Cape Foulwind

In a country famous for its walking tracks, we have several good hikes nearby.  The walk at Cape Foulwind is the nearest and is quite well-known;  it's a favorite of visitors and tour buses.  The cape was first mapped by Abel Tasman, but named by Captain Cook in 1770 (evidently during some bad weather).  Fair or not, the name has stuck.

The walk is 3.4 km long one way,  and you can start at either end.  We have visited 4-5 times since moving here, to walk at least part of it.  This past weekend, I started at the light house, still operational.

After climbing a short hill, the walkway meanders along the top of the seaside cliffs, offering spectacular ocean views to the west, and pastures to the east.  At one point, I walked through a sheep pasture, and they did not seem especially pleased to see me.

After 50 minutes or so (depending how many photo stops one takes), you reach the fur seal colony on the south end.  At this time of year, the baby fur seals are getting bigger and have all been tagged.  They still are quite playful, and some are still nursing, and it is very fun to watch.

The very end of the track descends back down to the beach through the lush foliage of New Zealand flax. This 6-8 foot plant seems to grow everywhere and is amazing to me.  Overall, Cape Foulwind is a wonderful place to spend an hour or two;  where else can you see seals, sheep, and horses all on the same hike?  Not to mention the western weka, begging for food in the parking lot.

Minor observations on the New Zealand Medical System

So given this is our hospital and we work in the most isolated part of New Zealand which has a very different medical system than most other parts,, maybe my observations should be taken in that context. We work for the West Coast District Health Board, one of many throughout New Zealand but ours is close to the largest geographically and the smallest in terms of population. That has presented great problems in organizing the health care system. Because it is so rural, there is difficulty maintaining adequate numbers of physicians and the practices rely on Locum physician. like us from overseas but also from New Zealand. Also, the District Health Board has assumed management of virtually all the general practices, whereas throughout the rest of NZ there are many private practices in operation. The practice we work in now is not greatly unlike the community health clinics we have worked in in the States. Patients are charged a nominal fee and the practice receives funding from the District health Board based on the number of patients enrolled in the Practice. They do not get paid really for the services themselves, they are left to sort out how to best do that within some constraints.There is much reliance on advanced Nurses to provide a great deal of the preventative care and management of chronic diseases. I think the model is quite appropriate for the population. The biggest change is in Prescribing medications. Direct to consumer advertizing for prescription medications now approaches 5 billion dollars per year. A blockbuster drug makes 10 billion or so dollars, think lipitor or crestor or ability or prevacid. The New Zealand health care system was aware in the early 1990s that they could not keep up with the obscene cost of these medications an founded a pharmaceutical board to address the issue. Know as Pharmac, the committee reviews medications and creates a formulary for prescribing including which drugs will be subsidized by the government. They are able to negotiate contracts with generic drug makes and then supply what I feel to be a very comprehensive list of medication to treat most conditions. If you are a health care policy geek, check out more information at ________________ http://www.pharmac.health.nz/about _____ Of course the US pharmaceutical giants hate this arrangement and are always trying to undermine it with trade agreements, perhaps why we never get New Zealand lamb at Costco, just a conjecture. A downstream problem was created for the little pharmacies in the small towns however. With meds being so cheap, the pharmacies have very little profit margin. They make up for this by charging for the prescriptions fills, charging us and the patient if we make a mistake on the prescription that needs fixing, charging a fax fee if the script is faxed, etc. Our practice actually charges the patient for prescription refills, and the amount varies based on how soon it is needed. In fact, a patient who calls for a same day script is charged $20, more than they are charged if they come in for a visit with me and I write prescriptions, $17. --- Lastly, check out this Semi: This Semi comes about once a month. It travels all over the North and South Island with an OR staff, anesthesia and surgeons doing surgeries and colonoscopies at the more remote sites. It is actually privately woned and teh District Health Board hires them out. Very innovative. So look forward to Carolyn's adventure on Cape Foulwind while I was on call for our next post

Karamea

With another weekend without call, We took advantage of yet more beautiful weather and traveled north to Karamea, a tiny little secluded town that is at the end of the road of the Coastal Highway on the west coast. Karamea is a little haven for outdoor enthusiasts including hikers , backpackers, fishermen, birdwatchers and bikers. Most famously, it is one end of the Heaphy track, one of the great walks of New Zealand.

Carolyn and I hiked the last 8 kilometers of the walk to one of the little shelters along the way and then returned, we walked through beautiful Nikau Palm forests and stunning beaches, all completely deserted.

The weather was perfect and the views outstanding. The true trampers will continue the walk for three or four days, climbing away from the coast, over the southern Alps and down into the Tasman area. Someday we hope to do that as well but for now we are content with our day hikes. Sunday we drove the slightly nerve wracking road up to the Oparara Basin, famous for the beautiful rainforest and the large limestone arches.

There we were fortunate to add the endangered Blue Duck to our list of sightings, at some point we will do a blog about the Birds as, living on the estuary, we have become quite the amateur birders. We did not quite get a good picture of it so this will have to do for now.

The photos always fail to live up to the actual beauty of the landscape, unless of course you are photographing road signs, then it is actually quite representative. Coming home Sunday evening we had made reservations to perhaps on of the world's most remote gourmet restaurants. The Cowshed cafe is situated halfway between Karamea and Westport, 45 KM from a town of 900 people and 45 km from a town of 8000 people, yet it was run by two young women with experience as private chefs in the Mediteranean.

As it was the Sunday before Valentine's Day, they had a special menu, check out the appetizer tray:

It is astonishing to find places like this and try to figure out how they stay in business and such. Apparently 100 or so women are gathering there this Sunday for a formal tea with fancy dresses and hats. You never know. A great weekend. Boring alert: look for the next blog to cover a little more medical stuff that I find interesting. Here's us on the Heaphy:

Weekend in Nelson

I was a bit ambivalent about taking our first weekend away to the "big city" of Nelson (metro population about 60,000), I thought we should be hiking and exploring the wilds of New Zealand.  But no worries:  Nelson was a great get-away and I am looking forward to a return trip.  The three hour drive involved a very twisty drive up Buller Gorge, marked by one-lane bridges and startling road signs.  Eric did an admirable job of "keeping left."  Once we were over the mountains, the landscape suddenly was drier, and farm crops needed irrigation.  Arriving in Nelson, we explored the city center on foot:  the Saturday farmer's market, the beautiful church on Cathedral Hill, the Suter Art Gallery and the Queen's Gardens.     The Maitai River courses down the center of Nelson, and we strolled on the walking path next to it.
  Birds continue to entertain us, and we took many photos of the diving cormorant and the multi-hued ducks.

 Our map clearly marked the "Center of New Zealand" so  we took the short but steep 20 min walk up the cliff to the monument.  Turns out, as the marker on top states "...it depends how you define "center."   Still, it was a lovely view.

We stayed in a beautiful bed and breakfast, the historic Warwick House,
 where we shared appetizers and wine in the courtyard with our hosts and another couple, kite-boarders from Bangkok.

On Sunday morning, I slept in luxuriously late, and we started a round-about lazy drive home:  to Mapua, an oceanside village, to a vineyard for wine-tasting, to a world -class art glass studio, and then to a late lunch in New Zealand's oldest pub.   
 It was a great little get away for the weekend,  even if it involved the first traffic light we have seen in three weeks.