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 alumni Sarah McMurtrie has recently returned from Namibia having worked at a remote Bushman clinic, a post advertised through EWM, a has kindly written her impressions up to inspire you!
Based in POS 3: Epukiro- North East Namibia 1800 elevation.
Nearest town and district hospital 100km away at Gobabis. Facilities include an Accident and Emergency, TB ward, women’s ward, and maternity and paediatric ward.
Gobabis- 200km from Windhoek (capital of Namibia). Windheok has two major hospitals: Windhoek Central and Katatorah Hospital. It is Gobabis hospital that is the closest place for the people of Epukiro to get an x-ray and it is also the closest place for blood tests and TB sputum samples to be processed. The samples can be taken in Epukiro but need to be transported to Gobabis hospital.
Epukrio/ Pos 3 is a community of San Bushman and Herero people. The settlement is a mixture of small brick buildings and corrugated iron roofs, simple shacks made from wood, cloth and open fires. Communal living within a sandy compound- with relatively infertile land. No toilets so families use the bush – raising sanitation problems and risk of spreading and contracting worms.
The village itself contains two small shops selling sweets, sugar, oil, soap, tinned goods and two bottle shops ( bars selling bottled beer). A government building involved in agriculture. The state clinic run by nurses – here everyone pays the equivalent of 7 euros for treatment, there is also an ambulance that can make trips to Gobabis hospital.
There is only one communal tap for the whole of the Bushman community and until one month ago the Bushman were buying water from the Hereros. There are also a few Shabeems, these are shacks selling cheap alcohol blasting out local pop music, this is unfortunately where a lot of local people – mainly the Bushmen – spend their time and money.
The Lifeline clinic in Eupikro was set up by a Namibian family in 2003, all part of the foundation called N/aankuse. This is a free clinic for Bushman people and where Hereros pay the equivalent of 7 euros. It is run by a permanent Namibian nurse (working there for more than six years) and a resident doctor who comes for at least one year. It is staffed by local people – a receptionist, two translators and a gardener. Volunteers come throughout the year, nurses, doctors or students for an experience.
As a paediatric nurse I came for 4 weeks to the Lifeline clinic. The clinic opens from 08:30- 17:00 Monday to Friday. There are three consulting rooms, family planning and immunisation room and small emergency/ rhesus room. On average 25- 30 patients are seen each day, anything from birth upwards.
For children there is a lot of diarrhoea and vomiting. Immunisations, dehydration, rashes, worms, tinus capitas, occasional broken bones and rapid malaria testing. Tonsillitis, upper and lower respitory tract infections.
For adults a lot of TB patients and TB sputum samples taken- these have to be processed in Gobabis. HIV related illnesses and HIV testing (which has to be done at the State Clinic). Upper and Lower respitory tract infections, chronic pain, arthritis, unknown wounds from insect bites or animals. Family Planning- Ladies coming in for their two or three monthly injections, fungal rashes, STI’s. Alcohol related problems or injuries.
It runs like a GP surgery. Patients histories are taken, these take a long time as most patients speak Bushman, Herero or Africans. Nearly all consultations require a translator and frequently it is hard to get clear patient histories and the exact information. Patience is needed and often the presenting compliant turns out not to be primary compliant.
Temperature, blood pressure, weights, saturations, heart rate and respirations are all taken. Urine samples, stool samples, TB sputum’s, BM’s taken when required. For children MUAC (middle upper arm circumference) taken between the age of 6 months to 6 years.
Examinations taken – listening to chest sounds, looking in ears, throats, feeling for lymph nodes, assessing limb from range of moments, pain assessments. Vision examinations (an eye doctor visits the State Clinic every other month). Abdominal examinations feeling for enlarged spleens and livers, or looking out for distended abdomens especially in children.
The clinic has a pharmacy, frequently dispensed medications are paracetamol- but only one or two days worth as alcoholism is a big problem in the village. Methysal gel – to rub over muscle aches- very popular in this community. Ibuprofen – only a few days worth- it’s the Herero ladies with high blood pressure which like this. Oral Antibiotics given for infected bites, secondary lesions and open wounds, also respiratory bacterial infections and some tonsillitis. Albendazole- a de-worming tablet given to the over 2 years. Zinc is given for diarrhoea to prevent a reduction in the immune system. Multivitamins are given as standard to nearly all patients that come through the door. Blood pressure meds and oral rehydration solution. Kez shampoo given for Tinus Corpetus, Vitamin A given frequently to children and Intra Muscular contraceptive injections.
