Focus: It is nearly one month since the fatal eruption of the marine volcano at White Island, the general view down the Strand in central Whakatane.
Middlemore Hospital has resumed elective surgeries this week after suspending hundreds of operations to care for victims of the Whakaari/White Island tragedy.
Forty-seven people were on the small, volcanic island when it erupted on December 9, leaving dozens seriously injured.
Patients flooded into hospitals and urgent calls were made toskin banks across the globe, as New Zealand suddenly needed 120sq m of donated skin for grafts.
Counties Manukau District Health Board chief medical officer Dr Peter Watson said the same volume of work they would usually see in a year arrived in just over a day.
Around 600 surgeries are expected to be postponed by the end of January.
Following the disaster lots of staff members gave up their holidays or returned early from leave to work very long days, Watson said.
They were joined by a burns surgeon from Australia who cancelled a booked vacation to help, and a Canadian specialist.
It was the first time that a national 'multiple complex burn action plan' was activated, he said.
"We had a lot of commitment, energy and generosity from people but there are also lots of learnings, from which I mean, you don't know how big the challenges are until you are actually in them."
Watson said 13 patients remained in four hospitals across the country – including the two injured New Zealand tour guides and others from America, UK, China and Germany.
Eight of those patients are being treated at Middlemore Hospital.
Thirteen other patients were transferred to Australian hospitals, eight of which remain in the care of two New South Wales public hospitals and three of which continue to receive specialist burns care at The Alfred.
At least two among that Australian group remain in a critical condition.
After the dead skin was removed patients had required multiple temporary skin grafts which could hold for a few days or about a week - "it's not long," he said.
"That's why people have to go back to theatre quite a lot."
Both the dressing changes and grafting were performed in theatre.
Eight people who were injured by the Whakaari/White Island disaster on December 9 are still being treated at Middlemore Hospital. Photo / File
Most of the patients had progressed to the stage where they could have their own skin now grafted onto their burns, he said.
"This is a long-term healing process, and for many of them it will take years."
Watson said there were two important things to remember about skin.
"One it prevents infection, and second it keeps you warm. When you have lost lots of skin you are prone to temperature control problems and infection."
Patient rooms and the theatre had to be kept in the low 30 degrees, he said.
While it was "not quite like working in a sauna" the room was noticeably warm and for medical staff donning theatre gowns it could make for "hot, sweaty work".
It could be physically hard work as well as psychologically as people were witnessing trauma, he said.
Director-General of Health Dr Ashley Bloomfield said the tragedy placed sustained pressure on the health system.
But at short notice six Australian nurses and one Kiwi had volunteered to support their colleagues at Whakatane Hospital to ensure specialist care over the holiday period.
"District Health Boards, particularly in the greater Auckland area, have also been working closely together to ensure other patients can get acute and urgent surgeries."
The Ministry also wanted to acknowledge international assistance received, particularly from Australia, but also the UK, Canada and the United States.
Aussie nurse felt connection to NZ
Three of the six Australian nurses currently working at Whakatāne Hospital, Helen McCarthy, left, Madelaine Hooper and Amanda Wieland. Photo / Supplied
Clinical Nurse Consultant Madelaine 'Maddie' Hooper volunteered without hesitation when staff at her workplace, The Royal Brisbane Hospital, were asked to help.
"I remember seeing the reports of the White Island eruption on the news," Hooper said.
"I was quite upset to hear about it and so when they asked if anyone would be interested in going to help out I put my hand up straight away."
Hooper had previously worked at Christchurch Hospital and her godmother's family is from the Whakatāne area.
She said she already felt a connection to New Zealand.
