This is RAB writing now: Practicing medicine is quite different in NZ (pronounced "En Zed" by Kiwis). The office where I am working is Avon Medical Care Centre in Stratford. The practice is privately owned, and doctors are paid via a very complex capitation formula, dependent on our rural location, age of patients, etc..... We also get paid for accidents of any sort (car, self-induced, medical misadventures, work related) on a fee for service basis. Costs are controlled by the government by limiting access to testing and specialty care, and by having a very limited formulary of medications that are covered. So, it is kind of like a big national HMO. You can also go "private" if you like, by paying out of pocket for private doctors or having a secondary private insurance. The private insurance basically puts you at the front of the line for elective surgical procedures. We do not screen for prostate or colon cancer in NZ, and pap smears are done only every 3 years. Mammography starts at 50 and is done every other year at most. We do not do routine labs or dexascans or recommend aspirin to every 50 year old male. All prescriptions are good for 90 days only, and anyone on a chronic medication must come in every 90 days.

When I am on call, I have to back-up the ambulance service. This means I have to go to the Shell Station at the roundabout in the middle of town and pick up a portable defibrillator and a backpack with an assortment of medical equipment. I have a tackle box full of drugs and chest tubes and gloves (and prayers) that stays with me in my car. I got called to a farm WAY out in the country last weekend, for a syncopal 66 year old woman. When I finally found the place, the solo female ambulance driver was very happy to see me. The patient had been brought from the paddock where she was working when she fainted in the bucket of a front end loader. She then took off her gum boots (wellies) before climbing into the ambulance. So I got there to find a pair of boots in front of an open ambulance. The patient was well attended to and the driver gave me a great presentation, vital signs and rhythm strip. She then went to the hospital, 40 minutes away. If she had been really ill I would have gone with them to take care of her during the ride. I am definately out of my comfort zone... which I reckon is a good place to be since that is when I learn the most.

In the office I get to see lots of children, which I enjoy. Asthmaand eczema are very common for some reason, as are scabies, chicken pox and impetigo. Yesterday I sewed together a four year old's middle finger that had been slammed in a door -- the nail was avulsed as was 40% of the pad. This would have gone to a hand surgeon in Easton, but I got to repair it, which was fun (for me, not the little girl). In after hours today I did a layered closure of a to-the-bone laceration on a 19 year old's forehead. Also fun and interesting. This would have gone to the ER in Easton. Don't know how much the Kiwis are getting out of it, but the experience is great for me.

Hope has done a great job making our new little farm cottage into a home. She has lots of new bovine friends. This weekend we are going on an office exercise jaunt -- 9 kilometers walking -- as a way of encouraging exercise. I would have a heart attack if I saw the RFP staff walking that far! We are starting at 7 am, and finishing at someone's farm for a big "fry up" breakfast of bacon and eggs and pork chops, so the effort will have some reward! RAB