The clinic also runs outreaches to neighbouring villages- in particular POS 10, about 10km away- to a local school, and to other local community centres at least once a week. Basically taking a mobile clinic to the villages , providing nearly all the same facilities.
The Life Line clinic is a busy clinic and each day is varied, if it isn’t busy with medical conditions, then it maybe that a crowd of kids come by to see if we have any shoes, clothes or just to sit in the waiting room or hang around outside under the tree. My work in the clinic came to an end in December – just in time for the Christmas party. Hot dogs, flap jack and fizzy pop for the kids of POS 3. I Lasting memories of our Christmas photo around the Christmas tree- even the chief joined us!
The clinic was set up in 2003 and is based in Epukiro, approximately 120km North of Gobabis and 400km East of Windhoek. It’s a small community made up of mainly Herero, cattle rearing people, and a small group of San Bushman who are traditionally nomadic hunter gatherers that live in small family groups.
Sadly, San are treated as second or even third class citizens in Namibia and providing free and accessible primary healthcare to this community really is a lifeline to many. People walk hundreds of kilometres to receive medical care when they are sick and unfit to travel these distances. The clinic was set up to provide free medical care to the San Bushmen community. The majority of our patients are San who receive all their treatment free at the clinic (84% of consultations). The rest of the consultations are for fee paying locals, mainly Herero (16%).
The doctor’s role is extensive in nature but is extremely satisfying. The clinic is primarily open Monday- Friday, 8am- 5pm with a lunch break from 1pm-2:30pm. Patients are seen on an open access basis. We also provide an outreach clinic to a large primary school with 150 San pupils and to a village 40 kilometres away. We also run a community program which is in its infancy and consists of training and supporting community health workers in several San Bushman settlements in the area.
Many of the San come from the surrounding regions and may travel several hours to reach us. 40% of the patients we see are children. We see a lot of TB, respiratory infections and diarrhoea. We also see trauma, domestic violence, alcoholism and malnutrition. Patients who need to be admitted to hospital are transferred via our clinic car/ambulance to Gobabis Hospital, 120 km away, mainly on gravel roads. On some occasions they need to be taken straight to Windhoek which is a 4 hour drive away.
Facilities in the clinic are very good and include a microscope, ultrasound machine, computer facilities and the internet. We have a good relationship with the state clinic and mutually support each other. The Lifeline clinic is entirely funded by charitable donations. It is part of the N/a’an ku se foundation which also has a wildlife and conservation sanctuary just outside of Windhoek. The farm is 320 km away from the clinic, mainly on tarmac roads.
The doctor is responsible for the clinic staff, currently consisting of a nurse, receptionist, translator, cleaner and gardener. The doctor works with Anna Daries, our wonderful Namibian nurse who has been with the clinic for approximately eight years. She has good local knowledge of the San community and is well respected by them. The doctor also looks after the medical volunteers who come from all over the world and stay for a period of two weeks upwards, provides teaching & projects for them to undertake and ensures they are looked after. They are vital to the financial aspect of the project. The doctor/ partner picks the volunteers up from the farm and then drops them back at regular two weekly intervals. This also allows for a few days leave from the clinic itself.
Accommodation is attached to the clinic and is shared with the nurse and medical volunteers so there is not a lot of privacy. The accommodation is comfortable with a fully equipped kitchen, electricity, solar heated water, a television, a garden and two small affectionate dogs. Regular visits to Gobabis are undertaken to pick up food and provisions.
Other responsibilities include keeping regular updates for the management team, writing reports to obtain further funding (working with the fundraising manager), ordering the medications for the pharmacy and generally maintaining patient records.
There is often a lot of driving involved, some of it on gravel roads, but the clinic car is a Nissan X-Trail in good condition and reliable and safe to drive. You do need to be able to change a tyre as punctures will occur!
Namibia is one of the safest African countries to visit; the main nuisance is petty crime. Driving around Namibia is quite safe as long as you keep to a sensible speed and avoid driving in the dark. The roads are not busy.
It must be stressed that this is a remote area of Namibia in a small but friendly community. There are frequent power and water cuts particularly in the rainy season. Accommodation and food are all provided. There is also a small monetary remuneration of N$5000/ month (about £400/ month). The job would be suitable for a single doctor or a couple (not necessarily two medics).
This very rewarding role would suit a doctor with a passion for people, who would be prepared for the remoteness and heat of Eastern Namibia and who can be flexible and embrace all aspects of the role.
For more information about N/a’an ku sê please visit www.naankuse.com.
