Doctor in Greenland: 24 hours in Nanortalik

Nanortalik is the Southern-most village in Greenland with a population of 1450. We are far south of the Polar Circle, so the sun is never completely away. Northern lights may even be seen. Nanortalik is located on a small rocky island and the weather on this part of the coast is very unstable, helicopters often being delayed for days. I was stranded for two days in Qaqortoq on my way there.

You are the only doctor here and always on call.

07:50 I walk to the hospital. It is extremely slippery after a couple of days with rain and now frost. Many patients fall and end up with ankle fractures.

08:00 Morning meeting with handover from the night shift. A man was admitted the day before, a broken ankle is suspected and we prepare for an X-ray.

08:30 Ward round. Two patients are currently admitted, one being treated for pneumonia, the other is under investigation for tuberculosis.

Nanortalik
                          The doctors house in Nanortalik

09:00 Patient clinics begin: Three patients per hour are scheduled, which is appropriate as many need assistance from a translator. The first three patients present with 1) Control of diabetes, 2) itching skin, and 3) gradual hearing loss. Otoscopy reveals a perforation and the patient is electronically referred to the forthcoming visit from the ENT specialist.

10:00 It is Tuesday morning, thus the day of vaccinations/children´s obligatory examinations. Wednesday morning is set aside for minor surgeries. Normally a nurse would do the vaccinations but the position is vacant so I do it. Many tasks are delegated to assistant nurses such as  X-ray, sexually transmitted diseases, outreach psychiatric care, the laboratory as well as  the emergency room.

10:30 Lunch break. A bit early, but that´s how it is done here.

11:00 The man´s ankle was broken and there is indication for surgery. I discuss with the orthopedic surgeon in Nuuk and they will receive the patient on a 1st connection (first commercial flight out of here).

11:30 Call from Aapilatoq, one of the settlements. A woman has been coughing for months. Tuberculosis is suspected. We book her on the next helicopter for initial evaluation and examinations (Quantiferon, sputum tests, thoracic X-ray).

12:00 Two abortions are scheduled for tomorrow and I see both women today.

Nanortalik
                          Traditional house in Nanortalik

13:00 A patient has post-traumatic epilepsia and is not well-regulated on his current treatment. I email the specialist in internal medicine in Nuuk for advice.

14:00 Three young men present for health examinations prior to attending the Maritime School in Nuuk.

16:00 Groceries shopping: The two supermarkets are well-stocked, though expensive – one tomato costs almost one dollar. However there are no ducks left and there is only one week to Christmas. I am reassured that an emergency sending of ducks will arrive in a couple of days.

Nanortalik
                             The churchyard in Nanortalik

17:00 Home. I live in a beautiful wooden yellow house to your disposition located right in the middle of the village.

18:00 Call from hospital. The police car already waited outside my house, they said. I look out the window and it is there, barely visible in the snowstorm. They request a medical examination of a citizen prior to placing him in detention.

20:00 The police car is parked outside my house once again. A man has been found dead in his home. We fill out the necessary paperwork and I check his medical records.

Other posts on Greenland:
Working as a doctor in Greenland: The basic facts.
Doctor 24/7 on call in Qaanaaq.
Life as a doctor on Thule Air Base.
The doctor visits  Siorapaluk, northernmost settlement in Greenland.
A visit to Alert, northernmost settlement in the world.

A photogallery of Nanortalik is available on flickr.

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Offshore rig medic: FAQ

The questions I am typically asked when I tell people that I have been working almost two years as an offshore rig medic on the Maersk Deliverer outside Cabinda (Angola).

Q: How do you get to the rig?
A: Commercial plane overnight to Luanda (8h). Heli Malongo charterd plane Luanda-Cabinda (1h). Helicopter from either Cabinda or Malongo (1h drive north of Cabinca) and out to the rig (45 min).

Q: What does the rig look like?
A:

Maersk Deliverer
Maersk Deliverer

Q: Does the rig stand on the seabed?
A: No. The Maersk Deliverer is a deepwater semi-submersible rig constructed to drill on water depths until 3000 meters (the world record is 3400 meters). Maersk Deliverer float and an advanced electronic system (dynamic positioning) makes it possible to keep the rig still while the drilling is going on.

Q: How many people are on the rig?
A: 180 when full.

Q: How big is the rig?
A: 117*117 meter.

Q: Are there any women onboard?
A:  Yes, but very few, maximum 5 at any time. Occasionally I would be the only female onboard. A couple are hired as stewardesses. Additionally one DPO, and a couple of geologists and engineers (MWD).

