Working in New Zealand: The Doctors Perspective

I decided to come here after three previous trips travelling around this beautiful country and as so often happens in Medicine, recommendation from colleagues. I’d previously spent only three nights in this city before deciding to sign up for a year long post doing a job I had little experience of, but I had a gut feeling that the kiwis would have a decent health system and from my previous experience at Bristol Children’s hospital, I knew that specialist kids hospitals are generally friendly places to work.

The Starship is the only designated Paediatric hospital in New Zealand, and contains the only dedicated Intensive Care unit for Children. As such, it is the referral hospital for the whole of New Zealand and the Pacific Islands. As with most Paediatric specialist centres in the world, the Starship offers a dedicated retrieval service to pick up the sickest children and deliver them to the Paediatric Intensive Care unit and the services available at the hospital which include Cardiac, Transplant and Neurosurgery. It was this part of the job description that attracted me the most. With a passion for aeromedical transport of critically ill patients, I jumped at the chance of being a member of this specialist team in such a scenic part of the world.

Now in to month three, the job has surpassed my expectations. We share a roster system which means that a third of my shifts are designated to being on call for transports. I left the unit ten minutes before my first shift even started to go on my first retrieval, and the relaxed way in which you get told you are required to fly to the other end of the country always amuses me. The farthest I have been so far is Dunedin, a total trip time of 13 hours, which when alone with a sick child for a significant proportion is a long time. But of course you are never alone. The guardian angels of this world class service are the critical care nurses who accompany us. They are all extremely senior and have been looking after sick children both in the air and on the Paediatric Intensive Care Unit (PICU) for years.

This week I did two retrieval evening shifts which start at 4pm on the PICU and after midnight are on-call from home. On Monday afternoon a stationary school bus was hit from behind by a logging truck near Whakatane. I flew down to Rotorua hospital by helicopter to pick up the most seriously injured child who had been sat on the back seat.  Aged 8 she had multiple life threatening injuries and needed neurosurgical intervention and critical care. I got home at 3am, exhausted but satisfied to have provided essential care for a seriously ill child.

Tuesdays shift seemed quiet until 11pm when I was asked to go to Hutt hospital to pick up a 2 year old girl with suspected Haemolytic Uraemic syndrome in need of kidney dialysis and critical care. I initially felt myself groan at the prospect of flying to Wellington overnight when I was about to go home to bed! However, travelling with a terrific nurse and the life flight crew in our own plane when you can joke with the pilots through the headsets, made the trip light-hearted. We arrived at Hutt hospital around 3am only to be told that thick fog had descended on Auckland and we were practically stranded until morning. Fortunately the child was well monitored in a safe place with decent, capable staff around who were happy to help with our predicament and accept joint care of the child overnight. Two hours sleep in a random on call room, a change of nursing and paramedic shift and one powercut later, we finally left Hutt and started the long journey back to Auckland. We arrived back at 11am and exhausted but again satisfied, I handed the little girl and her relieved parents over to the PICU day staff.  

When not out on a retrieval we cover the emergency pager for the hospital and the mobile phone for nationwide calls. We are often asked to respond to emergencies in the resuscitation room, the most notable of mine so far being a two week old baby who was brought in peri-arrest. Initially suspected of having severe sepsis or a significant cardiac defect, the child’s cardiac failure was so bad she was about to die. A heart rate of 280 led me to consider the possibility of supra-ventricular tachycardia (SVT) whilst we got an emergency echocardiogram. After about two hours we managed to stabilise her but she remained critically ill, flicking in and out of SVT for several days. Fortunately she didn’t appear to have a significant congenital abnormality requiring surgical correction unlike so many of our other patients. We accept on average 2 children each day post cardiac surgery. Many of whom have been on cardiac bypass for many hours undergoing the most complex surgery there is. Being responsible for these precious kids post operatively poses many challenges, least of all the infamous cardiac ward round in the morning when you’ve been awake all night! What has impressed me most though is the way the New Zealand health system seems to work. For the first time in a long time I find I go to work to enjoy being a doctor and can concentrate on looking after patients rather than fighting the inadequacies of the NHS. My computer system here, not just works, it exceeds my expectations, I can view all the information I desire about my patient in a few simple clicks and when I ask for an investigation to be done to my patient, it happens before it would have passed the first stage of being processed in England. Add this to a fabulous team, smart attentive Consultants, exceptionally well trained and brilliant nurses who actually love their job, and it creates an atmosphere with a can do attitude that I’ve never had privilege to work in before.

