Captain Neary preparing for armoured patrol.

Captain Martin Neary, thank you for agreeing to this interview for the ISMM and we want to wish you a very warm welcome back from UNDOF Syria. Can you tell us a little about your medical career up to now?

I graduated from NUIG in 2008, after which I carried out my internship in UCHG. I then completed my Basic Surgical Training scheme. My specialty interest prior to joining the Defence Forces was in Trauma and Orthopaedics, in which I undertook lab research in the form of an MD after my BST. I was commissioned into the Army Medical Corps in July 2012, and have been serving as a Medical Officer since then.

What attracted you to join the Medical Corps as a Medical Officer?

The Defence Forces was something I had always considered as a career option. I toyed with the idea of joining the cadets, but finally decided to pursue a medical career. However, my interest in the military never waned, and I always looked at a way to combine the two careers. When I saw the role of the Medical Officer, I thought that it was a job that I would enjoy. I was attracted by the variety offered by the job, the chance to serve as an officer, the sense of adventure, and also the opportunity to do an overseas tour of duty.

How does your current job as Medical Officer in the Defence Forces compare with your work as an NCHD in the HSE?

I don’t think it’s entirely fair to compare the two, as they are different in so many ways. I find that being a Medical Officer has given me more job satisfaction. In the Defence Forces, you have more autonomy, whilst still functioning within a structured medical framework. Also, I have found that it is easier to build up good doctor/patient relationships, as our patient base is smaller than a HSE service, and you have more contact with them.

Can you describe your average working day as a Medical Officer here in St. Bricin’s Military Hospital?

Our day commences at 9am with sick parade. This is similar to a GP’s surgery, and is the period of the day where we look after acute presentations. For the remainder of an average day, we conduct the Occupational Health aspect of a Medical Officer’s practice. This involves seeing soldiers for their occupational medical examinations, which they require prior to overseas deployments, participation on courses, and extension of their contracts. We also conduct screening medicals on potential recruits and cadets for the Defence Forces, to ascertain their fitness for a military career. In addition to the above mentioned duties, we also participate in educational activities, be it as instructors to other soldiers, or as students to continue our professional development. Other duties include providing medical cover for exercises and artillery and infantry support weapons live fire exercises, as well as compiling medico-legal reports and, on occasion, being called to court as expert medical witnesses in cases involving the Defence Forces.

How do the pay and conditions in the Defence Forces compare to working in the HSE?

The pay rates are quite competitive in comparison, and there are additional allowances available that increase the base salary. In addition, funding is available for professional development courses. I find that the conditions are quite favourable, as the hours are regular, and generally the working week is Monday to Friday.

How did you find the move to a military environment?

The move from a medical point of view wasn’t very difficult at all. I found it quite easy to adjust and slot into the mentality and requirements of a Medical Officer. However, the adjustment to the military aspect of the job took slightly longer. There can be a lot of administration and procedures to follow, as well as the adjustment to the ranking structure and chain of command. One difference that I found between civilian and military medical practice is that the focus and duty of care as a military Medical Officer are not just centred on the patient, but also have to take into account the responsibility to the organisation. The primacy of the mission is paramount in a military setting, and this creates an interesting change in your mind-set when seeing patients.

How were you prepared for your mission with UNDOF in Syria?

I felt that I was well prepared for my tour in Syria. As part of our ongoing training, Medical Officers remain current with their ACLS and ATLS qualifications. Prior to any overseas deployment, we spend time in a busy Emergency Department to enable refreshing and updating of our skills. I also underwent the pre-deployment training and mission readiness exercise, which assess the skill set that will be required during the tour.

Can you give me an idea of what your daily routine was on overseas service in Syria.

Daily routine in Syria consisted of two sick parades for Irish troops every day. In addition, a civilian clinic was conducted. Outside of sick parade, I was involved in other duties, including administration and medical training. As part of the Quick Response Force (QRF), I was on standby at 15 minutes notice to move to deploy to any potential situation as part of the ambulance crew. The QRF was deployed quite frequently, and also conducted regular patrols.

What medical kit did you carry on you when you were out on patrol?

