After finishing his junior doctor years, Jamie took on a cycling trip from Canada to Mexico along the length of the Rockies. He admits to a phase of being a bit obsessed with endurance cycling, so before his injuries caught up with him and he decided to stick to touring, he raced from London to Istanbul, and a big route round Kyrgyzstan. 

Jamie confesses that his career path has meandered a little, with time out for the longer sailing and cycling trips, but it means he’s been able to develop a specialism in expedition and remote environment medicine, alongside enjoying UK-based general practise and urgent care roles when he’s at home in Oxford, UK. 

He’s spent most of the last year away sailing, and in his current deployment to a gold mining community in Guinea, West Africa. Here he’s setting up a small medical clinic to care for the local workers. As the only doctor there, he’s on call 24/7 for emergencies and the focus is on primary care and tropical medicine. 

Days are pretty varied and start at 0500 when Jamie is driven to the clinic in a 4x4, dodging cow or goat related traffic jams. The commute incorporates views of the sunrise over the Niger river which always starts the day off well.

Guinea is a very poor country with some of the worst health outcomes in the world. But the gold mine is really trying to provide workers with a good standard of living and Jamie loves to be part of that. The Guinean management staff are well educated but often have complex views on health, which require a bit of negotiation.

Patients tend to be local labourers, who bring the additional challenge of strong beliefs in traditional healing, who can’t read or write, and those who have never consulted with a doctor before. This cultural divide is fascinating to try and bridge. He also cares for expatriates and occasionally sees local village elders who like to pop in for a check up now and then.

Days may be spent in the clinic, seeing patients all day, or in the nearby town if a meeting with local doctors is called. Much of Jamie’s time is spent writing briefings on disease outbreaks, developing new protocols for the clinic and trying to source equipment and medications. 

The current clinic is a small building with very limited resources, though a new, larger clinic is under construction. Jamie has examination tools and an emergency bag with airway adjuncts, a defibrillator and a reasonable supply of oral and injectable medications. In terms of investigations, he has Covid and Malaria rapid tests and urine dipsticks. But that’s about it. Most decision making is based on history taking and examination, which alternates between being very satisfying and a bit terrifying! 

The most common illness Jamie treats is Malaria, followed by a plethora of nasty skin infections. The day he wrote the blog, he drained a huge facial abscess, which he said is always very satisfying.

In Guinea, he often sees people become ill very quickly with a high fever. But in the absence of any real testing facilities, it can be really hard to make an accurate diagnosis. He ends up treating empirically with combinations of antibiotics and antimalarials more often than he would like to.

Jamie told us that the most dramatic emergency he’s seen to date was actually a psychiatric crisis. A patient became convinced that they were possessed by the devil and started attacking their coworkers and Jamie. Thankfully a family member arrived and resolved the situation, calming the patient down by rubbing garlic on their face. A treatment modality that Jamie has yet to try back in the UK. (We can’t wait to hear the result when he does!).

The local people are the best bit of the job and Jamie works with two Guinean nurses who are always interested and keen to learn. He does provide a lot of training, but said that in truth, he learns at least as much from them as they do from him. 

The patients often have a great sense of humour and are very pragmatic, but that can make it a bit heartbreaking when you have such limited resources to care for them. 

Guinea is a beautiful country, especially in the rainy season when the landscape is incredibly lush. The weather is gloriously dramatic and there was a huge thunderstorm while Jamie wrote the blog. There are brightly coloured birds and lizards everywhere, though he’s less of a fan of the other wildlife such as the snakes, scorpions and spiders. A close encounter with a scorpion recently means he’s now learnt to inspect light switches more carefully before putting his hand on them!

Another downside is the concern over security, which means that Jamie can’t go outside on his own much. But he’s adjusted to the limited physical freedom and found ways to exercise in his room, becoming pretty good at skipping!

Jamie’s Guinean deployment ends soon and for now he’s looking forward to spending some time with his wife as he’s been away for so long. From October he takes on a new job at a specialist GP practice that cares for homeless people. He’ll also be consulting for a couple of companies that focus on remote environment medical care. 

Longer term, the goal is to keep doing as much expedition and maritime medicine as possible… there’s even a couple of exciting trips planned for next summer, so watch this space!