Starship children's hospital is on the front line in dealing with child abuse and its staff have learned how to cope with the horrific tragedies they see each day.
Every day, one or two children show up at Starship children's hospital having been abused by someone in their family and often the perpetrator is right beside the victim.
Yes, says Starship paediatrician Patrick Kelly, staff often know who the assailant is, and yes, there is anger.
"One of the greatest tragedies in child abuse is it seems so unnecessary. It seems such a needless waste of life."
"But for some of the children, I have to acknowledge, their brain damage is so severe that by the time they are in hospital, death may be the best outcome.
"Sometimes, once we are dealing with a child in hospital and we have done our best to help them recover, you come to a point when you realise they are not going to make it."
Unlike Nia Glassie from Rotorua or the Kahui twins from South Auckland, most cases go unnoticed by the media.
But for the staff of Starship's paediatric intensive care unit (PICU) and its ground-breaking Te Puaruruhau child abuse unit it is daily fare.
PICU is New Zealand's only such unit. Dr Kelly, regarded as a pioneering hero by his peers, sees something magnificent in the work he came to by accident 15 years ago.
"The reward is that if you intervene successfully in this area, you can probably have more of an impact on a child's life than you can in almost any other area of paediatric medicine."
Outcomes can be "wonderful and rewarding".
Staff cope in many different ways.
"They're in the work because they care about children and children's health, and are usually passionately committed to what they do and they cope by doing their jobs the best they can."
Extensive debriefing helps.
Families often deny what has happened and give false and misleading information.
"In accidental injuries the staff feel they are standing alongside families in their time of need," Dr Kelly says.
"Often in the case of child protection, while we try to stand beside the family, there is always the tension created by the fact that one of those family members caused the injuries.
"That is the thing that staff find particularly difficult. Many staff feel angry.
"I don't think any staff member would show that anger or carry it out toward the family, but they would discuss it among themselves."
Staff anger is channelled constructively into making medical practice better, Dr Kelly says.
Paediatric Society head Nick Baker says child abuse work is most draining.
"People identify with children, especially if they have got their own children. Fortunately, dealing with dead and dying children, even for most paediatricians, is not that common an event."
Burnout is always an issue and the best defence is strong peer support, he says.
"They seek help in looking at a problem shared is a problem halved."
Starship Foundation chief executive Andrew Young says the media focus is on one or two cases at Starship, but the tragedies are "ongoing and relentless".
"I've seen the staff in group huddles with tears freely flowing. I think that is a healthy outlet when you see the cases they deal with on a daily basis."
Te Puaruruhau, across the road from Starship, was established in 2002 and unites Starship, police and Child, Youth and Family.
"You could say it's a national shame that we've had to fund-raise for a separate building for our abused children, but you could also say it is offering coordinated solutions which are long overdue," Mr Young says.
For much of last century, Auckland was cursed with the decaying Princess Mary Children's Hospital. In 1968, paediatrician Ron Caughey argued that it was "essential that at least one centre in New Zealand be encouraged to develop its paediatric services to the maximum degree".
Starship opened in November 1991, costing $79 million.
The idea was to create a national hospital and to ensure that when all else failed and a child needed specialist care, the very best was available.
Helicopter ambulances swoop into Starship from throughout the country, and the hospital uses tele- paediatrics to link child specialists.
In a Friday video link-up the main medical cases are shared nationwide.
As striking as its architecture, its name and its multi-colours is the fact that Starship is a globally recognised centre of excellence that many believe is at the forefront of not only treating children, but preventing illness and injury, with initiatives such as its child safety service, Safekids.
Dr Baker, who lives in Nelson, says the Starship model has been a success, though the funding of paediatric healthcare, built around 21 district health boards, is out of sync with it.
"There should be an outreach. Starship can support the rest of the country without the child going there."
- The Dominion Post