Travel doctor Jenny Visser talks mobile medicine and exotic bugs
Travel doctor Jenny Visser mixes business and pleasure in exotic locations.
On the long trip home from Antarctica, Jenny Visser broke open suture packets and set the NIWA scientists to work.
The ship's cook had saved pork flaps especially for the task - a workshop on sewing people back together in case of an onboard emergency.
As the Tangaroa rolled in the Southern Ocean swell, voyage leader and biologist Richard O'Driscoll tried to join the pieces of slippery pig skin.
"It's not as simple as it looks to put a stitch in someone and tie it up nice and neatly. I'm better at dissecting things than putting them back together," he jokes.
The messy exercise also highlights the common thread binding the patchwork of experiences making up travel doctor Visser's varied career. From running a film crew first aid station from a lava lava on a remote Bougainville beach to treating Nepalese porters at a clinic higher than Mt Cook and six days walk from help, success has depended upon learning to do what she could with the barest of essentials.
It's a skill grounded in the very best of old-school medicine - clinical diagnosis based on what you see, hear and know. And it's a skill Visser fears this generation of technology-dependent doctors are losing.
Safely back on dry land after her fifth Antarctica trip as ship's doctor, Visser still looks ready to jet off in a flash.
An indestructible Baby G replaces a dress watch; her wallet comes in a flight-regulation clear ziplock bag. That's for the night mountain-biking session she's been doing every Thursday since teenage son Christopher was a baby, she explains.
There's a restless energy to Visser, who fell in love with travel in the late 1980s, during two years touring, mostly by bike, with husband-to-be Mike.
It's probably inevitable in a workplace that trades flu warnings for "Prevent rabies" posters and world maps. In place of snotty kids and stressed mothers, the Travel Doctor's waiting room houses a young woman poring over a Lonely Planet Africa guide and a uniformed airman preparing for some overseas mission. Behind reception are photos of dark faces in exotic places.
"You're seeing healthy people, by and large, going off doing something they're really looking forward to and they're coming to you for preventative healthcare information. That's a bit of a luxury in clinical medicine," Visser says.
Pursuit of luxury is nonetheless not a life-goal for Visser. Quite the opposite - the adventure of adversity seems to appeal. She has braved sea-sicknessness to work in an environment often dubbed a prison with better food; she's treated film crew in tropical heat from a ship where power constraints meant deciding between toilet-flushing or air conditioning; she's worked at a clinic in air so thin that she would wake, oxygen-deprived, to a sensation of suffocation.
Growing up in the Hutt Valley in the 1970s the 54-year-old always wanted to be a doctor. But in those days travel medicine was barely a thing.
She did a degree in zoology and botany at Victoria University before completing medical school at Otago University. Even in those early days she knew she wanted to be a GP, partly because they were seen as underdogs (that attraction to adversity again).
Before specialising, she and Mike bought one-way tickets to Los Angeles and roamed for two years. Visser's parents Celia and Herman had emigrated from Holland in the 1950s but she had never been there. She'd never been anywhere - this was only her second trip overseas, the first being her medical elective to the Cook Islands in her final year of medical school.
Visser has that knack for being in the right place at the right time. During that 1989/90 trip she and Mike found themselves cycle touring in Eastern Europe within weeks of the Berlin Wall coming down. They crossed from West Germany's beautiful autobahns to time-warp villages with cobblestones and potholes.
In Czechoslovakia the front derailer on Visser's 21-speed touring bike broke. At a specialist bike shop in Prague they pointed to the necessary part - the owner just laughed.
"In Bulgaria, if you saw a queue you joined it. You didn't know what you were going to get. There might be a loaf of bread or a packet of chocolate biscuits."
The couple's tiny Macpac mountain tent with its click-clack poles and their early thermarest mats caused crowds to gather at campsites. Occasionally, the gatherings would get aggressive, mistaking the tall blonds for German tourists.
The trip had Visser well bitten with the travel bug. It's the pinch-me moments of seeing the famous sites you've seen so many times in movies or photos but never expected to see up close. It's exploring a different way of doing things from the monocultural Lower Hutt of her upbringing. It's anchoring in Terra Nova Bay on a beautiful afternoon and looking out at a vista of snow and ice and knowing that it's an environment many will never see.
Or it's hearing, while soaking your clothes in insect-repelling permethrin for your imminent trip to South Africa, that Nelson Mandela has died and knowing that the link you forged when facing down the Red Squad at Athletic Park during the 1981 Springbok tour is about to be further cemented.
"Initially I thought gosh I hope that's not going to fuel political unrest. But it was a really special time to be travelling, because there was a lot of reflection in South African newspapers and among South African people about whether black South Africans were better off than they were."
Visser was a family doctor in Ngaio for about 13 years before taking Otago University's new travel medicine paper, in 1998. Within two years she was running the travel and wilderness medicine programme, which she still does half time.
She began working part time at Wellington's newly opened Travel Doctor in about 1999. Since then she's been advising everyone from everyday Kiwi travellers off on their big OE to missionaries taking their families to deepest, darkest Africa.
It's mostly preventive medicine - vaccines, anti-malarial drugs, risk advice to agencies such as police, military and volunteers going in to help in disaster areas such as post-earthquake Nepal.
But there is the occasional tropical nasty that makes it across the border. Visser has had emailed pictures of round worms fished out of toilet bowls. Then there was the impressive botfly, whose larvae burrows under the skin and has to be lured out by attempted suffocation.
