Day 12 -Last rendez-moo of the module

Today was our last organised day of activities before having two days off to prepare for our presentations on Friday. We travelled a few more miles, this time to Larne Market Yard (bringing the tally to 695 miles) for a ‘Focus on the Farm Family’ event. This was part of an initiative run by the Northern Health and Social Care Trust, Rural Support, Health and Safety Executive and the Ulster Farmers Union, all bodies I have had some contact with over the course of the SSC, with the aim being health promotion among farmers in the local area. Each farmer attended a health check with the farm families health checks team, and now attends a monthly workshop on an issue pertinent to their health. Today’s presentation was by the GP Ruth and I were with last week, and he was trying to put across the point that the most valuable asset on the farm is not the machinery, land or livestock but the farmer themselves, with their wide skill set and experience. In true rural style everyone had a good feed which was an opportunity for chat, including to a lady who was involved in setting up Rural Support!

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The programme of events

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It’s hard to believe my time on this module is coming to an end. Apart from an excuse to make lots of baaa-d animal related puns, it has been a real opportunity for me to further my skills as a future doctor. As a doctor, I believe it is so important your services are accessible and acceptable to all of your patients, not just urban dwellers who have public transport links and the ability to take time off work readily for an appointment. However while your services should be equitable in that they are available to all, I have learnt that the health issues farmers in particular may have, and how they present, may be unique, and it is vital clinicians recognise this. Working on the farms and getting to know farmers individually has given me a truer insight into their lives, on a much deeper level than I could ever have got from reading the news or studying an article – when you hear someone talking about people they know personally who have been in farm accidents, or how the price of milk affects their own family, it is hard not to be affected. I am all too aware that I have had a really positive experience on the farms I have visited, but I am in no doubt that this is not an easy life, and with Brexit on the horizon things look set to remain uncertain. There’s been a certain camaraderie among the five of us studying the module, all to some extent taken out of our comfort zone yet working together to support and help each other throughout, and I know this ability to get along with colleagues will be vital in my future career. Team work and communication is just as vital on farms and in veterinary practices as in the hospital, and the ability to empathise with patients from all backgrounds will be vital for my future practice.

It’s almost time for my brief adventure into rural life and farming to end, and to swap yards for wards and waterproof trousers for scrubs. I have thoroughly enjoyed the whole module, from watching calves being born to hearing farmers consult their GP to seeing farmers help members of their community through social farming, it has been an amazing experience. Perhaps being covered in all sorts of animal bodily fluids is what I will miss least about the module! I definitely have a few extra skills (still some perfection of them necessary!) to add to my CV – including milking, cow/sheep counting and predicting poo trajectories. I have got to appreciate parts of Northern Ireland I had never visited before, and enjoyed uninterrupted views of sunrises, sunsets and rolling hills while surrounded by an array of animals (an expert farmer, after all, is out standing in his field). I have learnt so much more than purely about the many challenges facing Northern Ireland’s farmers today, and their way of life. I have learnt a lot about what should be valued about our rural communities – their generosity, kindness and straight talking, which combine to give a spirit of helpfulness that will not see anyone stuck. As I go back into hospitals, I’m going to try and take their attitude with me, and so recreate a little of the country in the clinic!

Thanks should go to everyone who has been involved in this moo-dule and made it such a great experience – it truly has been a baa-rilliant insight into the agriculture industry. Now it’s time for me to do some work, and prepare my presentation for Friday!

Day 11 – A ewe-nique life

Today Ruth and I had another early start and headed baa-ck to the Ards peninsula for a day on a farm, this one predominantly sheep (numbering over 600 – you’d fall asleep long before you finished counting those), with some beef cattle, cereals and willow also grown.

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The perks of an early start…

We were welcomed into the farmhouse for a cup of tea with the farmer and his parents, and had a laugh at a sign in the kitchen – ‘ewe’s not fat, ewe’s fluffy’ – a good motto for us perhaps, given the copious amounts of food we have been given this module! We heard a little about the farm and how it functions before going out to the shed where some of the ewes were dosed for worms – in contrast to the solution that was used at the dairy farm which was poured on the cows’ backs, this one has to be swallowed and so required a little more precision! Various lambs were moved about and some went through the foot bath to try and prevent foot rot, ever a problem in damp NI. They were happy to trot through the foot bath but less so when they saw the clippers come out, a necessary task to ensure the future health of the flock.

