Steve's Entry

Greetings from Kiwiland,

Sandi's done a great job of covering our travels and describing our home away from home - so I'm going to focus on the medical side. I work in one of the two small primary care clinics in town. Population: 3k in Waimate, 10k in the area. I work Tu-Fri, on call Th and every 4th weekend. We have one-plus clinic manager and one-plus nurse. The medical staff include: Crispin, a British transplant of 6 years and Nikki, also sheep recently turned dairy farmer, and Hammond, the boss who lives in Christchurch - 2 hours north. All are polite, efficient and very patient with the new doc who cannot speak or understand Kiwi English and still has not figured out all the various ways that ACC (Accident Compensation Corporation) and L&I (Labor and Industries Ins.) are not the same. I actually work more hours than the other 3 docs together. I often without another doc and sometimes without a nurse, so my learning curve has been a bit bumpy.
NZ has a KISS (Keep it Simple, Stupid) HC system and a computer system that operates under the same principle. Primary care documentation is sparse here, so I have made up a drop down menu of phrases to paste together notes. Yes, all of you at Group Health will be delighted to know that I have introduced a little bit of the EPIC computer program into the NZ medical system.
The HC system is sort of an upside down HMO. Specialists have more clout than GPs, but are addressed as Mr, not Dr. Only specialists can order expensive medicines and tests like CT scans. MRIs, nuclear medicine scans and heart caths are only available in the 2 largest cites on the South Island (Christchurch and Dunedin), so it doesn't make much difference that I cannot order them. The nearest x-ray machine is in Timaru, 30 minutes away. That is where the Hospital/ER and the nearest specialists are too. The result is that if someone is sick, needs testing or specialty care in a timely manner, I send them to the ER. Having no clout does simplify the decision making process.
The ambulance system is also nation-wide. We have 2 paramedics and several EMTs in town. Their training is similar to the US, but they are certified for individual skills, so you have to ask to know what you've got. (A paramedic may not have gone through intubation training yet.) There are Practice Nurses (Not Nurse Practitioners) who have training similar to an our ER nurses that take primary care call in some more isolated rural areas. We have one in our practice. The ambulance has limited drugs, but I have a bag full of goodies that would drive a compliance officer to distraction. So when I am on call, I get called occasionally and sometime see someone at the clinic. The ambulance might make 4 runs in a night, but call me to go on one that needs meds. The result is that I average one patient seen per night on call. I have ridden the ambulance with patients to the hospital 3 times in 8 weeks: upper airway obstruction from angioedema, asthma and a fractured femur. Sandi drove me to meet the ambulance on the last, while I located Old Gumtree Rd on the map.
The whole process is helped out a lot by a very friendly, welcoming and health conscious population - sort of a Kiwi Lake Wobegone, where everyone is above average. The ACC system has essentially eliminated lawsuits. Generally, if you do your best, people will accept the results. Public education, home health, nursing home care and therapies are readily available. High tech is harder to come by, but it all seems to work out.

Just to make sure you all are paying attention, I am including a Kiwi vocab quiz. The winner will be awarded a hand crafted gift from NZ after our return to the States in late May. The first to get all correct answers, or the best result by the 1st of April wins!!!
Please define the following Kiwi terms:
Sparky
Panelbeater
Holiday Park
Belty
Farm Bike
Crutching the Daggers
Give Way
Dub-dub-dub
Silver Beet
Pavlova
Swedes
Ambo
Enzid (phonetic)
Jangles
Mossies