"It's fantastic fun," Visser bubbles enthusiastically.
There's also the odd sports star thrown in. Visser, who admits she doesn't know much about rugby, laughs that one of her least celebrated moments as a travel doctor was when she suggested the All Blacks get yellow fever jabs, which can cause flu-like symptoms, the week of a test match.
"The rest of the staff were absolutely aghast. I can just see the headlines: 'All Blacks lose test match due to travel doctor's ill-timed advice'. It was absolutely classic."
When Visser saw an advertisement for a ship's doctor for a seven-week Antarctic voyage 15 years ago she thought "What a dream" and, in the same breath, "But I could never do it". Christopher had just turned three. Within 24 hours she had talked herself around.
"These things often don't arise at a time that's convenient but you've got to seize the day."
It's that relentless positivity that makes Visser the ideal shipmate, says O'Driscoll, who was voyage leader on this summer's Antarctic whale-watching voyage and also sailed with her on a 2008 Antarctic trip.
"Jenny is one of those people that will have a smile on her face and be enthusiastic."
Ship's doctor is a tricky role, O'Driscoll says, as the perfect voyage is one where Visser is unemployed. But rather than sitting around waiting for something to happen, she puts her zoology degree to use, helping sort the spineless creatures they drag from the deep.
Visser is often asked if she is terrified that she will have have to deal with a major medical emergency. The worst she's encountered so far was someone knocked unconscious, which kept her on her toes for a few days.
Advanced technology has raised expectations, allowing a patient's vital signs to be live-monitored from shore and opening the possibility of tele-medicine. But wilderness medicine is essentially about learning to trust your skills and work with what you've got, Visser says.
To make things more interesting, she gets horribly seasick.
"The joke always is if you really need the doctor in the first three days you are going to have to find her in her cabin. I've got a grab bag sitting there with all the anti-nausea drugs, so I can minimise movement. I think it's worth it for the excitement of being in a place that so few people get to go to."
Visser also suffered for her art while volunteering in Nepal's Gokyo Valley for three months in 2009. Having trekked the Annapurna Circuit in the 90s, she was keen to give back.
In Machermo, a tiny village at 4400m, the International Porter Protection Group runs a shelter and medical clinic for porters, who sometimes resort to sleeping in exposed rock shelters as trekkers crowd out their traditional tea house accommodation. It was a six day trek to reach the clinic, so supplies were limited and the only way out in an emergency was by helicopter or walking.
Visser was one of two doctors running the post, treating porters for free but also treating villagers and trekkers as needed.
She never fully acclimatised to living at an altitude far higher than Mt Cook summit, depending on mountain sickness medication to prevent breathing problems at night.
"It's the most terrifying thing - you fall asleep and then your oxygen levels drop really really low. You're not going to die because that prompts your body to start breathing, but you wake up feeling like you're suffocating."
On quiet days, Visser would read books, roam the area or just gaze out at the icy landscape. On busy days she would treat anything from severe altitude sickness to traveller's diarrhoea.
She also gave lectures to trekkers about porter health. While most major companies now have insurance for their porters, independent porters can still be overburdened, poorly equipped in sandals or jandals and even left to die when sick.
The experience changed the way she thought about trekking. It also emphasised the importance of making do. There were no x-ray facilities or lab tests so your only guide was your own clinical judgment, backed up by excellent history-taking and examination skills.
It's a skill Visser fears modern medics are losing, as they become increasingly dependent on diagnostic tests and technology.
She had only one death on her watch - a tragic case of a Nepali guide dying from methanol poisoning from the local jungle juice. She suspected the diagnosis but had neither the skills nor equipment to help and a helicopter could not be summoned in time.
As if the challenges of the job weren't enough, at the end of her tenure Visser and her husband cajoled Christopher, then 11, over the 5000m Cho La Pass.
In 2011, a Mister Pip film crew representative called Visser to discuss Bougainville. She thought they just wanted advice. "Don't you need a doctor?" she said hopefully.
She'd already visited the primitive islands on a factfinding mission for police, while acting as their medical adviser for overseas deployment, so she knew what she was getting into. What she didn't realise was that the crew accommodation ship would be a fraction Fawlty Towers.
"The air conditioning survived two days. Every time they tried to get it going the pumps would stop working. Then it was a choice - do we keep the air conditioning going or do we flush the toilets."
The toilets won.
By 6.30 or 7am most days Visser would have lugged her dry bag and suitcase of equipment to wherever the day's filming was taking place.
Her job was to look after the crew, plus the actors when necessary. (She's coy about her dealings with lead Hugh Laurie, but says all the cast got at least one scratch or graze needing treatment) The trouble was that, at times, the actors included the entire village.
"Every day I'd set up a first aid station. Sometimes it would be on a lava lava on the beach. Sometimes I'd have a table or I'd just be sitting in the jungle on my first aid case. As soon as you were there, all the mums and dads would line up with the kids with their skin infections."
While treating locals was great public relations, Visser had to be careful not to usurp the local health system. The Wontok cultural system also demands that anyone found responsible for another person's death is beholden to their family.
Visser has a policy when travelling of only treating patients if she can follow the treatment through to completion. In one case that meant turning away a villager with a very high fever who might have had malaria or dengue fever. Instead the crew transported her to the nearest hospital and paid for an appointment.
In spite of the challenges, Visser would return in a flash. She'd also like to return to Nepal to help with the post-earthquake rebuild.
"Who knows what will come," she says.