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Expedition Medical Kit: the essential checklist

Expedition Medical Kit

One of the most common questions we’re asked as expedition medics is “What do I put in my medical kit?”

The answer does of course depend on your destination and environment, the purpose of your expedition, your own skillset, your experience, and personal preference. In fact, if you asked every doctor involved in remote medicine, they’d likely give you differing answers. So, bearing this in mind, we’ve produced an Expedition Medical Kit list to treat common ailments, courtesy of World Extreme Medicine co-founder and experienced expedition medic, Dr Sean Hudson MBE.

What do I put in my medical kit?

These items will cover the most common conditions, so make a strong start to your ‘essentials’ list.

Medical kit essentials

  • Roll of zinc oxide tape: covering blisters, taping injuries and dressings
  • Ibuprofen: simple analgesia, especially useful for musculoskeletal injuries
  • Imodium: to control symptoms of gastroenteritis when participating in essential activities
  • Tincture of iodine: used to purify water and antiseptic for wounds
  • Gauze dressing: simple dressings
  • Compeed or similar dressing: adds padding to nasty blisters

Plus, don’t forget the non-medical basics:

  • Paper and pen/pencil (old fashioned and reliable!)
  • Gloves
  • Mobile cellular or satellite phone

Environmental and destination-specific kit

The remaining contents of your expedition medical kit depend on your own experience and how remote you will be in terms of seeking help. If it’s easy to obtain extra medical attention, then you can afford to take less. If you’re in a remote area with a small or poorly equipped hospital, you should take more and plan to deal with potential accidents and illness without outside help. Even when very remote, however, you should always have some form of communication if the need arises for a medevac.

Once you have your basic kit, you can break the expedition medical kit down as follows:

  • Analgesia: Analgesia is going to differ relative to your country of origin, although essentials are: Morphine, IM Voltarol, Rectal Voltarol, Co-codamol, Paracetamol.
  • Fracture Management: There are a variety of ways of immobilising a fracture, the simplest being ingenuity (essential when working with limited and rudimentary equipment), zinc oxide tape or clingfilm. Otherwise, Sam Splints are very versatile, and a Kendrick Traction Device is lightweight and fantastic for lower limb fractures.
  • Antibiotics: You want antibiotics to cover as wide a variety of infections as possible, from dental abscess to travellers’ diarrhoea. We advise Co-Amoxiclav, Ciprofloxacin, Metronidazole, and Flucloxacillin. Just remember to always be aware of sensitivities to antibiotics.
  • Lotions and potions: Irritating skin conditions are common on expeditions, especially in tropical regions. Consider taking an antifungal, an antihistamine, a steroid, an antibiotic, Clotrimazole, Anthisan, 1% Hydrocortisone, Fucidin and an antiseptic spray or liquid.
  • Dressings and Wound Closure: Simple dressings impregnated with betadine are useful, together with some dry dressings and crepe bandages. Wounds can be closed with steristrips, sutures, staples or even superglue. Training is essential here, which is why leaving plenty of time to prep is so important.
  • Medical Emergencies: I always carry a Salbutamol Inhaler, and treatment for anaphylaxis, such as Adrenaline, Piriton and Hydrocortisone.
  • IV Access and fluids: IV Fluids, Giving Sets and Venflons, plus an assortment of syringes and needles.
  • Specialist Equipment (environment-dependant): Extra equipment is often needed for different environments. For example:
    • Altitude Expeditions are most likely to see AMS, HACE and HAPE, so the correct training and medication to look after these conditions is imperative. Dexamethasone, Nifedipine, Acetazolamide, Oxygen and a Hyperbaric Chamber are often used, including other medications that have been trialled with some success.
    • Polar environments may need portable devices for rewarming hypothermic patients – e.g. the HEATPAC is light and easy to use.
    • Lightweight stretchers are useful, you can even improvise using rope, but ski stretchers are invaluable when backcountry skiing.

Where do I start when organising an expedition medical kit?

Organising an expedition medical kit should never be a rushed, so start by leaving plenty of time. This is important because it’s easily overlooked, and assembly of a full kit can require a fair degree of effort to get right – not simply through assessing and obtaining what you do need, but what you don’t.

Inevitably you’ll need to make compromises; you need enough equipment to deal with the most common medical problems that are likely to occur but not so much that you’re weighed down with kit you won’t use. Environment and destination will play a part here, so your medical skills and correct assessment of the risk factors are crucial.

Remember you’ll be carrying your medical kit everywhere. Pack, reassess what you’ve packed and then re-pack the essentials, and do so in a small lightweight bag.

Essentially: Take the minimum kit necessary to deal with the broadest array of anticipated environmental risks and common health issues.

What are the most common ailments and injuries I’m likely to encounter?

Common injuries to virtually every expedition include blisters, minor wounds and small burns, all of which should heal correctly if cleaned and dressed correctly.

The most common ailments range from aches and pains and bowel disturbances to insect bites and sunburn. These usually get better over time, although common drugs and ointments can provide relief.

What else do I need to think about?

In addition to putting together your expedition medical kit supplies, you should also check the Foreign Office travel advice website or contact the embassy of the country you’re travelling to. They’ll advise you on current inoculation and international certification requirements for travellers in to and out of the destination country. Last thing you need are any nasty surprises!

Also, here’s a potentially lifesaving tip that shouldn’t be ignored:

Once your kit is ready, split the medical supplies across several expedition team members – this will minimise the risk of losing everything in one go. (In extreme environments, loss of equipment is far more likely than usual, so don’t tempt fate!)

You should also think about the types of kit you’ll need to prepare:

  • Field first aid kit: A basic kit containing first aid equipment for a small group of people who will be away from base camp for a day.
  • Mobile camp kit: This kit should contain supplies for a small group (approx. 6 people) who will be away from base camp for a few days.
  • Base camp kit: This is the main medical kit for the expedition. You will also use this kit to replenish the other kits and hold a reserve stock of any medicines required for individual team members.
  • Accident kit: This will be a pre-packed emergency kit (and part of the Base camp kit) to be used specifically in case of a serious accident. It should be always kept on top of the base camp kit so that it’s quickly and easily accessible. It goes without saying that it will also need to be portable!

Packing your expedition medical kit

Finally, when packing your equipment, ensure all your medical kit is protected in clear, resealable polythene bags or plastic boxes so everything is protected from water, dirt, and damage. Don’t forget to clearly label each of the contents in your kit – they’ll need to be found easily under strenuous conditions, like bad weather and poor light.

As you can see there is no ‘easy answer’ to this question. You may choose to take a 25kg rucksack full of equipment, or it may fit into a camera case. So, start by looking at the common conditions, endemic diseases, common injuries and logistical & medical support on hand – and adapt your medical kit to suit.



Other expedition medicine blogs that may be of interest, include:

What is Wilderness Medicine and how do you get into it?

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Wilderness MedicineThe term Wilderness Medicine has been around for a short time when considering how long wilderness medicine has been practised. The Wilderness Medical Society, which started in 1983, began to use the term ‘Wilderness Medicine’ and have since been a cornerstone of research and education in the United States.

Forty years may not seem a short time, but when you consider the first recorded instance of medical support was evidenced some 3,000 years ago during the Trojan War, four decades is a drop in the ocean. To read more on the history of expedition medics, click here, but what really sparks our interest, is what 21st century wilderness medicine offers.

Let’s take a closer look…

What is Wilderness Medicine?

Wilderness Medicine can be defined as the practice of medicine in remote areas where access to medical services, support, and facilities is limited or non-existent.

Therefore, if a medical professional is called into action, they must go beyond basic first aid training to provide advanced care and treatment.

Why is Wilderness Medicine needed?

Wilderness medicine is a rapidly evolving field and is becoming increasingly relied on as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the pursuit of adventure.

As well as a response to the increased demand in adventure travel, wilderness medicine training also encompasses the medical skills crucial to providing care on educational trips, scientific expeditions, humanitarian rescues, disaster relief and military aid.

Roles for medics in wilderness medicine

Wilderness medicine is a broad term that covers multiple sub-specialties, harnessing the skills and experience found in different medical roles.

These include:

  • Doctors: Can consist of GPs, Psychiatrists, and other experts in medicine.
  • Nurse: Providing wound care
  • Paramedic: Assessment of injuries
  • Dentist: Dental care (Note: It’s recommended that other medical professionals learn the basics of dental care, since a dentist isn’t always available.)
  • Dietitian: Providing support and guidance about food, nutrition, and hydration.

Medical responsibilities during a wilderness expedition

Providing medical care and support is the primary focus of a medical professional during a wilderness expedition. In A Comprehensive Guide to Wilderness & Travel Medicine, author Eric A. Weiss suggests that at the heart of wilderness medicine is ‘improvisation’. By that we mean employing a combination of medical science with creativity and ingenuity – because in the wild, you’re forced to utilise whatever supplies or medical equipment you have to hand. How you put those to use is heavily reliant on a common sense approach.

Equally important is early clinical intervention and logistics decision-making, which often has important effects on subsequent outcomes. Primary responsibilities include the evaluation, triage, preliminary care of acute injuries or illnesses, and the medevac of patients.

Non-medical responsibilities and skills

Success in extreme conditions requires Health Care Professionals (HCPs) to go beyond medicine.

Survival skills, field craft and mastery of support equipment are just as vital. These include learning how to find and purify water, navigation, hiking and trekking, and choosing suitable clothing for survival in the wild.

Equally important are skills in leadership, risk assessment, incident management and search and rescue – all of which are a core focus of the most comprehensive training courses.

How do you get into Wilderness Medicine?

The first thing you need is a positive mindset and a thirst for adventure. Secondly, you’ll need additional medical training and experience.

Valuable experience can be achieved by attending expedition courses. For instance, you could start with our foundational Expedition and Wilderness Medicine courses to get to grips with the basics. You’re then able to follow up with a specialised course to hone your skills in a particular environment, like Mountain or Jungle Medicine.

That said, experience is just part of the puzzle. Networking can go a long way to helping you secure your first posting. Our courses give you the opportunity not only to meet likeminded medics learning alongside you, but also to engage with our world-class faculty who are always happy to point you in the right direction.

For unparalleled networking opportunities, we highly recommend attending the annual three day World Extreme Medicine Conference, where you can meet and build valuable relationships with hundreds of extreme medics from around the world. You can attend both in person in Edinburgh (UK) or online via our digital conference platform.

MSc Masters course in partnership with University of Exeter

Fancy taking it to the next level? If you wish to experience full wilderness medicine training, then we encourage you to consider the world’s first and only International Diploma/MSc in Extreme Medicine.

Run in partnership with the University of Exeter, the qualification covers the gamut of extreme medicine, and you’re free to niche down and specialise in whatever direction you desire. Humanitarian medic? Check. Jungle medic? Check. Dive medic? Check.

Find out more to see if it’s right for you.

What career opportunities are available after the course?

Equipped with your new wilderness medicine skillset, knowledge and some experience, what are the next steps towards a career?

Many alumni fresh from our foundational Expedition and Wilderness Medicine course are now involved in expeditions around the world. They get involved in anything from disaster response and humanitarian aid, to placements with organisations like Raleigh International, UK-Med, Team Rubicon and Médecins Sans Frontières.

One of our recent students, Thomas, said:

This course was a comprehensive introduction to the world of wilderness medicine … [and] a great opportunity to network and learn amongst similarly-minded individuals.
Across the board, the faculty have experience working in hostile and austere environments and bring a diverse skill set to the table, presenting their own minds on what has worked for them in the field.
I could not recommend this course highly enough to anyone considering taking their medical or nursing career in a more exciting direction.”

The most recent job postings can be found on websites like Critical Care International, Adventure Medic and our own job section. Good news is that market growth is boosting demand for competent leaders in expedition and wilderness medicine, so you can be sure that the list of opportunities will continue to grow.