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All this waiting makes me sheep-y zzzz

We then headed to a nearby farm with the farmer for a meeting of local UFU members with representatives from UFU headquarters. Ruth and I felt quite out of place with our relative ignorance of the issues farmers face (although we would have felt worse had we been there at the start of the module!), but were made very welcome by everyone, albeit after a heart stopping moment when we were asked how long we were talking for! My short stature once again proved problematic as we heaved ourselves up onto (surprisingly comfy) bales for the duration of the meeting, and my feet dangled a good foot off the ground. What followed was a chance for the UFU staff to talk about the main issues as they see them, followed by a chance for discussion and the farmers to raise their own concerns. It was great to see the UFU in action, having heard about their work at the start of the module (https://frombaatoahh.wordpress.com/2016/09/06/day-1-moo-beginnings/). Unsurprisingly, Brexit was much discussed and lots of speculation took place, along with the challenges of working with environmental campaigners and the price differential between here and mainland UK – this really shocked me, I never knew that meat of the same value would fetch a significantly lower price in NI than elsewhere in the UK. Being at the meeting was a baa-rilliant insight into the opinions of farmers in this area, although we were glad to head back to the warm farmhouse for a roast dinner!

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Meeting – Farmer style

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Much of the afternoon was taken up with preparing the lambs that were going to be sent to the abattoir. Each needed to be checked and weighed, before their tag numbers and details were recorded (Ruth and I took this very seriously but were glad we avoided the less enviable task of shaving the wool off around their bottoms). They were then sorted into pens and we were told to count them, all the while resisting the urge to fall asleep! I can confirm sheep are even harder to count than cattle – they are all identical, love to move around and some sheep themselves are even sleeping and obscured! All too soon (for the lambs, at least), it was time to say good-baa and put them onto the lorry for their one way journey – it was bye bye, black sheep – and there was mutton to be done for them, it was time to face the chop! (Admittedly Ruth and I were rather more sentimental about their fate than the farmers!) Various paperwork has to be filled out to ensure the traceability of the lambs, and fulfil other regulations, and while this wasn’t a problem for the farmer we were with, in a survey carried out in England and Wales 62% reported that paperwork and record keeping was causing them stress (article available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1757527/ – ‘Stress in Farmers: A survey of farmers in England and Wales’.)

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Counting sheep

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(Wo)Man’s best friend

Work on the farm continued with another set of lambs to be dosed and returned to pasture, before we saw the willow fields and biomass boiler, an important part of diversification for this farm. It was hard to baa-lieve it was 5.30pm and our time on the farm was over – I had a great day and really enjoyed getting a bit more of a flavour of what life is like for farmers in NI, the challenges they face but also what they are doing to overcome them. All the farmers I have met have had a really strong resolve to try and improve things – they are not the kind of people to sit around and complain if they could be doing something about it themselves!

Day 10 – TB or not TB

Today I returned to the veterinary practice for the last time, marking the end of my week on placement for this module. Miles travelled this week brings the total up to 555 miles for the module – and today certainly featured a lot of mud (and worse) and (veterinary) medicine.

To start the day I headed out with one of the vets to read TB tests that had been carried out on Tuesday. I felt like I was in ‘All creatures great and small’ as we drove through the Antrim hills in a Land Rover that had enough supplies to qualify as a roaming veterinary practice! TB testing has to be carried out annually, and is a huge source of stress for farmers, who know if one of their herd reacts they face the prospect of having to cull cattle and further rigorous testing before they are allowed to sell cattle on from their farms. (Link to document on the control of bovine TB in NI – http://www.bovinetb.info/docs/Bovine_Final.pdf ) We visited two farms, one a dairy and one for beef, where all the cattle older than 6 weeks were injected with avian and bovine TB on Tuesday and today were checked for any differences in the resultant swellings. Both farms we visited were given clear tests, which was obviously a huge relief for the farmers. On explaining what I was doing, (aside from writing down the results, staying well clear of the crush and attempting to slip n slide my way across the slotted slurry tank), they responded that ‘sure a farmer dis’ney go to the doctor’, and one went on to explain how they waited three days before going to the doctor after sustaining an injury. Neither would leave it that long to seek help if one of their animals was showing signs of distress!

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All done and ready to mooo-ve on

We headed back to the practice for lunch, where I saw a dog get a growth removed from its paw and walked/looked after/played with an adorable Andrex puppy!

