Life as a GP in the Falkland Islands

Dr Angela Rowlands explains how she came to be a GP on the Falkland Islands and the challenges of practising in such a remote area.

How did you begin working in the Falkland Islands?

I saw an advertisement looking for doctors to work short-term contracts in the Falklands. At the time, I was a partner in Cornwall. I took a sabbatical and went to the Falklands from January to May 2010.

On returning to the UK, I worked on a locum basis because I had decided I wanted to work regularly in the Falklands. Since then, I've been back more than once.

This April, I am going out to work more permanently and I'll be taking on the chief medical officer role.

What first attracted you?

I wanted to do something different. I knew a bit about rural general practice. I had also worked in practices with a GP hospital, and in the Falklands, GPs work in the hospital.

It was a bit terrifying because I had lost a lot of skills because of the way general practice in the UK has changed. Now I was going to work as I did when I first qualified, including emergency on-call work.

How does healthcare in the Falkland Islands work?

There are roughly 3,000 residents on the islands, most of them living in the main town of Stanley. There are four full-time GPs, a part-time GP, an anaesthetist and a surgeon. The GPs do everything except surgery. There are two practice nurses, one part-time nurse practitioner and in the hospital, two casualty nurses, ward nurses and healthcare assistants.

Dr Rowlands with one of the ward nurses

We have a reciprocal agreement with the NHS for anyone whose illness requires hospital care. These patients are transferred to England by the RAF. Serious emergencies are flown to Chile by emergency air ambulance. While the plane flies in from Chile, we use our emergency skills.

General practice is similar to the UK. We use the same EMIS system, but we do not have QOF. We still try to keep standards very high. It works because we're committed to doing our best, but without someone breathing down our necks. The patients really come first.

The hospital has 20 beds. We have a mini ICU and an excellent theatre team. The X-ray department includes ultrasound. We use our laboratory for routine tests. Some complicated, unusual tests are sent to the UK. A patient coming into the hospital and a GP surgery can have tests quickly. Patients with cancer are referred to the UK straight away.

There are an additional 2,000 people on the islands who are in the forces or linked to the forces, but they are looked after by military GPs and only come to us if they need to be admitted to the hospital or to have X-rays.

What is a typical day like?

One doctor is on call and will see any emergency patients and look after the patients in the hospital.

Every day we do a ward round in the hospital first thing and all the doctors attend. We discuss all the patients and their management and following this, the on-call doctor will look after them. The other doctors do normal GP surgeries.

Every week one doctor goes on 'camp'- country visits. You drive to the settlements on the main island or take the small local plane to the other islands to see patients.

What are the challenges of practising in the Falklands?

You do feel like you're miles away. The plane to Chile is only once a week and flights to the UK are twice a week via the RAF. The flight to Chile takes about an hour and a half.

The biggest challenge is dealing with emergencies and making the decision about when to transfer, trying to decide when someone needs transferring or whether we can look after them ourselves.

The army helicopter is scrambled when there is an emergency away from Stanley

Obstetrics is also an issue. There are about 30 deliveries a year. There are three midwives. We are looking at improving the service, helping midwives and GPs, and developing telemedicine links.

What do you like about living and working there?

When I first went there, it was like a breath of fresh air. It is a beautiful place, with lots of wildlife.

I love photography and have made a book of pictures. The small islands are wonderful to visit and you can wander about among the penguins.

It's a different way of life. There are two supermarkets, a few places to eat and that's it. It's great for children as it is so safe. Doors are seldom locked and there are no traffic lights.

Observing the view

The work is challenging and exciting - something different every day. We see fishermen from all over the world, often from places where they don't have such a high standard of healthcare, so they turn up with all sorts of things we haven't seen before. And there are the tourists.

Wildlife in the Falklands

Would you recommend it?

For any GP who wants a change, it's great. It makes you stand back and look at your life. There is a very supportive team and nurses and doctors can learn from each other. I would recommend it to anyone and we're expanding the posts as we want another GP to join the team.

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