Q: What nationalities work on the rig? Are the majority Danish?
A: No, I would say at any time no more than 10 Danes were onboard. Half are from Angola, Scottish, British, Americans, Poles.

Drilling. Maersk Deliverer
Drilling. Maersk Deliverer

Q: What is the food like?
A: Meals are served four times/24h in the Galley. They galley is always open. Always snack

Q: What are sleeping arrangements like?
A: Most share a cabin with a colleague working the opposite shift – ie. 6 am-6 pm would share with 6 pm-6 am. Initially, The doctor was assigned a two-bed cabin with generally no other occupant, which was later changed to a single cabin. All cabins had TV and wifi signal.

Q: Telephone and internet?
A: No mobile telephone reception. Wifi was available indoors with a data limit to prevent movie download etc. Computer and telephone via satellite in the sick bay.

Q: What else is there to do in the spare time?
A: Hang out in the TV room. Exercise in the gym: Well-equipped with treadmills, cycles, weights.

Drill pipes, Maersk Deliverer
                                 Drill pipes, Maersk Deliverer

Q: Can you perform surgery on the rig?
A: Yes, in theory. The sick bay is well-equipped. However, unless a life-threatening emergency, evacuation onshore would be performed.

Q: Did you experience any emergencies? Severe illnesses? People who died?
A: No. No. No.

Q: What exactly did you do during the day? What did a typical day look like?
A: Described in detail here.

General information: The basic things one should know about the job of an offshore medic.
Photogallery of my time as an offshore rig medic on the Maersk Deliverer is available on flickr.

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Offshore rig medic: The basic things to know

I worked for Maersk Drilling on the rig Maersk Deliverer in Angola 2013-5.

On an offshore rig the position is called a medic. According to local regulations as well as company preferences the medic can be a nurse, a paramedic or a doctor. Most are, in fact, not doctors.

The drilling contractor: Owns and operates a drilling rig. In my case the drilling contractor was Maersk DrillingThe drilling contractor then hires the staff necessary to run the rig, some directly, others via an agency. I was hired by the agency Vikarlaeger, who again was hired by Maersk Drilling to supply the rig with doctors.
The operator: Owns the right to operate (drill) in a certain area. Hires the drilling contractor to drill a certain well by paying a fixed day-rate as well as additional fees according to a complex contract. The relationship between Operator and Drilling contractor is complicated and both hire service companies etc. In my case, the operator was Chevron.
The drilling rig: Essentially a machine creating holes in the earth. Rigs come in may different sorts: Some operate on land, some offshore, some stand, some float. I worked on Maersk Deliverer, a semi-submersible drilling rig, a floating rig designed to operate on deep water. Maersk Drilling produced a short video from the Maersk Deliverer in 2012.

Maersk Deliverer
                                               Maersk Deliverer

The working schedule: Varies from rig to rig. I worked a schedule of 4 weeks on-4 weeks off..

The work: Again, varies according to the company. Generally speaking the tasks may be divided into medical duties and non-medical duties. Depending on local as well as maritime regulations you may or may not be the only medic onboard. Some countries require local medics to be present onboard. I was alone onboard.
I have described a typical working day on the Maersk Deliverer in another post.

Working hours: Normally 6am-6 pm followed by on-call.

General medical duties:

Patient consultations: The majority of patients seen in the sick bay have minor illnesses such as common cold or musculoskeletal complaints. Dental complaints are also common. Furthermore malaria was not uncommon among the Angolan employees in high season.
On the Maersk Deliverer, the sick bay is well equipped, however any patient with serious illness would be evacuate onshore. I never had any emergency evacuations, however occasionally a crew member had to be sent off the rig for treatment, the main reason being dental problems and non-work related musculo-skeletal problems.
Day to day running of the sick bay: Ordering medicines and necessary equipment, maintaining logbooks, checking equipment.
Health promotion and hygiene: Adhering to basic principles of hygiene is extremely important when so many people live together in a confined environment. The role of the medic in this context may be to give lectures, put up posters etc. Promoting a healthy lifestyle is another potential focus area for an offshore medic.

A medical support system, where advice may be provided upon request will always be in place. In my case Radio Medical Denmark. Furthermore, Chevron has a clinic in Cabinda. 

The derrick, Maersk Deliverer
The Derrick, Maersk Deliverer, Christmas Eve 2013

Occupational health is a major priority in the industry and offshore safety is major concern in the industry and an important parameter on which company performances are measured. One safety parameter is the number of work-related injuries.  For these purposes there is sharp administrative division between work-related and not-work related illness and as an offshore rig medic you will be involved in discussing and preventing work-related injuries with colleagues onboard.

