Medicine On The High Seas – The Life Of An Offshore Doctor

Grania: I’m a local graduate, I did my undergraduate degree in nursing in at UWA and then became a GP through WAGPET after 3 or 4 years in the hospital system. A lot of what I had been doing professionally is emergency and I have done an ACEM Certificate in emergency. Prior to that I was a nurse, I was a nurse for 20 years. Actually I was 41 when I started my medical degree.

Shaun: That’s a really interesting path. Had you done much remote work before either as a nurse or doctor?

Grania: I lived in Karratha and worked as a nurse for 5 years, that was years ago, more than 20 years ago, so it was quite remote and more remote than now. As a doctor, not particularly, until I took an MRB scholarship which is Medical Rural Bonded Scholarship in medical school and that required that once I got my fellowship I had to go to a rural and remote location for a period of time, up to 5 and a half years so I’m bound to be rural or remote.

Shaun: You’re now working with Beat Health as a locum doing offshore work. What attracted you to offshore work, initially, what did you find interesting about it?

Grania: As I had this requirement to go rural or remote, I was thinking of what would be interesting for me and I guess I wanted something a bit more than suburban or big town general practice. I wanted something a bit more different and challenging, I guess, and interesting. So I was thinking of all sorts of things, where would I go, what would I do, I considered credentialing for Defence force work, for instance. Really, this opportunity just came up and I’d never been on a ship before. It was opportunity, really, to be honest.

Shaun: How many rotations have you done so far? How many weeks?

Grania: On the ship offshore, I’ve done about 15 weeks in total or 16 weeks in total on the ship.

Shaun: That’s a long time offshore.

Grania: Yeah, it was in 2-3 week rotations and the last one was 5 and a half weeks.

Shaun: Going back to your very first day, what was it like stepping onboard a vessel?

Grania: It was pretty surreal, as I said I hadn’t really been on a ship. I’ve been on a ferry, going from Ireland to England, and to Tasmania. I was always worried actually that I might be sea sick and it was quite surreal but it was very exciting, it was almost an unexpected new world – a dream come true,really, something I never thought I will do. It was really exciting.

Shaun: What are living conditions like for a doctor onboard?

Grania: Very good. As a doctor,  I’m on call 24 hours a day on the ship and so you’ll be given a cabin that I don’t have to share with anyone. The living arrangement is very good, so you get your own cabin, and it’s a big cabin, not the biggest, not bigger than the captain, etc. With your own shower room, of course. And I got a porthole and some of the cabins obviously don’t get a porthole.

Shaun: In your downtime, what was there to do onboard? Do you have a TV, is there a gym? Are there activities to do?

Grania: There are about 4 different type of gyms, one for bicycling, one for rowing, one for weights etc so yes, there are facilities for keeping fit for sure. And, just about everyone on the ship does a couple of hours on the gym daily and keeps them fit and gives them something to do when they are not busy. In the cabin, there is a TV, and there are a lot of TV series on the hard drive that you can access anytime that you like. There is a galley and there’s a dining room which is open 24 a day almost. Other activities well, some of the crew, they can be quite social especially in the evening, there is no alcohol at all, but there are board games or card games. I like to play Scrabble with the people who play in the evening. You really have to occupy yourself – there has to be something within you that you want to do.

Some people probably would use the time to go to the gym, some people might be studying, some of the people aboard are learning to speak Spanish, or art if you like to draw or write; I guess you need to have something for the downtime.

Shaun: What does the daily routine look like for the doctor, what time do you start work and what type of cases are you seeing?

Grania: On a shift things run pretty well to schedule. Breakfast is from 7-8 in the dining room of the mess. Meeting at 8:30, between the people who run the ship and the medical people. We run some training, we run a lot of preparedness courses.  We tend to do other things like upskilling some of the crew members that might be able to help in such a situation, basic life support or more advanced life support –  helping us out on how to set up, how to set up lines and things like that. We spend some time doing inventory and servicing equipment, and upgrading, doing what we need to do with the stocks and stores and equipment. Then, I am in the hospital in the ship, with open doors to anyone who can drop in, we call it ‘sick parade’, people can just come in anytime, you know, drop in if they want to be seen by a GP. And then, there’s lunch, then after lunch we will check in to the hospital to see what we need to do including, maintenance and things like that and probably finish around 3.00pm. After that, well it’s a ship but they know where my cabin is, but also, I’ve also got a portable DECT phone.

