NEUROLOGICAL LETTER FROM
South Georgia and the Southern Ocean Hazel Woodland
Correspondence to Department of Gastroenterology, Royal United Hospital, Combe Park, Bath BA1 3NG, UK; [email protected] Accepted 8 February 2015 Published Online First 5 March 2015
To cite: Woodland H. Pract Neurol 2015;15:396–399.
396
So, what does a doctor on a Sub-Antarctic research station do with only 11 young and fit people as potential patients? I get asked that a lot and I’ll endeavour to give some impression of what life is like as the only doctor on South Georgia (figures 1 and 2): the answer is essentially, ‘not a lot of doctoring’! However, before going South, I spent 18 months working in rural Tanzania, running a busy medical ward, watching too many people die, and battling the complex challenges invariably faced while working in this environment. The thought of a more relaxed pace of life and the chance to learn some non-medical skills was appealing. In summer on South Georgia, I was responsible for the medical and dental needs of around 50 people, but over winter that fell to just 11, plus the occasional fishing boat stopping by for a consultation. Overall, I spent 9 months split over two trips on the Royal Research Ship James Clark Ross floating around the Southern Ocean doing research and logistics work, and 10 months on the absolutely stunning Sub-Antarctic Island of South Georgia (figure 3). During that time, I ran a post office (discovering the philatelic world to be extremely complicated and at times demanding), learnt how to drive jet boats and rigid inflatable boats through ice, with seals and penguins popping up around the boats, ordered and managed the station’s food supply (no mean feat to order dry food and frozen for a year for an unknown number of people with unknown eating habits), rationed the crisp and chocolate supply (Oh, the stress!) and explored some of the most beautiful landscapes on Earth on foot and by sea. MEDICINE AT SEA Spending 9 months on board a ship was fascinating, breathtaking, educational and, occasionally, incredibly dull! Practising medicine at sea—particularly in the
Southern Ocean—presents certain challenges, especially when even standing upright is a challenge. The simplest task becomes a complex exercise in timing and preplanning. Things do not stay where you put them: if you miss-time opening a cupboard door you risk being attacked by triangular bandages, surgical instruments or tampons. There is nothing like being seen scrabbling on the surgery floor chasing flying tampons to check your ego (figure 4)! British Antarctic Survey doctors have to acquire extra skills during the 5–6 months of predeparture training, some of which I had to put into practice. It turns out that taking and developing X-rays—the old school way with chemicals and a red light—is very satisfying, as is filling teeth, though both become more ‘interesting’ on a moving ship. All the extra effort involved in living at sea for weeks on end is worthwhile when you enter sea ice and the world becomes eerily calm just before the ship starts juddering and crunching as it meets the ice. Standing up on the bridge with an undulating bright white sheet covering the sea ahead as far as you can see is indescribably beautiful. And then, as the ship pushes forward, a crack opens and a black channel appears ahead. Everything is quiet and incredibly peaceful for a moment as you cruise along it, until you hit the next patch of ice with a crunch and some creaking. Penguins and seals react in different ways to the approach of a big red ship. Some head off at high speed and dive into the nearest pool of open water, some gaze lazily up at the ship and wait for their bit of ice to be pushed out of the way and some (mostly the Adelie penguins, who appear particularly stupid) run straight at the ship in a panic before realising their mistake, skidding to a halt and speeding off in a different direction. It’s rarely dull when you’re travelling through ice (figures 5–7).
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
NEUROLOGICAL LETTER FROM
Figure 3 King Edward Point Research Station, South Georgia. Figure 1
South Georgia.
