiwis take the lowest amount of medications of any developed nation, and the life expectancy is 81 years compared to 78 in the US (all figures from the World Health Org website).

Health care expenditure is less here not only because people are healthier but care is provided in a more rational way.  Fear of malpractice and defensive medicine in the US without a doubt increases the amount of expensive and frequently unnecessary testing that we do.  New Zealand is one of the only countries in the world where you are unable to sue someone including doctors and hospitals for personal injury or what they refer to as medical misadventure.  This is all covered under a government entity known as the Accident Compensation Corporation which is the sole provider of insurance for all accidents that occur in NZ to citizens and visitors alike.  It is administered on a no fault basis and coverage is provided regardless of the circumstances,  paying for the costs of treatment, recovery and lost wages.  People who have suffered a personal injury do not have the right to sue except for what is termed as exemplary damages.  If you live alone and are injured the ACC will even provide someone to help with household chores until you are able.  I get the feeling that some abuse the ACC and come seeking time off and services that they don't need but for the most part it seems to be used appropriately.

Back to my point though, without the threat of an attorney waiting outside your hospital for you to show up so they can serve you a malpractice summons, medicine seems to be practiced in a more sensible way.  For instance if I call the radiologist in the middle of the night to do a CT scan of an old drunk who fell down and hit their head and aren't acting quite right, their argument will be "you do not need the  CT scan now because even if there is a head bleed you are not going to be doing anything about it until the morning anyway".  While they would get the scan for sure in the states, and 95% of the time they would be normal, here we watch them until the morning and most likely they will wake up and be fine.  Anyone over 50 in a US ED with abdominal pain most of the times doesn't go home without a CT scan. Here I call a surgical registrar, the equivalent of a resident, and they usually observe the patient and maybe get a CT scan later if warranted.  There is no "pan scanning" (full body CT) trauma patients, only focused studies on where injuries are likely.  I haven't seen many missed injuries yet.  Here I very rarely admit someone having chest pain unless there are signs of ischemia on an EKG or an elevated troponin.   They usually get a second troponin 6 hours later and then I order an out patient stress test will get done the next day and reported to a cardiologist and their GP.

I believe that part of the problem in the states is all of the people making money in health care who have absolutely nothing to do with providing it.  All the millions that go to insurance companies and their handsomely paid executives, all the lawyers and expense of litigation in our system, all the billing people that hospitals and doctors have to hire.  Too many people in the middle preventing the delivery of appropriate and cost effective health care.  The way health care is run here may be sustainable due to a by and large more healthy responsible and much smaller population than in the US.  I wonder though if in the future New Zealand will be forced into a more private model of health care as in the states.  These days it seems as if every country with the exception of China owes a ton of money and many including NZ may be forced to make less financial promises to its people.

Increased efficiency comes with all the public hospitals being able to access patient records no matter where they have been previously.  This saves on repeat workups on chronic conditions that patients present to different hospitals with.

While it is true that in a socialized medicine framework care is rationed to a certain extent and people will have to wait for certain elective procedures but no body will go bankrupt because they became ill or injured.  Those with the means to do it can buy separate insurance so if they need a non emergent procedure like joint replacement, gall bladder removal, or knee arthroscopy they can get it more immediately.

I don't pretend to know what the answers are for health care, but I very much enjoy working in a system where good people without health insurance don't ask me how much a test or hospital admission is going to cost them.  I am realistic and realize though that in the future this system is likely not going to be sustainable.  As in the states there is an aging baby boomer population that is going to put more stress on the economy and it seems as if countries that do provide health coverage for all are in financial uncertainty.  I also get the sense that the legal landscape will change here at some point into one that is more litigation friendly.

As far as the work goes I enjoy the ED at Taranaki.  We serve a district of about 100,000 people and see about 35,000 annually in the ED, about 90-100 a day.  As boarded in emergency medicine I am considered a consultant and there is single coverage consultant level care in the ED 24 hours a day.  There are also several house officers, the equivalent of interns though with better training than typical US interns.  Medical school in NZ is typically 6 years followed by an indeterminate time as a house officer, sometimes for many years before they decide on a specialty track.  They sign on to work in the ED for 6 to 12 month stretches and are quite functional and helpful.  There are registrars (residents) and house officers that cover medicine, surgery, orthopedics, ob-gyn, and pediatrics.  I usually consult the appropriate service early in the patients ED course and they take the patient over if admission is needed.   There is also a crisis team that will come to the ED and manage any psychiatric, or suicidal patients and they don't require a whole slew of medical tests for me to prove to them that the patient is medically stable.   The hospital does have a fairly wide range of services that it provides.  Neurosurgical cases usually get transferred to Wellington, cardiothoracic surgery or interventional cardiology go to Hamilton, and spinal cord injuries to a center in Christchurch.  There is also somewhere where major burns go as well but I don't remember where.
We do have a trauma team but it does not get activated much.  No shootings, most real trauma has to do with logging, farming  or oil and gas industry.  EMS does not board and collar everyone in an MVA, they are actually allowed to use some clinical judgement.

Nursing staff is excellent and hard working.  I work with people from Scotland, England, Ireland, South Africa, Zimbabwe, Canada and the US as well as New Zealand.  The kiwi lifestyle is one that places a high value on time away from work.  I work on average 3 and a half  8 hour shifts per week for my salary but will usually work a few extra shifts here and there.  I also get 6 weeks paid vacation, which seems to be pretty standard, as well as 14 days of paid CME (conference  time) which is nice.  I am able to spend far more time with Jenny and the kids than I ever have before which  I think is great (they may disagree).  We are leaving for a 2 week road trip through the South Island tomorrow which will be the longest vacation I have had since medical school.  People from other countries can't understand why we work so hard in the states and they think it criminal that I didn't previously have paid holidays.

Aloha from Oakura

Jenny ran the New Plymouth half marathon 2 weeks ago.  She had been doing fairly rigorous training runs with a local running club and she finished in 1:58 which was a personal best.  The fact that the entire course is either up or down hill and that it was pouring rain at the beginning make it all the more impressive.  Good on ya Jenny as the Kiwis say.

Sunday, October 2, 2011

Traveling and 1st Day in NZ

Hey Friends and Family!! Well, we finally made to the lands down under. We figured that we traveled for a total of 26 hrs!!! We left Overland Park @ 1:30 pm on Thursday, and arrived in New Plymouth on Sat. morning @ 9 pm. The flight from KC to SF was 4 hrs. and then the flight from SF to Auckland was 12 hrs. and our final flight from Auckland to New Plymouth was 1 hr. The kids did amazingly well considering the time on each plane. We were on a 747 out of SF, the kids first time on double decker airplane, which made for some extra excitement :) Everybody had their own TV screen on the seat in front of them, so we were all able to watch whatever we wanted. It had about movies, games and TV. shows to  to choose from.  I can't say enough nice things about Air New Zealand, the staff was beyond kind and believe it or not the food was decent. I think the best part was the wine they served with dinner and then they walked up and down the isles with the bottles asking who wanted seconds!! We all took our "sleepy pills" and got about 5-6 hrs of sleep. Woke up to a breakfast of fruits and omelets and Mimosa's.
Sweet travel attire Owen