N/a’an ku sê Foundation, P.O. Box 99292, Windhoek, Namibia.
T: +264 (0) 817 438 505
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
Our aim is to provide volunteers with the wonderful opportunity to contribute to the medical welfare of the San community and experience unspoiled African wilderness. Our volunteers are key to the success of this special place. All the money raised through our volunteering programme goes directly back into the project which provides employment, healthcare, education and accommodation to the local Bushman and to ensure the rescue, survival and rehabilitation of orphaned and injured African wildlife.
Namibia truly is a wonderful country to experience, the scenery is spectacular and you will work with our friendly and dedicated team. If you come prepared to learn and to give your best you will be rewarded with a fantastic experience and wonderful memories to take home.
We do hope you will come and join us!
DR RUDIE AND MARLICE VAN VUUREN
OWNERS, N/A’AN KU SÊ FOUNDATION
During the project you will spend your time at our remote San (Bushman) clinic in rural east Namibia. The village homes around 500 San and Herero villagers and the clinic is at the heart of the community. Here, you will assist our Doctor and Nurse with the running of the Lifeline Clinic and help provide primary healthcare to the local community. You will provide hands on support at the clinic, participating in observations, running reception and helping in the dispensary. You will deal closely with patients from the local San community, learn more about their way of life and give care to patients living in extreme poverty at the clinic’s remote location.
Your arrival and departure base will be our N/a’an ku sê Wildlife Sanctuary, near Windhoek Airport, so if you choose you can also have the unique opportunity to stay here a few days and work with the animals here. The Lifeline Clinic is in Epukiro (or Pos 3 as it’s commonly known), approximately a 5 hour drive from the sanctuary and we will arrange all your transfers. Our aim is to provide volunteers with the wonderful opportunity to experience African wilderness in the knowledge that they are contributing to improving the lives of the people of Namibia.
CARNIVORE CONSERVATION VOLUNTEER
This 10 day programme offers a unique opportunity to play a hands on part in the conservation of wild cheetah, enabling you to work up close with these incredible animals and contribute towards their welfare. N/a‘an ku sê plays a vital role in rescuing and releasing threatened cats in Namibia to help reduce humanwildlife conflict. The overriding aim of our study is to alleviate existing human-wildlife conflicts using new approaches and assess whether translocations of cheetah and leopard are a viable long-term option for dealing with so-called ‘problem animals’. Since our programme began in 2008 we have rescued and released 41 cheetahs, 20 leopards and 3 brown hyena.
We have 4 release sites: NamibRand Nature Reserve, Sandfontein Nature Reserve, Solitaire and our Windhoek study site. Our new research base in the stunning area of Solitaire hosts a 500 hectare soft release boma for cheetahs.
Only large carnivores who have been held in captivity for long periods of time, or who have been rehabilitated from ill health, undergo a soft release rather than a hard release back into the wild. Cheetahs stay in this soft release site in order to acclimatise to the area and learn how to fend for themselves once again. The duration of their stay depends on how successfully the cat adapts to their new environment but can be between 6- 12 months.
You can also combine your 10 day programme in Solitaire with an additional stay at N/a’an ku sê Wildlife Sanctuary and Windhoek Research Study Site, which you can do before or after your Solitaire trip.
To apply please contact Lucy Hale| [email protected] – please mentioned ‘Expedition & Wilderness Medicine’
World Extreme Medicine Specialised courses
Having participated in an Expedition and Wilderness Medicine training course can open up a whole network of contacts and opportunities, not only do expedition, media and travel organisations look more favourably on EWM trained medics who have participated in one of our courses we a have an incredible network of contacts who are constantly on adventures, working remotely and who need remote medical cover.
Recently expedition medics have been working with UNICEF and with a well known charity challenge compamy to provide medical cover on thier fundraising adventures – they are off to Namibia next and you can find out more about UNICEF’s fundraising expeditions here.
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.
Our foreign courses always run on a fairly fluid timetable, but this year’s Desert Course in Namibia was certainly more fluid than expected. Having never seen rain in the desert before, we had rain every day bar one, most of it torrential. A storm on the second night tried its hardest to blow down/away most of the tents and the large tarps put up by Faan, our local agent. His cooking staff had never experienced such a storm and then still managed to produce a hot meal for us all shortly afterwards.
We still had a great week. The group included some extremely experienced medics and everybody contributed to the learning. A fascinating demonstration of snake handling from Stuart involved his venomous and non-venomous snakes and a parabusis scorpion.
