A hospital without surgery, down the road from a mobile OR


The hospital’s a hundred years old

And I watched the drama unfold

    No dark and no gloom

    In these inpatient rooms

Built during the rush for the gold.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical avoid burnout, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  After four weeks in Wellsford, on the North Island of New Zealand, I just arrived at my new assignment.

I drove the plains east of the Southern Alps, low white clouds racing across clear blue skies, to my first morning at the Waikari clinic, where I found the mobile surgical unit parked.

People face a long wait for elective surgery in New Zealand.  To ease the burden on the hospital facilities, Christchurch has a mobile operating theater that travels the outlying areas. 

The US medical system includes a number of specialty hospitals for low risk surgical operations, but the larger hospitals complain about cherry-picking.  Here the bigger institutions send out a mobile Surgi-center.

New Zealand’s approach involves less bricks, mortar, and whining.

A tour of the interior showed a modern OR, including scrub sinks and anesthesia. 

The roster (=schedule) included patients with umbilical hernias and hemorrhoids, procedures which needed general anesthesia and an OR but not much recovery afterwards.

It seems like a good idea to me, something we could probably start up in the States, but unlikely to occur because the Joint Commission on the Accreditation of Hospitals would never approve.

The manager showed me around the clinic.  My office for the next four weeks looks much like the offices I used for the last seven weeks in Wellsford/Matakana, and I asked if the furniture came as a standard issue.

I don’t like the layout; a desk separates me from the patient. 

They asked me if I’d mind making ward rounds at the hospital.

Not at all, I said, but I hadn’t known one existed.

Walking distance up the road, the hundred-year-old Waikari Country Hospital commands a striking view. 

I don’t know when surgery stopped at WCH, but I met several people who had been born there and talked with others who had their babies there.  The midwife movement has taken over non-operative obstetrics in New Zealand, most babies deliver at home or in birthing centers. 

The hospital here has facilities for emergency childbirth, but no operating theater. 

Nor do they have lab or x-ray.  A courier collects blood work once a day, and patients needing radiologic studies get sent to Christchurch; thus the clinician relies more on physical exam and reasoning than on imaging or test results.

The hospital here cares for people who don’t need an acute hospital bed, but who cannot go home.  Some come for respite care, some for terminal care, and some for fine-tuning of chronic problems. 

The atmosphere stays quiet and restful, and the Victorian architecture lends a touch of grace, but the last earthquake cracked walls that had never been cracked before.

Charts remain thin despite long stays.  Reducing paperwork keeps nurses efficient and the staff small.

The Joint Commission would never approve.

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2 Responses to “A hospital without surgery, down the road from a mobile OR”

  1. hoang tran Says:

    I am considering doing locum tenens in Australia or NZ ( 3-4 week assignment) , I am an internist in VA. I am interested to hear from you re your overall experience working in NZ. Thanks , Hoang Tran.

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