This week we have Dr Beth Moos (trainee GP in Oxford) who has written about her experiences in expedition medicine. Thanks for this fascinating article!!

Want to be an expedition medic?

Always dreamed of being an Expedition Medic but not sure how to get started? Read on…

Why expedition medicine?

There are now so many opportunities to practise medicine outside of traditional settings and, as more people are taking time out of training, the field of expedition medicine is becoming an increasingly popular option. In addition to returning to training refreshed and revitalised, expedition medicine leads to increased confidence and improved leadership and problem-solving skills. A break from training can allow increased flexibility over both work and leisure. Medicine outside of the hospital encourages lateral thinking and to survive and indeed thrive, one has to be resourceful. Working with minimal equipment in an unfamiliar and challenging environment is not for the faint-hearted – but if you are up for the challenge, the rewards can be sweet.

What to expect – a personal experience

Having done an expedition and wilderness medicine course as a F1 Doctor, I started off by shadowing and being an extra pair of hands on a weekend walking and cycling event. I then did another. Subsequently, as an F2 Doctor with a bit of experience, I was able to officially work on events for the same company, with which I am still working.

After completing the Foundation programme I found myself heading to Borneo. During the three months spent there, I was fortunate enough to work on a water, sanitation and hygiene project – we were the first ever non-Malaysians to enter the village which was a real privilege. This was a real opportunity to try and get an insight into the local culture, customs and language. We formed close links with the community members, who we worked and lived alongside, in order to complete the build of a toilet or ‘tandas’ and repair the gravity-fed water system. Spending time there gave a real insight into what it means to live without access to clean water and put the Sustainable Development Goals (SDG’s) into context.

I supported a group as leader and medic on a trek through the rainforest, managing diarrhoea and vomiting (of course), heat-related illness, poisonous insect bites and leeches and even a corneal abrasion. Without the use of a fancy slit lamp machine, I instead fashioned a blue light out of a headtorch and a piece of blue plastic from a toilet paper wrapper to identify a corneal abrasion.

In the last phase, as Fieldbase medic, I was working to provide medical support to teams in the field, coordinate medevacs (medical evacuations) and was responsible for the organisation of medical kitbags and stock. It was nice to get back to the home comforts of living in a house, such as an actual bed and shower, having washed in a river and slept on a floor or in a hammock for the best part of two months. However, there wasn’t much time to relax – we had to organise several medevacs for people, many of whom were unwell with a high fever. Fever in the tropics has a fairly wide differential, but on our expedition the main culprits were leptospirosis and dengue. Regular trips to the local hospital and liaising with the UK medical support team certainly kept me occupied. The UK team were on hand to manage emergency situations and importantly get in touch with relatives if needed – most medical advice if needed could be sought locally if the guidelines were not sufficient. Teams would call in on the radio daily and I was responsible for taking both routine and emergency medical reports, or ‘medreps’. This was a very busy phase and you really never knew what the next day or even hour would bring. Thankfully, I was only woken up once in the middle of the night to get some one into hospital with a septic bursitis. At the end of three months, I was very tired but also very happy, having learnt a great deal and having felt that I had done a good job.

Spurred on by my time spent in the tropics, I then went on to study on the Diploma in Tropical Medicine and Hygiene in Liverpool. Eager to put what I had learnt into practice, I followed this by signing up for a volunteering role where I was part of a team that ran mobile clinics for remote indigenous communities in Panama. This allowed me to combine the global health and tropical medicine with an element of adventure and exploration. Most of the villages were inaccessible by land and relied upon the visits by boat for access to healthcare. Whilst we didn’t see many ‘tropical diseases’, many diseases that go hand-in-hand with poverty were prevalent. I was surprised to see how common the non-communicable diseases were in such isolated areas with many people taking medicines for diabetes and hypertension. I was particularly interested to meet a man who had been bitten in the past by a snake and had evidence of severe local tissue necrosis. Snakebite is a neglected tropical disease and something that I have developed a keen interest since learning about it at the Liverpool School of Tropical Medicine and Hygiene.

From my personal experience, taking time out of training was the best decision I ever made – I had the most fantastic experiences and made some wonderful long-lasting friendships. Having returned to start GP training I have continued to take opportunities where possible to spend time overseas, gaining further experience in the fields of expedition medicine and global health. During an Erasmus exchange in Martinique (note from the Editor – Martinique is included in Erasmus which is a European exchange programme as it is a part of France), I spent time with a GP learning about the health attitudes and behaviours there and how the French healthcare system has adapted to a tropical island setting. HIV has a high prevalence there and I was able to spend some time in HIV and sexual health clinics in what is the largest hospital in the Caribbean.

Using weekends and annual leave I have continued to provide medical support at ultramarathons and walks in the UK, France and Belgium. Although tiring, it is possible to fit these around a busy rota! I have continued to develop my interest in snakebites, attending conferences on venoms and recently a snakebite-specific conference in the Netherlands. Having just completed ST2 I am now taking another year out of programme to spend seven months in Myanmar working on a research project investigating an anti-venom for Russell’s Viper, before I return to complete ST3. After that, who knows…

Where to start?

It can seem like a daunting task to embark on a career in expedition medicine. Attending an expedition medicine course is an excellent way to get an overview of what to expect and how to prepare for being an expedition medic. They also offer an opportunity to share experiences and get a flavour for what opportunities are available. Rotations in both general practice and emergency medicine provide a good foundation for expedition medicine. Whilst the majority of medical problems are minor conditions common to general practice, good critical care skills appropriate to the environment and distance from help are crucial. Having some courses under your belt, such as Advanced Life Support (ALS) and Advanced Trauma Life Support (ATLS) are often looked for on application forms.

It can be difficult to know where to start but getting experience at a UK-based sporting event can often be a good stepping-stone to a trip overseas. This is a great way to get comfortable with footcare in addition to many other minor injuries and common problems seen on expedition. This is also an opportunity to meet other medics with similar interests and share experiences. Many companies run both UK-based and overseas trips and they often prefer to keep the overseas trips for the more experienced medics, so getting practical experience is important.

Useful resources such as the Adventure Medic website and the Royal Geographical Society can help to find out about opportunities available. It then becomes a case of sending off an application and potentially attending an interview or assessment. Make sure that you will be physically up to the challenge and used to the environment – being the medic can be physically and emotionally exhausting, so making sure you are comfortable with the challenge itself is your prerogative!

Get out there

There are many things to consider before going away on an expedition: which organisations to work with; indemnity insurance; the medical kit; medical screening; medevac/casevac planning; and so on. This can seem daunting but early and thorough preparation is the key.

If you want to find out more and meet up with like-minded people, the Royal Geographical Society is running a workshop on 13^th September – Expedition and wilderness medicine: an introduction for early career medics. A wide range of topics will be covered by experienced medical professionals.

Interested? Tickets available online now at £35

https://www.rgs.org/events/expedition-wilderness-medicine-an-introduction/

Tips

Start planning early

Attend a conference – get inspired

Ask questions before signing up – make sure you know what is expected of you and that you are happy you can deliver it

Speak to as many people as you can – listen to others experiences and learn from them

Get experience in both General Practice and especially Emergency Medicine

Look at the Adventure Medic website (https://www.theadventuremedic.com) and the Royal Geographical Medical Cell (https://www.rgs.org/in-the-field/advice-training/resources-for-expeditions/expedition-medical-cell/)