More pictures from Whongamumu

I am still working on this blog picture process.  Here are some additional photos from our trip to Whongamumu:

Trek along the shore to the whaling station.Joel learning some history.

Kim and McKeely bypassing the crowd!

Wh = F and Whongamumu = A Bay to Ourselves

    Three weeks ago we were able to take a hike to the old whaling station in Whongamumu Bay.   We have had some recent winter low pressure rain storms hanging over the Northland, so it was terrific to have a sunny day on the weekend. The temperatures have been comparable to a beautiful fall day in the Pacific NW, so the hiking has been awesome when we get the chance to go.  As you can see from the pictures, there was not a whole lot of competition for parking spots at the trailhead. 

   Googlemap Rawhiti (pronounced Ra Fiti) and head down the road a few kilometers west of town, and you will find this bay.  About 6 kilometers round trip up and over a small ridge.  Getting to the trek required a quick ferry ride from Paihia to Russell which was a first for the kids.  As you will see from the final picture in this series, there was some crowding at the end of the trail.  May have to split this into two or three posts, so bear with us.

Welcome to Kaikohe

     Yeah, Santa Claus got stoned here once.
     They promised me that I would get to work on Broadway, so that drew me in.  Broadway Healthcentre, in Kaikohe, is the clinic at which I will be working for the next year.  Yes, it is located on Broadway, the main road through town.  No, I did not get a banner on the marquee, as I am just one of a decent sized line of locum docs who have passed through here.
      Kaikohe made international headlines in 1991, when during the Christmas parade, local children threw stones instead of candy at Father Christmas.  Since then Kaikohe has found other ways to displace any pent up anger during traditional christian holidays.  If you get a chance, search out the DVD "Kaikohe Demolition Derby" produced in 2004 by Florian Habicht.  It gives a whimsical look at the town of Kaikohe, coupled with breathtaking shots of the surrounding countryside and highlights of the Christmas and Easter demolition derby.  (Google search gets to a site to view it online.)
   Like Ben Haretuku, a local star of the movie, who refers to his profession as being a doorman instead of a bouncer, a description of Kaikohe depends on the labels you apply.  In reality Kaikohe is primarily farming community located in the central Northland of the North Island, nearly equidistant from both coasts.  Since I have recently practiced in Oregon, I do include marijuana as a cash crop in my definition of farming.  It is home to the Nga Puhi of the Maori.  Nga Puhi is the largest Iwi, or subtribe, of the Maori in New Zealand.   Historically, Nga Puhi were considered the fiercest warriors. Many of the Kaikohe whana (family) tree reach back to Hone Heke, the most well known warrior of the Nga Puhi. To some of the New Zealanders we encountered in Auckland and Wellington, Kaikohe is a wild, remote, uncultured region of the Northland.  I hope they keep thinking that, because Northland really is beautiful.
    If you exclude the Pakeha dominated tourist communities of Kerikeri, Russell, and Paihia, the Northland is considered one of the poorest regions in NZ.  Yet the people I have the privilege of seeing as patients in Kaikohe, much like Ben describes himself in the movie, are happy to be here. Broadway Healthcentre, which serves as the only medical facility (ie ambulances arrive here, really sick people can show up here) for a service population around 8,000 people, is a busy place.  The Healthcentre is staffed by our multicultural "League of Nations" group of 8-10dedicated physicians, 12-14 nurses and a few allied professionals, who are here for reasons I will detail in a later post.
    I had some initial anxiety about the my skills in managing the spectrum of illness and disease that I may find in this subtropical impoverished community.  So far, I am happy to say that the majority of things I have seen here are exactly the same as those that present to family practice clinics in the US.  I have had to adjust some thinking due to the early onset of disease amongst the Maori.  Gout, asthma, diabetes, horrible pediatric eczema and cardiovascular disease are much more prevelent and severe than some of the cases I have cared for in the US. 
   Suprisingly, I have found a couple of things about practicing medicine here, that I had not realized were distressing to me in the US.  Due to the Pharmac program, I can send an economically challenged family out the door knowing that it will only cost them $3 for the prescriptions to help control their children's asthma.  A burden that most families are able to afford.  I can refer patients for laboratory and specialty care, knowing that it will not result in bankruptcy for the family.  Just a couple of golden nuggets in medical practice found at the end of the rainbow. 

  

Fishbone: In US= $1000+, In New Zealand Priceless?

      Like most good stories involving urgent/emergency care, this one did involve alcohol....and fish.

Joel wrote earlier about our first fishing trip in the Bay.  (Yes, those are Joel's hands holding onto the rod, but dad and son are still ribbing each other about who actually "caught" the fish.)  Little did I know that the Kahawai pictured above would lead to my first encounter with the New Zealand Accident Compensation Corportation or ACC for short.  The process of ACC was a wonderful experience that  made me realize that alot of healthcare dollars in the US are wasted on processing medical claims, and not on the treatment.  

     The ACC is the branch of the government run healthcare that provides coverage for any accidental injury that is sustained by a person visiting or residing in New Zealand.  Imagine coverage for workman's comp, assault victim compensation, medical, automobile and personal property liability, disability and accidental death insurance and one's own stupidity all rolled into one!  It is funded from the goods and services tax (GST) that everyone starts paying upon arrival in the country.  I found the fact I had already paid into the system an amazing relief of injury related anxiety as I sought out my own treatment.

