Dr Katie Sellens / GPST1 / Hampshire
In summer 2014 Katie traveled to a remote island in Indonesia to volunteer as a medic with Operation Wallacea on an environmental research project. Practicing medicine in a wild location with limited resources wasn’t without its challenges, but the rewards of some of the world’s best diving in warm, azure seas provided more than adequate compensation.
‘Hoga base, Hoga base, this is Papasa for the first radio check, over’
Rolling backwards off dive boats named after marine animals (Papasa = manta ray in Bajo Indonesian) into the azure Banda Sea in Indonesia was my daily break from Island clinic life.
For nearly two months I volunteered as a medical officer at Hoga Marine Research Station on a tiny tropical island basking in the centre of the area known as the Coral Triangle – a vast area of lush coral reef and incredible biodiversity that spreads from Indonesia, Malaysia, Papua New Guinea, the Phillipines and Timor Leste. Hoga Base is run by Operation Wallacea, an NGO which runs a series of biological and conservation management research programmes in remote spots around the world. University students contribute to OpWall’s data pool by data collecting for dissertations and PhD theses. School and college students make up a large but transient part of the island’s population by visiting for diving expeditions. Hoga’s season runs for 8 weeks in the summer and at peak times there can be over 200 people on the 3.42km² island.
Burns, bites and ‘the bends’
Whilst at times it could feel a little like a British University in a tropical setting, Hoga couldn’t be further away from civilisation as we know it. It’s very remoteness is the reason OpWall choose to have two medics on site during the season – so that if the proverbial hits the fan, one medic can be evacuated with the casualty while the other medic can stay on land, so that business can continue safely. Hoga is miles and miles from anywhere…anywhere with a hospital, and anywhere with a decompression chamber.
The great thing about working for OpWall was that the organisation and professionalism of the group meant that everything I would need as medic would be provided on site, and I was fully briefed on what to expect. OpWall works at many sites around the world in areas of high biodiversity, but Hoga is their oldest and most established site. I had my own clinic room fully equipped with (quite a lot of random Indonesian) drugs and ointments. Placenta extract cream was a particular delight! Great for burns and bites and everything else dermatology, it seems. Hoga also has very comprehensive emergency and CASEVAC plans which were sent out in advance along with risk assessments for the sites, which gave me a heads up of what I might encounter. Head injuries secondary to falling coconuts, falls down coral holes, Dengue fever, malaria, marine organism envenomation (potentially fatal jellyfish and cone shells), gastroenteritis, sunburn, bites, skin infections…not to mention diving-related problems of barotrauma and ‘the bends’.
Safety first
It turned out that the previous season had been one of the most successful in terms of medical incidents – not a single person needed to be evacuated to a place of definitive medical care. Of course that could have been just luck, but I think the rules that are in place (which did at times seem onerous), such as strict safety limits on diving depths and surface intervals, as well as only allowing two dives a day, greatly reduced our risk of decompression illness. Limiting alcohol consumption and keeping bodies covered up reduced other injuries and heat/sun related calamities. Each week when a new cohort of students, scientists and clients arrived they would have long safety briefings on the dangers of the island and the local sea-beasties, and myself and the other medics would give a briefing on how to avoid becoming unwell on the island. All these precautions helped to keep my customer numbers at the clinic down.
The daily grind
My daily routine involved waking at 6am to the music of the boat engines and the generator, then an early morning dive. Following this, I would run an hour long clinic at 8.30. There was another dive opportunity mid-morning, followed by a lunch of fish and rice and another clinic. An afternoon dive was followed by a Mandi (small bucket to scoop fresh water for a makeshift showed) and an evening clinic before a dinner of fish and rice.
Once a week we would give the medical briefing to the newcomers and go through PADI medical forms to make sure everyone was fit to dive. Common medical problems we encountered were ear barotrauma, lots of otitis external and media, viral URTIs and bruises and scrapes. A lot of our medical work was administering ear drops, iodine and elastoplasts.
Celebration-related hazards
Tuesday night every week was Party Night, and that was generally when things got interesting. Despite the high IQ of the participants, trips, falls and hammock related injuries became suddenly more prevalent. The Lebaran festivities (local celebrations of the end of Ramadan) also fell during our time on the island. This generated a few casualties for us, with some young local boys sustaining serious hand injuries after playing with fireworks. It reinforced my feelings of how lucky we are in the UK to have the NHS, as travelling thousands of miles to pay for specialist treatment was out of the question for the local Indonesians. A rewarding part of the job was also to be able to provide some care for locals on the island (which was very much in demand), albeit for only 8 weeks of the year.
In summary
There were a few things about being on Hoga that I found challenging. Being on call 24/7 and living and socialising with people that became my patients was harder than I thought it would be. I also became unwell myself, managing to prove to my diving colleagues how bad doctors are at being patients. But the experience of being somewhere so beautiful and remote, the opportunity for diving and the wonderful people that I had the honour to look after and become friends with, is one that I will always be thankful for. Hoga showed me that life and medicine is much better when practiced outdoors – and under the sea!
Further information
Who can volunteer / Operation Wallacea will consider applications from post-FY2 level doctors
Expenses / Depending on how much time you are available to spend at a site, OpWall can contribute towards some of your travel costs.
Medical indemnity / I extended my MPS cover to cover me for providing care in Indonesia for both locals and international patients including those from the USA and Canada – this cost a few hundred pounds.
