I know it's been a while since I 've written anything but it's raining today so I have time and I have lots to say.  So buckle up and  hang on it's going to be a bumpy ride

First, to all you Debbie Downers who gave me a snowball's chance in hell, which is to say took a short position, on my survival down here without Helen....a pox...a pox I say on you and your family.  I'm still on my feet - Yes maybe a little malnourished and with multiple vitamin deficiencies, scurvy comes to mind,  and coughing a bit from the smoke inhalation from countless catastrophic culinary calamities and yes I am still struggling with my plyntiphobia  - but getting counseling and in recovery - 3 days, 14 hours and 33 minutes -  I get my first clean clothes coin next week.... but still on my feet.  Hey!  I'm a victim here too ya know.

So how much does it rain around here on the west coast you ask?  It rains so much that ducks carry umbrellas ($50.00 to anyone who comes up with something better) but it does rain enough that a lot of pretty nice  houses out in the wop wops (Kiwi for boon docks) get their domestic water from what runs off their roof.  No kidding.  The rain water is collected in the gutters and drains into big
in- ground cisterns and then pumped straight into the house.  When there is a drought ( three days without rain) the local fire department sucks water out of any convenient  creek and fills every one's cisterns.  Now New Zealand is known for all of it's beautiful birds.  In fact the only mammal native to NZ is a small bat.  So with all these cool birds flying around one has to wonder what all is up there on the roof.  So if offered a beverage when visiting a house outside the city water supply it is my policy to, no matter how dehydrated, decline the "anything with water in it" option but rather opt for, if offered,  beer, wine or whisky - single malt is preferred but a fine bourbon will do nicely in a pinch.

Now that we are on the subject of bourbon whisky I need to tell you about my new fall back carer path as a bootlegger / gold miner. A month or so ago I drove out to the wop wops about 30 miles outside of town and 7 miles up a gravel road to a grass field car park and trail head along the Moonlight River to hike up the Moonlight River trail.  Parked there were two RV campers and out in front of one sitting in the warm sun drinking what looked like warm beer was this casually groomed Kiwi dude.  Most Kiwis are pretty friendly as a baseline and on top of that throw in who knows how many beers and before I knew it I had a new best friend.  So Mark lives up there with his friend Martinez who lives in the other van and they both support themselves by panning for gold in the Moonlight River going into town every month or so for supplies. Between them they usually find about $100.00 worth of gold a day but every once in a while they find a nugget worth thousands of dollars. Well he didn't have to say gold nugget twice to get my attention and after talking about gold for a while I didn't have time to get very far up the Moonlight trail. The next weekend I went back up the Moonlight to do the hike and afterwords dropped off a 6 pack of beer as pay back for the gold panning advice.  Mark was overjoyed to get more beer and payed me with a small $15.00 gold nugget.  It was then that I realized that I had the fever.....The gold fever and Mark said from the look in my eyes I had it bad. I also realized I had stumbled on to a new business opportunity. Meanwhile back at the ranch Rachel  and her hubs Bryan were due to arrive in a few days for a 2 week visit (Even at 30 weeks pregnant, 2 weeks with Rachel was go, go, go, and fun, fun, fun and left me physically and financially drained) and so to give them an authentic, back woods, off the grid, New Zealand hillbilly experience I arranged with Mark to return with R and B for some supervised hands on gold panning time.  There was absolutely no doubt in my mind that Rachel would get the fever bad with the first tiny glint of color (gold) in her pan.  Leaving nothing to chance we arrived back  with a nice bottle of Makers Mark bourbon whisky.  Mark was ecstatic and helped us, mostly Rachel, find about $50.00 U.S. in gold and, as expected, Rachel was more than willing to kill anyone who tried to take HER gold away.  So the coin of the realm up the Moonlight appears to be whisky and gold.

I do need a consensus ruling on this.  Am I a bad person for running whisky up the Moonlight for gold or is it just good business?   Why does the word "enabler" keep coming to mind? On second thought to heck with what you think....I must have more gold!

So how is business?  The patients and the medical problems down here are pretty much the same as in the US.  The other doctors, nurses and people in the clinic are great.  My house is small and humble but funtional.  Helen says I need to work on my humility anyway.  I am hopping to jack up my humility score enough to become damn near perfect.  The country is beautiful,  there a lots of outdoor things to do and the Kiwis are super friendly.  I've adjusted to driving on the left side of the road with hardly any life threatening close calls....yet.  The pay is enough to support my living and exploring expenses and if I ever did need to, I know where to find a bit of gold to supplement my income.  I 've even  gotten pretty good at using the Med Tech the computerized medical records system which is much simpler than the ones available in the US.  The way the clinic is set up and run however is very inefficient especially regarding the doctors time.  The administration keeps saying we need more primary care doctors but I tell them I could see 3 times as many patients if I had my own nurse to boss around and a transcriptionist.  Stephanie!  Marie!  Help!

There are a few things I find  challenging however.  Call it what you want but the medical care here is definitely rigidly rationed.  I have trouble with this for  several reasons. There are many patients that don't get the care they need because they don't score high enough on the access score to see a specialist and even if they do, but there is no availability of the  service, then things just don't get done.  This is particularly true for orthopedics.  There is virtually no availability of non emergency orthopedic services so I have many patients enduring years of disabling hip or knee pain waiting for their hip or knee replacements.  In general patients here wait for months to years for things that would generally be done in days to weeks in the US. Also it seems that here many times the specialist's primary concern is the system and not what is best for the patient.  For example I have had several patients with a history and / or  symptoms that would get them a colonoscopy in  a week or so in the US get declined by the surgeons here because their access score is not high enough even though their symptoms are worrisome for cancer.  I even volunteered to do the scopes myself at no charge but that is against policy.  And this is especially vexing  since colon cancer is the number one cancer killer in NZ and there is a big national campaign to educate people about early cancer  symptoms and detection.  While the US system is far from perfect  it was my training and was generally my experience that "What's best for the patient" is the guiding principle in treating all patients in the US and the system is flexible enough to allow for the fact that every patient is different.  The other thing that I have a problem with is the unavailability of some very useful medicines - particularly for Type 2 diabetes which is very common down here,  These  meds are expensive but are much much better than what is available.  It just bugs me to know that I am unable to offer my patients what I think is the best treatment available.  

This all would be understandable if New Zealand was a poor third world country but it's not.  It is fairly well off.  Helen keeps telling me to keep my mouth shut, don't make waves and just do my job and enjoy my time in NZ. But keeping my mouth shut is not something I excel at so I guess we'll see how it goes.

Cheers