doctor in greenland – the basic facts

Greenland is a former Danish colony, now attached to Denmark via bilateral agreement. The population is 56.000. The majority of the island is covered by The Inland Ice, a massive icecap with villages and communities are dotted along the  coastline, with no roads connecting any of them. I have worked locums on the coast in Greenland regularly since 2004 in the following places: Qaanaaq (twice), Narsaq, Paamiut, Nanortalik and Thule Air Base.

Organization of the health care system in Greenland

Nuuk is the largest city with 17000 inhabitants and Queen Ingrids Hospital (DIH). The DIH is equivalent to a provincial hospital and provides basic functions in surgery and medicine. More specialized functions such as vascular, thoracic and neurosurgery, as well as interventional cardiology and burns treatment are transferred to Denmark.

Hospitals and health centers are spread along the coast from Qaanaaq in the far North to Nanortalik in the far South and up again on the East Coast to Ittoqortoormiit.  Sisimiut, the second largest city after Nuuk has 6000 inhabitants and 4-5 doctors. Nanortalik with 1300 inhabitants has 1 doctor.  The smallest village with a permanent doctor are Ittoqortoormiit (pop: 450) and Qaanaaq (pop: 635).

Nanortalik
Nanortalik

The doctors on the coast are normally general practitioners, however doctors from other specialties may be employed if they have sufficient experience within general medicine. In some of the larger villages, one of the 3-4 doctors should have surgical skills, mainly for Cesarean sections.

As a doctor on the Coast, you perform all medical duties, the majority being within the field of general medicine. Every village has a hospital-health center, where all consultations and examinations take place and, if needed, patients are admitted.  Minor surgery, such as abortions, may be performed depending on the local competences. Furthermore, smaller remote settlements in the area are visited on a regular basis. After normal day duty one of the doctors will be on call. If there is only one doctor you will then be on call all the time. The staff are generally very competent and used to dealing with most emergencies. Most emergencies during the night are related to alcohol and violence including medical examinations prior to detention placement, at the request of the police.

The generalists on the Coast have a close collaboration with the specialists in Nuuk: For non-urgent cases an online referral system and for emergency cases a doctor is on call within each specialty.
Furthermore, specialists visit the Coastal communities on a regular, often yearly basis:  Ophtalmologists, orthopedic surgeons, psychiatrist etc. As dental health is a major issue, dentists are present in all, but the very smallest communities.

At the coast level, basic examinations such as  X-ray and standard blood analyses may be performed.  Further investigations take place either in Nuuk or at the yearly specialists visit. Emergencies may be transferred to Nuuk with a chartered plane.

The doctor is either employed directly by Greenlandic authorities or via an agency. As I understand it, you need a Danish authorization to work in Greenland. For Scandinaves, the authorization is easily transferable, for other EU citizens some language tests may be requested. However dispensations may be given. It is a huge challenge for the health system to employ doctors in Greenland and many positions are covered as short-term locums. Also in Nuuk there may occasionally be a lack of certain specialists.

Glacier near Paamiut
Glacier near Paamiut

The challenges for a medical doctor are both medical and cultural and often a mix between the two:

Cultural considerations.

The level of spoken Danish is quite low among young people, problematic in terms of education as all diplomas above primary school-level require good knowledge of Danish. A translator is needed in approximately half of all medical consultations. Now, several educations (police officer, nurse, teacher etc) are offered in Nuuk (as opposed to having to travel to Denmark), but still Nuuk is far away from many villages. In Greenland there is a tendency  to live in the present, rather than by the European style of long-term planning. Thus many young people renounce on an education preferring to stay with their families. Generally speaking, one section of the inuit population seems to stay behind in the small communities while the other section often moves from smaller settlements to Nuuk or even Denmark. This pattern leads to a depopulation of  smaller settlements and creates social challenges. As an outsider, it is very difficult to get genuine insight into inuit, though the people are incredibly friendly.

Medical considerations

The disease pattern in Greenland differs quite significantly from the European mainland as outlined below:

While the incidence of hypopharynx cancer is increased, possibly related to viral infections, lung cancer is by far the most common cancer, related to a high incidence of smokers.

Due to the relative isolation down through the centuries, certain genetic diseases are endemic for Greenland such as Cholestasis familiaris Groenlandica and propionemia. Both may now be detected via pre-natal screening. Iridocyclitis and primary angle closure glaucoma also appear more frequently in Greenland.
Greenland has one of the highest suicide rates in the world,  and almost every Greenlandic citizen knows someone who took their own life. Special task forces/initiatives have been launched to battle the problem.

Qaanaaq
The Qaanaaq fiord

Tuberculosis is still a major health concern, with an incidence the level of several African countries, and attributed primarily to rough living conditions in small, remote communities.

Sexually transmitted diseases (STDs) are rampant, and increasing as of 2013 with 1 in 26 adult Greenlandic citizen suffering from Gonorrhea, 300 times as many as in Denmark. Syfilis is also present.

The transition from traditional inuit lifestyle towards a Western lifestyle and diet predictably has led to an increase in  the lifestyle-associated diseases (diabetes, cardiovascular). Lactose intolerance is relatively common.

High alcohol consumption has traditionally been associated with Greenland, however in fact the alcohol consumption in Greenland is on the decrease and is now lower than in Denmark. However, Greenland is one of the most violent countries in the world, and most of this violence is associated with alcohol.

