I never expected this career. Thanks to Australia

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Practice in UK, East London Hertfordshire and Prison medicine. The latter is akin to remote as no easy to get them out for secondary care

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It’s Acceptable with a population of 4 million to send a patient for neurosurgery to Brissie. Like telling my patients in London they need to fly to Rome.

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From Borrolloola

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Population of 1000, 2000 with other settlements, own renal unit. That’s the new $19 million flood resistant bridge under there.

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Learning from those around you, who clearly have the local experience and much more. One is only complimenting, not usurping, when working remotely

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Footy to keep fit, alas quickly moved back to the clinic as we have a sick 21 year old. 13 hours later we get a flight to Darwin, then the patient goes to Adelaide. Here the wonderful remote nurses do most. We see pancreatitis, Norwegian scabies, Diabetes of course, and more. School check shows wonderfully fit children, some old ear troubles and new Rheumatic heart disease. As a fixed population more like UK care and fewer PBS restrictions. In effect a dispensing practice.

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Getting patient out at night, and there flights across a green NT on route to outstations. Look after acute patients for 12 hours plus if flights cannot get in

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Then I go to Soroako, Sulawesi. Nickel Mine sponsored hospital, 65 beds, offers ITU to the “village” state hospital. Doing ward rounds as advisory consultant; It all comes back. But this land of 1000 different smiles I was warned of care needed for loss of face. Low sodium does not mean more saline, so tell in private, not on the ward round

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Nickel ore mine and the ore is turned into a sulphide matt on site using hydrolectrics from the dams. Clean, ecological, safe H&S. I was very impressed

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The tragedy of 3rd world medicine is that doctors feel impotent without the technology. Staff look on the internet, Uptodate.com. NICE, Sign, and other protocols and read the gold standard. As they cannot offer that, feel impotent and walk away. No gastroscope for example, but why not barium meals? The Silver standard is all that might be needed. Could be gold after all. We need a new textbook for third world medicine that is not imposing litigant and expensive systems as we have in the west, that will offer so little extra in health benefit for these poor communities.

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I was giving talks on Prison medicine and drug dependency. Impressed with their health care. Not remote!

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Curious nurses’ uniforms and the ward messenger flits around all ten floors on roller blades. Stops on dime. Seems so sensible but would it get past H&S anywhere else. In remote medicine H&S is top priority after all, my H&S sceptic dissolves when it comes to working alone in remote locations

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Went there having passed all the paperwork, but Canadian doctors colleges controls the number of doctors, and restrospectivly added a new condition when I was there. My GP training certificates needed to be backed up by a signatures of each module from the consultants that trained me. They are deceased. So after three weeks flew out. This was a lucky break as instead when to Tristan Da Cunha. I would be much richer as Canadian doctor pay is vulgar

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Remote medicine. The Island was occupied 1815 ish to prevent French from using it to get to St Helena to rescue Napoleon some 1700 miles north. Some stayed on, population added by four women sent from St Helena (all had asthma) and then Italian shipwreck. Revenue sufficient from fishing contract (Crayfish) the latter provided the two monthly supply ships. No airstrip. This is remote.

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No port as such, so back and forth on tender, huge deep ocean swell. Little in way of H&S. You can “walk” to upper level on the mountain where some sheep live. The one doctor is the ONLY medically qualified person on this Island of 270 people.

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270 people. Never knew it was so many. My fridge was like a startreck device that filled up with food: Crayfish pie automatically, milk delivered in old gin bottles. Australia Drinks 7 l there 24 l The hospital and doctor’ house. No other medical staff. No nurses, doctor in charge which is problematic as each doctor does his own thing.

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Jobs. Passing ships medical problems (MI) and fractures. Cut up, cannot say dissect, (chain saw)this rare Shepherd’s whale (only seen 30+ times as deep sea whale) and freeze head for University team

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More Heath and Safety unloading people. The right shows the settlement and cows. Limits on cows as grazing land is limited.

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Christmas shearing and choosing Christmas dinner. Brought down from the mountain side

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7 family names. The entire Island

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Problems. Again even Islanders wanted technology such as an incubator. Asthma poorly controlled. Path lab. I started a quiz of UK consultants, a Desert island Discs, choosing 8 records… 8 items you think you must have where so isolated, where the next boat is in two months. She was going to deliver on the Island, but the next doctor was a surgeon bottled out of delivering her or the prospect of a caesarean. Now all go at least 32 weeks to Cape Town. I had NOTHING for delivery onv the 8 day trip!