The evolution of the expedition world means that groups with more diversified needs are commonly taking part in expeditions, so the range of opportunities for all levels of HCP is diverging. And that means more opportunities to take a path less trodden – with a little advice from our friend, Bear Grylls: “Do not go where the path may lead, go instead where there is no path and leave a trail.”

So go on: #BeExtreme

Challenges of Managing the Response to a Major Incident

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22 November 2021, 19:30 GMT

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Challenges of Managing the Response to a Major Incident - 22 November 2021, 19:30 GMT

Price: £15.00

Presenter

Matt Bonner – Former Detective Superintendent, Met Homicide and Serious Crime Command

Session Aim

To explore the wider challenges that arise when leading a team responding to a major incident and the impact on all those involved – including casualties, communities and responders.

Content

  • Conducting a Criminal Investigation in parallel to a DVI (Victim Recovery) process.
  • The impact of a prolonged investigation on all those affected by the incident.
  • What does staff welfare mean?

Intended Learning Outcomes

  • How to deal with initial (and potentially conflicting) priorities.
  • The importance of developing trust and confidence in the emergency response and subsequent investigation.
  • The diverse situations where secondary trauma can become a challenge.
  • Personal impact of leading a high profile investigation.
  • The importance of ‘living’ staff welfare and not just ‘saying’ it.

Matt Bonner Bio

Matt recently completed his service with the Metropolitan Police Service as a Detective Superintendent where for the last four years, he had the privilege of leading the Criminal Investigation following the tragic events at Grenfell Tower in 2017 as the Senior Investigating Officer (SIO).

Matt’s detective pathway took him via a CID main office, to leading burglary and robbery teams, offender management teams and on to become a Senior Investigating Officer with the Metropolitan Police Homicide and Serious Crime Command – the archetypal “Scotland Yard Detective”.

Prior to his service with the MPS, Matt served with Hertfordshire Constabulary where he led on the development and implementation of an innovative approach to offender management and then supported the Police Service of Northern Ireland to successfully introduce a similar approach to policing in N. Ireland.

Alongside his role as an operational detective, he has also been involved in detective training throughout his career, leading on the delivery of senior detective training both locally and nationally and remains an associate trainer with the College of Policing for this purpose.

After an eventful career in policing, Matt is now the Head of Investigation Technology with Black Rainbow Consulting Group who deliver software solutions for law enforcement agencies and other investigative bodies globally.

What is an Expedition Medic? A guide to this exciting career and how you can get involved

Expedition Medic | What is an Expedition Medic | World Extreme Medicine

An Expedition Medic is quickly becoming one of the hottest career choices for medical professionals. Find out what the role involves, what training is available, and where to find exciting new career opportunities.

What is an Expedition Medic?
Expedition Medics are responsible for the physical and psychological wellbeing of people during expeditions, often in austere environments where access to medical services is limited, or in some cases, non-existent.

Expedition Medics need to evaluate, prioritise, and conduct preliminary treatment of acute injuries or illnesses until emergency evacuation can occur. Their role encompasses skills from doctors, paramedics, nurses, and physiotherapists.

But how did we arrive at the term ‘Expedition Medic’? Let’s take a look back through history…

Before the Romans, the Ancient Greeks chartered new territories and fought in wars to expand their empire. Their armies would have almost certainly ventured into remote environments during these expeditions and had medical assistance alongside.

Greek poet Homer refers to a medical incident during the Trojan War. When Menelaus was wounded by a Trojan bowman, the fleet surgeon, Machaon (son of Aesculapius, god of medicine), was called to treat the wound. Although the term ‘Expedition Medic’ may not have been used back then – the role has existed for thousands of years.

Expedition Medics today
Today’s Expedition Medic has come a long way from empire expansion. Of course, there are still educational trips, expeditions for scientific discovery, and military needs, but adventure travel is increasing in popularity, as is charity fundraising events, extreme challenges, and enjoy personal travel.

Regardless of the goal or reason for the expedition, the aims and responsibilities of the Expedition Medic remain the same. They need to minimise the risk of trauma and diseases and need to anticipate medical problems.

So, what does an Expedition Medic do?
The primary role of an Expedition Medic is to look after the physical and psychological wellbeing of people before, during, and after an expedition. No two adventures are the same, and each will bring a variety of challenges, physically and mentally, which is why thorough planning is essential.

Expedition Medics play a key role in supporting an expedition. They draw on three areas of expertise to ensure the success of the trip.

  1. Clinical
    First and foremost, an Expedition Medic will use their knowledge of first aid and emergency and primary healthcare skills to treat injuries and illnesses that may occur.
  2. Expedition
    Secondary to their medical expertise, Expedition Medics play a full role in the expedition, taking on general, non-medical roles such as assisting with research, bushcraft, climbing, navigating, or photography.
  3. Interpersonal
    An Expedition Medic will also be able to use their excellent communication skills to maintain the physical and psychological health of the team members. The presence of a medic can provide a psychological benefit to the group, and if an accident does occur, they can provide emotional back-up for the expedition team.

How do you become an Expedition Medic?
You will be able to gain valuable experience by joining expedition courses, such as our Expedition and Wilderness Medicine qualification.

Our four-day course is open to any doctor, nurse, paramedic or other medical professional. We offer unique learning opportunities by blending engaging lecture content with hands-on practical workshops out in the wilderness, culminating in a real-time search and rescue simulation. By the end of the course, you will have gained skills in planning an expedition, understanding climate, wound care, and how to look after mental health.

You don’t need any prior experience of expeditions to join us; the only prerequisite is that you need to be a Medical or Allied Health Professional or a medical student in the final two years of study.

What career opportunities are available after the course?
Many of our Expedition and Wilderness Medicine course alumni are part of expeditions across the globe. They are responding to natural disasters and emergencies or enjoying placements with organisations such as Raleigh International, UK-Med, Team Rubicon and Médecins Sans Frontières.

One of our recent students, Thomas, said: “This course was a comprehensive introduction to the world of wilderness medicine … [and] a great opportunity to network and learn amongst similarly-minded individuals.

“Across the board, the faculty have experience working in hostile and austere environments and bring a diverse skill set to the table, presenting their own minds on what has worked for them in the field.

“I could not recommend this course highly enough to anyone considering taking their medical or nursing career in a more exciting direction.”

Critical Care International and Adventure Medic feature an exciting list of opportunities.

As the expedition world evolves and groups with more complex needs are commonly taking part in expeditions, the range of healthcare providers required can be incredibly varied. This could include joining research trips with universities or charitable aid missions to remote parts of Africa.

These are exciting paths. Paths less trodden.
As Bear Grylls once said, “Do not go where the path may lead, go instead where there is no path and leave a trail.”

Have you got what it takes to #BeExtreme?

What is an Expedition Doctor? Here is everything you need to know.

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Expedition Doctor | What is an Expedition Doctor | World Extreme MedicineThe fusion of medical expertise and a passion for travel can carve an exhilarating career in extreme medicine, and will be a valuable asset to any expedition team – but how does one make this happen and what is involved? Read on…

What is an Expedition Doctor?
An Expedition Doctor is responsible for the physical and mental wellbeing of people before, during, and after an expedition. Excellent planning and evaluation of risks before an expedition is integral to its success. Planning allows the necessary precautions to be taken so that during and after the expedition, the expedition doctor can treat any injuries or illnesses that occur.

3 roles of an Expedition Doctor
The role of an Expedition Doctor can be varied, but we can define the role more clearly in three parts:

  1. Prepare and Prevent
    The most important work an Expedition Doctor can do will take place before the expedition begins. Claire Grogan is an emergency medical doctor, honorary clinical lecturer at the University of Exeter Medical School and fellow of the Royal Geographical Society. She told the Guardian she must “anticipate the unexpected.”She recalls a time in the Himalayas when an earthquake struck, but prior planning meant she was well prepared to deal with the crisis. “An Earthquake had been one of the risks we discussed before leaving the UK, and we had agreed to always have a grab bag with water, passports and food ready to go in an emergency. It seemed like overkill at the time, but that small amount of forethought really helped.”An Expedition Doctor’s pre-expedition checklist should also include pinpointing the location of nearby medical facilities, analysing the geography and weather of the country they’re visiting, the number of expedition members in the team, and what prophylactic drugs and medical equipment they need to take.
  2. During the expedition
    During the expedition, the Expedition Doctor will follow their robust plan to ensure injuries and illnesses of team members are kept to a minimum. Some of these prepare and prevent methods can work during the expedition too.In an interview with Lonely Planet, Australian ER doctor Andrew Peacock said that a key part of an expedition doctor’s role is to prevent things before they happen, rather than reacting to them. “…keeping an eye out and mentally noting who isn’t doing what they need to do to stay well and acting accordingly. Turning one or two around early, for instance, before they run into real trouble.”In some instances, there could be two parts to a doctor’s responsibilities during an expedition. For example, an expedition to provide humanitarian aid to people in remote parts of Africa would require the Expedition Doctor to care of their team as they travel to and from the location. The second part of their job would be to provide medical aid for people in those remote areas.
  3. After the expedition
    An Expedition Doctor’s role can continue after the expedition. There may be a requirement to provide support for people who need rehabilitation or physiotherapy following an injury. Doctors may need to prescribe a course of antibiotics to treat an illness or offer mental and emotional support for a traumatic experience.

How do you become an Expedition Doctor?
The first step to becoming an Expedition Doctor is completing your medical training. Once you are a qualified doctor you will have the fundamental skills you need to apply your medical brilliance in a remote environment.

Extreme medicine and wilderness courses are designed to provide experience and to put your knowledge to the test. Our World Extreme Medicine Training Courses blend engaging lecture content with hands-on practical workshops out in the wilderness, culminating in a real-time search and rescue simulation. Once you have completed the course, you will be ready for your first expedition.

How do you start your career as an Expedition Doctor?
A great way to gain more real-world experience is join expeditions with organisations such as Raleigh International, UK-Med, Team Rubicon and Médecins Sans Frontières. Many of our course alumni have gone on to provide care during natural disasters and emergencies around the world.

Francesco is one of our former students and told us that the course went far beyond his expectations. “This course opened my mind to new horizons, uncovering possibilities that I otherwise would probably never have considered!

“The excitement and the productive learning acquired at the World Extreme Medicine course came back with me to the critical care where I work, and I am convinced will improve my practice, regardless of how hostile and wild the environment may be.”

As the expedition world evolves, groups with more complex needs are commonly taking part in expeditions. This means the range of healthcare needed can be incredibly varied.

We recommend you make connections and check websites such Critical Care International and Adventure Medic for exciting opportunities, extreme medicine updates, and job posts.

Have you got what it takes to #BeExtreme?

How the World Extreme Medicine Conference helped to further my career

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Interview with Dr Sanjaya Karki: How the World Extreme Medicine Conference helped further his career

Dr Sanjaya Karki is the current Head in the Department of Emergency Medicine at Nepal Mediciti Hospital and main author of the recent paper entitled ‘Helicopter Emergency Medical Services During Coronavirus Disease 2019 in Nepal’ (Karki & Sprinkle, 2021).

The Nepalese health service, like most of the world, has suffered under severe pressure. But unlike much of the Western world, Nepal’s lack of critical care facilities, resources and trained personnel, traffic infrastructure issues and mountainous terrain are a huge challenge to overcome. Identifying these critical issues, Sanjaya and his team are working hard to help overcome these systemic shortcomings.

We caught up with him for a friendly discussion not long ago and it was then that he revealed how the David Weil Bursary (now defunct, but soon to be replaced by new WEM Fellowship bursaries) and the World Extreme Medicine Conference helped usher him towards his first job placement in Nepal.

Naturally, we wanted to find out more. So, we sat down with him (virtually, of course) to learn more about his work in the hope that it helps other aspiring extreme medics identify avenues where World Extreme Medicine can help give their career a boost in the right direction.

Read on to learn more about Sanjaya’s journey and experience – and then we encourage you to delve into the Air Medical Journal article itself for free.

