Friday night and the end of my fourth week of work here. Just thought I'd jot down a few scenes from the clinic I'd like to remember from the last week or so.
- Two old men chatting in the waiting room together about being in the same hospital when they served in the war. "If Hitler had that Matron on his side, he'd a won the bloomin' war!" one told me as I called him back.
- Patients often returning to the waiting room to finish a conversation with another waiting friend after I'd seen them.
- 92 year old woman telling me about how she lives alone, "I only have the nurse come 3 days a week to check me" and proudly showing me the alarm buzzer on her wrist. "When I fell and broke my hip last year, they came in 15 minutes". Also telling me, "I never expected to live this long, I'm long past due my expiry date!". [expiry date= the date food goes bad on New Zealand labels]
- Two tough old sheep shearers giving me the business as they both lay in the dressing area, one with a deep leg wound that was just getting over a nasty infection (behind the curtain) , the other in front of me with a new cut on his hand.
==My (dumb) question "How dirty was that shearing comb?"
==Patient, "Why doc, it just come out of the sterilizer, don't you know!". Laughing from behind me.
=="Well, we better put you on some antibiotics to prevent infection".
==Patient, "Why doc, it was a clean cut, I'd a sewed it myself if I had me own thread. And I don't like to take pills."
==Me, "Well, I'll give you some anyway". Nurse behind patient shaking head that he won't take them anyway.
==Patient, "Doc, I got some at home from last month, I'll take those". More laughter from behind the curtain.
==Me, "Well, I'd sure hate to see you lose your finger from an infection".
==Patient, holding up hands to show me missing index fingers on each side, "Heck doc, I'd still have 7 good ones left anyway!" Gaffawing from behind other curtain.
- Smiling curly haired two year old with huge eyelashes, hopping up the exam table and pulling his ear back voluntarily for me to look into.
I don't have pictures of these episodes, except in my head. However, I've posted pictures from our last two weeks on a separate page, if you're interested.
We might be off or Queenstown tomorrow. Or not. We'll see. I have my "I" hat on!
An academic Family Doc and his family's adventures on a 6 month working "sabbatical" in New Zealand.
Wednesday, February 11, 2004
Waitangi Day was last Friday, and a long 3 day weekend here. Thursday afternoon, the hot water went out in our house. The electrician came and thought he fixed things, but by the next morning things were ice cold again. Waitangi day is mostly celebrated (or protested) on the North Island. There were no commemorations in Southland that I could find in the newspapers, beyond sales advertisments. There was a lot of discussion on the telly and in the papers comparing the ambivalence Kiwi's have for their national day with the exuberant, blow out celebrations "across the ditch" for Australia Day. This year the big news has been the leader of the National Party here, Don Brash, giving a speech calling for an end to "special treatment" of Maori in government policies, and quite a bit of political debate following that, leading up to a session of name calling on the floor of Parliament at the opening Monday. It's all a bit hard to follow as a non-native, although one of Mr. Brash's arguments, about admitting supposedly "less qualified" Maori applicants preferentially over "pakeha" (European) applicants is reminiscent of the famous Bakke case in the U.S. I have to keep reminding myself that it's a different nation and situation, and that "mapping" my poor understanding of race relations and affirmative action debates from my own country onto events in New Zealand is only going to get me into real trouble. So I mostly just listen and watch the events and try to keep up. The most interesting article was in Sunday's paper. An analysis of healthcare for Maori shows that although they are 15% of the population and consume about 16% of health resouces, overall their health is much poorer than other groups and on average they have 10 years less life expectancy. The article concluded that although porportional resouces are devoted to Maori healthcare, the delivery is not doing the job. More worrisime is the fact that even when NOT in a lower or deprived socioeconomic state, Maori patients still have poorer health and shorter lifespans. What this means for social policy here I haven't a clue, but it is sure interesting, and something for a healthcare worker to ponder on Waitangi day.
We spent the day mostly hanging around Winton. I was tired from the week which had been very busy. I messed around on the computer, and Vicki and I took a nice walk to through the Winton Reserve, a local park at the North end of town which is a nice bush walk, and has beautiful trees and shrubs. We stopped in the grocery store, made dinner and just hung out, as it was a bit rainy off an on. My computer work was for planning Saturday's trip, which was South to the Catlins. This area, the southernmost coast of the South Island is largely forest park, and very sparsely populated. The main attractions are along the seacoast. We consulted our tide tables, and discovered low tide was at 10:10 AM; so we all got up about 0630, had a quick brekkie, and headed off for our first stop, a fossilized forest from 60 million years ago. This was at Curio Bay. The drive there took about 1.5 hours, through beautiful countryside with hills, sheep and bush, finally to 20 km of gravel road. You come over the hill and there is the Southern Ocean, with breakers. All the trees in the area are "one sided" with almost no branches on the Western sides, due to prevailing and howling winds. We parked and walked out onto the beach to look at the fossilized tree stumps and logs. These were covered in mudflows at the time of the dinosaurs, but you can still see the tree rings and the stumps with roots in place in the rock. It really puts the age of the earth in perspective, to stand over these and remember that when they were alive, there were no birds, nor modern mammals. Our next stop, timed for the tide nadir, was Cathedral caves. These sea caves have been hollowed out of the rock by the surf, and they are reached by a hike down a steep hill that takes about 30 minutes, followed by a brisk windy 15 minute walk over the sand. When we got to the bottom of the hill, an old woman was coming up on crutches- amazingly tough, these people! The caves were wonderful, but even more special, were the baby blue penguin chicks up in the furthest recesses of the cave. We could just barely see their white bellies, but we could hear them calling and crying for their mums. We continued down the coast after hiking back up off the beach, and did a short hike to two nice waterfalls, then returned to a high bluff overlooking the sea in time for the sun to break through during our lunchtime. People were stopping and hiking down the bluff to go fishing or paiua harvesting- brave work in very cold, rough seas! We took another walk on a sandy beach for awhile, watching weekend surfers and children scamper out of the cold waves, then headed back to Curio Bay to watch for yellow-eyed penguins. These fellows live in the bush next to the beach all year, and they "come in from the surf at tea-time" in the afternoon. By this time, although intermittantly sunny, the wind was gusting up to 80 km per hour. We climbed up to the "hide" above the beach and stood against the gale for an hour before seeing our first penguin. Eventually, we saw three at the edge of the bush, before calling it a day and heading out. Thoroughly chilled, we stopped at a nice little tea house in Niagara (location of the Catlins famous Niagara Falls, where lamprey eels swarm during mating season). We had hot tea and supper and then headed home to our hot-waterless house. However, once a fire was going in the woodstove, we improvised and heated water on the stove and teakettle, enough for each of us to have a hot bath, before flopping into bed.
Sunday, of course, was a day of rest and recovery. It was raining again, but I marched down and got a Sunday paper and took a short walk around town. It was nice to relax and get ready for this week. I will try to post some pictures of our trip later on this week.
We spent the day mostly hanging around Winton. I was tired from the week which had been very busy. I messed around on the computer, and Vicki and I took a nice walk to through the Winton Reserve, a local park at the North end of town which is a nice bush walk, and has beautiful trees and shrubs. We stopped in the grocery store, made dinner and just hung out, as it was a bit rainy off an on. My computer work was for planning Saturday's trip, which was South to the Catlins. This area, the southernmost coast of the South Island is largely forest park, and very sparsely populated. The main attractions are along the seacoast. We consulted our tide tables, and discovered low tide was at 10:10 AM; so we all got up about 0630, had a quick brekkie, and headed off for our first stop, a fossilized forest from 60 million years ago. This was at Curio Bay. The drive there took about 1.5 hours, through beautiful countryside with hills, sheep and bush, finally to 20 km of gravel road. You come over the hill and there is the Southern Ocean, with breakers. All the trees in the area are "one sided" with almost no branches on the Western sides, due to prevailing and howling winds. We parked and walked out onto the beach to look at the fossilized tree stumps and logs. These were covered in mudflows at the time of the dinosaurs, but you can still see the tree rings and the stumps with roots in place in the rock. It really puts the age of the earth in perspective, to stand over these and remember that when they were alive, there were no birds, nor modern mammals. Our next stop, timed for the tide nadir, was Cathedral caves. These sea caves have been hollowed out of the rock by the surf, and they are reached by a hike down a steep hill that takes about 30 minutes, followed by a brisk windy 15 minute walk over the sand. When we got to the bottom of the hill, an old woman was coming up on crutches- amazingly tough, these people! The caves were wonderful, but even more special, were the baby blue penguin chicks up in the furthest recesses of the cave. We could just barely see their white bellies, but we could hear them calling and crying for their mums. We continued down the coast after hiking back up off the beach, and did a short hike to two nice waterfalls, then returned to a high bluff overlooking the sea in time for the sun to break through during our lunchtime. People were stopping and hiking down the bluff to go fishing or paiua harvesting- brave work in very cold, rough seas! We took another walk on a sandy beach for awhile, watching weekend surfers and children scamper out of the cold waves, then headed back to Curio Bay to watch for yellow-eyed penguins. These fellows live in the bush next to the beach all year, and they "come in from the surf at tea-time" in the afternoon. By this time, although intermittantly sunny, the wind was gusting up to 80 km per hour. We climbed up to the "hide" above the beach and stood against the gale for an hour before seeing our first penguin. Eventually, we saw three at the edge of the bush, before calling it a day and heading out. Thoroughly chilled, we stopped at a nice little tea house in Niagara (location of the Catlins famous Niagara Falls, where lamprey eels swarm during mating season). We had hot tea and supper and then headed home to our hot-waterless house. However, once a fire was going in the woodstove, we improvised and heated water on the stove and teakettle, enough for each of us to have a hot bath, before flopping into bed.
Sunday, of course, was a day of rest and recovery. It was raining again, but I marched down and got a Sunday paper and took a short walk around town. It was nice to relax and get ready for this week. I will try to post some pictures of our trip later on this week.
Sunday, February 08, 2004
A lot has happened since the last blog and I'm just now recovering I think. Its Sunday night here of a long holiday weekend. Last weekend we spent Saturday shopping and looking around Invercargill. Vicki was on a mission to find Crisco shortening, so we checked every store, to no avail. Everyone here has never heard of using vegetable shortening to make pie crusts, etc. They all use lard or butter, which, considering the farming community here, makes a lot of sense. We did our "big shopping" for the next few weeks in a large grocery store there. This is always fun but a bit tiring. For example, the cuts of beef in the case all have different names than we are used to, so it takes some thought. We have decided that the bisquits (cookies) are so delicious and varied, that we are going to start at one end of the aisle and try one of each kind during out time here. There is NO WAY we will be able to reach the end of the aisle without putting on 30 kg! {We did get a real chuckle out of an article in the papers recently about "boozy bickies"!} I also took Vicki shopping for her birthday, and found a beautiful paiua (abalone shell) ring. Liz did most of the shopping, getting things she needed for school, which started in ernest this last week for her. We had lunch in the Japanese restaurant, and came home and just took it easy the rest of the evening. Sunday was a bit of a rainy day, but in the afternoon Vicki and I went out to Forest Hill Reserve, a hilltop covered with native forest about 6 km south of Winton. We walked up into the drippy, wet forest. Out in the fields the wind was howling and the drizzly rain driving sideways, but as soon as you enter the dense "bush" here, the wind stops. The forest is so thick that hardly any rain falls on your head- it mostly drips down the vines and trunks of the trees. The birds were singing loudly. The bellbird is VERY loud and has a beautiful song , but you can never see them, even when you know they are right over your head. At one point Vicki went ahead and I was messing around trying to take a picture of a spiderweb, when over my head about a half-dozen tui came into a large rata tree. They were eating from the flowers and were quite vocal. This is a lovely forest that is rarely visited. There is a track across the top of the hill to another pick up point, and we promised ourselves we would do that some day and have Liz pick us up at the other end.
Monday I was the only doctor in the clinic, so it was well that I'd had a nice outing the day before. I saw 28 folks, only 1 or 2 of them were rechecks, and supervised a half-dozen wound checks. It was a busy day, but the staff did an awesome job of triaging patients, so most the problems were acute. That made things go a lot faster. Tuesday through Friday we other "relieving" doctors helping. These are two women who help out in rural clinics on a contract basis, episodically, as a form of practice. I was very glad to have Liz and Penny helping me after Monday. Many of the patients we see are older and have multiple medical problems and medications. Since they are all new to me, it is a real challenge to get up to speed on their cases and fulfill their needs. I've quickly realized that a lot of return visits are in order, just to have enough contact to get things done bit by bit. Fortunately, the patients expect this and don't seem to mind. Each day here has its own special challenge: an asymptomatic middle aged woman with BP of 230/130, two kids with a rash I thought was bug bites, followed two days later by a playmate with the same rash; a farmer with a black and blue (fractured!) ankle he's walked on for a week, etc. Wednesday I did 3 excisions of suspicious lesions, as well as "liquid nitrogen clinic" at the end of the day. LN Clinic is a walk in session where the nurse and I line up about 8-15 patients who have come in with warts, papillomata, seborrhic keratoses, and actinic keratoses that need to be frozen off. I have to admit the excisions were great fun for me- as a teacher, my residents are always pushing for as many procedures as they can get, so I seldom get to do many of these by myself. There is a simple joy in removing a suspicious lesion, and closing the wound nicely, and having the patient thank you for helping them resolve that worry. The most exciting time of the week was a stat call over lunch hour one day to go next door to the birthing center. A woman had just been delivered by the midwife, and had a huge postpartum hemorrhage. They needed a lot of hands, so I helped by starting the IV. Got it on the 2nd try- I was pretty pleased (and relieved!), since its been about 6-7 years since I last started one. The midwives had already been giving her the appropriate drugs, with good result, so we poured in a lot of fluids and got her stabilized for the ride to Invercargill.
Wednesday night, I attended at the "Urgent Doctor Center" in Invercargill. There is no night or after hours call here; and our patients with problems are directed either to go to the hospital 30 km down the road, or to the Urgent Doctor. This is a small office building downtown which during the day and evening also doubles as a surgeon's private office, and a private ultrasound facility. It is not an ER. It has a crash cart, but no EKG, and minimal oxygen, etc. It is really designed for after hours visits. This time I took the 7-10 pm shift and saw about 8-9 patients. The patients usually call in and are given a time to come. One lady needed a shot of narcotic for her migraine- so the nurse calls 2 buildings down the block to the Police station, and tells them she (the nurse) will be over to pick up the shot- because that's where it's stored. It was a nice, quiet functional facility and I was greatly relieved to see it wasn't a "mini-ER" type of setting. Later this year I will get to do the long 5pm-7am shift, which is the phone calls and home visits part of the shift. That doctor was busy, so I never got to meet him Wednesday.
After this long week in the office I was ready for a nice weekend, but I'll blog about that tomorrow. Liz has started regular school sessions, and I'm trying to talk her into doing a "guest blog". Vicki has mostly kept busy taking care of the two of us, writing notes, catching up on the bills from our vacation at the beginning of this journey, etc. Somewhere in this week she turned 50, we had a small birthday party and Liz and I made her a cake. (Well, Liz mostly made it and I cleaned up the dishes.) The hot water went out in our house on Thursday, and the fix didn't work, and its Waitangi Weekend here; but that's a story for another day....
Monday I was the only doctor in the clinic, so it was well that I'd had a nice outing the day before. I saw 28 folks, only 1 or 2 of them were rechecks, and supervised a half-dozen wound checks. It was a busy day, but the staff did an awesome job of triaging patients, so most the problems were acute. That made things go a lot faster. Tuesday through Friday we other "relieving" doctors helping. These are two women who help out in rural clinics on a contract basis, episodically, as a form of practice. I was very glad to have Liz and Penny helping me after Monday. Many of the patients we see are older and have multiple medical problems and medications. Since they are all new to me, it is a real challenge to get up to speed on their cases and fulfill their needs. I've quickly realized that a lot of return visits are in order, just to have enough contact to get things done bit by bit. Fortunately, the patients expect this and don't seem to mind. Each day here has its own special challenge: an asymptomatic middle aged woman with BP of 230/130, two kids with a rash I thought was bug bites, followed two days later by a playmate with the same rash; a farmer with a black and blue (fractured!) ankle he's walked on for a week, etc. Wednesday I did 3 excisions of suspicious lesions, as well as "liquid nitrogen clinic" at the end of the day. LN Clinic is a walk in session where the nurse and I line up about 8-15 patients who have come in with warts, papillomata, seborrhic keratoses, and actinic keratoses that need to be frozen off. I have to admit the excisions were great fun for me- as a teacher, my residents are always pushing for as many procedures as they can get, so I seldom get to do many of these by myself. There is a simple joy in removing a suspicious lesion, and closing the wound nicely, and having the patient thank you for helping them resolve that worry. The most exciting time of the week was a stat call over lunch hour one day to go next door to the birthing center. A woman had just been delivered by the midwife, and had a huge postpartum hemorrhage. They needed a lot of hands, so I helped by starting the IV. Got it on the 2nd try- I was pretty pleased (and relieved!), since its been about 6-7 years since I last started one. The midwives had already been giving her the appropriate drugs, with good result, so we poured in a lot of fluids and got her stabilized for the ride to Invercargill.
