Initially, I planned to have my topic of interest pertain to the differences in skin
cancer between New Zealand and the United States. New Zealand is known to have
the highest rates of skin cancer in the world due to the tilt of the planet toward the
sun, the hole in the ozone centered mostly over the islands, and also the temperate
weather encourages outdoor activities. However, as often happens with research
activities, another topic came up that was of more interest to me. One of my
registrars (resident level trainee) was pregnant and was planning her year-long
maternity leave, while the other registrar had a baby at home and was working part
time because of it. I spent a lot of time speaking with them about perceptions of
women in medicine, maternity leave, and balancing work-motherhood life as a
physician.
In New Zealand, physicians and physician trainees are guaranteed 6 weeks of paid
maternity leave, however, they may opt to take up to a year of unpaid leave. There
is also an option to find a person to split maternity leave with and then you can
work part time. My registrar was working toward finding someone to split time
with her, but was also planning on taking a full 12 months if that could not be done.
Both doctors were astonished at the lack of leave granted to trainees (or anyone, for
that matter) in the US.
After hearing about the lenient maternity policy, I was certain that the attitudes
toward working mothers must be better in NZ, however both registrars said they
felt additional pressure as women in medicine. Much like women in the US, they
said they feel as if their prime reproductive years are spent in the training
environment. This forces them to either have children during the training years
when they have less control over their schedules or wait until post-training, at
which point they have higher risk pregnancies. Both women felt their male
consultants (attendings) judged them for their pregnancies. They also believed that
they might have been passed up for certain positions because they had families.
Adding to the stress of training as a mother, the registrars talked about the training
requirement of moving hospitals every six months to a year. My registrars each had
to separate their families (husband in one town and them in another) because they
are required to move hospitals each year. For dermatology, they also have a
requirement to go abroad for the last two years of their training, furthering the
strain on family life in medical training. Each specialty has different requirements,
with some requiring a move every six months.
On the plus side of balancing family life and training, the registrars report that
having onsite daycare at many of the facilities makes that a much easier issue. They
are able to have easily available/affordable care. One of my registrars was able to
visit her daughter on breaks from work and she said this was particularly great for
feeling connected to her throughout the day.
Overall, though there are definite advantages in policy for trainee mothers in NZ, the
women I spoke with seem to face similar internal and external struggles of
balancing motherhood and medical training as do mothers in the US.
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I signed up for the dermatology rotation because I was potentially interested in
specializing in dermatology at the time. Since submitting my initial choices, I
changed my specialty to family medicine. Knowing that I would still need a fair
amount of dermatology knowledge in the primary care setting, I stayed with that
specialty. In addition to being in a foreign country, being in dermatology was like
being in a foreign land. The language used in that specialty is so different from other
specialties and the medications, though mostly steroids, are things that aren’t often
used outside of dermatology.
One particularly interesting aspect of dermatology in NZ is that they have an
inpatient unit. I had never heard of such a thing and it was interesting to see what
was done for these patients in hospital. Many of the patients were those with bad
eczema or psoriasis that needed steroid wraps and cleansing baths due to infections.
Going on inpatient rounds was interesting since I hadn’t seen patients hospitalized
for these conditions before. Additionally, since NZ is a socialized healthcare system,
conversations on rounds often centered on hospital utilization and cost control.
Patients were often discharged because they were as good as they could be and
keeping them in hospital was only going to continue to be a burden on the system.
One particularly memorable part of rounds was a patient who had been given
vancomycin for a MRS infection. The attending couldn’t believe that vancomycin
had been used! She was so alarmed by this fact, which I found strange given that
vancomycin is used like water in our hospital. She was appalled when she found
this out!
Other than the inpatient service, the most memorable patient experience was with a
guy who had been brought to Auckland from the South Island to care for his chronic
dermatitis for the past five years. The patient was suspected of having dermatitis
artifacta, which means he was somehow causing himself to have the skin condition
that was affecting him. They brought him in to the hospital in order to monitor and
see if they could determine that he was indeed causing this himself. The patient had
suffered a workman’s comp-type injury many years ago and was receiving benefits
from that. He subsequently developed a blistering skin condition near that injury. It
got so bad that he had them cut off his arm because the skin would not heal! When
he left the hospital after his amputation, he had no more dermatitis. As soon as he
went home, the skin condition reappeared. Many doctors and nurses suspected the
patient had been doing this to himself given that when he was in the hospital it got
better and when he went home it got worse. While he was in the hospital at
Auckland, he again was improving. Multiple specialists, including psychiatry, saw
the patient and it was a mixed opinion as to whether or not he was doing this to
himself. He discharged back home with improved skin and no clear answer. He will
continue to get his workman’s comp benefits until it can be proven that it was selfinjurious behavior.
