Details of the Medical Mission

(Lynn)
My apologies to all sailors who do not cuss! We had a sunny day finally and took a long family hike after an hour of "home church" with our iPod player and a bible reading. The church we were planning on visiting started earlier than I thought so we missed it- but we had a blessed time just the six of us and the Holy Spirit. Remember, wherever two or more are gathered in His name, God promises to be there! Phillip and I rode down to Auckland and back yesterday (Saturday) with Pastor Miguel and his 9 year old son, Champ, to a men's prayer breakfast. It was a great time of fellowship with about 50 guys. Isaiah 46 was the topic- (read the chapter straight through and see what it says to you. ) After a great Sunday with the family I turned around and flew back to Auckland this evening in order to be at an 8am meeting at the large public hospital. Hence, the time and energy to make an extended blog entry because I am sitting by myself in a hotel in Auckland.

I would like to tell you more about the medical mission as it's shaping up and about my job. The most important thing (to me, at least) I'm doing at the moment is working, along with nurse Linda O'Grady, to establish an efficient and effective lung cancer service. I am the only full-time pulmonologist working for the Northland region presently. In Northland we have mostly visiting oncologists from Auckland, no thoracic surgeon, and no radiation oncology. One must go to Auckland for all these services. That's easy to say, but most of the patients have a very difficult time getting to Auckland. It looks close to Whangarei and Northland on a map but the roads are two-lane, hilly, and windy most of the way making travel slow. And lest anyone forget- they're usually wet with a fresh rain. That's just from Whangarei. Many of the Maori live in the Far North- 3-5 hours drive from Whangarei. And they have the highest smoking and lung cancer rates of all! So here's my goal/directive from the Australian-New Zealand cancer guidelines : have every new lung cancer patient begin their treatment within one month of being notified of the patient's abnormal chest x-ray.

Sounds deceptively easy. The four weeks pass quickly. In a socialized health care system you usually have to wait months for a CT scan because there aren't many scanners. (The radiologists have said they'll try to do my patients within 2 weeks.) Then you have to get O.R. time for the bronchoscopy, wait a week for a pathology report, and then make a formal presentation of the patient to the tumor board in Auckland for the patient to get accepted for therapy. Which brings me to my meeting in the morning. I am presenting 4 new lung cancer patients to the the conference in the morning and then touring the facilities here as well as a lung cancer clinic. These are only 4 of at least 15-20 cases of lung cancer I've seen over the past month. It is truly a crisis in Northland. Many of the other lung cancer patients I have simply given pain medicine and hospice support because they were too ill or unwilling to consider chemotherapyor radiation. Something I teach the nurses and training doctors about lung cancer is that we comfort always and cure occasionally. I have identified one surgically curable lung cancer thus far.

I am not discouraged, though. We will find the best care this system can generate and comfort alot of patients and family along the way. I had a very special day last week in the Far North (I fly about twice a month up to Kaitaia for clinic days). A very sweet and relatively young Maori patient had brought about 25 extended family members to meet with me and discuss her cancer. She had told me previously that she believed in the One True God (as opposed to the polytheism of her ancestors). We discussed the bad news, challenges to even getting to therapy-much less tolerating it- and what to expect in the next year. I asked her if she wanted prayer to which she responded emphatically, "Yes". We then welcomed God into that room with crying adult children and beautiful young mokopuna (grandchildren) surrounding this woman. May God, the great physician, bless her and help me to do my best to serve her and her family- not on my own strength and understanding- but with God's heart and power.
-Amen

