Medicine is both a passport and a visa, permitting access to unknown places and insights into places most will never see. This week I flew to Gisborne with Professor John Werry.

John is terribly eccentric, but also sharp, quick witted and energetic. He is a shocking flirt and is 76 years old. The plane was like a schoolbus, small but full of old friends on a regular commute. I’ve never seen such dazzling countryside so lucidly. We saw the sun rise over Auckland. It was a pink sky, like flying through a big screen sky.

We spent a brief time in Gisborne, then travelled 200km up the East Coast. The coastal road is breathtakingly beautiful, but windy and I was carsick, but at least that meant when we stopped for me to be sick, I saw more of the astonishing beaches. The good thing about travelling with a Prof is that he has a well stocked medical bag and I was soon better.

I was surprised by the severity of cases we saw. There were most of the conditions I was used to seeing in the inpatient unit and national specialist teams at the Maudsley, but for this whole region there was just one nurse (who also looks after adult patients) and a monthly flying visit from an aging Auckland Prof. He took me to see diagnostically complex cases and we had lively discussions in people’s homes and fields among cows, sheep and horses. Small rural communities seem to adapt and accept symptoms that cities do not accommodate as easily, but it means people don’t come to medical attention.  It was particularly disturbing to see young people with long durations of untreated psychosis, which is so neurotoxic. When I was an SpR working at the Bethlem hospital in Kent, youngsters like this would be admitted, stabilised on medication and return to their homes and studies. Today I saw children who are on a chronic course, because they have been untreated. It was like seeing smallpox.

In some ways my training prepared me for today, in others it did not. I found myself using complex diagnostic skills, wondering how to plan treatments with minimal resources, teaching unqualified carers what to do, assessing risk and management planning in unfamiliar territory, dabbling in hands-on anthropology, arguing with esteemed professors in a field, admiring how people cope with no services and gawping at filmic views while being car sick. It’s been a challenge, but an exhilarating one.

Before this trip, I could count the times I’ve been really heartily thanked during my psychiatric career on one hand. This week I lost count, and that was humbling and magical.