By Nathan Skelley, MD
Kia Ora! In March 2016, as a chief resident at Washington
University in St. Louis, I was very fortunate to spend two weeks in Auckland,
New Zealand. Through the support of the Washington University School of Medicine, Department of Orthopaedic Surgery, I was able to study sports medicine techniques and
trauma orthopaedics with the surgeons at Starship Hospital.
Starship Hospital is the largest public pediatric hospital
in New Zealand and sees approximately 90,000 patients a year. The hospital is
located in Auckland which is the largest city in the country with a population
of approximately 1.5 million people—the entire country of New Zealand is
approximately 5 million people across the North and South Islands. Auckland is
part of the North Island. Starship opened in 1991 and has several modern
amenities. However, some common amenities we may not appreciate in St. Louis,
such as air conditioning, were not present in the clinics. In the orthopaedic inpatient
unit, four patients were present in a single room separated by curtains. There
were two chairs for visiting family and friends and a sleeping pad that was
laid out on the floor for family that wished to spend the night.
Healthcare System
New Zealand has a very different healthcare system and
training program compared to the USA, however, during my two weeks, I found
many similarities between our programs. The healthcare system has a private and
public component. There is also the Accident Compensation Corporation which
covers New Zealanders for medical expenses related to any hospital presentation
for an accidental injury. The ACC covers healthcare costs and offers income
reimbursement during the leave for care. This comprised a majority of the
presentations I saw during my time at the hospital. Another interesting
difference was that medical trainees in New Zealand are represented by a union
which advocates for trainee education, resources, and compensation. The trainee
structure for becoming an orthopaedic surgeon was very different from our
training program. Junior trainees would
commonly operate independently. Of note, gunshot wound trauma was very rare in
New Zealand, but I was able to teach several trainees about the management of
these injuries. The day-to-day activities at the hospital were very similar.
Trainees began their day by pre-rounding on patients. They presented overnight
and pending cases to staff physicians in the morning during a standing room
conference. Then they would round with the consultants (attendings) on their
patients before heading to the “theatre” (operating room) or clinic. On
Tuesdays, they have an educational conference in which trainees stand in front
of the audience while they are asked questions about various cases and topics.
Surgical Cases
My trip began when I flew from St. Louis to San Francisco and
then on to Auckland via Air New Zealand. After the 14 hour flight to Auckland, I
went straight from the airport to the hospital to check-in. I expected to have
the first day to get oriented, but after receiving my badge was invited to the
theatre for a Woodward procedure for a Sprengel’s shoulder. This is a complex surgery
for the scapula. It is not a procedure I had participated in during residency,
but as the largest referral hospital in the country, most of the complicated
cases are sent to Starship Hospital. During the two weeks, I met four patients with
Sprengel’s shoulder. The patient
population in Auckland was very diverse and different from the USA. Many of the
rural patients in New Zealand are at a higher risk for infections and this
presented a significant challenge for the staff and hospital at Starship. I was
interested in the care of several of these complex cases and it was helpful to
collaborate on some of the issues related to treating orthopaedic infections.
The team at Starship has also helped pioneer several unique treatments for
sports injuries. Given my interest in
sports orthopaedics, I was especially interested in observing and discussing
these treatments as they relate to our population in the USA. Athletes in New
Zealand were very engaged in their healthcare and pain medication use was much
less common than in the USA.
Culture
The Maori are the native Polynesian people of New Zealand.
Approximately 20% of the population identifies as Maori and they are the second
most common ethnic group in New Zealand. The Maori language, Te Reo, is spoken
throughout the country and several of the television and radio channels in
Auckland were only in Te Reo. Their influence on sculpture art and crafts was
apparent throughout the city and surrounding area. Cultural tattoos are also an important aspect
of expression in New Zealand. Maori composed a large percentage of the patients
we saw at Starship.
New Zealanders are
very active and involved in many sports. Rugby is very popular in New Zealand
and the national Rugby Union team, the All Blacks, have a very successful
history. The team is also known throughout the world for their “Haka” performed
at rugby games. They perform this traditional ancestral war-cry ritual in honor
of the Maori history in New Zealand. The All Blacks win ratio is so high they
have one of the most successful teams in the history of all sports. The
Warriors are the New Zealand Rugby League team and have also been very
successful in this version of rugby. It was a great honor to meet national
rugby players and discuss their injuries and recovery. Stewart Walsh has helped
care for numerous athletes in New Zealand and has pioneered several unique
treatments. He was helping to cover a Warriors game during my visit and took me
to the rugby game. We also saw the training facilities for athletes in New
Zealand.
Mentorship
I was extremely thankful for this opportunity to visit New
Zealand. It is a beautiful and amazing country. It was an excellent experience to observe and
learn about another healthcare system, aid in the care of a unique and diverse
patient population, and collaborate with leaders in the field of orthopaedic
surgery. The trainees, Anand Segar, Jim Kennedy, and Dan Liyanage, are
excellent surgeons and care deeply for their patients. Similarly, the
hospitality of consultants Haemish Crawford, Stewart Walsh, and Theresa Bidwell
made this a very positive experience. I look forward to collaborating with
these physicians throughout my career in orthopaedic surgery.
