Lana Rose Buchheim received her Bachelor’s and Master’s degrees at Towson University in Baltimore, Maryland, USA. A far cry from the secluded isles on the other side of the world, where she now finds herself.

The 27-year-old paediatric occupational therapist has now had to adapt to the quiet life of an islander in Stornoway, Isle of Lewis.

Lana was aided by her colleague, 31-year-old Careen Matheson, an Isle of Lewis native, when she first landed on the Scottish Western Isles. The two may have had very different cultural backgrounds but their jobs are the same.

“The differences between the USA and the Western Isles are pretty stark.” Lana commented. “For one patients are empowered and encouraged to remain in the comfort of their own home if and when possible. I find that the length of the hospital stays, recovery timeline, distribution of equipment and medications and completion of tests and appointments (e.g. x-rays, MRIs, psychological testing) is longer but no one seems particularly bothered by it. ‘Island time’ is a real phenomenon.

“People here work hard; but work feels like an aspect of life rather than its rival. In warmer months, I camp during the week and hillwalk after work, especially when I can fl ex my schedule. That, in and of itself, is a game changer for me. My clients, their families and my co-workers all seem to engage with the outdoors in some capacity, too. There is a strong sense of family and trust among islanders here, which is, in fact, quite similar to the way that families interact with each other in Baltimore – different social circles are pretty clued into each other’s lives and it’s common to enquire about someone’s ‘people’ (family) are.”

Careen, who studied in Glasgow, always wanted to return home, missing what others might find unusual. Careen said: “I was born and raised on the Isle of Lewis and always knew I wanted to come back. After some travelling after university I was lucky to get a temporary Band 5 post in the community that was then extended for two years. I later moved to Inverness and worked in Raigmore hospital for four years before moving back to Lewis into a paediatric post. Although I wanted to live on Lewis, I think it was very important to go away and gain experience elsewhere before settling back here.

“The occupational therapy team (hospital, neuro, community, mental health, hand therapy, rheumatology, paediatrics, the community equipment service and the telecare service) on the Western Isles work very closely together and are managed by the same person. Having worked in other areas, I find this reduces duplication of work and increases consistency for clients. This team approach allows joint working, sharing of knowledge and skills and using each other’s strengths and expertise when necessary. Remote and rural practice, I feel, allows for lots of opportunity to trial innovative ideas and practice.”

Lana acknowledged that this takes some getting used to: “Because we have fewer staff members covering the islands, we are expected to wear many different hats and work outside of our comfort zones. In a given day I might be using physical dysfunction knowledge, a sensory-motor approach to treatment and mental health concepts.”

In Lana’s home country, the education process is very different and the culture of healthcare in the USA is another animal entirely. Lana said: “Medical professionals in the US generally spend more time in university and are required to sit for a licensure exam prior to practicing (e.g. in the US, OTs are required to have Master’s degrees—six years of school, physical therapists need clinical doctorates—approx. seven years of school, etc.).

“Evidence-based research and standardised assessments are emphasised and high productivity standards were typical of most workplaces in the States (e.g. 4.5 hours of your eight-hour day might be spent directly treating patients).  The salary for some AHP staff is as much as one third less than it is in the US. Americans get less annual, sick and maternity/paternity leave and our health care system is largely privatised. I feel as though I worked more and at a much faster pace in the US. Moreover, American clinicians rely more heavily on a medical model to guide their practice; when I worked in paediatric mental health, many of my patients were on medication, despite being as young as five years of age.”

Not only was the procedure of her trade completely different, Lana also had to adapt to the islanders’ way of life and abandon mainland conveniences. She said: “House numbers are rarely in order and you rely on physical, paper maps to navigate home visits (we don’t get 3G/4G on most places on the island) which can be quite tedious at times.”

Careen admitted that the Western Isles situational obstacles are hard to avoid. She added: “The biggest challenge is the complex geographical environment and ensuring an equitable service to a population of 27,400 across the islands. The islands extend for 140 miles from the Isle of Barra to the Isle of Lewis, with 30% of the population in the Stornoway area and the remaining population scattered over 280 townships. Areas can be very sparsely populated so we may need to travel large distances to see one or two clients. Also with such a small population you have to work harder to ensure confidentiality. Most of the children on our caseload are seen at home and in schools.”

Lana also finds that small populations can spring up some issues. She commented: “Island life presents clinicians and service users with unique confidentiality challenges. Although I have only been here a couple of months, I already feel very connected to the people and aware of social circles. You run into co-workers, patients and their families on a daily basis in the community. In addition, people on the island are fairly religious, thus all shops are closed on Sundays and generally discouraged from work or play of any kind. This impacts many of our clients’ goals and priorities for treatment.”

Careen recognises that this is very difficult to navigate. She said: “Working in remote and rural practice, particularly in the Western Isles, you have to be aware that communities are strong and everyone knows each other, this is very much a strength. However as a health care professional you have to work harder to maintain confidentiality at times both in and out of work hours. There is a natural resilience among the local population and communities are very supportive of each other; there is a culture of self-reliance and self-sufficiency and these are highly valued in rural areas. Gaelic is the predominant spoken language amongst older people and it can assist a therapeutic relationship if you acknowledge this. You have to be aware of cultural differences. There is an increasing aging population more marked that anywhere else in Scotland; from 2005 to 2015 the 65-74 age category increased from 10.6% to 13.2%. That means that those over 65 years represent a fifth of the population. There is a continuing trend for young adults to leave the islands for further education or employment purposes, therefore reducing the local skill level and this can pose challenges for recruitment and retention within the NHS and other sectors. Employment is different in remote and rural areas, many are self-employed, rely on subsistence crofting and fishing, off-shore work or the other main employers the NHS and the local council and many rely on multiple jobs. Access is an issue in rural areas, affecting all aspects of life – access to services, information, transport links, support, employment opportunities, learning and training.”

One thing most people who live in urban areas would find odd about the Western Isles is just how trusting the islanders are. Lana said: “I still find the sense of safety and trust among islanders to be unique. I recently asked a friend why he keeps his keys in the ignition of his car while he’s away and he responded “How else can people borrow my car?!” I don’t know many people here who lock their doors and with that comes a sort of ‘open door’ policy where your pals just show up to your home whenever! It is actually wonderful, just takes some getting used to.”

Of course, moving away from everyone and everything you know would give anyone cause for a bout of homesickness. Lana admitted: “I miss the social, food, and art-related opportunities I have in a big city. I also miss being able to just walk or bike to a friend’s fl at; here, some of my friends live in villages 30 minutes away. But, I do love the fact that I spend a great deal of my time here using the land— biking, surfing, hillwalking, running, kayaking, camping, rock climbing, etc. If I am working in one of the schools or in a home, it is quite nice to have your lunch on the beach. Although most places are far away, there are beautiful beaches in nearly every village.”

Lana has taken all these challenges in her stride and even plans to implement some of her own ideas into her work. She said: “One topic I’ve become more passionate about over the years is helping to empower children and young people to use art (specifically music and literature) to support them in recovery. That might mean helping parents read and sing to their kids to address particular motor, sensory, and social skills. Or supporting a teenager’s recovery by discussing and studying their music preferences and incorporating that into their treatment goals.”

 To keep up-to-date with any job opportunites available in the Western Isles, visit www.wihb.scot.nhs.uk/ot-home.

Full story from the Jan/Feb 2017 issue of The OT Magazine