We trekked in some seriously hot conditions and at times were lucky with cloud cover. One unexpected bonus was coming across a deep pool of water in a bend on a (usually permanently dry) riverbed giving us the chance to swim in the desert – magical. The view from the high peak of the Doros Crater Rim was well worth the walk in. Out final night out was luckily under the beautiful Southern Cross and the other stars as the clouds finally relented. We walked past fresh rhino tracks and saw herds of zebra, springbok and flighty ostriches as we drove out. Faan looked after us impeccably as usual.
Mother Nature surprised us again at the end of the course when the volcanic ash prevented Mark and I, and many of the course participants from flying home at our intended times. The latest person home was 10 days late and one participant endured an epic 3 day flight/train/train/ferry/train/ferry/train journey. At least we are all getting used to the unexpected.
Operating in extremely hot conditions creates a unique set of medical risks. In the link is the medical outline – for non medics, regarding those risks from the Namibia Ultra Marathon training guide.
Dehydration is the most common heat related illness – in fact, it is thought that dehydration could be the single greatest threat to the health of an athlete. When training regularly and for long distances, fluid intake should be made a priority. You must drink fluids all day – not just during training.
Don’t depend on feeling thirsty to tell you when to drink. Thirst is a late response of the body to fluid depletion. Once you feel thirsty, you are already low on fluids. The best indicator of proper fluid levels is urine output and colour. Ample urine that is light coloured to clear shows that the body has plenty of fluid.
Dark urine means that the body is low on water, and is trying to conserve its supply by hoarding fluid which means that urine becomes more concentrated (thereby darker).
Dehydration can be the cause of feelings of fatigue or exhaustion – at all times watch out for signs of dehydration and take on water regularly through out the day.
We’ve just heard from the Namibia Ultra Marathon race director Steve Clark, that everyone is now back in Swakopmund. Steve said the race was very tough with temperatures getting up to 42 ºc. Winner Darren Roberts was very surprised and shocked to hear he won the race but once it sunk in he was delighted. Tom Adams very nearly caught Darren up at the finish line which made it a nail-biting finish.
Namibia 24-hr Ultra Marathon Results are as follows:
1st Place – Darren Roberts 20hr 28
2nd Place – Tom Adams 20hr 29
3rd Place – Tom Maguire 21 hr 05
4th Place – Emma Rogan 21 hr 27 – First female to complete the Namibia 24-hr Ultra Marathon
5th Place – Jerry Haywood 22 hr 30
6th Place – Nick Tidbull 23 hr 17
7th Place – Nicholas Wright 23 hr 45
8th Place – Helen Skelton 23 hr 50 – BBC Blue Peter Presenter
9th Place – Adrian Crossley, Stuart Moore, Kellie Power & Michael Skakesheff 25 hr 07. These guys all crossed the line together holding hands, they were all just outside the 24 hour deadline but all were allowed to finish.
Dr Amy Hughes will when she’s back write up about the medical situations she was faced with on the race and how people coped with the extreme heat.
Dr Sean Hudson explains why we’ve chosen Namibia to run our new Desert Medicine Course.
There truly aren’t enough superlatives to describe how beautiful Namibia is. Hence when we came to choose a destination for our new desert medicine course, there was only one possible choice.
As a group, Expedition Medicine have been working, travelling, holidaying and honeymooning in Namibia for over 10 years. It has a quality which is becoming increasingly rare and difficult to find in Africa. It still remains exotic and predominantly unspoilt, tourism is increasing but slowly.
The diversity of the country is its strength, whether you yearn for endless deserts, exotic mountains, huge dunes, canyons, rivers, a myriad of game parks or the most remarkable coastline in the whole of Africa, it is all here. All set to the backdrop of German efficiency, which has created a medical infrastructure which can support any expedition.
Caroline and I first worked in the Namib as guides and medics in 1998 and fell in love with the country. We have returned many times and are very excited about the desert medicine course. It’s a beautiful location, with Brandberg as a backdrop, and the opportunity to encounter the remarkably adapted desert elephants which often can be found in the Uhab River.
The team are quite exceptional, and I can’t wait to learn from them and their vast experience, in this and other desert environments around the world. If you want to camp in one of the oldest deserts in the world, in the shadow of a mountain which has been a refuge for desert nomads in hard times for over 6000 years, track elephant, learn how to survive and treat medical conditions common in this environment, then there is no question you would enjoy our trip to Namibia.
Dr Sean Hudson
Find out more about the Expedition Medicine Desert Medicine training course in Namibia.