Thule Air Base
Around Thule Air Base

Practical considerations on the coast

Living conditions – as a doctor you are provided with either a house or an apartment with modern facilities, heating, kitchen, shower, hot water, television. In a few communities there are no cloacal systems so toilets are emptied via a bag (Ittoqottormiit, Qaanaaq).

Daily amenities – All settlements has at least one  supermarket with  basic items, loads of canned and dry foods. Transport is by ship and in remote places only two ships pass every year. Brædtet is a place where local fishermen sell their catch.

Geographical considerations: There are no roads connecting the settlements and villages in Greenland meaning all transport is by air. Often weather prevents helicopters flying and people may get stuck on the way for days.

Weather: From the Arctic desert of Qaanaaq, where minus 40 degrees Celsius is common during the Arctic Winter to the  milder climates in the South resembling Southern Norway. The Polar Circle runs approximately through Kangerlussuaq.

Transport: The only all-year international airport is Kangerlussuaq, an old American naval base with flights to/from Copenhagen. Narsarsuaq (for Southern Greenland) is open in Summer. East Greenland may be reached directly from Iceland. From Kangerlussuaq and Narsarasuaq a mix of planes (Dash-7 or Dash-8) or helicopters then depart to the final destination on the coast. Due to the often changing weather conditions delays are common and may last a week if not more.

Outdoor activities: The scenery is unique and spectacular every where. However I have mainly worked in villages where I was the only doctor, thus I could not venture outside the village except in exceptional circumstances.

Other posts on Greenland:
Doctor 24/7 on call in Qaanaaq.
A typical day as a doctor in Nanortalik.
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 the places I have worked in Greenland is available on flickr.

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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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a day in the life of an offshore medic

Between 2013 and 2015 I worked as a rig medic on the Maersk Deliverer (Maersk Drilling) located offshore Cabinda, Angola.

Below a typical day onboard:

05:50 The Sick Bay is supposed to open at 6am. I get up at the last minute and walk the 20 meters upstairs from my cabin..

06:00 The daily rush hour in the Sick Bay is  6-8 am: The crew on night shift just got off, and if they have some medical concerns they will see me before they go to bed. The day crew also prefers to visit the Sick Bay early. Furthermore all the managers both off and onshore start working at 6-7am(and sending emails) and issues may come up at the morning meeting that requires my input: Questions about the status of medicine supplies, maintenance of medical equipment, advice on certain haphazard chemicals etc.

Drilling on the Maersk Deliverer
Drilling on the Maersk Deliverer

06:30 Daily water test: I test a sample of tap water in the Sick Bay. The water onboard is produced by a fresh-water generator.

06:45 Two crew members present with what looks like a common cold, both Angolans. I test both for malaria and both test negative.

07:00 I walk the 50 meter down the corridor to the galley, where I grab breakfast. Bacon and eggs..Breakfast is served between 5 and 7 am, and includes pasta dishes and french fries as this meal serves as “dinner” for the crew working 12 pm-12 am.

08:00 Via email I am advised of several crew member needing an update of their DMA Medical Certificate. I work with the RSTC to arrange appointments with them..

09:00 Time for coffee break in the galley with the Camp Boss and the Chief Cook. No issue is to small to be discussed here.

Abseiling, Maersk Deliverer
Abseiling, Maersk Deliverer

10:00 I go through the medical inventory.  This may takes several hours, and I perform one inventory per month. The autoclave failed the testing and it has been decided to replace it. I briefly go down to check some ordering issues with the MatMan.

11:00 Several crew members pass by and ask for seasickness medicine. It is crew change day for many of the Angolan employees who crew change by boat. They transfer from the rig via a basket to the boat, which then takes them onshore. Unfortunately I have never tried this basket transfer myself as I always transfer by helicopter.

12:00 Lunch is served in the galley from 11-13. There is actually a choice of healthy food, vegetables and salad next to the deep-fried foods. I make a sandwich.

13:00 The bimonthly Safety Meeting is held in the TV room. The Safety Officer presents the safety data and one topic is singled out for discussion. Today it was about wearing the correct PPE.  A monthly safety award is presented to a crew member who has made a significant contribution toward safety. 

Maersk Deliverer in Port Elizabeth
Maersk Deliverer in Port Elizabeth for the 5-yearly yard stay

15:00 Time for the daily afternoon coffee again with the Camp Boss and Chief Cook. The TV screen on the wall displays some of the key safety performance indicators such as days since last LTI (Lost Time Incident).

15:30-18:00 Time for the weekly safety inspection, which takes me all around the rig checking the various first aid equipment.

15:30 I am called on the PA system. It turns out one of the crew members have a headache.

18:00 I go down to the gym and run 8 km on the treadmill.

Casings, Maersk Deliverer
Casings, Maersk Deliverer

19:00 Dinner. Lasagne, my favorite dish. I asked the cook if he could make it.

21:00 Time for the weekly safety drill. This week the scenario was fire on the main deck. The four crew members acting as stretcher team and assistants to me are called to the site, to transport and move a dummy. After the drill, the team leaders meet for a debriefing on the bridge.

22:00 I take a walk on the helideck. Everyone around the deck is busy assisting the drilling operations and the PA system goes off every 20 minutes. The rig is active 24-hours, no difference between night and day.

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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