Wednesday night, I attended at the "Urgent Doctor Center" in Invercargill. There is no night or after hours call here; and our patients with problems are directed either to go to the hospital 30 km down the road, or to the Urgent Doctor. This is a small office building downtown which during the day and evening also doubles as a surgeon's private office, and a private ultrasound facility. It is not an ER. It has a crash cart, but no EKG, and minimal oxygen, etc. It is really designed for after hours visits. This time I took the 7-10 pm shift and saw about 8-9 patients. The patients usually call in and are given a time to come. One lady needed a shot of narcotic for her migraine- so the nurse calls 2 buildings down the block to the Police station, and tells them she (the nurse) will be over to pick up the shot- because that's where it's stored. It was a nice, quiet functional facility and I was greatly relieved to see it wasn't a "mini-ER" type of setting. Later this year I will get to do the long 5pm-7am shift, which is the phone calls and home visits part of the shift. That doctor was busy, so I never got to meet him Wednesday.
After this long week in the office I was ready for a nice weekend, but I'll blog about that tomorrow. Liz has started regular school sessions, and I'm trying to talk her into doing a "guest blog". Vicki has mostly kept busy taking care of the two of us, writing notes, catching up on the bills from our vacation at the beginning of this journey, etc. Somewhere in this week she turned 50, we had a small birthday party and Liz and I made her a cake. (Well, Liz mostly made it and I cleaned up the dishes.) The hot water went out in our house on Thursday, and the fix didn't work, and its Waitangi Weekend here; but that's a story for another day....
Thursday, January 29, 2004
A day in the office
Today I finished my 9th day in the office, and its become enough of a routine that I thought I might describe a "typical" day, if I can do that after only 9 days...
I have been getting up around 7 am, although I have usually been awake for at least 30-45 minutes- the sun is still coming up before 6 AM here. Get dressed, have a cup of coffee, and watch the first 15 minutes of the daily news on New Zealand "ONE" TV station. About 8:20 to 8:30 I start walking to work. Its about 20 blocks, a very nice 12 minute walk which goes past the "College", the local high school. This morning was first day back for all the upper level students. The boys slogged along the street with me, all with their heads down, like they were heading to their own executions.
At work I get the computer up and running, tidy up my desk, look in the bin for lab results or other paperwork left over from the previous day and generally mess around a bit. The office here uses i-Macs, and I have a very small desk in the corner of my "Room" with the computer on it, some shelves above and two chairs. Across the room is an exam bench. It is a simple bench, with a pillow and some sheets. It sits on 4 posts and there are no drawers nor stirrups; but it is nice and high- something I appreciate with my height. There is a wooden box forming two steps that patients use to get up on the table, which must be about 3.5 feet off the floor at least. We have the usual Welch-Allen diagnostic kit on the wall, mercury sphygmomanoters, and a goose neck lamp on the wall also. There is a "trolly", or wheeled cart to my left, which has various materials on it- tongue blades, culture swabs, pap smear stuff, etc. I have a sink with a nice fluffy towel for washing. On my bookshelves there are only a few key patient handouts- a set of about 10 topics so far that are commonly used- hypertension, diabetes, UTI, gout, etc. And there are two small drug books that I shall mention below.
The computer program we use is called "Profile" and its made here in Auckland. It features a nice daily schedule screen, patient lookup screens with a "summary" page and buttons to call up "Scripts", "Previous Visits", "Investigations" (Labs), "Problems" and some other patient information. It took me about an hour the first day to get my bearings on it- mostly because writing a new script is a bit complicated. But I must say that "repeats" (refills) are a breeze, and I do a lot of that.
So I begin my day looking at the schedule. I have patients scheduled at 15 minute intervals during the day. In that time, for a typical patient, I go to the desk and find the patients paper folder (which contains all the old records before 1996 as well as any paper letters or government forms since then.) I call the patient out of the waiting room myself, introduce myself and we walk back to my "Room" (consulting room) together. I have been asking patients to take a seat up close where I can hear them well, and also trying to sit them so they can see the computer screen. Most of them have little or no interest in what I am doing on the computer however. I then take a history: chief complaint, HPI etc. I've discovered its usually a lot more efficient if I do that first and only AFTER that, review the electronic and paper charts. Often the visit is highly focused, so it helps to know what I am looking for- e.g. past blood pressure values, a heart echo done in 1990, recent lab results, etc. Once we've got an established agenda (I ask the "any other concerns" question at this time and really get things focused!)- we move on to the exam. I am really glad I brought my automatic battery-operated Lifesource BP machine with me. I put the cuff on and get my vital signs while I am finishing up my chart review, and entering a few details of the history, etc. If needed, we then move to the exam table. But for a lot of geriatric patients, I simply am doing heart and lung exams, etc right next to the desk, with them in the chair. This is quite quick usually, although many of the older folks are wearing 4 layers of clothes while they complain about our recent "hot" weather (its been in the mid- to high-70's (degress F)), and it might take them a few minutes to unbutton their shirts. Once the focused exam is done, and they are buttoning up, I go back into the computer and order drugs and labs. Most common labs are easy, on a pick list. Drugs are another matter. If I am prescribing a new drug, I often need to look up the drug in one of the New Zealand formulary books, to be sure its covered. I'll blog on the medicine system here later- its a separate topic. If a referral is to be made, we figure out who they are going to see, and I compose the letter right there. Then we say goodbye, the patient collects his or her papers and heads for the desk. I quickly finish up my note, re-tidy up my room and march out to the desk to collect the next patient.
A word about the office notes. I have not found any text templates in Profile so far, except for the referral letters. Fortunately, one of the previous locums ahead of me has loaded a little program on the machines here called "TypeIt4Me". It will type out simple macros, like autoComplete in Word. I wish is was as full-featured as Shorthand for Windows, with branching text functions; but alas, I have been unable to find anything like "Shorthand" for a Mac! Last week I set up a bunch of macros for my normal physical exam, and labeled them z1 through z5. So to document a normal exam, of the HEENT + Neck + chest say, I just type z3 and my whole normal exam is pasted into my note. I just go thru and edit to add any abnormals and that's very fast. Since the drugs and labs are pasted in the note automatically by the system, the only real typing I'm doing is the HPI and history now. And I may build some more macros next week to speed that up for common problems, like HTN.
Today I saw 21 patients in my Room in this fashion. The nurses only come in when I drag them (reluctantly!) to chaperone a pelvic exam. Otherwise they are quite busy doing their own jobs, which also entails a lot of patient care and treatments which they do with variable supervision, as needed. I'm often called back to check their work, for documentation and billing, for things such as wound care- which they really do an excellent job on, and are teaching me a lot about doing NZ style. Nurses also do all the triage, review and order of recalls for things like 6-monthly diabetes labs, and other things, like draw all the bloods. Most of the lab here is "send out" except for urine dipstix. We have a microscope, but it is really old, and I've only used it once.
A word on pelvic examinations. Because stirrups are not an office tradition here, I am doing most "smears" as we call paps here, in the left lateral supine position (side). I ask the women what they prefer, and if they've done it before they usually will say side. It is much easier doing this to see the cervix and get a good quality exam. I certainly see the posterior perineum better than in stirrups. I have the women roll back over for the bimanual exam; and my only difficulty here is that I am accustomed to using my LEFT hand as the internal hand (taught that way 25 years ago), so either have to reach around at an awkward angle (the bench is set up with the woman's head to my left side), or I'm going to have to learn to switch hands. I've tried the right hand swap once, but that side of my brain is just not used to doing it. It's like trying to write with your non-dominant hand. I think I will stick with the awkward reach and just have patients scoot down as far as they can on the table, and be glad I have long arms.
So thats an introduction to a very busy rural office, that is well-organized. As a guest, I am content to just mesh into this machine, and have worked hard and sucessfully resisted putting even 1 cent in, not to mention 2 cents. I'm just going with the flow. The patients are delightful and I'm really enjoying the chance to just see patients and not have to have administrative responsiblities.
I'll close with the best part of the daily schedule: morning and afternoon tea. I am motivated to stay on schedule, because we all break at 10:45 AM for morning tea. This is 10-15 minutes of a cup of tea, some goodie like Edam cheese on crackers or a sweet, and a chance to talk to others in the office. We usually avoid talking about work- and I have learned a lot about the local area, customs, walking tracks, history, good areas to visit on "holiday", etc. Yesterday I learned the proper pronounciation of "pikelets"- the 'pike' part rhymes with "bike". [They thought that rhyming it with piglets was VERY funny.] Tea is a really nice break in the day; and after seeing the 7th or 8th patient, I find that morning tea recharges me for the 9th and the rest of the morning. Lunch, which today included pikelets (Yummy!), lasts from 1 to 2:30 (usually I am not done with the AM till 1:30 however). Then there is afternoon tea at 4pm. Same idea. From 4-5 pm the office schedule is all "acutes" and we stay to see anyone who makes it inside the door by 5pm- so I'm usually out by 5:45 or 6.
My workday ends with a walk home, a nice wind-down from the concentration at the office. Today it was raining at the end of the day; and all the farmers and herders are VERY happy because the area is having a severe drought. I took off my hearing aids and walked home in it, and didn't mind a bit.
Today I finished my 9th day in the office, and its become enough of a routine that I thought I might describe a "typical" day, if I can do that after only 9 days...
I have been getting up around 7 am, although I have usually been awake for at least 30-45 minutes- the sun is still coming up before 6 AM here. Get dressed, have a cup of coffee, and watch the first 15 minutes of the daily news on New Zealand "ONE" TV station. About 8:20 to 8:30 I start walking to work. Its about 20 blocks, a very nice 12 minute walk which goes past the "College", the local high school. This morning was first day back for all the upper level students. The boys slogged along the street with me, all with their heads down, like they were heading to their own executions.
At work I get the computer up and running, tidy up my desk, look in the bin for lab results or other paperwork left over from the previous day and generally mess around a bit. The office here uses i-Macs, and I have a very small desk in the corner of my "Room" with the computer on it, some shelves above and two chairs. Across the room is an exam bench. It is a simple bench, with a pillow and some sheets. It sits on 4 posts and there are no drawers nor stirrups; but it is nice and high- something I appreciate with my height. There is a wooden box forming two steps that patients use to get up on the table, which must be about 3.5 feet off the floor at least. We have the usual Welch-Allen diagnostic kit on the wall, mercury sphygmomanoters, and a goose neck lamp on the wall also. There is a "trolly", or wheeled cart to my left, which has various materials on it- tongue blades, culture swabs, pap smear stuff, etc. I have a sink with a nice fluffy towel for washing. On my bookshelves there are only a few key patient handouts- a set of about 10 topics so far that are commonly used- hypertension, diabetes, UTI, gout, etc. And there are two small drug books that I shall mention below.
The computer program we use is called "Profile" and its made here in Auckland. It features a nice daily schedule screen, patient lookup screens with a "summary" page and buttons to call up "Scripts", "Previous Visits", "Investigations" (Labs), "Problems" and some other patient information. It took me about an hour the first day to get my bearings on it- mostly because writing a new script is a bit complicated. But I must say that "repeats" (refills) are a breeze, and I do a lot of that.
So I begin my day looking at the schedule. I have patients scheduled at 15 minute intervals during the day. In that time, for a typical patient, I go to the desk and find the patients paper folder (which contains all the old records before 1996 as well as any paper letters or government forms since then.) I call the patient out of the waiting room myself, introduce myself and we walk back to my "Room" (consulting room) together. I have been asking patients to take a seat up close where I can hear them well, and also trying to sit them so they can see the computer screen. Most of them have little or no interest in what I am doing on the computer however. I then take a history: chief complaint, HPI etc. I've discovered its usually a lot more efficient if I do that first and only AFTER that, review the electronic and paper charts. Often the visit is highly focused, so it helps to know what I am looking for- e.g. past blood pressure values, a heart echo done in 1990, recent lab results, etc. Once we've got an established agenda (I ask the "any other concerns" question at this time and really get things focused!)- we move on to the exam. I am really glad I brought my automatic battery-operated Lifesource BP machine with me. I put the cuff on and get my vital signs while I am finishing up my chart review, and entering a few details of the history, etc. If needed, we then move to the exam table. But for a lot of geriatric patients, I simply am doing heart and lung exams, etc right next to the desk, with them in the chair. This is quite quick usually, although many of the older folks are wearing 4 layers of clothes while they complain about our recent "hot" weather (its been in the mid- to high-70's (degress F)), and it might take them a few minutes to unbutton their shirts. Once the focused exam is done, and they are buttoning up, I go back into the computer and order drugs and labs. Most common labs are easy, on a pick list. Drugs are another matter. If I am prescribing a new drug, I often need to look up the drug in one of the New Zealand formulary books, to be sure its covered. I'll blog on the medicine system here later- its a separate topic. If a referral is to be made, we figure out who they are going to see, and I compose the letter right there. Then we say goodbye, the patient collects his or her papers and heads for the desk. I quickly finish up my note, re-tidy up my room and march out to the desk to collect the next patient.
A word about the office notes. I have not found any text templates in Profile so far, except for the referral letters. Fortunately, one of the previous locums ahead of me has loaded a little program on the machines here called "TypeIt4Me". It will type out simple macros, like autoComplete in Word. I wish is was as full-featured as Shorthand for Windows, with branching text functions; but alas, I have been unable to find anything like "Shorthand" for a Mac! Last week I set up a bunch of macros for my normal physical exam, and labeled them z1 through z5. So to document a normal exam, of the HEENT + Neck + chest say, I just type z3 and my whole normal exam is pasted into my note. I just go thru and edit to add any abnormals and that's very fast. Since the drugs and labs are pasted in the note automatically by the system, the only real typing I'm doing is the HPI and history now. And I may build some more macros next week to speed that up for common problems, like HTN.
Today I saw 21 patients in my Room in this fashion. The nurses only come in when I drag them (reluctantly!) to chaperone a pelvic exam. Otherwise they are quite busy doing their own jobs, which also entails a lot of patient care and treatments which they do with variable supervision, as needed. I'm often called back to check their work, for documentation and billing, for things such as wound care- which they really do an excellent job on, and are teaching me a lot about doing NZ style. Nurses also do all the triage, review and order of recalls for things like 6-monthly diabetes labs, and other things, like draw all the bloods. Most of the lab here is "send out" except for urine dipstix. We have a microscope, but it is really old, and I've only used it once.
A word on pelvic examinations. Because stirrups are not an office tradition here, I am doing most "smears" as we call paps here, in the left lateral supine position (side). I ask the women what they prefer, and if they've done it before they usually will say side. It is much easier doing this to see the cervix and get a good quality exam. I certainly see the posterior perineum better than in stirrups. I have the women roll back over for the bimanual exam; and my only difficulty here is that I am accustomed to using my LEFT hand as the internal hand (taught that way 25 years ago), so either have to reach around at an awkward angle (the bench is set up with the woman's head to my left side), or I'm going to have to learn to switch hands. I've tried the right hand swap once, but that side of my brain is just not used to doing it. It's like trying to write with your non-dominant hand. I think I will stick with the awkward reach and just have patients scoot down as far as they can on the table, and be glad I have long arms.
So thats an introduction to a very busy rural office, that is well-organized. As a guest, I am content to just mesh into this machine, and have worked hard and sucessfully resisted putting even 1 cent in, not to mention 2 cents. I'm just going with the flow. The patients are delightful and I'm really enjoying the chance to just see patients and not have to have administrative responsiblities.
I'll close with the best part of the daily schedule: morning and afternoon tea. I am motivated to stay on schedule, because we all break at 10:45 AM for morning tea. This is 10-15 minutes of a cup of tea, some goodie like Edam cheese on crackers or a sweet, and a chance to talk to others in the office. We usually avoid talking about work- and I have learned a lot about the local area, customs, walking tracks, history, good areas to visit on "holiday", etc. Yesterday I learned the proper pronounciation of "pikelets"- the 'pike' part rhymes with "bike". [They thought that rhyming it with piglets was VERY funny.] Tea is a really nice break in the day; and after seeing the 7th or 8th patient, I find that morning tea recharges me for the 9th and the rest of the morning. Lunch, which today included pikelets (Yummy!), lasts from 1 to 2:30 (usually I am not done with the AM till 1:30 however). Then there is afternoon tea at 4pm. Same idea. From 4-5 pm the office schedule is all "acutes" and we stay to see anyone who makes it inside the door by 5pm- so I'm usually out by 5:45 or 6.