International Night

Our school community had an international potluck last night wherein every family was to bring a dish from their home country. I included a photo of the world map with the various thumbtacks representing family origins in our school including our little red thumbtack from Tennessee. Everyone brought dishes from their home country. I took beans, ham-hock, and cornbread although my cornbread turned out more like polenta. Interestingly enough the only person who knew the difference was the PTO president/event coordinator who was born and raised in Beaufort, South Carolina but made her way to our school via 12 years living on a refurbished 100 year old boat in Amsterdam. It's a long story but per usual for folks here it is a fascinating life story. I included a picture of a dad who looks like MY dad and is indeed a fellow mariner. He is actually American but has sailed the world after retiring as a Navy seal in the 70's. His son Oden was in Phillip's class and is seen sitting between him and Lynn. You may have noticed I said "was" in Phillip's class. Phillip came home last Monday saying he didn't want to try to work out the social scene at school anymore and was ready to look into Parua Bay school about 5 miles up the road where his Rugby mates go to school. It has worked out for him to transfer there and he seems MUCH happier. We have since learned there maybe some anti-American sentiments from a few key kids/staff in his class. More than one person has told us that the war in Iraq has eroded America's image in the world. For whatever reason, Phillip was just never really accepted into the group. So far it is much better at the new school. Anyway, back to the international pot luck. The kids played a game of eat the chocolate fish from the string but I am not sure what country that was from. The night included a family go around and share time where people explained where they were from and how they ended up at Whangarei Heads School. My kids volunteered us to go second (after the Beaufort/Amsterdam gal and her family from Holland)! Then Phillip volunteered ME putting me on the spot (Lynn was outside having a pow-pow with one of the other dads) to tell all 50 people that we were Christians and felt called to come to NZ. I muddled through some how and people did talk to me afterwards all though the room was silent as I tried to explain in 30 seconds what Christ means to our family. I felt horribly uncomfortable but I hope you will pray with me that we would be "the aroma" of Christ's love in this community. I think many people wouldn't know how to take what I said. When I told Lynn afterwards we talked about how I am a teacher (love to study the scripture and apply it to our individual lives) not an evangelist. We accept people far more than they typically think we do. Lynn has a servant's heart (medically speaking and in a church,etc) and I hope will share soon some of the amazing moments he has had with patients. Billy Graham I am not but please pray for us as we just try to share our lives in love. These folks are so interesting to us as many have these all over the world courageous experiences, love of great outdoors/wide open spaces, and current job of raising a family in semi-rural New Zealand. As they say, "It's cool and awesome!"

Raindrops Keep Falling On My Head

Anna and Andrew enjoying our indoor pool day last Sunday afternoon.

Claire was trying to surf in the wave pool.

Buff and blue (hands up), Phillip, and Anna in the splash area. The woman in the black one piece is NOT me.
Dr.Fernando, Lynn's Sri Lankan colleague, had a wonderful meal and the cutest puppies.

(Lynn)

I've taken long enough between entries now to have some observations. First of all, it rains here for four solid months- and we came at the beginning of those four months. Reportedly, the other eight months are sun-filled and delightful. I'm waiting. Secondly, Kiwi culture is coarse and a little difficult to get accustomed to. I'd heard they didn't really care much about God but didn't realize their eight-year-olds cuss like sailors and that drinking heavily, smoking and gambling are epidemic. I realize we are in the "Mississippi" of New Zealand-Northland- with higher unemployment, etc. so I may be getting an unbalanced view. But the people I've met from all over the country seem to have busted marriages and kind of a hopeless outlook regarding the future- unless, of course, they have plans to move to "Oz". Now, I haven't been to Australia yet, but aside from making more money and being warmer is it really the land of milk and honey the young Kiwis make it out to be?



Regarding politics- my Democrat friends and relatives will be interested to know that I am now a card-carrying union member. Don't tell the Knox County Republican Party chairperson! About 90% of doctors belong to the union which serves to represent their interests when dealing with the government in this socialized health care system. I will draw the line if asked to set up a picket line. I feel a little like Sylvester Stallone in FIST. Our crunchy, liberal friends will also be pleased to hear that Dawn is the proud new owner of a 1995 Subaru wagon- she's already talking about moving to Asheville. I am behind the wheel of a conservative 1996 Honda Odyssey with groovey curtains over some of the back windows. I have discovered that when cars are no longer wanted in a country they are shipped to New Zealand and sold at bargain prices. Both of our cars served happy Japanese families in the 90's and now carry us through the mud and rain of NZ in the new millenium. They actually market cars by promising that you will be the first New Zealand owner of this great 1994..........etc. I just love the prices. I would bring the cars home if the steering wheels weren't on the wrong side.



