Students — 24 November 2018 at 7:32 am

There and Back Again: An Emergency Medicine Elective in New Zealand

Dr Emily Watts / Foundation Doctor / Chesterfield

Emily is an FY1 doctor in Chesterfield, after graduating from Nottingham Medical School in 2017. She spent her final weeks of medical school on elective in Rotorua, working in their Emergency Department (ED) and taking advantage of New Zealand’s rich culture and great outdoors.

Aotearoa

Aotearoa, the Land of the Long White Cloud, had been in my sights as my elective destination from pretty much day one of medical school. As a self-confessed Lord of the Rings fan and outdoor enthusiast, the combination of New Zealand’s outstanding scenery and adventure, the opportunity to visit Hobbiton and climb Mount Doom, and a placement in Emergency Medicine created the elective recipe I had always wanted. The cherry on top was the opportunity to work with and learn from the Maori people, whose culture and history are vastly different from my own.

‘Hands on’ in Emergency Medicine

I had six weeks of clinical experience in emergency medicine, working in Rotorua’s ED, at the level of a Trainee Intern, New Zealand’s (paid!) final year medical students. This meant I managed my own patients under consultant supervision. It was a practical and educational placement, I soon learnt to suture a variety of wounds and apply casts to an assortment of broken limbs, thanks to the 130km of premier mountain bike trails running throughout the Redwood Forest right on our doorstep. I was taught how to do a FAST scan, lance abscesses and remove foreign bodies from eyes. I also assisted in three cardioversions, two resuscitation cases and an extensor tendon repair.

In New Zealand, people pay to see their GP but not for ED visits. Naturally, this results in many presentations to the ED that may better suited to primary care management. However, many of the ‘GP’ cases I saw whilst in ED were actually quite complicated, perhaps because patients delayed presenting due to the cost incurred. There were patients I saw who had never seen a GP because they simply could not afford to; a concept I found hard to deal with coming from the NHS. In the UK there is constant liaison and collaboration between primary and secondary care. In New Zealand, however, they are two separate entities which integrate care where possible, but within the limitations of their separate funding.

As Rotorua ED is the closest department to both the extremely popular Whakarewarewa Forest (miles of walking, but also mountain bike trails of varying complexity) and the Luge, a large majority of presentations were injury-related, especially FOOSH forearm fractures. Some were minor cuts and scrapes, others more complex trauma requiring specialist input and occasionally transfer to a larger hospital.

I think my most memorable case was a gentleman who had been triaged as a low-priority PR bleed. Going to assess him, I was running through the important questions I needed to ask in my head. However, I had barely stepped into the room when he dropped his trousers, anxiously asking me, ‘Is this normal?’ Frank, fresh, arterial blood was spurting from his perianal area. Whilst I assured him it was not normal, I grabbed the absorbent pad the triage nurse had given him and hastily applied pressure, explaining that I was calling for assistance, and the room was about to get very busy. Sure enough, within five minutes, he was round in Resus with two consultants managing the bleed, and the surgical registrar en-route. We subsequently found out he had had a surgical procedure for an abscess three weeks previously, and whilst on the toilet had felt something ‘pop’. He recovered really well, and after a couple of nights as an inpatient for monitoring, was discharged home. This case was a lesson that you can’t assume what is written on the front of the triage notes is always the full story!

Cultural Exchange

With one of the largest Maori populations in New Zealand, I was excited to gain an insight into this unique and fascinating people, their beliefs and culture during my placement in Rotorua. I was lucky enough to find myself in New Zealand for ANZAC day and attended the Dawn Parade: a march from the centre of town onto sacred Maori land for the culmination of the Remembrance service at sunrise. Serendipitously, the Lions (the UK Rugby team) were on tour in New Zealand during my placement and played against the Maori ‘All Black’ team in Rotorua.

Generally, there were no real clashes between the provision of ‘Western’ healthcare and Maori beliefs during my placement. If issues did arise, they were nearly always due to ignorance of Maori beliefs on the part of the healthcare providers. For example, tables are sacred to the Maori people, as they signify the bringing of family together with food. Indeed, if you are offered ‘kai’ (food), you are not just being fed, but are being welcomed into the family, regardless of your background. If you put an empty specimen pot on the hospital table, or lean on a table whilst talking (both seemingly innocuous actions in ‘Western’ culture) it is taken by many of the Maori people as a sign of disrespect, therefore making a good doctor-patient relationship much harder to establish.