Shaun: During the rotations, did you have any serious medical cases that required evacuation from the vessel?

Grania: No. None of this stint-  I’ve done three rotations. I haven’t had anyone needing that but obviously that is the skill level that you have to acquire yourself and so in the ship that I am in, there is a hospital settled with resus equipment it has a ventilator, cardiac monitors, and all sorts of medications. There is a nurse onboard as well,  and the potential for disaster happening any time such as an explosion in the engine room, drowning and anything like that can actually happen so we have to be prepared for that. That’s why we run drills to prepare ourselves and the crew, but no, actually I haven’t had any evacuation but that probably is something that you have to be prepared to accept that there will be a possibility during the time you’re away.

I haven’t had any medical evacuations but I have had cases that can be treated medically which should be followed up when the crew go home. That’s a common enough thing. There will be a few people on the rotation that I need to write to their GP for follow up when they are back onshore, and to specialists as well.

Shaun: What did you find challenging when you first came onboard, or what was significantly different from your usual GP work?

Grania: Well obviously the challenge I suppose is that I was the only doctor onboard and that you can be days away from help, any other help aside from the nurse that you have – so the challenge is to overcome that fear and instead just try to remember and just develop strategies and the preparedness for any event.

The challenge is that I could be 3 full days away from anyone else, so there is the possibility that I would have to look after a patient is myself and the nurse for three full days which is pretty scary – if it’s life threatening, or very serious incident. So I suppose the challenge is learning the resources available to you while you are there and know your limitations and understanding how to evacuate a person, and how to treat a person in the short term. That is why we do a lot of drills to make sure they are a little bit cognaisant of the whole process. I suppose the other challenge is that there are shore doctors that we can reach through the satellite phone, but from moment to moment not having anyone to bounce ideas off is hard. There is also social isolation and that’s not just for you for you, it’s for the patient. Most of the crew are used to it but sometimes, especially if there problems going on back at home for them, it can be really emotionally difficult. And for me, I suppose because I’ve got two children myself, they are adults, but they’re still my ‘babies’, the issue of lack of access to them in an emergency, is something that you have to accept.

Shaun: If something did happen at home it will be very difficult, if not impossible to get there, right?

Grania: In some cases, it would take 3-4 days before I got to actually get home. But if it did happen, of course, the crew are just all in the same position so you know, they would bend over backwards to get you home as soon as possible.

Shaun: That’s good to hear. So it sounds like you’ve really grasped on to this or something you really like so what are you liking about it, what has caused you to keep going back, because I know you’re going back again later on in the year.

Grania: Yeah, I think it’s a whole other world, and it’s engaged me. It is something totally different – I never thought I would be on a ship let alone on a working ship. It is a whole other world and I don’t actually, to be fair, I don’t really like being at sea, I don’t really love being at sea, but it is almost a miracle because it’s so rare, I think, and you get very fond of the ship. There is a camaraderie and closeness between everyone on the ship, doesn’t matter what work they do, what status they have or whatever you are on the ship together. It has opened my eyes to a whole lot of a different world. I’m very happy with that, I’m quite fond of my ship. Of course the money is good and that’s another thing.

Shaun: Is there any advice that you could leave us with in terms of what you suggest for people considering this type of work-  any courses they should do, or any experience they should have, before they even think about undertaking work as an offshore doctor.

Grania: Well I think you need to have some basic emergency skills, that’s an obvious thing. To do the EMST course would be really beneficial.

I think you need to have experience in rural or remote locations on shore, before considering working offshore. You have to know your limitations and know your competencies.

If you have that background, I just think it’s a wonderful experience and it’s certainly worth trying. When I got the first rotation, I thought, oh that’s a miracle, I don’t know how that happened, then they give me another one, and I said, okay, I’ll take that.  By the time the third rotation came, I thought “I should do this regularly, you know, this is pretty good”.

As far as emotional issues-  clearly if there is anything that is distressing or difficult going on at home, I think it’s probably not a good idea to go offshore.  Presumably, if you have health problems yourself, that could go wrong, or if any of your family have health problems that could go wrong [you should reconsider]. There is the mental preparedness that you’re going to be there by yourself, with a nurse- you need to have the competencies and the confidence at least you’re able keep someone alive until you get them to shore. I think that you have to be realistic especially for the mass casualty scenario, you are so restricted in what you can do.