Take a look at our latest newsletter to find out more about the amazingly adventurous Dr Andrew Peacock
We‘re delighted to be working with specialist international medical recruiter Head Medical to promote some of their more interesting roles.
Arranging a position overseas is exciting, but Head Medical understand that it can also be a complex and time-consuming process. They’re the UK’s specialist in international medical recruitment and have helped many Doctors relocate since first starting in 2008. They know it’s important to balance career opportunities with lifestyle so they’ll talk through your plans and get to know you to make sure they find the right role in the right location.
Once they’ve secured a job for you, they’ll manage the Medical Registration and Visa application process, and support you throughout the relocation.
Check out these incredible opportunities:
GENERAL PRACTITIONER – RURAL ALBERTA, CANADA
3 permanent GP positions available with a well-established rural private practice based in Western Alberta.
This is an excellent chance to experience and explore the stunning natural beauty of Canada; you will be working with and making a positive impact on a local community while being exceptionally rewarded with high earnings and excellent benefits.
- Earnings of £162,000 to over £270,000 per annum
- CAN $10,000 towards relocation costs
- Accommodation is available; either single units or family homes. These are all paid for apart from utilities (which are at a reduced rate)
- Car hire paid for 1 year
Working closely with the local community, the practice aims to effectively and efficiently develop and administer programs and services. You will be working on a fee for service basis.
The practice is open 5 days per week, 8.30am – 5pm. There are also emergency on-calls at the local hospital (on average they will be 6-10 per month but more shifts are available). Weekend rates are higher during the week. As this is a rural position you will need to have skills in Emergency Medicine.
- To be considered for this position you must have MRCGP (acquired through examination)
- You will ideally have your ATLS, BASICS or proven trauma and emergency medicine experience
For further information, contact Yan Scouller on 0131 240 5274 or email [email protected]
REMOTE GENERAL PHYSICIAN – AUSTRALIA
- Challenging and complex medicine
- Fantastic clinical job
- Unique environment – adventure of a lifetime
- Supportive and enthusiastic colleagues
- Lucrative remuneration package and benefits
This is an amazing opportunity for a General Physician with an adventurous spirit and desire to make a difference to the health and well-being of an amazing community in outback Australia.
The job is arguably the most exciting general medicine position in Australia and would attract a committed and dynamic medical professional who can think on their feet, work autonomously and enjoy one of the most remote places on earth that also has unique health challenges.
Based within a township some 300 km from Darwin you will also continue to develop a significant outreach program that has already made some instrumental gains in health care in the region.
There are very high rates of rheumatic heart disease, glomerulonephritis, diabetic retinopathy, infectious diseases and respiratory illnesses. Most of the health care issues are poverty related with life expectancy being only 45 in the region. Applicants with interests in renal, infectious diseases, respiratory, gastroenterology, cardiology or endocrinology will be highly regarded and would add real value to the service.
This position would suit General Physicians qualified in either the UK, Ireland, USA, Canada or South Africa. Your communication skills will be first class and you must be interested in working within a cross-cultural environment, across all ages.
A first class remuneration package (circa GBP150k and above plus benefits) will be awarded.
For further information, contact Alasdair Spinner on 0131 240 5276 or email [email protected]
GENERAL PHYSICIAN – REMOTE & RURAL SPECIALIST – AUSTRALIA
Physician with an adventurous spirit required for an outback town in North West Queensland. If you are looking for a total change in practise and experience, this role could be for you.
We are seeking a General Physician to join a team in Mount Isa Hospital, which is also considered a centre of excellence for remote and rural training.
- Competitive remuneration package (up to AUD$400k dependent on experience)
- Experience the real Australian Outback
- Wide variety of cases and opportunities to teach
- Opportunity to make a real difference
- We support you in obtaining medical registration and work visa
- You will have broad range of experience and enjoy working in a multidisciplinary team setting
The Medical Ward has 24 beds and consultative services are provided to the surgical and maternity wards. In addition, there is a 5-bed high dependency unit. Most referrals arise from acute medical cases seen by the emergency department or from medical, diabetic or specialist outreach Outpatient Clinics.
Ideally you will hold FRACP (or equivalent specialist qualification), and be registered or eligible for registration with the Medical Board of Australia as a Senior Medical Officer or Specialist Physician. You must have also experience and interest in working with remote and rural communities.
