Wednesday, May 28, 2008

Some posts need few words....


That's a 20 pound red snapper that I caught at while we were staying at the Chillout Taiwawe Retreat. The Chillout is just about the most perfect place on earth, and Des Corgan is an amazing host. Anyone who comes to New Zealand should enquire about staying there for a couple of nights!!

Friday, May 23, 2008

More Snapshots

We're currently on the west coast of New Zealand's South Island, in a small town called Fox Glacier. Most glaciers in the world (and most ice cover in general) is shrinking at an alarmingly fast rate and it is possible that during our lifetime there will be only a few glaciers left on the planet. In our usual part of the world (the eastern arctic) the Ward Hunt Ice Shelf has been rapidly disintegrating. The Fox Glacier is one of the few glaciers on Earth that is currently growing in size (due to very particular local weather patterns). Dr. H and I had a chance to hike high on the glacier and explore some of the beautiful ice caves. It was an amazing experience, but unfortunately one that may not be possible even 20 years from now.

Dr. H and I on the glacier.


The view from inside an ice cave on the Fox Glacier.

Tuesday, May 20, 2008

Through the looking glass...


Things are a little different in the southern hemisphere, and occasionally take a little getting used to. Driving on the left side of the road took a few days to adjust to (without any mishaps thankfully). It turns out most of what I do when I drive is automatic and I had to re-think much of what I usually do to hold a car on (my usual) wrong side of the road.
The seasons are also flipped here so we are enjoying a beautiful autumn (my favorite season). The trees here are beautiful and seem to only get better around each corner as we drive around this beautiful country. (More pictures when we get home and have an easier internet connection)

Monday, May 12, 2008

Snapshots

Here are a few pictures from our trip so far.

Dr. H and I getting ready to go into a cave.


A view of the Blue Lake in Rotorua as we hike around it.


Some of the many breeds of sheep here in New Zealand during a 'sheep show' put on for tourists.

Saturday, May 10, 2008

A quick post


We're traveling in New Zealand right now. It's an amazing country and the people here are very friendly. The internet access however is not great so this will only be a short post.
We arrived in Auckland last week and are currently in Rotorua, which is basically a town built in a geothermal field so there are geysers and mineral bathes around. A couple of days ago we went to something called a glow-worm cave. It was amazing! There were thousands of glow-worms on the ceiling that gave enough light to see everyone in the cave. The cave had a river in it so we floated around on a raft in there for about 45 minutes. AMAZING!
The tour was run by a small company called Spellbound and I would definitely recommend it to anyone who gets a chance to visit this country.
More posts next time I can connect to the net!

Sunday, May 4, 2008

OBS up here

I was sitting at the nursing station one night while on obstetrics call chatting with the nurses and generally distracting them from their work. We were talking about the differences between obstetrics in the south, and in the north and having quite a laugh. Leanne, one of the best OBS nurses I know, was talking about visiting a friend in an L&D suite in a southern Canadian city; 'She was just laying in bed, there were tubes and wires everywhere. She was on a monitor, the baby was on a monitor, and I thought the $%*# must be hitting the fan!'. It turned out her friend was having a normal term delivery, but in a different style than we are used to here in Nunavut. We all had a chuckle and agreed that going back to working obstetrics in a southern environment would be difficult at best.

I've written previously about the type of obstetrics we do here in Iqaluit. It's low to medium risk, with careful export of known high risk patients to southern tertiary care centres. In practice that means managing labour and delivery of patients 35+ weeks, including patients with PIH/pre-eclampsia, VBACs, previas, and other higher risk situations. It also means managing the unavoidable complications of obstetrical practice; cord prolapse, abruptions, eclamptic seziures, hemmorhages, thick mec, flat babies, etc. At times it means managing high risk cases in consultation by phone with obstetricians in the south, in particular premature labour and it means medevacs of preterm labour from remote communities. Because of our remote location women from even more remote communities come down to Iqaluit at 36 weeks for 'confinement' until they deliver. This is often the most emotionally difficult part of obs up here, as they are often seperated from family and kids at home while they wait to deliver.

There are 6 docs who practice OBS. It's a nice group and we all have a similar philosophy. We have about 400 deliveries a year in our hospital, and we have good outcomes. Our C-section rate is 5%, and we do about 1 or 2 epidurals a year in total (there is no epidural on demand service). For uncomplicated labour the strategy is low-tech and dependent on the wishes of the labouring woman. Want to labour at home for a while? No problem. Want to stay in the hospital? No problem. Want to eat? The toaster is over there. Want to walk around? By all means. Want pain control? You're welcome to any or all of the options we have available. Monitoring is by intermittent auscultation unless there is a compelling reason for something more invasive.

There are probably lots of reasons why obstetrics is different here than it is in the south. There are cultural and historical reasons. The reason that is most striking however has to do with what patients expect around labour. Labour and delivery in the south (at least in the media) is often framed as an 'experience', in the same way that climbing a mountain or bungee jumping is an experience. It also seems (at least from what I read on various blogs/comments and forums) that there is at least some population of people who believe that doctors are willfully trying to take away from their labour experience.

When I talk with women about L&D at their prenatal appointments, I often ask what they expect will happen. Usually the person says something along the lines of 'I think it will probably hurt'. What do you think about that, I ask? They laugh and say, 'Well it's not optional'. Most people seem to view labour and delivery as a natural process, and my role (and the hospitals role) to intervene when required for the sake of safety. It's pleasant, it's happy, sometimes one women in early labour is in the room next door coaching another women who is pushing. People are walking around (yes, and going for a smoke), laughing, talking and feilding various relatives and visitors who are stopping by to see how things are going. It's a different world than down south. My role is a little more on the sidelines, there to spot and deal with any problems that may arise. Usually there are none, and all I need to do is hand a nice baby to a new Mom, whose first question is almost always 'So I can fly home tomorrow?'.

Friday, May 2, 2008

Scenes to remember...

We're heading out on vacation today after a long and very busy April here in Iqaluit. Keep checking back for posts, we have our MacBook with us, and will hopefully see some sights to inspire us over the next month.
Here is a picture of the surf I took in Tofino. I have it set on my desk top at work, and in hectic moments I like to look at it and imagine the sound, smell and feel of standing beside the surf....
Enjoy.