Archive | Heritage

AProf Bruce Chater on Dr MacLeod and #ruralwonca

Today highlighted the tribute speech given by Associate Prof Bruce Chater to the life and work of Dr John MacLeod of Lochmaddy in Scotland.

I was delighted to catch up with Prof Chater after his speech, to ask him more about Dr MacLeod’s work with Rural WONCA, how the WONCA Working Party for Rural Practice is progressing, and also for some advice to younger rural doctors on how to effect change in their own communities.

You can listen to the recording below…


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The legend of Dr John MacLeod remembered at #ruralwonca

Today’s #ruralwonca programme includes a keynote delivered by Associate Professor Bruce Chater: the Dr John MacLeod Oration.

Dr MacLeod was a legend in the world of WONCA and an inspirational rural GP.  I regret that I never had the opportunity to meet him; my own career in rural practice was just starting when he died and whilst a student experience in the Hebrides (Stornoway) was an inspiring part of my own interest in rural practice,  my travels didn’t take me to Lochmaddy.  I was running the site at the time of his death, however, and you can read more about Dr MacLeod in the obituary, eulogy and tribute that were published at the time by Dr James Douglas and Dr John Wynn-Jones.

His legacy in the WONCA World Working Party on Rural Practice is evident, and I’m looking forward to hearing more from Prof Chater’s perspective in his keynote today.

Dr Sarah Chalmers

In the last few days I also met Sarah Chalmers.  When Sarah was a medical student, she experienced an elective with Dr MacLeod and I was delighted to be able to ask her more about her experience in this podcast.  Coincidentally, she had arranged another elective which had fallen through, and it was a chance conversation at a student event with Prof Chater which led to him emailing Dr MacLeod and thus the elective was set up in Lochmaddy instead!

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#RuralGPframed – bringing rural healthcare into focus

Check the end of this article for tweets and images that have been posted online since the hashtag went live… and you can also now view most of the photos from the #ruralGPframed series at too

Image from W Eugene Smith’s “A Country Doctor”.  LIFE Magazine, 1948.

the best camera is the one you have with you

1948 saw the beginning of the National Health Service in the UK.  Many of its principles were based on the development of the Highlands & Islands (Scotland) Medical Service which was launched in 1913 following the publication of the Dewar Report into the challenges of rural healthcare in Scotland – and many consider the Dewar Report to be the blueprint of today’s NHS.

1948 was also a key moment in photojournalism, when LIFE Magazine featured the photography of W Eugene Smith. His photoessay of the work of Colorado country doctor Ernest Ceriani became a benchmark for photojournalism, and remains an iconic reference in the power of photography to provide perspective and insight. A YouTube presentation of the article is available too.

Since then, photography and photojournalism has evolved significantly.   Nearly everyone now has a quality camera-phone in their pocket.  The development of digital photography has resulted in the limits of photography being confined only to battery power, memory card space, and creativity.

Dr Greg Hamill (Arran GP) and Dr Stephen Hearns (Consultant, Emergency Medical Retrieval Service) work together using ultrasound-guided vascular access in an acutely unwell patient. (Patient consent obtained).  iPhone; 2017.

And yet, some would argue that this has had the effect of devaluing the art of good photography.  Paradoxically, because photography is within such easy reach, we sometimes fail to document episodes of experience – either as we assume someone else will be, or the immediacy of image capture devalues the art of composition, style and creative depiction.  And because so many images are produced (Facebook estimates that over 300 million photos are uploaded to its website every day), it is likely that great images fail to get the recognition and prominence that they deserve.

In just over a month’s time, I will be running a ‘Practical Tips’ session at the Rural WONCA conference in Cairns, Australia – on The Visible Rural GP: developing an image bank for modern rural practice.  The idea for this evolved through a personal interest in photography and its journalistic role, an interest in ‘how do we represent rural practice to potential rural GPs’ and awareness of projects such as  Document Scotland – just one inspirational project that aims to “photograph the important and diverse stories within Scotland at one of the most important times in our nation’s history”.

A tick that I removed from a patient who presented to our Arran War Memorial Hospital one summer weekend oncall. (Assumed consent from tick).  Canon 60D, with reversed 50mm; August 2016.

Perhaps we should be considering the need for presenting inspiring, accurate visual representations of rural practice today.

And so today, in the run-up to Rural WONCA 2017, I am committing to share (via Twitter, using the hashtag #RuralGPframed) at least one photo per day, from my own images, that depicts an aspect of rural practice.

I would be delighted for others to join me.  The more images that we can collect and share, to represent the stimulation, challenge and professional satisfaction of rural practice, the more insight that others – including potential rural GPs – will have into the opportunities that rural practice can offer.

Dr Kate Dawson (GP, Benbecula) and Dr Charlie Siderfin (GP, Orkney) during a valuable opportunity to get together and discuss research opportunities in rural practice.  Fujifilm XT1; January 2017.

