Floating Medical Practices
Thursday, 01 November 2018
Drs Jim Repper, Ruby Watt & Fiona Garton
Three semi retired Aberdeen GPs share their experience in medical volunteering with the Vine Trust and their role in delivering medical services in Peru and Tanzania.
The president welcomed everyone to the meeting and noted apologies and new members. Reminders were given about the forthcoming Heritage Exhibition (with a call for volunteers) and Founders’ Commemorative dinner.
The winner of the Strachan Bursary was announced. This is presented to the 4th year Medical Student with the highest OSCE mark. This year’s recipient, Maggie Goodlad, was presented with her award from the President.
The President then extended a welcome to the speakers-Dr Jim Repper, Dr Ruby Watt and Dr Fiona Garton, retired GPs, who have all volunteered several times with the Vine Trust.
Jim began by explaining the background of the Vine Trust and showing a short video. Ruby and Fiona gave overviews of typical days volunteering on the ships and the range of diseases which are dealt with.
The Vine Trust was founded in 1985 by a church congregation in Bo’ness. Some members had links with Peru and a shop was opened with the aim of raising funds to support a ferry for communities living in poverty. As the project developed, the focus changed to the provision of medical ships. The Vine Trust now has two medical ships in the Peruvian Amazon Basin and one in Lake Victoria, Tanzania. It has become an international and interdenominational volunteering charity, with the motto “Connect People to Change Lives” and is now headquartered on a barge in Edinburgh. The Patron is HRH the Princess Royal. The charity aims to empower local people and tries to help organisations which already exist in the areas to develop. Government help in these areas is encouraged and the Peruvian Government now operates six medical boats of its own in the Amazon Basin.
As well as the medical projects run via the boats, the Vine Trust now runs housing and children’s projects, e.g. building houses for widows with families, and building children’s homes for vulnerable children and orphans. Young people from the UK on school expeditions have the opportunity to participate in these projects.
Volunteering trips with the Vine Trust are of two weeks duration, with ten days spent working on the boats. This makes it feasible to volunteer during holidays, even if in full-time employment. Ruby and Jim have each had five trips to Peru and two to Lake Victoria. Fiona has volunteered four times in Peru and three times in Tanzania. Staff on the boats includes translators, doctors, midwives, pharmacists and cooks. There is a strong “family feel” on each of the boats. Accommodation is basic, but comfortable. Consultation space is limited, equipment such as couches is shared between doctors, and confidentiality is limited, with drapes used as partitions between “consulting rooms”.
In the five Peruvian river basins within which the ships operate, up to 70% of the population lives in poverty. The people have very little access to healthcare. An estimated 250 000 children in Peru live on the streets. Each of the two ships are staffed by six Peruvian health workers and overseas volunteers providing medical, dental and obstetric services, health promotion and eye surgery. It is hoped that the two ships can provide 1 million new consultations over the next five years, on top of the 1.3 million consultations which have taken place to date. A mix of people attends for consultations, including many families.
A typical day on board the Peruvian boats begins with devotions, followed by breakfast. The day is then taken up by consultations and there is often CME in the evening. Examples of topics include fungal infections and snake bites, but not all topics are medical. As well as consultations on the boat, there is public health involvement in schools and villages e.g. immunisations, education. Patients attending for consultations on board the Peruvian boats have a registration process where personal details are documented along with weight and BP, and everyone over the age of 2 years is given worm treatment. Patients access the boats via a gangplank, which is often somewhat unstable!
Typical conditions presenting in Peru include anaemia (80-90% of children are anaemic due to dietary iron deficiency), diarrhoea, parasitic infections, URTIs, chest infections, skin conditions, MSK conditions, malaria, machete wounds, burns, snake bites, HIV, TB and leprosy. A few older adults present with diseases which are considered to be those of Western societies such as cancer and CV disease.
Up to 400 000 people live on over 100 islands in Lake Victoria, all with very poor access to health care. In some areas infection rates with HIV/AIDS are up to 30%. There are 1.3 million orphans in Tanzania and infant mortality is 10X that in the UK. At least 45% of the population lives in poverty. Very few women and children live on the islands in Lake Victoria. The main employment is fishing, a dangerous occupation where the men have very poor life expectancy. There is little employment for women and many of those who do live on the islands are involved in the sex trade and levels of infection with STDs are high.
A typical day on board the Tanzanian boat begins with prayer at 7am. This is followed by an incident meeting. Discussion topics are varied and involve not only the medical volunteers, but also catering and engine room staff. CME also takes place in the morning and often involves training in local protocols e.g. schistosomiasis, governance in relation to prescribing, significant events and complex cases. A well-cooked breakfast is eventually served after what seems like a very long wait!
As well as on-board medical consultations, there are some village visits. These begin with meeting and greeting local dignitaries, before health promotion activities relating to handwashing, dental care, STDs, clean water, UTIs and fungal infection. Patients attending for consultation are often ferried to the medical ship on smaller boats. Presenting conditions include anaemia, HIV, STDs, malaria, diarrhoea, parasitic infections, URTIs, MSK conditions, skin conditions, lacerations and other wounds and chest infections. There is also scope for dental care and HIV testing and co-ordination of care.
It is common for UK medical students to seek electives in low income countries and the Vine Trust offers well organised and supervised experiences. Two students (Claire and Lucy), who spoke briefly towards the end of the evening, had greatly appreciated the wide range of conditions they saw and also valued the teamwork experience. A pharmacist from RGU (Trudy) also spoke briefly and had also valued the supportive team environment.
The NHS Scotland Global Citizenship Programme was mentioned. This encourages NHS Scotland staff to volunteer abroad without losing annual leave. On return, they are expected to share their medical and leadership skills. The Vine Trust has become part of this programme.
The evening concluded with the team of speakers answering questions and receiving thanks from the President.