     Back to fishing:  The alcohol involved was a very fine Marsden Winery (Kerikeri) Pinot Gris.  The fishbone was from the freshly barbecued Kahawai that we were enjoying during our trip to Urupukapuka Island.  I had just taken a bite of fish and chased it with a sip of wine, when I felt the jab of a fishbone in the back of my throat.  Like many a good holiday maker whom I have met over the years, I took the next most logical step....I drank some more wine!  To no avail, as I continued to feel a sharp but tolerable stab in the back of my throat during the rest of our meal.

      Later that Sunday evening after returning home, I gained more empathy for the daily perils of a bulimic while failing miserably at retrieving the bone.  I did get some good practice at my manual intubation technique by inserting my fingers all the way to my epiglottis.  Yet the bone remained lodged in my vallecula despite my attempts.  

     At this time, I was unfamiliar with the benefits of the ACC and how it could apply to my injury.  So it was with some trepidation on Monday, that I approached my work colleague, Dr. Taco and asked if he could visualize the bone.  My trepidation has been trained into me during my years of practice in the US.  Many a time, I have seen holiday makers whose injury pain and anxiety is worsened by the reality of a sudden pile of unexpected medical bills.  Even if they are well insured, they will spend the next several months sorting through medical bills and figuring out how and when to pay them.  Since my upper airway had been operated on within the past year, I was wondering how our US purchased travel insurance would apply their preexisting condition clause to my care.  Maybe I was a bit neurotic about the preexisting condition clause.  I once had to help defend a patients claim for surgical removal of a sixteen penny construction nail accidentally fired into his knee by confirming it was not due to a preexisting condition.  So I hope my neurosis was not unfounded.  

     We lacked the necessary medical equipment in our office to properly examine my throat, so Taco quickly arranged an appointment for me with an ENT consultant in Whangarei the next day.  On Tuesday, after finishing work, I made the one hour drive to Dr. Sheddy's (honorary member of the physician all name team, if you say it fast with a NZ/Indian/English accent) office.  Mentally I ran over the numbers I was probably more familiar with in the US.  Car travel one hour $30, ENT office consult fee $250, procedure fee for foriegn body removal $800, etc.  I mindfully patted by wallet to assure my Visa card would be there.  

     After filling out the small 4 x 6 notecard of my pertinent information (name, address, phone, email, referring doctor...that was it, and no identification check) I was allowed to wait for Dr. Sheddy.   Twenty minutes later I was in his chair, nasopharyngoscope insterted, tongue numb, and forceps grasping the fishbone.  Relief and appreciation for another physician's skills soon followed .  The offending trophy is pictured below. 

         

       I walked back to the reception desk, Visa card at the ready.   A pleasant smile from his receptionist, a statement of "No payment needed, it is covered under ACC".  A "Thank you"  and a dumbfounded look from me and I was on the way back home.  One week later I received a single page letter from the ACC stating my procedure was covered and payment was made to Dr. Sheddy. 
      Having just made our payment to St. Charles Hospital in Bend for the blood work that Kim and I had done for immigration  medical 3 months ago, I could not have had a more blatent example of a difference in administrative costs.  Kim and I had that blood work done in February.  It required a ream of paperwork to be filled out, even though I had been a patient at the same facility within the past year.  HIPPA paperwork, insurance verification, photocopies of our driver's license, and on and on.  Then once the blood work was completed, four seperate mail pieces for each of us between the hospital, us and our insurance company.  Finally after all of the insurance company "adjustments" we were left with our final bill.
      Hmm, a 4 x 6 notecard vs. eight sheets of legal mumbojumbo documents.  Immediate payment vs. adjustment and medical review by an insurance company.  One letter from the ACC stating payment was made vs.  4 letters with a final verdict that we needed to make the entire adusted payment to the hospital because we have a high deductible and the blood tests were not medically indicated?  No additional burden after my relief of pain vs. months of confusing bills and final additional financial burden.  Both processes are spending healthcare dollars, which is more appropriate?
    So as I contemplate these things, and look at my receipt from a recent dining experience, I smile happily knowing that the 12.5% GST is serving its purpose.  I might never know what kind of devious bones may have been lurking in that butter chicken we enjoyed!

Best Fish and Chips in the World, Part Deuce

The beach was not crowded. 

Mom and Dad thought the water was warmer than the Deschutes or Payette Lake in the summer.

We then went to have fish and chips.

They serve them in a big paper wrapper.

I am having fun here in New Zealand.

McKeely

Best Fish and Chips in the World

  Last weekend we went to Mangonui.  The guidebook said they were supposed to have the best fish and chips in the world there.

We went for a swim on Cooper's Beach.

Everyone put on their wetsuits and swam.

It was not crowded.

We had the beach to ourselves.

More in a minute.  Having trouble posting pics,

McKeely

Good News, Drought is Over in the Northland

                    Bad news for this guy as he has been trying to make alot of boat repairs this week.
Not so bad news for us, since it has given our family time to watch the Lord of the Rings Trilogy. 
Couch site seeing in New Zealand on rainy days.