A Travellerspoint blog

By this Author: pyrakc

Part 6

Medicine in New Zealand

overcast 4 °C

NOTE: Below is my impression of the Medical System in New Zealand. I have tried to write with as little jargon as possible for the non-doctors in the crowd. However, please email me if you have taken the time to read this blog and would like a more clear explanation.

One of the reasons I decided to spend a year in New Zealand was the opportunity to work in a medical system with universal healthcare. While living in Idaho, I spent a lot of hours outside of work promoting Medicaid expansion. Through the Idaho Medical Association, I attended many mixers and social events with congressmen. Medicaid expansion should by no means be considered as an effort to gain universal healthcare in the US. But at nearly every event, I was asked questions about socialized medicine and its "failures." Though I have read a lot on the healthcare systems in Canada and the United Kingdom, I never felt convincing in my response. Looking across the world, I noted New Zealand and Australia as models of successful mixed pay systems; medical systems that include both healthcare paid for by the government and healthcare paid for through insurance or by the patient. I believe that if the US ever reconstructed their medical system, a mixed payer system including both public and private options would make Americans most happy. New Zealand and Australia have health care systems that include both a public health system that is partially funded for all residents by the government as well as a private system that allows individuals to buy insurance or pay out of pocket for faster and/or more advanced medical care. Classically American, as with any product or service, the US will always feel entitled to an option for those with more money to pay for faster and more advanced services. Overall, my goal was to better understand how to reduce the cost of healthcare in the US. Though a small country and not as comparable to the US, I chose New Zealand because the total cost expenditure per resident of the country per year was the lowest. For example, per the World Health Organization in 2013 the US spent $9523 per capita on health care expenditures. In Australia, the cost was $3866 per capita and in New Zealand the cost was $3328.

The public medical system in New Zealand is built on a capitated model. New Zealand is broken up into health districts. Each district gets a annual lump sum of money to care for the people registered in each district. The sum of money is estimated based on age of population, average income and historical data. The money from the government covers anywhere from 50%-99% of health care costs of the patient. The remaining expense is covered by the individual patient. For example, at my clinic, it costs $115 to see a doctor for a regular visit. We get $75 from the government and then each registered patient then pays $40 to the clinic to see the doctor. The out of pocket expense for all services from labs to doctor visits and procedures like mole removals are listed as you walk into my clinic; similar to walking into a fast food restaurant and observing the cost of food items on a menu overhead. Cost of services are adjusted each year depending on the governments health care budget. Overall, it is extremely refreshing to have cost transparency. When a patient asks, I can tell them for certain their expense when pursing any medical procedure. This includes the cost of a night in the hospital and a hip replacement!

The public system also incentivizes preventive medicine. Clinics that demonstrate high rates of cervical cancer screening, mammography referrals, counseling for obesity or tobacco use cessation as well as improvements in blood pressure or diabetes markers get extra incentive funding from the government. All these markers are monitored in the single electronic medical record used by the majority of clinics. This makes mining of this data incredibly easy. Unlike working in the US with more electronic medical records than one can count and poor interface communication, using one primary electronic medical system that communicates fairly easy with the hospital electronic medical record makes being a doctor surprisingly more easy.

There are a few of the ways the public medical system in New Zealand limits costs.

First, annually New Zealand selects a drug formulary for the year. Patients in New Zealand have access to about 1/8 of the amount of prescriptions when compared the the US. 70% of the drugs on this formulary are subsidized. Therefore, if only subsidized prescriptions are chosen, a patient can get up to 10 prescriptions per month for $5. As a provider, this makes my life much easier because I need to know the actions, sides affects, and interactions of a much smaller pool of medications. Also, though lagging behind ~ 3-5 years, the medications on the formulary are mainly generic options and go through a pretty strict review process being chosen based on patient outcome standards. Meaning, only medicines with research to support improved health in patients are included on the formulary. The downside, if you have a rare disease or cancer, the options for new and innovation treatment pretty much do not exist.

