Take a look at our latest newsletter to find out more about the amazingly adventurous Dr Andrew Peacock
We know that education opens doors and as the EWM crew are both interested and a bit nosey, we love to hear what our alumni get up to after attending our courses. Naturally then, we were delighted to hear from Ian P, who told us he and his wife loved the 2013 Wild Medicine course so much, they’re busy packing up in the UK and moving to Namibia…
Not many things you can say that change your life! Attending the Wild Medicine course was one of those events. Amazing set of people and a fantastic opportunity to learn about conservation and desert medicine.
The kind of odd things we learnt…
– Take blood from a cheetah,
– Learn about (and touch – optional) many poisonous snakes,
– Sleep in a desert, walk 14km through a dry river canyon,
– What are the problem animals with Rabies? (A: Kudu),
– How can carnivores live outside conservation areas & not get killed by farmers &
– How to build a vineyard in a desert … what?!..
And the thing that changed our lives? Meet the Bushmen and see their need for healthcare! My wife and I are volunteering at Naankuse to run the Bushmen medical services. The real thing we learned? There are many people out there that can benefit from our skills …
Oh and by the way Namibia is amazing you get to see loads … but you can also get a 4×4 and do a week or so trip before the course.
Expedition & Wilderness Medicine’s new Conservation Medicine course in Namibia has been accredited for 16.5 CME
Located at the stunning N/a’ankuse Lodge and Wildlife Sanctuary only 42kms east of Windhoek is Expedition & Wilderness Medicine’s new Conservation Medicine Course. This truly unique lodge is set amidst a natural savannah, with riverine vegetation, lush grass plains and magnificent mountain views, and offers a malaria free Wild Medicine course.
The main objective of the course is to educate attendees as to how we can integrate the diagnostic and problem solving skills of both human and animal health professionals with the knowledge of conservation professionals. Ultimately this should help all concerned to better manage the environment and biodiversity to the benefit of all the inhabitants of our beautiful planet.
The emerging interdisciplinary field of conservation medicine, which integrates human and veterinary medicine and environmental sciences, is largely concerned with zoonose. At the present time there is very little sharing knowledge in both an academic and practical session and this course serves to address this significant gap.
More information on our course here
The treatment of cholera in an active malaria zone is a difficult matter. This is especially true with lessons being learned in Haiti and their recent cholera outbreak. I am specifically referring to the combination of Chloroquine (antimalarial) and the antibiotic class Macrolides (used in treatment of cholera). A post that I made back in 2009 has new recent relevance and I wanted to repost that here:
Azithromycin, Chloroquine and Arrythmias:
Travel medicine frequently uses medicines that are taken under special circumstances and for short periods of time, like a trip. Many travelers carry an antidiarrheal antibiotic on their trip and a common choice is azithromycin. This can potentially be a problem when they are also traveling in a malaria area and using chloroquine for prevention. Two very commonly used medicines chloroquine (antimalarial) and azithromycin(macrolide antibiotic used for respiratory infections and diarrhea) both have wonderful safety profiles, individually. However when taken together, there is discussion of the chance of a heart arrhythmia, specifically prolonging the QT interval. In fact, my software I use for prescribing cites this as a combination to avoid.
There are several important articles that can be used to look at this problem and evaluate the risks. One very good paper looks at medications that prolong this QT interval:
- “What clinicians should know about the QT Interval” by Sana M. Al-Khatib, et al.
These authors list azithromycin as a “very improbable” medication, although other macrolides are listed as higher risk. Chloroquine is listed as an “Unknown” medication, with respect to prolongation of QT interval. This article was based on expert opinions.
- “Azithromycin/Chloroquine combination does not increase cardiac instability despite an increase in monophasic action potential duration in the anesthesized guinea pig” by Fossa, et al.
This study looked directly at this problem, in animal models. Their research showed no increase in arrhythmia risk.
- “Lack of a pharmacokinetic interaction between azithromycin and chloroquine” by Cook, et al.
A wonderful article that is actually helping to look at using this drug combination to treat resistant forms of malaria. More about this combination and treating malaria here. Their study did show an increase in the QT interval in both groups of those who received chloroquine alone and those who received the combination of chloroquine and azithromycin. This QT interval increase was maximum on day number three and returned to baseline by the end of the study.
