The Land God Made in Anger – an Expedition Nurse in Namibia

Having spent ten years working as a nurse in a city emergency department, four years as an emergency nurse practitioner, I wanted new challenges. I undertook  an expedition medicine course in the Cumbrian village of Keswick and immediately searched for an adventure. As a nurse, its very difficult to get work as an expedition medic, but undeterred, I told everyone I met that this is what I was interested in, (whether they wanted to hear about it or not!). Then on a wet evening in May, a chance encounter in the ambulance bay with an anaesthetist gave me the opening I was looking for.  The anaesthetist told me his father ran a company taking CEO’s and executives from large companies on team-building exercises in remote regions of the world. He explained to me his father was taking a group of businessmen for a ‘stroll’ up a mountain in Namibia, which is just to the north of South Africa and was looking for a medic to accompany them. I thought about it for thirty seconds and immediately said I would do it!

One month later I was sat in the Institute of Directors Club in Pall Mall talking to John Peck, the owner of Executive Stretch – the expedition organisers. It was explained the trip was not exactly the stroll I thought. The plan was to attempt to summit the Brandberg mountain – the highest mountain in Namibia – via an unmapped route using, on occasion, ropes and harnesses in forty degree heat and needing to be completely self-sufficient for five days on the mountain.   After speaking to friends who work as expedition medics, I discovered most medics cut their teeth on a UK-based event such as an ascent of Ben Nevis for charity with back-up support from mountain rescue and with a helicopter on standby. I hadn’t cut my teeth and now I was committed with the promise of an all-expenses trip to Namibia. What could go wrong, after all I probably wouldn’t need to open the medical kit!

The flight to Namibia was uneventful and during the seven hour drive across the barren Namib desert, we stopped at the only services in the country. I grabbed a burger and got back on the bus. On the second bite, I realised the burger was raw and discarded the rest. That evening, whilst sleeping under the stars at the base of the mountain, the effects of the bad meal took hold. The diarrhoea started and punctuated the long night.  Having slept very little we began to climb through the landscape known simply to the locals as ‘The Land God Made In Anger’. The terrain above us was brutal. Out of the Namib desert stretched miles of boulder fields with rocks the size of houses. What little vegetation survived was poisonous or thorny. The local fauna was equally hazardous with snakes, scorpions and spiders, not to mention mountain leopards.

There were eight clients of varying ages but all were mentally and physically strong with mountaineers, ultra-marathon runners and North Pole expedition veterans amongst them. The organiser, two guides and myself made up the complement of twelve men. Each member of the team would have to carry twenty litres of water with the rest of his kit so had around 37 kilos at the start line.   I felt OK, if a little tired, during the morning’s exertions where we crawled, scrambled and abseiled our way slowly across the boulders. Ever present on my mind was the risk of longbone fractures and the complicated logistics of a casualty evacuation in such an environment. Then at noon, whilst negotiating a narrow rock ledge, I heard the shout I was most dreading, “We need a medic up here!”. Having rounded the ledge, I found one of the clients sat on the floor with an ankle the size of a cantaloupe. He had everted his ankle, had severe swelling and reduced range of movement. Perched on the cliff edge, I strapped his ankle and gave him analgesia which allowed him to partially wait there. It was however obvious he would not be able to continue with the expedition. He was helped down the mountain by our only support crew – two men from a nearby village.   The rest of us had lunch of salty crackers and biltong and continued the ascent. About thirty minutes after lunch, the infamous burger decided it was not done with me just yet. Nausea took hold, closely followed by persistent vomiting. I knew I was in trouble by 1600 hrs when one of the clients grabbed me and said “What are you doing!?”. Dehydration had taken hold, and I had been walking like the majority of people present in an ED waiting room at two o’clock on a Sunday morning. As a result of this, I had nearly stepped off a steep ledge into a vertical drop down the mountainside! Luckily, we stopped to make camp for the night an hour later and I had another restless night under a rock overhang suffering with more vomiting and diarrhoea.  The rest of the day was spent staggering forward up the mountain, stopping regularly to either vomit or dress others’ wounds. That night I decided that something had to be done and stabbed myself in the leg with IM Ondansetron, which I can categorically say hurts like hell!. This did not stop the vomiting but the pain of the injection took my mind off it at least!

The next day I was staggering on, vomiting bile and feeling like I was about to collapse. Earlier the guide had told us all a story about another climber who had died of dehydration whilst trying to climb the mountain only the week before. With little hope of a cas-evac and the story playing on our mind, the group kindly agreed to divide and carry some of my kit for the remainder of the day. I continued for another hour feeling more and more delirious. I could tell by the manner of our unflappable guide that he was concerned for me.

Later I asked the guide to stop so we could have another break and I explained to him that I was going to cannulate myself and give myself some I.V. fluids. He asked “How do you cannulate yourself?”. I replied “I don’t know. I’ve never seen it done before”. At which point, one of the clients shouted “Before you do that, can you take a look at my eye infection?”. I gave him some Chloramphenicol eye drops and settled down on a rock to apply a tourniquet to my left forearm. At which point another client called “Hang on! I’ll get my camera!”. I only had three cannulas between all of us and with the last two waterholes being dry, I thought it was likely we would need them all. Therefore missing my vein was not an option. I inserted the cannula into my left hand, got a flashback and, with relief, fed the cannula into my vein. I then injected four milligrammes of Ondansatron and showed the guide how to prime and attach a 250 ml bag of saline. Within thirty minutes I began to feel better. I gaffer-taped the cannula into my hand and told the guide that if I collapsed he should attach more fluids and, if this was unsuccessful, he should inject 50mls of 50% dextrose and, if that didn’t work, I was definitely was in trouble!

Fortunately, as the day progressed I felt stronger, was able to drink some water and at lunch try some solid food. Later that afternoon, another client became sick with dehydration but he recovered quickly after a 250ml bag of saline. Due to the local drought, we were dangerously low on water on day three of the trek and having discussed the possibility of having to drink the last of the I.V. fluids, we decided to not attempt the summit, (only 5 km distant but our current pace had dropped below 1.5 km/h), and began to descend by a known route in search of water.

By late morning on day four, we reached Springbok Fountain. Despite its name, there was neither a fountain or antelope to be found. Rather a small pool of stagnant water covered in biting insects. But with double-strength chlorine tablets, that water tasted like nectar! It was a mere five kilometres to the foot of the mountain and our support vehicle but there was still time for some more drama. We negotiated a difficult abseil then further down the trail, passed under a cave entrance. We noticed fresh blood splattered on rocks and our guide said there must have been a leopard kill here recently. At that moment, one of the group behind us shouted “LEOPARD!!”. In the cave directly above us a leopard stood observing us. Luckily, having eaten its fill for the day, it decided to leave us alone and we finished the descent tentatively.

We all got off the mountain safely and headed to a ‘luxury’ safari lodge for Kudu steaks and the best-tasting cold beers ever! Despite nearly dying, I have already signed up for next year’s expedition, where burgers and waterholes permitting, we intend to finish the job and summit Brandberg mountain!

Of  interest

• Extreme Medicine Conference: Harvard Medical School, Boston
• Expedition Medicine CME accredited wilderness medic courses