Second, through the public medical system, there can be wait lists or requirements for certain criteria to be met prior to seeing specialists or having a procedure. Wait times can be anywhere from 1 week to 6 months. It is up to the GP to treat the patient accordingly during the wait period. Interestingly, I have noticed that roughly a third of the referrals I send are cancelled because this original medical complaint or injury has resolved with treatment by myself or the problem resolved without any intervention while the patient has been waiting to be evaluated by the specialist. Maybe there is something to "tincture of time." On the other hand, I do not agree with some of the criteria requirements for procedures. For example, one area that New Zealand has horrible outcomes is in the area of colon cancer. The criteria to get a subsidized colonoscopy is very strict excluding many individuals with risk factors for the cancer. Also, these criteria can change depending on funding available. For example, in the beginning of the fiscal year more hip replacements may be offered compared to the end of the year. There are criteria for many other referrals for subsidized procedures; hip/knee replacements, long term contraception options, weight loss surgery, osteoporosis screening, and substance abuse rehabilitation to name a few. The downside is that while waiting to see the specialist or while waiting for the needed procedure, the medical problem can progress beyond repair. One particular patient I see regularly developed heart failure from a bad heart valve. Though she eventually got a new heart valve, her heart had experienced so much damage she only marginally improved post repair. Whereas, she would now have a normal heart if the valve was replaced as soon as the defect was found. These stories are common and make the wait times hard to understand for the patient at times.

One area of the New Zealand medical system that is surprisingly functional is their Accident Care Coverage (ACC). This program is similar to worker compensation in the US but much more broad and stream lined. If you get hurt in New Zealand, a claim is submitted by the first doctor you see. The claim covers 85% of doctor visits, imaging, hospital care, physiotherapy, acupuncture, counseling, massage and other non-traditional treatment modalities. More impressively, they cover up to 90% of lost wages starting at 2 weeks post-injury if the patient cannot return to work. The claim is more likely to be accepted the sooner it is submitted after the injury. Therefore, most Kiwi's see a doctor for any injury as soon as it occurs no matter how big or small. This allows them to claim ACC if the injury remains debilitating. Under ACC, the return to work rate at 2 weeks is very high. In addition, ACC also covers non-residents. So, lets say you were visiting from Germany and decided to go skiing. If you had no traveler's insurance and fractured your ankle, New Zealand would pay a portion of your medical expenses. This is amazingly nice of New Zealand to cover travelers to their country and likely reduces liability on New Zealand adventure activity retailers. However, this is a hot point of debate in the governments health care budget.

The private system in New Zealand is quite simple. The majority of doctors that provide care in the public system maintain a part of their schedule for private patients. Paying out of pocket or through purchased insurance often allows the patient to schedule an appointment with a specialist or for a procedure within a few days. Controversially, if there is high demand for a procedure, patients that pay privately are moved to the top of the wait list. I have never seen a patient wait longer than 2 weeks for an appointment if they have requested private medical services. Unlike Australia that has completely independent private hospitals and clinics, with a few exceptions in New Zealand, the private medical services are mainly provided in the same hospitals and clinics as the public system.

Currently, I am working at Twizel Medical Centre. I am one of two general practitioners at the clinic and our clinic is designated as one of the three most remote clinics in New Zealand. We are the only doctors for 100km in all directions and the closest hospital is 165km away. We do not have an x-ray. Any labs that are completed must be sent away and the results do not return for 24 hours. Minus having to learn a few new names for medications, getting frustrated with the spelling of diagnosis based on the British Medical System and observing the dramatic differences of opinion between my partner physician and our medical center's new management, my day to day patient care is really not that different from the US. I can see anywhere from 15-36 patients per day; greater than a half of patient visits are urgent care same day appointments. This is because of the ACC system and because I am working in a high tourist area.

The most anxiety provoking and learning point of my job in New Zealand has come from taking PRIME (Primary Response in Medical Emergency) call. In New Zealand, all but very urban areas depend on volunteer Fire Fighter and Ambulance staff. Because of this, the staff has very little training and there are no EMTs or paramedics in rural areas. If there is a bad accident, car wreck, or medical emergency like a heart attack, stroke or seizure, the local PRIME doctor or nurse practitioner is called to attend. We are then responsible for stabilizing the patients and getting them to the closest hospital. I have learned a lot about where helicopters can land, how to put in IV lines on the side of the road, not to lift with my back, and to think twice about entering a patient's home alone.