Although Mount Isa is a small town, established as a result of the mining industry, it is home to a variety of different cultures with a population of 25,000 and services a region spanning 300,000 square kilometres. Jump in the four wheel drive and explore the outback, do a bit of fishing, or camp out under the stars. And if you’ve never been to a rodeo, this could your chance.
The local airport has regular flights to Brisbane and ongoing international connections.
In this role, you will experience a supportive community and a relaxed lifestyle in a truly unique environment, as well as a diverse patient mix and an excellent remuneration package.
For further information, contact Caroline O’Hagan on 0131 240 5276 or email [email protected]
SENIOR MEDICAL OFFICER – AUSTRALIA
Fantastic management and clinical opportunity, giving you the chance to lead a vital service with an outstanding salary and benefits package on offer.
- Salary £220,722 to £261,763 per year
- Housing at a subsidised rental rate
- Car provided
- End of service gratuity
An enthusiastic Senior Medical Officer (SMO) required to lead a team in the beautiful East Kimberley region of Western Australia, based in Kununurra. The East Kimberley SMO position is a combined clinical and administrative role responsible for administrative duties and supervision/support for other medical staff working in the Kununurra, Wyndham and Halls Creek hospitals. The SMO reports to the Operations Manager at Kununurra Hospital, working closely with each site’s Director of Nursing and liaises with the Kimberley Director of Medical Services on operational and strategic issues for the hospitals. Clinical duties will include involvement in the Emergency Department and/or GP Clinic at each hospital.
Appointment to this position is based on skills and experience with a minimum requirement of 12 years’ experience in general practice environment.
Experience in rural hospital settings desired. The Kimberley region has a high Aboriginal population as well as a large transient population, which impact the health services. Three quarters of attendance to hospitals with in the Kimberley are for semi-urgent and non-urgent. The leading cause of emergency attendance for Kimberley residents are skin related diseases and disorders; injuries; toxic or drug effects; ear, nose, throat respiratory system problems. This is a fixed term position with the opportunity to work flexible hours allowing time off for professional development and long holidays.
For further information, contact Yan Scouller on 0131 240 5274 or email [email protected]
Extreme medicine and expedition doctor Alexander Kumar provides an account of his time spent working in one of the coldest places in Antarctica and one of the few true extreme environments on Planet Earth. Known for his sense of humour, he has lived, worked and travelled through over 80 countries all over the world, including the Amazon and extensively across the Arctic and the Antarctic a few times also over the past 10 years.
Shackleton in Space
Antarctica is a large flat egg-white expanse with bits of egg shell in it (aka the TransAntarctic mountain range) that is greater in area than India and China put together.
Exactly 100 years on from Scott and Shackleton, I travelled to Antarctica and spent around one year living at Concordia, a joint French-Italian inland Antarctic research station as the Human Spaceflight Research MD to conduct research for the European Space Agency in an attempt to understand how far human physiology and psychology can be pushed towards a future manned mission to Mars. It is one of the most remote outposts on the planet located in one of the world’s most extreme environments.
The most extreme place on the planet?
Environmental extremes experienced there include:
* Enduring around 3 months of complete darkness, where the sun does not rise above the horizon
* The world’s coldest temperatures dropping down below minus 80 degrees Celsius
* Complete isolation with no means of escape for 9 months, simulating long duration space missions and life on the surface of another planet
* Chronic hypobaric hypoxia being located at around 3800 metres equivalent altitude
* Nothing lives outside the station for over 1,000 kilometres, in nearly all directions.
* Our nearest neighbours are the astronauts orbiting the earth on board the International Space Station, and then some Russians snowed* in at Vostok station (* = it does not actually ‘snow’ inside Antarctica).
Answering the job advertisement for what may be the coldest and loneliest job in the world, I found packing my mind for a year away was much more difficult than my bags.
“The uttermost end of the world”
To travel to the moon from the base would only take three days – far less than the three weeks it took to fly from London to Hobart and then to sail by icebreaker across the Southern Ocean, battling high seas, whales and being stuck in the ice pack with leopard seals before reaching a 60,000-strong rookery and football stadium’s worth of Adélie penguins. The stench nearly turned me back home.
Antarctica is an ill defined space in people’s minds. It incorporates South Georgia and other sub Antarctic islands, which are in fact closer to South America than the continent of Antarctica itself. People can and have sailed to South Georgia even during its winter. Whereas the interior of Antarctica remains an impenetrable block of ice. Even a team led by Sir Ranulph Fiennes’ (Coldest Journey) could not penetrate the continent’s interior during winter.