My month studying abroad in New Zealand is actually my second time studying
abroad in the country. I first went during my junior spring of college and loved it so
much that I stayed for my senior fall semester as well. When I found out in my first
year of medical school that doing a clinical rotation in New Zealand was a
possibility, I immediately contacted the International Office to figure out how to
make this happen. I thought this would be a fantastic opportunity for my husband
and kids to get to experience a country that I love so much. Having two small
children definitely made the trip a lot more logistically challenging than it had been
15 years ago when it was just me. Luckily, my mother was able to travel with me in
order to take care of the children during the day while I was at my rotation.
Some of the main questions that people ask me when they find out that I went to NZ
with kids are: how was the flight? Did they love it? And, what is the biggest
difference between the US and NZ?
First, the flight… Traveling internationally with two small children is a challenge no
matter how you slice it. The airlines have a lot of amenities that make it easier today
than in generations past but it is still a long time to be in a very small space. My
mom and I packed games, toys and snacks so that the kids would hopefully not get
bored. Our flight left KC at 8PM, which was around their bedtime. Had we not had
to change planes in San Francisco this probably would have been fine but we had a
2-hour layover in SF. By the time we got on our international flight and settled in, it
was almost 1AM our time and my children were both exhausted and wired! We
used all our toys and all our snacks and eventually the kids went to sleep. I got very
little sleep on the trip but all things considered, my kids did very well and I think we
will still be allowed back on United flights in the future!
My children absolutely loved being in New Zealand. It is culturally similar enough to
the US and life was close enough to normal for them that they felt comfortable, but
they still noticed differences about being in a foreign country. When we first got
into the car my daughter said I was driving on the wrong side, which I thought was
very perceptive for a four year old! The accent was immediately noticed, as were
some of the differences in lingo. Hearing my daughter say “rubbish” was adorable!
They loved being in summer for a month and getting to go to parks and beaches.
They learned that nobody in NZ cares if they run around naked all the time! It was
highly encouraged for them to be a little bit adventurous! They also loved eating
sausages and chips (fries) all the time!
When people ask me what was the biggest difference having kids there I have to say
that parents in NZ have a much more hands-off approach to parenting. If we are the
helicopter parents, they are the submarine parents. They are there and available if
needed but are not hovering over every move of their children. At the playground,
you hear parents say, ‘give it a go’ rather than, ‘be careful, you’re too small to do
that’. There is a feeling that kids need to try and fail, or try and succeed on their
own. There is less interference when kids bicker. The feeling is that kids will work
it out on their own. Kids need to have room to learn and experience the world on
their own! Yet, the parents are always there if something terrible were to happen. I
think my main take away from my cultural experiences this trip would be to let my
kids live their lives unencumbered by overbearing parenting. They will figure out a
way that works for them if we just let them.
Participating in a foreign elective will impact my future career because it opens the
door on the possibility of more foreign practice. I love being in NZ and could see
myself going back there to work. It was good to get a taste of what to expect prior to
making a big decision to go there. Additionally, working in a system of socialized
medicine is an illuminating experience. I got to see the positive side where people
who wouldn’t otherwise be able to afford care have top-notch medicine delivered to
them. I also saw patient frustration at having to wait to be seen by a doctor. How
frustrating it can be when you’re in a cost-controlled system and aren’t allowed to
have certain treatments available to your patients because it costs too much to the
health system. I also go to see how doctors make it work financially by working part
time in the public system and part time as private physicians.
Overall, I don’t know that it was always the best use of my time. The medical
students in the NZ system are at a much different level than those in the states. We
know as much as the registrars (resident level) but were treated as if we were
students. It made it very frustrating to be there and only to be shadowing. I think if
I ever have a foreign trained student or doctor come to my practice I will do a better
job of trying to assess what they know and what they want out of the rotation in
order to not waste their time, energy and money. All that said, my family and I had a
wonderful time in NZ and would go back any time.