How did being a beneficiary of a David Weil Bursary and attending the World Extreme Medicine Conference help you and your career?

The World Extreme Medicine Conference helped me to interact with many other people that are heavily involved in a similar field. I got to know many of the latest developments in our arena from around the world and it improved my communication skills.

Academic heroes whom I met there boosted my energy to work more in the field.

Were there any skills/insights that you picked up from the conference and have used/still use at work?

I met a young doctor there who’d graduated from Canada who also had the similar intention that matched mine to set up prehospital care. He later visited Nepal and the first time I intended to set up a prehospital care unit in a hospital he was also involved.

Where were you in your career when you first attended the conference – what job/position?

In 2013, I started my professional career in Nepal. In September 2014 I went to University of Leipzig as a Scientific Research Fellow for about a year, then went back to Nepal to carry on my career. I was working in the capacity of Scientific Research Fellow when I received the award.

What are your current job roles?

I am currently working in the capacity of Head in the Department of Emergency Medicine/Emergency Medical Service/Helicopter Emergency Medical Service at Nepal Mediciti Hospital.

Was there a particular reason behind writing your latest article for the Air Medical Journal?

Nepal is a country where we have extreme geography. Also, we have extreme weather variation dependent on place. When COVID-19 hit us, we came to understand that using only the road route is not easy to transfer patients with COVID pneumonia. A helicopter was a great choice, though expensive. So, we fitted Patient Isolation Units (PIU) inside B3e helicopters, and we started to transfer critically ill COVID patients via helicopter.

Carrying COVID patients in a helicopter is not a popular choice in every country. Nepal is a country where we do not have a single dedicated medical helicopter, even though we have been providing such a service to patients successfully.

That’s the reason why we wanted to publish a paper.

What has been your own personal experience of working in Nepal during the Coronavirus pandemic?

It was indeed great initiative that we took during COVID-19. Very few countries in the world have operated a helicopter medical service for COVID patients.

Though Nepal does not have a dedicated medical helicopter, we still shifted COVID cases even when they were under a mechanical ventilator. However, due to poor advanced ambulance services, it was not easy for the patients to transfer from low resources set up to higher centers.

You said in the article there is a shortage of critical care facilities, resources, and trained personnel – is this essentially what it comes down to, or are there other daily challenges that you come up against and how are you finding solutions to these challenges?

In Nepal, medical facilities are centralized. Not everywhere are highly advanced critical care facilities available. During COVID-19, huge numbers of patients were in need of ICU. On one hand, due to the unavailability of advanced EMS services, patients were facing difficulties in reaching higher centers – Helicopter Emergency Medical Service are expensive! On the other hand, due to the shortage of ICUs, patients suffered in some extent.

However, through the private and government level, rapid extension of ward beds and ICU beds brought some relief. At the moment, the number of cases is going down and things are trying to go back to normal, but from now we need to have a proper plan for if a third wave hits us.

You’re considered somewhat of a pioneer in establishing hospital-based helicopter EMS in Nepal, what is next on your career wish list?

HEMS is getting more popular in Nepal day by day. Now, Nepal consists of three hospitals with a proper HEMS system. Many hospitals have either a Heli-roof or ground Helipad. People are much more aware of the service and helicopter companies are also keen to provide such services.

Now, we need to develop the prehospital care course in the country. Paramedics’ proper education is not available either, so we need to develop that too.

Dedicated medical helicopters, if available, would be a great benefit for patients, as well as flight medics. A national level campaign is necessary to create awareness about the system.

Therefore, we are doing our best for all these developments.

Any tips or advice you would give to any aspiring extreme medics?

“When you want something, all the universe conspires in helping you to achieve it.” ― Paulo Coelho, The Alchemist.

It was not easy to start the proper HEMS system in Nepal. Lack of dedicated manpower, no dedicated medical helicopters and no relevant education of prehospital care were the factors barring us from operating the system. However, we started it and it’s going in a good direction.

To start with the difficult thing is not easy. In the extremes, things are extreme – but once we overcome those extremes with our extreme work, the happiness and satisfaction we achieve is also extreme!


We’d like to thank Dr Sanjaya Karki for his time answering our questions and wish he and his team all the best as they build on their work in Nepal.If you’d like to see how the World Extreme Medicine Conference could help your extreme medicine career, book your place today – you can either attend online or in Edinburgh this November.

If you’re interested in finding out more about our new upcoming bursaries, please head over to the Fellowship of Extreme & Wilderness Medicine website, where you can join up to be the first to know when they launch.

#InternationalPodcastDay – World Extreme Medicine Podcast

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Listen and learn with the World Extreme Medicine Podcast!

The perfect way to take your first step into the world of extreme medicine is to subscribe and listen to the World Extreme Medicine podcast.

With over 145 listening hours, it’s the leading platform for extreme medicine content and guests have included Megan Hine, Steve Backshall, Aldo Zane, Jason Fox and many more mavericks.

We would like to say a huge thank you to all our amazing guests so far and to celebrate #InternationalPodcastDay our team have pulled together several of their favourite podcasts from the World Extreme Medicine podcasting journey so far.

 

Take a listen to their picks below or subscribe today and explore the World Extreme Medicine Podcast for yourself…

Explore the World Extreme Medicine Podcast today, subscribe here or listen via most podcast streaming services.

Have you got an interesting story? We would love to hear from you! Contact our team and you could be joining us on the World Extreme Medicine Podcast very soon.

Healthcare in Ghana – The Harsh Reality of a Developing Country

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Trixton May shares his experiences of healthcare in Ghana

Background

‘Yaw’, that was the local name given to me as a male, born on a Thursday; one of many traditions the locals live by here in Takoradi, Ghana. My independent venture to West Africa during my second year of student paramedic studies was a challenging decision. Still, one I will always hold as my most significant life experience to date. With aspirations to serve in areas less fortunate in my future career, this step was the first of many more to come within humanitarian medicine. Ghana was a country I had no motives behind travelling to, I wanted to walk into a new culture and health care system blinded to learn to survive.

Ghana is a standout country compared to other West African cultures, with 40% of the population signed up to a National Health Insurance Scheme (NHIS). On paper, these schemes seemed beneficial to the Ghanaian Government. However, in practice, they have been shown to fail. Many factors play a role in funding health care in Ghana, the primary source being the country’s oil production capabilities. The Government of Ghana is pushing to have a healthcare service beyond aid, meaning they are moving not to become donor dependant.

Due to the adversity of Covid-19, I had multiple barriers travelling and working in Ghana, which resulted in having my trip condensed. I have no concerns that the few images displayed in this article will talk enough for themselves about the working conditions. Additionally, I must warn you that some topics and visuals may be disturbing. However, I strive to summarise my experience of the healthcare system in Takoradi, with the attempt to highlight the privilege for which we withhold having a free and established, yet unfortunately abused, healthcare system in the United Kingdom (UK). My end goal is to encourage others to see the beauty that we refer to as the National Health Service (NHS) and change the approach we all view and use the NHS.

Click here to read Trixton’s full Ghana experience > 

WEMLive session: Rocky Mountain Medicine

Another fabulous Monday, FREE #WEMLive session on Mountain Medicine that you will not want to miss out on!!

WEM Founder Mark Hannaford is privileged to be speaking with ace-medics from the Grand Teton National Park; Firefighter & Paramedic Kevin Grange award-winning author of ‘Wild Rescues’, and Dr Will Smith, Medical Director of the US Nationals Park Service.

On July 21, 2010, Will was the medical director in a search and rescue operation to find three separate parties of 17 people who were stranded above 13,000 feet near the summit of the Grand Teton during a lightning storm. It was the largest rescue event to occur in Grand Teton National Park. He was the medical supervisor for 16 of the 17 people rescued. The next day, the rescue operation continued to retrieve the one person who died after being struck by lightning and falling 3,000 feet. The rescue involved two helicopters, a dozen climbing rangers, two mountaineering physicians and numerous other responders. “It was a monumental test of rescuer skills and stamina, combined with incident command management ability,” said Fire Rescue Magazine.
Kevin’s book ‘Wild Rescues’ is a fast-paced, firsthand glimpse into the exciting lives of paramedics who work with the National Park Service: a unique brand of park rangers who respond to medical and traumatic emergencies in some of the most isolated and rugged parts of America. In 2014, Kevin Grange left his job as a paramedic in Los Angeles to work in a response area with 2.2 million acres: Yellowstone National Park.
Miss the FOMO and become a maverick medic and join us Monday 21 June: 11:00 / 18:00 BST
Sign up right here: https://bit.ly/3wGzm3e 
This session will be available afterwards on the WEM Facebook page and the WEM Academy website.

Interested in Mountain Medicine?
Discover our WEM Mountain Medicine course; the ultimate Mountain Medicine Nepal course, where you’ll follow the Everest Base Camp Trail from Lukla along the Khumbu valley to base camp, situated in the shadow of the world’s most iconic peak.

Myanmar Coup: Statement of Solidarity

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We, the undersigned and the organisations we represent, express our grave concern regarding the situation in Myanmar and the persistent abuse of human rights. We are particularly alarmed by the targeting of medical professionals, including those engaging in their human right to protest against the illegal military coup. We stand in solidarity with them and all those who are impacted.

On 1 February 2021, the Myanmar Armed Forces, the Tatmadaw, seized control of the government. Many have protested and medical professionals have been at the forefront, setting up their practices in makeshift health centres and clinics instead of government hospitals. The Tatmadaw have responded with appalling brutality including targeting medical professionals and interfering in their activities, which is an abuse of the principle of medical neutrality, enshrined in the First Geneva Convention.

Myanmar security forces have shot at health workers without provocation, arbitrarily arrested many, assaulted some, and forced others to flee their homes. In Yangon alone, at least a hundred medical students have been arrested.

This is a gross violation of the rights of doctors and it is also detrimental to the healthcare of patients, diminishing their right to the highest standard of health which is guaranteed by the International Covenant on Economic, Social and Cultural Rights which was ratified by Myanmar in 2017. Not only is medical care being provided in makeshift health centres with limited resources and facilities, but actions by the Myanmar military, such as cutting off internet access for large sectors of the country, further harm the ability of doctors and nurses to offer the highest level of care.

As doctors, and representatives of medical professional organisations, we are appalled by the treatment of peaceful protestors, especially our colleagues, and the resulting impact on healthcare. Members of our organisations are currently providing support to healthcare professionals in Myanmar and the reports we have received from them and others paint a damning picture of the actions of the Myanmar security forces.

We strongly urge the Tatmadaw to release all those they have arbitrarily arrested, to respect the right to freely protest, and to respect the principle of medical neutrality: allowing medical professionals to provide healthcare unimpeded. We urge telecommunications companies to extend coverage throughout Myanmar (to counteract the steps taken by the Tatmadaw) and the international community to explore coordinated action to oppose the abuse of human rights.

We have included resources at the end of this letter that may be of use to medical professionals looking to support colleagues in Myanmar and may also be of some help to doctors in Myanmar.

