After watching my children grow up and take gap years I began pondering the potential for a middle-aged gap year, more officially known as a sabbatical.
I wanted to travel with a purpose and spend some time getting under the skin of a country. After 25 years in general practice I wanted a complete change of emphasis - less stress, less pressure and I wanted to help develop people. I also wanted to develop myself and to learn from health workers in different countries. This is why I decided to work as an expedition doctor for various different organisations throughout the year.
If you are considering a sabbatical it’s a good idea to start researching your plans early, I would suggest at least 18 months in advance.
If you are a partner or employed then you will obviously need approval from your practice. If your practice agrees, organising a locum is the key early task. Establishing a reliable replacement is essential for your peace of mind and a smooth return to work.
When looking at who you want to work for during your sabbatical it’s a good idea to try trying and work with the organisations for short periods beforehand. This allows you to see how they work, how medics are viewed and work out whether your personality and skill set matches the organisation.
I felt this was crucial for a successful trip. I worked for two companies and decided that they weren’t for me. Be selective and critical - this is a once in a lifetime opportunity.
Interviews, assessment days and then trying to coordinate your schedule with the organisations’ schedules takes lots of time and planning, particularly if you are plan to work for different organisations across the year. I found constructing a timeline for the pre-sabbatical and sabbatical periods very helpful.
Book your flights early if you can, and give yourself plenty of time to sort out visas and vaccinations.
Be realistic about what you can achieve. Can you actually do the expedition, never mind delivering medical cover while you're there? Can you cope with hot, humid, insect-filled jungles? Can you cope with altitude? Do you get seasick? Can you walk 20km with a backpack for days on end? Can you work with young people?
Try some activities or trips in the pre-planning phase to assess your abilities - it is better to discover you are seasick in the Solent or your knees aren't suited to trekking in the Lake District than on some remote expedition when everyone is depending on you.
It's easy to try to pack too much into your year, so make sure you allow time for family and friends and downtime. Planning and preparing for trips soaks up vast amounts of energy and time, building in downtime should be an essential part of your planning.
There is a huge amount of expedition medicine literature around so analyse what you're thinking about doing. Look constructively at your career and your skills and weaknesses and brush up where you feel it's essential.
A good place to start is a Wilderness Medical Training course, which are fantastic courses that can take place in exciting places. Education is informal, interactive and wide ranging, presented by experienced expedition doctors. It's a great opportunity to network and run your plans past people have done it all before, pick up some CPD and have an adventure holiday.
I also attended an ATACC course, which involved three days of reconstructions of every conceivable type of emergency from nightclub stabbings, to collapsed buildings and potholing disasters. It's probably more aimed at A&E and HEMS doctors but it gave me as a GP a real insight into how I could approach a major disaster and coordinate with emergency services.
Finance and insurance
Look at your finances. Do you need to work in between your trips to ensure you have enough money across the year? Working, but in a different speciality to your normal job, could be part of your sabbatical.
Be prepared for some cashflow issues - pension contributions and tax are not easy to reduce in advance. Above all, if you are a partner, you need to have your practice manager on your side, so be extra nice to them.
Personal insurance for the trips is often provided by the company you're working for, which is the simplest way of arranging this. If not, think about using a specialist company that do very specific, tailormade expedition cover.
Professional insurance for your normal work can be reduced, but you need to be aware of what work you are going to do while you are away and make sure you have indemnity in place.
My medical defence organisation was incredibly helpful. You need to know your expedition, how many medics are going on the trip and exactly what your role and responsibilities will be to ensure you have appropriate cover.
Where can you work?
There are plenty of exciting and challenging adventures to use your medical skills on, all you need is imagination and energy. There is virtually no paid expedition work, at best it's a free trip for you but beware of the risks and responsibilities.
I would suggest paying for expeditions with true charities as the best experience - risks are mitigated wherever possible, but above all there is good back-up if things go wrong. These are all things to consider when doing your research.
These are the organisations I chose to work with during my sabbatical.
Tall Ships Youth Trust
Pictured while working with the Tall Ships Youth Trust
The Tall Ships Youth Trust is based in Portsmouth and has a variety of yachts. It runs an extensive programme of adults trips and youth work expeditions. If you love sailing, the 72 ft Challengers are for you. In my planning year I took a couple of cross channel trips with them, I was then recommended to be a watch leader and did the transatlantic Arc Rally in my sabbatical year.
The administration is excellent, the organisation is professionally-run and very safety conscious. All skippers have the ship captain medical qualifications, communication is first class and advice and guidance from the UK always available. It's a great chance for a sailing doctor to gain some expedition experience, clock up some sea miles and have a great time exploring a wonderful coast and beyond.
With Raleigh International volunteers in Nicaragua
Raleigh International is an excellent programme of well-supported and well-organised 13-week expeditions to Borneo, Costa Rica/Nicaragua, Nepal and Tanzania. These trips for 18 to 23-year-olds mix adventure expeditions with community projects based around water and sanitation. They are mentally and physically challenging trips, but ultimately immensely rewarding.
My projects in Nicaragua included supporting a village to build a gravity fed water system and walking unsupported nearly coast-to-coast for over 300km. The organisation is well-suited for younger doctors as there is a good medical backup from the UK and excellent pre-expedition in-country planning.There are also other medics and nurses on the project for support and guidance.
Medical Sailing Ministries
Aboard the Medical Sailing Ministries yacht
Medical Sailing Ministries is a low-key Melbourne church-based charity delivering dental, medical and optometry to the Vanuatu chain of Pacific Islands using a 54-foot yacht.
Administration and planning are excellent and the crews and islanders are incredibly friendly. It's a great way to see Vanuatu through sailing and working in its rural clinics.
This is medicine primarily based around hypertension and diabetes, you run clinics in primary care giving advice to island nurse practitioners without the ability to investigate. It is primary care in its rawest form with only the most basic equipment to use.
Crew are all volunteers and the medical missions run for two weeks usually covering four to five islands. This is a fantastic way to start a holiday of the diving sites and volcanoes in the island chain or en route to Australian or New Zealand, especially if you love sailing.
In the Sahara while working for Action Challenge
Action Challenge is one of many charity fundraising companies that take clients to exciting places to accomplish a challenge. After undertaking a number of UK-based challenges you're invited to be medic on a foreign trip.
These trips are to some challenging and remote places and as the expedition medic you don’t have to pay. Those undertaking the trips are often very focused on achieving the challenge and raising the money so giving medical advice, and possibly suggesting people don't complete the trip, can be difficult.
The in-country back up is variable and preplanning of evacuations much less comprehensive. I would suggest these sorts of trips for more experienced travellers and doctors due to the increased risk.
Taking a sabbatical is a real opportunity to open your horizons. Imagination is your only limiting factor, so have an ambitious vision and challenge yourself. Whether your sabbatical is a month or a year, if you use it wisely you will come back refreshed, wiser and rejuvenated.
- Dr Allen is a GP in Hampshire