Additional tasks vary greatly from company to company and may include various tasks related to safety and training issues.
On larger rigs, such as Maersk Deliverer, a safety officer is responsible for all issues related to safety (inductions, meetings, reporting, inspections, prevention, work-place evaluations, etc). Larger rigs may also employ an RSTC (Rig Safety and Training Coordinator) to assist in all safety and training-related issues. On smaller rigs, several of the above job functions may be performed by the rig medic.

Drilling on the Maersk Deliverer
                              Drilling on the Maersk Deliverer

My additional tasks:
Maersk Deliverer had two safety officers as well as one RSTC employed, thus I did not have many additional tasks. I did have a few however:

  • Daily and weekly tests of the drinking water. Fresh water is made onboard with a fresh-water generator.
  • Weekly safety inspections: A tour of the entire rig checking eyewash stations  ear plugs, first aid equipment and AEDs.
  • Weekly hygiene inspection of the galley and cabins with the Camp Boss.
  • Weekly safety drills: Drills involving the entire rig with scenario such as fire, toxic gas outlet etc. This is an opportunity to train the stretcher team: Four crew members assigned to assist the medic in emergencies, mainly to carry a stretcher.
  • Being a medical doctor I had the additional task of completing DMA Medical Certificates for the crew.

This is what a typical day working offshore would look like.

Specific offshore requirements for a medic: Required certificates vary according to the rig location and the drilling contractor. In my case: OPITO (BOSIET) (offshore safety course) including HUET, OGUK and a DMA Medical Examination.

Offshore vocabulary:  Be prepared to learn a complete new terminology and an astonishingly high number of abbreviations.

Online information sources:
Offshore rig medic jobs
Learntodrill Guide to offshore medic jobs
Rig medics UK
A photogallery from my time as an offshore rig medic is available on flickr.

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Mediterranean boat migrants: Stories from Moria Camp

An Afghan man of about 50 years was sitting with his son in front of their tent. No English was spoken, but they always smiled when I passed. They had made a small fire and they tried to heat some pita bread. They would always offer me a bread whenever I passed the tent.

Stories Moria Camp
                Stories from Moria Camp: Heating pita bread

An Afghan Woman from Kabul, also about 50, had arrived with her daughter and two sons. All children spoke English, she spoke a little bit. I was immediately offered peanuts when I sat down in front of her tent while we waited for her daughter, who spoke English. To find female Farsi-English interpreters was not easy. The daughter immediately volunteered to spend time in the hospital tent translating and she spent two days with us, until she got her registration papers and left.

Stories Moria Camp
             Stories from Moria Camp: A woman from Kabul

Ramazan, 20 years, comes from Herat, Afghanistan. He left alone, in search of settling in a country with better opportunities for education and jobs. He had been traveling for two months, spending additional time in Turkey trying to raise money for the boat journey to Greece. He told me he payed 800 Euro for a seat in an overcrowded rubber boat. He wants to go to Switzerland, where his uncle is.

Treating patients at Moria Camp
Treating patients at Moria Camp – Ramazan, in the background is translating

KK is a 40 years old and from Kabul. He said worked for the NATO forces as a translator in Helmand province. He left Kabul as he was afraid that the Talebans may take the city, in which case his life would be in danger.

Life jackets on the beach of Lesvos
                        Life jackets on the beach of Lesvos

Zainab is 30 years old and from Iraq, less than 20 km from the Syrian border. She does not speak English. She arrived with her three young children. Her husband had been killed in a bombing. Her son was injured. She showed me the scars. She does not care which country she will go to.

I met the above-mentioned people while I worked as a doctor in the Moria Camp on Lesvos in November 2015.

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Mediterranean boat migrants doctor: 13 lessons learned

During the Mediterranean migrant crisis I worked on the Greek Island Lesvos with the organizations PAIH and Health Point Project in November 2015. I worked both on the north coast receiving the boats and in the inland Moria transit camp.

  1. Rubber boats overfilled with migrants/refugees arrived on the northern coast of Lesvos only 7 km across the narrow strait to Turkey. Migrants are neither allowed to take the 10-Euro public ferry, nor to cross safely to Greece in northern Turkey. Thus the bizarre situation had arisen where people risked their lives crossing the sea from Turkey to Greece in shaky rubber dinghies, often without a captain.

