The House of God.. NZ general practice unabriged

Trip Start Nov 30, 2009
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16
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Trip End Feb 26, 2010


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Where I stayed
Tapanui

Flag of New Zealand  , Otago,
Friday, February 12, 2010

There are some major differences between NZ rural practice and urban seaside UK practice.However,more surprising is the difference between rural practice within NZ
In the North Island I saw Maori patients (15%of total population).They had particular health problems, the most striking of which was Rheumatic fever with heart valve damage
after strep sore throats.
The North also had a multicultural and multi ethnic population.We frequently encountered migrants from Canada,Russia ,France,Germany ,Holland,Chile,South Pacific Islands, China , Japan and of course Birmingham!
We had holidaying Aucklanders described by locals as Jafas(see previous entry) but projecting themselves as "Californians" 
In the North we saw an extraordinary amount of cellulitis( skin infection) and regularly treated patients with courses of IV antibiotics.
Gastroenteritis was often associated with multiple growths including amoeba and giadia on culture which would have been minimal in UK.
Diabetes and Asthma were very prevalent throughout NZ.
Haemachromatosis(too much iron in the body)was considered common with an incidence of 1 in 200 and a carrier state of 1 in 7 . One can only assume a randy Scotsman with a twinkle in his eye, disembarked after 4months at sea and began spreading his C282y gene throughout the land.

In Oxford the patients were mainly second generation English Migrants..retired generally wealthy,  well behaved and healthy.Despite the gentile nature of the area the farming was still very hard and injuries were commonplace.It is always said that man is cruel to animals,but they do get their own back.

In Tapanui it was truly rural and I was single handed.
9 times out of 10 the consultation would start with a cheery g'day "How are you doc?" The voice belonging to a wirey blue eyed old Celt,who had padded into the surgery in his thick woolly socks and shorts ( boots were invariably left outside) His skin was nearly always extensively peppered with solar keratosis.Surprisingly or unsurprisingly I saw a lot of depression and migraine .

New Zealanders pay for their treatment,so tend to pack multiple problems into one consultation. The fees range from about $15 to $100 ( double UK pounds) depending on nature and time of consult.
If one has a condition that can be attributed to an accident (ACC) it is covered by the state.This is as one can imagine involves form filling (Aaarh) and bureaucratic wrangling.Everybody has lumbar "strain "not just back ache.

They also pay for their prescriptions some of which are subsidized and change according to bulk purchasing price(sound familiar?) 
The health boards are top heavy, try cost cutting and merging (sound familiar?)
The waiting times for hospital appointments are so long that unless you go privately you may not be seen for 6 months that being the case they take off the lis t( waiting list manipulation ..remember this?)

I have done quite a lot of minor OPs. Instruments are autoclaved and sterile gloves are optional,paperwork is minimal( Any slip of the scalpel is fortunately covered by ACC)
One day it took rather a long time to get the instruments together and I apologized to the patient saying " I am sorry for all this fiddling about before hand but once I start it shouldn't take too long"
Her quick dry response .." I am a farmers wife ,I am quite used to that!!" 

My most difficult case was an emergency call to a 15 yrs old Maori who was said to have a rash and was shaking"Yea Right" was my first reaction....but when I got down to the beach I was greeted by a pale unconscious patient who was looking decidedly unwell.His skin had some vague pink areas.Managing a case like this in hospital may be straightforward but kneeling in the sand it seemed strangely out of context.The ambulance was there but I hadn't realized they were just local volunteers until one referred to the other as "mum".It is over 20 years since I have had to seriously resuscitate anyone and it was made worse by 10 sets of eyes looking at me ..waiting for me to to make the decisions..probably the most expensive of which was "did I want the air ambulance?"
Anyway a couple of shots of I/M adrenalin I/V hydrocortisone and a saline drip seemed to perk him up enough for him to look forward to his chopper ride to Auckland.I am expecting a BILL in the post for wasting the air ambulance's time!!
For the medics in the audience ..hypotension secondary to cold urticaria......

Next up ....The leaving of New Zealand .." dagging, Gorons, scarfies and cockies
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