Sincerely,

Dr Chaand Nagpaul CBE
Council Chair, British Medical Association (BMA)

Dr John Chisholm CBE
Chair, BMA medical ethics committee

Dr Kitty Mohan
Chair, BMA international committee

Dr Adrian James
President, Royal College of Psychiatrists

Dr Katherine Henderson
President, Royal College of Emergency Medicine

Mr Edward Morris
President, Royal College of Obstetricians and Gynaecologists (RCOG)

Miss Ranee Thakar
Senior Vice President for Global Health, RCOG

Professor Martin Marshall CBE
Chair, Royal College of General Practitioners (RCGP)

Dr Helen Crawley
International Medical Director for Membership and Networks, RCGP

Professor Andrew Goddard
President, Royal College of Physicians (RCP)

Dr Mumtaz Patel
Global Vice President, RCP

Professor Neil Mortensen
President, Royal College of Surgeons of England

Professor Helen Stokes-Lampard
Chair, Academy of Medical Royal Colleges

Dr Jeanette Dickson
President, Royal College of Radiologists

Mr Ben Simms
Chief Executive, Tropical Health and Education Trust

Mr Chris Jones
Chief Executive Officer, British Medical Journal

Dr Tanya Bleiker
President, British Association of Dermatologists

Professor Adrian Gelb
President, World Federation of Societies of Anaesthesiologists (WFSA) and WFSA (UK)

Mr Julian Gore-Booth
CEO, WFSA and Secretary, WFSA (UK)

Mr Amal Paonaskar
Head of Programmes, WFSA

Dr James Brockbank
Myanmar-UK GP Health Action

Dr Sonny Tin Tun Aung
Myanmar-UK GP Health Action

Dr Bethany Moos
Medics 4 Myanmar

Mr Mark Hannaford
Founder & Managing Director, World Extreme Medicine

Ms Evelyn Brealey
Director, Cambridge Global Health Partnerships

Dr Emma Mitchell
Global Health Roots

Dr Nazaneen Nikpour
Global Health Roots

Resources
• Videos on providing first aid care (narrated in Burmese): https://youtube.com/playlist?list=PLJgobuRNCrM0W1E2T7zSW1KxCefRWJduo
• Myanmar clinical guidance, including virtual support for Myanmar doctors and nurses: https://www.myanmarclinicalguidance.com/
• Support for Myanmar: https://www.isupportmyanmar.com/
• Action Aid, Myanmar: https://www.actionaid.org.uk/about-us/where-we-work/myanmar
• Médecins Sans Frontières (Doctors Without Borders), Myanmar: https://www.doctorswithoutborders.org/what-we-do/countries/myanmar
• UK GP skeleton statement for writing to your MP on the issue (can be adapted by other clinicians also): https://www.gponline.com/uk-gps-helping-support-doctors-myanmar- following-military-coup/article/1711338
• Webinar series ‘Medics 4 Myanmar’: WEMAcademy and WEM Facebook page

Skin in the Game – The Risk and Reward of Mountain Rescue

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Mountain RescueWEM Faculty share what it means to be part of a Mountain Rescue Team

The mountains were once the domain of farmers, shepherds, road builders and quarrymen. There for necessity, rather than pleasure, the harsh surroundings acted as a constant reminder severe injury on the hills would most likely result in death. Despite best efforts and good intentions ad-hoc, makeshift rescue by members of the local community, over difficult terrain, was far removed from the 21st Century Mountain Rescue service we are now familiar with.

It wasn’t until the birth of modern mountaineering in the late 18th Century when walking and climbing became a past-time of the rich, rather than a chore of labourers, that organised mountain rescue was even conceptualised. Yet, it took a fatal accident in the Peak District during 1928 to formulate the structured teams we rely on today.

Hidden among World Extreme Medicine Faculty, and the medical professionals you serve with, are the exceptional volunteers that transition their skill-set from a traditional medical setting to a challenging, outdoor environment.

Jamie Pattinson: Paramedic

The first thing I always say is, “I’m Jamie from Mountain Rescue, I’m here to help you”. I try to make sure we keep them informed, “There’s going to be a bit of noise as we get close to the helicopter, it’ll be a little bumpy as we move you, I’ll be at your left shoulder the whole time though”.

I’ve been part of countless incidents, some with positive outcomes, some not. Every time we get called out the stark reality of the situation is always on my mind, going to the aid of someone who, but for the grace of good fortune, could easily have been me. There is a huge sense of pride when we get the job done, I’m not ashamed to admit the high fives and buzz after a successful rescue. And, as the Medical Officer, responsible for ensuring the medics of our team are well-equipped, competent and confident, the sense of pride and reward when the team comes together is second to none.

We are called out in the harshest of conditions; long hours in the cold, wet and darkness. The risk to ourselves, while mindfully managed, is nevertheless a feature of the work. Every single member of the team cares, and it is that vulnerability that enables us to give our all when required, both for the casualty and for the team. Mountain Rescue is a family and the bond that you forge with each other, over the hours of training and live operations, is one of the closest I have ever experienced. Ultimately, this is what makes my role so rewarding, overcoming the challenges and obstacles to get the best outcome for the person. Mountain Rescue has given me the career, friends and experiences that shaped who I am.

Wayne Auton: HEMS Paramedic and Specialist Retrieval Practitioner

When you finish the job and are having a cup of tea back on base, knowing each other performed during a difficult rescue, the bond is formed. It gets stronger and stronger the more time you spend on the mountains. Respect, admiration, camaraderie.

Adversity brings people together in a way you only get from the most difficult of experiences. Mountain Rescue offers that type of experience; looking after yourself and the casualty in an austere environment, post-avalanche or white-out is a good example. The challenge. You’ve got to have your mate’s backs and you have to know they have yours. The trust. When you get the call there’s a little niggle of fear and excitement, no outcome is certain when you head out, everything plays out in real-time and you have to respond because people are relying on you. The responsibility. Every decision you take has an impact on the result but it’s a pressure you secretly enjoy which is one of the pulls of this job. We’re so fortunate in the U.K that we can go into the mountains knowing there are a group of professionals willing to give up their time to help us, to be part of that is a great privilege.

Ben Cooper: ED Charge Nurse and Advanced Nurse Practitioner

01 January 1993 I had my first introduction to Mountain Rescue the hard way. I fell climbing, plummeting into a waterfall plunge pool. I woke up wet, in pain, and bloodied. I looked around, my climbing partner suffered massive facial trauma, his helmet split in two. I opened my backpack, grasped for the whistle and started to blow the emergency distress signal. I’m still friends with the Mountain Rescue called to my location that day, I was the 4th incident they dealt with, they inspired me to join.

It was exciting, I was 20 years old and getting to know my team who were all like-minded climbers and mountaineers. I got invited to engagement parties, weddings and birthday parties, treated like a member of their families. Mountain Rescue is a fraternity and often teams are made up of multiple medical professionals, at one point 12 of us worked together in the mountains and also the same hospital.

Yet, despite experience, the worst outcomes never fail to touch you. We got a call to a fallen climber on a crag very local to where we were. Within 20 minutes we were on scene, within 21 minutes I was doing everything I could as a 4-year qualified senior staff nurse to save a young climber’s life. The Sea King helicopter arrived and whisked us off to the hospital where I worked in A&E. I handed the casualty over, but after a time the young climber was pronounced dead. The sister on duty put her arms around me and said, “You’re going to help me clean this young man up and prepare his last offices as part of your grieving process”. Afterwards, we had a debrief as a team in the local pub. Later, over the following weeks, I was called regularly to make sure I was OK. That’s what happens on Mountain Rescue, you look out and after each other. It’s more than just rescuing people, it’s more than a team… it’s a family, a big family with a huge heart.

How to Volunteer for your local Mountain Rescue Service

There are many ways to support your local Mountain Rescue from being a part of operations to fundraising. Even an hour or two a week makes a huge difference.

Mountain Rescue England and Wales: www.mountain.rescue.org.uk/how-to-volunteer/

Mountain Rescue Scotland: www.scottishmountainrescue.org

Mountain Rescue Northern Ireland: www.communityrescue.org/about-us/

If Mountain Rescue isn’t your bag other volunteer emergency services include the Royal National Lifeboat Institute: RNLI lifeguards and lifeboat crew,  (https://rnli.org/support-us/volunteer/how-you-can-volunteer), Coastguard Service (www.gov.uk/volunteer-as-a-coastguard/what-to-expect-as-a-volunteer), and fire service (www.fireservice.co.uk/recruitment/retained-firefighters/).

Up-skill to Volunteer for Mountain Rescue

To apply for volunteer positions the following core skills courses may be a useful addition to your portfolio:

Expedition and Wilderness Medicine (Keswick, Plas Y Brenin, Corfe Castle and Slovenia): www.worldextrememedicine.com/products/all-courses/

Ocean Medicine (Plymouth): www.worldextrememedicine.com/products/all-courses/

Introducing the FEWM Fellowship with NASA Astronaut Dr Mike Barratt

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The FEWM Fellowship is introduced by lifelong student of extreme medicine NASA Astronaut and Flight Surgeon Dr Mike Barratt.

A fellowship built to serve a community of professionals committed to medicine in the most challenging environments.

World Extreme Medicine is excited to announce the FEWM Fellowship! (Fellowship Extreme and Wilderness Medicine).

This movement is OURS
And our time is NOW

What is it?
A standardised framework of experience, competencies, and values that denotes a benchmark for practitioners of Extreme Medicine.

What does it add?
This is a Fellowship like no other. A fresh approach, built to serve the dynamic, inclusive, and diverse global community of Extreme Medics from all walks of life.

It’s a fellowship that recognises and elevates the key members of this community: teachers, role models, and thought leaders who are forging the path for the next generation. You don’t need to be part of any existing ‘old boys’ network’ to join.

There’s no requirement to be nominated by an existing member. The criteria are clear and simple.

Whatever your background, wherever you are in the world, if YOU’ve made a significant contribution to the care of patients in extreme settings, YOU can apply.

Who can join?

All health workers and allied professions that directly support the delivery of medicine in extreme settings are eligible to apply. You will need to demonstrate how you meet the required level of competency and experience through an online application form.

What are the benefits?

– Become an integral part of a dynamic and cohesive global community
– Gain instant access to a network of like-minded, highly skilled professionals
– Use the post-nominals FEWM
– Gain full access to the closed FEWM forum
– Gain full access to the WEM Academy CPD platform
– Gain discounted access to WEM courses and conferences

What if I want to be part of this, but I don’t have enough experience quite yet?

There is also a ‘membership’ level for more junior clinicians and students who would like to be involved and find opportunities that will open the doors to an extreme career. You are entitled to many of the same benefits above, although members are not entitled to use the post-nominals ‘FEWM’.

For pricing and more information head to the FEWM website.

Main home

Medical Volunteering in Moria Refugee Camp

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Doctors Flora Burns and Rose Brenna discuss and share their own experiences of medical volunteering in Moria Refugee Camp – December 2020

In September 2020, devastating fires at a refugee camp on the Greek Island of Lesvos were reported in the news. This once again brought to the forefront of people’s minds, the desperate situation of many people fleeing their native countries and seeking asylum abroad. In this article, we provide a firsthand account of our experiences volunteering as doctors at this very same camp earlier in the year. We hope that it provides the reader with a useful insight into current conditions in these camps, and perhaps even provides inspiration for action.

Mória Refugee Camp, on the Greek Island of Lesvos, was built in 2015 to accommodate 2,200 of the growing number of refugees escaping conflict and poverty across the Middle East and Africa. There are currently between 12,000 [1] to 20,000 [2] people living there. Owing to the camp’s overwhelming growth many inhabitants have been forced to spill out into the surrounding olive groves; building makeshift homes out of whatever they can find. This is an area known as ‘Mória Jungle’ [5]. Once named ‘the worst refugee camp on earth’ by the Field Coordinator of Médecins Sans Frontières (Doctors without Borders), many of those living there have waited for over a year for interviews to further their asylum process. Of the asylum seekers arriving in the Aegean Islands, 46% are from Afghanistan, 18% from Syria and the remainder from countries including the Democratic Republic of Congo, Somalia, Iraq and Iran [3].

In 2017 the risk of tension between communities living in the camp was rated as ‘red’ by the United Nations Refugee Agency. A number of other factors at the camp were also assigned this status including the nutritional value of food available, access to cooking equipment, and participation of school age children in formal education [3]. It is estimated that between 6,000 to 7000 camp inhabitants are children under the age of 18 [2].

We travelled to Lesvos in the summer of 2020, to volunteer as doctors with Medical Volunteers International (MVI). MVI is a non-governmental organization that has been providing medical care to displaced people in Lesvos, Thessaloniki and Athens since 2016 [4].