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That gong was rung on old year’s night, but is rung on days when weather is OK for fishing at 5am. The whole village hears it. Women serving men folk.

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Australian Antarctic Division prepares you best of all, for every eventuality. Tasmanian training and emergency kit. Getting cold with scenarios with young paramedics and tour guides. Out of my comfort zone but necessary.

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Going back to pathology and medical school. Appendix operation training, Also fire training, confined spaces, Quad bike, abseiling, mass casualty, cold injury. Restocking stations.

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The ship, being replaced next year. The clinic has everything and can do surgery. Malaria tablets for example. Coping with every possible eventuality has made systems overly complicated. There ix Xraym ultrasound, condoms dished out with the promazine sefl service.….pregnancy on the ice you are sent back immediately. Doctor has to have appendix out before going down.

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Size of RV Aurora Australis seen on right next to a cruise ship. Celebrations honouring King Neptune crossing 60 degrees south The brown is the algae which the whole arctic ecology depends.

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2nd time send down in October on the first possible flight via McMurdo on C17, a flying cathedral with four helicopters on board. Other doctor flown out with a medivac, so for a few weeks I was in effect a winter doctor with only 20 at Casey. Then the summer team arrived, up to 95 people.

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Stuck at McMurdo as the Bassler’s pitot tube (converted DC3 1943 vintage) was blocked getting to UK station Rothera, then bad weather. There is Scott’s hut 1903, an old Aussie sheepstead house. Compression chamber. Royal Society Mountains in background. McMurdo is in NZ territory and US offers NZ free logistics. The cross is on Observation hill where they where waiting for Scott to return. McMurdo, Ross Island is the deepest in you can get into Antarctica by ship in summer. That is sea ice

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That is steam at the top. Active. Shacklelton in 1904? climbed it, did drawings and wrote a poem about it, as one did.

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On DC3. Aviation medicine. Survival kit. Not pressurised. Reassuring mechanical levers in cockpit

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Transantarctic Range that hold back the ice over millennia so is now 3km thick

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Antarctica is deep ice.

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3486M ASL but only 600ft agl or rather above ice level,….. For hours.

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Landed at Casey ice strip

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Snow petrel, Ice has many colours, Katabatic winds, 100knots… Not so much at Casey.

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Doctors duties :Trained for dentistry. New filling but contact HQ before doing anything advice. Genuine SAR for a fall. Psychology as there with winter team which had fallen apart

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Own Brewery has risk benefits. Station is dry for resupply and other risky times

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Pink ice is a algae. Iceberg Alley, Casey

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Sleep in the hole overnight. Nothing is left behind

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Midsummer swim and doctor of course needed to stay dry next to his resucitation kit.. Cricket with obligatory streaker. If no wind -8 degrees is OK Drive a hag, Not comfy. The surgical team include the sparky, the plumber and storeman.

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Keeping kit in order on of the dutires. Testing x-ray, pathology equipment. Testing treated waste, sewerage for Oxygen load it might put on the sea, Portable decompression chamber. Put patient in with O2 and pump it up. It whistles when at right pressure, not that you will here that in a tent with a blizzard blowing. Cold low pressure and height make altitude sickness possible. Part of preparing for a deep field expedition

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Preparing the main Wilkins airfield every year for the Airbus A319 Nov-Feb Mass Casualty kit training

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Remote. Deep sea. 6 RR Azithimol probs. She stays within 6 inches when drilling 10,000 feet below. H&S risk because of super high pressure hoses and the rest. Systems excellent. But not prepared for remote working Gabon…Malaria, Chickingunwa, HIV, Gastro, kit to treat and for medivac. Getting that organised was much of the work. Just one injury in 5 weeks… supraspinatus in the gym has H&S so good

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O deg. Big thrill for me as a radio ham. 1st person in the wold to make contact here. G3WIP/MM

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Should be and African Australia. Has everything, including water underground. Here supporting helicopter slinging operations, treating local workers. Malaria, if anything over treated. Simandou, a Mountain of ferrous sulphate, 700km railway was being buld and a new port. Treating chinese workers and teaching chinese doctors.

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Mobile phone in each hut. Problems here was a cholera epidemic next door, so preparing isolation unit in the HQ, a converted hotel for tourists who never come. Also Teaching Chinese doctors who where with the rail program. All has since stopped since Ebola. Huge corruption, but it is now all on the internet, and US of course leading the way with indictments.

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Just had a call to work here.

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