SOUTH GEORGIA For those that don’t know, South Georgia (as opposed to the American state of Georgia or the country near Russia called Georgia) is a small island in the middle of nowhere (figure 8), famous for being the place where the Falklands War started and where the whaling industry brought the Southern Ocean’s whale population to near extinction. Anyone lucky enough to visit it—looking at the map you’ll realise why that’s only a select few—would probably agree it is one of the world’s most beautiful and unforgettable places. Waking up every day and opening your curtains to see icebergs, penguins, lenticular cloud formations over jagged snow-covered mountains or newly born seal pups yelping loudly for their mothers (figure 9), is not easily forgotten. Light pollution is no problem and the midnight skies on evening security checks are like nothing seen at home. More and more stars appear the longer you stare upwards with almost hypnotic effect; it’s often hard to return inside despite the warmth of the station. I lack the literary ability to describe the sights of South Georgia adequately so I hope the photos will help with that (figures 10–12). However, it’s not always the most amazing job in the world, and at times I might even have preferred a busy emergency department on a Friday night (or at least I thought I would). Generally, doctors in the UK get used to being busy, having a purpose and knowing that it probably will matter if you stay in bed rather
Figure 2
Flag of South Georgia.
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
than going to work that day. That’s not always the case on a small, barely inhabited island. There’s nearly always something to do, but it’s usually the jobs that no one else wants and so you might not feel fulfilled professionally. I have always thought it might be interesting to learn to use an angle grinder, but I can now say with some authority, having spent many, many hours grinding non-stick paint off a boat, that it is less interesting than expected. I also felt my medical knowledge seeping away as I was called upon so infrequently to use it, but also knew that if anything bad were to happen, everyone would still look to me as the only doctor for 700 miles. Having said that, we did have support from the British Antarctic Survey Medical Unit back home, but that was via telephone or email. Virtual handholding is certainly better than nothing, but anyone who has used satellite phones knows it can be frustrating. I also missed having colleagues with whom to discuss odd cases. I even missed journal clubs and had no idea what was going on in the world of real medicine. However, medical responsibilities also included training staff in advanced first aid. I’ve now been successfully cannulated by a purser, a plumber, a zoologist and a boating officer among others: teaching people with little prior medical experience to manage effectively things like anaphylaxis and major trauma was extremely
Figure 4 Ship’s surgery.
397
NEUROLOGICAL LETTER FROM
Figure 5 Royal Research Ship James Clark Ross tied up at Rothera Station.
rewarding. Teaching people to plaster broken arms and legs mostly just leads to mess and dollops of plaster being discovered in random places in the surgery for many weeks afterwards! I also had to order a medical kit for the coming year, to ensure the surgery was kept clean and tidy, and to ensure that all equipment was working well. It’s not glamorous, but this did mean I could be fairly sure I didn’t have diabetes, a broken finger, anaemia, an arrhythmia, hypertension or a urinary tract infection.
EMERGENCY NEUROLOGY Exposure to neurological cases in Antarctica was limited, and the only case I can possibly shoehorn into this category—other than a lot of musculoskeletal back pain with the occasional hint of sciatica— involved trauma rather than a complicated collection of neurological symptoms with insidious onset. The surgery phone rang (unusual in itself ) and a shaken voice requested my presence in the boatshed, implying a degree of urgency. I found a colleague, and good friend, looking paler than usual with blood dripping down her face, too close to her eye for comfort. For reasons that with hindsight are hard to explain, the dry suits were hung on meat hooks and, in trying to
Figure 6 The Southern Ocean at its best (taken through the Bridge window).
398
Figure 7 Finding a way through the sea ice.
get her suit down, she had detached the meat hook along with the suit, landing hard on her head and rendering her briefly unconsciousness. After cleaning and patching the wound and a (brief ) neurological examination, I prescribed tea, chocolate and rest. I also suggested a temporary ban on boat driving because of the severe nausea, double vision, headache and inability to walk in a straight line from which she was now suffering. While this all ended well—she’s now my housemate in the UK after a full recovery—it was an abrupt reminder of how limited the facilities really are down South. She never met the criteria for an urgent CT scan of head, but if she had, it would have taken a minimum of 4 days by boat to get her to the Falklands (8 days if there were no ship nearby and one had to be sent down). Had it shown something requiring intervention, she would have needed a flight to the UK or South America for treatment. In someone young and previously healthy, the implications of such a delay are sobering. I also realised that it takes much,
Figure 8 Location of South Georgia. Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
NEUROLOGICAL LETTER FROM
Figure 9
The view from my bedroom window.