Of course, there are many bright spots- it's just been a few tough weeks and perpetually gloomy weather doesn't help. We have been shown great hospitality by several families and I have met some very sweet and funny patients. I also do not forget that we have a common enemy who would be glad to see us pack it in and head home. "We do not battle flesh and blood..."



All of your comments serve to encourage and strengthen. Keep it up.



P.S. Go Cubs!

More Fun

Andrew had a sick day at home this week. He had me make him soup because he said Nana said soup makes you feel better. It worked!

Anna enjoyed all her packages from you guys. She is modeling the new jammies.

Andrew enjoyed the presents too.

We made sushi one night this week. we used some fish Phillip caught on the dock.

The kids enjoyed rolling up the rolls.

They were really tasty!!

OK you guys better start leaving comments or at least your name because I am starting to feel like no one is out there. Where is Debra??? We love to see that who has been on line with us.

Thank you to both Mimi/Pop-pop and nana/Papa who sent birthday packages and clothes to us. They come right to our door and provide much excitement when we drive up, see them, and open them. Thank you.

The Silver Lining

American College Students Visiting for Summer

Birthday Bash- Anna turns six, Brooke sitting next to her
Andrew blowing out candles

5 friends from school and their siblings come to the party

Opening presents...Andrew loved the scooter, Anna a babydoll bed

First Tennis Match: Lynn and I try artificial grass (split sets 7-5, 4-6)

Claire tries Riparugby (like flag football) at a regional field day

She did great!

Don't get me wrong. There is no need for Prozac. I am not manic either. Lest everyone think we are on a year long Holiday, there are challenges here. Like anything else in life, this experience is a mixed blessing, a two-sided coin, a mixed bag, etc. I am not ready to throw this baby out with the bathwater. I am just saying nothing is perfect here or anywhere else for that matter. With that said let me tell you some of the great things we have been doing recently. Lynn still is seeing a lot of patients and spreading his kind heart, earnest prayers, and special medical knowledge to the patients at the hospital. I am making in roads with the histopathology folks and learning a lot about lab management through the hospital. We have made some ever dearer friends in the Abascal family (pastor who was Lynn's first patient). I have enjoyed Claudia (his wife), Anna's friend Brooke's mom (named Rene), and my coworker, mentor, and friend Viv especially a lot. We recently had 4 college students from Oklahoma, Ohio, and Massachusetts spend a few weekend nights with us. They are in New Zealand for 6 weeks with a mission through the Nazarene church. They did some programs at elementary schools, some afterschool programs with at risk teens, and some service projects like painting while they were here. The kids loved to play Cluedo with them and just hang out. They were such a blessing to our family as we got to know them. Lynn and I got some tennis in on a sunny day. We were rusty but the view was great. Claire and Phillip made Whangarei Heads school proud playing Riparugby at a regional field day last week. The twins birthday party was a great opportunity for us to meet other families including a german family and an Irish family who live close by. We are so excited about our little international rural community that the school is hosting a potluck and culture share for the school families to be held right on our street. I am thinking about bringing southern fried chicken but will take other suggestions in the comment section or via e-mail.

Going Deeper-Remembering the Dream

Ok for you bloggers consider this fair warning. The entries titled "Going Deeper" may be sappy, soulful, and spiritual with reflection and intraspection. You may want to quickly scroll down to the pics and read no further!