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Soft, strong, and very very cute!

I soon learnt that heifers have unexpected pregnancies too, when a farmer arrived in with a heifer he had been trying to sell only to find out they thought it was pregnant. Sure enough, the vet confirmed (and not by a blood test – more of a bum test whereby she was left in no doubt of the result) that the heifer was over 6 months pregnant. That cow was barely out of the crush before another arrived, this a cow that had become lame. It transpired that it had an abscess in one of its hooves, which was cleaned and dressed before the other toe had a special shoe fitted to it (made to measure – Cinderella the cow?!) to take the pressure off the abscess – essentially that toe is given a high heel (someone did tell me cows are real divas!). I feel like I should revise my list from day 8 to include another challenge of working with animals being the real hazard of getting kicked – here’s hoping not too many of my future patients bite or kick me!

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If the shoe fits…

My time at the vet’s is over, and I’ve picked up a few things (and not just puppies and kittens) about life in a rural community. I have the utmost respect for what vets have to do as part of their work, and the environment in which they do it – I will never complain about an air conditioned hospital being too cold, having stood testing cattle in a stiff Autumn breeze (literally mild compared to winter ice and snow!). The chance to meet some more farmers and hear about their priorities has given me more of an understanding of the issues they face, but I feel that their perception that their own health is not a priority is something that needs to be urgently addressed. While I’ve enjoyed my time at the veterinary practice, I don’t think I have a) the muscles or b) the resolve (I’d take everything home with me if I could, from calves to kittens) to work as a vet and so I’m looking forward to getting stuck back into medicine after this module.

Day 9 -Clutching at paws for a title…

I was out at the veterinary practice again today, where I saw a couple of minor procedures carried out on dogs and played with the kittens. I observed some of the consultations that took place in the clinic and was struck by the communication barrier that exists when dealing with animals, and how there is only so much one can learn from a history taken from the owner. I am glad that for the most part, many of my patients will be able to talk to me themselves, but for those who cannot due to extremes of age or illness then I will have to take a similarly detailed history from family members. I also took a loveable St Bernard for a walk – all the while contemplating which of us actually weighed more! (Childhood dream of having a Beethoven come true!) A card arrived in the post from a lady whose animal had recently been put down, she lived alone in a rural community and having a dog had made her feel more at ease in a somewhat isolated environment. I imagine there are many people in a similar situation to hers. She was very thankful for the care her dog had received from those at the practice!

I then accompanied the vet to help her vaccinate some horses. It was a bit of a quiet day today at the veterinary practice, especially with the large animals since it’s not lambing season, at which point they are completely run off their feet. This was a big contrast with the GP or the hospitals I have been placed in, where there never seems to be a quiet day – it goes on a scale from busy to extremely busy!

I had a really interesting chat with one of the vets about the similarities between vets and doctors. I recognized that vets remain generalists while aside from GPs many doctors have become very specialized. It is also amazing that after only 5 years at university vets are qualified to diagnose, prescribe, perform anaesthesia and operate – it makes our course seem very long! There is also the fact that doctors deal with 1 species, while vets are left with every other species of animal to treat! On this point, the vet said she thought that the work of doctors has an added seriousness to it, given that humans have ‘souls’ and are worth more than animals, which at the end of the day most people do not think of being as precious as human lives. There is of course also the added fact that many animals end up being put to sleep once the vet can do no more for them or they can no longer afford treatment.

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Innocent practice cat or Professor McGonagall in disguise?

Day 8 – Halfway through – are you kitten me?!

Today it was back to the rural GP for the morning and another busy surgery ensued. I was struck by the variety of the patients seen, and the fact that before they walk through the door the GP doesn’t know what they are coming to talk to him about, and he could have one patient, happy to be pregnant, immediately followed by a discussion about end of life care.

One patient, a farmer, came in, and following a discussion about rollators revealed two weeks ago he had fallen while trying to put a cover on a silo, put his arm out to break his fall and has been left with stiffness and pain in his shoulder. It was only now, as it hadn’t got better and was restricting his activities on the farm, that he decided to seek help. After he left, the GP told me that he doesn’t have anyone to take over the farm, so now at 70 he is doing the same tasks he was at 30. I think this must be an increasing problem for farmers in Northern Ireland, many of whom do not have succession plans in place. Spending time with the GP and observing his interactions with his patients has given me a lot to ponder as I contemplate starting placement in a hospital in a couple of weeks time, good communication skills are clearly essential.

