Why expedition medicine is a valuable trek into the unknown
Authors: Katie Ovens
Publication date: 22 Sep 2015 BMJ Careers
Alumni of Expedition Medicine, Wales
As an expedition doctor in Tanzania Katie Ovens gained useful clinical and managerial experience
Throughout my foundation years I knew that I wanted to have a year to broaden my knowledge of medicine and to gain experience in an entirely new setting, outside hospital, before continuing on to specialty training.
At the end of my first year of medical school I volunteered for a charity in Zambia for four weeks promoting health in remote communities, and I also spent one month in Sarawak General Hospital in Borneo for my medical elective. Both of these trips gave me an insight into working abroad and provided the opportunity to combine my passion for travel with my interest in medicine. As a qualified doctor I was keen to work abroad more independently, where my skills would be fully used and I would have exposure to more tropical medicine.
My introduction to expedition medicine was a four day course in Plas-y-Brenin in Wales. The course incorporated lectures, practical sessions, and small group sessions on common medical issues; advice for working on expeditions; and specific skills required for expeditions (such as rope skills and navigation). The inspirational speakers had an extensive knowledge of the field.
The week after the course I took part in Raleigh International’s gruelling assessment weekend. Raleigh International is a sustainable development charity, giving young people the chance to work in developing countries. During the assessment weekend I had to complete multiple tasks based on expedition scenarios to demonstrate my ability to lead a team while also working as a team member. This was both physically and mentally challenging.
Three days later I accepted the dual role of volunteer manager and medic in Tanzania for 13 weeks. As a volunteer manager I was responsible for supporting a group of young people carrying out sustainable development projects and trekking. I also helped set up the trek projects and ensured the success of sustainable development projects on site.
Before deploying to Tanzania I attended the Raleigh training weekend for volunteer managers. This training mainly focused on sustainable development, how to provide life coaching to young people on an informal basis, and the main aims and conduct of the charity. There was no specific medical training but pre-reading was provided on common medical problems in expedition and tropical medicine. Recognising that I was likely to come across conditions I may never have seen, I also learnt some specific expedition medicine by reading expedition medicine books. The Oxford Handbook of Expedition and Wilderness Medicine is particularly good.
Working as a volunteer manager
After arriving in Tanzania all volunteer managers had a two week induction before the volunteers arrived. During this time we were given final training and helped to set up the projects. Each expedition is split into three 19 day phases and during the induction phase all of the volunteer managers gave their preferences on whether they would like to work on a particular project or whether they would enjoy leading a trek.
I was allocated to work on a project that brought clean water to a remote village. In the second phase I was the field base medic, and, finally, leader of a 20 day trek in the Usambara mountains. Setting up projects included casualty evacuation planning, risk assessments, route planning, meeting project partners, and locating houses suitable for homestay. The evacuation planning was very detailed and included visits to local hospitals, dispensaries, and airstrips to plan for all eventualities. In addition to being able to take patients to these local facilities we also had email and phone advice available from the UK through Raleigh.
I underestimated the volunteer manager role before going to Tanzania, but it turned out to be an incredibly rewarding aspect of my trip. I gave daily feedback to members of my team, helping them to think through important life decisions and plan for the future. I was also responsible for the success of the projects and the safety of the team round the clock. Having responsibility for a team of young people aged 17 to 24 did mean at times that I had the role of mum, from teaching how to chop onions to saying things like “be careful,” “don’t get too near the edge,” or “please don’t hold the machete like that.”
During induction, medics teach first aid and general expedition health to managers and volunteers, as some groups do not have a medic. Education was fundamental throughout the expedition and needed to be tailored to the particular environment. For example, living with families meant that hand hygiene and bleaching utensils was essential to reduce the chances of contracting gastroenteritis.
As field base medic I travelled to groups without a medic and held medical clinics in remote locations, as well as giving telephone advice, which was a new and rewarding challenge. The main medical problems I encountered were diarrhoea and vomiting, fever, dehydration, rashes, skin infections, wound care, scorpion stings, and mental health problems. Expeditions can be stressful so this latter problem was common, ranging from homesickness to severe depression.
Washing a volunteer’s vomit covered clothes and bleaching floors to help reduce a diarrhoea and vomiting outbreak were jobs I hadn’t anticipated. On site you are often the only Raleigh medic available and your nearest medical colleague can be several hours away. However, I was always able to contact the field base medic to discuss patients and get a second opinion (either via mobile, or satellite phone if there was poor reception). Being able to discuss patients with other medics meant that I never felt isolated, and preparing detailed casualty evacuation plans reassured me that I knew how I could get to the nearest health facility if needed.
During trekking, foot care and general hygiene advice was essential. In the first few days of the trek we covered feet, hips, and shoulders with a good quality zinc oxide tape to prevent blisters. We also decided to implement daily foot siestas where everyone had to wash, dry, and talc their feet, and as a result we avoided any major foot problems.
I missed out on the usual highlights of a trip to Tanzania such as a safari, climbing Kilimanjaro, or a visit to the island of Zanzibar. However, I had an incredible experience working with inspirational people. I gained valuable experience as a leader and working alongside others in a management team. As I was a similar age to some of the volunteers, one of my main challenges was gaining the authority to lead the team.
