We seem to have had a PE epidemic recently (admittedly the one with the ragingly, apparently diagnostically high D-dimer turned out to have no PE but a genuine anaphylactic allergy to exercise, but I digress). It doesn't do much for your confidence when you're about to embark on a trip to rural Thailand. 4 plane journeys out; and 3 plus an overnight bus on the way back - for the first time I actually tried to stave off the clots.
The rural idyll I was heading for? A refugee camp on the Thailand/Burma border, home to about 40,000 refugees for the last 30+ years. And interloping among them were 40 students, ethnic Karen from inside Burma who've crossed the border for three months of their training as village healthcare workers and medics. Some have finished primary school, some secondary; all of them work unpaid to provide healthcare in their communities.
I'm among them for a week, with another GPST from Brighton (who seriously considered Orkney for her training) and a retired Singaporean doctor. We're a good team: Emma and I do solid, practical, interactive sessions ranging from poisoning to calculating medicines administration, finding patients in the camp hospital for them to clerk and examine, and teaching them to inject and cannulate; Seet covers the pharmacology that we've forgotten. By the end of the week they can safely give insulin and vaccines to bananas, and most can cannulate real live people. Steff and his team from Hope 4 the World have created a curriculum with the Karen Department for Health and Welfare and we stick to it carefully. There are different trainers every week, some new ones each year - so hopefully this attention to detail means each new group of students will come out with the same basic knowledge. It's my fourth time teaching the course, my sixth visit to the border - I've worked in one of the clinics for 4 months altogether - and after a few years' absence with my travels it feels like coming home.
I remember: this is why I do medicine. Each trip back to the border reminds me of the struggles the ethnic groups still face, hidden behind a heat haze, miles of jungle, and media disinterest. It isn't a 'sexy' struggle; the border camps are going nowhere; the village voices are restricted - but I'm a small cog in the team that plants well trained medics among them, training them a little more reach year. Maybe one day I'll even get to visit some of their clinics and train them there - I can dream.
For now, it's back to Orkney again. From 35°C back to 0°; From cool showers to cool me down back to cold water swims to... um... freeze me?
2 'homes', 2 loves.
This, too, is rural medicine.
This, too, I love.
Dr Alison Lievesley,
GPST, Orkney