At lunch time it was time to swap with Ruth and I headed out to a veterinary practice in the countryside, first being unsure whether I classed as a large or small animal for which door I should enter the practice through!

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Are humans big or small animals?

It was small animals this afternoon, so I saw a little kitten that had got caught up in a car engine get stitched back together, followed by a dog getting a polyp in its ear cauterized. It struck me as somewhat ironic that while studying medicine the first surgery I have observed has been on animals! Many of the techniques used are similar, although there is the added challenge in establishing a diagnosis in that a) your patient cannot talk; b) your patient may have sharp teeth and c) there is a high probability they may use said teeth on any nearby limb or digit.

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A little the worse for wear after an encounter with an engine

The cacophony of plaintive whines coming from the room where they are housed, coupled with an array of distinctive smells was certainly a feast a lot for the senses! One cat in particular certainly had cat-titude. During the afternoon many farmers came in looking for various medications and treatments for their livestock and it was clear they had a very good relationship with the local vets. I’m not so sure that many of them are as frequent visitors to their GP surgery. I’m looking forward to hopefully getting out to farms tomorrow and dealing with the big animals!

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A stray trying to be paw-sitively irresistible!

After finishing at the vets, the GP very kindly had Ruth and I out to his house for dinner, where we saw some of his livestock and machinery. We then saw the kind of support networks that exist in these rural communities in action. A neighbouring elderly farmer and his wife have both recently taken ill and are in respite care, and the GP along with other neighbours are looking after his animals while he is away. We went up to see the cattle being fed and watch a beautiful sunset over the rolling hills. Although the circumstances are unfuortunate, it was heart warming to see the genuine regard and care with which these farmers view their neighbours.

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A rural sunset

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Once the cattle were fed, we headed into the town nearby to see around the Doctor on Call centre, which our GP says has revolutionised rural provision of health care, by taking pressure off local GPs being obligated to work on calls multiple nights in the week while still preventing unnecessary attendances to the emergency departments. It was interesting to see how it works and see the triage nurses in action. Visiting early in the night on a weekday in September is a very different scenario to if we had visited on a Winter Bank Holiday, I imagine!

 

Day 7 – An-udder day, an-udder place

Today I was in a local hospital (back to the hand sanitiser and bare below the elbows), shadowing the GP who was wearing another hat as one of the medical directors. There was more time for chat and finding out about his roles than yesterday, with distinctly fewer patients around. He spent time explaining the ins and outs of the bureaucracy and challenges involved with managing health care services at the trust level. Something that is never out of the headlines is waiting times at local emergency departments or ambulance turnaround times, and getting an insight into the various factors influencing these was useful.

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Even the parking tickets are used for health promotion!

The GP took me down to the Acute Assessment Unit, where GPs can refer patients to and I stayed to see what happens there. As well as taking some of the pressure off the emergency department, it allows the GPs to refer patients they are concerned about to have more tests and investigations done. It was interesting to see what happens there, and I was surprised as I had never heard of it before! I observed as a patient was admitted, a history taken and examination done, before seeing the various investigations take place and results come back, allowing a course of action to be established.

I had a really interesting discussion with the GP about the opportunities and challenges of working in a rural practice. (This is a great website with lots of information about being in rural general practice – http://ruralgp.com/). In his spare time (I know, apparently he has some, even with his extremely busy schedule!), he is a part time farmer, and he feels this gives him an insight and affinity with his patients of the same profession. I think it also gives him more weight when giving them advice, as he clearly has more of an understanding and appreciation of what their lives are like than most doctors. The one key difference is that he does not rely on the farm for his income, and so clearly the many financial stresses that we heard about last week in Rural Support are less applicable to him (https://frombaatoahh.wordpress.com/2016/09/09/day-4-rusty-skills-and-drills/). We then talked about how in the countryside, everyone is related, and he tried to explain to me some of the complicated connections between different families in his practice (some of which were so involved I found them hard to follow!). The fact that he treats a lot of whole families, over their whole lifetimes, means he is aware of a lot more of the contextual and background information and situations that may be influencing their health and this means he can treat them more appropriately, using a biopsychosocial approach. He said something that resonated with me – these people are people, not medical conditions – and in a healthcare sector which some say is becoming increasingly depersonalised, it was good to hear this opinion voiced. By living in the community in which you practice, and investing in your lives, it will inevitably be more difficult to see patients suffer but I believe this is good motivation to do your utmost for them to alleviate suffering and where possible help restore them to full health.