My workday ends with a walk home, a nice wind-down from the concentration at the office. Today it was raining at the end of the day; and all the farmers and herders are VERY happy because the area is having a severe drought. I took off my hearing aids and walked home in it, and didn't mind a bit.
Sunday, January 25, 2004
A Busy Week in Winton
This has been a week of adjusting and getting settled in our house here and in the clinic. I'm not really disposed to say much about the medical practice this week as I'm still getting used to it and feeling a bit overwhelmed. But I was pleased that Friday afternoon I was in the office all by myself for the last few hours, and at the end of the day the nurses and office staff congratulated me for surviving the first week and doing "good as gold" as they say here. That was a great feeling. The biggest adjustment for me has been to learn the New Zealand Pharmaceutical schedule, and the procedures for referrals and forms. I'm coming with the drug schedule, although there are some things I commonly prescribe that are unknown here, like Pepto Bismol. This precipitates a scramble to adapt and try to figure out what people here use instead. I've already learned about some things, like tea tree oil (melaluca), which is great for stings and bites and itching. The nurses and the local pharmacists are both big helps in this regard. I had a lot of fun in the office last week meeting the patients, and figuring out what to do. I'm looking forward to tomorrow, Monday and a new week.
Vicki and Liz have been busy getting everything unpacked and organized in the house. It is a great relief to have a place to just call home. The house is great- really comfortable and light and airy and quiet. They have been grocery shopping, and the previous doctor and his wife left a garden in the back full of delicious vegetables that we have been picking and eating. Thank you Dr. & Mrs. Cantlebury! Dinners have been great; we even had roast lamb shoulder with roasted veggies last pm. We have a car provided by the local medical Trust, a little manual Mitsubishi Lancer, which I have NOT had a chance to drive yet 'cause the girls are having so much fun with it. They took it down to Invercargill on Thursday and checked out the Southern Institute of Technology for Liz. This didn't seem like a good fit. The curriculum is a set course of study (not at alll like our community colleges with their menu of courses), and the cost for her as a foreign student is relatively high. Liz and Vicki are going to check out the local secondary school, the Central Southland College, here in Winton tomorrow.
Yesterday was the Winton A&P show. This is an agricultural fair, where people bring their stock and compete for ribbons and honors for the best entry. The livestock, especially the sheep, cows and horses were a very big deal. But there were even competitions for best funny food sculpture and best farm or home invention. I really enjoyed watching the kids with their pet lambs. Some of the youngsters came dressed in traditional Scottish attire, and competed in Highland dancing, complete with live bagpipe music. This is a reminder of the local Scottish heritage here. But the best thing to watch was the dog trials. One dog and the shepherd have to move the sheep through a series of fences and gates, and finally into a pen. If you've ever seen the movie "Babe", you've seen this competition. The old shepherd who was judging the trials took a liking to Vicki and came over many times to explain and comment on the performances ("This next dog should be really good", "Perfect score is 100, I've only seen that once in me life", "Bloody sheep aren't working well today- they only want to stay with the mob"). It was great, a beautiful sunny day and perfect weather.
Today we had a lazy Sunday morning at home. This afternoon Vicki and I drove over to near Gore and went hiking in Croyden Bush, a nature reserve with huge trees and wonderful bird life. We heard the beautiful bellbird, and saw tui and New Zealand pigeons. We hiked up the hill 300 meters all the way to the lookout on the top, and then back down to a wonderful little waterfall in a ferny nook. The cloudy afternoon slowly burned off. From the top we could see the ocean and Bluff, way to the South. A day to remember. I've tried something new, posting the pictures on a separate page. Be patient- if you have a slow connection it may take 5-10 minutes to load!
This has been a week of adjusting and getting settled in our house here and in the clinic. I'm not really disposed to say much about the medical practice this week as I'm still getting used to it and feeling a bit overwhelmed. But I was pleased that Friday afternoon I was in the office all by myself for the last few hours, and at the end of the day the nurses and office staff congratulated me for surviving the first week and doing "good as gold" as they say here. That was a great feeling. The biggest adjustment for me has been to learn the New Zealand Pharmaceutical schedule, and the procedures for referrals and forms. I'm coming with the drug schedule, although there are some things I commonly prescribe that are unknown here, like Pepto Bismol. This precipitates a scramble to adapt and try to figure out what people here use instead. I've already learned about some things, like tea tree oil (melaluca), which is great for stings and bites and itching. The nurses and the local pharmacists are both big helps in this regard. I had a lot of fun in the office last week meeting the patients, and figuring out what to do. I'm looking forward to tomorrow, Monday and a new week.
Vicki and Liz have been busy getting everything unpacked and organized in the house. It is a great relief to have a place to just call home. The house is great- really comfortable and light and airy and quiet. They have been grocery shopping, and the previous doctor and his wife left a garden in the back full of delicious vegetables that we have been picking and eating. Thank you Dr. & Mrs. Cantlebury! Dinners have been great; we even had roast lamb shoulder with roasted veggies last pm. We have a car provided by the local medical Trust, a little manual Mitsubishi Lancer, which I have NOT had a chance to drive yet 'cause the girls are having so much fun with it. They took it down to Invercargill on Thursday and checked out the Southern Institute of Technology for Liz. This didn't seem like a good fit. The curriculum is a set course of study (not at alll like our community colleges with their menu of courses), and the cost for her as a foreign student is relatively high. Liz and Vicki are going to check out the local secondary school, the Central Southland College, here in Winton tomorrow.
Yesterday was the Winton A&P show. This is an agricultural fair, where people bring their stock and compete for ribbons and honors for the best entry. The livestock, especially the sheep, cows and horses were a very big deal. But there were even competitions for best funny food sculpture and best farm or home invention. I really enjoyed watching the kids with their pet lambs. Some of the youngsters came dressed in traditional Scottish attire, and competed in Highland dancing, complete with live bagpipe music. This is a reminder of the local Scottish heritage here. But the best thing to watch was the dog trials. One dog and the shepherd have to move the sheep through a series of fences and gates, and finally into a pen. If you've ever seen the movie "Babe", you've seen this competition. The old shepherd who was judging the trials took a liking to Vicki and came over many times to explain and comment on the performances ("This next dog should be really good", "Perfect score is 100, I've only seen that once in me life", "Bloody sheep aren't working well today- they only want to stay with the mob"). It was great, a beautiful sunny day and perfect weather.
Today we had a lazy Sunday morning at home. This afternoon Vicki and I drove over to near Gore and went hiking in Croyden Bush, a nature reserve with huge trees and wonderful bird life. We heard the beautiful bellbird, and saw tui and New Zealand pigeons. We hiked up the hill 300 meters all the way to the lookout on the top, and then back down to a wonderful little waterfall in a ferny nook. The cloudy afternoon slowly burned off. From the top we could see the ocean and Bluff, way to the South. A day to remember. I've tried something new, posting the pictures on a separate page. Be patient- if you have a slow connection it may take 5-10 minutes to load!
Wednesday, January 21, 2004
Light Switches and Hot Water Taps
I got up this morning in the hotel and came home from work today to our house here in Winton. Vicki and Liz had moved all our stuff after the Cantlebury's left this morning. The house is a "really cute" little 3 bedroom home in the center of town. It has high ceilings, huge windows with great light, and is full of comfy couches and nice furniture. I'm sure it will be a very cozy, pleasant lodgings for the next 5 months. This house got me thinking about physics.
Now the "Many Worlds" interpretation of quantum mechanics states that since each event in the universe is indeterminate, and there is no predilection for one event to happen over another at the quantum level, that each event spawns two universes, which exist side by side and differ only in the outcome of the particular event. In one universe Schroedinger's cat lives; in the other it dies. This has led many science fiction writers to build stories in "alternate universes" where outcomes were different. (e.g. "Hitler won WW2", or "the Black Death killed 95% of the population of Europe"). What the heck does this have to do with our new house?
After being in country for over 2 weeks now, it is sinking in that I am not a tourist, bound to go home one day soon. I will live in this reality for the next 5 months. And it is a reality that is both very familiar, and disturbingly different. Power outputs have 3 prongs. Light switches turn on when you push them down. The HOT water tap in the sink is on the right side about 99% of the time. Rarely does a sink have a union tap where the hot and cold water mix; almost all sinks have separate faucets on them. We drive on the left side of the road here, shift gears with the left hand, and turn on wipers (located on the left side of steering column) when we mean to signal a turn (located on the right side). "Windshields" are 'windscreens", "insurance" is a "cover". You can be sure that medicine is different here also.
Since we've arrived in Winton, and I've now started work, I will strive to carefully watch the tone and style of this blog. New Zealand is different from the USA; that's obvious. I am not a tourist any longer. I am a guest here, hosted by very nice people who are working hard to make me feel welcome, and who need my skills. And a guest should follow certain rules.
When I was 11 my parents put me on a plane to Finland, by myself, to spend 8 weeks with my Mom's college roommate (who had been an exchange student in the U.S.) and her family. My Mom gave me a diary to keep, and in the beginning she wrote some advice for me, and repeated words of wisdom and love on every page. The most important things she wrote, I found, were "Don't compare", and "If you can't say anything nice, don't say anything at all".
As a guest here, I will try to follow this advice. I would never want to upset any of my hosts in Winton, and I certainly want to keep patient confidentiality and be professional. So you shouldn't read anything bad or upsetting about Winton and my hosts in the following blogs. I will not write anything about clinical encounters until I get guidelines from my sponsoring doctor. As with most blogs, this will be mostly, narcissistically about me and what I am feeling and experiencing with my family. It is not intended as a "cross cultural comparison" or critique. For example, I can understand that there is a good rationale for having 3 big prongs on the plugs here; the voltage is 220. Physics tells us you are less likely to get a heat related short if the area of the current-carrying conductor is big. Tea water heats up very fast with 220 volts and hair dryers really have POWER because of it. Is it better or worse? I'm not comparing; I am just collecting observations, like the 19th Century naturalist in Timaru collected butterflys. Is a brilliant blue Amazon butterful better than a honeybee? The question makes no sense; it is not correctly put. I have to remember that I will not always understand the reasons that Kiwi's do the things they do. I'm not that smart. One needs to accept that it is just their way.
So I intend to share my observations, and try not to make conclusions. I ask you, my reader to also try not to compare when you read this blog. Things are different in other places, that is all. You will read nice things about my hosts and my host country; just as I hope a Kiwi doctor would say nice things about Iowa if they were a guest in the chilly Midwest. I know that I will look at things at home with new eyes when I come back, and be a different person. (But note that if I stayed at home however, this would also happen.) The attitude to strive for is as the Zen master said, when returning from a visit to a sacred forest: "The high mountains! The beuatiful waterfalls! - They were nothing special."
I got up this morning in the hotel and came home from work today to our house here in Winton. Vicki and Liz had moved all our stuff after the Cantlebury's left this morning. The house is a "really cute" little 3 bedroom home in the center of town. It has high ceilings, huge windows with great light, and is full of comfy couches and nice furniture. I'm sure it will be a very cozy, pleasant lodgings for the next 5 months. This house got me thinking about physics.
Now the "Many Worlds" interpretation of quantum mechanics states that since each event in the universe is indeterminate, and there is no predilection for one event to happen over another at the quantum level, that each event spawns two universes, which exist side by side and differ only in the outcome of the particular event. In one universe Schroedinger's cat lives; in the other it dies. This has led many science fiction writers to build stories in "alternate universes" where outcomes were different. (e.g. "Hitler won WW2", or "the Black Death killed 95% of the population of Europe"). What the heck does this have to do with our new house?
After being in country for over 2 weeks now, it is sinking in that I am not a tourist, bound to go home one day soon. I will live in this reality for the next 5 months. And it is a reality that is both very familiar, and disturbingly different. Power outputs have 3 prongs. Light switches turn on when you push them down. The HOT water tap in the sink is on the right side about 99% of the time. Rarely does a sink have a union tap where the hot and cold water mix; almost all sinks have separate faucets on them. We drive on the left side of the road here, shift gears with the left hand, and turn on wipers (located on the left side of steering column) when we mean to signal a turn (located on the right side). "Windshields" are 'windscreens", "insurance" is a "cover". You can be sure that medicine is different here also.
Since we've arrived in Winton, and I've now started work, I will strive to carefully watch the tone and style of this blog. New Zealand is different from the USA; that's obvious. I am not a tourist any longer. I am a guest here, hosted by very nice people who are working hard to make me feel welcome, and who need my skills. And a guest should follow certain rules.
When I was 11 my parents put me on a plane to Finland, by myself, to spend 8 weeks with my Mom's college roommate (who had been an exchange student in the U.S.) and her family. My Mom gave me a diary to keep, and in the beginning she wrote some advice for me, and repeated words of wisdom and love on every page. The most important things she wrote, I found, were "Don't compare", and "If you can't say anything nice, don't say anything at all".
As a guest here, I will try to follow this advice. I would never want to upset any of my hosts in Winton, and I certainly want to keep patient confidentiality and be professional. So you shouldn't read anything bad or upsetting about Winton and my hosts in the following blogs. I will not write anything about clinical encounters until I get guidelines from my sponsoring doctor. As with most blogs, this will be mostly, narcissistically about me and what I am feeling and experiencing with my family. It is not intended as a "cross cultural comparison" or critique. For example, I can understand that there is a good rationale for having 3 big prongs on the plugs here; the voltage is 220. Physics tells us you are less likely to get a heat related short if the area of the current-carrying conductor is big. Tea water heats up very fast with 220 volts and hair dryers really have POWER because of it. Is it better or worse? I'm not comparing; I am just collecting observations, like the 19th Century naturalist in Timaru collected butterflys. Is a brilliant blue Amazon butterful better than a honeybee? The question makes no sense; it is not correctly put. I have to remember that I will not always understand the reasons that Kiwi's do the things they do. I'm not that smart. One needs to accept that it is just their way.
So I intend to share my observations, and try not to make conclusions. I ask you, my reader to also try not to compare when you read this blog. Things are different in other places, that is all. You will read nice things about my hosts and my host country; just as I hope a Kiwi doctor would say nice things about Iowa if they were a guest in the chilly Midwest. I know that I will look at things at home with new eyes when I come back, and be a different person. (But note that if I stayed at home however, this would also happen.) The attitude to strive for is as the Zen master said, when returning from a visit to a sacred forest: "The high mountains! The beuatiful waterfalls! - They were nothing special."
Tuesday, January 20, 2004
Winton, At Last
This will be a delayed post, as I don't have Internet access here yet, but I want to keep up to date.
Saturday and Sunday were spent traveling down South from Christchurch to Winton. Its about 600 km, so we did it in two days and took our time. Saturday we stopped for Lunch in Timaru, visited the Rose gardens there on the waterfront, and enjoyed the South Canterbury museum. The museum, free, is another New Zealand "hidden gem". It has great displays about the natural history of the area, as well as great pictures and artifacts from the pioneer eras. One of the local surveyors in Timaru was a great Victorian naturalist, and he amassed a stunning collection of butterflies and minerals- unexpected in this small town. Continuing down the coast to Oamaru, we checked out the penguin colonies there, but discovered they are only seen at dusk, when they return from the sea. We took the coast road south from there, through Kakanui, a really cute seaside town. The coast there is a grass covered bluff overlooking the beach. We pulled over to just look at the ocean in the afternoon light, and discovered a pod of 3 of the endangered and rare
Hector's dolphins just playing in the surf. They were plaining body surfing in the waves, and occaisonally leaping out, having great fun. Just after this we rounded the bend to find a farmer driving his sheep down the road to a new pasture. The sheepdogs were amazing, responding to whistles and calls of the farmers. 
Our next stop was Moeraki, home of the
famous boulders. We walked down the twilight beach in a stiff wind, to explore these strange, surreal rocks. Vicki thought they looked like a someone had dropped giant golf balls all over the beach. We rolled on into Dunedin at nightfall and found a nice hotel. Sunday we slept late, then drove out to the tip of the Otago peninsula. The drive was spectacular- Dunedin has a wonderful natural harbour. At the tip of the peninsula is an albatross colony and seal colony. The wind was howling and the sea bashing the cliffs- but we saw two huge Royal Albatross soar up overhead. Liz got some great pictures of the Hooker's sea lions at close range (10 feet). The road then took us inland over kilometers of pastureland. It was a beautiful, clear blue day, with the green pasures filled with white sheep. We arrived in Winton about 4pm and found our hotel. Mr. Frasier, a member of the local hospital board met us and welcomed us. He asked me to report to the medical center this morning at 9 AM for orientation.
