Antarctic medicine – the challenges of being a doctor in an isolated and confined environment
Rothera research station is a British Antarctic Survey (BAS) base on the Antarctic Peninsula that is operational year round. During the 8-month winter the 20 people living there are physically isolated from any other humans. I was the resident doctor during the 2005 season. I did not leave Antarctica for 17 months of my employment with the British Antarctic Survey Medical Unit (BASMU), and during the winter period I was the sole medical practitioner on station.
My medical work load was light in comparison to any other job I have done. All personnel deployed to a UK Antarctic base were fit and well, and the wintering team in particular had been screened for any significant physical and mental illness. On average during the winter period I would perform 40 consultations per month. Because I was only serving a population of 20, the relatively large number of consultations reflected the harsh environment in which we lived and worked. The perceived major health risks of BAS Antarctic employment were the operational tasks of year round SCUBA diving and summer light aircraft movements and environmental cold injuries. Predeparture training and on-site equipment (eg, a recompression chamber) equipped me to deal with these issues. However, most of my work load was composed of minor injuries sustained during work or leisure pursuits in the difficult environment, psychological issues, dental work, gynecology, and genitourinary medicine.
During the summer months there were 2 doctors, one who had just arrived and one who had finished a winter season and would return home at the end of summer. One doctor was always on base, as diving and aircraft operations continue throughout the 24-hour daylight. In winter the solo doctor took part, as all base members did, in 2 winter training trips, each a week long, which made them inaccessible to base other than through a nightly prearranged radio call. During this time remote assistance and advice was provided to the station by BASMU based in Plymouth, UK. This group of specialist consultants also provided advice and support for the doctor throughout the term of duty.
There are many aspects of the season I spent in Rothera that I will continue to reflect on for some time. The enclosed environment created an amplified feedback on many of my actions and forced a range of emotions. Although few of the medico-social issues are unique to Rothera, I had never before been in a position where every action or word on my part, either in a clinical situation or socially, had the potential to significantly change my relationship with the other members of my group (particularly in winter) and alter my ability to serve that group as a doctor. I would like to discuss specifically the topics of medical confidentiality, treatment styles, 24-hour on-call duties, and personal relationships.