Tuesday, April 26, 2016

Auckland, New Zealand – Starship Hospital

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.

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.

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. 

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