I was really nervous this morning. Its been 12 years since my last "first day on the job"; plus this is another country and medical system. I arrived to find that my supervising doctor had suddenly had a death in the family, and left this morning for England for 3 weeks! There were two other locum's docs in the office, one of whom I am replacing, so it was his last day. I was introduced to everyone in the office, and then Dawn, one of the nurses, gave me 2-3 hours of orientation to the forms, charts, and computer system. Because of the crisis, I was asked to see patients beginning this afternoon at 2. We did have a special "morning tea" at 1045 AM, which the office threw for the leaving doc , and Vicki and Liz came over and met everyone. I had time to review the charts of the afternoon patients and when 2 pm came, I started in. There are a lot of differences in medical practice, which I may blog about later. But the patients were very nice, understanding as I looked up all the drug names, struggled to master an I-Mac based computer system and filled in for their absent doctor. I only deleted one progress note accidently before saving, and I kept fairly well to (an admittedly light) schedule, seeing about 8 patients between 2 and 5:30 PM. In a word, both the patients and I survived my first day. And everyone was really nice and glad to have me here. And it was fun.
VIcki and Liz spent the day exploring the town; the library, the pharmacy, and some of the shops. We will be staying here in the motel for a few days until the practice can turn the house around. They will figure out what Liz is going to do for school or classes here, and I've given them the job of finding out about Internet access. It is great to finally be here after so much planning, and they are both happy to "get out of the car". We put 1400 km on the campervan, + 600 on the rental car; so 2000 km in 11 days.
This will be a delayed post, as I don't have Internet access here yet, but I want to keep up to date.
Saturday and Sunday were spent traveling down South from Christchurch to Winton. Its about 600 km, so we did it in two days and took our time. Saturday we stopped for Lunch in Timaru, visited the Rose gardens there on the waterfront, and enjoyed the South Canterbury museum. The museum, free, is another New Zealand "hidden gem". It has great displays about the natural history of the area, as well as great pictures and artifacts from the pioneer eras. One of the local surveyors in Timaru was a great Victorian naturalist, and he amassed a stunning collection of butterflies and minerals- unexpected in this small town. Continuing down the coast to Oamaru, we checked out the penguin colonies there, but discovered they are only seen at dusk, when they return from the sea. We took the coast road south from there, through Kakanui, a really cute seaside town. The coast there is a grass covered bluff overlooking the beach. We pulled over to just look at the ocean in the afternoon light, and discovered a pod of 3 of the endangered and rare
Hector's dolphins just playing in the surf. They were plaining body surfing in the waves, and occaisonally leaping out, having great fun. Just after this we rounded the bend to find a farmer driving his sheep down the road to a new pasture. The sheepdogs were amazing, responding to whistles and calls of the farmers.
Our next stop was Moeraki, home of the
famous boulders. We walked down the twilight beach in a stiff wind, to explore these strange, surreal rocks. Vicki thought they looked like a someone had dropped giant golf balls all over the beach. We rolled on into Dunedin at nightfall and found a nice hotel. Sunday we slept late, then drove out to the tip of the Otago peninsula. The drive was spectacular- Dunedin has a wonderful natural harbour. At the tip of the peninsula is an albatross colony and seal colony. The wind was howling and the sea bashing the cliffs- but we saw two huge Royal Albatross soar up overhead. Liz got some great pictures of the Hooker's sea lions at close range (10 feet). The road then took us inland over kilometers of pastureland. It was a beautiful, clear blue day, with the green pasures filled with white sheep. We arrived in Winton about 4pm and found our hotel. Mr. Frasier, a member of the local hospital board met us and welcomed us. He asked me to report to the medical center this morning at 9 AM for orientation.
I was really nervous this morning. Its been 12 years since my last "first day on the job"; plus this is another country and medical system. I arrived to find that my supervising doctor had suddenly had a death in the family, and left this morning for England for 3 weeks! There were two other locum's docs in the office, one of whom I am replacing, so it was his last day. I was introduced to everyone in the office, and then Dawn, one of the nurses, gave me 2-3 hours of orientation to the forms, charts, and computer system. Because of the crisis, I was asked to see patients beginning this afternoon at 2. We did have a special "morning tea" at 1045 AM, which the office threw for the leaving doc , and Vicki and Liz came over and met everyone. I had time to review the charts of the afternoon patients and when 2 pm came, I started in. There are a lot of differences in medical practice, which I may blog about later. But the patients were very nice, understanding as I looked up all the drug names, struggled to master an I-Mac based computer system and filled in for their absent doctor. I only deleted one progress note accidently before saving, and I kept fairly well to (an admittedly light) schedule, seeing about 8 patients between 2 and 5:30 PM. In a word, both the patients and I survived my first day. And everyone was really nice and glad to have me here. And it was fun.
VIcki and Liz spent the day exploring the town; the library, the pharmacy, and some of the shops. We will be staying here in the motel for a few days until the practice can turn the house around. They will figure out what Liz is going to do for school or classes here, and I've given them the job of finding out about Internet access. It is great to finally be here after so much planning, and they are both happy to "get out of the car". We put 1400 km on the campervan, + 600 on the rental car; so 2000 km in 11 days.
Thursday, January 15, 2004
Time to catch up on my blog after being "off the Internet" on the wild, west coast of New Zealand.
Its Friday pm here and we are back in Christchurch at the Chateau on the Park..
By last Sunday night, Liz right foot had swollen up to about twice normal size, as a result of her many sandfly bites after our mountain hike last week, and a whole day of caving and rafting. We went into Westport and found a "chemist". I was able to buy some dexchlorpheniramine maleate antihistamines for her, and some elastic wrap, sorta like Coban. I have not seen any ACE bandages here. The groceries and chemists are very interesting; they do not have nearly the amount or number of OTC meds we would expect in the States. No Benadryl. Only cough drops, and few cough and cold remedies. Two of the nonsedating antihistamines are OTC here- and its funny to see it spelled "Clarytin". I wrapped Liz foot and we decided to help her elevate it and not tramp on it for the next couple of days.
So Monday, we went out to Cape Foulwind to see the seal colony. There is a wonderful bay on the tip of this peninsula, and a great restaurant, the Bay House Restaurant overlooking it. After a short (<100 meters) walk out to see the seals, we went back and had breakfast on the porch. The "nested eggs" and muesli were great with hot tea. After that we drove down the wild and rocky coast to the "pancake rocks" at Punakaiki. These are wonderful formations, where the seal pounds through many arches and spouts up in blowholes. We arrived just before the rain, and Liz managed to hobble around the path, being a good sport. We then continued down the coast to Hokitika, an artists colony. We took a quick walk across the street to look at the glowworm dell (nice, but nothing like the cave rafting) before hitting the sack.
The next morning, Liz's foot was still pretty swollen, so we decided to just hang around Hoki for the day. We had read about a class where she could make her own greenstone jewelry- and she was pretty interested in that. So we left her in the hands of the Mad Kiwi at the Just Jade Experience for the day. Vicki and I walked the shops and drove out thought the beautiful Hoki valley to the Hokitika Gorge. When we came back, we took Liz through a few shops and also visited the Kiwi Centre. This is an eclectic menagerie that is obviously someone's aquarium hobby that got away from them. I could do without the giant eels. However, the kiwi exhibit was great. They are in a nocturnal room, so they were awake and feeding, and they come up to just a few feet away from you, so you can really see them well. Before we left Hokitika, we had a great meal of Indian food. We each had a lamb dish. Because the sun sets so late here, we were able to leave Hoki at 6:30 pm and drive down to Franz Josef , reaching that town at the foot of the glaciers while it was still light out at 8:30 pm. The weather was great, for the wet West Coast, and we could see the mountains marching down to the sea the whole way.
Wednesday morning, I got up and made arrangements to do a glacier hike. Liz and Vicki checked out the town, and walked up the valley to the glacier foot. However, to go up onto the glacier, you need to take a guided tour. So at 10:30 I reported to Franz Josef Glacier Guides. Here they give you a set of special leather boots with hobnails in them, a pair of "talonz" (which are just special ice crampons for the boots) and a Goretex parka. About 40 of us hopped on the bus to the carpark up the valley, and then we hiked in to the foot of the glacier, about 2 km. over very rough country. Once at the foot of the glacier, we split into 12 man teams, then started climbing- straight up the ice. After going up just a little ways, we stopped and put on our talonz. Then keep climbing, up and up over ice that graduallly cleared of rock and became the most beautiful turquoise blue color. We crossed over two crevasses on ladders, climbed up many pitches with ropes and finally at the "top" walked next to an 800 meter tall huge waterfall cascading down the valley wall onto the side of the glacier. We traversed down into a few crevasses,and walked through an ice cave- something I've always wanted to do. Overall we spent about 2 hours on the ice. We walked about 8km total, and climbed about 200 meters in altitude- although it seemed a lot more because it was such rough climbing. The glacier was awesome, and as we came back down, the sun came out and I could see, looking back, that for all our effort, we had only climbed up a very small portion of the glacier in our half-day trip. The mountains here are marvelous- they rise right out of the sea straight up to tens of thousands of feet. You really get a feel for how small you are on the face of the Earth in this landscape. When I got back down, I had the world's best tasiting peanut-butter and jelly sandwich, and we took off back north to the Hokitik area again. We stopped in town and grabbed "takeaway" fish & chips for supper. This time, instead of staying in a campgroung, we "free camped" out in a DOC campground on Lake Kaniere. This beautiful lake is tucked a way at the foot of the mountains. I took a swim in the lake, and fell into bed.
Thursday morning, after breakfast, we drove around the lake to Dorothy Falls. This is a beatiful waterfall out in the middle of nowhere. It had rained the night before, and we could hear the waterfall from the lakefront, over 100 meters away. After coming back into Hoki to do a few errands, we drove over the Arthurs' Pass. This is a wonderful feat of engineering. and one of the steepest mountain passes I've ever been over. The high country of New Zealand is dry and beautiful and the rivers really are turquoise in color due to the glacial snowmelt and powder in them.
Coming down into Canterbury, we stayed the night at Ashley Gorge at a wonderful campsite filled with families with little children on holiday. The kids here are really cute, and Vicki and I both have the impression that they are really allowed and encouraged to be children, and are less media-influenced than U.S. kids. All of them were wearing sun hats and sunscreen also, and a sundress here for a little girl means long sleeves,a nd long skirt with ruffles! We enjoyed watching them play in the dirt, river, swings, etc.
This morning we came back into Christchurch, said a sad goodbye to our campervan. In one week we put on 1400+ km, and did SO many activities. It will be a relief to stay back here in the hotel with soft beds and our own shower. Tomorrow we start down to the deep South of the country, and Monday I start orientation in Winton. Its been a great holiday, but we are anxious to "light" and stay in one place for awhile.
Its Friday pm here and we are back in Christchurch at the Chateau on the Park..
By last Sunday night, Liz right foot had swollen up to about twice normal size, as a result of her many sandfly bites after our mountain hike last week, and a whole day of caving and rafting. We went into Westport and found a "chemist". I was able to buy some dexchlorpheniramine maleate antihistamines for her, and some elastic wrap, sorta like Coban. I have not seen any ACE bandages here. The groceries and chemists are very interesting; they do not have nearly the amount or number of OTC meds we would expect in the States. No Benadryl. Only cough drops, and few cough and cold remedies. Two of the nonsedating antihistamines are OTC here- and its funny to see it spelled "Clarytin". I wrapped Liz foot and we decided to help her elevate it and not tramp on it for the next couple of days.
So Monday, we went out to Cape Foulwind to see the seal colony. There is a wonderful bay on the tip of this peninsula, and a great restaurant, the Bay House Restaurant overlooking it. After a short (<100 meters) walk out to see the seals, we went back and had breakfast on the porch. The "nested eggs" and muesli were great with hot tea. After that we drove down the wild and rocky coast to the "pancake rocks" at Punakaiki. These are wonderful formations, where the seal pounds through many arches and spouts up in blowholes. We arrived just before the rain, and Liz managed to hobble around the path, being a good sport. We then continued down the coast to Hokitika, an artists colony. We took a quick walk across the street to look at the glowworm dell (nice, but nothing like the cave rafting) before hitting the sack.
The next morning, Liz's foot was still pretty swollen, so we decided to just hang around Hoki for the day. We had read about a class where she could make her own greenstone jewelry- and she was pretty interested in that. So we left her in the hands of the Mad Kiwi at the Just Jade Experience for the day. Vicki and I walked the shops and drove out thought the beautiful Hoki valley to the Hokitika Gorge. When we came back, we took Liz through a few shops and also visited the Kiwi Centre. This is an eclectic menagerie that is obviously someone's aquarium hobby that got away from them. I could do without the giant eels. However, the kiwi exhibit was great. They are in a nocturnal room, so they were awake and feeding, and they come up to just a few feet away from you, so you can really see them well. Before we left Hokitika, we had a great meal of Indian food. We each had a lamb dish. Because the sun sets so late here, we were able to leave Hoki at 6:30 pm and drive down to Franz Josef , reaching that town at the foot of the glaciers while it was still light out at 8:30 pm. The weather was great, for the wet West Coast, and we could see the mountains marching down to the sea the whole way.
Wednesday morning, I got up and made arrangements to do a glacier hike. Liz and Vicki checked out the town, and walked up the valley to the glacier foot. However, to go up onto the glacier, you need to take a guided tour. So at 10:30 I reported to Franz Josef Glacier Guides. Here they give you a set of special leather boots with hobnails in them, a pair of "talonz" (which are just special ice crampons for the boots) and a Goretex parka. About 40 of us hopped on the bus to the carpark up the valley, and then we hiked in to the foot of the glacier, about 2 km. over very rough country. Once at the foot of the glacier, we split into 12 man teams, then started climbing- straight up the ice. After going up just a little ways, we stopped and put on our talonz. Then keep climbing, up and up over ice that graduallly cleared of rock and became the most beautiful turquoise blue color. We crossed over two crevasses on ladders, climbed up many pitches with ropes and finally at the "top" walked next to an 800 meter tall huge waterfall cascading down the valley wall onto the side of the glacier. We traversed down into a few crevasses,and walked through an ice cave- something I've always wanted to do. Overall we spent about 2 hours on the ice. We walked about 8km total, and climbed about 200 meters in altitude- although it seemed a lot more because it was such rough climbing. The glacier was awesome, and as we came back down, the sun came out and I could see, looking back, that for all our effort, we had only climbed up a very small portion of the glacier in our half-day trip. The mountains here are marvelous- they rise right out of the sea straight up to tens of thousands of feet. You really get a feel for how small you are on the face of the Earth in this landscape. When I got back down, I had the world's best tasiting peanut-butter and jelly sandwich, and we took off back north to the Hokitik area again. We stopped in town and grabbed "takeaway" fish & chips for supper. This time, instead of staying in a campgroung, we "free camped" out in a DOC campground on Lake Kaniere. This beautiful lake is tucked a way at the foot of the mountains. I took a swim in the lake, and fell into bed.
Thursday morning, after breakfast, we drove around the lake to Dorothy Falls. This is a beatiful waterfall out in the middle of nowhere. It had rained the night before, and we could hear the waterfall from the lakefront, over 100 meters away. After coming back into Hoki to do a few errands, we drove over the Arthurs' Pass. This is a wonderful feat of engineering. and one of the steepest mountain passes I've ever been over. The high country of New Zealand is dry and beautiful and the rivers really are turquoise in color due to the glacial snowmelt and powder in them.
Coming down into Canterbury, we stayed the night at Ashley Gorge at a wonderful campsite filled with families with little children on holiday. The kids here are really cute, and Vicki and I both have the impression that they are really allowed and encouraged to be children, and are less media-influenced than U.S. kids. All of them were wearing sun hats and sunscreen also, and a sundress here for a little girl means long sleeves,a nd long skirt with ruffles! We enjoyed watching them play in the dirt, river, swings, etc.
This morning we came back into Christchurch, said a sad goodbye to our campervan. In one week we put on 1400+ km, and did SO many activities. It will be a relief to stay back here in the hotel with soft beds and our own shower. Tomorrow we start down to the deep South of the country, and Monday I start orientation in Winton. Its been a great holiday, but we are anxious to "light" and stay in one place for awhile.
Sunday, January 11, 2004
Saturday, January 10, 2004
Westport
Today is Sunday.. This will be a late post as I have to type this offline and hope I can find someplace to upload these blogs soon. The internet access we have had has been disappointing to say the least. At last nights attempt, I could read email, but not Reply because java-script was disabled, apparently by some virus checker on the rental machine!
Friday morning dawned in Kaikoura with a double rainbow over our caravan, in the mist between us and the mountains. This quickly gave way to another absolutely blue day, with intense sunshine on the bay. The mountains were in stark relief and the wind was gentla and cool off the Pacific. We packed up and drove our campervan out to the end of the peninsula to explore the rocks and tide pools before leaving this magical place. As we drove into the "carpark", we pulled up and saw a sea lion basking in the sun right in front of us. We walked down and watched him (or her) back-scratching with a hind flipper. He let us take a few pictures, then waddled off into the bay, rolling over and waving flippers, doing somersaults on the way out into the sea. We explored tidal pools for awhile, then climbed into the campervan and headed off into the center of the South Island.