After arriving in Lesvos, we were required to follow a strict two-week isolation to minimize our risk of spreading Covid-19 in the camp. Covid-19 has had devastating effects on what is already a tough life for those living in the camp. However, the Greek government’s strategy to reduce transmission between the camp and the local population of Lesvos has included introducing strict lockdowns in the Camp which has exacerbated tensions.

Neither of us knew what to expect when we eventually started work. On our first day in Mória, as we entered the barbed wire enclosure under the watchful eyes of the Greek armed police, we both sensed an overwhelming feeling of tension and desperation.

The camp’s medical ‘centre’ consisted of a few isoboxes (large storage containers) with 2-3 clinic rooms in each, separated by curtains, and a small pharmacy which relied on donations from NGOs and local Greek pharmacies. In addition to this, there was a separate triage area used to screen anyone with respiratory symptoms of Covid-19. Using WHO criteria, those we identified as medium or high risk would be sent for further tests or isolation and contact tracing.

To prepare us for work at the camp, we spoke to friends and colleagues who had worked in humanitarian settings. The overriding advice we received was to identify our personal reasons for going and keep them in mind day-to-day. The importance of this became evident as our time in Mória progressed. As we talked to refugees and learned about their individual horrific stories, we found ourselves becoming despondent, saddened and powerless considering the scale of the crisis in Europe and beyond.

Upon reflection, it would be fair to say some of our incentive for volunteering was curiosity. Our work in emergency medicine in the UK often sees us treating patients who were once asylum seekers and are now living and receiving healthcare in a very unfamiliar system. It is often difficult to empathize with what they have been through before arriving in the UK. Volunteering in Mória provided a good opportunity to gain an insight into their world, as well as get some firsthand humanitarian experience.

In reality, what we learned in Mória went far beyond our expectations. Of course, we gained experience and knowledge around acute medicine in crisis settings, some of which is outlined below, but perhaps more importantly, we came away with an understanding of the human side to this ongoing tragedy. We hope that our accounts of specific cases will provide you with a true insight into the impossible and complex mess of challenges being faced by people living in Mória, as well as those attempting to work there.

Common conditions in Mória Refugee camp

  • Gastrointestinal – reflux, constipation, gastroenteritis, IBS, intestinal worms
  • ENT – otitis externa and media, traumatic bilateral ear drum perforations
  • Women’s health – thrush, weak pelvic floor, antenatal care
  • Dermatological – bacterial and fungal skin infections, scabies
  • Respiratory – ‘Mória flu – chronic cough due to open fire smoke and dust’, suspected tuberculosis
  • Psychological – insomnia, panic attacks, PTSD, memory loss, low mood, drug and alcohol use
  • MSK – back pain, injuries from torture
  • Other – dental caries, visual impairment, poor nutrition, weight loss

The above list is by no means exhaustive but lists some of the more common problems we saw. Something we quickly realised is many of the medical complaints were secondary to or exacerbated by living conditions and mental health, e.g., gastritis caused by poor diet but exacerbated by stress.

Thought-provoking cases from Mória

Rose: ‘One patient that really summed up the challenges of Mória for me was a woman from Afghanistan in her 40s who presented with the quite common heart sink list of problems including gastritis, back ache and difficulty sleeping. Her main problem was pain in her joints. She had been seen several times before and advised she would have to wait several months until blood tests were available for potential rheumatoid arthritis. When she saw me blood tests were still not available and she was on all the simple analgesia we had to offer as well as a trial of steroids. When I explained there was no more I could currently do she became very upset saying “you’re not helping me here at all, I wish I had never left my country, Mória is much worse”. At this point I felt so helpless, I was doing as much as I could, but she was right, I wasn’t helping, it did not feel fair at all.’

 ‘Another case that really stuck with me was that of a young woman from the Democratic Republic of Congo who was here on her own, which was unusual for a woman. She had come with abdominal pain, something she had had for the past year and had been investigated with an ultrasound but nothing was found. On questioning her further she opened up about being horribly abused by her ex-partner, to the extent he had caused a traumatic miscarriage which was subsequently delivered by caesarian section. The pain had been ongoing since then. Through listening to her story and exploring the reasons behind her symptoms, I was able to refer her on to the domestic and sexual violence support available in the camp’

Flora: ‘The most difficult case I was involved with while medical volunteering at Mória was a prepubescent boy from Afghanistan who presented with genital ulcers. He was accompanied by his concerned father, the young boy was tearful and quiet. With the invaluable help of a translator’s sensitive questions, we ascertained that the family were living in an old bus in ‘Mória Jungle’ along with two other large families. We tried our hardest to get the young boy to open up about why he was tearful and if anyone had hurt him in any way. We asked the father to leave the room for a bit and the boy became even more tearful. He said some other boys had been throwing stones at him and chasing him but denied anyone touching him in a way they shouldn’t.

In the UK, a case like this would appropriately trigger red flags to social services to ensure the child was not a victim of sexual abuse. Genital ulcers can be a symptom of other acute illnesses in children however sexually transmitted infections such as herpes simplex virus should be investigated. I was struck with the heartbreaking realisation that the best I could do for this boy, alongside treating the ulcers with the antiviral medication that the clinic thankfully had, was give him and his dad the time and space to talk about their social situation and try and create a ‘safeguarding plan’ there and then. The anxious father listened and agreed to be more watchful of him. They then disappeared back into Mória. This was one of my last days working in the clinic so I handed the patient over to another volunteer who was able to follow him up.’

Challenges of working as a humanitarian doctor

Medical volunteering in Mória refugee camp presented several challenges that we had not experienced working in UK emergency departments. A key difference was working with translators. We had to modify the way we spoke to allow the translators to understand. In addition, sometimes, despite the patient talking at length, the translator would only provide a few translated words – things definitely got lost in translation! Culturally, we faced challenges when the combination of female patient and male translator arose; neither party would be comfortable discussing intimate problems. On top of this, the majority of the translators were asylum seekers themselves and had been through similar situations to the patients. It was important to be mindful of the underlying factors that may affect the translator and try to avoid potentially burdening them further. Between clinics we had the opportunity to chat with the translators and learn about their stories as well as how they had ended up in Mória.

Access to investigations and secondary care was almost non-existent. There was a several month wait for any blood tests unless it was an emergency (each case would be assessed by the sole Greek doctor in the clinic). The same applied for secondary care referrals, this was again on an emergency-only basis. In terms of mental health support there were only two psychologists, so subsequently only the most severe cases could be seen. This difficult situation was exacerbated still further as, while we were there, much of the community support was unavailable due to Covid-19.

On a more personal note, due to the heartbreaking and desperate situations that we witnessed every day, turning off at the end of a shift and not becoming too emotionally invested was difficult. Working under camp conditions but living in NGO accommodation amongst local Greeks living their everyday lives was a strange juxtaposition. We had to fight an urge to try and force change. We were only there for a short time, and although the system was flawed, we were never going to fully understand it and bring about long-term changes. We had to appreciate what we were able to do both there, and back in the UK. Coming home and going back to work in the comparatively well-resourced NHS, we have realized the importance of perspective when it comes to how people experience ill health and hardship.

How can you get involved?

It was by no means just doctors that were needed camp Mória. Integral roles at the camp included allied health professionals such as paramedics, nurses, psychologist, physios, as well as people with an aptitude for people management skills and logistics. The wider group of NGO workers include teachers, plumbers and lawyers. Medical volunteering in Moria is challenging and not always the most rewarding experience, but overall it is something we would definitely both do again. Even the relatively small changes you make can be significant for people at a very difficult time in their lives.

Top tips

  1. There is no pressure to do things and remember your own limitations. Never agree to work in a situation where you feel unsafe or you are working outside of your competence. You will be working alongside doctors and nurses from many different countries with various backgrounds and levels of experience. The ‘professional hierarchy’ we are used to in our native healthcare systems no longer exists. We were lucky enough to have a consultant in the UK who was happy to answer clinical questions and support us. Don’t be afraid to question practices that you are not familiar or happy with.
  2. Write a risk assessment. Consider your personal and health insurance including any vaccinations and professional indemnity.
  3. Prior experience in medical volunteering – having some experience in primary care or emergency medicine is invaluable. To work with organisations such as Médecins Sans Frontières, the Diploma of Tropical Medicine and Hygiene is an absolute requirement however it is also a very useful qualification to have in many humanitarian settings.
  4. Be self-sufficient – find below a ‘kit list’ we found useful
  5. Don’t be naïve. Do as much background research as you can about the organisation you are working with, the political situation in the country, the outlook for the asylum seekers, cultural backgrounds of translators and patients. Try and remain sensitive to the variety of cultures and religions through your behaviour and dress.
  6. Focus on the small changes you might be making on a case-by-case basis. Strive to be patient. Sometimes the most useful thing you can do for someone is just sitting and listening.
  7. Many of the asylum seekers come from countries where they had very good levels of health care. They have high expectations – managing these can be incredibly challenging and frustrating at times.
  8. The translators are invaluable! We were constantly reminded how vital it is to look out for the translator’s welfare and ensure they remain neutral within a consultation.
  9. Remember your personal reason for going. Keeping in mind your specific aims is useful for maintaining your own morale.
  10. Coming home – debrief and spread the word through reflecting and talking about your experiences.

Kit List

All medical kit below was available in the clinic, except the stethoscopes. However, it may be of questionable quality or not always working.

  • Pulse oximeter, temperature probe and manual blood pressure monitor
  • Ophthalmoscope and otoscope
  • Urine test kit, pregnancy tests and blood glucose machine
  • Any medication you can bring including any over the counter medication that we take for granted in the UK including simple analgesia, diarrhea and constipation relief, multivitamins, antihistamines, cough syrups
  • First aid kit and suture kit
  • Personal protective equipment – the clinic was well equipped with PPE however it was nice to not use up their valuable supply
  • Food and drink – make sure you are self-sufficient you never know when you might be able to get a break
  • A positive mindset!

References

  1. Melissa Godin. Blaze That Destroyed Greece’s Moria Refugee Camp Symbolizes Breakdown in E.U. Over Future of Migrants. Time [Newspaper on the Internet]. 2020 Sept 10 [cited 2020 Dec 01].

Available from: www.time.com

  1. Aegean Boat Report. [Weekly statistics update on the internet]. Dec 2020, [cited 2020 Dec 09]

Available from: www.aegeanboatreport.com

  1. The United Nations High Commissioner for Refugees. Aegean Islands Weekly Snapshot. [Internet]. 23-29 November 2020 [cited 2020 November 03].

Available from: www.data2.unhcr.org

  1. Medical Volunteers International What we do? NGO website [cited 2020 Dec 09] Available from: www.medical-volunteers.org
  2. Bill Frellick. Greece: Refugee Hotspots, Unsafe, Unsanitary. Human Rights Watch. [Internet] 2019 May [cited 2020 Dec 09]

Available from: www.hrw.org



Other blogs that may be of interest include: 

World Extreme Medicine Founder honoured in Iconic Explorers Club Top 50

The iconic #ExplorersClub has recognised WEM Founder Mark Hannaford as one of 50 people worldwide who is actively changing the worldWith 400 nominations received from 48 countries12 judges composed of international Explorers Club members had the monumental decision to select just 12.5% of the women and men nominated for the inaugural ​Explorers Club 50 (EC50)​ program. Strict criteria and the following questions were considered:  

  • Does this candidate’s work involve an outstanding, innovative, and impactful mode of exploration and inspire a greater understanding of the world around us?  
  • Does their work impact the communities they live in, in innovative ways?  
  • Would this recognition help expand the definition of exploration and further promote the Club’s mission? 

The extraordinary findings and stories can be read in this special edition of The Explorers Journal (Mark is on page 15). 

Mark comments: What an honour it is to be part of the prestigious #ExplorersClub and to be recognised as one of 50 people changing the world – thank you so much, Shawna Pandya, for my nomination.  

