Setting: Lifou Island, New Caledonia
Position: Private general practitioner
It is the wedding season and almost every weekend I am invited by a tribe to participate in their festivities. Each is a big production that lasts three or four days with local gourmet food, such as grilled lobster, fresh fish, coconut crabs and the signature dish called “bounia.” It is basically a piglet cooked atop sizzling stones and stuffed with coconut milk, yams, taro and sweet potatoes wrapped in banana leaves and covered with dirt. It takes hours to be ready. Wine and liquor flow freely day and night. By the end of the first day, a few people are drunk (mainly young folks). Most guests sleep in the village huts and try to cure their hangovers by drinking more the next day!
My presence on the island had created a dilemma for the local social structure: How can an alien be integrated without disrupting traditional rules? All foreigners have the same status, but they appear to want to create an exception for me because of my medical contributions. A solution has been found, and now at ceremonies I am seated to the right of the big chief (there are three on the island).
It is Sunday and one of these happy days. I am enjoying the company, the food and the ceremony. Suddenly, a car pulls up on the lawn and the driver makes a beeline toward me. His son is experiencing acute abdominal pain and needs urgent medical attention. I go to his place and examine him. Diagnosis: Suspicion of acute appendicitis. I spend hours organizing a medevac to the hospital on the main island. Phone calls take place between me, the airline, the hospital, the airports, the hospital and the surgeon. I also have to find an accommodation for the mother, who will stay in Noumea until her child is discharged. Moreover, on a Sunday everything is slower and more complicated. Ultimately, it equates to another Sunday spent at the office. For some reason, many emergencies wait for the weekend or evening to emerge! Everyone knows where I live (which is also where I work) and because I am the first and only private practitioner for about 10,000 people, the demands are high for medical services. It takes me a while to adjust to this fact. I remember my intern days at GWU hospital when I was on call every third night and was envious of my counterparts on the West Coast on call only every fourth night. Little did I know that one day my on-call schedule would be 24/7!
Lesson for the doctor: Before accepting an assignment/position on an island, always consider the special working conditions created by the physical environment.
Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.