I drove the first stretch up along the outer Kaikoura range. This started as a pleasant drive through the valley floor, studded with wooly sheep as far as one could see. Then the road began to climb up into the hills and mountains. This became more of a challenge, as the road twists and turns quite a bit. Just as you top a rise of a hill, you suddenly dive back down into the next canyon, going around hairpin turns and switchbacks, with Kiwi drivers and trucks barreling around the turns at 100 kph in the opposite direction, just to make it interesting. Then, at the bottom of the ravines, you come to the famous New Zealand "one lane bridge". Almost all the backcountry bridges are of this variety. As you approach the bridge, a sign with up and down arrows tells you whether you or the opposite driver has the right of way. If your arrow is bolded, you can run right across- assuming there is no one already on the bridge. If not, you must slow down and wait till the other side is all across. Vicki surmises that these bridges are one lane to keep costs down. New Zealands geology is such that flash floods and bridge washouts must be very common. Many of these bridges looked fairly new.
Once we climbed up onto the plateau, we came into "tussock country" with large basins and ranges covered with sheep farms. It has been do dry here that all this land was golden-brown colored; dotted here and there with trees and flowers in bloom.
As we drove up into the mountains, we crossed a divide and came into a river valley where the river was obviously in full flood stage. It was chocolate brown, roaring down the canyon, and full of tree trunks and logs. A bit farther up the road, and we came around the corner to find a long line of cars ahead of us. The drivers and passengers were all out in the road, talking and partying. In fact, the 3 or 4 cars ahead of us were having a group picture! One of the drivers came back and told us "Bridge is washed out up ahead by the flood, eh? Might be 2 or 2 and 1/2 hours they tell us. Might as well take it easy." Although we had planned to drive through the mountains to Westport, we decided at that point to double back to Hamner Springs, since we had just passed the turnoff.
Hamner Springs is a mountain spa or retreat popular with people from Christchurch. It is well known for its mineral springs and hot baths. We drove through the town, and found a wonderful campsite a few kilometers out of town. It was a former forestry camp, converted into a retreat center for the physcially and mentally handicapped. Since school is out now, they welcome campers. After making arrangements, we went back into town and took a baths in the hot springs. These were 39 to 42 degrees Centigrade, and very nice. Vicki and I even spent a few minutes in the sulfur pools. The baths were nicely remodeled, witth rock pools, little bridges and wonderful landscaping. We really felt clean after soaking for an hour. We found Liz some Internet access for awhile, and got some fish and chips for dinner. We returned to the campsite and listened to the birds singing in the trees overhead. It was a lovely site, very quiet (we were 1 of 2 families there).
About 4 AM I got up to use the facilities, and was just "gobsmacked" at the stars overhead. It was really the first time I'd seen them well- it was too humid and lighted in Kaikoura. Up in the mountains, the stars were spectacular, although I will have to work a bit to find my way around this Southern Hemisphere sky. Orion is prominent, but the constellation appears to be standing on his head, with Betelgeuse towards the horizon and Sirius well overhead. I could identify the Southern Cross, and the Milky Way. Otherwise, the constellations are completely unfamiliar.
Saturday we had a little muesli and coffee or tea, and then went hiking. It seems every little town in this country has some "walks" nearby. We had seen some labeled as "nature trail" and "waterfall trail" just down the road from our campsite. So we drove to the trailhead, put on our hiking boots and set out. Liz was game for the Waterfall Trail, so we started up. And up. And UP. This trail rose along a mountain stream that was pure waterfall surrounded by ferns. We climbed at a steep pace for 1 and 1/2 hours up through the forest. I figure we went up about 1500 feet vertical elevation, and around several twists and turns in the canyon. In several places there were stairs to climb. However, it was a pleasant climb. The forest was Mountain Beech with many other trees mixed in, and it was full of birds. The birdsongs here are amazing- they sing extremely loudly, especially in the morning and evening. In the forest, we could never see the little bird singing however, sometimes they seemed only a few feet away, they were so loud. There are few insects, and no small animals. The stream is clear, and I could not see any minnows or fish in it. When we came out to the top, we had a grand view of the valley to the south. The trail then wound back into the canyon to a high waterfall coming down from Mount Isobel, that I estimated to be about 75 to 80 feet tall. It was in a grotto full of moss, ferns, and lichens. Quite beautiful and worth the climb. Once back down to the trailhead, we had a quick lunch, and drove on over Lewis Pass. We stopped in the little town of Reefton for ice cream, then drove through a beatiful valley in front of the Victoria Range. Vicki drove down the Buller RIver canyon, which features not only many one-lane bridges, but one section of "one-laned" highway, where the road literally hangs off the rock over the gorge, with nothing but wall to wall river below. To decide who goes first, one looks into the parabolic mirrors to see if any traffic is coming.
We rolled into Westport around 6 pm, and everything was closed. Westport is a port on the Tasman Sea, and looks like the south pacific towns in movies like "Mr. Roberts". The sidewalks are all covered with corrugated awnings, the single story cinderblock buildings are brightly painted in pastels, and there is one lane to the town, ending in the harbor full of fishing boats and the cement-loading port facility. We found a nice campground after having supper in a combination "Chinese restaurant/fish and chips takeaway" (which was really quite good). We had a nice walk on the beach whick featured roaring surf and dinner plate sized jellyfish washed up on the sand. Liz was bitten by sand flies at the end of our mountain hike, and she was having a lot of swelling and itching despite her Alavert, but she was being a good sport about it.
Upon signing in at Westport, the campground manager talked us into signing up for the Underworld Rafting tour in Charleston, just south of here. So this morning we got up at 0715 for shuttle pickup. Our guide, Sandy, who looked to be about 20 met us and took us to the "base camp". There we collected our wet suits, helmets and gear, and took a further shuttle down into the valley of the Nile river. This is a beautiful temperate rain forest, full of tree ferns and tall rata trees covered in red flowers. Several people told us the valley was used as an outdoor set for BBC series, "The Lost World". The river runs through a canyon of tall limestone cliffs, at least 200 feet tall. It certainly looked like a dinosaur could appear at any minute. The journey continued with a 2km train ride up the valley, through the rainforest. Once at the end, we were warned that this was "the last toilet break for 3 hours" and directed into the bushes. Then we put on our wet suits, grabbed our inner tubes, and then tramped about 1/4 km through the jungle and across the river. Next, we climbed 111 steps up to the cave entrance. This is the largest cave in New Zealand, and it was only discovered in the 60's. Its now part of a local National Park. Its still very wild, and very little changed from its discovered state. We started on the top level of the cave, and progessively walked down and deeper into the earth. The cave formations were exquisite; pure white flowstons in draperies, thousands of staws, and columns. I have never seen such beautiful draperies, and I've been in many caves, (including Mammoth Cave in Kentucky). We progressed down through 4 distinct levels, and took a break once to sit on our tubes and experience complete darkness, and complete silence except for the drip of the water in the cave. It was cold in there- 11 degress C. and we could see our breath. I was glad for the wet suit, as we tromped through mud and fell on our bottoms more than once. As we reached the lower levels, we came into a glowworm chamber. These insects are unique to the Southerrn hemisphere. The larva live on the roofs of caves or rock grottos, and spin sticky threads. They then attract flying insects by glowing, like a firefly, but with a steady light. In the dark, they shine like the stars in the Milky Way. In the dark cave passage, they were very special and beautiful. But the best was yet to come. The inner tubes we'd hauled all through the cave were now put to good use. As we came into the bottom level of the cave, after walking about 3 km through it, we entered a rivering passage. It was clear that the recent flooding here had washed stuff up into the tubes- there were leaves and branches, and a few logs. We then reached a dark underground lake. Here we plopped our bottoms into the inner tubes and set sail in an "inner tube" train through the passages leading out of the black pool. We turned off our lights, and as we floated backwards through the darkness, tens of thousands of glowworms became visible on the roof of the passages. Words do not describe the sensation of lying in the cool water and floating down this river of night. Finallly we rounded a bend and faint light of day began to appear. As we floated out of the gloworm's domain, gaps appeared in the roof overhead and sunlight streamed down, along with long lianas, ferns and the roots of trees precariosly perched on the edges of these skylights. Rounding a couple of more bends, we came out into an a small recess in the cliff face above with the river in front of us. To complete our trip, we plopped back into our tubes, and rafted down the river, over several fun rapids back to our starting point. A quick change, a train trip back to the shuttle, and a short ride up the hill took us back to the daylit world and a cup of delicious hot chocolate, tasting wonderful after a long mornings walk and rafting. Home again, a shower and the rest of day spent doing camp chores, making dinner, talking over our adventure and giving Liz's swollen foot a rest and wrap. Another wonderful day in New Zealand.
Today is Sunday.. This will be a late post as I have to type this offline and hope I can find someplace to upload these blogs soon. The internet access we have had has been disappointing to say the least. At last nights attempt, I could read email, but not Reply because java-script was disabled, apparently by some virus checker on the rental machine!
Friday morning dawned in Kaikoura with a double rainbow over our caravan, in the mist between us and the mountains. This quickly gave way to another absolutely blue day, with intense sunshine on the bay. The mountains were in stark relief and the wind was gentla and cool off the Pacific. We packed up and drove our campervan out to the end of the peninsula to explore the rocks and tide pools before leaving this magical place. As we drove into the "carpark", we pulled up and saw a sea lion basking in the sun right in front of us. We walked down and watched him (or her) back-scratching with a hind flipper. He let us take a few pictures, then waddled off into the bay, rolling over and waving flippers, doing somersaults on the way out into the sea. We explored tidal pools for awhile, then climbed into the campervan and headed off into the center of the South Island.
I drove the first stretch up along the outer Kaikoura range. This started as a pleasant drive through the valley floor, studded with wooly sheep as far as one could see. Then the road began to climb up into the hills and mountains. This became more of a challenge, as the road twists and turns quite a bit. Just as you top a rise of a hill, you suddenly dive back down into the next canyon, going around hairpin turns and switchbacks, with Kiwi drivers and trucks barreling around the turns at 100 kph in the opposite direction, just to make it interesting. Then, at the bottom of the ravines, you come to the famous New Zealand "one lane bridge". Almost all the backcountry bridges are of this variety. As you approach the bridge, a sign with up and down arrows tells you whether you or the opposite driver has the right of way. If your arrow is bolded, you can run right across- assuming there is no one already on the bridge. If not, you must slow down and wait till the other side is all across. Vicki surmises that these bridges are one lane to keep costs down. New Zealands geology is such that flash floods and bridge washouts must be very common. Many of these bridges looked fairly new.
Once we climbed up onto the plateau, we came into "tussock country" with large basins and ranges covered with sheep farms. It has been do dry here that all this land was golden-brown colored; dotted here and there with trees and flowers in bloom.
As we drove up into the mountains, we crossed a divide and came into a river valley where the river was obviously in full flood stage. It was chocolate brown, roaring down the canyon, and full of tree trunks and logs. A bit farther up the road, and we came around the corner to find a long line of cars ahead of us. The drivers and passengers were all out in the road, talking and partying. In fact, the 3 or 4 cars ahead of us were having a group picture! One of the drivers came back and told us "Bridge is washed out up ahead by the flood, eh? Might be 2 or 2 and 1/2 hours they tell us. Might as well take it easy." Although we had planned to drive through the mountains to Westport, we decided at that point to double back to Hamner Springs, since we had just passed the turnoff.
Hamner Springs is a mountain spa or retreat popular with people from Christchurch. It is well known for its mineral springs and hot baths. We drove through the town, and found a wonderful campsite a few kilometers out of town. It was a former forestry camp, converted into a retreat center for the physcially and mentally handicapped. Since school is out now, they welcome campers. After making arrangements, we went back into town and took a baths in the hot springs. These were 39 to 42 degrees Centigrade, and very nice. Vicki and I even spent a few minutes in the sulfur pools. The baths were nicely remodeled, witth rock pools, little bridges and wonderful landscaping. We really felt clean after soaking for an hour. We found Liz some Internet access for awhile, and got some fish and chips for dinner. We returned to the campsite and listened to the birds singing in the trees overhead. It was a lovely site, very quiet (we were 1 of 2 families there).
About 4 AM I got up to use the facilities, and was just "gobsmacked" at the stars overhead. It was really the first time I'd seen them well- it was too humid and lighted in Kaikoura. Up in the mountains, the stars were spectacular, although I will have to work a bit to find my way around this Southern Hemisphere sky. Orion is prominent, but the constellation appears to be standing on his head, with Betelgeuse towards the horizon and Sirius well overhead. I could identify the Southern Cross, and the Milky Way. Otherwise, the constellations are completely unfamiliar.
Saturday we had a little muesli and coffee or tea, and then went hiking. It seems every little town in this country has some "walks" nearby. We had seen some labeled as "nature trail" and "waterfall trail" just down the road from our campsite. So we drove to the trailhead, put on our hiking boots and set out. Liz was game for the Waterfall Trail, so we started up. And up. And UP. This trail rose along a mountain stream that was pure waterfall surrounded by ferns. We climbed at a steep pace for 1 and 1/2 hours up through the forest. I figure we went up about 1500 feet vertical elevation, and around several twists and turns in the canyon. In several places there were stairs to climb. However, it was a pleasant climb. The forest was Mountain Beech with many other trees mixed in, and it was full of birds. The birdsongs here are amazing- they sing extremely loudly, especially in the morning and evening. In the forest, we could never see the little bird singing however, sometimes they seemed only a few feet away, they were so loud. There are few insects, and no small animals. The stream is clear, and I could not see any minnows or fish in it. When we came out to the top, we had a grand view of the valley to the south. The trail then wound back into the canyon to a high waterfall coming down from Mount Isobel, that I estimated to be about 75 to 80 feet tall. It was in a grotto full of moss, ferns, and lichens. Quite beautiful and worth the climb. Once back down to the trailhead, we had a quick lunch, and drove on over Lewis Pass. We stopped in the little town of Reefton for ice cream, then drove through a beatiful valley in front of the Victoria Range. Vicki drove down the Buller RIver canyon, which features not only many one-lane bridges, but one section of "one-laned" highway, where the road literally hangs off the rock over the gorge, with nothing but wall to wall river below. To decide who goes first, one looks into the parabolic mirrors to see if any traffic is coming.
We rolled into Westport around 6 pm, and everything was closed. Westport is a port on the Tasman Sea, and looks like the south pacific towns in movies like "Mr. Roberts". The sidewalks are all covered with corrugated awnings, the single story cinderblock buildings are brightly painted in pastels, and there is one lane to the town, ending in the harbor full of fishing boats and the cement-loading port facility. We found a nice campground after having supper in a combination "Chinese restaurant/fish and chips takeaway" (which was really quite good). We had a nice walk on the beach whick featured roaring surf and dinner plate sized jellyfish washed up on the sand. Liz was bitten by sand flies at the end of our mountain hike, and she was having a lot of swelling and itching despite her Alavert, but she was being a good sport about it.