So you’d think I’d have enough on my plate with this PICU job, but I couldn’t resist a second opportunity that came my way one day. I heard on the grapevine that Auckland was about to launch a trial of doctors working with the famous Auckland Rescue Helicopter Trust (ARHT) who have been saving lives in this region for over forty years. Having spent the last three years working voluntarily for the Great Western Air Ambulance in the South West of England, I jumped at the possibility that there might be a place for me on the team. An interview with the Clinical Director of the Adult Emergency department who was “impressed” by my CV, revealed my passion for pre-hospital critical care and a reference was sought from by boss in Bristol. I was delighted to accept the offer of the last place on the team. Even better, the place came with promise of a new personalised red flying suit to add to my collection of blue and orange ones. It also came with the opportunity, which for many years I have dreamed of, to be trained to be winched out of a helicopter to rescue someone.

So a few weeks ago I spent the day training with the crew and was winched out of a BK117 on to Brown island (ironically named as it is beautifully lush and green).                

This week I have my first shift with the Helicopter Emergency Medical Service (HEMS) crew and as the world has come here to play rugby this month......we expect to be busy!

New Zealand club field skiing – same snow, different attitude

After a week’s skiing in the South Island and a long weekend in the North Island we have truly experienced NZ skiing albeit in almost perfect weather conditions. With blissful ignorance we threw ourselves into my first and Kate’s second experience of NZ skiing, by booking ourselves into a weekend at the aptly named Broken River, near Christchurch. You would think that a name like Broken River would raise questions as to how the name came about, but no, a weekend of full board and lodging up a mountain would appear to be a no brainer (awful turn of phrase but sums up the situation well).

Small alarm bells starting ringing when during the booking process you had to confirm that you were happy to undertake a few chores in the chalet “to keep the cost down”. No problem, I live with a doctor and therefore have quickly learnt to do the chores. Well having booked the skiing, Kate and I returned to our respective work places to crow about our forthcoming skiing. Without exception on hearing of our skiing venue the reaction was “it’s not quite like what you would be used to! Expect it to be hard”.

In the week leading up to our skiing, New Zealand experienced its coldest winter blast for 40 years, resulting in snowflakes falling in Auckland causing gridlock, not as a result of snow on the road, but drivers stopping to stare and attempt to catch snow (later classified as grapple a hail snow composition). While Auckland had only half an hour of snow, the South Island was properly hit, with Christchurch airport closed and the place at a standstill.  So when the hire company rang to say they were out of 4 x 4’s and would we mind a normal estate car with chains, the apprehension of tackling a snowy mountain road increased.

After a short lesson on how to put on a snow chain on a standalone tyre at waist height in a warm hire car reception, we set out for our overnight stay at the base of the mountain. After a Sharpie style early morning start (10 o’clock after a cooked breakfast), we drove up the Arthur’s Pass road and into the mountains. At the turnoff for the ski field we found a number of cars whose drivers where grappling with their snow chains. After a lesson in putting them on I backed myself and so challenged Kate to a snow chain race. Now parts of the snow chain are colour coordinated to make matters easier, but still the chains had an uncanny knack of behaving like fishing line and no matter what, ending up in a solid mass of tangled chain. A triumphant cry from Kate saw her complete her side with me still no closer to figuring out how to get this mass of tangled iron around the tyre. With appropriate grace, I accepted her offer of help.