As I enter my last two months of working in New Zealand, I have come to a few conclusions. Overall, no health care system is fair or perfect. However, I think I would rather have a model where patients have to wait for medical services than where patients have no access medical services or must declare bankruptcy if they get injured or develop a serious illness; which happens often in the US. It is hard to observe patients on a daily basis that could potentially get better medication or treatment in the US. However, with a limited pool of money, how can you argue for the treatment for one patient when the same amount of money could potentially help 50-100 other people live healthier longer lives? Also, after never fully understanding the workers compensation system for accidents at work in the US, I am incredibly impressed by the ACC system for its ability to keep patient off long term pain medication and return patients to work fast. I have appreciated my time working in New Zealand and am sure it will make me a better and more understanding Family Doctor and political advocate when I return to the US.

Posted by pyrakc 15:28 Archived in New Zealand Comments (0)

Part 5

A year in New Zealand

storm -4 °C

The last few months in New Zealand have been busy. I have learned that for me to keep a blog, I have to take notes or I get stressed over remembering details and making time to write. This has resulted in me procrastinating. I hope to catch-up those friends and family members that are interested in some of our more entertaining adventures. Below is a jumble of major events in our lives in New Zealand since February. I hope you enjoy.

Most appreciative, we have had a few more visitors. Charles’ sister Tina and her family Mark, Quinn and Devin Thomas stopped in NZ a few days before heading to Australia. Though Mark is Australian, we were able to convince them to stop and enjoy the rival country. We picked them up in Queenstown and drove them over the countryside to Twizel. We had explained that we really do live quite remote, but I think they were surprised after driving 2 hours and only seeing sheep. They got a day at Mount Cook National park, took a chance at catching local salmon and “luged” or rode a sled on wheels down a hill in Queenstown. Unfortunately, the poor weather (exceptional winds) limited their time for exploration in Twizel. Fortunately, later in their trip we were able to meet them in Sydney, Australia and joined them for some tourist activities including gazing at the iconic Sydney Opera House, observing some very active koalas at the Sydney Zoo, exploring a street market and walking partially across the Sydney Harbor Bridge.

Our second group of visitors was the lovely Sandy Mudge, a fellow Family Doctor I trained with in Boise, and her husband James, a Business Professor at Boise State. Charles and I have been on a few adventures with Jim and Sandy in Idaho so we knew we could plan about anything and they would be up for the challenge. I booked one of the six great bike rides on the South Island called the Rail Trail. Combined with the more challenging Roxburgh Gorge trail on the first day, we spent three days biking across wine country in Central Otago on the South Island. Old railroad bridges/tunnels and quaint cafes/motels kept us entertained as we covered roughly 85 miles or 125 km on our bikes. We finished with a wine tour and enjoyed many of the local pinot noirs. The Central Otago wine region is young but growing rapidly and can be an experience contrasting the established vineyards with the new start-ups. Only complicated by occasional rain and a small wreck when I stylishly ran into a bike parked in the middle of the trail, the bike trip was a great way to see a new part New Zealand.

Thanks for the visits! We miss you!

In early march, we took the opportunity to travel to Australia. As hinted at above, we spent the first few days in Sydney. I like Sydney. The city is vibrant with great food, fashion, art, and appreciation for the surrounding ocean/beaches and rugged outback. It also has one of the most functional public transportation systems I have ever experienced. You can buy an Opal pass and smoothly transfer between bus, train, ferry, and hire a bike without hesitation. Following the tourist activities with the Thomas family, we took time to visit the famous surf site, Bondi Beach, relaxed on the grass in the Sydney Botanical Gardens while enjoying a rehearsal for that nights opera, and took photos, lots of photos, of the Sydney Opera House from many different points in the city. I hope we get to go back again before the end of our time in the Southern Hemisphere.

Following Sydney, we flew to Brisbane and rented a campervan to drive up the Sunshine Coast of Australia. Our van was a hi-top van with a small kitchen in the back that converted into a bed at night; perfect way to explore Australia without having to sleep outside with all the venomous creatures of the outback. Australia does stay true reputation regarding dangerous creatures. Giant spiders, snakes, sharks, jelly fish, and bats the size of a cat are to name just a few of the animals we were lucky to experience personally. One evening at camp, we were playing a game of cribbage and heard a rustle in a nearby small palm tree. Charles decided to go explore and nearly got pelted in the chest by a large bat (literally 1 meter wing span). I tried not to laugh; terrifying and funny all at the same time.

Outside of Brisbane we took a ferry to Moreton Island, an island composed primarily of sand dunes and a well known international 4x4 driving track. We primarily went to snorkel at a shipwreck site roughly 50 meters off the southern beach of the island. Although the water was murky due to wind, it was a memorable scene to see all the 4x4 trucks, gear, and type of people who owned the gear.