Upon signing in at Westport, the campground manager talked us into signing up for the Underworld Rafting tour in Charleston, just south of here. So this morning we got up at 0715 for shuttle pickup. Our guide, Sandy, who looked to be about 20 met us and took us to the "base camp". There we collected our wet suits, helmets and gear, and took a further shuttle down into the valley of the Nile river. This is a beautiful temperate rain forest, full of tree ferns and tall rata trees covered in red flowers. Several people told us the valley was used as an outdoor set for BBC series, "The Lost World". The river runs through a canyon of tall limestone cliffs, at least 200 feet tall. It certainly looked like a dinosaur could appear at any minute. The journey continued with a 2km train ride up the valley, through the rainforest. Once at the end, we were warned that this was "the last toilet break for 3 hours" and directed into the bushes. Then we put on our wet suits, grabbed our inner tubes, and then tramped about 1/4 km through the jungle and across the river. Next, we climbed 111 steps up to the cave entrance. This is the largest cave in New Zealand, and it was only discovered in the 60's. Its now part of a local National Park. Its still very wild, and very little changed from its discovered state. We started on the top level of the cave, and progessively walked down and deeper into the earth. The cave formations were exquisite; pure white flowstons in draperies, thousands of staws, and columns. I have never seen such beautiful draperies, and I've been in many caves, (including Mammoth Cave in Kentucky). We progressed down through 4 distinct levels, and took a break once to sit on our tubes and experience complete darkness, and complete silence except for the drip of the water in the cave. It was cold in there- 11 degress C. and we could see our breath. I was glad for the wet suit, as we tromped through mud and fell on our bottoms more than once. As we reached the lower levels, we came into a glowworm chamber. These insects are unique to the Southerrn hemisphere. The larva live on the roofs of caves or rock grottos, and spin sticky threads. They then attract flying insects by glowing, like a firefly, but with a steady light. In the dark, they shine like the stars in the Milky Way. In the dark cave passage, they were very special and beautiful. But the best was yet to come. The inner tubes we'd hauled all through the cave were now put to good use. As we came into the bottom level of the cave, after walking about 3 km through it, we entered a rivering passage. It was clear that the recent flooding here had washed stuff up into the tubes- there were leaves and branches, and a few logs. We then reached a dark underground lake. Here we plopped our bottoms into the inner tubes and set sail in an "inner tube" train through the passages leading out of the black pool. We turned off our lights, and as we floated backwards through the darkness, tens of thousands of glowworms became visible on the roof of the passages. Words do not describe the sensation of lying in the cool water and floating down this river of night. Finallly we rounded a bend and faint light of day began to appear. As we floated out of the gloworm's domain, gaps appeared in the roof overhead and sunlight streamed down, along with long lianas, ferns and the roots of trees precariosly perched on the edges of these skylights. Rounding a couple of more bends, we came out into an a small recess in the cliff face above with the river in front of us. To complete our trip, we plopped back into our tubes, and rafted down the river, over several fun rapids back to our starting point. A quick change, a train trip back to the shuttle, and a short ride up the hill took us back to the daylit world and a cup of delicious hot chocolate, tasting wonderful after a long mornings walk and rafting. Home again, a shower and the rest of day spent doing camp chores, making dinner, talking over our adventure and giving Liz's swollen foot a rest and wrap. Another wonderful day in New Zealand.
Wednesday, January 07, 2004
Kaikoura
I've blogged a bit on my laptop the last few days, but can't figure out a way to upload them, so I'm writing this in an Internet Cafe in Kaikoura, New Zealand, while the girls are taking a well deserved nap. {I will add the missing blogs later when I can}.
Tuesday: we got up, ate a great breakfast in the hotel, the Chateau on the Park, and on return from breakfast our bags had arrived (24 hours late). We had just enough time to check them in and then we and walked down through same park to Christchurch Hospital, where I had my final interview for my "Registration"- same as medical license- with the Professor who runs their residency program. He had few questions for me, was very nice and helped me through the paperwork. His advice for rural practice: "be careful of your distance with patients" in a small town. He also wanted to know if I was used to prescibing generics, since the NZ government contracts for a formularly of approved drugs, and Brand names can be very expensive. After the inteview, we took a quick look at the hospital- very nice, and like all hospitals the world over, shadowed by a giant construction crane building a new wing. Wandering down thru the rest of the park in to the center of town, we watched an Asian grandmother and her grandchild float past on the Avon River, part of "punting in the park". Visited ANZ bank where we were told to come back at 3 pm for an interview to set up a new bank account. We visited the Christchurch cathedral and walked through it- very interesting history- the stepple's been toppled 3x by earthquakes. Rode the Tram through the town center. The Tram is actually a guided tour of the town, and was quite helpful at getting us oriented. Visited the art museum, where an exhibit of "Japonese" influence on fashion was showing. The kimonos were quite beautiful. Liz like the dress designed like a Zen sand garden, with the pinned pleats. Capped off the afternoon (after visiting the bank again) with a walk through the Botanical Gardens on the way back to the hotel. This was wonderful- I was surprised and delighted at every turn. Turn the corner, and there is New Zealand native forest, turn again and a giant redwood tree, at least 150+ years old. Turn again, and a wonderful rock garden with herbs and small shrubs appears. One more turn, and a beatiful lilly pond, reminiscent of Monet's painting, complete with stone bridge. It was quite beautiful.
Yesterday we awoke in the hotel and reorganized; checking the viola and a bag of mostly SHOES to lighten our load. The shuttle came and we rode out to the airport, where we spent about 2 hours getting the check out and instructions on the campervan rental. I got to be first driver, since Vicki admits she does not know right from left. I tentatively drove out about 3 km. to a local grocery store, where we stocked. Then we took Route 1 north, out of Christchurch through stunning landscapes toward Kaikoura. Everything is browned here due to the heat and drought they are having, but the hills rise right up out of the plain and then there are sheep everywhere. We also saw herds of deer, and 1 flock of about 100 ostriches. Only saw 2 llamas. I drove for about 1.5 hours, which was as thrilling and scary as any driving I have ever done- my first time driving on the LEFT hand side, on mostly 2 lane roads, with huge lorries (trucks) coming the other way.
Then it was Vicki's turn. If my driving was a thrill ride, her's was a horror ride. Not because of her skills, but because the road soon turned into twisting, turning, switchbacked mountain roads and it began to rain. We were also following a tandem truck carrying a load of sheep. They do NOT have guard rails in this country,and I had great views over the edge down into many ravines on the way here. Liz was sleeping in the back (motion sickness) but kept getting woken up with shouts of "shoulder, shoulder" or "truck, truck". It was a relief to come down out fo the mountains and down to Kaikoura and the turquoise blue of the Pacific. We camped in a Top Ten Holiday Park here (its a brand name, like KOA), made ourselves a dinner of lamb steaks, "roasties" (pototoes, kumara, etc) and salad, and fell into bed, listening to the drizzle.
I was up at 0700 today to find a beautful clear, blue sky day with minimal breezes. We had a quick cup of tea, took our meclizine and headed down to the Dolphin Swim HQ here in town. (read prev. posts about this plan). Our check in was 0820. After a bit of delay waiting for the "0530 swim" to return, we had our briefing and climbed into our clammy wet suits, hopped on the bus to go to the harbour at South Bay. We went around the peninsula here to the North Bay first, but the dolphins we found there were swimming extremely fast- about 20 knots and not in a mood to play with us. So back around to South Bay, and Liz was a little green around the gills despite meds, but was a trouper in the 1 meter seas. South Bay was calmer, we went down coast about 15 km and found a pod of resting dolphins. Then, its jump off the back of the boat into the cold seas when the horn sounds, and swim out and "entertain" thge animals. There is no baiting or other enticing of the dolphins, which are wild animals. They will come to you only if you are of interest. The tour suggests things like diving down (see Dec 11th pic) or singing. Since I knew dolphins were intellilgent, I picked the first part of a Bach Partita to hum and sing. And zoom, here come 3 dusky dolphins up out of the green deep to look me right in the eye. My heart started pounding; what an adrenaline rush this was. I dived down and swam around and just enjoyed watching them on this beautiful day. We were called back to the boat after only 10 exhausting minutes, but then moved around and had 3 more similar swims with the dolphins. On my last swim I dove down and sang and had 3 of them circle me twice about 2-3 feet away. This place, Kaikoura, is really stunningly beautiful, much more than pictures can ever show. And this was certainly a wonderful experience. Liz prounounced it "very cool". We are going to rest up overnight and try to figure out where the wanderlust takes us next, as from this point out, we have NO PLAN (very hard for a High "C" person like me to deal with, so I will put on my "I" hat and be impulsive, inquisitive, and spontaneous. I am SO glad to be here. The last 3 days have been truly intense living.
I've blogged a bit on my laptop the last few days, but can't figure out a way to upload them, so I'm writing this in an Internet Cafe in Kaikoura, New Zealand, while the girls are taking a well deserved nap. {I will add the missing blogs later when I can}.
Tuesday: we got up, ate a great breakfast in the hotel, the Chateau on the Park, and on return from breakfast our bags had arrived (24 hours late). We had just enough time to check them in and then we and walked down through same park to Christchurch Hospital, where I had my final interview for my "Registration"- same as medical license- with the Professor who runs their residency program. He had few questions for me, was very nice and helped me through the paperwork. His advice for rural practice: "be careful of your distance with patients" in a small town. He also wanted to know if I was used to prescibing generics, since the NZ government contracts for a formularly of approved drugs, and Brand names can be very expensive. After the inteview, we took a quick look at the hospital- very nice, and like all hospitals the world over, shadowed by a giant construction crane building a new wing. Wandering down thru the rest of the park in to the center of town, we watched an Asian grandmother and her grandchild float past on the Avon River, part of "punting in the park". Visited ANZ bank where we were told to come back at 3 pm for an interview to set up a new bank account. We visited the Christchurch cathedral and walked through it- very interesting history- the stepple's been toppled 3x by earthquakes. Rode the Tram through the town center. The Tram is actually a guided tour of the town, and was quite helpful at getting us oriented. Visited the art museum, where an exhibit of "Japonese" influence on fashion was showing. The kimonos were quite beautiful. Liz like the dress designed like a Zen sand garden, with the pinned pleats. Capped off the afternoon (after visiting the bank again) with a walk through the Botanical Gardens on the way back to the hotel. This was wonderful- I was surprised and delighted at every turn. Turn the corner, and there is New Zealand native forest, turn again and a giant redwood tree, at least 150+ years old. Turn again, and a wonderful rock garden with herbs and small shrubs appears. One more turn, and a beatiful lilly pond, reminiscent of Monet's painting, complete with stone bridge. It was quite beautiful.
Yesterday we awoke in the hotel and reorganized; checking the viola and a bag of mostly SHOES to lighten our load. The shuttle came and we rode out to the airport, where we spent about 2 hours getting the check out and instructions on the campervan rental. I got to be first driver, since Vicki admits she does not know right from left. I tentatively drove out about 3 km. to a local grocery store, where we stocked. Then we took Route 1 north, out of Christchurch through stunning landscapes toward Kaikoura. Everything is browned here due to the heat and drought they are having, but the hills rise right up out of the plain and then there are sheep everywhere. We also saw herds of deer, and 1 flock of about 100 ostriches. Only saw 2 llamas. I drove for about 1.5 hours, which was as thrilling and scary as any driving I have ever done- my first time driving on the LEFT hand side, on mostly 2 lane roads, with huge lorries (trucks) coming the other way.
Then it was Vicki's turn. If my driving was a thrill ride, her's was a horror ride. Not because of her skills, but because the road soon turned into twisting, turning, switchbacked mountain roads and it began to rain. We were also following a tandem truck carrying a load of sheep. They do NOT have guard rails in this country,and I had great views over the edge down into many ravines on the way here. Liz was sleeping in the back (motion sickness) but kept getting woken up with shouts of "shoulder, shoulder" or "truck, truck". It was a relief to come down out fo the mountains and down to Kaikoura and the turquoise blue of the Pacific. We camped in a Top Ten Holiday Park here (its a brand name, like KOA), made ourselves a dinner of lamb steaks, "roasties" (pototoes, kumara, etc) and salad, and fell into bed, listening to the drizzle.
I was up at 0700 today to find a beautful clear, blue sky day with minimal breezes. We had a quick cup of tea, took our meclizine and headed down to the Dolphin Swim HQ here in town. (read prev. posts about this plan). Our check in was 0820. After a bit of delay waiting for the "0530 swim" to return, we had our briefing and climbed into our clammy wet suits, hopped on the bus to go to the harbour at South Bay. We went around the peninsula here to the North Bay first, but the dolphins we found there were swimming extremely fast- about 20 knots and not in a mood to play with us. So back around to South Bay, and Liz was a little green around the gills despite meds, but was a trouper in the 1 meter seas. South Bay was calmer, we went down coast about 15 km and found a pod of resting dolphins. Then, its jump off the back of the boat into the cold seas when the horn sounds, and swim out and "entertain" thge animals. There is no baiting or other enticing of the dolphins, which are wild animals. They will come to you only if you are of interest. The tour suggests things like diving down (see Dec 11th pic) or singing. Since I knew dolphins were intellilgent, I picked the first part of a Bach Partita to hum and sing. And zoom, here come 3 dusky dolphins up out of the green deep to look me right in the eye. My heart started pounding; what an adrenaline rush this was. I dived down and swam around and just enjoyed watching them on this beautiful day. We were called back to the boat after only 10 exhausting minutes, but then moved around and had 3 more similar swims with the dolphins. On my last swim I dove down and sang and had 3 of them circle me twice about 2-3 feet away. This place, Kaikoura, is really stunningly beautiful, much more than pictures can ever show. And this was certainly a wonderful experience. Liz prounounced it "very cool". We are going to rest up overnight and try to figure out where the wanderlust takes us next, as from this point out, we have NO PLAN (very hard for a High "C" person like me to deal with, so I will put on my "I" hat and be impulsive, inquisitive, and spontaneous. I am SO glad to be here. The last 3 days have been truly intense living.
Monday, January 05, 2004
Arrival
It was 28 hours after leaving Cedar Rapids that we touched down in Christchurch. I figure "Sunday" for us lasted about 6 hours, before we crossed the date line. Four takeoffs & landings. I put on my old TED hose in LA before boarding the long flight to Auckland, and I'm glad I did. (Took a baby ASA also). Twelve hours is a long time to sit in the plane, even on Air New Zealand. We had a 747, very nice. All the headrests had covers on them: "Air New Zealand, the Airline of MIddle Earth". They have footrests, which I hadn't seen before- very helpful at preventing leg cramps and soreness from prolonged siting in one position. I also noticed that they had about twice as many attendants as most US airlines. And the food was very good. When was the last time any of us had airline food at all, much less good food? I slept most of the flight- about 7 hours. Vicki couldn't sleep at all, due to about 2 hours of moderate turbulance near the beginning of the flight. She watched movies and documentaries on the monitors all night long. The tea for breakfast was wonderful, as we watched the orange and crimson sunrise under a deep blue-black field of blue at 60,000 feet. Then there appeared a few craggy small islands in the sea below, havens for wildlife; then finally the green hills and fields of the North Island and we were skimming over the bay to land at Auckland.
Immigration went very well. Then we watched an entire, full 747's worth of luggage unload, and NONE of our bags on the carosel. That is a lot of bags to watch and never see one of your own. A check with the Air NZ agent reveals that United messed up and our bags are still sitting back in Los Angeles. The good thing about this was it made clearing Customs easy; they will just check out bags when the do come in and promise to deliver them to our hotel in Christchurch. The most interesting thing on arrival, and the most fun to watch, was the Biosecurity dog. A lady came in with a small beagle which proceeded to sniff all the luggage that came off the plane, looking for any biological material that might carry harmful pests into New Zealand. Non-native organisms are a really big problem in the ecology here, and an economic threat to N.Z. agriculture. The beagle went nuts over the little old lady in front of me, who happened to have "forgotton" the two apples in her backpack, which were promptly confiscated.
Then the last flight from Auckland south to Christchurch. I was able to look out the window at Farewell Spit, Golden Bay and Able Tasman National Park, and then the foothills and peaks of the Southern Alps appeared briefly before being lost in the clouds. The geography is quite wonderful to look at from above. We came in over the Canterbury plain, the large agricultural area on South Island, which is currenlty have a heat wave and drought. Most of the fields are brown.
Christchurch is called the "garden city", and the small part I've seen certainly deserves that nickname. Our hotel has wonderful gardens with koi ponds. After taking one of the 10 best showers of our lifetimes, we walked through one suburb to a local mall- to buy a few clothes to hold us over till the luggage arrives, and also to get something to eat. This is an area of very neat, one level houses, all with gardens full of flowers in bloom, subtropical tress and bushes, and a wonderful moist marine breeze. We hope to see more of it tomorrow, but for now, we are watching a cricket match on the telly, and tyring to stay awake at least until 6-7 pm so we can get on the local time here. Its good to be here, finally. Its been a really long two days.
It was 28 hours after leaving Cedar Rapids that we touched down in Christchurch. I figure "Sunday" for us lasted about 6 hours, before we crossed the date line. Four takeoffs & landings. I put on my old TED hose in LA before boarding the long flight to Auckland, and I'm glad I did. (Took a baby ASA also). Twelve hours is a long time to sit in the plane, even on Air New Zealand. We had a 747, very nice. All the headrests had covers on them: "Air New Zealand, the Airline of MIddle Earth". They have footrests, which I hadn't seen before- very helpful at preventing leg cramps and soreness from prolonged siting in one position. I also noticed that they had about twice as many attendants as most US airlines. And the food was very good. When was the last time any of us had airline food at all, much less good food? I slept most of the flight- about 7 hours. Vicki couldn't sleep at all, due to about 2 hours of moderate turbulance near the beginning of the flight. She watched movies and documentaries on the monitors all night long. The tea for breakfast was wonderful, as we watched the orange and crimson sunrise under a deep blue-black field of blue at 60,000 feet. Then there appeared a few craggy small islands in the sea below, havens for wildlife; then finally the green hills and fields of the North Island and we were skimming over the bay to land at Auckland.
