two medical weeks in NZ

Hello, from finally sunny NZ.  Our fourth day of sun in three weeks, we were concerned we had gotten the wrong info about hot dry summer.  "Hot" is relative here, they think 80 is beastly, we love it.  Lots of fascination about our snows, weather and us 

Uniformly friendly and helpful folks, welcoming and eager to socialize as well as find out about each other. Contrary to what I had read, they are not as shy and retiring as expected. By asking "what  does your name mean" or "where is you family from" unlocks ready talk about anything.  Patients are glad to see me, eager for my advice - the care here is almost spartan, genuine shortage of trained GP's, as family docs are called.

Beverly left out details about our 1800's tin roofed  600 sq. ft. cottage which had no screens on arrival, took only one day to have that fixed.  40-50 degrees and rainy our first weekend here, a big wood shed next to us, so fireplace, clear classical radio station and settled in with books.  Landlady has added enough kitchen supplies to make it quite workable, and we were so glad to get off restaurant food after two weeks on the move. Salty, fat, ugh.  Beverley has made this abode quite homey, sofas are horribly uncomfortable, bed and shower are fine.  Lovely grounds, pastures, flowers everywhere.  Organic garden, 200+ dairy cattle.  Our TV has two channels, one good, one fuzzy, and 2-3 others which on some days might give us either picture or sound, or neither or both.  Thank goodness for a clear classical music station.

Sticker shock at the grocery, so just decided we get what we get and deal with it.  Gas price about equal to almost $7/gallon.  There is a heated pool here, wateraerobics Thursday afternoon, joined the library for $9, and found a great massage therapist, who got my back unkinked after several hour journey here from rainy windy Wellington.  I had finished 3 days of intense orientation, including very frustrating 2 hours of computer instruction which didn't serve me well my first week at work. Think I was also kinked up from anxiety of new location, new job, etc, but all is well now.

main clinic has 5 docs, only 3 there now, another temporary "locums" and I are filling in. Standard basic clinic but the best possible co-workers, eager to help and be supportive.  Good nurses, administration and support staff.  Friendly and comfortable, everyone is first name, and patients enter saying "good morning Jay" so I have quit saying "Im' Dr. Buston" now "I'm Jay Buston", after going to reception and calling the patient back to the office/exam, complete in one room with a privacy curtain for the exam table. 

Satellite clinic "in the bush" is 45-minute drive on country roads, well-kept, well-marked, but our Toyota Corolla is not comfortable. I'm only 5+ minutes from the main office, so will be glad to be finished with the bush appointment.  Same population as in town, same problems.  NO support services, can draw and send labs, but no x-ray, usually send acute or severe to hospital in Palmerston North. ambulance and helocopter  transport.  Auto and farm accidents are frequent.

Generally as least one family member, come with the patient, especially the Maori,which represent 15% of the population.  The usual gamut of disorders, blood pressure, diabetes, aches and pains, lots of rashes, bad skin in the country with the highest rate of skin cancer and melanoma in the world, thanks to floating ozone hole coming up from antarctica. Best to look at birthdate rather than the person to assess age, some folks do not weather well, and aged and sun-damaged skin is almost universal in the older.  Many farmers, active and retired. 

Scheduled visits are 15 minute, if you have multiple problems, you must make another visit, as only one or two can be handled. "Bloods" are blood-draws, everything is sent out, except dip urine, glucose and urine pregnancy test.  There is no rapid strep, no hemoglobin, no stool for blood cards. EKG's done in house.

The main clinic is connected to an eight-bed hospital, which has birthing rooms (all deliveries by midwives who do all the pre-natals. No "dirty" admissions: pneumonia, wounds, etc. which could contaminate the birthing area.  Only post-stroke recovery, post-op transfers from the main hospital 45 minutes away, so usually no medical admissions. no surgery, no ER, so in-office suturing and casting.  Plain x-rays and sono on site, physio, periodic visits by podiatry from the city Palmerston North. Mental health/drug abuse services.

Complex or contrast images (IVP's, gi series, scopes) are sent to main hospital, and may take weeks to months to schedule.  We (GP's ) can't order complex (MRI of knee with suspected torn cartilage) but they
must be seen by and ordered by specalists.  Referrals thru the public system take a LONG time, private referrals can be much faster but a lot more out-of-pocket cost.

Approved Meds on the formulary -national authorization - are almost all cheap, 3 months of birth-conrol: $3.  3 months bp meds: $3.  However, non-approved meds (Viagra $15 per pill, azithromycin - SSS, requires prior authorization which is a challenge).

More later, but that's a first look at the medical situation as I have learned it so far.  Have FINALLY gotten less incompetent on the computer.  There are forms for everything, but prescriptions are automatically printed when entered, so that saves a step.  No biggies on the medical records, just learning to navigate them, which comes easier with experience and getting my errors corrected by helpful folk.

We want to hear from you people, please keep us in the loop.