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