North of Brisbane, we primarily stayed along the coast relaxing on various beaches from Mooloolaba to Noosa. Our farthest north destination was Bundaburg. Here we took a boat out to the Great Barrier Reef. The travel out the reef was over open ocean water and was an extremely rough boat ride resulting in multiple people around us getting seasick. Overall, it was worth the bumpy ride because the reef was some of the most beautiful snorkeling I have every experienced. We got distracted exploring and didn’t take any photos; but really it is one of those things you have to see in person. We feel fortunate to have made it out to the reef even more now. Over the last few months, there has been a lot of worry and press about a large bleaching or dying off event of roughly 30% of the Great Barrier Reef due to uncommonly warm ocean temperatures. Very sad.

We have definitely become more active while living in New Zealand. Overall, physical activity is more engrained in the daily life of Kiwis. From hiking to hunting to biking to skiing, they are always getting outside and exercising. After being pressured by one of my nurses, I decided to sign up for one of the local weekend races, the Women’s Configure Sprint Triathlon. I have done a race as part of a team in the past, however I have never completed a whole race myself. The race distances were not that far including a 300 meter swim plus a 16 kilometer bike and a 5 kilometer run. I started “training” roughly 5 weeks before the event. It was a great way to see the local area by running/biking the area trails and swimming in the local pool or lakes. A couple weekends, I met my nurse Ange at Lake Ruitaniwha (Ru-tan-ni-fa), the main lake near Twizel used for boating, kayaking and crew races. Initially confident about my tolerance of cold water after growing up in Montana, I was taken off guard by a near hypothermic event. Ego bruised a bit, I bought a wet suit. Similar to lakes in Montana, the local lakes are glacial fed. I think the difference is that you can see glaciers that feed the lake while actually swimming in the lake in New Zealand…….

The triathlon could not have been more beautiful, located in Arrowtown, a quiet “suburb” of Queenstown. Race day went well. Though my strongest leg of the race is swimming, my swim time was poor due to moderate waves on the lake. I still met my goals of finishing the race and not walking during the run. The best part of the race was the atmosphere of support from the locals. The race was exclusively women, many of whom it was their first race. It was great to hear the cheers as the last women crossed the finish line. She was part of a weight loss challenge and it was extraordinary to see the support for the larger women exercising. Although I have re-confirmed my dislike of running, I hope to complete another race soon.

We still try to do at least one longer trip per month. Last month we took the Tranz-Alpine railroad through Arthur’s Pass across the South Island to the West Coast. We decided to catch the train in Darfield, a small town outside of Christchurch. The morning of departure, we were already running late for the train. We arrive in Darfield and pulled up to the train tracks. We look left and right and didn’t see a train station. We drove around the small town of ~ 300 inhabitants twice without locating the station. I convinced Charles to stop at a petrol station and ask for directions. The clerk points across the road at a tiny 4ft by 8ft shed missing a wall sitting next to the tracks. We cross the street, get out our backpacks and our bikes, walk up to the shed and down the track comes the train. The train stops for a total 2 minutes, just enough time to get our gear on the train and hop inside. A classic rural New Zealand experience.

The train ride over the pass to the West Coast was beautiful. The multicolored autumn leaves scattered across the different ecosystems as we ascended elevation from the seaside to alpine terrain were memorable. Our destination on the West Coast was Greymouth and Hokitika. We took our bikes to ride the West Coast Wilderness Trail, another one of the great rides on the South Island. I again booked accommodations though Airbnb. We stayed with a lovely couple from Brazil. To Charles dismay, our only transportation was our bikes. The bed and breakfast was located up a small to moderate hill. So, if we wanted to go into town for shopping or dinner or at the end of a day of riding, we repetitively had to climb the hill on our way home. I maybe should have considered this when making reservations.

We spent our first day on the West Coast in Greymouth. The weather was hit or miss and we spent most of our time there at the local brewery, Monteiths. Over the next two days, we completed a portion of the West Coast Wilderness bike trail. It was a beautiful mix of rainforest, large river deltas and birchwood covered mountains with small quaint towns like “Cowboy’s Paradise” along the way. Our ride ended in Hokitika, a small beach town known for jade carving. We spent a day in Hokitika shopping and stayed with a very British ex-cop at a local bed and breakfast. Our host had many memorable opinions and may have resembled a cast member from Reno 911. The weekend ended with a shuttle back to Greymouth and a return train ride back across the island.