    Rubber boat with migrants arriving on Lesvos
                   Rubber boat with migrants arriving on Lesvos
  2. In fine weather this short crossing was generally uneventful. However, in bad weather as well as at nighttime problems may arise. Such as at the remote  Lighthouse beach area, covered with life-vests, which lightened up at night subsequently attracting boats to what is a dangerous coastline. Upon arrival in Lesvos rubber boats were immediately punctured and left on the beach and locals as well as volunteers scavenge whatever they may use.
  3. UNHCR buses deposited all the incoming refugees at a transit  camp, where they then waited up to 7 days for registration. Once registered they could leave the camp,  and most opted for the ferry to Athens. A boat ticketing office was even located right outside the main camp entrance.  Some migrants were allowed to wait inside the camp, however the majority have to wait outside.

    Moria Transit Camp, Lesvos
                                     Moria Transit Camp, Lesvos
  4. The Moria camp itself is an old military installation just outside the small village of Moria surrounded by privately owned olive groves. On one side of the camp UNCHR had built some shelters where people could stay on a first-come first-serve basis.  On the other side, also known as The Olive Grove or The Afghan Hill, people were left to themselves. More than 400 people mainly from Afghanistan but also from Bangladesh and Pakistan stayed there. No one was managing the hill:  No infrastructure, no toilets, no showers. People were left to buy low-quality tents for 35 Euros from vendors. The whole place looked and smelled like day four of an outdoor rock festival.
  5. On the north coast, there is an excellent  look-out point where people gathered and follow the journey of the rubber boats over the narrow strait. Both Greek and Turkish coast-guards were spotted in the water as well as Frontex helicopters in the air, all seemingly passive.
  6. The entire coast was cacophony of unorganized organizations and volunteers milling up and down to receive the arriving rubber boats. The large organizations such a UNHCR were not visible. Neither was the official Greece. Thus, astonishingly, hundreds of unpaid,  inexperienced individuals as well as interimistic organizations were managing the border or Europe.

    Treating patients at Moria Camp
        Treating patients at Moria Camp
  7. Volunteers consisted of local people stepping up to the task, individuals traveling  on their own, or interimistic aid groups. Some groups consisted of doctors, others of lifeguards, paramedics or general volunteers offering blankets and hot drinks.
  8. Though highly motivated, most volunteers were unexperienced and supervision was not available. Furthermore, there was no central coordination of efforts which led to volunteers congregating at certain areas of the beach while others were completely empty.
  9. Thus, I would not recommend people to show up now unless they are affiliated with an organization. This applies to all of Greece.
  10. It was quite a moving experience seeing a boat coming ashore, with people crying from relief at what they think is the end of the dangerous part of their journey.

    Arranging the pharmacy, Moria Camp
     Arranging the pharmacy, Health Point Project, Moria Camp
  11. At Moria Camp, I worked with Health Point Project, an organization established a couple of weeks prior to my arrival and run by approximately 10 volounteers. Prominently located at the bottom of the Afghan Hill, hundreds of people would queue outside the white plastic tent. Furthermore, the volunteers, all of whom had dropped in from the street, were both very qualified as well as motivated. On the medical side I worked with a Canadian rural general practitioner,  US and British emergency physicians and nurses as well as highly qualified people managing supplies as well as logistics.
  12. We saw approximately 100 patients every day, most with minor complaints, but also a couple of more serious cases, such as old burns. A major concern was dental problems.
  13. During the time I spent in Lesvos, the weather was fine and clear and no genuine emergencies happened at the coast where an average of 3500 migrants/refugees arrived every day.

    Volunteer helping to strengthen the hospital tent
                Volunteer helping to strengthen the hospital tent

Following the agreement between EU and Turkey in March 2016boat arrivals on Lesvos have vastly declined, however as I understand it, boats still arrive. 

Among the many people and volunteer organizations I collaborated with on Lesvos were:

The owners of the Aphrodite Hotel:  They had, at their own expense, assisted hundreds of boat migrants, who arrived at their nearby beach since early summer. They most kindly offered me a free place to stay.

The Kempsons: Philippa and Eric Kempson, long-term residents,  have been active since the beginning and became informal coordinators of the entire response on the north coast. They kindly introduced me to the work. They are still active through The Hope Project assisting those (few), who now arrive.
Positive Action in Housing: With whom I was affiliated and loosely worked together with The Kempsons.
Health Point Project: With whom I worked in Moria Camp. The organization has now split into Health Point Foundation and Off Track Health.
AdventistHelp: A fully equipped medical bus including highly qualified staff stationed on the coast. Now this project has moved to Athens.
IsraAid: A team of doctors working on the coast.
Disaster Medics: Primarily a mobile team of paramedics. I clearly saw that paramedics has the exact skill set needed to manage a situation like the one on Lesvos.
Lighthouse Relief: Was running a transit camp as well as a health post on the beach and as of  November 2016 they are still active.
Furthermore I had the pleasure to work with Nurses Ravi and Sarah as well as John Caron in Moria.

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