Siorapaluk: Medical visit

At 77°47′ N , 47 km north of Qaanaaq, Siorapaluk is the northenmost settlement in Greenland as well as one of the northernmost permanently inhabited settlements in the world. 68 people live here permanently. There is a school, a church and a small library, all combined in one building. The doctor from Qaanaaq visits approximately every 3 months. Health services in these small settlements are provided by a health assistant, employed for a couple of hours a day, and with only a couple of weeks training. Thus all health issues are normally discussed either on phone or telemedicine with Qaanaaq. Siorapaluk is connected with Qaanaaq by twice-weekly helicopter flights.

It is February. Windy and around -30 °C. We travel with two snow-scooters over the frozen fiords and .bring rifles in case we encounter a polar bear. We wear special polar suits including protection glasses. In the middle of the polar winter, the sun is never up, but nevertheless there is a shimmer of light in the horizon. I have no idea about the direction we are taking and have to trust the local driver. In this hostile environment, all it takes is one wrong turn and we will never be seen again.

We leave Qaanaaq at 7am and arrive in Siorapaluk a couple of hours later. With me is an assistant nurse, who also doubles as interpreter, and the plan is to work as we possibly can in one very long day before returning. I see all the children and vaccinations are brought up to date. Dental status is checked. In fact I end up seeing most of the inhabitants and those not on the list, turn up queuing at the door once the rumor had spread of our arrival.

A tragedy struck this remote community in 2013: An old man died, presumably of food poisoning. What no one knew at the time of his death, he did indeed die from botulism, from the traditional meal kiviak. At his funeral, several of the guests ate from this sane meal, and subsequently his 46-year old daughter died and five additional guests were seriously ill. A case report on this event was later published in a forensic science journal.

On the way to Siorapaluk via the frozen Robertson fiord

A 25-year old Japanese man happened to pass by this place 40 years ago in search for extreme wilderness. He never left, and founded a family there. His reputation as a hunter is widespread and as I was looking to buy a polar fox fur, I went to see him at his storage facility in the basement of his house. He immediately apologized, he did have polar foxes, however they were brown and not white.  The white were sold out as confirmation season was approaching.

At 5 pm we wrap things up and travel back over the frozen Robertson Fiord to Qaanaaq.

Other posts on Greenland:
Doctor in Greenland – the basic facts.
Doctor 24/7 on call in Qaanaaq.
A typical day as a doctor in Nanortalik.
Life as a doctor on Thule Air Base.
A visit to Alert, northernmost settlement in the world.

A photogallery of my time as a doctor in Qaanaaq is available on flickr.

Photos from

The doctor in Qaanaaq is always on call

Qaanaaq, the Northernmost village in Greenland is a very special place. Founded in 1953 when the original inuit population was forcefully evacuated from  Thule Air Base, now 650 inhabitants remain. The history of Qaanaaq is fascinating and descendants of the Polar Explorers Robert E. Peary and Matthew Henson still walk the streets of Qaanaaq today.

Qaanaaq

So far north, the sun is permanently down between November and February, and permanently up between June and August. Temperatures in winter may drop to below minus 50°C. We are even too far north for the Northern lights.  It is an arctic desert, with little, if any snow even in winter. The Qaanaaq fiord is frozen 9 of 12 months and only a couple of ships a year pass by with supplies, the last one in August. Trucks drive out on the frozen fiord to collect chunks of icebergs, which supply Qaanaaq with drinking water during the Arctic Winter. You are the only doctor here. The next settlement on the Coast is Upernavik, 1:30 hours south by plane, one plane a week.

I worked as a doctor in Qaanaaq in 2006 and again in 2013.

Qaanaaq
Qaanaaq

07:30 January. The middle of the Arctic Winter. While the sun is never up, it is not pitch dark all day, as reflections of light shimmer over the flat mountains. Some people suffer depressions in this eternal darkness. I think it is wonderful. I have an entire house at my disposition, right next to the hospital. First I empty my toilet bag (there is no cloacal system here) and place it outside the house to be collected. It is minus 35 °C. After a quick coffee I run the 200 meters to the hospital.

08:00 Morning meeting at the hospital. It is Wednesday: Surgery day. Thursday is for vaccinations, Tuesday for examining children. Today we have two abortions scheduled. If I was not able to perform them, they would have been sent down south to Upernavik or Ilullissat.

09:00 Patient consultations begin: Two patients present with a common cold. One needs his diabetes controlled. One child presents with a rash.  I need an interpreter for the majority of the consultations, as especially the younger patients do not readily speak Danish. 3 patients per hour are booked. While this may not seem a lot, the lack of prior knowledge of the patients as well as the need of translation makes it appropriate.

09:30 A hunter has been out on the ice-edge, hunting for walrus. They caught one and ate some raw meat. Now he feels weird. Could it be trichinosis? I have to look it up in the text book.

10:00 I administer a paracervical blockade, and the two abortions are performed without problems.

Qaanaaq, the arrival of the sun

11:00 The consultations continue: One patient presents with tendinitis. He is a hunter, and it comes from holding the reins of the dog-sledge.

12:00 Lunch break: The nurse told me that a helicopter from Thule Air Base had just landed bringing eggs. There have not been any eggs in Qaanaaq for two weeks. I run down to the supermarket Pilersuisoq, where 15 boxes of eggs are left. I took two.  I check the rest of the store out: Well stocked with mainly dry and canned foods. Dairy products and vegetables are frozen.

13:00 Visit to the retirement home. The lack of continuity is a problem, a new doctor coming in every 1-3 months.  I do not know the patients, but try my best together with the leading nurse to go through and update all the prescriptions.

14:00 Call to the settlement Siorapaluk via the telemedicine platform ”Pipaluk”. I talk to the settlement health worker who presents a couple of patients, mainly with coughs and skin issues.

15:00 The visiting psychiatrist is here for her yearly visit. The secretary tries to get hold of all the villagers referred for psychiatric consultation. This includes arranging transport for those living in the smaller settlements around Qaanaaq: If they don´t make it this week, they have to wait a whole year until the next visit.

15:30 Off duty. It is minus 25 degrees Celsius now. I walk the 50 metes down the hill to the public library and shuffle through the books. There is a an interesting new book out on Knud Rasmussen, signed by the author. Knud Rasmussen is well remembered here in Qaanaaq and his sledge from the Thule expeditions can be seen in the Qaanaaq museum, the building itself being his old trade station (Thule Trade Station) moved up to Qaanaaq from Dundas.

Qaanaaq
Qaanaaq

16:00 In many ways the history is very much alive here: The descendants of Robert Peary are well respected as are the descendants of Matthew Henson, who was first on the North Pole together with Peary and perhaps the first one to actually touch the pole. Henson was a black man, and his descendants lived for many years in the small settlement of Moriusaq. Even now, three generations later, they may be distinguished by their slightly darker skin color.

18:00 Dinner with the visiting psychiatrist at the only hotel in town. Soup with seal is served. It tastes mainly of salt water.

21:00 A call from the police. A young man has committed suicide by hanging. He is 19. The police officer picks me up at my house and we drive to examine him and fill the necessary paper work. The suicide rate in Greenland is one of the highest in the world.

01:20 Another call from the police. They want to lace a man overnight in the detention, and a prior medical examination is mandatory.

Other posts on Greenland:
Working as a doctor in Greenland: Some basic facts.
24 hours working as a doctor in Nanortalik.
Life as a doctor on Thule Air Base.
Visit to Siorapaluk, northernmost settlement in Greenland.

A photogallery of my time as a doctor in Qaanaaq is available on flickr.

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.