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Medicine in the military: A labour of love

This month, GP Dr Patrick Kelly will return to the Golan Heights as part of the United Nations Disengagement Observer Force Mission.

The Waterford native will be stationed there for six months. He has been working with the Defence Forces since September 2014, after completing GP training.

While many young GPs choose to emigrate to practice medicine on completion of specialty training, Dr Kelly decided on a different path, having always been interested in the Defence Forces and the vital work it does in international peacekeeping and many other activities.

This has taken him to Syria, a country ravaged by war for several years. But despite the immense devastation wrought by the conflict, Dr Kelly has also witnessed a “beautiful country” with friendly people.

“In winter the mountains are covered in glistening snow, in spring the fields are lush and green, the wadis (valleys) are teeming with animal life. In summer, it’s slightly more barren and hot, only the most robust vegetation survives. The few Syrian people whom I’ve met in order to provide medical care are extremely welcoming, hospitable, gracious and friendly. They have endured so much for over five years but like many people are very resilient.”

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Dr Kelly on a night patrol with the Quick Reaction Force

Working abroad

Although Dr Kelly confesses that it has always been considered a rite of passage that Irish doctors would work abroad for a short period of time, the large cut to new-entry consultant pay and FEMPI cuts to GPs have meant that young Irish doctors have decided to take up permanent residency in countries like Canada, New Zealand and Australia.

“I get to work abroad with the Defence Forces on a consistent basis so it satisfies that ‘grá’, for want of a better term. April will be my fourth consecutive six-month deployment since I joined,” Dr Kelly revealed in an interview with the Medical Independent (MI).

Dr Kelly is a specialist in general practice and is on the specialist division of the Register. He underwent training in the South East Training Scheme based out of University Hospital Waterford (UHW).

“Primarily my hospital training was at UHW and my GP placements were in Co Waterford in the towns of Ardmore and Tramore. My time out in rural areas served me well for my present work in remote locations worldwide,” Dr Kelly said.

“My role as a senior medical officer is to ensure the health of troops deployed overseas. The majority of my work is preventative and occupational medicine – identifying issues before they become a problem. Some things can seem mundane like having mosquito nets for troops when they are outside, but if a soldier is bitten by a mosquito or sandfly, they may not contract malaria or leishmaniasis, but could develop cellulites, which could end up in their repatriation home or not being able to fulfil a key role or duty, which could influence mission success.

“I provide an administrative and human resource role managing medical staff as well as treating patients on ‘sick parade’. Sick parade is akin to a GP morning or evening surgery. I must also be prepared to treat and respond to medical emergencies in the mission area.”

Dr Kelly is happy in his current role, but he admits that six-month stints abroad can be difficult when away from family and friends. Being deployed means that one misses out on family occasions like weddings, baptisms and birthday parties.

“You also miss the simple things that everyone takes for granted; going shopping, cooking your own dinner or even driving a car. I’m sure loads of people reading this will be like ‘sign me up quickly’, but I do miss these things,” Dr Kelly revealed.

“I especially miss fresh pasteurised milk that will actually expire, not like the UHT stuff, which will keep even if you leave it outside in 30 degree heat for a few years! By the way, the National Dairy Council didn’t pay me to say that. You also miss the home comforts like ‘proper tea’. I won’t mention any particular brands, but there are two main ones depending what part of Ireland you’re from – when I’m overseas I’ll happily accept either!”

EHR

Many developments have taken place within the Defence Forces in recent years in terms of information technology (IT). Dr Kelly, who has a keen interest in IT, is involved in IT healthcare projects, such as electronic healthcare records (EHRs) and telemedicine.

In 2015 the Defence Forces transferred from paper-based medical notes, which were stored at soldiers/officers’ home station, to an EHR.

The advantage of the EHR is that no matter where the soldier presents for medical care in the Defence Forces in Ireland, at sea or in one of the larger overseas missions in the Middle East, the medic or doctor has access to the most up-to-date medical information for that individual, Dr Kelly advised.

The EHR has decision support software, which alerts the doctor to drug allergies should they prescribe a medication that the patient previously reacted poorly to.

The system is compatible with Healthlink, thus ensuring that Defence Forces’ doctors can receive reports from civilian hospitals, laboratories or radiological imaging in a secure manner. The system tracks patient presentations and ‘hot spots’ of activity across the country. It allows management to better resource military treatment facilities at times of increased demand.

In another development, colleagues in the Defence Forces physiotherapy service are presently recording patient videos for prehabilitation and rehabilitation, which they intend to make available to soldiers, Dr Kelly noted.

“You can imagine that the work some soldiers do can be extremely physically challenging and injury can result. ‘Prehab’ is providing exercise in order to prevent injury, while rehabilitation is attempting to return a person to their baseline status prior to the injury. We are constantly striving to keep up with new developments in IT,” Dr Kelly outlined.

“Telemedicine allows members of the Defence Forces in remote locations to access consultations with doctors or physiotherapists over Skype for Business. It was first piloted in 2016 actually from the Golan Heights when I needed a physiotherapy opinion remotely as my own physiotherapist was not available.”

Irish general practice

Dr Kelly is acutely aware of the significant challenges facing GPs in Ireland. He believes that GPs are extremely committed healthcare professionals who are working in a challenging system that is under-resourced.

“Not only is the population increasing and ageing, but this is associated with an increase in chronic illness and exacerbated by a generation of GPs soon to retire. It’s well known that FEMPI cuts have reduced the ability of the primary care system to respond to the increased healthcare demands of Irish society,” he said.

But there is some cause for hope, with indications of plans to reverse FEMPI, while two GP training places are being provided through the Military Medicine Scheme, Dr Kelly noted.

“We are not training enough GPs to meet population demands. On a more positive note, the Government has announced removing FEMPI cuts from general practice, which is long overdue. The Defence Forces is responding in a very small way by now providing GP training places each year through the Military Medicine Scheme in conjunction with the ICGP and Faculty of Military Medicine.”

But despite the crisis in general practice in Ireland, Dr Kelly is keeping his options open regarding future career opportunities and may one day return to general practice in Ireland.

“As for long-term career goals, whether I’m in a sweltering hot Ebola treatment centre in Sierra Leone or sitting in the mist and rain of the Glen of Imaal on an artillery shoot, I’m certainly happy where I am at the moment. But sure, I’m always looking for a new adventure or challenge, so who knows. I may even go back to the real frontline of medicine and take up a GP assistant post in Waterford some day – I can’t say I haven’t been offered one or two in the recent past. It’s good to have options.”

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