12 minute read
Interview with Sarah: Sun, Sea and Serious Business
Sun, Sea and Serious Business
Have you ever wished you lived on a tropical island like the Maldives? Perhaps even thought about what working there would be like? We all know a little bit about what working in healthcare in the UK is like, but don’t often know much about it outside the UK. Sarah, who is currently studying her masters in Epidemiology at Bristol had a fascinating role before commencing her studies with us. She first studied a bachelor’s in health rehabilitation in Australia, before joining the public health sector of Maldives under the WHO. She was kind enough to share with us a little about her life in Maldives and what working in such an influential role in public health was like.
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I understand you are studying a master’s in Epidemiology at Bristol, what made you want to join Bristol Medical School?
One of the main reasons I applied was because Bristol was part of the Chevening scholarship scheme, which allows international students to study in the UK. I wanted to study epidemiology for a while because of my job. We are a very small country and when it come to higher education, especially health related, we have very few opportunities. You either have nursing or public health, whereas I was hoping to study a more specific course like Epidemiology. Chevening was how I could get there. Obviously, Bristol has a great reputation, especially when it comes to health research. A bonus was that Bristol itself is a beautiful city.
What was your role in the ministry of health?
I manage the national emergency and health preparedness program, and I have been doing this since 2017. It is a very rewarding job, but it is a very busy job as well, you had to be on call 24/7. Even when emergencies that weren’t directly health related like fires or flooding occurred you had to be prepared to coordinate the health sector. When the Maldives emergency operation system was established in February 2020, I was a leader in the contact tracing team. I used to supervise all the contact tracing teams under the guidance of health prediction agency. I worked in contact tracing till September 2020, and then this year I started working with the vaccination campaign. Getting all the data from the island was a part of my role, it was very different from other parts of the world because we are all islands. Then, I transitioned back to contact tracing in the smaller islands. At a point we were getting about 2000 cases daily within a population of 400,000. We had to separate our contract tracing, so we had to separate sections between smaller islands and Male, I worked with establishing a system for atolls (the smaller islands in the Maldives) as our old system got so overwhelmed (we actually had to revert to google sheets at one point – we ended up setting up a google sheets for each island). I’ve worked in different areas of the response so far it was an interesting experience – I don’t think it’s one that anyone else could’ve gotten.
Prior to your role at the Ministry of Health in the Maldives, what roles did you work in?
I finished my bachelor’s in health and rehabilitation science in Australia. My degree was focused more on allied health, but we had one module around health promotion and public health in our last year. When I went back home there was no scope for allied health as we
don’t really have that there. I was unemployed for 6 months, since I had that one module of public health the minute a position came, I took it. My first position was at the society for health education at the Maldives. There I was a programmes officer and responsible for communication and resource utilisation. We ran workshops to provide education for sexual and reproductive health, mental health and similar things. We would travel to different islands and have workshops for parents and teachers, for different sub populations. I loved travelling within the Maldives, and I naturally gravitate towards jobs I can travel more. I worked there specifically to support the elimination of measles in Maldives, we carried out a nationwide MMR vaccine campaign to create the herd immunity that was required. We were able to get certification for elimination of measles from the WHO in 2017. Maldives is one of the few countries in our region which reached that goal, because we have good vaccination rates and we worked to maintain that. Because I got to know the work and the people there, I got really interested in it.
How did you find the role/what pushed you to take it?
At my previous position, I felt like I wasn’t fulfilling my potential. I was doing stuff that was more administrative. It happened by chance, an acquaintance mentioned WHO were looking to hire a consultant for the measles campaign. I had an interview, and they were happy with my experience, and from there I transitioned to my current role.
How did you find working there? What did you like about it/what challenges did you face?
It’s combination of good and bad. It’s a very small country, we are severely understaffed. Over here, there is probably a large department whereas back home our entire national surveillance department was run by 3 people. With the emergency preparedness and response program, I am the only permanent staff. You get the freedom to do what you want, you can say “this is what needs to be done this year”. The bad thing is that you get severely overworked, because you are doing the work of 3 or 4 people by yourself. A lot of people working in the ministry, we are crazy about our job. We prioritise it over ourselves. It can be a bad as sometimes you tend to put your personal life to the side.
How did the pandemic affect your life there?
I think it was different for me as I was personally involved. None of the staying home applied to me. We started our prep work in middle of January. As emergency program manager, I had to be a part of everything. Since January I have been working since coming here. We prepped very early on, and we were praised by WHO. Basically, it was all day and all night, I only went home to sleep. Only social life was within work, so I got to know my colleagues on a more personal basis. It became like a family at work for me.
The Maldives has a very lovely reputation as a holiday destination, but what was living there like?
In my country, I live in a place called Male. It is capital city of Maldives and it’s the most crowded city in the world. It has a 5 km radius so you could walk through the whole city, with 250000 people living in the small space. The way the Maldives is arranged is in chains of islands. There are capital islands with the centre hospitals. The smaller islands only have one doctor and a couple of nurses. The island life is peaceful, compared to the city of Male which is quite congested. There are a lot of people, lot of noise. I always have the luxury that I can get on a boat and get to a beach in 5 – 10 minutes, I feel very lucky because of that. People here have their own idea of tourism; they think it’s simply private resorts which our usually owned by foreigners. We have local bed and breakfasts and guesthouses on local islands now, where
the profit goes to the communities. They give you a better chance to experience the community rather than a 5-star hotel.
Was it difficult transitioning from working life to being a student?
