Illegal Immigrants

     Would you let this person into your country?
   
     To say that I buggered up the immigration paperwork for our trip to New Zealand would be an understatement. That is what I get for doing most of it on my own.  In all fairness, the Immigration NZ website is a somewhat confusing to negotiate, and the crisscrossing paperwork, website instructions and mailed instructions, left a few holes for me to fall through.  Fotunately after some hasty phone calls at the San Francisco airport, a delay with immigration at the Auckland airport while some of our bags disappeared, and then three days of working with immigration officials on two different hemispheres, we were able to become legal visitors to NZ.
    For those interested in visiting or working in New Zealand, here is the Immigration NZ for Dummies that I wish I had before leaving.  If you only plan on visiting, you can stay for up to six months.  You will  need to have a visitors visa and evidence of a planned departure date and finances to be able to afford to leave.   If you plan on working here less than one year, you need only to  apply for a work visa, which does not require a police or medical certificate.  If you would like to work for more than 12 months, you and all members of your family older than age 17 years, will need a medical certificate including a chest xray and blood work and an FBI (police?) certificate to be eligible for two year work visa. Children under 17 years require a medical exam, and blood tests and  chest xray only if recommended by a physician.
    Ultimately the lack of an FBI certificate would be our downfall.  I diligently followed the written instructions, that failed to mention US citizens needed an FBI certificate as a police certificate.  If I would have scrolled to the bottom of the online instructions, I would have found the required steps to follow for contacting the FBI.  The Bend Police Department was excellent in quickly producing certification that neither Kim nor I were criminals.  On an international level, I guess the Bend PD doesn't rank as high as the FBI for security clearance.  More on this at the end of this post.
    The Immigration NZ medical certificates were the closest thing I could find that may equate to preexisting condition screens undertaken by the majority of US health insurance companies. New Zealand as an island nation, is protected from arrival of undocumented people due to the dangers of travel on the southern ocean or need to arrive through airports.  Subsequently, its government has chosen to reach beyond its borders to verify the health and productivity of anyone who may want to remain in the country for an extended period of time.  Since people who qualify for a work visa longer than a year are eligible to covered under the NZ public health system (yes we get to pay taxes in two countries this year), INZ is tasked with verifying the health of immigrants prior to arrival.
     While much less invasive than any preexisting condition paperwork required by the US health insurance industry, the Immigration laws are very helpful at limiting medical expenses for New Zealand's medical system.  For a two year work permit, you must: 
     1.  Be aged 25-55 (productive working age and less likely to have developed long term medical condition)
     2.  Show offer of employment and income (higher socioeconomic status generally equates to better health)
     3.  Confirm no history of long term medical conditions that require expensive medical treatment (yes, diabetics receive an unfortunate drubbing worldwide)
     4.  Admit to your smoking, alcohol or drug use  (you oughta see the cost of cigarettes over here, good on you NZ!)
     5.  Have blood work verifying that you do not have HIV, Hep B, syphylis, renal or liver failure (decreases country wide infectious disease risk)
     6.  Have a chest xray that does not show evidence of active tuberculosis (guess I didn't just learn about histoplasmosis in Minnesota, I acquired it.  Nice granulomas.  Hope that preexisting condition legislation is enforced before I have to reapply for US health insurance.)
     I found all this an interesting lesson in how the cost of healthcare amongst a population really starts at the border.  Something the US health insurance industry has known and more aggressively enforced over the years to protect their profit.  Now that health reform has passed in the US, I wonder what the next step will be by the insurance industry.  Perhaps building fences through the desert? 

    Back to our immigration story.  After several emails between us and the INZ officer in London, (yes, London, another mistake of mine) helpful phone calls from staff members at NZLocums to immigration, and two trips to the Wellington INZ office, we were successful in obtaining our two year work visa and student visas for the kids.
    The process reminded me once again that I married up.  You see, the first trip to Wellington INZ, I was on my own during a break from the orientation session with NZLocums.  The very pleasant INZ Officer that day, took one look at me, and only pushed the exact same stack of applications that I had already sent to London toward me.  Telling me to fill them out again.  Dejected I left.  The next day, with Kim accompanying me, and not having completed any additional paperwork, the officer smiled at Kim and kindly processed our visas!

   Next stop Wellington Police Department for fingerprints to send back to the FBI. 

Amateur photographer gets lucky

Sitting at the dining room table having breakfast. 
Saw this amazing light before the coffee really kicked in.
Fortunately the camera was handy.
An open invitation to share a sunrise and cup of morning coffee,
for anyone who wants to come visit us in NZ.

Fishing by Joel

Fishing:  We fished in the Bay of Islands.  I enjoyed my first fishing trip in New Zealand.  We went out in the Bay with Dr. Taco Kistemaker's boat.  It is an aluminum power boat.  Taco works with my dad.  He is from Holland, and not a Taco that you eat.

Taco let me drive the boat.  We found the fish by looking for the birds on the water.  We used rubber lures.  I caught 3 fish and my dad caught 0 fish.  The fish we caught are called kahawai. 

We took the boat out to Urupukapuka Island and stopped in Otehei Bay.  We barbecued up the fish and had a wonderful lunch on the beach.  Talk about fresh fish!  There is a great hike that we took to the top of a hill on the island.  The island is named after the Urupukapuka tree.  There is a lone tree standing on a hill overlooking this bay, and I drove toward it to get us into Otehei Bay. 

    We are having alot of fun here in New Zealand.
     Love, Joel
  

A word about our sponsors.

     Ok, reality check.  We do not really have any sponsors. 