With the recent onset of cooler temperature, our adventures have slowed down a little. Work is also slower with fewer visitors to the South Island. We still get out most weekends for a bike or a hike. Mount Cook National Park is very close and our default is a local hike in the park. The beauty of the tallest peak in New Zealand, its glaciers and lakes can be seen in many of our photos. However, overall winter has ascended on us fast. Snow falls regularly on the hills behind our house and frost covers the ground most mornings. Though we are most recently from Idaho. It just feels colder in New Zealand at times. Minus 5 Celsius or 16 degrees Fahrenheit is cold. Maybe it’s a mix of the proximity to the ocean and the high elevation. When we first arrived in NZ, our house was only heated with a small fireplace. We bought wood for winter. But after a few weeks, we got tired to waking up to a house that was nearing freezing temperatures. We have since bought slippers, a heated blanket, wool base layers and have pressured our property manager for a heat pump. We are apparently not as tough as the local Kiwis.

We have made a few friends locally and continue to appreciate Kiwi generosity. A few weekends ago, another local, James, who works on the ambulance took us up in his plane. He has a very tiny 2 seater Microlite plane that he built. The tiniest and lightest plane I have ever seen, constructed from material similar to canvas. A mild adrenaline activity being 7000 ft in the air over giant mountain peaks in a tiny plane, but overall the best way to see and experience the Southern Alps. James took both Charles and I up in the plane. He showed us local landmarks and let us fly a little. It had snowed a few days before flying and the mountains were beautifully dusted with snow. Imagine sharp peaks, teal glacial water, numerous scree, scattered pine forest and the distant ocean on the horizon.

If you have made it to the end of this blog post, I commend you and thank you for being interested in our lives. We fortunately just left the New Zealand cold for one week and are in Fiji. Following an injury to my foot on coral, we are spending the week relaxing on the beach. I wrote most of this blog sitting on the beach under palm trees blowing in the breeze. Our goals for the next few months are to stay warm, ski occasionally, visit a few more cities on the South Island and expand our hobbies (I’m slowly learning how to crochet). We have learned a lot about working in New Zealand a hope to write another post soon about healthcare and building practices locally. Stay tuned.

Posted by pyrakc 23:47 Archived in New Zealand Comments (0)

Part 4

There are times when you get exceptional experiences shared with you that you truly feel lucky to be alive.

sunny 21 °C

Part of my job in Twizel includes doing emergency/first responder call. I can get called to local car accidents or to patient homes pending the medical problem and acuity. In these situations, you get to know the local ambulance staff very well. One of the local volunteer EMTs name Vanessa, “Nessie,” overheard one day that Charles and I might not make it to one of the monumental and most well known parts of New Zealand called Fiordland National Park during the optimal season and took it upon herself to get us there.

Besides being a volunteer EMT, Nessie is the office manager for the local branch of Meridian Energy. Meridian Energy is a large partially private, partially federal energy company that is a leading developer of renewable energy in New Zealand. They specialize in hydroelectric energy development. Admirably, New Zealand in general is environmentally conscious maintaining that > 90% of their energy comes from renewable resources. For example, Twizel was founded in the late 1960s for the development of a large hydroelectric dam/canal system. One of Meridian Energy’s most innovative and largest hydroelectric dams, Manipouri Power Station, is located at a very remote site in the middle of Fiordland National Park. During a random clinic afternoon, Nessie strolled into my consult room and tells me that she is taking Charles and me to Manipouri Power Station. We had not yet made plans for the following weekend and without talking to Charles or knowing anything about Manipouri, I kindly answered “sure, why not!?”

We left for Manipouri Friday morning. Nessie, vivacious rowing coach/EMT/office manage with bleach blond spikey hair, picked us up in one of the company cars. Fiordland National Park is located roughly 5 hours away. We spent the drive discussing emergency cases, odd Kiwi vs. American customs and the itinerary for the weekend. We soon learned that the power station is not open to tourists and we were company guests for the weekend.

We spent the first night of our trip in Te Anau, the entrance to Fiordland National Park. While in Te Anau, we enjoyed a traditional woodfired pizza and avoided the other tourists. The town was quite busy given it was Chinese New Year and NZ is a common Chinese vacation destination. I had complained about the price a wool on our drive down and Nessie showed me a local shop with budget wool clothing. I “accidently” bought four sweaters.

