A lot of people have asked me what it is like to be a “remote site” doctor or about providing medical care to expeditions or groups in “far away locations”. The glamorous sounding job of “expedition doctor” is not always what is sounds like. Here is what a typical contract or service is like, from my point of view. Obviously, each job is different but there are a few common threads:
Pre trip phase and packing
Packing the tools of my trade: stethoscope, ent kit, a few favorite medical books, Kindle with the rest of my medical books, iPad with pharmocopeia, more medical text books and reference material. This all depends on what gear is already on hand at the destination. Sometimes I have to bring a whole medical kit with diagnostics, medicines or even a portable hospital with me! Generally I bring my personal items that are customized and just the way I like them. The books are noted and highlighted and the ebooks are noted and bookmarked for rapid reference.
Packing things to entertain me such as a kindle with my RYP books, pleasure reading (non-fiction), iPad loaded with music and movies, iPod loaded with music, external hard drive loaded with movies, lap top, work out mat, etc. I also never forget my power-monkey charger for those power outages in the middle of my 212th time viewing Indiana Jones III.
Packing clothes for the area and I generally work in the tropics or desert. This means lots of shorts, sandals, scrubs, ex officio shirts, running gear, one pair of boots and a dress outfit in case I need to meet important people…I have yet to wear this outfit though. On duty I generally wear an ex offico style shirt and cargo pants with a few IV kits, tourniquets and medicine vials stuffed into the pockets. If I have to go into the field with a smaller team I carry my shoulder bag or backpack filled with doctor like stuff including saline, clotting agents, antibiotics, tourniquets, etc. I also wear a vest sometimes…yes I am AM that guy but screw it…the vest holds a lot of stuff and does not interfere with a back pack and still gives easy access to items.
Travel phase
Take a plane from my home town to the capital city of where I am going. This generally involves several airports, layovers and an unavoidable overnight in a “hotel near the airport”.
From capital city x,y,z I usually take a crappy plane, often a prop plane or rotary wing to the site. This can often be the most hazardous part of the trip!
Finally I arrive in the camp/area/clinic and find my quarters and work area.
Settling in phase
I usually end up staying in con-ex boxes, mobile homes, trailers or tent structures. Some have a/c and some do not. Most are filthy and very lived in, complete with body hair from others scattered everywhere, dirty dishes, moldy food in the fridge (if I have one) and the first goal is to clean up the area. I usually bring my own sleep sack/bivy so I avoid scabies and bed bugs and do not have to deal with yucky, stained sheets. I do not unpack my suitcase and bags unless I am there for more than one month and can clean the drawers/chests out.
Meeting people I will be working with for the assignment is always interesting. There is a lot of ego measuring, posturing and trying to show off without actually being nasty about it. I try to be nice and say a lot of “I hope you guys just keep me out of trouble” and “let me know if I am making any mistakes”. The nurses and other staff are trying to figure out if I am a complete idiot or going to work out ok. This usually takes a few weeks to sort out. There is the type that wants to tell you how great they are, the type that kisses your ass and the type that is too lazy to care.
Getting down to work
The first few days are generally spent trying to tread water and not screw up too bad. Lots of new paperwork, forms and “the way we do things here” stuff. I also love the “I am not sure how you do it where you are from but we do this this way, here”. Learning from others, being nice and still having to lead the team is a fine art I am still mastering.
Typical day
Clinic from 9am to 12:00
The usual gambit of injuries and illness depending on the area and people I am covering. Miners get respiratory complaints, sore muscles and twisted ankles and knees. Shooters get sore shoulders from weight workouts, twisted ankles and knees and everybody gets flu like illnesses and vomiting/diarrhea. The trick is to plow through the mundane crap each day and not miss the important red flags. That vomiting and stomach pain is probably gastroenteritis but it could also be a gallbladder or gi bleed. Staying vigilant when you repeat the same stuff every day is difficult some times.nthe morning also has the sick bay commandos looking for excuse notes and a day off work.
Clinic from 14:00-16:00
Same thing. I also usually see the chronic illness patients in the afternoon to make sure their blood pressure is not too high and they take their medicines Ike they should.
A few days per week I also have to do some public health duties like checking water supply, the kitchen and food storage. This is generally done after clinic and involves a mountian of paperwork and being a hard-ass about temperatures of food storage, parts per million of chlorine and other safety issues that make me quite unpopular some times.
My personal time
After 4pm I am usually done unless there is a problem. I am on call 24/7 for emergencies. The 57 year old guy that never takes his blood pressure meds, has horrible cholesterol, is 50 pounds overweight and smokes a pack a day usually has his chest pain episode around my dinner time. The guy that is not paying attention gets his fingers cut off around 2 am on night shift. Night time is generally when “badness” happens. A lot of times it is just being on standby in the clinic and then giving everybody a once over when they get back to the area. Still, it is nerve wracking, involves geting up out of bed and getting ready to work.
During “my time” I generally read, study or watch movies on the lap top or tv if I have one in my little shack. Even if their is tv there are never any good channels and knight rider in Arabic is just not that fun to watch. Working out in your trailer and not leaving the compound can be challenging. I do alot of calesthenics, pushups and the like. I always tend to make friends with the people I am working with. This means I worry about them when they are on a particularly dangerous outing, getting far from camp or I get a radio call that someone is coming into the clinic with “a problem”. Classic worrying mother syndrome!
If I get really beat-up at night with calls, sick visits or trauma, I cancel the clinic in the following morning to sleep in. Once per week or so I also give a lecture to the crews about some first aid topics, disease background or hygiene. I also try to give a lecture to the nurses at least once per week on an interesting case or point of learning such as physical exam or laboraty test interpretation.
Food can be challenging. Generally there is a base kitchen and a few freezer/fridge boxes in the camps. They are stocked with frozen meats, little airline sized condiments and sometimes fresh veggies if you get there quick enough and before everybody else. Generally I cook my own food if I have a kitchen in my trailer and if not I am at the mercy of the cooks. The food is ok, not great but not crap either. Some contracts give me a credit to spend at a local commissary store to get some luxury items like coca cola, yoghurt and a frozen pizza. Pasta and hamburgers are mainstays along with lunch meats and cheeses. Bottle water is the only way to go, mixers such as Gatorade or emergen-c help change the taste of crappy water.
The next day I head back to clinic, and this cycle repeats itself everyday for the duration of the job. What sticks out the most is a lot of boredom, watching crappy movies in a sweaty box called my house, the same boring food over and over and the people I meet. There is the occasional moment or two of sheer terror when there is a sick patient or bad trauma and we are trying to stabalize and coordinate an evacuation.
This is is…lather, rinse and repeat until the job is over.
Of note, this was written late one night while I was waiting for lab results on a patient on Mornington Island off the Coast of Queensland, Australia.