I feel humbled by the outstanding contribution and work my fellow awardees are making to our society and it’s an honour to be counted amongst them. It’s such an eclectic and vigorous community of explorers, scientists and thought leaders – it is great to see Marc O’Griofa physician, aquanaut, fellow WEM faculty member and friend on the list too. 

I feel privileged to have been invited to become an Explorers Club Fellow. It is also fantastic international recognition of World Extreme Medicine’s work in pushing the boundaries in expedition, wilderness, and remote medicine. Thank you.”   

Richard Wiese President of The Explorers Club says: “I could not be more pleased with the group selected to represent this first class. Every honouree featured [here], as well as the hundreds of other nominees, are exploring, inspiring, and creating the future – the future of the planet, the future of food security, of palaeontology, of biology, what our communities should look like, and so much more. The EC50 was established to not only reflect the great diversity of exploration, but to give a voice to these trailblazing explorers, scientists, and activists doing incredible work.”  

 

What is The Explorers Club? 

Founded in New York City in 1904, The Explorers Club promotes the scientific exploration of land, sea, air, and space by supporting research and education in the physical, natural and biological sciences.  

Past members include astronaut Neil Armstrong, Peter Freuchen (Danish explorer who escaped an ice cave armed with his bare hands and frozen faeces)President Teddy RooseveltSir Edmund Hillary (first to the summit of Mount Everest) and aviator Charles Lindbergh (first aviator to complete a solo transatlantic flight)  

Today the prestigious Club has approximately 3,500 members representing every continent and in more than 60 countries, comprising 34 chapters around the globe; amongst them is astronaut Buzz Aldrin, primatologist Jane Goodall, CEO of Tesla and SpaceX Elon Musk, Amazon CEO Jeff Bezos, film director James Cameron – and now Professor Mark Hannaford Extreme Medicine Pioneer, founder of World Extreme MedicineAcross the Divide ExpeditionsMSc Extreme Medicine (Exeter University) and the world’s largest subject matter conference (#WEM21). 

Doctors for Nepal: Online Auction

folder_openExpedition & Wilderness Medicine, Expedition Medicine, Nepal
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Our friends over at Doctors For Nepal are hosting an online auction to raise funds urgently needed to provide healthcare workers with much needed PPE, as they serve on the frontline of the COVID-19 pandemic in some of the most remote parts of Nepal.

There are some fantastic prizes to be won – including a flight in a private plane, a unique ‘Glamping’ experience, a week’s rental of an amazing house in the south of France, plus loads of gorgeous handmade Nepalese goods.

Doctors for Nepal is a small UK based charity that raises funds to support some of Nepal’s brightest, but most impoverished students, to train to become doctors, nurses, and midwives. They are bonded to work back in their remote districts, to provide essential healthcare to tens of thousands of patients.

Currently, they are working in terrible conditions, and are in desperate need of outside support to cover basic protection for themselves and their teams. By bidding in this auction, you will help provide essential PPE, and ensure that Doctors For Nepal are able to support the continued training of their students.

Click HERE to start bidding!

All aboard! Life as a Ships Medical Officer supporting an offshore conservation campaign

A few months ago, Arav Gupta replied to an advertisement on our Facebook page – Sea Shepherd were looking for a Ships Medical Officer to support an offshore campaign against illegal and unreported fishing (IUU) in Gabon. He took some time out of his busy life onboard to tell us more about how he got involved, the lessons he’s taking from this incredible experience and how it’s changed his outlook on life…

***

It was within touching distance. Four years since that first taste of expedition medicine on my elective and my FY3 was running as smoothly as I could ask for; I’d finished a fantastic ICU fellowship and in front of me stretched eighteen months to dive into expedition medicine before speciality training began. Countless emails had landed me four trips which had me beyond excited for all the adventures around the corner. Then, the Pandemic arrived. And just like that, a meticulously planned year was looking more unsure than Dominic Cummings’ eyesight. With my trips cancelled, it was back to the upsettingly empty drawing board.

I was on the verge of accepting a fellowship that in truth my heart wasn’t set on when in landed an email containing the most leftfield job offer I’d ever received: the chance to work as a Medical Officer (MO) with marine conservation charity Sea Shepherd Global. The mission? An offshore campaign against illegal and unreported fishing (IUU) in Gabon, an equator-straddling nation on the Atlantic coast of Africa. I’d applied in response to a Facebook post advertised through World Extreme Medicine (WEM), never considering I may actually get the gig. I had to do some reading…

Sea Shepherd has earned a reputation since their foundation in 1977 for their fearless and direct approach to defending marine wildlife from illegal whaling and fishing activity across the world, from the sweltering equatorial Atlantic to the unforgiving polar Southern Ocean. If you ever watched Whale Wars on Animal Planet you’ll be familiar with their historically confrontational methods. They’re not without controversy, but if recent societal issues are anything to go by, tangible progress is driven by radical change, and Sea Shepherd’s results are quite phenomenal: for example being the major player in the cessation of Japan’s whaling programme in the Southern Ocean. It was an offer I couldn’t refuse.

***

Fast forward a fortnight and I was already in the port of Las Palmas, Gran Canaria, where the M/Y Bob Barker, a former Norwegian whaling vessel and my new home, had been moored throughout Spanish lockdown. After a short quarantine, it was already time to get on board. The twenty-something crew I would live with are a community of passionate volunteers from all walks of life who have perfected the constant process of maintaining their 55-metre queen of steel fit for purpose. Many fit into dual roles on board and I am no different, working also as a Quartermaster, which involves a nightly watch on the bridge of the ship (the equivalent to a plane’s cockpit but with binoculars instead of aviators).

And just like that, we were at sea. I had assumed (I thought quite reasonably) that I had turned my back on night shifts for some time to come. How wrong I was. Every night begins at quarter to midnight when my alarm goes off in the cabin following an hour’s kip. As I pull my shoes on, I imagine they’re Jon Snow’s and whisper “Night gathers, and now my watch begins” which hypes me. The stairwell to the bridge door is steep and eerily illuminated by a flashing red light reminiscent of a post-apocalyptic Call of Duty map. At the top, a heavy door opens into the wide bridge and my pitch-black watchpost for the next four hours. My time is spent studying the matrix-green radar, plotting our coordinates on the charts and keeping vigilant for errant fishing vessels crossing into the marine parks. It’s not difficult to imagine that we’re pushing new galactic frontiers when the windows are shut and the bridge is silent. There’s no time for caution.  I’ve even learnt how to steer and hope to get signed off on some basic proficiencies before I go home. On my fourth night, muscle memory had me relieved that it was my last night. I then realised these aren’t ICU nights, and there are no zero days here. This is my routine now and will be every night while we’re at sea. The constant fine tuning and elements of risk management has me drawing parallels with anaesthetics and ICU, as does the regular data plotting. Perhaps that’s why the watch so far has been an oddly satisfying experience.

Of course, my main role is that of the ship’s medical officer and I’m lucky that there is a nurse-turned-deckhand on board too. On arrival, I was surprised to find out we’re stocked with full capabilities to intubate a casualty! Initially, this made me nervous, but I’ve since reflected that equipment present does not necessitate use, and if I’m not trained to perform certain procedures at home, I need to know my limits here as well. Furthermore, what would be the post-intubation plan without a ventilator?

Speaking of ventilators, let’s discuss a good old pandemic. Have you heard of Covid-19? It’s a virus that grows on 5G masts and dies if you drink bleach. My one reservation in working with Sea Shepherd presently was of course Covid-19, a virus I’d had the pleasure of befriending in ICU earlier this year. My short notice arrival was partly due to the NGO’s desire to have a doctor on board to enact Covid-19 precautions and in the worst case, manage an outbreak. I already had access to a comprehensive risk assessment of crew activities, a safety protocol for boarding fishing vessels and a large supply of PPE. For all the paperwork in the world however, reality has an uncanny way of playing against the rules.

At the end of our two-week transit from the Canaries to Gabon via the pirate-infested Gulf of Guinea, we arrived thirty miles outside the port of Libreville. Under the cover of darkness, we dispatched our two RIBs (small powerful mercenary boats that we use to board vessels) to collect six marines and four government officials from shore. We were told they had self-isolated for two weeks and would have negative Covid-19 tests. As the ships medical officer I am on perpetual standby and was woken up at 2300, quite literally the 11th hour, to come to the bridge.

Our initial information was that one of the marines due to board had tested positive and had been sent home. They had all travelled to the clinic in the same vehicle. The RIBs were already in port, loading up the other nine. A myriad of questions was flying through my mind, trying to ascertain level of exposure, test details and RIB logistics. Should we allow boarding? Why had this information only just arrived? At some point during the meeting, a call came through with more intel: it was a serology test. A collective sigh of relief from the others in the room but my suspicions were still raised – why had he been sent home based on a serology test? I also realised we still didn’t have the PCR results for the rest of the marines. After a prolonged brainstorm with incoming drip-fed updates, we decided to radio the RIBs to leave the marines in port and delay collection by a day until the PCR results came through. We finally got through to them after several attempts when they were already one mile from shore with the marines already on board. To add to that, one of the RIBs then broke down and was finally recovered at 0430. Talk about Sod’s Law. Luckily, a full house of negative swab tests was received the following morning and a significant campaign delay was avoided.

Living offshore is the ultimate amnesic for Covid-19 and the night’s proceedings had served me a hefty slice of reality check pie. With our Gabonese colleagues now on board, patrols and therefore vessel inspections were soon underway. Illegal fishing vessels in the area are often crewed by multiple nationalities, both local and from afar. Language barriers and working conditions mean it’s virtually impossible to guarantee their Covid-19 status. With an ethos of “control the controllable”, we’ve taken doffing to a new level, converting the bow into a hot zone for decontamination upon return to our ship after boardings. It’s not perfect, but expedition medicine by nature isn’t.

A successful expedition medically is one where I have to treat very little. Minor illness is however inevitable and I’ve managed presentations that would be common in primary care such as pompholyx, sciatica and stubborn traumatic olecranon bursitis. Exciting as malaria prophylaxis and hand hygiene are, every medic relishes the idea of having a slightly hairy situation to manage (The chest rash doesn’t count). There have been flashes of so-called expedition medicine: Removal of a chigoe flea (Tunga penetrans, a local parasitic insect) from a beneath a toenail and a swim stop resulting in stings from a mop of wayward jellyfish filaments come to mind, not to mention plenty of seasickness. Awkwardly, the most acute injury was my own, crushing my finger under a rung of the rope ladder back onto our ship after a boarding, held down by the full weight of the RIB below me. Thirty seconds of increasingly loud calls for the RIB to move away left it numb and misshapen, but a buddy strap and time has done the job – it could have been much worse!

***

The pace of life onboard has created more personal headspace to think analytically about processes around me, often using past NHS experience as a comparison. One of the most eye-opening experiences so far was less to do with human medicine, but rather human factors, the bane of junior doctor teaching that I never thought I’d admit an interest in. Human factors describe the infinite number of psychological and behavioural influences that allow a group to work efficiently and safely towards a goal. In healthcare, we often learn about it in the context of aviation and how recognition of human factors has made the industry many times safer in recent decades.

One muggy evening the call came down from the bridge: a live net had been spotted in the water. It was the end of a busy patrol day, several crew had been out in the RIBs for hours and were exhausted. It had just started to rain. It was one hour till dark. Insert pathetic fallacy here. Nevertheless, within minutes, most of the crew were out on deck peering over the bow at the fishing buoy. A snappy decision was made to snare the line and retrieve it. Fast forward ten minutes and I felt as if I’d been transported to a Sunday fish market. Our crew of passionate volunteers was hauling up the line, large eels hooked on at one-metre intervals – alive. Two crew members experienced in marine biology became impromptu surgeons, using pliers and tweezers in the fading light to remove hooks and toss the dazed fish back to the murk. It was noisy, dark and chaotic to say the least. I had a strong sense of too many cooks and decided to take a step back to process what was unfolding in front of me. We had a fishing line of unknown length (it turned out to be nearly 5km), innumerable fish waiting to be hauled up, a team of variable experience and no overriding plan.