Super cute cow joke because I’m currently finding it hard to be punny:-

What did the Mama Cow say to the Baby Cow?

-It’s pasture bedtime!

Day 6 – Consultations in the Countryside

Week 2 began with a rather shorter journey to a rural GP practice in County Antrim to see the ins and outs of country life and healthcare provision. It was a contrast to my previous GP placements, which have both been in central Belfast where knowledge of tractors and the farming forecasts is rather less important! The Assembly have produced a document detailing what they see as the key health issues affecting rural communities, available at http://www.niassembly.gov.uk/globalassets/Documents/RaISe/Publications/2010/Agriculture-Rural-Development/12510.pdf . I split my day between the reception area, the treatment room and the GP’s surgery, all of which offered a different insight into the clinical environment.

A Monday morning in a GP surgery is certainly a good wake up call for the week, with the phone lines not pausing to draw breath and all the health care professionals equally busy. A few things in particular struck me about today, and have given me food for thought. The GP I was with had been off on leave for the two weeks prior to today, but his list was completely filled with patients who had waited longer to have an appointment in order to see him, who they trusted. This loyalty shows the importance, particularly for rural GPs, of building a relationship with your patients in order to ensure that they are open and honest in giving you their history, to enable you to make an accurate diagnosis. In general, the rural community is accepted to be more close knit than that in urban areas, and GP practices are smaller, giving the doctors the opportunity to get to know their patients, and also their parents and their children – these GPs truly are ‘family doctors’.  In his consultations, the atmosphere clearly reflected the fact that this GP has more than a purely paternal, ‘in-out-let’s find out what’s wrong’ relationship with his patients, and that obviously means a lot to them.

One patient I saw in the treatment room was having their dressing on a leg ulcer changed. They admitted it was initially a simple cut which they had neglected, but now, six months later, they are still receiving treatment for it. I imagine this kind of situation is not uncommon among farmers, who like those I met last week, may be more inclined to ignore ailments until they reach a level beyond which they can no longer be ignored.

On returning home tonight, I saw on the news that a man died over the weekend in Co. Tyrone in a farming accident (http://www.itv.com/news/utv/update/2016-09-12/man-killed-during-farm-accident-in-co-tyrone/) . This brought home the reality of the dangers involved in farming which we learnt about last week (https://frombaatoahh.wordpress.com/2016/09/06/day-2-scones-smurfs-and-slurry/) – they are not something to be taken lightly, they are very real, and tonight have left a family grieving. My thoughts are with the family of the man involved. It also shows me how important this module is, through highlighting to me, as a future healthcare provider, the unique risks and challenges farmers face, with hope that in the future some of these may be mitigated.

Day 5 -Rusty skills and drills

On Wednesday we thought three counties in a day was good but today we did five, and the miles travelled now stands at 399 (half tempted to drive along the road to make it a nice round 400!). Following breakfast at the hotel, Ruth and I travelled to Dungannon, where we joined the Farm Families Health Check team for the day at Dungannon Mart, where a machinery sale was taking place.

This is an initiative, now in its fifth year, which was set up to allow farmers and their families to undergo simple health checks in a purpose built van housing two consulting rooms, in the community rather than having to travel to a hospital, which they are less likely to do. The service employs trust nurses and travels all over the province to shows and marts. It is part funded by the Public Health Agency and the Department of Agriculture, Environment and Rural Affairs and more information can be found here: http://www.publichealth.hscni.net/farm-families-health-checks-programme.