We left for Manipouri the following morning. The power station is quite remote and can only be reached by boat. All staff and supplies are shuttled in via the Meridian private ferry or by the local cruise ships that escort tourists around Fiordland National Park. Our ride in on the boat was amazing as we watched the sunrise over the boundry fjords of the park. The boat ride ended at a dock located near an unassuming cement platform on which a few transmission towers were situated. We got off the boat where we were met by the weekend operator, Paul, a large, rather direct, but passionate man. Nessie soon ran away to get some work done and left us in the enthusiastic hands of Paul. We headed up the hill to the small office building were he fitted us in fire retardant overalls and where he started explaining the power station and underlying hydroelectric dam. I soon realized what we were about to do.

From Wikipedia:
Manapouri Power Station is an underground hydroelectric power station on the western arm of Lake Manapouri in Fiordland National Park, in the South Island of New Zealand. At 850 MW installed capacity, it is the largest hydroelectric power station in New Zealand. Completed in 1971, Manapouri was largely built to supply electricity to the Tiwai Point aluminium smelter near Bluff, some 160 km (99 mi) to the southeast, as well as into the South Island transmission network. The station utilises the 230-metre (750 ft) drop between the western arm of Lake Manapouri and the Deep Cove branch of the Doubtful Sound 10 km (6.2 mi) away to generate electricity. The construction of the station required the excavation of almost 1.4 million tonnes of hard rock to build the machine hall and a 10 km tailrace tunnel deep into the hillside of the surrounding fjords.

After donning safety attire, we hopped in Paul’s truck and entered the 2 km long tunnel into the side of the mountain heading down to the hydroelectric power station. Corsely cut rock, a potholed dirt road and traces of dripping water led our way downward. I was greatfull I am not claustrophobic. We parked and were directed though some signs noting historical events and into the machine hall. The machine hall was enormous composed of 7 large blue turbines and surrounding operational equipment that mildly resembled daleks from the British Dr. Who series. We then spent the next two hours in restricted areas climbing lower and lower observing each area from the turbine to the generator and to the transformer. Finishing our time with Paul, we were greatful for the opportunity to see the innerworkings of a unique industrial marvel. Overall, surprisingly interesting for this more art/biological sciences minded individual but I have rarely seen Charles smile more during a tour.

Following the time at the power station, we went on a short hike around Lake Manapouri up the mountain side and down to the beach. However, we were soon forced inside due to the large abundance of sand flies. We had dinner, played cards, watched Top Gun and admired the local beauty of the surrounding fjords from the bay windows of the top floor of the staff quarters.

We stayed at the staff hostel over night and then woke up early the next morning to catch our boat. Nessie, being completely amazing, had booked us a complementary boat tour of Doubtful Sound a region of Fjordland National Park prior to heading home. We jumped in one of the local Meridian trucks and Nessie drove us, mildly too fast, over Wilmot pass via a rutted dirt road usually only traveled by tour buses. The road ended at the harbor and we set off on our tour. Blue skies, calm water, dolphins, seals, and fjords; Fjordland National Park includes some of the most amazing untouched remote scenery I have ever seen. Please look at our photos.

Our return home following the tour was long but included a return drive over Wilmot pass, a boat ride across Lake Manapouri, and a roughly 5 hour drive home with a stop at a fruit stand for fresh plumbs and cherries.

Overall, a weekend to remember.

Posted by pyrakc 23:16 Archived in New Zealand Comments (0)

Part 3

A hot Christmas and many new outdoor adventures…….

sunny 29 °C

After our first few months in New Zealand, we are feeling more comfortable. It’s more noticeable to hear an American accent than a kiwi accent these days. We also now look forward to returning home after weekend adventures to our small cottage located on a dirt road 10 km in the countryside outside of Twizel. We are impressed with the general kindness, humor and generosity of the locals. However, we still miss our friends and family. Charles would appreciate some American beer, particularly a northwestern IPA.

Overall, the food is an issue. Carbohydrate heavy with influence from English fare, common foods you get eating out including fish and chips, schnitzel, hamburgers, lamb, hogget (18-24 month old sheep), or mutten (grown sheep) prepared any way you can imagine; all served with apricot jelly or tomato sauce. All stores, from petrol stations to quaint bakeries that litter small towns nearby, do prepare fist-sized meat and vege pies. Tasty, but another carbohydrate source that makes you feel a little guilty after eating. We have started cooking/baking more at home. A small feat with our stovetop that mimics hot plates and the limited groceries at our rural location.