Figure 12 St Andrews Bay—one of the largest King penguin colonies in the world.
with a head injury advice sheet. As her double vision persisted for days not hours, and her headache took nearly a week to settle, there were many moments when I questioned whether paracetamol and reassurance really were the correct treatment! Would I go back again? Probably not right now: life moves on and the thought of a ‘normal’ job with lots of patients, numerous colleagues with whom to discuss things and the option to request rapidly a large array of complex investigations is an exciting prospect. Has it put me at a disadvantage when it comes to getting back into medical training? Not so far, though revalidation was somewhat ‘interesting’ after 5 years abroad! Am I glad I did it? Absolutely! Figure 10 Fur seal pup. Background
Hazel completed Core Medical Training in 2009 before deciding to spend some time working abroad. She will be starting training in Gastroenterology in the Severn Deanery in February 2015.
Figure 11 Grytviken and the station from Mount Hodges.
much longer for concussion to settle than I thought, having previously seen it only in the acute phase when discharging patients from the emergency department
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
THE BRITISH ANTARCTIC SURVEY The British Antarctic Survey, an institute of the Natural Environment Research Council, delivers and enables world-leading interdisciplinary research in the polar regions. Its skilled science and support staff based in Cambridge, Antarctica and the Arctic, work together to deliver research that uses the polar regions to advance our understanding of Earth as a sustainable planet. The British Antarctic Survey Medical Unit is based in Plymouth Hospitals NHS Trust and advertises yearly for Medical Officers to work on the research stations and ships. Competing interests None. Provenance and peer review Commissioned. Internally peer reviewed.
399
South Georgia and the Southern Ocean Hazel Woodland
Correspondence to Department of Gastroenterology, Royal United Hospital, Combe Park, Bath BA1 3NG, UK; [email protected] Accepted 8 February 2015 Published Online First 5 March 2015
To cite: Woodland H. Pract Neurol 2015;15:396–399.
396
So, what does a doctor on a Sub-Antarctic research station do with only 11 young and fit people as potential patients? I get asked that a lot and I’ll endeavour to give some impression of what life is like as the only doctor on South Georgia (figures 1 and 2): the answer is essentially, ‘not a lot of doctoring’! However, before going South, I spent 18 months working in rural Tanzania, running a busy medical ward, watching too many people die, and battling the complex challenges invariably faced while working in this environment. The thought of a more relaxed pace of life and the chance to learn some non-medical skills was appealing. In summer on South Georgia, I was responsible for the medical and dental needs of around 50 people, but over winter that fell to just 11, plus the occasional fishing boat stopping by for a consultation. Overall, I spent 9 months split over two trips on the Royal Research Ship James Clark Ross floating around the Southern Ocean doing research and logistics work, and 10 months on the absolutely stunning Sub-Antarctic Island of South Georgia (figure 3). During that time, I ran a post office (discovering the philatelic world to be extremely complicated and at times demanding), learnt how to drive jet boats and rigid inflatable boats through ice, with seals and penguins popping up around the boats, ordered and managed the station’s food supply (no mean feat to order dry food and frozen for a year for an unknown number of people with unknown eating habits), rationed the crisp and chocolate supply (Oh, the stress!) and explored some of the most beautiful landscapes on Earth on foot and by sea. MEDICINE AT SEA Spending 9 months on board a ship was fascinating, breathtaking, educational and, occasionally, incredibly dull! Practising medicine at sea—particularly in the