“Unsustainable” sprang to mind. The mammoth effort for me was summarised when instead of an eel, the next animal on the line was a hammerhead shark. It was devastating to see such an iconic and majestic creature, a species I’d spotted swimming freely earlier that day, dragged up on several hooks. It was immediately clear that the poor shark was dead, yet precious time was spent removing the hooks when it was futile. The crew were mucking in with admirable enthusiasm, but I couldn’t help but compare it to my experiences at in-hospital cardiac arrests. There, the team leader is trained to step back for perspective and allocate roles to staff. This helps team members avoid the trap of getting sucked into tasks that they may be comfortable with but are counter-productive. I headed to the bridge to relay my observations. If this were a terrorist attack, we were doing the equivalent of randomising all victims into a queue and treating the person at the front with all our resources, regardless of injury severity and blind to what was coming next. Mass casualty triage is a nightmare scenario for any expedition medic and one that requires a head-not-heart approach. With a crew of dedicated conservationists who care so much for ocean life, this was the real deal.

Eventually, the focus started to change and the approach became more systematic, perhaps in part due to the thoughts I relayed to the captain, but mainly due to the innate gravity humans have towards order and improvement. Our approach became more rational, prioritising faster line retrieval and humanely killing eels with hooks embedded too deep, ending their suffering and enabling us to remove the lethal snares rapidly. In this way, they could be returned to the sea to become safe food for predators. When the line finally became stuck under our hull four hours after it was spotted, it had to be cut and left to sink to the ocean floor, sadly condemning all the remaining anonymous animals to a slow demise.

***

The whole experience was an exponential learning curve for us all. This was my first time at sea, I told some of the more experienced conservationists the next day. I don’t know how to retrieve nets or operate on fish (or for that matter people!) but I have had human factors drilled into me once a month for 3 years (a slight exaggeration). If this or any new challenge were to arise again, a step back and a deep breath before diving in would do wonders for our work. I’ve often said that my mantra is “there’s always time.” Normally, that refers to my chronic refractory FOMO and wanting to say yes to everything that comes my way. Now, however, it took on a more salient meaning. Even in the most headless of times, there is nearly always time to step off the gas, stick your head into neutral and apply a little handbrake to your situation. It may just be the headspace you need to save a fish.

The illegal line retrieval has so far been a one-off occurrence, although for some Sea Shepherd campaigns ghost-net recovery is the focus of the mission.  The crux of our work in Gabon is the international issue of illegal, unreported and unregulated (IUU) fishing. This umbrella term refers to activities that contravene fishing and conservation laws, including unlicensed vessels, improper management of bycatch (unwanted species such as sharks, cetaceans and turtles) and falsifying records to maximise revenue. These processes destroy ecosystems and have brought hundreds of species to the brink of extinction. Incredibly, some sources suggest that 25-40% of global seafood catch could be traced to the IUU industry. In recent years, Sea Shepherd has been working collaboratively with several West African governments in Gabon, Benin, The Gambia and Liberia to assist them in enforcing their fishing regulations. Gabon’s laws are strict compared to its neighbours but enforcing them in the open ocean is a tall order. By providing our ship, crew and experience, we help to facilitate law enforcement through fishing vessel inspections and making arrests when appropriate. At our campaign’s half-way point, we’ve made two arrests, detaining a pair of trawlers caught with nearly one tonne of illegally finned rays and keeping endangered species for commercial use. I recently read a BBC article that this year’s closure of Southern African safari tourism has led to increased poaching activity. I can’t extrapolate to West Africa’s coastal waters, but what is clear is that the pandemic has not stopped marine poachers from recklessly damaging this fragile ecosystem. That said, our overriding approach seems to be working; this is our fifth year in Gabon and the number of illegal vessels caught annually is showing signs of decline.

***

Without a doubt, this year has been a force for reflection for the majority of us. In a year where no one’s plans have come to fruition, we’ve had a rare opportunity to stop and reevaluate what’s important to us in our lives and how we interact with the world around us. Back in January, I was off skiing when that flurry of offers for expedition medicine jobs came through. I arrived in France with one and left with four – I couldn’t believe my luck! In the last months, four became three, two, one and then finally none. I’m extremely lucky to have replaced them with this incredible conservation campaign in Gabon, a trip I could have neither predicted nor committed to if Covid-19 hadn’t reared its ugly head.

The silver lining has got me thinking about what I’ve lost and gained: I’ve missed out on adventure tourism trips to Kilimanjaro, the Amazon and the Himalayas but found an eye-opening replacement. As well as the very nature of the campaign, living with others who care so much about our impact on the environment has got me thinking about the direction I want to head in with future expedition endeavours. Adventure tourism can be one of the most exhilarating ways to experience a country’s natural landscapes, but also bears the risk of damaging them and their inhabitants.

All companies recognise this and go some way to mitigating these risks, promoting the idea of eco-tourism, sustainable development and fair treatment of local staff. Some do this better than others, and in the future, I will be doing more to sound these attitudes out before committing to a trip. Life at sea and long discussions with my officer have also prompted some thoughts about pushing out into the world of humanitarian medicine. Her long-standing work with Sea Watch is inspirational. It’s an NGO committed to rescuing stranded migrants in the Mediterranean and will certainly be getting my look-in. Pushing my own career is possible while minimising the negative impact on the world around me. Not saying I’ll be going vegan, but it’s food for thought.

***

Last week I persuaded Spotify to work and had the pleasure of listening to a WEMcast interview with adventurer Anna McNuff. I related to her story immensely: Her rowing career took her painfully close to Olympic selection, reigniting memories of my experience with the Oxford vs Cambridge Boat Race whilst at medical school. After this ‘failure’, she stepped back and reassessed what was fulfilling her in life, finding a new direction through her legendary human-powered journeys. She had some very thought-provoking ideas about how so much of what we do nowadays is goal-directed while focusing little on the journey – the idea that the end rather than the means will bring us happiness. She ventures that if you surround yourself with experiences and people that make you happy, your end-game may be unknown but it will inevitably be a good one. It has to be a balance of course, especially in medicine where so much of what we do is goal-focussed and there are so many boxes to tick. But it’s hard to shake Anna’s reflections, which is why after this two month whirlwind of new adventure, I’ve decided to extend my time here by a month.

Who knows where it’ll take me, but I have no doubt it’ll be a whale of a time.



Other blogs that may be of interest, include:

#VirtualWEM20 Conference Tickets Launched!

Having reviewed COVID-19’s impact on large gatherings, we have come to the decision to move WEM20 over to the online arena and for it to become VirtualWEM20 (book your ticket here!).

While we understand you may be saddened to not be attending Dynamic Earth this October (we are too), everyone’s safety must take priority.

That said, we believe your continued access to new learning opportunities is also a priority, so we have a remedy…

Introducing: The Virtual World Extreme Medicine Conference 2020

For the first time in WEM history, we’re hosting a virtual conference – so you can be inspired from the comfort of your sofa (or, frankly, from wherever in the world you can get online).

Split over two action-packed days, you’ll encounter the biggest and best content at VirtualWEM20 that we had planned for the stage at WEM20, plus we’re adding brand new panel sessions and speakers.

We’ve worked hard to make sure you still have a first-rate conference experience, meaning most of what you love about attending a WEM conference in person has been moved to the virtual space:

  • The reception area where you’ll find your schedule, updates from the WEM Team and our fantastic sponsors
  • Live group breakout spaces for our WEM roundtable panels and collaboration with fellow delegates
  • Networking hubs that allow you to search for and discover people to chat to, where you can then jump into a one-on-one private live video conversation
  • Our virtual exhibition hall featuring showcases from our exhibitors and a dedicated chatroom where you can find out more from them directly
  • Your personal profile, where you can share information about yourself with other delegates, upload your picture and be discovered via our networking hub

Conference-specific details, including session times, speakers and how you can get actively involved, will be released via our social media channels and email – so keep your eyes peeled!

Book WEM20 Now

I’m a WEM20 ticket holder – what happens now?

As a paid-up WEM20 ticket holder, you have a couple of options:

  • First refusal on tickets for our 10th anniversary WEM21 conference next year
    Contact us to request that your place be transferred to WEM21 and secure your spot months before they go on sale to the public (you’ll also receive a 10% discount on a place at VirtualWEM20)
  • A full refund for those who can’t commit to WEM21
    You can request a full refund at any time (no need to decide right now, so no rush). We aim to process refunds within 30 days.

Why transfer a WEM20 ticket to WEM21?

A good question deserves an even better answer: because next year signals the 10th anniversary of the World Extreme Medicine Conference!

And since last year was a sell-out (leaving us with an extensive waitlist), transferring from WEM20 to WEM21 now guarantees that place – which means zero FOMO at what promises to be our most extreme event yet.

Do you have information on WEM21?

We’re still working out the details so, for now, picture this:

  • A jam-packed schedule featuring the most prolific convention-breaking, discipline-blending, boundary-shattering medics this side of the known universe.
  • Evening events where rubbing shoulders with those same maverick medics is a must – and at which we may even consider switching our waterproofs for black tie (shocker!)
  • Plus, every detail that makes a WEM Conference so career-defining: tonnes of networking, ‘get your hands dirty’ workshops, outdoor ‘rain or shine’ technical sessions, and bracing morning runs with our team to kickstart your day.

We’ll be heading back to Dynamic Earth in Edinburgh from 13th – 15th November 2021.

Can I buy my ticket to WEM21 yet?

Tickets aren’t available right now, but after the #VirtualWEM20 conference in October, you’ll be able to register your interest with us so we can update your progress and notify you when tickets go on sale.

If you’re a current WEM20 ticket holder, you can ask us to transfer your ticket to WEM21.

We’d like to sincerely thank you for your continued support and patience during what has been a trying experience for us all.
If you have any further questions, please get in touch.



Refund Terms & Conditions

  • If the VirtualWEM20 Conference is cancelled for whatever reason, you will receive a full refund, although you can choose to transfer your funds to the following year which guarantees your space at what we expect to be a sell-out conference.
  • For all delegates who purchased a WEM20 ticket before 22nd July 2020, we are offering you 10% off your #VirtualWEM20 ticket.
    • Please note you can only purchase up to 10 tickets (unless your original booking was of a larger size).
    • Should you choose to transfer your ticket/payment from 2020 to WEM21, and later decide to cancel, our standard cancellation terms will apply. You would also lose your 10% discount for #VirtualWEM20 Conference.
  • Refunds will be processed in line with PayPal’s terms of 30 days. Once received back from PayPal, WEM will issue the refund within 2 days.
  • WEM reserve the right to refuse the purchase of tickets and/or transfer of funds should they deem this necessary.

COVID-19 FAQs for World Extreme Medicine (WEM) Courses

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What are the symptoms of COVID-19?

As stated on the NHS website the main symptoms of coronavirus or COVID-19 are:

  • a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • a loss or change to your sense of smell or taste – this means you have noticed you cannot smell or taste anything, or things smell or taste different to normal
    Most people with coronavirus have at least 1 of these symptoms.

What happens if I start showing symptoms on the course?

  • Inform a member of WEM Faculty at once
  • Look to quarantine yourself at once (facilities will be provided where possible)
  • Should this be the case, we will assess on a case by case basis against several factors, i.e. our location (abroad or within the UK), how far into the course we are and your personal situation and feelings

What information is collected for courses?

WEM Faculty and Delegates:

  • Full name
  • Contact phone number, full home address and email address
  • Date of visit, arrival time and departure time
  • List of which Delegates are assigned to which WEM Faculty members

Third parties:

  • Main contact who work at the premises
  • Contact phone number
  • Dates and times of WEM’s attendance at the training facility

All information is collected in advance where possible. If not collected in advance, this information will be collected at the point of entry to the premises, or at the point of service.