Christmas in the Southern Hemisphere was hot! It was a bit odd to have a 30 degree celcius (80 degree farenheit) holiday, but we did not find it hard to fit into the local activities. Most kiwi seasonal activities involve a camper trailer parked along a river or lake with a BBQ and a boat. Christmas decorations with fake snow appear misplaced and the 6 week break for local schools over the holiday mimics summer vacation.

On Christmas Day, Charles and I traveled to Arthur’s Pass, the highest pass over the Southern Alps on the South Island. We initially planned on doing a two night backpacking trip. However, after a 5 hour drive to the trail head and possibility of heavy rain, we opted for the car camping option with day hikes. This was a good choice, because the next 36 hours became a comedy of errors. We started by looking for a campsite. In route we acquired a flat tire. This was frustrating given it was our tire that was patched roughly one week prior. After testing out a few camping areas we chose the edge of a river valley with tall grass. Finally relaxed and ready to sit down to share a bottle of wine to celebrate the holiday, the sand flies appeared. Sand flies are a small gnat-like bug that swarms and bites. Initially the bites don’t bother you. However, roughly 12-24 hours after the bite, often in the middle of the night, the bites swell and itch like no other bite you have experienced before. Admist dealing with sand flies we also attracted a few Kea birds. These beautiful high elevation green parrots are known as the “clown of the Alps” for their large feet, giggle like chirp and affinity for eating/destroying inedible objects. They particularly like rubber windshield wipers. We spent the night re-applying bug spray and looking out for our packs and car. The next AM, we got up and headed off for a hike. During our attempt to leave fast and avoid more bug bites, we left our camp stove on top of the car. The stove proceeded to fall off in the middle of the narrow highway and break an adaptor. We retrieved the stove from the busy road and drove quickly to the top of the pass to share breakfast in a parking lot overlooking the road to the west coast and surrounding peaks of dark brown near black volcanic rock and sagebrush like vegetation. With some hesitation but still determined to enjoy our holiday, we proceed with a short day hike up a river valley by a large chasm and up to a small snow basin. Lucky the hike was enjoyable and was completed without another issue. We headed home following the hike and are not sure if we will return to Arthur’s Pass.

Since Christmas, the weather had been warm nearly every weekend and we have had many other successful weekend trips. A couple weekends ago, Charles and I completed one of the nine New Zealand Great Walks called the Rakiura Track on Stewart Island, a small island off the Southern shore of the South Island. The hike was a beautiful mix of tropical vegetation and white sand beaches. Given Stewart Island is so far south, the weather was mild but wet. We completed the 32 km hike over two nights and three days. We chose to tent camp. This allowed us to stay at a more remote camp site on Stewart Island called Maori beach. Please see our photos. Locals think we are crazy to tent camp. The great thing about New Zealand is that nearly all trails have huts (small cabins) situated at various distances along the trail. Thousands of huts across New Zealand have been developed over the last 100 years as sheep musterers (herders) moved sheep to higher and high elevations. Locals are used to utilizing these huts while hiking and rarely ever sleep on the ground. Overall the huts are nice option on longer trips because they allow you to pack lighter by leaving the tent at home.

Following Stewart Island, we hosted our first visitors to New Zealand, the lovely Josh and Kara Kuntz. The Kuntz’s arrived in Twizel in their camper van ready for fun. Charles and I were hoping to share some of our favorite parts of New Zealand. We spent the first few days around Twizel showing them our new tiny rural home. We then headed off to nearby Mount Cook National Park to do an overnight backpacking trip to a famous hut located in the park. However, due to forecasted 90km/hr winds, exposed trail and big packs, I got nervous about potential injuries and persuaded the group to do a day hike instead. We utilized our time and visited the Mueller and Tasman glaciers. From Mount Cook, we headed south to a small lake town called Wanaka for a few days. Weather was tumultuous with rain and wind, however we did not let it stop us. In Wanaka, we spent our time biking the local mountain bike trails and tasting wine. One evening, we added on the hike up to Rob Roy Glacier, an impressive hike with numerous waterfalls. Evenings were spent in town or at our bed and breakfast playing croquet on the owner’s well manicured course. It was lovely to see the Kuntz’s and reminded us that New Zealand is great, but it is even better to share it with friends. More visitors are welcome!