Southern Ocean—presents certain challenges, especially when even standing upright is a challenge. The simplest task becomes a complex exercise in timing and preplanning. Things do not stay where you put them: if you miss-time opening a cupboard door you risk being attacked by triangular bandages, surgical instruments or tampons. There is nothing like being seen scrabbling on the surgery floor chasing flying tampons to check your ego (figure 4)! British Antarctic Survey doctors have to acquire extra skills during the 5–6 months of predeparture training, some of which I had to put into practice. It turns out that taking and developing X-rays—the old school way with chemicals and a red light—is very satisfying, as is filling teeth, though both become more ‘interesting’ on a moving ship. All the extra effort involved in living at sea for weeks on end is worthwhile when you enter sea ice and the world becomes eerily calm just before the ship starts juddering and crunching as it meets the ice. Standing up on the bridge with an undulating bright white sheet covering the sea ahead as far as you can see is indescribably beautiful. And then, as the ship pushes forward, a crack opens and a black channel appears ahead. Everything is quiet and incredibly peaceful for a moment as you cruise along it, until you hit the next patch of ice with a crunch and some creaking. Penguins and seals react in different ways to the approach of a big red ship. Some head off at high speed and dive into the nearest pool of open water, some gaze lazily up at the ship and wait for their bit of ice to be pushed out of the way and some (mostly the Adelie penguins, who appear particularly stupid) run straight at the ship in a panic before realising their mistake, skidding to a halt and speeding off in a different direction. It’s rarely dull when you’re travelling through ice (figures 5–7).
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
NEUROLOGICAL LETTER FROM
Figure 3 King Edward Point Research Station, South Georgia. Figure 1
South Georgia.
SOUTH GEORGIA For those that don’t know, South Georgia (as opposed to the American state of Georgia or the country near Russia called Georgia) is a small island in the middle of nowhere (figure 8), famous for being the place where the Falklands War started and where the whaling industry brought the Southern Ocean’s whale population to near extinction. Anyone lucky enough to visit it—looking at the map you’ll realise why that’s only a select few—would probably agree it is one of the world’s most beautiful and unforgettable places. Waking up every day and opening your curtains to see icebergs, penguins, lenticular cloud formations over jagged snow-covered mountains or newly born seal pups yelping loudly for their mothers (figure 9), is not easily forgotten. Light pollution is no problem and the midnight skies on evening security checks are like nothing seen at home. More and more stars appear the longer you stare upwards with almost hypnotic effect; it’s often hard to return inside despite the warmth of the station. I lack the literary ability to describe the sights of South Georgia adequately so I hope the photos will help with that (figures 10–12). However, it’s not always the most amazing job in the world, and at times I might even have preferred a busy emergency department on a Friday night (or at least I thought I would). Generally, doctors in the UK get used to being busy, having a purpose and knowing that it probably will matter if you stay in bed rather
Figure 2
Flag of South Georgia.
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
than going to work that day. That’s not always the case on a small, barely inhabited island. There’s nearly always something to do, but it’s usually the jobs that no one else wants and so you might not feel fulfilled professionally. I have always thought it might be interesting to learn to use an angle grinder, but I can now say with some authority, having spent many, many hours grinding non-stick paint off a boat, that it is less interesting than expected. I also felt my medical knowledge seeping away as I was called upon so infrequently to use it, but also knew that if anything bad were to happen, everyone would still look to me as the only doctor for 700 miles. Having said that, we did have support from the British Antarctic Survey Medical Unit back home, but that was via telephone or email. Virtual handholding is certainly better than nothing, but anyone who has used satellite phones knows it can be frustrating. I also missed having colleagues with whom to discuss odd cases. I even missed journal clubs and had no idea what was going on in the world of real medicine. However, medical responsibilities also included training staff in advanced first aid. I’ve now been successfully cannulated by a purser, a plumber, a zoologist and a boating officer among others: teaching people with little prior medical experience to manage effectively things like anaphylaxis and major trauma was extremely
Figure 4 Ship’s surgery.