I learnt to be flexible in difficult and remote environments, and gained independence as a clinician. After this expedition I studied for the diploma in tropical medicine in Liverpool, which covered tropical medicine, child health, parasitology, and public health. I hope to use what I learnt from the diploma and my experience in Tanzania in future expeditions and as a trainee doctor in the United Kingdom, where I hope to specialise in genitourinary medicine.
What to consider before going on a trip
It is important to consider the type of expedition before applying for jobs. Recognising your experience and limitations is fundamental. I had not worked as a doctor outside a hospital or general practice setting so wanted to work with a charity that was well set up in terms of risk assessment, casualty evacuation plans, and support in the UK from abroad.
I also wanted to work with a charity that supplied the medical kit and had other doctors on the expedition. I preferred jobs where the doctor was also a manager so that I could challenge myself not only medically but also on an individual level.
It is important to factor in buying general kit such as walking boots, a rucksack, and a sleeping bag as some expedition kit is quite expensive. Make sure that you also organise professional medical indemnity—some companies will provide a discount for voluntary work.
Competing interests: I continue to do voluntary (unpaid) work at assessment weekends in the UK with Raleigh International and receive travel expenses to get to these events.
Katie Ovens locum senior house officer, Birmingham, UK
Three ships, crews bustling on and off, are tied up at the pier as I walk towards the water, bags in hand. For the next three months or so, I am to be the ship’s doctor aboard the M/Y Sam Simon – one of conservation group Sea Shepherd’s three ships heading to the Southern Ocean and into inevitable confrontation with Japan’s whaling fleet.
As ever, I have my doubts. With my love for the exercise and all things outdoor, will I go crazy stuck on the ship for so long? Will I get on with the crew? What on earth will I do if I don’t? Medically, this is a big step up for me – I’m only four years out of med school, and am now responsible for a crew of thirty, in one of the most remote places on earth. I’m told that there is a very real risk of trauma, and that I could be two or more weeks away from medical backup if things do go wrong.
However, there is no going back at this point. I’m very much expected to join the ship by now, though our actual date of departure is unknown since it is dependent on the movements of the whaling fleet.
On board, I am introduced to the crew, who welcome me enthusiastically. Although this of course, is lovely, their happiness at my arrival almost makes me turn and run. I am always in awe of how much patients put their trust in us, as medics, and my fear that crew’s trust in me might be misplaced must be palpable.
After a few last-minute runs stocking up the onboard pharmacy, I feel as ready as I’m going to be to leave.
We slip out of Melbourne in early December, for what turns out to be 81 days at sea, covering over 15,000 nautical miles, getting down as far as 75 degrees South.
Thankfully, I’m underemployed as medic for the first half of the trip, leaving me plenty of time for my other duties as a deckhand. This means everything from cleaning toilets to launching our small rigid inflatable boat, and it’s good to be the non-medic most of the time, learning about ship life from the rest of the crew.
Not Going Well
It couldn’t last, of course. Somewhere in the Ross Sea, a crew member has an allergic reaction to some nuts that he has inadvertently eaten. He has not been able to complete his watch up on bridge, and is currently on all fours in a locked shower, vomiting, and feeling too faint to stand. He is breathing with some degree of difficulty through a tightening pharynx that has its work cut out balancing its now dual roles of food egress and ventilation. We are a long way from help.
As if this weren’t enough, the patient also happens to be me.
At this stage, I think its fair to say, things were Not Going Well.
Too British for Adrenaline
I am fortunate enough to have a caring and competent paramedic on board to help me out, who, left to her own devices, would handle this very well. Unfortunately, she is not left to her own devices, and I continue to attempt to direct my own treatment. And this is where my Britishness nearly kills me. Looking back, I think the biggest factor in my refusing a very sensible offer of IM Adrenaline, was my inherent desire to “not make a fuss”. I was convinced that a combination of IV fluid, antihistamine and steroid would see me through.
And, it did, just about.
However, this was not my finest decision-making moment, and I hope very much that I never provide as poor a standard care to anyone else, as I did to myself that evening.
Since getting back to land, I’ve found myself unable to summarise what the whole thing was like – either to myself or anyone else. It seems to me that the highs were so high, and the lows so low, that to give any summary would be misleading. The trip was amazing. But it was also hard, boring, exciting, unique, monotonous, and everything in between.
The one thing that I’m sure about though is the people; I was lucky to work, play, and live amongst an amazing crew on the Sam Simon, many of whom I’m sure will remain long term friends. Will I go back “down South” with Sea Shepherd? I’m still not sure. I hope I don’t have to of course, and that hunting whales in this great ocean wilderness becomes a thing of the past. But if it doesn’t, and if people still head South again to stop it, I might just join them. And this time, if I get sick, hopefully I won’t be so scared of making a fuss.
Bio: Chris is a UK trained doctor currently working as an Emergency Department Registrar in Tasmania. He has completed our general Expedition & Wilderness Medicine course in Keswick, and our Polar Medicine course in Alta, Norway. Chris has also done the AWLS course and is currently collecting points towards his Fellowship of the Academy of Wilderness Medicine (FAWM). Sea Shepherd is a non-profit conservation organisation most famous for using sometimes controversial direct action tactics to disrupt whaling in the Southern Ocean. “Operation Relentless” was the organisations tenth Antarctic anti-whaling campaign. For more info on Sea Shepherd, go to www.seashepherd.com.au