A summer tourist invasion, life far away from hospitals, and unpredictable weather make life as Aran's doctor most demanding, writes Dr Muiris Houston.

It is mid-morning on Inis Mór, the largest of the Aran Islands. Despite a slight drizzle, large numbers of visitors stream off the first ferry of the day. There to meet them is a fleet of minibuses; further up the quay and in the village of Cill Ronán await serried ranks of bicycles for hire and some horse-and-traps, offering an alternative means of transport. For the intrepid walker, nine miles of island stretches west, waiting to be explored.

Dr Marion Broderick, the sole doctor on the Aran Islands for the past 22 years, observes the arrivals. With a minimum of 1,000 daily visitors during the months of June, July and August - rising to 3,000 on a busy sunny day - it is inevitable she will provide medical care to a significant number before they leave.

"Cill Ronán looks like Blackpool a half an hour after the ferries begin to arrive," she says with a hint of disapproval.

Some visitors will fall on rocks, develop bad sunburn or get bitten by ticks, but it is those heading for the bicycles who give her the greatest cause for concern. Although all are offered helmets as part of the hiring process, many decline. The main roads of Aran are twisting and narrow even if well tarmacked.

Some leading to the sights still consist of loose stones. Both roads and tracks are lined with the trademark stone walls of Aran, complete with a top layer of sharp stones placed vertically at intervals. Some foreign visitors have found themselves sailing on to or over the sharp walls.

Unfortunately, when they reach for what in the US would be a bicycle's rear brake, it is, in fact, the front brake.

The result is an emergency stop which is likely to propel the cyclist over the handlebars, resulting in a minimum of heavy bruising with head injuries not uncommon.

The previous week a 12-year-old boy undid a number of years of expensive dental treatment when he came off a bicycle.

One of the worst injuries seen by Dr Broderick involved an Italian whom she found unconscious and fitting as a result of a severe head injury. His scalp was peeled back and he had a depressed fracture of his skull. Luckily it was during the day and the patient was transferred by an Aer Arann plane to Galway. He required neurosurgery and subsequently spent a number of weeks in the intensive care unit before making a full recovery.

Twenty years ago the only option for transporting a seriously ill patient to the main land at night or in inclement weather was the lifeboat. Admittedly, the number of visitors was much smaller; during the summer months 200 to 300 people arrived on the ferry, the Galway Bay. But there was a period until the late 1980s when visitor numbers were on the increase and yet there was no facility for helicopter evacuation.

Following a preventable death on board a trawler off the Mayo coast, the West Coast Search and Rescue Action Committee was set up to lobby for improved emergency services for the islands and western seaboard.

Asked for her worst memory from these times, Dr Broderick recalls an incident in 1982, when an elderly man fell downstairs on Christmas Eve. He sustained a serious injury and had to be transferred in heavy fog to Rossaveal, followed by a road journey to Galway.

Dr Broderick's professional life changed considerably last April when Dr Maura O'Meara was appointed by the Western Health Board as GP for the two smaller islands, Inis Meáin and Inis Óirr. Approval was also given for the appointment of a second GP to Inis Mór. That post is expected to be filled in the autumn; in the meantime a young German doctor, Dr Hans Olaf Pieper, shares the workload.

With 900 year-round residents and a daily summer influx of up to 3,000 people, Inis Mór's medical needs are considerable. Compared to the average general practice, the incidence of trauma is significantly greater. In addition, management of a suspected heart attack or a psychiatric emergency pose considerable logistical challenges as urgent transport to Galway is needed.

There are three options during the day: the Aer Arann plane, a rescue helicopter or the lifeboat. At night, the lifeboat helps out in most cases, though the latest Coastguard and Aer Corps helicopters have a night-flying capability. Overall the lifeboat-to-helicopter ratio is 10:1, according to Dr Broderick.

A lifeboat evacuation can be a family affair. Dr Broderick's son Ronán and daughter Sinéad have followed their father and grandfather as lifeboat volunteers. Marion herself is the lifeboat medical officer. Both her children recall waking up at night to discover that Mum and Dad had left on a mercy mission.

Marion Broderick is a mild-mannered but determined woman. She has saved numerous lives over the years and must be one of the most skilled primary care doctors in the Republic.

Whether you are having a premature baby or suffering from multiple fractures, there is no more reassuring face to appear over you. And with a 24-hour emergency transport service just a VHF call away, it could be argued that Inis Mór is a better place to meet the misfortune of a medical emergency than many mainland locations.

But problems persist. Dr Broderick says she is short of equipment to deal with multiple trauma.

"In the event of a road traffic accident involving two buses and a horse-and-trap or a fire aboard a ferry involving smoke inhalation, we would not have enough oxygen supplies to cope."

Stretchers and a properly equipped ambulance are also needed, given the volume of emergency transfers dealt with. Earlier in the week of The Irish Times visit, Dr Pieper had transferred five patients to the mainland during a single 24-hour period. Indeed, a dedicated resuscitation area in the local health centre would seem a necessity.

There is also concern that the traditional 24-hour availability of public health nurses may be under threat as part of a review of nursing services on the islands.

"If they remove nursing personnel, lives will be lost, Dr Broderick says starkly.

As she shows off the island's new nursing home and independent living units (Áras Ronán) - which allow repatriation of older islanders from nursing homes on the mainland - Dr Broderick says the most pressing health issue on Inis Mór is legislation to make the wearing of bicycle helmets mandatory.

"Overnight, this would significantly reduce the number and severity of seasonal injuries."