Taking the time to learn a little about Maori customs was by far the best part of my elective. ‘Whanau’ (farn-o) means family, and it is all important. I was privileged enough to be asked to spend a weekend at a ‘marae’ (Maori meeting house), where I participated in ‘hongi’ (sharing of breath – gesture of respect), heard some of the Maori legends including the creation story of New Zealand, learnt some nursery rhymes in ‘Te Reo’ (Maori language) and the ‘Haka’, and was welcomed into the Whanau (family) with a ‘Hangi’ (feast). This is an experience I will always treasure.

Rotorua hospital is built on Maori land that has been donated to the town for the purpose of healthcare by the local ‘iwi’ (tribe). I find the Maori culture fascinating, and their beliefs, particularly about death and dying, are vastly different to those of the Western world. They believe that every person dies two deaths. Firstly a physical death and secondly when they are no longer remembered by those who are still living. I have come to realise that, regardless of cultural beliefs around death, the idea holds true universally – our own myths and legends prevent those who are long passed from being forgotten.

Extracurricular activities

I would highly recommend planning an elective in New Zealand: the scenery is stunning, the people are friendly and as an English-speaking country, you are only misunderstood if you forget to use Kiwi colloquialisms (flip flops = jandals, swimsuit = togs, bedding = manchester)! Driving is on the left, and whilst New Zealand’s main roads are more like our B roads than motorways, navigation is surprisingly straightforward. There really is something for everyone. Wellington’s ‘Te Papa’ museum and Hobbiton were fantastic experiences, and a trip to the Waitomo Glowworm Caves is a must-see.
I can definitely vouch for Rotorua if you like outdoor sports. Some of the best mountain bike trails in New Zealand run through the Redwoods, as well as miles of hiking trails (‘tramps’). The infamous Luge down the side of Mt Ngongataha (essentially a gravity-driven go-kart ride, down increasingly difficult tracks) is not for the fainthearted, but incredible fun. Rotorua also boasts some of New Zealand’s best geothermal activity, including the Pohutu geyser, and the extensive range of spas and hot springs. In addition, Rotorua is ideally located centrally, making weekend trips to most of the North Island easily accessible.

Top Tips

  • Get organised early: I organised my elective around a year in advance, as availability in New Zealand fills up early. I emailed every hospital on New Zealand’s North Island, usually an elective administrator or departmental lead – (whoever was listed as a contact on the hospital’s website), and then applied directly for a placement to the hospitals that replied.
  • Set a budget and plan: The cost of living is more expensive in New Zealand than in the UK, and there’s often an admin fee for the placement. That being said, you can make your money stretch further by booking things early and asking for student deals
  • Accommodation: Renting a room locally is much cheaper than hostel/hotel options. Discuss potential options with hospital administrator when you apply – they may have hospital accommodation available, or many members of staff have spare rooms they lease to students allocated to smaller hospitals, as medical schools are not in commutable distance.Dress code: It may be a weird concept to us, but it’s very normal in Rotorua, and throughout New Zealand – even when patients (and doctors!) come to hospital barefoot.
  • Mana buses: The easiest and cheapest way to get between places during your time off. Very cheap (around $20 for a 4 hour bus journey!), you just need to book in advance. Apex car hire: reputable and reliable company, they DO NOT penalise you for being under 25 years old, if you hold a full license, making them the cheapest care hire by a country mile.

Trip Summary

Where / Rotorua, North Island, New Zealand

When / April-June, but they accept students February-November

Costs / 1000 NZD for 6 week placement

Weather / Varied! Despite approaching winter, there were still many days spent in shorts and t-shirt, granted, others required wearing as many layers as possible! Generally whilst the sun was out, it was hot, but following sunset, the temperature would plummet

Accommodation / There is hospital accommodation available, but you can also arrange to rent with hospital staff (cheaper, and gave me a more authentic Kiwi experience)

Contacts / I arranged my placement via the admin department of Rotorua Hospital, and one of the consultants within the Emergency Department: if people are interested in a similar placement, I’m happy to be contacted via Adventure Medic to pass on their details.