397
NEUROLOGICAL LETTER FROM
Figure 5 Royal Research Ship James Clark Ross tied up at Rothera Station.
rewarding. Teaching people to plaster broken arms and legs mostly just leads to mess and dollops of plaster being discovered in random places in the surgery for many weeks afterwards! I also had to order a medical kit for the coming year, to ensure the surgery was kept clean and tidy, and to ensure that all equipment was working well. It’s not glamorous, but this did mean I could be fairly sure I didn’t have diabetes, a broken finger, anaemia, an arrhythmia, hypertension or a urinary tract infection.
EMERGENCY NEUROLOGY Exposure to neurological cases in Antarctica was limited, and the only case I can possibly shoehorn into this category—other than a lot of musculoskeletal back pain with the occasional hint of sciatica— involved trauma rather than a complicated collection of neurological symptoms with insidious onset. The surgery phone rang (unusual in itself ) and a shaken voice requested my presence in the boatshed, implying a degree of urgency. I found a colleague, and good friend, looking paler than usual with blood dripping down her face, too close to her eye for comfort. For reasons that with hindsight are hard to explain, the dry suits were hung on meat hooks and, in trying to
Figure 6 The Southern Ocean at its best (taken through the Bridge window).
398
Figure 7 Finding a way through the sea ice.
get her suit down, she had detached the meat hook along with the suit, landing hard on her head and rendering her briefly unconsciousness. After cleaning and patching the wound and a (brief ) neurological examination, I prescribed tea, chocolate and rest. I also suggested a temporary ban on boat driving because of the severe nausea, double vision, headache and inability to walk in a straight line from which she was now suffering. While this all ended well—she’s now my housemate in the UK after a full recovery—it was an abrupt reminder of how limited the facilities really are down South. She never met the criteria for an urgent CT scan of head, but if she had, it would have taken a minimum of 4 days by boat to get her to the Falklands (8 days if there were no ship nearby and one had to be sent down). Had it shown something requiring intervention, she would have needed a flight to the UK or South America for treatment. In someone young and previously healthy, the implications of such a delay are sobering. I also realised that it takes much,
Figure 8 Location of South Georgia. Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
NEUROLOGICAL LETTER FROM
Figure 9
The view from my bedroom window.
Figure 12 St Andrews Bay—one of the largest King penguin colonies in the world.
with a head injury advice sheet. As her double vision persisted for days not hours, and her headache took nearly a week to settle, there were many moments when I questioned whether paracetamol and reassurance really were the correct treatment! Would I go back again? Probably not right now: life moves on and the thought of a ‘normal’ job with lots of patients, numerous colleagues with whom to discuss things and the option to request rapidly a large array of complex investigations is an exciting prospect. Has it put me at a disadvantage when it comes to getting back into medical training? Not so far, though revalidation was somewhat ‘interesting’ after 5 years abroad! Am I glad I did it? Absolutely! Figure 10 Fur seal pup. Background
Hazel completed Core Medical Training in 2009 before deciding to spend some time working abroad. She will be starting training in Gastroenterology in the Severn Deanery in February 2015.
Figure 11 Grytviken and the station from Mount Hodges.
much longer for concussion to settle than I thought, having previously seen it only in the acute phase when discharging patients from the emergency department
Woodland H. Pract Neurol 2015;15:396–399. doi:10.1136/practneurol-2014-001068
THE BRITISH ANTARCTIC SURVEY The British Antarctic Survey, an institute of the Natural Environment Research Council, delivers and enables world-leading interdisciplinary research in the polar regions. Its skilled science and support staff based in Cambridge, Antarctica and the Arctic, work together to deliver research that uses the polar regions to advance our understanding of Earth as a sustainable planet. The British Antarctic Survey Medical Unit is based in Plymouth Hospitals NHS Trust and advertises yearly for Medical Officers to work on the research stations and ships. Competing interests None. Provenance and peer review Commissioned. Internally peer reviewed.
399