I conducted patrols as part of the QRF. An Armoured Personnel Carrier Ambulance deployed on all QRF patrols. The MOWAG PIRANHA III ambulance was fully stocked and equipped, and is capable of transporting two stretcher patients and 2 seated patients. In addition, I carried personal equipment in the form of a Blackhawk tactical medical bag. This contained all the required supplies to administer pre-hospital emergency care. It contained emergency medications, analgesics, cannulation sets, IV fluids, plasma expanders, dressings, spinal collars, airways and intubation equipment, diagnostic equipment, suture kits, and triage cards. Other specialty items that may not be present in a civilian doctor’s medical bag included CAT tourniquets and haemostatic dressings for haemorrhage control, and intraosseous access drills and needles.

What kind of casemix did you have in Syria?

The caseload for our tour was varied, interesting, and at times unique. We attended to the day-to-day needs of the UNDOF troops, which has included conditions such as the inevitable gastroenteritis, respiratory tract infections, soft tissue infections, and minor injuries and sprains. As we had very good facilities in our camp hospital, including inpatient admission beds, most cases were treated without the need for onward referral. Every day, local Syrian civilians could come to the camp for medical assistance. The majority of these patients were treated at the gate for minor ailments, but the more serious cases are brought to the hospital for treatment. Most of these cases involved the treatment of burns, including follow-up dressing changes. In addition to the routine clinics, we provided a 24 hour emergency care service for the locals. These emergency cases broadly fell into two categories- paediatric emergencies or trauma, and adult victims of the civil conflict. I treated a choking child, paediatric head trauma, open fractures, anaphylaxis, and lacerations. With the ongoing conflict, we saw a number of casualties, including victims of gunshots and explosive trauma. These type of injuries meant that needle thoracotomies, application of tourniquets, aggressive resuscitation, and emergency department life-or-limb surgery became mainstays of our treatment repertoire. We successfully treated patients with severe trauma, including tension pneumothoraces and penetrating head injuries caused by shrapnel. Our mandate allowed us to treat civilian patients and stabilise them sufficiently, before we transferred them to a civilian Syrian hospital.

How close were your working relationships with Doctors from other UNDOF participant nations?

We developed very close working relationships with the Doctors of other nations. We had medical staff from Fiji, the Philippines, India and Nepal. As we were working in close proximity, we came to know each other very well. This resulted in new experiences, as we learned about different cultures. It also meant that there was an exchange of ideas over medical matters. We had monthly medical meetings where members of each medical team presented on different topics. We also conducted multi-national exercises to increase our efficiency working together, which were very successful. Overall, we formed close relationships, and friendships, with the other doctors.

Apart from your clinical commitments, what other duties did you have to fulfil as an overseas Medical Officer?

As a Medical Officer overseas, your job entails more than just looking after the medical needs of the troops. There are many facets to the job description. An overseas MO acts as a dispensing pharmacist, a hygiene officer, a lecturer, a personnel manager, and a counsellor. As we had our own stock of medications, every tablet dispensed must be recorded and accounted for. The MO also supervises the regular inspection of accommodation and ablution facilities, as well as the regular testing of water supplies, and also testing of the food handling personnel. An important part of my job was to provide ongoing in-theatre medical training for both the medics, as well as the general troops.

Did you enjoy working overseas and were there any particular high points of your tour of duty?

I thoroughly enjoyed my time overseas. The job is interesting and exciting, and changes on a daily basis. You develop a great camaraderie with the other troops serving, as you are all in it together. The homesickness can be hard, but aside from that, overseas is my favourite part of being a Medical Officer. There were a number of high points for me during the tour, so it is hard to pick just one! From a medical point of view, the successful treatment of two civilians who had been severely injured in a mortar strike rates as a very high point. As this was my first deployment, I enjoyed the medal presentation parade, which took place on St Patrick’s Day, and the atmosphere was great. Having joined the Defence Forces to experience overseas, the tour definitely delivered in that regard.

Captain Neary, thank you again for taking the time out for this interview. The ISMM wants to wish you all the best for your future career in the Medical Corps.