Immigration went very well. Then we watched an entire, full 747's worth of luggage unload, and NONE of our bags on the carosel. That is a lot of bags to watch and never see one of your own. A check with the Air NZ agent reveals that United messed up and our bags are still sitting back in Los Angeles. The good thing about this was it made clearing Customs easy; they will just check out bags when the do come in and promise to deliver them to our hotel in Christchurch. The most interesting thing on arrival, and the most fun to watch, was the Biosecurity dog. A lady came in with a small beagle which proceeded to sniff all the luggage that came off the plane, looking for any biological material that might carry harmful pests into New Zealand. Non-native organisms are a really big problem in the ecology here, and an economic threat to N.Z. agriculture. The beagle went nuts over the little old lady in front of me, who happened to have "forgotton" the two apples in her backpack, which were promptly confiscated.
Then the last flight from Auckland south to Christchurch. I was able to look out the window at Farewell Spit, Golden Bay and Able Tasman National Park, and then the foothills and peaks of the Southern Alps appeared briefly before being lost in the clouds. The geography is quite wonderful to look at from above. We came in over the Canterbury plain, the large agricultural area on South Island, which is currenlty have a heat wave and drought. Most of the fields are brown.
Christchurch is called the "garden city", and the small part I've seen certainly deserves that nickname. Our hotel has wonderful gardens with koi ponds. After taking one of the 10 best showers of our lifetimes, we walked through one suburb to a local mall- to buy a few clothes to hold us over till the luggage arrives, and also to get something to eat. This is an area of very neat, one level houses, all with gardens full of flowers in bloom, subtropical tress and bushes, and a wonderful moist marine breeze. We hope to see more of it tomorrow, but for now, we are watching a cricket match on the telly, and tyring to stay awake at least until 6-7 pm so we can get on the local time here. Its good to be here, finally. Its been a really long two days.
Sunday, January 04, 2004
The Day Arrives
I'm writing this from the Air New Zealand terminal at LAX, waiting for them to call the flight. The last two days have been busy, to say the least. We've been "packing" all week; but didn't really put things into the suitcases until New Years Day night. Liz had a New Years Eve party and slept in late the next day. Leah and I went to see The Return of the King because I just couldn't leave for N.Z. without seeing it. Then we came home and started packing suitcases. We did this by getting everything out all over the living room floor and then trying to arrange it by "needed in the Caravan" vs. "needed in Winton later on". We got it down to 5 checked suitcases, and a carryon each, plus Liz's viola. Although two of the suitcases are huge. The universal packing list was really helpful, although mostly for being able to discuss what to take, what to buy there (flip-flops for example) and what we will just get along without.
After packing Thursday night, Liz stayed up till 4 AM and took Leah to the airport. She left at 5 AM and was back in Cleveland by 10 AM. Liz went to bed about 6. Then Friday morning the plumber showed up an hour early. Vicki had just put a load in the wash- we didn't expect them till 9 AM. I had to wake poor Liz back up and tell her it was "now or never" to use the bathroom. To winterize the house, we had the plumber drain all the pipes and blow them out. This meant no more water to wash clothes, house or hands. Worse, he put antifreeze down all the drains, so we couldn't even use the toilets. We cleaned up and finished preparing the place with a few runs to Vicki's mom's place in between. We set the thermostats to 50, turned the alarms on, said a prayer and left. The neighbors and friends will keep a close eye on the place. We have spent so much time planning and preparing that it is just a relief to finally be on our way.
I'm writing this from the Air New Zealand terminal at LAX, waiting for them to call the flight. The last two days have been busy, to say the least. We've been "packing" all week; but didn't really put things into the suitcases until New Years Day night. Liz had a New Years Eve party and slept in late the next day. Leah and I went to see The Return of the King because I just couldn't leave for N.Z. without seeing it. Then we came home and started packing suitcases. We did this by getting everything out all over the living room floor and then trying to arrange it by "needed in the Caravan" vs. "needed in Winton later on". We got it down to 5 checked suitcases, and a carryon each, plus Liz's viola. Although two of the suitcases are huge. The universal packing list was really helpful, although mostly for being able to discuss what to take, what to buy there (flip-flops for example) and what we will just get along without.
After packing Thursday night, Liz stayed up till 4 AM and took Leah to the airport. She left at 5 AM and was back in Cleveland by 10 AM. Liz went to bed about 6. Then Friday morning the plumber showed up an hour early. Vicki had just put a load in the wash- we didn't expect them till 9 AM. I had to wake poor Liz back up and tell her it was "now or never" to use the bathroom. To winterize the house, we had the plumber drain all the pipes and blow them out. This meant no more water to wash clothes, house or hands. Worse, he put antifreeze down all the drains, so we couldn't even use the toilets. We cleaned up and finished preparing the place with a few runs to Vicki's mom's place in between. We set the thermostats to 50, turned the alarms on, said a prayer and left. The neighbors and friends will keep a close eye on the place. We have spent so much time planning and preparing that it is just a relief to finally be on our way.
Tuesday, December 30, 2003
Christmas and New Years
There haven't been many posts lately and its all Leah's fault.
Our house is usually quiet and peaceful, but when she comes home from college its full of noise, music and laughter. That's not a bad thing. She has enjoyed staying home with us, NOT practicing violin, and cooking a lot in the kitchen. The Food Channel and Martha Stewart are apparently favorites of her college crowd, and she is constantly coming up with little food fact tidbits that are funny or surprising.
Our tradition is for me to take my daughters out shopping, for their Mom, on Christmas eve. I was on call that day, so we went the weekend before. As they've gotton older, we bring Vicki along also. We went to our favorite restaurant, Sushi Popo, in Iowa City, then to complete the day, took in The Last Samurai for our holiday movie. It was a great day. However, it led to some fallout later in the week when the girls made Christmas cookies.
True to form, this was the LAST Samurai cookie to be eaten.
We kept Christmas simple, staying at home. We've wanted to spend a lot of time with Leah since we won't see her for 6 months.
Liz did most of the Xmas decorating- her "5 minute" decorations could give Martha a run for the money I think.
We ARE getting ready to go. There are a million things to do. Spent last weekend doing financials and backing up data from computers in the house. Doing a lot of cleaning and organizing. Going to the store for last minute things, or ordering them express on line. My electronic stethescope went on the fritz last Friday, so I had to frantically order a new one rushed, so it wouldn't arrive the day after we leave. Found a good deal online, and it arrived today.
Leah and I did have time to sneak away Sunday for an hour to see the new IMAX movie here in Cedar Rapids: Shackleton's Antartic Adventure. I'd read South a number of years ago. Ernest Shackleton, the explorer, was an unsung hero who is only now, almost 100 years later getting the recognition he deserves. His book is very "matter of fact"; when you see the size of the ocean, icebergs and mountains he survived, it just takes your breath away. This is the kind of film the IMAX was invented for. The views of the icebergs, wildlife and seas of the Southern Ocean and South Georgia are stupendous and have an otherworldly beauty. I don't think I'll ever get to Antarctica, but I do hope to at least see some penguins in N.Z.
Everyone has been asking me if we're packed, ready to go, feeling excited. I would say that we're excited but also a little terrified. Vicki's dislike of flying, the terrorist alerts and the distance all make it a little daunting. I can find new things to worry about every day. I think it is natural, with only a few days to go, to wonder what we've got ourselves into. The Shackleton film was helpful in maintaining perspective. New Zealand is a civilized and friendly country. It helps to remember: "No matter how bad a fix you're in, its never going to be as bad as the one Shackleton encountered." And he brought every man back alive.
There haven't been many posts lately and its all Leah's fault.
Our house is usually quiet and peaceful, but when she comes home from college its full of noise, music and laughter. That's not a bad thing. She has enjoyed staying home with us, NOT practicing violin, and cooking a lot in the kitchen. The Food Channel and Martha Stewart are apparently favorites of her college crowd, and she is constantly coming up with little food fact tidbits that are funny or surprising.
Our tradition is for me to take my daughters out shopping, for their Mom, on Christmas eve. I was on call that day, so we went the weekend before. As they've gotton older, we bring Vicki along also. We went to our favorite restaurant, Sushi Popo, in Iowa City, then to complete the day, took in The Last Samurai for our holiday movie. It was a great day. However, it led to some fallout later in the week when the girls made Christmas cookies.
True to form, this was the LAST Samurai cookie to be eaten.
We kept Christmas simple, staying at home. We've wanted to spend a lot of time with Leah since we won't see her for 6 months.
Liz did most of the Xmas decorating- her "5 minute" decorations could give Martha a run for the money I think.
We ARE getting ready to go. There are a million things to do. Spent last weekend doing financials and backing up data from computers in the house. Doing a lot of cleaning and organizing. Going to the store for last minute things, or ordering them express on line. My electronic stethescope went on the fritz last Friday, so I had to frantically order a new one rushed, so it wouldn't arrive the day after we leave. Found a good deal online, and it arrived today.
Leah and I did have time to sneak away Sunday for an hour to see the new IMAX movie here in Cedar Rapids: Shackleton's Antartic Adventure. I'd read South a number of years ago. Ernest Shackleton, the explorer, was an unsung hero who is only now, almost 100 years later getting the recognition he deserves. His book is very "matter of fact"; when you see the size of the ocean, icebergs and mountains he survived, it just takes your breath away. This is the kind of film the IMAX was invented for. The views of the icebergs, wildlife and seas of the Southern Ocean and South Georgia are stupendous and have an otherworldly beauty. I don't think I'll ever get to Antarctica, but I do hope to at least see some penguins in N.Z.
Everyone has been asking me if we're packed, ready to go, feeling excited. I would say that we're excited but also a little terrified. Vicki's dislike of flying, the terrorist alerts and the distance all make it a little daunting. I can find new things to worry about every day. I think it is natural, with only a few days to go, to wonder what we've got ourselves into. The Shackleton film was helpful in maintaining perspective. New Zealand is a civilized and friendly country. It helps to remember: "No matter how bad a fix you're in, its never going to be as bad as the one Shackleton encountered." And he brought every man back alive.
Thursday, December 18, 2003
What Have I Forgotton
This week feels like I've done most of the "do way ahead" (passport, documents, reservations) stuff, but its still too early to pack. It feels like I'm in limbo, and a little unreal. Because three weeks from today we start driving around NZ. I have this terrible feeling that I've forgotten something crucial.
The one cool trick I've found in the last week involves the mail. The post office will let us do a temporary "change of address" so I can forward all our mail for someone to check through while we are gone. They will only forward magazines for 60 days- and frankly I could miss most of them, but it seems a waste to just pitch them. I found that its a snap to change your magazine addresses on-line. You just go to the site- like Newsweek- and put in your old address. The magazine will find your subscription, and then let you change it to a new address. I guess like Rings of Power and nuclear physics, this trick could be used for evil purposes, but in this case I've sent the magazines to my mother-in-law who knows a lot of people who might like to read them. And she can save the Natural History magazine for me.
I've spent a lot of time in my clinics the last month talking to patients about "who will cover for me" while I am gone. While there is much bemoaning the statistics that show patients don't value "continuity of care" [one study showed patients would switch doctors for $5 difference in price!], I sure don't find this to be true. Some of my patients have been really upset. Goodness, its only 6 months, and it might mean 1 visit with someone else for many of them! I don't feel like I'm that special or irreplaceable. But then I think how I've missed some of the professionals I've seen for years- my optometrist from Quincy, my dentist when she injured her hand- and I can see their point of view. Its the security of seeing someone you know, versus the anxiety of having to meet a new person when you don't feel well. The most poignant visit was with one of my little ladies who is in her late 90's. We both knew there was a great chance I might not see her again at all, or at least in her current state of health. That will make me sad. I'm not sure I've done much good for her, but we've had some great talks about end of life care, and the death of her husband a few years ago. I imagine it must be very hard to lose so many people, and be one of the last survivors of your generation. She said goodbye with such grace and humor however; I only hope I can emulate her in my dotage.
This week feels like I've done most of the "do way ahead" (passport, documents, reservations) stuff, but its still too early to pack. It feels like I'm in limbo, and a little unreal. Because three weeks from today we start driving around NZ. I have this terrible feeling that I've forgotten something crucial.
The one cool trick I've found in the last week involves the mail. The post office will let us do a temporary "change of address" so I can forward all our mail for someone to check through while we are gone. They will only forward magazines for 60 days- and frankly I could miss most of them, but it seems a waste to just pitch them. I found that its a snap to change your magazine addresses on-line. You just go to the site- like Newsweek- and put in your old address. The magazine will find your subscription, and then let you change it to a new address. I guess like Rings of Power and nuclear physics, this trick could be used for evil purposes, but in this case I've sent the magazines to my mother-in-law who knows a lot of people who might like to read them. And she can save the Natural History magazine for me.
I've spent a lot of time in my clinics the last month talking to patients about "who will cover for me" while I am gone. While there is much bemoaning the statistics that show patients don't value "continuity of care" [one study showed patients would switch doctors for $5 difference in price!], I sure don't find this to be true. Some of my patients have been really upset. Goodness, its only 6 months, and it might mean 1 visit with someone else for many of them! I don't feel like I'm that special or irreplaceable. But then I think how I've missed some of the professionals I've seen for years- my optometrist from Quincy, my dentist when she injured her hand- and I can see their point of view. Its the security of seeing someone you know, versus the anxiety of having to meet a new person when you don't feel well. The most poignant visit was with one of my little ladies who is in her late 90's. We both knew there was a great chance I might not see her again at all, or at least in her current state of health. That will make me sad. I'm not sure I've done much good for her, but we've had some great talks about end of life care, and the death of her husband a few years ago. I imagine it must be very hard to lose so many people, and be one of the last survivors of your generation. She said goodbye with such grace and humor however; I only hope I can emulate her in my dotage.
Thursday, December 11, 2003
Plans
I don't start actually working in Winton until January 19. So we are going to do some traveling around New Zealand before that. I have my interview with the representative of the New Zealand Medical Council in Christchurch on January 6, and then I've reserved a campervan for the next 10 days. When we've traveled other places, we've followed a philosophy of picking one area, and learning about it in depth, rather than hopping all over the map. I like this approach, and some of the best travel memories we have are of the little places not found in travel guides. New Zealand is a large country, so we've decided to focus only on South Island, and not go to the North. So far I am trying to resist the urge to plan every moment down to the tiniest detail. However, I did give in to making a "booking", as they call a reservervation, to swim with the dolphins in Kaikoura.
I read about this in the book "Kiwi Tracks", and the advice to "sing to the dolphins" through the snorkel just sounded like a lot of fun.
However, I got to thinking about snorkeling, and realized that withouit my glasses, I might sing to them but never see them. This led to a bit of web research about low vision in divers. Turns out you can order specially made diving masks that have corrective lenses. These are, understandably, pricey. There are some "stick on" inserts you can order to put into a mask, but they only go up to 3 diopters, and I need 7. However, one site suggested getting some disposable contact lenses. So I called my optometrist, Dr. Kimberly Cruise who was just wonderful, and has provided me with some trial disposable lenses. I will need to put them in and try them out before the trip, since I've not worn contacts for about 10 years. So we should be all set, providing the weather is not too bad, and the dolphins show up.
The plans after that are to NOT have a plan, but to creatively wander around the north part of South Island and talk to people, and follow any leads. Vaguely we might go to the beach in the north, and visit the glaciers on the West Coast. We will save Southland for day trips on weekends later in the summer and fall.
The next thing to do is finish up the To Do list and start packing. I did find a cool site, for a Universal Packing List, that is going to help us get organized, I hope...
I don't start actually working in Winton until January 19. So we are going to do some traveling around New Zealand before that. I have my interview with the representative of the New Zealand Medical Council in Christchurch on January 6, and then I've reserved a campervan for the next 10 days. When we've traveled other places, we've followed a philosophy of picking one area, and learning about it in depth, rather than hopping all over the map. I like this approach, and some of the best travel memories we have are of the little places not found in travel guides. New Zealand is a large country, so we've decided to focus only on South Island, and not go to the North. So far I am trying to resist the urge to plan every moment down to the tiniest detail. However, I did give in to making a "booking", as they call a reservervation, to swim with the dolphins in Kaikoura.
I read about this in the book "Kiwi Tracks", and the advice to "sing to the dolphins" through the snorkel just sounded like a lot of fun.
However, I got to thinking about snorkeling, and realized that withouit my glasses, I might sing to them but never see them. This led to a bit of web research about low vision in divers. Turns out you can order specially made diving masks that have corrective lenses. These are, understandably, pricey. There are some "stick on" inserts you can order to put into a mask, but they only go up to 3 diopters, and I need 7. However, one site suggested getting some disposable contact lenses. So I called my optometrist, Dr. Kimberly Cruise who was just wonderful, and has provided me with some trial disposable lenses. I will need to put them in and try them out before the trip, since I've not worn contacts for about 10 years. So we should be all set, providing the weather is not too bad, and the dolphins show up.