The road up was a stunning winter wonderland with over a foot of snow on either side and no sight of any tarmac or grit. However the little Toyota estate, complete with chains was coping with the hair pin bends and steep climb like a seasoned mountain goat. The same could not be said of the campervan we were following which after much wheel spinning shed its chains and closed the road temporarily before being unceremoniously pulled to one side by a Land Rover.

The approach to the “resort” was via a passenger operated train. Open lift would be a more appropriate description, as I nervously eyed the manual emergency break, wondering if I would have the presence of mind to activate it while plummeting to earth at an ever accelerating speed.

On arrival we dumped our bags at the chalet and headed to the lift office to purchase a ticket. The ticket part was normal, the leather belt, leather glove cover and strange metal device that came with the ticket, was not.  After a ten minute hike we reached the first lift. About ten people were standing around it looking apprehensively at a circular rope that was moving with some speed (later found to be 4m per second).

The method for getting on was to put the leather glove on one hand to protect your ski gloves and hold the metal device, or nutcracker, in the other. To get on you gripped the tow rope until you were up to speed and then flipped he nutcracker (which is just a big version of its namesake) around the rope before letting go with the leathered glove hand. While sounding straightforward enough, the process must be completed before the first pulley some 20 metres away or around 8 seconds away, as you must have released your gloved hand before it gets mashed by the steel pulley holding the rope. If successful the metal nutcracker takes the full whack of the pulley and on you proceed to the next pulley and so on. The trick with pulleys is to aim straight for them moving your body out of the way at the last second to avoid pulling the rope off the pulley and making it more difficult for the following skier.

Those lucky enough to get to the top in one piece, release the nutcracker and ski off to an almost empty ski field with everyone else either at the bottom vainly trying to get on, or half way down either having given up the struggle to hold on or having been taken out by a pulley or another skier falling ahead of them.

Once the tow rope is mastered through a combination of cool head and good technique, Broken River was an awesome ski venue, with two vast ski anywhere bowls that returned you via a traverse to the bottom of the lift system. The views of endless mountains provided a stunning backdrop to good quality almost back country powder skiing.

Club skiing is highly recommended for those who like their skiing a little less regulated and who are prepared to work a little harder to get to it! It does though help to be fit and have a good harness!

What better to do on a single day off work than to get muddy? Very muddy!!!

I just love this sort of adventure....no discussions....so need to plan, Nick had my day off all arranged. We headed west out of Auckland passing the small hospital that I had been to in an ambulance on my first paediatric retrieval. Out past Whitakere are the rolling hills of the Whitakere Ranges Regional Park. Only forty minutes out of Auckland you find yourself in a rural heaven with steep green hillsides and deep valleys. The road becomes a gravel track and finally after some expert navigation we end up at the driveway to a posh house....the end of the road! A surprised young lady directs us back about 800m and we find the start of the DOC walk.

Nick had researched the DOC website for a local tramp and had decided on Golden Springs. We park our car next to the DOC van (obviously no other tourists around!) and headed down the well marked track to the waterfall. On the way we met a couple of DOC workers digging the path and enquired about our proposed route.

“Well......” said the Kiwi foreman eyeing up Nick’s gaiters, “two fit young trampers with the right gear and experience should be able to make it......but expect to get wet.” We agreed the river would be a little higher than usual with the recent heavy rain, but I have to say I was somewhat surprised on his indication that we should expect to get wet up to our waists in the fast flowing river! “Mmm should we be even attempt this?” I thought..... “Let’s just try the first bit...” Nick started hesitantly.

So although our first official NZ tramp, we passed the sign that stated in large capital letters that it was for “EXPERIENCED TRAMPERS ONLY” and headed downstream. The decision to continue was actually helped by the fact that my boots became waterlogged at the first crossing. “Well my feet can’t get any wetter!” I laughed.

