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Monday, June 02, 2008

What about the doctor on board?

What about the doctor on board?

( editors note: here are soem excerpts from a great article from Australia we thought you might wat the read)

Ask the ship’s doctor aboard one of the world’s premier cruise liners, Sun Princess, if he has ever had to airlift anyone off the vessel and he looks at you quizzically.

“Why would you?” is the implication, as he explains that the medical centre offers all you would find in a hospital emergency department ashore, including digital X-rays, blood tests, theatre, autoclave, defibrillator and full intensive care.Apart from a hospital, there is nowhere else you would find such a comprehensive medical set-up.

“We can do most things on board,” says Colin Cameron, in what could win the annual understatement award. His role as senior doctor responsible for the health and welfare of more than 2000 passengers and 900 crew means he must be GP, emergency physician, intensivist, anaesthetist, surgeon, pharmacist, radiologist, pathologist and even, occasionally, psychiatrist.So a dramatic airlift is relegated to the realms of TV soapies.

“We would have to be within helicopter distance of shore and we would have to be sure we were airlifting the person for the correct reasons and that the facility there had the ability to do something we couldn’t do,” Dr Cameron says. “There is no point in airlifting someone ashore to a shack in South America just because you can.”

A visit to the medical centre, which is buried on deck four, is a bit like going down the fabled rabbit hole. Leaving the 10 upper decks that are the main hive of activity for passengers, you descend a spiral staircase and emerge into a scene peppered with the unexpected.The first surprise is the doctor himself. Sailing in Australian waters on the Sun Princess, which is now based in Australia, you expect to see a bronzed Aussie medico but Dr Cameron is a fair-skinned Scotsman with a broad Glaswegian brogue.

He was working in intensive care medicine in the UK when he was gripped by a desire to see the world. Several intense interviews and tests later, he was taken on by global Carnival group, which includes Princess Cruises, P&O Cruises, Cunard Line and others in its stable.

The company’s extensive reach means the 40-year-old has been to every cruise ship destination in the world, from Alaska to Antarctica.He finds his job intensely interesting because of the mix of medical cases he sees. His specialist training in surgery and intensive care in Glasgow has proved essential for his job, which he describes as a combination of general practice and emergency medicine.His day can bring the need to deal with respiratory infections, tonsillitis, wound infections, cellulitis and broken limbs to managing patients who have had a stroke or a heart attack.

In a single session, he can consult patients ranging in age from seven to 93 years old. Although being a doctor aboard a cruise ship might sound romantic, Dr Cameron stresses that it is no holiday.“When you are in the middle of the Pacific Ocean and someone has crushing heart failure, there is nowhere to hide and there is no ambulance to phone,” he says. “You have to do the job or someone dies, so it is not for the faint-hearted.”

The medical care, as with the rest of the services provided on board, is impeccable. If a patient urgently needs to see a specialist, Dr Cameron will phone ahead to the next port of call to arrange for one to meet the ship and treat the patient ashore. The patient can then usually carry on cruising and Dr Cameron will continue the management of the patient aboard.“We don’t disembark people unless we absolutely have to, we generally manage all medical conditions on board so people can continue their holiday,” he says.

He laughs when asked if some passengers might save up their routine visit to a doctor until on board the ship.“Sometimes we see some people who seem to have not seen a doctor for a long time and suddenly decide at the end of the cruise that they have got money left and they want to have the medical experience on board, so they come and see us,” he says.

The centre uses private billing and although passengers cannot claim from Medicare because they are out of Australia, they can recoup costs through their travel insurance.

Having been greeted by a Glaswegian doctor, the next surprise is the extent of the medical centre, a warren in which another room pops up as quickly as you leave the last behind. There are consulting rooms, four wards, a fully equipped operating theatre, pharmacy, X-ray room, nurses’ station and intensive-care facility.There are also two waiting rooms which seems like overkill until you learn that the doctors see an average of 30 patients a day. They are triaged by a nurse immediately after they arrive in the centre and the non-urgent cases are then seen on a first-come, first-served basis.

The centre, which has two doctors and three nurses, is open for two two-hour sessions every day but in the case of an emergency, passengers can dial a number and reach the doctors who are on 24-hour call.They do not usually do “home visits”. “If anyone is ill enough to see a doctor, I think they should really be down here,” Dr Cameron says. “And if they are so unwell they can’t leave the cabin, then that is even more reason to bring them here.”

The centre has a mini- ambulance, all contained on a rapid-response trolley, which is used to ferry the seriously ill back to the mini-hospital.“If you are going to have a cardiac arrest, have it on a cruise ship,” Dr Cameron says, noting that the doctors can be at the scene within two minutes. On port days, he and his medical colleague take it in turns to go ashore but at all times there must be one doctor and one nurse aboard. After work, Dr Cameron goes for dinner with his family — his wife and six-month-old son accompany him on all his cruises — and often takes in a show in the ship’s 550-seat Princess Theatre.

His ranking with 3.5 stripes on his epaulettes elevates him to the loftiest echelons aboard, taking his place on the executive committee beside the captain, chief engineer and passenger services director, who have half a stripe more stitched to their shoulders.His status affords him a suite with a lounge, double bedroom and bathroom. “I see quite a few emergencies,” he says. “Some days you can see none and sometimes you can see two or three.”His working life of being on call 24 hours every day for four months straight is compensated for by the two months of time off that follow each stint on board. “Then I generally try a land-based holiday,” he says with a chuckle.

Based now in Victoria, he plays golf and goes fishing, walking and driving.“You miss things like cooking and driving and doing normal things like cutting the grass,” he says.

It is the end of the tour and it is time to scurry back upstairs. But just when you thought it was safe to take the lift to deck 14 in your hurry to meet your friends in the Topsiders Bar for a cocktail, the doctor materialises beside you.“Take the stairs,” he counsels, “it’s healthier.”

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