Career paths - Working abroad in a rural practice

Dr Kingsley Poole describes the differences he experienced working at a remote practice in New Zealand.

The Waihi Health Centre Credit: Dr Kingsley Poole
The Waihi Health Centre Credit: Dr Kingsley Poole

The on-call phone woke me after midnight. I was wanted at the police station - a gang member high on methylamphetamine had multiple lacerations. Driving down in the dark I thought back to my old life in the UK.

I had been a partner in a lucrative practice but had felt trapped. Sensing my restlessness, one of my older colleagues would tease: 'Cheer up, only another 25 years to go!'

I decided to quit and follow my wanderlust.

New start
A job in New Zealand, or NZ as I learned to call it, caught my attention. It was in a town in the North Island; I checked the map, it was near the beach. A furnished 'villa' and a car came with the job.

A 15-minute phone call with one of the partners ended with the question 'When can you start?'

In June 2006 my family and I arrived in Waihi - the gold-mining capital of NZ.

Founded on a gold rush in the 1870s they are still digging there - about 100 yards from our villa as it turned out, where a gigantic open-cast gold mine remains fully operational.

Our three sons joined the local school where the all the pupils - and some of the teachers - walked around barefoot.

My position was funded by a local Maori health organisation and because of that, we were given a traditional Maori welcome (Powhiri) at the town Marae, a type of ceremonial meeting house.

The chief spoke eloquently for some minutes about his ancestry (whakapapa - the wh is pronounced f) and I had to respond with a speech about mine.

Before starting work I was sent to Wellington for an 'orientation course' for rural GPs.

On the early morning flight I gazed down at volcanoes on the central plateau - one had been Mount Doom in the Lord of the Rings.

There were only three of us on the course, all about to start rural jobs. We sat through lectures on the NZ health system, registered at the NZ equivalent of the GMC - showing our original certificates - and attended a resuscitation workshop at Wellington Hospital.

On the last day we were given a guided tour around the Te Papa National Museum. It was an enjoyable few days, albeit the calm before the storm.

In the surgery
I think the practice staff had been waiting for me; the week I started two of the doctors left on eight-week holidays, leaving me and one other doctor to hold the fort.

Surgeries could be interrupted at any time with A&E attendances - the A&E being a small three-bed bay at the end of the corridor.

On the first day my eldest son came in after falling off the monkey bars at school. Luckily, he could get an X-ray that day - Waihi had a radiology service three days a week.

The other doctor was at lunch so I dusted off my old radiology textbook, diagnosed a greenstick fracture and a practice nurse put the cast on. This treatment was all free because of a system called 'Accident Compensation Corporation', which covers any accident.

Otherwise people paid to see the doctor. At the end of each consultation I handed them a bill, which they paid at reception. I never quite got used to the PIN machine on the desk.

Home visits during the day were virtually non-existent. Perhaps the call-out fee was a deterrent or maybe Kiwis are just tougher than Brits.

On call
I worked five days a week with one in six on-call - we shared the on-call with the 'beach docs' who ran a surgery at Waihi beach, a small community that expanded in the summer months.

There was a district general hospital in Thames, a 45-minute drive away, on the other side of the Coromandel peninsula. We had only one paramedic for the Waihi area, otherwise the ambulances were manned by a gallant posse of St John's volunteers.

On one nerve-wracking occasion I had to call out a helicopter to take a fitting baby to Hamilton; the nearest major hospital.

When on-call, I carried an oxygen canister and a box like a picnic hamper from the 1960s, filled with goodies such as chest drains and prehistoric-looking cannulas. There was a pack for cyanide poisoning, which as far as I could make out consisted of a charcoal drink - the mine uses cyanide to purify gold.

Calls were triaged by nurses in Auckland, but I could still be up most of the night and have to work the next day.

I saw my fair share of characters. One Saturday morning a man came in with a huge fish-hook embedded in his ankle. I had to dissect it out with a scalpel and put four stitches in. Just as I was about the put hook in the sharps bin he stopped me.

'I'll have that back thanks, doc - it cost me 10 bucks and I'm going back out this afternoon.'

Returning home
The tour of duty over, I found a salaried job back in England and revelled in the fact that I could go home at 6.30pm and have a day off. The hard part was persuading our sons to wear shoes again.

  • Dr Poole is a salaried GP in Chichester, West Sussex

Learning points

1. Expect a protracted process of registering with the Medical Council of New Zealand. You need original certificates and proof of previous employment.

2. You and your family will need to pay for immigration medicals.

3. Establish your working pattern before signing the contract. Make sure you are entitled to annual leave in the first year.

4. In a rural post expect to do regular out-of-hours and A&E work.

5. A prolonged absence from UK practice may affect your working status on your return - check with the GMC/PCO.

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