Published: 06/10/2005 Volume 115 No. 5976 Page 30

The Falkland Islands' new head of health and social services is finding that small is beautiful, reports Emma Forrest

Turn your mind to the Falklands and what do you think of? The 1982 war? Penguins?

Chances are that your knowledge of this British outpost 8,000 miles from the UK does not extend much further than that.

But this did not deter Falkland Islands director of health and social services Nicola Osborne, who took up post two months ago after seeing it advertised in HSJ . Her previous job was head of primary care at Cheshire West primary care trust.

'It was the chance for an adventure, ' she says. 'It is the kind of job that I would never be able to do in the UK - I am head of the whole of health and social services.

My boss is the chief executive of the government. I had always wanted to work abroad and this pulls all my expertise together. You can really be at the heart of the population we are serving.' It also offered Nicola the opportunity to bring up her two-year-old son in a safe environment: 'There is no traffic here - three cars constitutes a traffic jam - and the air is so clean. It is a beautiful place.

And he will get to see penguins up close.' The island's tiny population of 2,500 (plus another 2,000 at a military base) means that all healthcare is situated in its only hospital in the capital, Stanley.

'We call it the hospital, but really it is everything; all primary care and dentistry, as well as 27 beds, ' says Nicola. 'In some ways the systems are not so different; we use the same computer systems as in the NHS, for instance.' 'But there are lots of challenges with being so far from the UK, mainly in terms of logistics, because all supplies have to be brought in. Most of our staff must be recruited from the UK, Australia and New Zealand because the island cannot produce enough of its own.' Specialists can also be brought in to deliver bouts of treatment of patients may be sent to the UK or Chile. 'It can be challenging for them when they are a long way away from home, and for us to support them, too, ' adds Nicola.

Patients are not the only ones. Nicola did not get the chance to visit the islands before they arrived, but an extensive interview process and 'lots of videos' gave a flavour of life there.

'I got a mixed reaction when I told people what I was doing, ' says Nicola. 'One guy I worked with was so shocked it was the first time I had ever seen him speechless.' Nicola and her family are now settling in to island life: 'Because there is nowhere else to go, a lot of entertainment is laid on; there is a leisure centre, swimming pool and library, and the base at Mount Pleasant has a cinema and bowling alley. There are also lots of clubs. I am learning to spin and weave, which is great fun.

'We are also planning trips to the outlying islands to spot wildlife; we have already been within 30 feet of sea lions and seen dolphins in the harbour... They say it is better for wildlife than the Galapagos Islands because you can get so close to it.' Nicola admits that the intimacy of island life took some getting used to.

'Until you have lived on an island you do not realise the extent to which people known your business. The only other thing that surprised me is the amount of sunshine, although I have been told I have not yet seen how windy it can get here.' With a two-year contract, and an option to extend it to three years, Nicola says being so far away has helped her realise how much support and expertise is available in the NHS.

'We try to meet UK standards, but it can be hard to keep up to date. In the UK you feel you are being bombarded with information, but here we have to track it down. But I do not miss being told what to do all the time, ' Nicola adds.

'We set our own targets. And I did get fed up with the reorganising. I will not miss not being around for another PCT reorganisation.'