Adventures — 7 July 2021 at 6:39 am

60 degrees North: Remote and Rural Medicine in the Shetland Islands

Dr Ella Bennett/Anaesthetic Core Trainee/South-East Scotland

Dr Ella Bennet gives us a glimpse into living and working on Scotland’s northernmost island archipelago of Shetland. The Shetland Islands are home to remnants of viking strongholds, fair isle knitwear galore and some of the best birdwatching in the world. The remote location of the Shetland Islands makes for some stunning landscapes, but does add an additional challenge when providing for the healthcare needs of its population.

Lerwick, Shetland.
Lerwick, capital of Shetland.
Coastal dwellings, Shetland
Coastal life.

It was 2am and I was settled in the handover room attempting a nap, wedged between 1950s textbooks and old coffee cups. I’d just kicked off my shoes when the bleep vibrated – ‘Ella it’s Thelma, two peerie things; have you had your tea yet (by tea she meant her homemade kedgeree and at least eight traybakes) and have you heard about the respiratory arrest coming in?’. The answer was a firm no to both. I re-shoed hurriedly and made my way back to A&E, hoping that some cake might help me remember my ALS algorithms before the ambulance arrived.

On-calls in Shetland can be eerily quiet or very busy, a situation exacerbated by the fact that you cover A&E, two wards and sometimes a tiny HDU on your own. This, in my opinion, is one of the most interesting things about working remotely; you feel simultaneously both very alone and very supported. The nurses are fantastic, you know the paramedics by name and the consultants pop in on their way home from Tesco. In a situation like this though, it’s difficult not to become acutely aware of your own vulnerability. To manage an arrest as an FY3 is unusual. To manage an arrest without senior medical, anaesthetic, radiological or laboratory presence even more so. Working in Shetland offers a challenge clinically, in a role that has both variety and (relative) independence. It is also offers a chance to work closely within a community that is almost defined by stoic self-reliance; a characteristic shaped by one of the harshest, yet most magical landscapes in the UK.

Shetland beach.
Isthmus to St Ninian’s Isle Tombolo.
Bay, Shetland.
Beautiful bay.

The respiratory arrest turned out to be a loyal customer well-known to Thelma and Gwen (as if any Islander isn’t…). By the time he had arrived, the paramedics had given some aptly-timed naloxone and he was up and fighting to leave. No need to call the consultant, no need to wake the labs and no need to drag the radiographer onto a sunrise ferry. A win all round really. I breathed a large sigh of relief and we passed the next few hours mingling the usual A&E bread and butter with occasional calls from the wards.

Another unique aspect of working at the Gilbert Bain is that whatever your day-time speciality, out of hours you’ll see paeds, geriatrics, minor injuries, psychiatry cases, fishhooks (they deserve a speciality of their own), eyes – essentially, everything. Aside from this, part of your job is communicating with the Shetland GPs who phone for referrals and advice. Some of these GPs work in the tiny remote communities that live on Shetland’s smaller islands such as Unst and Yell. Unst, the most Northerly of the Shetland Islands, has a population of about 650 and is two ferries away from the Gilbert Bain. This is more accessible than some (see Fairisle), but still requires two boats to be called out if someone needs to be seen overnight. Not only does this add an unusual pressure to your telephone decision-making, but it also often leaves the patient a minimum of two hours away.

Country road, Shetland.
Into the interior.
Sea cliffs.
Shetland’s rugged coastline.

This geography is in some ways an asset: the Gilbert Bain is fortunate to be far enough away from the mainland that a degree of self-sufficiency is imperative, particularly as the weather is often too bad to fly anyone ‘Sooth’. This has to some extent, protected it from being down-sized to a GP-run community hospital as in many other, more accessible, rural areas; a shift that has undoubtedly reduced the number of jobs available to junior doctors wishing to work remotely. Shetland’s distance from the mainland means that GBH has to be, and will always be, a fully-functioning, CT-scanning centre with a reasonable number of juniors. Amongst other things, this helps the community, greatly improving the hospital’s social life, particularly for those with a love of cold water. Take a job in Shetland and you’re almost contractually obliged to try sea-swimming at least once, and you may well find yourself swimming with the GBH clan – and a few seals or ‘selkies’ – that congregate at sunrise. For warmer pursuits, Lerwick offers more than you would think. There is a fantastic sports centre, a good number of pubs and a weekly quiz for the consultants to beat you at. There’s even the UK’s most remote Parkrun where you will undoubtedly run (pardon the pun) into patients, colleagues and the occasional orca.

Klippe, Shetland.
Shetlands tectonic remnants.
Spiggie beach, Shetland.
Spiggie beach, Shetland.

Unlike most of the nurses, only a few of the consultants are Shetlanders: many have moved over for work before becoming, either intentionally or unintentionally, honorary Islanders. As in most rural hospitals, they are supported by regular locums who often become part of the extended GBH-family. The lack of middle-grade doctors means that you work very closely with the consultants, many of whom are skilled generalists with a breadth of knowledge and experience that only exists in places with limited tertiary care. Equally important to this, is that the consultants are committed to welcoming, teaching and supporting their juniors, and are more than happy to introduce you to their own private island (and accompanying sheep!) when the weather allows.

Working at the Gilbert Bain is an opportunity to experience UK remote and rural medicine in all of its rugged, tree-less glory. It offers a glimpse into island life that, once you decipher the dialect, will make you forget what life was like without the weather, the people and above all, the puffins…

Puffin’ around.
Sea swimming, Shetland.
Practically tropical.

Intrigued? Interested in working in Shetland?

Every year Shetland offers a number of clinical fellow posts in both medicine and surgery (though be prepared to cross-cover overnight) and usually has around 3 trainees from Aberdeen per rotation. Your accommodation is free and NHS Shetland cover your travel expenses to and from the Island. For more information and contact details, see here.