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!
Threshold Sports Ltd – Doctors & Medics Needed For UK Outdoor Events in 2013
Threshold are looking to recruit medics and general crew for a series of UK outdoor events from March to September each year. These range from our own public events, to specific challenges for Comic Relief and Sport Relief as well as other corporate client events.
Medic and general crew vacancies are currently available on the following events:
The MITIE London Revolution – 18th & 19th May 2013
A fully supported route taking in the iconic London landmarks, scenic backroads and legendary Olympic sites over 2 days and 180 miles. www.london-revolution.com
Deloitte Ride Across Britain – 7-16th June 2013
The UK’s premier long distance cycling event which is now recognised as the ultimate way of completing the classic John O’Groats to Land’s End Challenge in 9 daily stages.www.rideacrossbritain.com
Race to the Stones – 13th and 14th July 2013
A fully supported 100km route following the footsteps of Romans, Vikings, farmers and traders along the iconic Ridgeway .
Paramedics, nurses and doctors can apply for the medic roles as we need to fill a range of positions, although some post qualification experience is definitely an advantage. All the above events also have general crew vacancies. Applicants need to be generally fit, have a love of the outdoor life, be prepared to camp and also work long and antisocial hours in some challenging environments!
If you are interested in any of the above events or wish to register your interest for future events, please email Karen Hannaford, outlining your relevant experience at [email protected]
28 February 2013
In many ways, the pictures tell the story. There are snow-capped mountains and lush rainforests, kayaks full of adventurers and smiling groups under makeshift shelters. And there are images that only a particular type of audience could find enthralling — close-ups of frostbite, tropical skin disease and ghastly intestinal parasites. All of these and more were exhibited by speakers at a recent London conference on opportunities in expedition medicine. They illustrate the obvious appeal for doctors of accompanying groups of travellers to remote regions: a chance to visit beautiful places while honing your medical skills and clinical judgement. Dozens of medics attended the event, organised by the trainees committee of the Royal Society of Medicine, and more watched from Aberdeen via a live link. There was plenty of advice for all doctors about the possibilities of combining expedition medicine with conventional postgraduate training and NHS commitments.
But there were also stirring words from one young doctor whose passion for expedition medicine and humanitarian work has prompted her to step off the traditional medical career ladder entirely — at least for the time being. SpR in pre-hospital medicine Amy Hughes graduated from Nottingham University medical school in 2003. At that stage, she had no interest in expedition medicine; in fact, she had barely travelled outside the UK. But as she progressed through her house officer jobs (now foundation years one and two), she began to wonder what the future held.
‘I was getting itchy feet, thinking: “What do I want to do? I don’t want to stay in hospital training”,’ she says.
All around her, fellow medics were studying hard for exams.
‘I wasn’t the slightest bit interested in doing exams at that time,’ she says.
So she decided to take a year out. It was not a move that attracted universal support; in fact, she faced dire warnings about how hard it would be for her to re-enter training, given the imminent introduction of ST (specialty training). Undaunted, she began researching opportunities in expedition medicine. Her first foray was with a social enterprise called Blue Ventures, which leads marine conservation projects in Madagascar and Belize. It was one of the few outfits willing to take on a doctor with no previous experience of expedition medicine. And it was to prove a valuable — and unforgettable — launch pad.
‘As an expedition medic … you have this incredible link with the community,’ Dr Hughes says. ‘You get to go to places that no tourist will ever go. You work with the locals, you are welcomed into their community and learn the importance of respecting cultures both professionally and personally. You teach public health education and basic health education.’
During her year out, she also gained a diploma in tropical medicine and hygiene from Liverpool University. That stood her in good stead when she applied to return to training at Addenbrooke’s Hospital. Despite competing against people with more exam qualifications, Dr Hughes was able to convince the selectors that she was the best candidate.
She says: ‘I talked about the skills I’d learned from the expedition world, the medical skills I’d improved on, how I’d had to become not just a medic but a multi-tasking individual — involved in logistics, decision making, team management, communication skill development, teaching and training.’ Dr Hughes believes her experience proves criteria have changed for those assessing trainee applicants. ‘They want an interesting, dynamic individual who’s going to be good at the job and work well with their peers,’ she says. While at Addenbrooke’s, she used her annual leave to join short Across the Divide expeditions to places including Namibia, and took a European masters in disaster medicine. By the time she was appointed to an ST2 post in the Severn Deanery in August 2007, her career was potentially mapped out: she could have stayed in emergency medicine training all the way to ST6.
But within a couple of years — during which she completed six months in anaesthetics and six months in ICU as well as stints in acute orthopaedics and emergency paediatric medicine — she was dreaming of escape again. At a conference in Birmingham, she picked up a flyer advertising opportunities with one of Australia’s ‘flying doctor’ services. She negotiated an out-of-programme experience, which enabled the deanery to keep her training number open for a year, and headed off down under.
Make or break
That was in 2009. So far, she has not returned to training. The make-or-break moment came during her stint in Australia, when she successfully applied — via an email and a long-distance telephone interview — for a job with Kent’s HEMS (helicopter emergency medical service). After a ‘fantastic’ year in that role, she made the momentous decision to resign her run-through training number and follow her interest in humanitarian medicine. Dr Hughes has since spent seven months working with relief organisation Médecins Sans Frontières in the aftermath of civil strife in Sri Lanka, and now has a post with the London HEMS.
In addition, she is medical director of remote medical training organisation Expedition & Wilderness Medicine. She says there is a huge amount to be learned from expedition medicine, but warns that no one should contemplate it unless they have a certain amount of postgraduate training under their belt.
‘When you’re in a hospital and you’ve got an ICU consultant, a paediatric consultant, an anaesthetist, an emergency doctor and an orthopaedics consultant next to you, fine; you can help treat the multiply injured patient as an F1 [foundation doctor 1].
‘If you go to somewhere like the depths of the jungle in Costa Rica, and you have a significant head injury or a pelvic injury, or a fall from height, or anaphylaxis, you cannot competently deal with that well as an F1 because you just don’t have the experience.’
Dr Hughes is uncertain what her future holds. But she knows that stepping out of training was the right think to do.
‘I took that risk and I have never looked back,’ she says.
‘I want to hold on to the immense passion I have for my work, which I think is often lost during standard training.
‘And I think the process of learning and the experiences I’m gaining are more important than the “end point” [of becoming a consultant] in making me a better doctor.
‘In four years I might go back to ST4. I’ll see.
‘I have to accept that I may never be a consultant, but if that is the case, I will never have any regret about the decisions I have made.’
To infinity, and beyond…
- Find out more about expedition and wilderness medicine at www.expeditionmedicine.co.uk
- Find out more about the Royal Society of Medicine global medicine course