24 hours in Nanortalik

Nanortalik is the Southern-most village in Greenland with a population of 1450. So far south of the Polar Circle, so the sun is never completely away and 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.

As a medical doctor, you are alone here and thus always on call.

07:50 I walk to the hospital. It is extremely slippery after a couple of days with a mix of rain and frost. Unsurprisingly, many patients fall and end up with ankle contusions and even fractures.

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

08:30 Ward round. Two patients are currently admitted, one with pneumonia, the other 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 of the eardrum and the patient is electronically scheduled to be seen on the upcoming visit from the ENT specialist.

10:00 It is Tuesday morning, the day of vaccinations and scheduled examination of children. Wednesday morning is set aside for minor surgeries. Normally a nurse would perform the vaccinations, but as the nursing position is vacant I do it. Many tasks are delegated to assistant nurses such as  X-ray, diagnosis and contact detection of sexually transmitted diseases, outreach psychiatric care, the laboratory as well as patient screening in 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 socalled 1st connection (first commercial flight out of here).

11:30 Call from Aapilatoq, one of the nearby 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.

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.

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

Nanortalik
The churchyard in Nanortalik

18:00 Call from hospital. The police car was already waiting 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: Some 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 photogallery of Nanortalik is available on flickr.

A typical day at work as an offshore rig medic

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

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 (and sending emails) between 6-7 am and issues may come up at the morning meeting that require my input: Questions about the status of medicical 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 have 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 members 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 count per month. The autoclave failed the test 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 a choice of healthy food, vegetables and salad next to the deep-fried foods. I make myself 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 has 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. Lasagna, 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 medical assistants 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 24/7 with no difference between night and day.

General information: Some basic things to know about the job as an offshore medic.
Photogallery of my time as an offshore rig medic on the Maersk Deliverer on flickr.

Offshore rig medic: Some basic information

I worked as a medical doctor for Maersk Drilling on the rig Maersk Deliverer in Angola from 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 contractual system. 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. A short video of the rig is available on YouTube.

Maersk Deliverer
Maersk Deliverer

The work 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 complaints such as common cold or musculoskeletal symptoms. Dental issues are also common. Furthermore malaria was not uncommon among the Angolan employees.
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

Occupational health is a major priority in the industry and offshore safety is a major concern 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 non-work related illnesses 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

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:

  1. Daily and weekly tests of the drinking water. Fresh water is made onboard with a fresh-water generator.
  2. Weekly safety inspections: A tour of the entire rig checking eyewash stations  ear plugs, first aid equipment and AEDs.
  3. Weekly hygiene inspection of the galley and cabins with the Camp Boss.
  4. 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, including, but not limited to carrying a stretcher.
  5. Being a medical doctor I had the additional task of completing DMA Medical Certificates for the crew.

I have described a typical day at work in a separate post.

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
A photogallery from my time as an offshore rig medic is available on flickr.

Greece: Working with boat migrants and refugees

In November 2015, I went to Lesvos, Greece, loosely associated with the NGO Positive Action, who arranged for accomodation and provided some local contacts. I soon found that, as a medical doctor, Moria Camp was the most relevant place to be, and I subsequently worked in an interimistic tent/emergency room set-up with other volunteers, who spontaneously arrived and offered their services,

09:00 It is olive harvesting season and I  liberate my car from under a huge net meant to catch the olives from the trees in the parking. I share a house just outside Molyvos on the north coast of Lesvos with two other volunteers, respiratory therapists from the United States, who mainly work on the north coast, where the boats come in from Turkey

09:10 On my way to Moria Camp, I pass an interimistic  camp. 50 people, who had arrived by boats during the night waited for busses to the transit camps. The ocean is at its smallest here, but nevertheless treacherous to cross. I can see Turkey in the distance: This is the border of Europe. An astonishing thought.

Refugee boat arriving on Lesvos
Refugee boat arriving on Lesvos

10:00 I arrive at Moria.  Colleagues are already at work examining patients, who queue outside the tent. Staffed with specialized emergency physicians as well as nurses spontaneously volunteering from both US, Canada and England, the medical staff was highly competent. Not to forget the non-medical volounteers who constructed the tent, helped organize the supplies, organized clothing for the people etc. However, many patients do not speak English. That seems to be the main issue right now. I then begin the day by walking around the hill looking for translators: Farsi-English was the priority as the Arab-speaking Syrians were quickly registered in the system, and thus left for mainland Greece sooner than the other nationalities.

Treating patients at Moria Camp
Treating patients at Moria Camp

10:30 I had succeeded finding three volunteer translators, all waiting to have their arrival officially registered: A 21-yr old woman from Afghanistan, a 20-year old man, also from Afghanistan and another 20-yr man from Iran. Female translators were in particularly high demand, for cultural reasons.

11:00 I start to see patients. Most have minor illnesses, mainly  common cold and many ask for antibiotics. Tooth problems are another major issue, for which we as medical doctors can do little but dispense painkillers. Our pharmacy was remarkably well supplied as several volunteers had brought medicines with them from their home countries. Furthermore, complete strangers would come by and donate medicines while others would buy medicines according to a list made by some of my colleagues at the local pharmacy.

Dentist at work at Moria Camp
Dentist at work at Moria Camp

12:00 A 20-year old Afghan male arrived with severely burned fingers, which he explained happened when lighting a campfire in Turkey. Luckily our extraordinarily well-stocked pharmacy had the items needed to treat him.

12:30 Out of the blue, two dentists from Bulgaria arrived with their equipment. They installed themselves on a plastic table right outside our tent and started working.  This first day they performed five tooth extractions.

Moria Transit Camp, Lesvos
Moria Transit Camp, Lesvos

14:00 A young man, paralyzed from the lower neck and down arrived in a wheelchair pushed by his brother. The young man had been paralyzed for 11 years after he broke his neck falling down from a rock. The told me they had made the long journey from Afghanistan hoping his brother could be cured in Germany.

16:00 I left Moria and drove up to the North Coast. It was a quiet afternoon and I chatted with volunteers from some of the other groups.

19:00 A big boat with more than 200 migrants arrived at the harbor of a small fishing village as I drove by on my way home. I went out to have a look, but all seemed fine.

Treating boat migrants during night on Lesvos
Treating boat migrants during night on Lesvos