What about video?

‘A picture is worth a thousand words’ but video often allows a narrative and mood to be more easily captured.  Video is important, and submissions of video are welcomed to this project.

Please remember, explicit consent is required for any footage featuring patients or anything related to them. Creativity  is welcomed!


(search Twitter)

4/4/17 Update

Within 24 hours of this post going live, we’ve had an amazing amount of coverage across the world, particularly our Australian confreres.  Keep them coming!  Here’s just a few of the tweets that we’ve picked up on the hashtag…

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New: Historical Perspectives on Rural Medicine

A key new text reflecting the development of rural practice over the last century, has just been published by the Wellcome Witnesses to Contemporary Medicine series.

Introduced by Professor Geoffrey Hudson, this volume comprises edited transcripts of two Witness Seminars held in 2010 and 2015 on the history and development of rural medicine. Participants in London and others world-wide contributing via video link, addressed the development of the curriculum for teaching rural and remote medicine; the importance of community involvement; and the growth of national and international networks and organizations. Discussion also included: the impact of specialization; professional identity and status; the relationship to other health professions; technological developments; and the challenges of isolation.

The collection of evidence for the series included input from UK rural GPs Jim Douglas, Gordon Baird, John Wynn-Jones, Iain McNicol, Jim Cox and David Hogg.  International stalwarts included Bruce Chater, Roger Strasser, Jim Rourke, Sarah Strasser, Ian Couper, Richard Hays, Oleg Kravtchenko, Tanja Pekez-Pavlisko and Jo Scott-Jones.

Subjects ranges from pre-NHS rural practice to modern day technology, and the use of that for activities such as Practice Based Small Group Learning, and initiatives such as the Northern Ontario School of Medicine, and Scottish GP Rural Fellowships.  Themes include 24-hour working, the psychosocial stresses of rural medicine, and the interface between generalist practice and secondary care.

Making this tome available as a free online PDF means it can be easily accessed and searched, including for future research activity.  You can also purchase it online at ( does not receive any commission from this).

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New research: rural recruitment & retention

rural-4In January this year, I was contacted by Pauline von Zabeltitz, a final year student at the University of Aberdeen, who was studying for an MA (Hons) in Economics and International Relations.

For her dissertation, she was keen to explore the various projects and initiatives being used to improve recruitment and retention to rural GP practice in Scotland.

Pauline has very kindly agreed to having her dissertation published on in order to share the analysis that she has undertaken over the last six months.  Her report provides yet more substance behind some of the core issues that we know affects rural recruitment & retention, whilst providing another perspective and some new ideas to add to the present work on this area.

Coming from a family with a strong medical background, healthcare related issues have always been of great interest to me and throughout my degree, I got the chance to explore this topic further through a Health Economics course. Discussing Health Economic issues and policies led me eventually to my final Dissertation topic, writing about the recruitment and retention issues in rural Scotland regarding healthcare providers such as GPs.

Specific issues highlighted include rural connectivity, access to undergraduate placements and the GP Rural Fellowship scheme.  She manages to cover a wide spectrum of other considerations, and some evaluation of present approaches to this problem.

You can download her report by clicking on the button below.

An analysis of current initiatives targeting the recruitment and retention of GPs to remote and rural Scotland [1.4 MB]


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Belford 50:150 Conference: 22-25 October 2015

belfordhospital‘Tis the season it seems, to start looking at what events are happening over the autumn and winter months.  Here’s a new one, which looks exciting and a great chance to join a wide range of fellow clinicians from rural medicine across Scotland and beyond.

The Belford 50:150 Conference will mark the 150th anniversary of the opening of the Belford Hospital in Fort William, and the 50th anniversary of being on its present site.

The Belford Hospital serves a large area of rural Scotland, and as a result has been responsible for producing innovative approaches – and some fantastic characters! – in the provision of rural healthcare.  The conference is aimed at a wide range of attendees – and there is an impressive line-up of speakers from Scotland and beyond covering a stimulating and interesting range of topics – including mountain rescue, difficult ‘oncall’ scenarios,  international perspectives, and reflections from Belford alumni on what their Belford training has done for them in their subsequent careers.

Some of the most recent 'graduates' of the Belford Hospital

Some of the most recent ‘graduates’ of the Belford Hospital

There’s also a social programme, featuring a ceilidh on the Saturday night, and I suspect there will be lots of reunions happening too.

Kudos to current Belford consultants Patrick Byrne and Sarah Prince for putting together such an attractive programme.  I’m booked and hope to see you there.

NB. Closing date for abstract submissions is Friday 28th August – full details on the website.

> Belford 50:150 Conference Website
Belford Hospital image used under Creative Commons licence: N Chadwick
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Inside the rural NHS: Steve McCabe


Portree, Isle of Skye

This podcast interview from Bateman Broadcasting was published just last week, and I think gives a real insight into the present challenges and highlights of working as a GP on the Isle of Skye.