The past week has been a bit of a challenge. Well in reality the past 2 months have been a lot of a challenge. We tried to come up with an acronym today for the instances (frequent as they are) where we encounter things just not working out as expected, as planned, as wanted. You know the times requiring trouble shooting, patience, and extra effort. We started with PITA but decided pain in the backside maybe wasn't clean enough. We are thinking of using....oh I forgot but it had something to do with GO and growth opportunity. I am saying that with my "whatever" voice.
I think this week I just reached a low with all the "growth opportunities". Many of you know that I am not the most emotional female on the planet but there were some blue moments this week and yes tears too! I miss everyone and the things about my corner of Tennessee where there weren't so many "growth opportunites". I get frustrated as some things aren't easy here and not everything in New Zealand is working out as expected, as planned, as wanted. Many times here we have had to rework, try again, fix, wait, accept less, move on, etc and it is so exhausting and frustrating to us because we are use to running fast, effective, and efficient and pretty much "gettin her done". To add to the the cog in the wheel, I miss my family and tennis and church and even looking at slides under the microscope. Making a transcontinental move requires adjusting and I am about adjusted to contorsion. To make it more of a "growth opportunity" not everyone we know is loving THEIR "growth opportunity" as our move has disrupted their lives and brought sadness and heartache. For you guys we are very sorry to bring this on you and it pains us daily (more tears, more blue feelings).
We have made an effort to put the highlights on the blog (the above was not one of them!) and the highlight has been how God is working in the midst of it all. (If you have gotten this far for heaven's sake don't scroll down to the pics now!) I am reminded how one of my church friends said we should write down what all God did to get us here. Of course I meant to do that! In a way God reminded me tonight. We were playing Cluedo (the local name for Clue board game) and I noticed that I was bearing down on a book randomly grabbed from the shelf. We brought a few books with us and this was one that somebody had given Lynn (Thanks Robert). The book is reminding me that God made Lynn and I to enjoy foreign lands (all be it that they are contorting and frustrating) and he had planted this love as far back as our teen age years. We love to explore and it brings great joy and life to us deep in our soul as we experience people (Lynn and Phillip fished with a woman from Russia before dinner and Cluedo. How this woman made it to Whangarei I don't know. I am sure she was wondering the same thing about us!)Anyway, We are at our best when we feel like we have a purpose and there is so much of a need for respiratory medicine here and people have such misconceptions about Christianity (you may not know that it is a loving and dynamic relationship with a real and personal God who forgives and cares and just wants you to do the same). We had to sacrifice to come here with the hope it would be worth it. The dream started in a corner of our heart and just grew and grew into a thrilling beating in our chest that couldn't be ignored. Many of you understand but some can't understand. It's our unique dream and even though it was hard to leave the comfort zone it would have been harder to let that dream whither. God in his unique way has reminded me deep in my spirit that he is the dream giver. His plan is an exciting ride (to quote Cory-'life giving"). He is with me and will help me. I feel ordinary, afraid, and doubtful but he is extraordinary, faithful, and encouraging. Some how in a truely amazing way I see how God uses difficulties (book calls it wasteland times of our lives) to bring out the doubt and fear in our hearts and replace it with a new faith in him, new hope in him, new strength in reliance on him. I feel a deeper resolve coming as we get beat up a little in the circumstances. It's crazy but you realize you are weak, really weak and some how you sense He is strong in a new way. Have you ever felt that way? I recommend the "I'm falling here. Can you lend some help?" type prayer. Contorted but feeling better, Dawn

The Cabin By The Bay

Upstairs Lounge aka living room in Kiwi lingo

Andrew's makeshift room from an entryway downstairs

Phillip's room (picture was from his sliding glass door to the deck)

Groovy downstairs lounge

Kitchen/dining room is upstairs

Claire's room doubles as guest room with a private patio

Lynn picked the "room with a view"

Anna's room...of course she wanted pink!