Why do you record arrival and departure times?

Recording both arrival and departure times (or estimated departure times) will help reduce the number of Delegates and WEM Faculty needing to be contacted by NHS Test and Trace. We recognise, however, that recording departure times will not always be practical.

What happens if the course is cancelled and I have already paid?

You will receive a full refund and our usual terms and conditions apply.

I have paid for the course, but am showing COVID-19 / respiratory infection and can no longer attend – what are my options?

You will be able to transfer the course fees to another course of your choice within 12 months.

The customer will be liable for any charges which cannot be refunded by host organisations or agents. WEM will aim to minimise this by working closely with customers and agents.

Are the WEM overseas courses still going ahead?

Yes. We will plan and prepare each course as if it is going ahead to be fully prepared for all possibilities and eventualities. Whether courses go ahead depends on UK and foreign government guidelines, quarantine periods and border and airbridge rules.

(For overseas courses, we suggest you book and plan as normal and we will keep you informed on the situation. If the course is cancelled, you will receive a full refund).

What do I need to bring in addition to the usual course requirements?

  • Suitable face coverings
  • Hand sanitiser for the duration of the course – where practical WEM will provide this for the full group, but we suggest brining your own supply.

I am unsure whether to attend a WEM course or not during this time, what do I need to take into consideration?

  1. All courses that go ahead have been risk assessed and considered safe
  2. Every WEM Faculty member has been briefed on the new safety precautions and logistical changes
  3. If you wish to discuss your concerns or have further questions before booking, please call our WEM team who will be happy to help

How many people are on each course?

The course number varies depending on the course, the location, and the type of experience. Please email us if you would like to know real-time attendee numbers or the attendee in-take cap. Please be reassured that we have taken the right precautions to reduce numbers so we can social distance as much as possible.

What parts of the course have changed due to COVID-19?

  • Part of the course may need to be carried out through online learning. You will be informed of the schedule to complete this task once you have booked. To get this information before you book, please contact us
  • Course numbers of Delegates and WEM Faculty have been reduced
  • Risk assessments (and reassessments) for each course are taken to ensure your safety

FREE WEM Academy Live Session #9: Expedition Medicine Careers Panel  

Find out how you can break into the incredibly rewarding world of Expedition Medicine Careers by hearing from our extreme panel of specialists who have done it all

Host: Mark Hannaford

Joined by: Emma Figures, Luca Alfatti and Taryn Anderson

When: Now available to watch on the WEM Academy site.

Length: 1 hours 30 mins

Ideal for: Health professionals of all grades, stages and training backgrounds

You’ll hear from WEM head honcho, Mark Hannaford, who is joined by Trainee GP Emma Figures, Paramedic Luca Alfatti and Nurse Taryn Anderson to cover your answers on expedition medicine careers, including:

  • What experience and qualifications do I need?
  • What kind of personal qualities are important for expedition work?
  • What resources are available for me to upskill?
  • How do I fit expeditions around my other clinical and family roles?
  • Where do I stand with medical indemnity?
  • How will this pandemic change the expedition and travel landscape?

Here’s why these maverick medic panellists are worth listening to…

Panellist Bio’s (Medic’s like you – so why not you too?)

Emma Figures – Trainee GP & Expedition Medic

In her life before medicine, Emma lived in a caravan in Wales, worked as a healthcare assistant, travelled solo around the world having never been on a plane, hiked the Himalayas, studied Geography at Cambridge and volunteered in Nepal, China, India, Sri Lanka and Zambia (Teaching, Tsunami relief and TB hospices). After graduating, she taught in Geneva and undertook an internship at the UN and WHO, where she attended the Human Rights Council and World Health Assembly.

She then returned to Cambridge to study Medicine and ventured to Borneo for her elective (in a busy city ED and rural jungle clinic). After Foundation training in Cornwall and a Mountain Medicine course in Morocco, Emma returned to Kathmandu with Nepal Critical Care Development Foundation and has subsequently pursued a colourful career in expedition medicine and education.

Her expedition medic work has taken her on charity cycles in Vietnam, Cambodia, Laos and Sri Lanka and hiking challenges in Iceland, the Grand Canyon and Kilimanjaro. She also had the chance to work in Fiji with the famous Dr Joe for the US reality TV show Survivor. Closer to home, she has worked as an Event Medic for a Children in Need Ramble and in the Brecon Beacons with Across The Divide.

Emma completed a PGCE during her clinical teaching fellowship at Birmingham University, before flying off to warmer weather (and Category 5 hurricanes) in the Caribbean, where she was as an Assistant Professor at Saba University. She is now back in the UK for GP training, but continues to dream of faraway places and enthusiastically teaches on expedition medicine courses dressed as a magical unicorn – true story!

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Luca Alfatti – Paramedic & Expedition Medic

Luca is a HCPC registered Paramedic, who currently holds a Diploma in Paramedic Practice and is hoping to complete his BSc by the end of 2017. When in the UK, which admittedly it is not often, Luca works as a Paramedic in the North West and South West of England.

In addition to this, he is a Fellow of the Royal Geographical Society, Wilderness Expedition Medicine Faculty Member, PHTLS instructor, Mountain Leader and Water Rescue Technician. Luca is also a HEFAT instructor, delivering hostile environment training to journalists both in the UK, before deployment and in-country, during deployment.

Luca also works as a volunteer and fundraiser with Team Rubicon, which is a disaster response humanitarian organisation working both in the UK and overseas.

Luca had always dreamed of travelling EVERYWHERE and in 2005 he eventually drove his own Ford Probe from New York City to Panama City and he never looked back! Luca became an overland driver and mechanic and during this time worked and travelled in over 100 countries across 5 continents. In 2015 Luca was then looking for a new venture and qualified as a Paramedic, with a view to combining this with his love of travel. In the last 2 years Luca has gone on to lead expeditions in places such as Afghanistan, Iraq, Iran and Chad just to mention a few.

Thanks to all those years working on the road his dedication was recognised, with him winning the Wanderlust Expedition Leader of the Year Award in 2012 and awarded a bursary. Luca then used this to set up a sustainable, income-generating, community project in Antigua, Guatemala to support women and their children who have been victims of domestic abuse. This project continues to run to this day.

Luca’s work has featured in magazines like ‘Trek and Mountains’ and ‘Adventure Travel’. His world first crossing of the Dash e Lut Desert, in Iran, in 2015 was featured in the National Geographic Traveller. Luca is also currently writing a publication for ‘Paramedic Insight’ narrating his experience as an expedition medic, for an unsupported winter snowshoe crossing of Spitzbergen.

Luca does not only lead all his trips but, has often designed the trips himself and acts as either expedition leader/medic or both.

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Taryn Anderson – Nurse & Expedition Medic

Taryn is a qualified nurse who trained in Australia and spent the first part of her career working as a Nursing Officer in the Australian Army. During her time in the military, she completed her Master’s in Public Health and Tropical Medicine and began providing healthcare to in complex remote environments including Kenya, Papua New Guinea and remote Australia.

Moving to the UK in 2015, Taryn began to seek out further clinical challenges and responded to the Ebola epidemic in West Africa as both a Clinician and the Senior Nurse overseeing the Ebola Treatment Centre, which involved developing protocols for stringent infection prevention and control procedures and a comprehensive training program for staff.

During the battle for Mosul, Taryn worked with the World Health Organisation (WHO) as Clinical Coordinator over the course of 12 months helping to establish and run three field hospitals providing damage control resuscitation for trauma patients and two maternity hospitals to provide obstetric care to the people of Mosul.

Taryn has also responded as part of disaster relief efforts providing medical cover to teams deploying to Haiti, Nepal and Mozambique but most recently has been working for WEM providing medical support to the CBS Survivor series in the South Pacific. She continues to regularly return to work in Australia as a Remote Area Nurse providing medical support to some of the remotest areas of the country and is currently enjoying exploring the South of England after a recent move.


 
An edited version of this session can now be located on the WEM Academy site along with a mass of other valuable interviews, resources and lectures to inspire your expedition medicine career.

MSc in Extreme Medicine Focus: Meet Current Student Nikki McLeary

We catch up with current 2nd year student Nikki McLeary as she shares her insights about the world’s first and only International Diploma / MSc in Extreme Medicine course that encompasses Expedition Medicine, Disaster & Humanitarian Medicine and Extreme Pre-Hospital care.

What’s your background?
Extreme sports science and medical publishing, 20 years ago I was working with athletes like Vendee Globe sailors and Formula 1 drivers before ‘extremes’ became sexy! I then spent 15 years overseas operating my own adventure company across desert, winter-mountain, and ocean based locations before returning to the UK 2 years ago to start my MSc in Extreme Medicine at Exeter University. 

What inspired you to sign up for the MSc in Extreme Medicine programme?
It combines adventure, academics, science and medicine, which encapsulate my skill set into something tangible that I can use for businesses purposes. Plus, as a developing field of study new opportunities are continually present. I also liked the fact it is linked to Exeter University which is well-respected.  

What were the main aspects that appealed to you?
It’s uniqueness. I’m self-employed and so always looking for engaging experiences that open doors and this felt like a positive pathway. Plus, the networking opportunities are amazing… WEM literally has an address book of who’s who!

Has it met your expectations so far? 
The faculty are superb. WEM have been really careful about who they have teaching, for example I recently completed Polar Medicine and Professor Chris Imray, leading expert on cold injury, was one of the staff. You definitely get your monies worth in terms of the level of education and the experts delivering. 

What’s been the highlight so far?
Actually, it’s the small things that add value, regardless of your level of experience and knowledge you gain from the programme as it is so multifaceted. But I doubt I would have booked to trek up to Everest base-camp independently just due to time and other plans, on this Master’s programme it can be chosen as a module which is pretty cool by anyone’s standards!

Who else is on the programme?
A mixed bag of newly qualified paramedics, GPs, humanitarian nurses, midwives, and senior anaesthetists! Interestingly, the clinical aspects of the course are tailored towards operations in austere environments with minimal kit so the teaching is suited to any healthcare level and can be adapted dependent on experience. The diversity amongst the students enhances the experience.

What modules have you chosen and why?
I’ve chosen Polar Medicine in Norway and Mountain Medicine in Nepal. I don’t particularly like the cold despite working in it so thought it would do me good to be uncomfortable, but in reality, Norway was awesome. The people were good fun, plus there was a sauna and bar we all embraced outside of building snow holes, sledging with the huskies, and pulk pulling to the middle of nowhere. I’m really looking forward to Nepal once lockdown is over. The university and WEM have been brilliant about juggling everything during COVID-19, they’ve gone above and beyond.

How will this help your career/future plans?
I’m already utilising my involvement in the programme; I’ve secured contracts with high profile universities for academic business collaboration in addition to the position of Content Editor for one of the British Medical Journal titles. I really believe this MSc offers credibility in a way bog-standard programmes cannot.

Nikki added:

Admittedly it’s not a cheap academic option but if you want to make that step towards offering care to others outside of a hospital environment preparation is key, and there is a wealth of experience to be gained within the multiple practical modules each academic year. This is a programme that consolidates knowledge, practical skills, and confidence to achieve objective.

 


Ready for an MSc experience that could change your life?

With the increased awareness of global burdens such as humanitarian crises and sudden onset disasters, more than ever there is a need to be delivering healthcare in highly complex and demanding situations.

The world’s first and only International Diploma / MSc in Extreme Medicine is the most flexible, modular and specialised Extreme Medicine programme in the world. Operated exclusively in partnership with the University of Exeter Medical School it provides the perfect bridge to bring your passion for medicine and adventure together.

You will learn the practical skills, knowledge and understanding needed to perform at the highest possible level in the field of extreme medicine. You can also choose to undertake a specialism based on your interests including Cold and Altitude Environments, Hot Environments and Humanitarian Relief.

Be inspired and find out more!

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