The plans after that are to NOT have a plan, but to creatively wander around the north part of South Island and talk to people, and follow any leads. Vaguely we might go to the beach in the north, and visit the glaciers on the West Coast. We will save Southland for day trips on weekends later in the summer and fall.
The next thing to do is finish up the To Do list and start packing. I did find a cool site, for a Universal Packing List, that is going to help us get organized, I hope...
Saturday, December 06, 2003
Little Details
When I was about 10 my favorite author was Robert A. Heinlein. His science fiction was really great because of all the little details he put into the stories. These little changes, like the invention of something to permanently eliminate the need to shave facial hair, really made his alien cultures and far planets come alive.
We're dealing with some of these details now. New Zealand runs on 220 volt current: U.S. has the 110 volt standard. Even the plugs
are differently shaped, and I guess that's a good thing to prevent blowing out U.S. made equipment with the higher voltage. However, it sure is strange that so many parts of the world use different standards for voltage and TV transmission, etc.... Turns out my laptop runs equally well (through the charger "brick") on either 110 or 220, so all I'll need is a plug converter for that. However, the Braun toothbrush only runs on 110 volts, so we will either need to buy a voltage converter device or buy a new electric toothbrush in N.Z. Vicki doesn't think she can use a "manual" for 6 months and still feel she has clean teeth. I agree that the Braun is a superior instrument.
We will have to set up a bank account in N.Z. on arrival, but how to be sure of cash flow is another detail. I read that ATMs in N.Z. won't work with a credit card that doesn't "have a PIN built into the card". How do we know if our cards have built-in pins? I don't think ours do at this point. A doctor I met at Mayo earlier this fall told me to avoid taking a cashiers check or bank transfer papers, as her transfer took over 4 weeks to clear. The modern electronic age! Vicki is checking with the bank.
The other detail we looked at was baggage allowance. Air N.Z. allows "2 pieces of baggage per person with a maximum combined dimension (length + width + height) of 158cm (62in) per piece
Each piece cannot exceed 32kg in weight". Carry on allows purse, walking stick, raincoat, and " 1 piece with a maximum combined dimension of 115cm, Maximum weight of 7kgs per piece". If we carry 2 laptops, and Liz's viola, we might be able to stuff in a bunch of stuff into "purses" and get by. But to plan for 6 months of varied activities from hiking, to working in clinic, to social events and get it all in to 64 kg. per person will be a challenge. I think my size 13 shoes probably weigh 4 kg. per pair alone.
When I was about 10 my favorite author was Robert A. Heinlein. His science fiction was really great because of all the little details he put into the stories. These little changes, like the invention of something to permanently eliminate the need to shave facial hair, really made his alien cultures and far planets come alive.
We're dealing with some of these details now. New Zealand runs on 220 volt current: U.S. has the 110 volt standard. Even the plugs
are differently shaped, and I guess that's a good thing to prevent blowing out U.S. made equipment with the higher voltage. However, it sure is strange that so many parts of the world use different standards for voltage and TV transmission, etc.... Turns out my laptop runs equally well (through the charger "brick") on either 110 or 220, so all I'll need is a plug converter for that. However, the Braun toothbrush only runs on 110 volts, so we will either need to buy a voltage converter device or buy a new electric toothbrush in N.Z. Vicki doesn't think she can use a "manual" for 6 months and still feel she has clean teeth. I agree that the Braun is a superior instrument.
We will have to set up a bank account in N.Z. on arrival, but how to be sure of cash flow is another detail. I read that ATMs in N.Z. won't work with a credit card that doesn't "have a PIN built into the card". How do we know if our cards have built-in pins? I don't think ours do at this point. A doctor I met at Mayo earlier this fall told me to avoid taking a cashiers check or bank transfer papers, as her transfer took over 4 weeks to clear. The modern electronic age! Vicki is checking with the bank.
The other detail we looked at was baggage allowance. Air N.Z. allows "2 pieces of baggage per person with a maximum combined dimension (length + width + height) of 158cm (62in) per piece
Each piece cannot exceed 32kg in weight". Carry on allows purse, walking stick, raincoat, and " 1 piece with a maximum combined dimension of 115cm, Maximum weight of 7kgs per piece". If we carry 2 laptops, and Liz's viola, we might be able to stuff in a bunch of stuff into "purses" and get by. But to plan for 6 months of varied activities from hiking, to working in clinic, to social events and get it all in to 64 kg. per person will be a challenge. I think my size 13 shoes probably weigh 4 kg. per pair alone.
Wednesday, December 03, 2003
There's an interesting article today on Stuff.com about lack of physicians in Gore district, Southland, NZ. Gore was an area that I was very interested in going to at one point this fall. We got as far as a telephone interview, but apparently the NZ Government filled the locum spot with a physician from their pool, who took priority over me. Winton is not far from Gore, and I suspect has the same type of needs- we'll see when I get there.
Yesterday and today spent some time working on my checklist of Things to Do before leaving. One of them is health insurance. Our current insurance, John Deere Healthcare, will cover any accidents overseas, but no illnesses or hospitalizations. Also, since 1/2 of my leave is unpaid, I would have to COBRA in order to keep coverage for the 3 months, and that would be very expensive. New Zealand has comprehensive coverage for all permanent residents and emigrants, but not for guest workers or visitors. EVERYONE in the country is covered for accidents and emergencies, but that is all. Global and others have recommended purchasing health insurance and comprehensive "cover" as they call it for other problems. I contacted Medical and Health Insurance Brokers of NZ. It turns out that a very reasonable family coverage that includes travel insurance, health and illness, disability, death, kidnapping, hijacking, loss of possessions, and repatriation or air evacuation covers the 3 of us for NZ$618 (or US $399.11) for 6 months. This about what 1 month of COBRA for John Deere would cost. We will arrange to use the vacation days to keep daughter Leah covered at the beginning and end of the term, and use college health insurance for her coverage in the interim during the unpaid leave.
Other things on the checklist have to do with getting the house ready to mothball. I spent Saturday afternoon digging a drainage ditch for a gutter, in case there is a heavy rainstorm. Will have to arrange for a plumber to come winterize the house, in case the power goes out. Tune up the burglar alarm, install large guard dogs and the kid from "Home Alone". I've had a few anxiety dreams about the house getting hit with a tornado while we are gone. But when I woke up, I thought, "what better time to be in New Zealand than when a tornado hits the house!"..
Yesterday and today spent some time working on my checklist of Things to Do before leaving. One of them is health insurance. Our current insurance, John Deere Healthcare, will cover any accidents overseas, but no illnesses or hospitalizations. Also, since 1/2 of my leave is unpaid, I would have to COBRA in order to keep coverage for the 3 months, and that would be very expensive. New Zealand has comprehensive coverage for all permanent residents and emigrants, but not for guest workers or visitors. EVERYONE in the country is covered for accidents and emergencies, but that is all. Global and others have recommended purchasing health insurance and comprehensive "cover" as they call it for other problems. I contacted Medical and Health Insurance Brokers of NZ. It turns out that a very reasonable family coverage that includes travel insurance, health and illness, disability, death, kidnapping, hijacking, loss of possessions, and repatriation or air evacuation covers the 3 of us for NZ$618 (or US $399.11) for 6 months. This about what 1 month of COBRA for John Deere would cost. We will arrange to use the vacation days to keep daughter Leah covered at the beginning and end of the term, and use college health insurance for her coverage in the interim during the unpaid leave.
Other things on the checklist have to do with getting the house ready to mothball. I spent Saturday afternoon digging a drainage ditch for a gutter, in case there is a heavy rainstorm. Will have to arrange for a plumber to come winterize the house, in case the power goes out. Tune up the burglar alarm, install large guard dogs and the kid from "Home Alone". I've had a few anxiety dreams about the house getting hit with a tornado while we are gone. But when I woke up, I thought, "what better time to be in New Zealand than when a tornado hits the house!"..
Monday, December 01, 2003
Paperwork, Paperwork, Paperwork
How did we end up going to Winton? This process started over a year ago. The first paper I filled out was Global's application, which included some letters of reference. This essentially "got me in the door" as a viable candidate for their marketing. At that point, I was assigned to a marketer, Julie, who talked to me on the phone about my interests and answered questions about the opportunities. Global sent me an information packet, which included some really nice information- including testamonials from other docs who have done this, and a "survival handbook" for being a doctor in Australia (sample tip: "never let the vacationing doctor you are replacing leave without getting his computer password!"). Julie also sent me 1-2 page summaries about different communities in both countries that were looking for help in my areas of experience. This led to hard decisions for me and my family- did we favor one country over the other, did we want to stay in just one place or move around, large or small community, tropical and hot (northern Queensland) or cold and rainy (South Island, NZ)? We looked at all the communities, and it became a periodic dinnertime discussion. Ultimately we focused down to New Zealand over Australia (we'd lived in desert and tropics before), access to ocean and mountains (we live in IOWA now), and stay in one area. I wanted to return to rural practice and we decided to visit and learn one area well, with a goal of making friends and maybe Liz would even go to school. Global helped us focus then on New Zealand. We considered several spots, on both North and South island, but as things just worked out over several months, were able to secure a posting in Winton. (I did make an error along the way and get too attached to the idea of going to one community which didn't work out. I think its really important to be flexible and open to new experiences, and not try to control too much about what is going to happen. At least that's what I'm telling myself about this whole experience. Hard for a doctor to not be in control!).
Then the paperwork starts. First we had to renew passports, which expired this year. Not hard to do, but we all had to go down to Walgreens for the cheapest (and ugliest) passport pictures in town. Second, I had to apply for a New Zealand license. This required filling out another form, getting 3 original letters of reference from doctors who knew me, and sending documentation of
How did we end up going to Winton? This process started over a year ago. The first paper I filled out was Global's application, which included some letters of reference. This essentially "got me in the door" as a viable candidate for their marketing. At that point, I was assigned to a marketer, Julie, who talked to me on the phone about my interests and answered questions about the opportunities. Global sent me an information packet, which included some really nice information- including testamonials from other docs who have done this, and a "survival handbook" for being a doctor in Australia (sample tip: "never let the vacationing doctor you are replacing leave without getting his computer password!"). Julie also sent me 1-2 page summaries about different communities in both countries that were looking for help in my areas of experience. This led to hard decisions for me and my family- did we favor one country over the other, did we want to stay in just one place or move around, large or small community, tropical and hot (northern Queensland) or cold and rainy (South Island, NZ)? We looked at all the communities, and it became a periodic dinnertime discussion. Ultimately we focused down to New Zealand over Australia (we'd lived in desert and tropics before), access to ocean and mountains (we live in IOWA now), and stay in one area. I wanted to return to rural practice and we decided to visit and learn one area well, with a goal of making friends and maybe Liz would even go to school. Global helped us focus then on New Zealand. We considered several spots, on both North and South island, but as things just worked out over several months, were able to secure a posting in Winton. (I did make an error along the way and get too attached to the idea of going to one community which didn't work out. I think its really important to be flexible and open to new experiences, and not try to control too much about what is going to happen. At least that's what I'm telling myself about this whole experience. Hard for a doctor to not be in control!).
Then the paperwork starts. First we had to renew passports, which expired this year. Not hard to do, but we all had to go down to Walgreens for the cheapest (and ugliest) passport pictures in town. Second, I had to apply for a New Zealand license. This required filling out another form, getting 3 original letters of reference from doctors who knew me, and sending documentation of
- MD Certificate
- Internship Certificate
- Residency Certificate
- Board Certification
- Original Certifcate of Good Standing from State Medical Board
- Copy of Face page of Passport
Sunday, November 30, 2003
When is a Sabbatical NOT a Sabbatical?
When I've talked to friends in Family Medicine about my plans, their first questions are always "How did you get your boss to pay for this?", and "How can they let you go for so long?". Actually, Global really wants doctors who can stay an entire year whenever possible- 6 months is not optimum for them. However, the Foundation I work for does NOT provide for formal sabbatical leave, so I can only stay 6 months. I don't know of any community-based residency programs that do this; just a few universities, and its seems to be fewer and fewer all the time, with budget cuts, etc.
The way this is working for me is, first, I have an incredibly supportive boss who has encouraged me for the last year and 1/2 to do this. He has supported me by going to our Board and encouraging them about this, and in working hard to provide coverage for my job while I am gone. Secondlly, I have accumulated a large amount of "vacation time" not taken over the last 12 years. I am going to use all my vacation days up during the 6 months process. That will give me pay for about 3 months. The other 3 months are an official "leave of absence". Global pays a living stipend for the days I will be working in New Zealand, and that will help fill in the gaps.
When my boss and I first started talking about this leave, he asked me to do some "goals and objectives" for the Leave of Absence (LOA). Here they are:
I would like to experience medicine in a country with a different health system and medical values. I have become particularly interested in Australia or New Zealand, as they both have national health systems and networks of small medical offices that are more computerized than those in the United States. I hope to see and treat a different population of people with problems that I have not seen before. Because I have always seen myself as primarily a rural physician, I hope to reconnect with this identity. And above all, I hope to learn from my coworkers and patients to be a better physician and teacher. With these thoughts in mind, I have prepared the following plan.
Goals and Objectives
When I've talked to friends in Family Medicine about my plans, their first questions are always "How did you get your boss to pay for this?", and "How can they let you go for so long?". Actually, Global really wants doctors who can stay an entire year whenever possible- 6 months is not optimum for them. However, the Foundation I work for does NOT provide for formal sabbatical leave, so I can only stay 6 months. I don't know of any community-based residency programs that do this; just a few universities, and its seems to be fewer and fewer all the time, with budget cuts, etc.
The way this is working for me is, first, I have an incredibly supportive boss who has encouraged me for the last year and 1/2 to do this. He has supported me by going to our Board and encouraging them about this, and in working hard to provide coverage for my job while I am gone. Secondlly, I have accumulated a large amount of "vacation time" not taken over the last 12 years. I am going to use all my vacation days up during the 6 months process. That will give me pay for about 3 months. The other 3 months are an official "leave of absence". Global pays a living stipend for the days I will be working in New Zealand, and that will help fill in the gaps.
When my boss and I first started talking about this leave, he asked me to do some "goals and objectives" for the Leave of Absence (LOA). Here they are:
I would like to experience medicine in a country with a different health system and medical values. I have become particularly interested in Australia or New Zealand, as they both have national health systems and networks of small medical offices that are more computerized than those in the United States. I hope to see and treat a different population of people with problems that I have not seen before. Because I have always seen myself as primarily a rural physician, I hope to reconnect with this identity. And above all, I hope to learn from my coworkers and patients to be a better physician and teacher. With these thoughts in mind, I have prepared the following plan.
Goals and Objectives
| Goals | Objectives | Activities/Timelines |
| 1. Experience Family Medicine in another culture | " Perform locum tenens in a rural or suburban practice in New Zealand or Australia" Work as a member of a egalitarian healthcare team | December 2003-June 2004 Keep diary of daily practice and activities Possibly post web site for CRMEF with "tales from the front" about my experiences |
| 2. Learn to diagnose and treat a different population, with assorted unfamiliar medical problems | " Look for opportunities to serve some underserved population, may include aboriginal peoples " Possible practice location with tropical diseases " Possible involvement in community health activities " Possibly gain perspectives on obstetrics as performed overseas | Planning: Now to Dec 2003, may include study of tropical diseases or other preparations, readings, etc. Onsite Dec 03-June 04: CME and reading, use of Internet if available |
| 3. Examine the use and management of medical information (medical informatics) in a different health care system | " Learn to practice in a national health care system " Learn charting and preventive care practices, examine from an evidence-based perspective | Orientation and training before leaving and on arrival Keep track of practice differences between American and foreign systems |
| 4. Gain new perspectives on office and practice management | " Work with office manager to understand payment, coding and office systems | Ask for help and guidance from office staff and hospital |
| 5. Refresh time management skills needed to work in a "production" setting | " Keep up with expected numbers of patients seen daily in office and hospital | Use PalmPilot for reference when possible, learn appropriate reference use for office practice. Learn efficiency rules/tricks from other staff |
| 6. Spend time with my wife and daughter exploring another country's culture, geography, and history. | " Vicki may work if opportunity available " Side trips on weekends or break time; 1-2 weeks at end of locum tenens to explore interests | Plan to visit historical sites, natural areas. Will take advantage of community activities in the arts, festivals, etc. |
| 7. Provide my daughter with new perspective on her education and future career, from experiences overseas. | " Elizabeth will make new friends overseas. " She will listen and learn about a different culture | Elizabeth will attend school overseas if in session; if not available, will pursue guided independent study |
| 8. Revitalize and rejuvenate myself | " Eat right, get plenty of sleep, and exercise and find joy every day in the act of discovery and learning | Ongoing |
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