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The van outside the mart

14249363_1134886989921464_1572242827_nWith the long summer break, this was my first ‘patient contact’ as such since May, and being in a van surrounded by loud working machinery certainly added something to the consultations. I was worried about my skills being a little rusty, but they weren’t as rusty as some of the machinery being bought and sold! Each client would have their cholesterol, blood pressure, weight, height and waist circumference measured, along with a questionnaire and a diabetes risk assessment. I was thrown in at the deep end and soon carried out all the tests while the nurse asked them all the questions. It was good to be dealing with patients again, although once again my small stature proved comical as I attempted to raise the bar to do the height measurements! Today was an opportunity to see just what a diverse collection of people farmers are, but also the varied problems they face, from physical health to mental health. One farmer remarked on how he’s eaten the same amount of food for his whole life, and his father before him, but it is only over the past 20 years that they have put on weight, and this is probably a consequence of the increasing mechanisation of the profession. While the farmers are there, the nurses take the opportunity to do general health promotion, with one of the main issues being skin cancer awareness. None of the farmers I saw ever wear sun cream, with many of them stating that it’s never that sunny. The Pubic Health Agency have developed something I think really useful – a little card with a UV ray detector, which tells you the level at which you should be wearing sun cream. They also talked about farm safety courses offered online, although computer skills did seem to be an issue for some, and gave them information about the services offered by Rural Support.

It is clear that this team do valuable work amongst the community, but still the majority of the farmers there showed no interest in finding out more about their health and looking after it. Although part of this can be attributed to the fact that many are male (I decided such a mart was the only place you would find where the queue for the men’s toilets was longer than the one for the women’s!), their profession and accessibility of services certainly play their part too. The more I see of different aspects of farming life, the more I think that the way to tackle health issues in farmers is at least partly through getting alongside them and getting them to champion your cause among their peers – one man appeared today flanked by two friends with a bad cut, and it was his friends’ ‘nagging’ that made him come into the van to receive first aid on it.

Week 1 is over today, and I think my highlight of the week was the day on the farm yesterday. Although it has been great to hear about the rural community in Northern Ireland, all of what we heard made a lot more sense to me and resonated on a deeper level once I had spent time with actual farmers. It was also good today to do some practical medicine, and to be reminded of why we are actually doing this module – because there is a real and deep need for better provision of healthcare for rural dwellers. Next week, I start off in a rural GP surgery where I’ll get to see the relationship between the primary care givers and the community they serve. You’ll have to wait until Monday for more moo-velous stories.

Day 4 – Udderly brilliant 

After an early start and comforting myself by the fact the farmers were already milking, I set off for a dairy farm on the Ards peninsula, picking up Ruth on the way. I think it’s fair to say I didn’t really have much of an idea what we would be doing, and I was a little apprehensive. We arrived and were welcomed into the heart of any farm – the kitchen, where we met Roger and his parents John and Oriel. After a cup of tea (lots of milk!) and a chat, it was time to don our waterproofs and wellie boots and head out onto the farm. Plenty of laughs, silly (or perhaps ill informed!) questions and good aul chat filled the day.

The farm has about 250 cows of which 115 are being milked currently. Throughout the day we followed Roger about and tried to help rather than hinder (not sure if we were entirely successful there!). Each day all the cows have to be checked on in all their various fields, as well as fed a little meal to supplement the grass. The cows needed to be cow-nted, easier said than done with 30+ moving black and white hungry cows. Ruth and I might need to do some weights training since it took both of us to carry a sack and attempt to pour it into the troughs while surrounded by hungry heifers. I was amazed by how responsive the animals were to the unique cow language spoken fluently by Roger – we have some way to go in developing skills in this area too (apparently more conviction on my part was required)!

 Our grand tour was cut short by the phone call we were hoping would happen, saying one of the cows was about to calf! AHHH!! Smiles spread across our faces and we headed back to the yard in time to see it born, which was truly amazing! Roger cleared the mucus from its nose and its head came up, ears pricked as its mother started to lick it clean. Unfortunately for Roger, it was a bull, which means in about a month it’ll be sold on. Although from the business perspective it is useless, it was certainly rather cute. Roger showed us a chart that would rival the Krebs cycle in its complexity, telling him which cows are in calf, when they are due, when they need to stop being milked etc. Excitement over, for the farmers at least, we headed back to finish what we had started, checking on the rest of the cows. 

Here he comes!

 

2.5L milk disappears surprisingly quickly!

It was back to the yard to prepare the indoor barn for the cattle, although we left sweeping the slurry to Roger and stuck to putting saw dust into each cubicle for the cows! A low point to the day was slipping and sliding our way across slotted slurry tank, although thankfully we managed to stay on our feet.