Posted by pyrakc 20:38 Archived in New Zealand Comments (0)

Part 2

We live in a very small town…….

semi-overcast 20 °C

Our first few weeks in NZ have been all about getting settled. Twizel is a very, very small town. The population is roughly 1500 people and the closest city is roughly 120 km away. Everybody already knows who I am before I introduce myself and Charles is known as the American with the fluffy beard or just as the new doctor’s partner. Although we are now comfortable with driving on the left side of the road, there have been a few other adjustments. We don’t have a clothes dryer and we hang dry our clothing. I am likely spoiled, but I have never had to do this. We also do not have heating or central air and must heat our house with a wood burning stove or space heaters. Given it is still spring here, our house can get quite chilly in the morning when it drops below 0 Celsius overnight. Actually, because we are living on the front range of the Southern Alps, the weather is very erratic. Freezing most nights with wind gusts that feel like they are going to rip the roof off the house, and with the limited ozone in this part of the world, very, very hot sun. We have learned you can achieve a memorable sunburn in 30min or less if not careful. Sticker shock has also been part of our transition. NZ is quite expensive; most items cost 2-4X the cost in the US.

I have started work at the Twizel Medical Centre. I work Monday through Thursday and do a combination of clinic and local emergency coverage. My clinic is a mix of chronic medical problems and urgent care. Given I am only one of two physicians in the Mackenzie High Country of the Southern Island, I can see any type of patient in clinic and it has been pushing my skills as a rural family doctor. There are many other differences about practicing in NZ. For example, no patients say they are sick, “buggered” = sick. Every illness or medical problem is a “wee” problem no matter how severe. The most common illness I see is asthma. Interestingly, asthma and severe seasonal allergies are the number 1 and 2 diagnosis affecting > 30% of the population and no one uses inhalers correctly. With no ozone, the public health campaign against skin cancer is very strong. The population is very fair skinned and mainly of Scottish descent on the South Island. We do multiple skin biopsies daily for abnormal moles or changing lesions; unfortunately most end up being cancer. Also, thankfully NZ has nowhere near the pain killer addiction problem that the US is struggling with; ibuprofen and paracetamol (Tylenol) are prescription here! In general, the population is quite healthy. The norm is to be very active. I see many patients daily age 60-80 that bike > 100 kilometers per week. Many more comparisons and stories to come in the future about medicine in Twizel, NZ.

Charles has also started working for a local builder, RAD Building. Yes, the company name is RAD. Twizel is an “up and coming” vacation spot for New Zealanders and is growing quite rapidly. They needed someone with carpentry skills and he was offered multiple jobs immediately. He is learning entertaining words for random parts of a house. Also, it is quite obvious that the New Zealand building code is very different from the United States building code.

Charles and I have lucked out and ended up with three-day weekends every week. We have used this time to start exploring. We leave Twizel nearly every weekend and travel to many local towns including Wanaka, Queenstown, Timaru, and Oamaru. Given the snowline remains quite low and we do not plan on taking up mountaineering this year, we have mainly been riding our new bikes.

NZ is very bike friendly. Biking can be divided into three areas including road biking, mountain biking and cross-country biking. I feel most people understand road biking and mountain biking. However, cross-country biking is new to me. There are many trails > 200km in distance that cross scenic parts of NZ. They are a mixture of gravel roads, easy to intermediate single track, and small amounts of road riding. They require a mountain bike to complete. One of these trails called the “Alps to Ocean” trail crosses in front of our house. Many travelers spend 3-7 days completing one of these trails. Living locally has been nice because you can cheat and just ride 10-20km of the most scenic portions. Mountain biking is more limited in NZ. The trails tend to be either mountain biking parks or very intense, long, and technical whole mountain rides. We have visited a few of the mountain biking parks in Wanaka and Timaru and they are fun short term but I have grown to love the cross country biking due to the scenery that can be taken in while pedaling. I hope Charles and I will get a chance to do a couple of the complete 3-7 day rides.

Christmas and summer are approaching fast. It is odd to be seeing Christmas lights and Christmas decorations while wearing shorts, tank tops and “jandals” (sandals). We have a few backpacking trips planned over the holiday and hope to share more of our adventure in the Southern Hemisphere soon.

Posted by pyrakc 22:52 Archived in New Zealand Comments (0)

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