The walk was awesome, crossing the river thirteen times in total. Dangerous enough to make your heart beat a bit faster but not to turn back. As you lifted one foot, the other had to take the strain to prevent you being knocked off balance. Every footstep required concentration often with your feet turned upstream to face the fast flowing water. About half way down was a rock scramble which in summer would be great to fall off in to the deep pool below, but in winter already wet up to my thighs I was clinging on tight. Fortunately the rock was surprisingly grippy sandstone which was a delight to traverse!

The final crossing was the fastest flowing, widest and deepest. Not for the first time I stayed tentatively on the bank whilst Nick sought a way across. This time he spent ages in the middle of the river trying to establish a safe route across. Eventually he came back and declared that the route he was attempting was too dangerous. The orange triangle way markers clearly signalled this was the expected route but the river was just too fast flowing. Together we decided to divert slightly upstream and then navigate the dense bush on the opposite river bank to rejoin the designated path. Joyous by our success we climbed the final bank up to the swing bridge which joined the easy but very muddy route back to the car.

A lesson learned.....always take spare dry clothes (including underwear) tramping.... but a reminder that being wet and muddy is so much fun!!  And so we headed home and picked up my new mountain bike (a bargain $220 on Trademe) on the way so that the next muddy adventure can be on two wheels......

Getting set in New Zealand

On the whole setting up life in New Zealand was easier than expected and easier than the UK. Banks believe that you are who you say you are and everything else is available on Trademe, NZ’s equivalent of Ebay and Gumtree rolled into one.

Most of our admin was completed in one morning. A 9.30 visit to the local official to confirm Kate’s qualifications (involving another fee) meant that Kate could practise medicine in NZ. Next stop the hospital to get a pass, register for computer access and set up payroll. This was quickly followed by a trip to ANZ bank who gave us a bank account and complementary SIM mobile phone card. The hospital had advised Kate that she needed a tax number and so if was off to the AA (yes as in the Automobile Association) who for $10 organised Kate a tax number and converted her UK AA membership to a NZ one. This was a classic example of Kiwi efficiency that is lacking in the UK, as this process would have taken days with our beloved HMRC.

All of the above was fairly simple. What was not simple was navigating around Auckland in a 6.5m campervan using only a Lonely Planet New Zealand Guide book. Luckily the van was white, and as in the UK the locals respected that white vans do not always behave as you would expect! Still while driving around the city I was very glad for the fully comprehensive van insurance we had taken out. The only other matter was the Sharpe – Woodmansey relationship that came under some strain, but on the whole survived intact, though Kate’s occasional “whoops can you just turn around”, were occasionally met with a steely look from Nick with a face that says “do you know how big a road you need to do a three point turn in one of these”.

With the admin done it was time to head out of the city north to the aptly named Northland.

Arrival

On arrival on New Zealand soil the first stop of all budding immigrants is the duty free store, the last chance to top up on reputedly cheaper booze. There were many signs comparing the cost of the duty free goods to a shop that we have yet to see in New Zealand, so obviously the boutique store of the Auckland Hilton!

After stocking up on London’s finest gin, Tanqueray, it was on to endless queues of passport control. Our choice of queue left something to be desired as the Japanese tourists’ tour leader went AWOL which lead to a total breakdown of communication between tourist and increasingly grumpy border officer, though most start pretty grumpy, so when a UK passport arrived brandished by an English speaker, it got barely a second glance.

The same could not be said of Biosecuity. The officer took one look at us, our huge baggage and decided that we were trouble. After scrutinising my walking boots, which we were wearing to reduce weight, he decided that I had too much mud on the soles. After entreaties that we had attempted to clean them, he relented and agreed that the few specks of dried mud between the tread was not a significant risk to the future of the Kauri trees.

The next stage was off to the Apollo hire depot and the myriad of forms that enable one to drive a £40,000 campervan.

Planning

Much to organise, much to do, VISA's to complete, bank accounts to open and decisions to be made on what to take and what to leave.

The hardships of moving abroad!