Hard at work

It wasn’t long before we had the chance to watch a second life come into the world, another bull, a moment that can’t help but bring a smile to your face! We were fortunate in that the two calves we saw being born were straightforward births, but I’m well aware calves don’t always arrive without complications or at such a civilised time of the day. With the calving season lasting from September to April, the farmers already short night can be interrupted by impatient calves, undoubtedly adding to the strain and stresses they face.
After dinner was eaten and the farming paparazzi satisfied, we returned to work – this time bringing down 20 18 month (ish) calves to get ‘dosed’ against worms in the yard and then back up to pasture. One of them had got sun burnt over the summer (who knew a) that cows get sun burn and b) there was enough sun this summer to get sun burnt). We checked in on the calves, to see one had started suckling from its mother while Roger fed the other colostrum milked from a cow that had given birth the previous day. In the varied life of a farmer, who is obstetrician one moment, then driver, then milkmaid, next Roger took on the guise of a mechanic, fixing the mud flap of a tractor while I considered the fact I am too vertically challenged to farm – one of the wheels of the tractor was the same size as me, and earlier I was too small to reach over the top of a gate and open it! A childhood dream was fulfilled as I rode in a big forklift (it was more impressive than it sounds) and Roger sorted silage into the feeding troughs for later.
It is fair to say nothing in our medical studies so far prepared us for milking (but then I guess it doesn’t really fall under the core curriculum), with Ruth and I slightly worried by the fact we were given caps and milking coats to keep us clean. 

Two maids a-milking

 

At the business end of things…

The cows have a specific order/hierarchy in which they go for milking, and some milk faster than others. It wasn’t long before Roger had us roped in, up to our elbows covered in things not found in a sterile hospital clinic, and having a go. If we got splashed with something rather unpleasant, we turned the udder cheek and moooved on. While exciting and interesting for us to see how it all works, I imagine doing it twice a day every day must get monotonous. There was a chance to discuss a pressing issue for dairy farmers – the milk price. It is clear these farmers are being pulled in every direction, with some schemes suggesting they be rewarded for producing less milk (http://www.belfasttelegraph.co.uk/business/news/eu-scheme-could-pay-northern-ireland-farmers-to-rein-in-their-milk-production-35033740.html) while other companies are calling for increased milk production (http://www.farminglife.com/news/farming-news/dale-farm-calls-for-more-milk-1-7570514). One thing was clear, and that is that something needs to be done about the milk price urgently to stop more farms going out of business – I for one would not object to paying a few pence more for my milk, now knowing what a difference it would make to these farming families.

Just before we left there was time to see the various calves fed with milk, fresh from the parlour, and some of the younger ones taught to suck.

 

The prospect of dinner created quite a din among these calves, from a couple of days to a week old.

All too soon our waterproofs were hosed down and it was time to leave. We headed to a hotel nearby, met up with the others on the module and had a lovely dinner which we felt we thoroughly deserved, swapping stories about our experiences.

Before today, I had never worked on a farm and didn’t really have much of an idea about what all went on. Spending the day there gave us the chance to chat to Roger and his parents about what life is like and issues that affect them. Topics like the price of milk, often in the news (just this week the EU announced a scheme to try and reduce milk production, read more here: http://www.belfasttelegraph.co.uk/business/news/eu-scheme-could-pay-northern-ireland-farmers-to-rein-in-their-milk-production-35033740.html)  take on a lot more meaning when you have seen how hard the farmers have to work and how little they get compared to what we pay, although it was good to hear that things seem to be looking up. Hearing Roger talking about having to plan when he isn’t at the farm and juggle this with his father made me really appreciate the fact that I am not tied down in the same way, rather than having cows that will need to be milked every day, be that Christmas Day or your birthday. The chat came round to health, first of the cows, all of whom are checked daily for signs of mastitis and other common ailments or conditions such as hernias, with the farmers admitting that should they themselves have an ache or pain they are more likely to wait and see if it’ll settle than rush immediately to the doctor. Thankfully, succession is in place for this farm but for many of their neighbours the situation is not as straightforward. To do work like this, day in, day out for a lifetime clearly takes a lot of physical strength, and I don’t think that’s something you can truly appreciate until you spend time on a farm – I certainly didn’t, and know what I saw today is only the tip of the iceberg of what farming incorporates. I really appreciated the time they took out of a busy schedule to have us on the farm, where the work is never done, and when you live in your workplace you cannot even leave it behind.

Day 3 – Farm-ewe-la One

Day 3 of SSC and it was time for county number three – Tyrone. We all converged on Rural Support HQ, based in Loughry College, and then a trip to our first farm – a hill sheep farm (hence the title – Farm-ewe-la One!). Current mileage – 210 miles.