Dr Steve McCabe, of the Portree practice, gives his views on what needs to happen to make rural practice more attractive and sustainable.

A recommended listen!


Photo by Jack Torcello, Creative Commons
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TV alert: Dr MacLeod of North Uist (tonight)

videoiconNews just in about a TV programme tonight on BBC Alba (with subtitles for those of us not fluent in Gaelic!)…

Dr Alexander MacLeod was the first doctor of the Isle of North Uist, looking after 3,000 people on 16 inhabited islands for more than 40 years. Hailed as the last traditional rural doctor of his kind, Dr MacLeod was also recognised as a visionary who brought healthcare to thousands.

An Dotair Mor, a one hour programme to be broadcast by BBC ALBA, tells the story of how the legendary doctor was appointed under the Highlands and Islands Medical Service in 1932 at a time when there were no vaccines available to prevent deadly diseases on the remote Scottish islands and healthcare was only available to those who could afford it.

The programme An Dotair Mòr will be broadcast on BBC ALBA on Monday 29th December 2014 from 22.00 to 23.00. featured the work of Dr Alex – and subsequently his son John – in October 2013.  You can read the article here.


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Tribute: Mark Bloch

mbMany of Scotland’s rural GPs will have benefited from the wonderful teaching skills of Dr Mark Bloch, who died on Saturday 18th October, 2014.  A passionate provider of prehospital care in his home town of Aberdeen, he also helped to encourage and enthuse many participants of BASICS Scotland‘s prehospital care courses.  A respected teacher, clinician and strategist, Mark was involved in a wealth of activities; he was a man in demand and yet had the knack of remaining approachable, fun and personable.

My principal memory of Mark is lying with him in a muddy ditch during a practice extrication of a casualty, whilst stabilising the casualty’s cervical spine during a PHECC Course at Douneside, Aberdeenshire.  He had the credibility of someone who had lain in many muddy ditches ‘for real’, with the sorts of tips and tricks to ensure optimum casualty care that only comes with experience.  Sometimes experts can seem remote, but Mark had an ability to become an engaging mentor during teaching.  It was clear that instructing was a role that Mark loved.  That softly-spoken Zimbabwean voice, which somehow seemed incongruent to his level of clinical acumen, combined well with his practical thinking: I can easily imagine the empathy and sensitivity that this would bring to a real-life prehospital incident.

Mark had seen lots, from young children involved in serious road accidents, to incidents where, perhaps frustratingly, the focus of care turns away from ABCDE and more towards ensuring comfort and dignity.  His determination to provide quality prehospital care is something that many of us can associate with; along with the underlying concern that switching off-call for a night might lead to regret the next day, and yet striving for some level of work-life balance.


Mark, second from the left, with other founders of the Sandpiper Trust Farmer’s First Aid Course

Mark progressed from Milton High School in Zimbabwe to do medicine at the University of Cape Town, South Africa.  After training, he had a consultant post at the Groote Schur Hospital before moving over to a consultant post at the Chelsea & Westminster Hospital.  It was during this time that he developed his interest in simulation training and the non-technical skills now referred to as ‘team resource management’.  This interest has continued since his move to Aberdeen in 2005.

Aside from Mark’s BASICS Scotland activity, his work showed he was at the top of his game:  Consultant Anaesthetist at Aberdeen Royal Infirmary, and the Royal Aberdeen Children’s Hospital; Clinical Lead for Bond Helicopters and Jigsaw SARH;  Honorary Clinical Senior Lecturer at Aberdeen University; and active member of the Grampian Immediate Care Scheme, which also saw the recent introduction of the prehospital response car based at Aberdeen Royal Infirmary.  In 2012 Mark was awarded the Queen’s Jubilee Medal in recognition of his contribution to emergency care in Scotland.

The immediate sense of loss felt by Mark’s confrères in BASICS Scotland – and the wider circles of prehospital and emergency medicine – is clear to see by the number of tributes on Facebook and Twitter. There will be many others who have shared a muddy ditch with Mark, and benefited from his enthusiasm for prehospital care.  We are so sorry to see that enthusiasm cut so tragically short.

Our thoughts are with his family at this time.


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‘From Cart to Air Ambulance’


Papers from a conference celebrating 100 years of healthcare in Skye & Lochalsh

Skye & Lochalsh Archive Centre have come up with this fantastic collection of papers which document the history of healthcare in their local area.  Against the backdrop of the 1912 Dewar Report, they have collected an insightful range of anecdotes, figures, stories and analysis of the healthcare situation over the last one hundred years.

Chapters include:

  • Dewar and the Highland Hospitals
  • Highland Medicine before and after Dewar
  • The Gesto Collection: Dr Lachlan Grant and some Predecessors at Edinbane

Even better, is that this resource is available for free download, and the Dewar Group would highly recommend a look.

Congratulations to the Archive Centre for coming up with such an interesting piece of work.

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