Intended for healthcare professionals

Views & Reviews From the frontline

Call of the curlew

BMJ 2007; 334 doi: (Published 12 April 2007) Cite this as: BMJ 2007;334:802
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    My face clung to the seats as I crossed the Pentland Firth for the first time. As the boat lurched and rolled again, the sound of cattle, terrified in the hold, resonated throughout the ship. I was unable to raise my head for fear of heaving. The Orcadians, welly booted and boiler suited, laughed and joked through cigarette smoke as they chewed on bacon rolls. I wanted to bawl.

    Ten years later I stood on the deck, drenched in sea spay. I chewed a bacon roll as the boat heaved and rolled fiercely. Basketball booted and stretch jeans suited, I clung to my new PVC Woolworths suitcase. In life it is often easier knowing what you don't want—I turned my back on Orkney.

    City life is very different from the remote island life of my childhood. Cities are polarised communities, divided by deprivation and wealth, and foreign to each other in almost every way—schools, health care, transport, and lifestyles. Each community is a remote island in the midst of the city. In theory all general practitioners do the same job, but in reality urban and suburban practices are different countries, with their own language and customs.

    A friend of mine returned to take up a GP position in Orkney, and many other professional people have returned home to Orkney over the years. Why would they choose such a small and closed environment?

    Remote communities offer limited choice in all things but especially in education and health care. There is therefore a strong vested interest in making public services work, with the most influential people in the community having no opt out clause. There is also a lack of anonymity in remote communities—people know you from primary school. Whether you become a doctor, lawyer, or member of the Scottish parliament, you have little scope to take up pretensions on an island, or you will soon be reminded of the time you cried for your mummy. Lastly, families are more stable because they have remained for generations in certain areas—consequently there is no faceless crime in a small community. The bottom line is that a community that is raised together stays together—it works.

    Many of the social and medical problems that we face are a product of the widening schisms in our society—and all communities are the worse for it. Despite all the superficial sophistication of our urban existence, there is much we can learn from rural communities. With the absolute certainty of youth long gone, I wonder if I was right to leave.

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