The house is starting to feel a little more comfortable to us but still not like home. Things are older here especially in the rental market. It is taking getting use to. We don't have central heat and air which gives the house more of a camping feel with wet cool temperatures, lots of spiders/mosquitos, and cabin like interior. The fall weather has been very sunny this week which raises the temperatures for the afternoons. I sat out on the deck today and started one of those books I got for Christmas. The kids fished with Lynn. Claire opened the windows (no screens here) and had a fastfood coffee shop going out the window with deck waitress service too. Anna said she thought it was the best day we have had yet. The boys got up early and went to an annual road race in downtown Whangarei and then on to Phillip's Rugby game. The girls slept in, called my mom, and walked to the cafe for a late breakfast. We grilled out the very common kiwi meal of "lamb sausages with onions and peppers" for dinner. They serve them every where here including for breakfast at the Rugby fields. They remind me of the sausages my dad and I use to get at the fair when I was a kid. Someone should introduce the Kiwis to funnel cakes and they would have "fair food" down! I included some pics of the kids at what we have termed "the cabin by the bay".
The work week last week was interesting for Lynn with 2 plane trips on a prop plane without climate control last Tuesday and Thursday. The trips were all day affairs to do clinics in the extreme northern community of Kaitia. He said he saw a lot of severe sleep apnea patients who can't be seen in Auckland for months even if they could drive the 5 to 8 hours for a sleep study. He started formulating some ideas and meeting with folks about how to set up testing and c-pap to serve this 150,000 person area on a budget that might get approved by controled healthcare. Seeing such severe sleep apnea, advanced lung cancer, and limited resources (no EEG in Northlands, no pet scan in all of New Zealand) has struck a compassion in him to see what can be done in the system we are in. He has termed it 2nd world medicine because it is much better than 3rd world countries and resembles modern medicine but simplified and scaled down. The gardener that takes care of our yard told me he has prostate cancer and is waiting on surgery for the past 3 months. He looks like he is 50 years old. I am not a Urologist but it doesn't sound good. There is no radiation Oncologist here. Our next door neighbor moved here with seizures and finally got a CT scan that showed a mass. She is going to Auckland for 3 weeks of work up, etc. We don't have neurosurgery or neurologists in the Northland. Radiology is limited to a few cat scans/MRI's a day so you just have to wait until you can get in. The pathology lab appears very similar to US labs and I am finding some opportunities to teach medical students, interns, and residents about lab testing, blood products, etc to try to decrease pre analytical lab errors and inappropriate use of blood products. I am working on some administrative projects like revising requisition sheets, updating lab manuals, and initiating some lab tests the clinicians want. Fascinating "A?" We have gotten a kick out of lingo here. Some of the common phrases are: cool and awesome, being keen on something if you like it, something good is said to be "sweet as" but they never say as what (side note until today Phillip thought people were saying 'sweet ass' all the time, there is common cursing here at all ages), instead of loads of something it is "heaps of", making a statement then saying "A?" as if your asking Do you agree (Claire is really picking this one up). It would go something like this....
We are keen on New Zealand and having heaps of fun because things are sweet as but it would be awesome and cool if you would visit. A?

Lynn at the top from another panoramic viewpoint
Claire at the top with Ocean Beach behind her
View from the top shows more mountains down the coast
The crew at the bottom after 3 fun hours climbing

Hike To Top of Manaia (Whangarei Heads)

Me looking at the Heads last week from Mnt Aubrey
Lynn took this evening shot from our porch
The view from the top of Heads ( see oil refinery at Harbor's mouth)
Wind blown cold kids at the top

Let's Go Surfing Now, Everybody's Learning How

We had a great 3 day weekend for the Queen's Birthday. Our pastor friend Miguel gave surf lessons to those willing to brave the water after church Sunday. We took a picnic and enjoyed Waipu beach about 30 minutes south of town and on the otherside of the bay from us. We had 2 invites to dinner over the weekend and enjoyed the food and conversation of a Christian family from the UK and then the next night some incredible pizza, homegrown olives, and fun with a fellow physician Kiwi couple from the hospital and their 2 boys who are in the same class at school with our kids. On my brother's advice we started inviting some of these folks over to our rental house and grilled out today with Miguel, Claudia, and their 6 kids. We did a muddy but fun 3 hour round trip trek up to the Whangarei Heads we show so much in the photos. We will show photos of the muddy crew and panaramic views soon. Phillip "got a try" aka touchdown in Rugby lingo. He also landed the merit award from his coach for the second week. He has his eye on MVP but seems to be knocking the block out of Rugby to me. Andrew said he hopes everyone is proud of him too so bring on the commens about him catching the first fish! We heard of some karate down the street from us at a little community center so we may check that out for Andrew. He seems to love to sword fight and wrestle and punch at things.