Irish doctor on a distant island

T o take up his new job, Kevin O’Brien first took a flight from Dublin Airport to Heathrow, then travelled to the RAF base at Brize Norton, where he joined members of the British Antarctic Expedition on a long-haul flight to Ascension Island, a tiny rockfall in the middle of the Atlantic Ocean.

O’Brien’s travels were far from over; from Ascension, he boarded the last working Royal Mail ship in the world, which steamed for three days before arriving at his ultimate destination, St Helena.

About 4,000km east of Brazil and 2,000km west of Africa, St Helena is about as remote as remote gets. The island, no bigger than Achill and just as mountainous, has been home for the past year to O’Brien, his wife Aoife McGough and their daughter Síomha.

“The plan was always to move away,” O’Briens explains down a surprisingly clear WhatsApp connection, given that his five-digit home number on the island was on the blink. “We figured this was a good time in our lives to travel, when we weren’t tied down.”

The couple arrived last February, three months after O’Brien answered an online advertisement. “Like many others in my GP class, I was reluctant to commit to general practice in Ireland in the current state of change. And then countries all over the world are crying out for Irish doctors.”

But while the medical brain drain has led most Irish doctors to sophisticated health systems in Australia, Canada or the UK, O’Brien finds himself in a British Overseas Territory with a population of 4,500 and a stripped-back medical service to match.

“It’s very British but also has a tropical island feel,” he says. “Everyone stops to talk when they pass. You salute every car, and say hi to everyone.”

“We were worried at first about it being claustrophobic, about not being able to get off the island for a day. But it’s an amazingly beautiful and varied place, and the people have been so welcoming. We felt at home very fast.”

The locals are descendants of English settlers, Chinese labourers, Boer prisoners and African slaves; names such as O’Bey and O’Dean hints at an Irish lineage too. The Union Jack is the official flag and English the lingua franca, though spoken with a unique dialect. “Place names such as Half Tree Hollow, The Gates of Chaos and Alarm Forest could have been plucked from Tolkien, and the laid-back pace of life and tropical fruit trees give an almost Caribbean feel.”

Island life has its own “nuances”, as O’Brien refers to them. The shops close at 5pm and that’s it for picking up supplies. Fresh fruit arrives on the boat every three weeks, and the best produce sells out fast. When his mobile phone broke recently, it was sent for repair in South Africa and came back two months later.

As one of St Helena’s two GPs, O’Brien is continuing a long tradition of Irish medical presence on the island. Its most famous resident, Napoleon, was attended to during his enforced exile by an Irish doctor, Barry O’Meara.

Then, there was the curious case of Dr James Barry, another Cork medic who performed one of the first caesarean sections in 1826 and lived on St Helena for two years. After his death, it was discovered that Barry was, in fact, a woman.

O’Brien’s life is more prosaic. Clinics are based in the island’s 31-bed hospital, which boasts an operating theatre and other basic facilities. Scans have to be reported remotely from South Africa, while specialist services are provided by visiting doctors. Serious cases have to be sent to Cape Town, where patients can spend months away from home.

In June, O’Brien found himself as the leading doctor in the first ever evacuation from St Helena, involving a sick premature baby who was flown to hospital in Cape Town.

Just as in Ireland, he spends a lot of time dealing with chronic diseases such as obesity and diabetes. But unlike at home, he can access tests directly. “In Galway, I used to have to send patients to a hospital appointment in order for an ultrasound to be booked. You also realise how much more careful we could be in Ireland with our drug spending when you work somewhere that is more prudent with its drug choices and budget.”

When he signed up for the posting, St Helena was on the cusp of great change, with the planned opening of a €300 million airport in the spring. However, the opening of the airport, which was built with a view to opening up the island to tourism, has been postponed indefinitely because of safety concerns over the wind shear. The project, already dubbed Britain’s biggest overseas aid fiasco, risks becoming a white elephant.

So for another while yet, St Helena remains marooned and apart. A round trip visit for two people costs a prohibitive €8,000 from Europe, making it unlikely that the parents of O’Brien and his wife will get to make that hoped-for visit to see their only grandchild.

"The other worry we always have is the amount of time it would take to get home in an emergency if needed – a minimum of one week and possibly up to three, depending on where the RMS St Helena is in its schedule."