     Feeling somewhat like this statuesque swimmer overlooking Wellington harbor, we have jumped off into New Zealand relatively bare.  Neither Kim nor I had ever been here before, and yet we were taking the plunge. It took quite a bit of effort to rent out our house, move out, figure what to pack for a year, drop off our dog, and say goodbye to family and friends for an unknown duration of time.  Throw in some angst of putting our children in a new school, starting work and living in a community about which we only knew details from the internet, having never met my new colleagues in person, no guranteed job when we return, some boundaries on financing, etc... I would have to say that my lower abdomen felt alot like this guy will when he hits the cold water.

   So far, all of the great things we have heard about New Zealand have been true.  The scenery is beautiful, the people have been wonderful, and it definitely is a great place to be.  The water is warming up and the angst and chill in my lower abdomen has been quickly resolved.

   Now back to the title of this post.  I have set some links, not really sponsors, under our picture at the top of this blog.   Their explanation is as follows:

     1.  NZLocums.com:  for family physician colleagues who may want to create their own medical working trip in New Zealand, this is a great place to start.  For my ER boarded colleagues, the sister organization NZMedics.com can help get you here.  They helped match me to a compatible practice, and helped organize all the paperwork.  You can work with Global Medical or Vista Medical out of the States, but understand that they tend to charge the local physicians a much higher price to bring you here for work.

    2.  Immigration.govt.nz:  For anyone who wants to visit, work, or travel in NZ, go through here first.  Even if on holiday, you need to let them know when you are coming and especially, when you will be leaving. 

    3.   Bill Yeaton Travel Photography:  Many of you may want to see some photos of our experience here in New Zealand.  During my first weeks of work at Broadway Healthcentre, I was lucky to overlap with Dr. Bill Yeaton as he finished his locum stint.  A fellow US physician, Bill is a seasoned world traveler and amazing photographer.  So if you want to see amatuerish pictures of our family in NZ, bear with Kim and I and follow our blog.  If you want to see some amazing professional photos of all the beauty of NZ and other countries, check out the link to Bill's site.

    4.  A sailing doctor's adventure:   At 4am when between patients in the ER, this is the website I would check out for inspiration.  Steve is a medical school classmate from Minnesota and fellow family physician who has taken his family on an even more amazing journey since 2007.  If all goes well, we will get a chance to share some time sailing on their boat Uliad once they make their way to NZ.

    5.  kiwisecondopinion.blogspot.com:  It is always good to get a second opinion. Dr. Ken Fabert, who has twice my years of experience in family medicine, has shared his experience of working in NZ.  A good reference to make sure that I am not making this stuff up. 

    6.  Teamhealth.com:  If you want to join a great group of ER docs on a part-time basis, check out this site.  Northwest Emergency Physicians, part of Teamhealth, provides physician staffing to the hospitals in Redmond and Prineville, OR.  I say check it out for part-time work, since I hope there is room for me to come back to work in a year.

    7.  Payette Lakes Medical Clinic:  The integration of the hospital, physicians, administration and medical providers in this beautiful community in Idaho provides the basis for alot of my comparisons in medicine.  Kim and I met, married, had our children, and have left our dog behind in McCall, so it still has ties for us, hence a link to this blog.

   I did have a couple of law offices, a medical malpractice insurer, and a health insurance company lined up to be our sponsors since they had provided some of the inspiration to leave practice in the States.  In the end they all declined.  Too bad, because the profile view of the above statue, which actually makes the guy look like he is preparing for his morning micturation and not a swim, would have looked great above their logos!

Driving on the Left and Healthcare is a Right

    Arrival in New Zealand brought with it the immediate challenge of learning to drive on the left side of the road.  Kim and I had traveled in the UK early in our marriage, but only traveled by rail there, subsequently missing out on our chance to gain a new skill.  Now with the kids in tow, keys handed to us by Bob from the Northland Rural GP Consortium, and bags stuffed into the Toyota Camray,  we were off to Kerikeri.
    I am happy to say that despite the jet lag of our 26 hours of travel we arrived safe and sound in Kerikeri.  Sure our windshield was extra clean (US drivers, the wiper lever in NZ vehicles is where you are comfortable reaching to use your turn signal), and there were a couple of near misses at the roundabouts during the four hour drive.  Our biggest saving grace is that we were able to tailgate Bob all the way to our house in the Northland.  My chance to prove that I have learned there are times to take the lead, and there are times to safely follow.
   Between the brief stints of actual driving from road construction to road construction sites, and while Kim and the kids caught some sleep, I had the chance to look forward to working here in New Zealand.  I was particularly interested in the differences of practicing in a country where healthcare has been legislated to be universally available to all.  Essentially made a right to for all New Zealanders to be able to obtain healthcare.
    In 1938 the Labour Government established the Social Security Act in New Zealand to try and secure free and universally available healthcare to all.  Not suprisingly, the Labour Party attempt was  opposed by the Medical Association (damn doctors) who did not want to become state employees.   Over the years since then, there have been various government attempts to either privatize portions of the system, cut back services, extend services, break it up into districts, etc.  Nevertheless, what remains is a government run healthcare system that now consistently ranks better than the US in a variety of categories including longevity of its citizens, neonatal and infant mortality, and percentage of GDP spent on healthcare.
   The above history of New Zealand healthcare is very similar to all of the debate that took place during our recent healthcare reform attempt in the US.  Of course I do not know the history of New Zealand  well enough to know if there was a pundit such as Glen Beck who could manipulate the propaganda to distract from the actual needs of the country.  Then again, a propaganda artist would not have compared the New Zealand prime minister to a Nazi since the horrors of that comparison were not yet known.  So I contemplated the kidding from the New Zealanders who helped us get here when they said, "You Americans drive on the wrong side of the road!"  Maybe we Americans are still on the wrong side of the road when it comes to healthcare.  I am excited to find out the difference. 
      Until work starts, it is time to enjoy the beauty of our new backyard.