Yasmin Jauhari / Surgical Trainee
In an approach Adventure Medic thoroughly applauds, Yasmin Jauhari looked around at where other trainees were at and decided to head off diving in Fiji with Greenforce before starting her surgical training. There, she found hospitality, butterflyfish and great adventure. (Photos: Yasmin Jauhari and Alex Bishop.)
Rationalising the stats
According to a recent survey published by the UK Foundation Programme Office, only 72% of doctors who complete foundation year 2 (FY2) enter a specialist training programme. Of those doctors remaining, popular alternatives include a career break or working in medicine outside the UK. Goldacre and colleagues studied the outcome of medical graduates between 1974 and 2002. They noted that a steady proportion of 1 in 10 graduates that were not in the NHS, were working abroad two years after qualification. These statistics and numbers can be rationalised in several ways, here is my way – become an anatomy demonstrator for the first part of the year, get a surgical job… then travel to Fiji to be a medic on a dive site.
The expedition doctor
Greenforce are a non-profit UK gap-year company who run diving and marine conservation expeditions based on Venua Levu, Fiji. The purpose of the expedition was for volunteers to experience marine research and conservation, learn to scuba dive and involve themselves in the local community. Over the three months of our expedition, there were 20 volunteers and staff (aged 17 – 45), and my role was to maintain the health and welfare of the members. Additionally, as the camp was based on a remote island off the bay of Savu Savu, I was also the nearest port of call for any emergencies in the local village.
In anticipation of these responsibilities, I realised that I had limited experience of medicine beyond the hospital doors. Furthermore, diving and tropical medicine had sadly not featured heavily on any of my medical curricula. Therefore, alongside personal research on the area, I found the Adult Trauma and Life Support (ATLS) and Expedition and Wilderness Medicine course extremely helpful in building my confidence and knowledge.
Camp Life
Despite all my preparations, the reality of camp life and my responsibilities as an expedition doctor formed a very steep learning curve. Rain was my main source of water, and I slept under a mosquito net in a grass ‘bure’ with an unobstructed view of the sea. With such luxuries, who needs flushing toilets, showers or electricity for longer than four hours a day?!
As the medic I was involved in all aspects of the expedition and was often needed as a spare pair of hands on camp. It was never all work however, as I also had the incredible unlimited opportunity to dive and learn about marine life and conservation. After three months I had completed my PADI Rescue Diver Course and was truly excited to be able to identify a pyramid butterflyfish.
Village Life
Within the local Fijian community, each expedition member was ‘adopted’ by a family. I had the privilege of being a daughter of one of the chiefs. I didn’t just gain four brothers and sisters, but an extended family that included a good third of the village! Villagers had an amazingly strong sense of community spirit. It was genuinely a humbling experience to be welcomed into their lives, participate in their events, and see first-hand how money and happiness aren’t always synonymous.
Medical duties
As the medic, I had to be readily available at any time of day (and night) for expedition members and villagers to approach me with their concerns. With restricted medical resources to support my role, my decisions were clinically based and I put a strong emphasis on health education for disease prevention. The latter unfortunately often translated to nagging about foot care, wearing shoes and hand washing!
The majority of my encounters were minor problems associated with scuba diving; skin infections and musculoskeletal injuries, although there were also rare moments out of my comfort zone. These included infected rat bites, stingray injuries, fish poisoning, a dislocated shoulder and suturing my own leg after a coral cut. In all honesty, in the beginning, the lack of medical support (and unavailability of Wikipedia) was intimidating. However, with the support of the other expedition staff I soon learnt to trust in my own abilities.
The health system in Fiji is a similar concept to the UK National Health Service, though most prescriptions and services required a small fee. Medical resources were very basic in the peripheries and I found that most services functioned on the goodwill of the Fijian medical professionals. Undiagnosed diabetic complications, poor dental hygiene and tropical infections were predominant. At one point our activities were restricted due to police enforcement of public health restrictions to control a typhoid outbreak.
The most demanding part of my role was my involvement with the villagers and their perception of medical problems. During my time, I learnt to understand and respect the influence of tradition and religion on their views. However, this was not always an easy ride. I was sought after as I was perceived to have ‘better western medicine’ than the community clinics, and it meant they did not need to spend money on the boat ride. My expedition members were my priority for our limited resources and I often left the village feeling uncomfortable that I may have denied someone a simple solution to a curable ailment. Conversely, I was once approached by a 20 year old man who told me of some visual problems and ‘tears of blood’ after free diving to 30 metres the week before. Other men had told similar stories of losing consciousness after free-diving and this was never met with any concerns!
The most difficult situation I encountered was when I found myself comforting a lady who had been physically and emotionally abused by her husband. The stoic and male dominant culture was very evident amongst the villagers, and as a female it was challenging to be torn between my personal belief and my non-judgemental medical professional role.
Take the leap
The experiences of my ‘year out’ were invaluable in broadening my perceptions of life and surgery. The skills I gained in leadership and decision-making have also continued to play a strong role in my current training. My advice to any junior doctors who are considering similar opportunities: Take the leap. It will remind you of why you wanted to do medicine all those years ago.
References
South Thames Foundation School Summary of F2 Destinations – August 2009 entry. August 2010. Webpage.
Goldacre MJ, Davidson JM and Lambert TW. Retention in the British National Health Service of medical graduates trained in Britain: cohort studies. BMJ. 2009 Jun 3;338:b1977.
