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!