We heard all about the work of Rural Support from its staff, it’s a small charity set up with the emotional health of the farmers in mind. They run a helpline for farmers, provide mentors for farm financing and business ventures, coordinate social farming (more on that later, and no it doesn’t involve tea and scones!) and promote positive mental health. One thing I found particularly interesting was a course they mentioned called Mental Health First Aid which all their staff and volunteers have completed. It is similar to the traditional first aid course, in that it aims to teach participants how to recognise a possible mental illness and provide initial help until a professional arrives. With farming and medicine both featuring high on the list of occupational related suicides, I think it would be really beneficial if as medical students this was something we attended – so we could recognise and help ourselves or our colleagues, as well as our future patients. More information on this website for those interested (http://www.publichealth.hscni.net/publications/mental-health-first-aid-training-programme).

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Us with the Rural Support Team

Following lunch, it was time for another road trip, this time in the Rural Support minibus up increasingly narrow, windy and bumpy roads to a hill sheep farm near Plumbridge. At one point someone asked ‘are we still on a road?!’ which gives you an indication of how rural it was, with small lanes, fringed by grass and tall, windswept hedges. You wouldn’t find Lewis Hamilton on roads like these!

At the farm we were met by the working sheepdogs, keen to smell and investigate. The farm is run by a couple with three children, and they currently have a placement student over from France. What makes this farm different, however, is that it is a social farm.

Yes, a social farm – not one where you go to have a coffee, pet the animals and look at the view (which was admittedly stunning), a working farm which ‘involves the innovative use of agriculture to promote therapy, rehabilitation, social inclusion, education and social services in rural areas’. Simply put, individuals with learning disabilities or those recovering from a mental health illness spend time at a farm near them, getting involved in the daily activities and learning new skills – it really is the biopsychosocial model in practice.

I was completely blown away by what I saw at the farm – the work they are doing with these disadvantaged people is truly amazing! Two days a week different people from the surrounding towns/villages come for a day, and the programme lasts for 40 weeks, at the end of which they get a qualification. Today we saw the participants help the farmer select lambs to go to market and tag them in preparation. There’s no room for sentimentality on a farm, especially where farmers have to pay £32 to remove any dead animal from their land but horses can be buried for free (they’re pets!).

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Ignorance is bliss – who knows what tomorrow will bring

During the short time we spent with the participants we could differentiate between those who were nearing the end of the course and those who were only beginning, so clear were the skills they had learnt and the confidence they had gained. On speaking to one of them, it was clear how much he valued it, saying it was the highlight of his week. We then spent time with the farmer and his wife, seeing around the farm. They have a polytunnel and kitchen garden which the volunteers help tend and then are given some of the produce to take home with them to encourage healthy eating. It was so clear what the benefits for the participants were, but those for the farmers were less obvious so I asked what they got out of it. Although there is a financial contribution to the farms, it is not significant and simply covers the costs incurred by the farmer. The farmer said it was amazing to see the participants grow and develop over their time at the farm, with his wife adding it was great to be able to make a difference and she looks forward to the days when the volunteers are on the farm. When talk turned to their own health, they said they do have a good GP but other services are harder to access being in a remote area. The farmer’s wife is a trained first aider and every participant first completes a course on health and safety when they arrive on the farm. While everything might sound rosy, in fact there are many worries which are taking their toll, not least the potential implications of Brexit – the future of the single farm payment and the funding they receive for the social farm. I am in no doubt that should programmes such as this one be scrapped it would be a huge loss for our society. In an era where ‘green prescriptions’ are becoming a buzz word, I believe one such way these can be filled is through social farms, and these initiatives should be expanded, not facing the chop (unlike the lambs!).

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Through the polytunnel – with the farmer’s wife

 

This morning we learnt about the many issues farmers can face and the support that is available to them, while this afternoon we had a chance to visit our first real life working farm of the module. On the farm, on a bright, sunny day in September it seemed idyllic. I couldn’t help thinking should we have visited on a dark, cold, wet, windy day (you could say, when it’s absolutely Friesian) in December and actually had to do the work of the farm we might have felt differently! It’ll be interesting to see if the farmers we meet throughout the rest of the module have similar opinions and experiences to those we met today – I suspect not!

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What a view!