It’s not that difficult, it just took some time to get used to things. My job was very full on, so sometimes now I feel like my mind is more relaxed whereas before I felt like I was on-call 24/7. Now I just focus on my studies. I was grateful that my work gave me unpaid leave, so my job is waiting for me when I go back. They have given me the space to study, they haven’t bothered me other than figuring out where the files are.
Do you have any plans for after you finish your course?
I am hoping to get a job in the epidemiology section – right now I work in the health emergency and preparedness section. Even though the titles are different, because we are a small country you end up doing a little bit of everything. I am looking forward to going back and am hoping to improve the epidemiology system. Right now, we are very understaffed so I feel like can go back and improve some of the surveillance systems, so we are better able to predict increases in cases.
What would you say to people who are perhaps interested in migrating to the Maldives and finding similar roles?
With Maldives, we have a lot of foreign doctors and nurses. In our country, we don’t have many health resources so there is a lot of demand. You get to work in very different situations, for example like a small island community. We have had medical students come and intern previously when they have requested. We didn’t have a medical school until very recently (23 years). There’s always a high demand for people from other countries back home. When you come from another setting, you bring a different perspective with you which we value.
Written by Akshata Valsanger
Written by Max Gerard A new wave of ketamine hype has swept the western world, catalyzed by the pandemic, to the point where in the autumn of 2020 some twitter users announced that the influx of ketamine jokes was considered cringe.
Ketamine
From club drug to dissociative therapy agent, ketamine’s future is now looking bright. The gradual de-stigmatization of the once scary ‘horse tranquilizer’ is leading to a new frontier of clinical research into the drug. An awareness of ketamine’s medicinal effects is hardly news. In 1985 the World Health Organization designated K an ‘essential medicine’ due to its anesthetic and painkiller properties. The drug was widely used in the Vietnam war by the U.S. Army under the name ‘Ketalar’, and to this day it’s still used as an anesthetic in Emergency Rooms around the world. This is also where it got the reputation as a horse tranquilizer, as vets also use it as an anesthetic.
At high doses, Ketamine knocks people out. This was discovered by a man called Edward Domino, who conducted the first human trials for the drug. He conducted his experiment on prisoners back in the 1960s; I’m sure the ethics committees of today would have something to say about his choice of subjects. More importantly however, Domino also discovered that at lower doses, there were some intriguing psychoactive effects in his subjects, despite them remaining lucid.
Usage
What does Ketamine feel like? In the late 1970s, a prominent doctor, researcher and (most interestingly) mystic John C. Lilly MD self-administered in order to achieve an altered state of consciousness. His description is stunning - he describes his varied experiences as “a peeping Tom at the keyhole of eternity.” - Reflect on that one for a second. In a Vice article published towards the end of 2020 titled ‘People Are Using Ketamine at Home to Escape Their Pandemic Reality’, it quotes a woman who started using Ketamine as a way of coping with the mental burden of the pandemic. She’s quoted as saying; “Some people get into witchcraft. Some bake bread. I’m doing ketamine,". Unsurprisingly there’s little data collected about how many people are starting to dabble in drugs like this, but the Vice article shares some anectodical evidence from suppliers which suggests an uptick in use during the pandemic. One reason for this might be the effects that this substance has on the mind, whereby users remain lucid
but still dissociate from their body. Ketamine is a dissociative anesthetic, and this potential widening of the gap between their perception and reality was welcome for many during lockdown, a time of heightened feelings of uncertainty, stress and loneliness. Use of ketamine has been compared to drinking a glass of wine at the end of the day –it allows people to unwind, to get away from the stressful noise of daily life in their head. It's also been used as a club drug, particularly infamously in Bristol, for the same reasons; people can remain lucid and aware of their surroundings but still dissociate their mind from their body. It’s been described as similar to weed edibles, but the come-up is slower, and with more intense effects.
Dangers
Those who use Ketamine can become dependent, and it’s easy to; people have described it as a ‘low investment’ drug. Not only is it relatively cheap, but its effects are not so long-lasting that you can’t take it in the morning and plan something in the afternoon –its effects only last around an hour. Naturally there are dangers to Ketamine; most importantly there’s a risk of overdosing, but prolonged exposure can also have detrimental effects on several systems. Dependents of Ketamine often have serious bladder issues sometimes leading to the bladder being removed, along with immune system problems and a plethora of other negative effects. Such stories of people’s bodies being trashed by Ketamine can be found online, such as the death Nancy Lee from Brighton who over 7 years slowly destroyed her body though Ketamine use, but she never exercised, didn’t eat well –she didn’t look after herself; perhaps a symptom of the lack of adequate drug education in schools.
Research
The anti-depressive effects of Ketamine are well-researched, but what’s interesting researchers now is the best way of administering the drug, as well as the best way to make use of its effects. The combination of Ketamine as a dissociative substance, which lasts for about an hour, alleviates anxiety and depression and allows subjects to remain lucid, makes it a good candidate for being used alongside psychotherapy. This is being trialed in Bristol, where the UK’s first Ketamine-Assisted Psychotherapy Clinic was launched last year. It costs £6000 and has been deemed costly by some, and perhaps lacking evidence for being used in this way. The goal for this therapy seems to be to combat treatment-resistant addiction, depression and anxiety by medicating subjects with Ketamine, which assists them in opening their mind to allow more productive psychotherapy sessions.
The Future
Ketamine has a promising clinical future. Through open-mindedness and destigmatization, we can help more patients than ever before in the world of Psychiatry, but we need to work safely, and in the most effective way possible to maximize the benefits this drug can bring.
