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The plane touched down and some detail now appeared out of the desert
haze. A number of four-wheel-drive vehicles were gathered around the
perimeter of the airstrip. There was only one small ramshackle
building standing intact. Armed men slouched in torpid menace. The
identifying flag of the International Committee of the Red Cross was
reassuring. Welcome to Mogadishu.
The drive to the hospital of Keysaney, in the north of the divided city,
wove through an urban landscape of chaos and destruction. Ten years of
civil war had left the country in an anarchic state. Little effective
social structure or function remained. As a Red Cross volunteer, I was
a member of a flying surgical team responsible for emergency surgical
care for victims of the conflict. It all seemed a long way from the
island of Espiritu Santo where I'd had my first volunteer experience
some years before . . .
. . . That had been a very different arrival. The plane had swooped low
over an azure lagoon, the island an explosion of vivid green. Coconut
trees fringed the single runway. Smiling Melanesian faces welcomed
me as I stepped onto the tarmac. I was to work on this dot in the middle of
the Pacific for two years, as a medical officer for a 110-bed hospital.
The job description read, "A doctor with obstetric and paediatric
skills is required to give anaesthesia at the Northern District
Hospital. Tropical medicine would also be useful". Having recently
completed my specialty training, I was at least happy about the
anaesthesia, but knew the other areas would need quite a lot of
resuscitation!
It proved to be one of the most rewarding periods in my career, the first
of many volunteer experiences. I was extremely fortunate to work with
a capable and easy-going expatriate surgeon and a shy, but very
competent, Ni-Vanuatu anaesthetist counterpart. The theatre
sessions were always great fun. I spent my time at the Northern
District Hospital doing outpatient clinics, looking after the
medical and tuberculosis wards, as well as giving anaesthesia for a
fascinating variety of general surgery and emergency obstetrics.
"Walking" clinics into "Middle Bush" with a Catholic nun added an
extra dimension to my understanding of ambulatory medicine.
Consultations took place under the eaves at the end of a thatched "long
house" with nearly the whole village looking on. I was reasonably
fluent in Bislama (the lingua franca of the 70-island archipelago),
and this helped with the medical work and social activities. There was
always a feast at the end of a day's clinic. The mountains of "lap-lap"
(grated taro, banana or cassava with coconut cream wrapped in banana
leaves and cooked slowly in a pit in the ground) were almost as daunting
as the numbers of patients. The "Middle Bush" people were
surprisingly healthy compared with the town dwellers, whose Western
life-style was encouraging the development of the Western diseases
of diabetes and hypertension.
A rudderless night in a storm off the south coast in the rural health
boat "cured" me of any nautical medical inclinations. It was a pity, as
this was the only way to see the west coast of Santo. Some months later, I
did, however, explore some of this area on foot during a five-day
leprosy survey. The two years in Espiritu Santo flashed by. I was very
sad when the time came to leave. There were so many good friends and I'd
had so many wonderful experiences.
But why had I gone to Espiritu Santo in the first place? What had taken me
from the security of a "staff" position in a paediatric teaching
hospital in Canada to a tropical island on the other side of the world? I
still wonder at the serendipity of that initial volunteer
opportunity. It was an experience which was to change my life and
redirect my professional energies irrevocably.
The years have certainly altered my expectations of the challenges
and rewards of working in developing countries. I have had the
opportunity to visit, live and work in quite a few different countries
— over 20 at last count. Mostly, I taught anaesthesia, to medical
assistants, nurses, doctors and medical students — in fact, to
anyone who was interested. I must confess that I have learned far more
than I taught . . .
For nearly a decade I was involved in the annual Pacific Anaesthetic
Refresher Courses, which took place at the Colonial War Memorial
Hospital in Suva, Fiji. The driving force for these courses was a small
group of ex-Pacific volunteers who, like me, had been bitten by the
"Pacific virus" and wanted to continue helping their Pacific
colleagues. Over the years, anaesthetists from almost every Pacific
Island nation in Melanesia, Micronesia and Polynesia have attended
these courses. The Australian Society of Anaesthetists sponsored
and encouraged this activity, with a number of ASA presidents even
going to Suva to teach. The courses were so successful that they
attracted Australian Government financial support through AusAID
(the Australian Agency for International Development) grants. The
World Federation of Societies of Anaesthesiologists also helped.
The Pacific Society of Anaesthetists has now taken over the running of
this annual Continuing Medical Education program, with Australian
anaesthetists still volunteering as lecturers and locums.
Opportunities for further experience increased dramatically
during my eight years on the Education Committee of the World
Federation of Societies of Anaesthesiologists. I now became
involved in international development work with an energetic and
financially well-resourced committee. At times these activities
seemed to engulf the other, more sensible parts of my life. What kept me
doing them?
Opportunities and challenging positions for medical volunteers
abound. Websites and professional journals carry tempting
advertisements. In general, activities fall broadly into either
"service" or "development" roles. The Australian Rotary Interplast
(Plastic and Reconstructive) Surgery tours to the Pacific started as
a charitable venture. This has become a two-million-dollar,
Australian Government-supported aid program. Known as the Pacific
Island Project, it now encompasses many specialties, including
otolaryngology, orthopaedics, ophthalmology and cardiology, and
depends entirely on the time of the volunteer doctors involved.
A number of professional colleges and societies have been very
proactive in the development area. The Australian Society of
Anaesthetists established the first postgraduate training program
in anaesthesia for the south-west Pacific in Suva. This led the way for
postgraduate training programs in Fiji in four other medical
specialties. The Royal Australian College of Surgeons now oversees
this AusAID-funded project. The Royal Australasian College of
Physicians has been involved for many years in the Master of Medicine
programs in Papua New Guinea. Professional organisations have
become important partners in the realisation of the Australian
Government's regional development objectives.
As the small aircraft left Mogadishu for the last time, I reflected on
my three months in Somalia. The Flying Surgical Team had worked all
over the country, from Berbera in the north, to Merca in the south, as
well as behind the rebel lines of an unknown civil war in neighbouring
Djibouti. We had operated in derelict hospitals, an old prison and in a
desert dispensary. The team had shared some intense experiences. I
was privileged to have been part of an international effort to bring
peace to Somalia. But there remained so much more to do.
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