Treating Kiwis I

8 things that made me go WTF?!

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Hidde is pretending to work hard in New Zealand at his final internship at a general practitioner's (GP) practice. To try to convince people that he is not just doing outdoor sports, he will be sharing his (medical) experiences with us. About a month into his internship, these are the 8 things that baffled him at first.

In short: my plane did not crash! On the bright side: now I can point out 8 things that made me go ‘WTF?!’ while working with the GPs here, anything for your entertainment! I might even provide you with some educational insight. But first, it might help to give you some background as to where I am and what the heck I’m doing.

For my final internships  I spend my final fourteen weeks at a general practitioner's (GP ) practice in New Zealand. Over here they call such a practice a ‘surgery’. As I’m getting more and more used to everything after having been here for about a month, I’m seeing more and more patients myself.

The surgery is located at Kaikohe and is quite big with twelve doctors working there and at two other locations. It also houses a small acute clinic and loads of supporting staff. Meanwhile, I am staying at Kerikeri with my supervisor’s awesome family. So, let’s try to convince you I’m not solely mountain biking and enjoying the beach around here.

1. ‘No koalas here mate’
This really baffled my fellow PanEssayers, so I just wanted to let all you ignorant guys know that New Zealand is not the same country as Australia and that there are no koalas to hug here. They have kiwis though, both the fruit and the bird, the last of which is New Zealand’s national symbol .

2. ‘Hidde, would you like to go to prison?’
Yup, these GPs go to prison regularly, not for illicit prescriptions of morphine, not for cutting into people without informed consent, nor for doing unnecessary vaginal exams on young ladies. No, they have been hired by the state to provide medical services for the prisoners.

Going with them was a pretty surreal experience! A big eery concrete wall turned out to hide an actually pretty peaceful piece of land with even a pond and what not. It was kind of unnerving to to be surrounded by nursing staff dressed as guards and to wear a distress button. My GP has never had to use it, but still…

More in general I think the GPs here do more diverse things than their Dutch counterparts. For instance, we visit the aged care centre (picture below) two times a week to act as a “verpleeghuisarts ”. These extra tasks  even range beyond the strictly medical. For instance, patients come in to get all sorts of medical certificates: to qualify for a driver's licence, to be able to get out of work when they are sick, or even to get a governmental benefit when they are unable to work due to chronic illness.

3. ‘Pain? Just give him some norflex’
Give him what? ‘Or you could try some acupan.’ What? Annoying enough, these guys don’t only use different brand names for most medications or subsidise different agents resulting in different first-choice-treatments. No, they use stuff that’s not even in the “Farmacotherapeutisch Kompas”, let alone us Dutchies ever getting taught about them.

Just to educate you guys a bit: Norflex is the brand name of orphenadrine: a muscle relaxant, painkiller and euphoria inducer. It’s a local favorite to treat musculoskeletal pain. Another painkiller is Acupan, a brand name of nefopam, which works centrally without acting on the opioid receptors. They use it a lot in the prison due to its lower abuse potential than opioids and therefore lower marketability under inmates.

4. ‘Sore throat? Take a swab and give some antibiotics’
Say what?! This might be a bit exaggerated but still, loads of throat aches get treated with antibiotics here or get swabbed. For what you ask? For Strep. A. Why? There is a high incidence rate here of both group-A streptococcus and rheumatic fever. Rheumatic fever is an autoimmune reaction that tends to occur after Strep A infection, with destruction of heart valves as its most feared complication. This mostly occurs in the indigenous population (the Maori )due to poor living conditions and a genetic susceptibility. Pretty much the same goes for the prevalence of gout.

The Maori’s white-skinned European counterparts on the other hand have been hit pretty hard by the (now shrinking) gap in the ozone layer, giving me ample opportunity to practice my skills with the scalpel.

5. O my god, that smell!
No, I’m not just hinting at the highly prevalent and terrible smell of cigarette smoke. I was absolutely stunned to recognize the exact same smell I smelled everywhere in the poorest corners of Nepal. The first time was when I examined two children who had obviously been wearing the same clothes for more than a week. And this would certainly not be the last time.

It is really staggering to see how poor this community is, especially the Maori population. Medically this poverty shows itself in some diseases we paradoxically call “welvaartsziekten” (literally translated: welfare diseases) in Dutch. Because healthy food is really expensive here and unhealthy food is really inexpensive, it seems like pretty much everyone is fat and has diabetes with all the complications you might think of, most notably kidney failure.

Reading up on New Zealand before coming here I understood it was supposed to be one of the most socialist countries of the world. Granted, a lot of the healthcare is available to everyone at a low cost. Still, something went terribly wrong somewhere with the distribution of wealth. I really see now how well we’re off back home. I’m getting more and more infused with the sense that we should fight for our welfare state tooth and nail.

6. ‘Doc, really, my left shoulder hurts after hitting my right knee’
No, Kiwis don’t believe in some mystical force connecting contralateral body parts. However, they do believe that every health issue that results from an accident, should be treated free of charge to the patient. Instead, a national insurance called ‘ACC’ will pay, even when it concerns foreigners!

Sounds great, doesn’t it? Well it does of course, but there are a few catches. Most notably that part of the income of the ACC is generated by the employers paying a premium for their workers. This premium goes up when an employee gets hurt on the job, in which case this employee will be more expensive than others. And in turn runs a higher risk of being fired.

7. Me: ‘Good morning! Please come in.’ Patient: ‘I’m fine, thank you.’
Me thinking: did I ask you how you were already? In fact, I did not. Asking ‘how are you’ is such an integral part of greeting someone here that people hilariously assume they have been asked this. There is more to this though, I think. The English really planted their overly polite culture here. Whereas we get taught about the value of good feedback, children here get taught: ‘If you don’t have anything nice to say, don’t say anything at all.’.

My supervisor tells me that even after eight years he just cannot get used to all this. Anotherexample , when an English person says: ‘we should definitely have a coffee some day’, he does not want you to pick a date right away, he’s just being polite without actually wanting to see you again. Its seems to me they use overly politeness as a shield, guarding themselves from a real connection. Being a bluntly direct and sober Frisian guy, I have a rough time adjusting to this.

8. ‘You’re not driving, get in at the other side of the car!
Granted, this is even more off the medical topic, but everything is on the wrong side here! Take driving for instance. Why drive on the left? Why?! It only results in everything being on the left (read: wrong) side, everything except the pedals! Even on the mountain bike I use here, they just had to switch up the brakes. The back brake is now instead of on the familiar right, on the wrong left. This has resulted in a near-death scenario or two. 

So now you guys have had a glimpse into my acclimatisation period here in New Zealand. If you have any questions, please post them below and I will answer them directly or in the next report! But before I say goodbye, let me end with one last mind-boggling story, showing another striking difference between two supposedly enlightened countries. A woman comes in with her two kids, she’s doing better than before.

What had happened? She had been an emotional wreck after they had had a burglary, during the investigation of which the police had found a few grams of marijuana. This resulted in her husband’s incarceration for two years. Two years! Considering everybody, and I mean everybody, smokes it around here, this felt so unfair. Especially to the young children having to do without their dad for two years. Our Dutch policy regarding marijuana may seem idiotic, but this!

So, any Questions? Don't be shy!