Most of the information I am finding looks reassuring for safely using this combination, in healthy individuals. Those with a history of arrhythmia should use this combination with caution and discuss this problem with their doctor, before they take these two medicines within a close amount of time.
Contributer: Dr Erik McLaughlin | www.adventuredoc.net
Feedback on our recent Polar Medicine training course in Norway has clearly affected some of the course delegates by creating a need for ‘biggles-speak’…
PapaFoxtrot calling Red Leaders AlphaHotel, AlphaCharlie, DeltaBravo, Bravo and Delta
Congrats on recent Operation Polar Bear
Bunks and chow excellent
Red Leaders all SPLENDID
Hope all returned to base safely
Please pass on to all members of Polar Bear as don’t have call signs
Do you read me ?
Dr Amy Hughes medical career has been far from ordinary and she talks about how she has ended up as medical lead at WEM.
Dr Hughes co-leads with Dr Luanne Freer our CME accredited Mountain Medicine course on the Everest Base Camp trail in Nepal.
Management of AMS
Prospective, Double-Blind, Randomized, Placebo-Controlled Comparison of Acetazolamide Versus Ibuprofen for Prophylaxis Against High Altitude Headache: The Headache Evaluation at Altitude Trial (HEAT)
High altitude headache (HAH) is the most common neurological complaint at altitude and the defining component of acute mountain sickness (AMS). However, there is a paucity of literature concerning its prevention. The researchers sought to compare the effectiveness of ibuprofen and acetazolamide for the prevention of HAH.
Three hundred forty-three healthy western trekkers were recruited at altitudes of 4280 m and 4358 m and assigned to receive ibuprofen 600 mg, acetazolamide 85 mg, or placebo 3 times daily before continued ascent to 4928 m. Outcome measures included headache incidence and severity, AMS incidence and severity on the Lake Louise AMS Questionnaire (LLQ), and visual analog scale (VAS).
Two hundred sixty-five of 343 subjects completed the trial. HAH incidence was similar when treated with acetazolamide (27.1%) or ibuprofen (27.5%; P = .95), and both agents were significantly more effective than placebo (45.3%; P = .01). AMS incidence was similar when treated with acetazolamide (18.8%) or ibuprofen (13.7%; P = .34), and both agents were significantly more effective than placebo (28.6%; P = .03). In fully compliant participants, moderate or severe headache incidence was similar when treated with acetazolamide (3.8%) or ibuprofen (4.7%; P = .79), and both agents were significantly more effective than placebo (13.5%; P = .03).
Fascinatingly the authors demonstrated that Ibuprofen and acetazolamide are similarly effective in preventing HAH. This adds another medication to the useful arsenal to use in the treatment of AMS and in particular is especially useful when you have a patient who can’t take acetazolamide (diabetics or sulphur allergies) .
Learn more about Altitude Medicine by joining Expedition and Wilderness Medicine’s CME accredited Mountain Medicine course in Nepal headed up by Everest ER founder Dr Luanne Freer
Feedback from delegates in our unique Desert Medicine medical training course in Namibia is feedback enough but the Wilderness Medical Society has also awarded it 20.5 CME points.
‘I had a fantastic time and feel like I learnt a lot. I will definitely be signing up for more courses and recommending the courses to people I know!’ Desert course participant.
Developed for medical professionals or advanced medics working in hot or arid climates. The Desert Medicine Course aims to introduce participants to the skills required to be a valuable member of a desert expeditionary team, and to care for and treat injuries and illness likely to occur in this fascinating environment.
Our Desert Medicine Course is based in Damaraland, an area bounded to the south by the spectacular Namib Desert, to the east by the Kalahari, Ovamboland to the North and the world famous Skeleton Coast to the west. Located near the famous Doros Crater, a massive volcanic crater formed over 140 million years ago. Our training area is a stunning region, remote from civilisation, inhabited by an array of desert adapted flora and fauna and with some of the most remarkable night skies in the world. As a result of the recent changes in wildlife management in Namibia, the Doros Crater has been chosen as the region in which the endangered white rhinos are being released. It is a very exciting location inhabited by elephants, hyena, giraffe, rhinos, cheetahs and occasionally lions. It is almost unique in Namibia and for this reason we have endeavoured and been allowed to gain access to this virtually uninhabited area. Its the perfect location for our desert course.