The longest on-call
Antarctica is full of surprises (and penguins). Adding to that it was the first time since the station opened 10 years previously that there would be just one doctor overwintering – that was to be me, since another doctor left the base just before winter began. It was a game of Tag and I was ‘it’. I can’t complain now about a set of nights or hardship on-call after doing nearly a year on-call in Antarctica.
The journey wasn’t over, it had just begun. After flying a further five-hour flight inland in a Twin Otter over the Great White Silence, a blank white canvas. Perhaps God had forgotten to paint this continent, intentionally I thought, as he took rest on the 7th day.
Coldest science on earth
Antarctica’s ice layer protects and hides its secrets like a thick skin, stretched over the bedrock many thousands of feet below. Recent efforts at Russia’s Antarctic Vostok station tapped the veins of the sub-glacial lakes, which flow deep beneath the surface, that may harbour evidence of life forms of our distant past. But as yet, this continent’s secrets remain teasingly elusive.
Ice cores plumbed out of the 800,000-year-old ice have told a story of their own – the impact of mankind on Earth and climate change. Century-old equipment was used in the discovery of a hole in the ozone – earth’s own flesh wound, which may yet scar over.
We conducted earth science research including glaciology, meteorology, seismology and astronomy, alongside my own research (on the adaptation of human health and well-being to this extreme environment), and trying to help in arranging the jigsaw pieces involved in sending a manned mission to Mars and back.
Curtain of darkness
As winter sets in, you stop living and start surviving. Temperatures plummet below minus 80C. In May the sun sets for the last time. A curtain of darkness falls, leaving you to endure three months of 24-hour darkness. Spinning uncontrollably through the world’s time zones, leaving you gasping as you wake from unforgiving, hypoxia-euphoric vivid dreams. The cold and isolation begin to seep in and your mind begins to stretch uncomfortably, as your senses become blunted by the sensory deprivation.
There is light at the end of the tunnel as multicoloured lights flicker overhead in the darkness, the Aurora Australis.
One way journey to the great beyond
Once you enter the Antarctic winter, you begin a personal journey of discovery and you will learn a lot about yourself. You cannot turn back or go home. Once that last plane departs, there is only one way up, you have to summit and there is no quitting, only crying along the way.
Living and over-wintering as the only British national among a team of 13 Europeans in the most extreme and remote environment on the planet was not ‘easy’ but not so challenging as it was predictable. As in any stressful environment living in an Antarctic station can be likened to living in one of the Old West frontier towns – a continual sense of not knowing who is going to shoot at who next or why. As a team, we ate, slept, exercised, conducted science and survived alone frozen into the landscape in close proximity. We all survived.
Not wanting to spoil the winter and many stories that came from it, I can summarise wintering in Antarctica in one sentence… it is one of the world’s only psychological marathons and one of the Earth’s greatest, most magnificent and most peculiar journeys.
‘I’ve been to Antarctica’
Tourists are so often bedazzled by Antarctica, and the public are often impressed by those who have been there. It certainly is special, however, all in all, you can say you have ‘been’ to Antarctica if you have flown in to work there for a few weeks or been on a cruise down there, during the breezy summertime. Take heed, when this is so often thrown about in conversations and talks.
We are all just tourists when it comes to Antarctica
Really, you can never say you actually know Antarctica until you have wintered there. And not just anywhere. A winter on a subantarctic island such as South Georgia, Antarctica’s coast or peninsula (-20C climbing and skiing activities which can be accessible during the winter) is nothing like a winter in the interior of the continent (-80C in hypoxic darkness that is inaccessible for months). And even a well connected wifi ridden winter in the interior nowadays is nothing like a broken radio winter in Shackleton’s day. If you want real isolation, you’ll have to bury your head and phone in the ice.
My own conclusion? Simple – Watching people around you unfold and unzip at the seams during wintering as a doctor is an interesting and can be an unforgiving past time. For sure, people aren’t made of the same grit and stuff these days. If you want to really experience something try to do it properly. Challenge yourself and mankind. What have you got to lose? … Only a few fingers or toes.
Alex has since worked in different space analogue environments and constructed the ‘White Mars’ research protocol for Sir Ranulph Fiennes.
As an accomplished writer, photographer and public speaker, he has published articles in BBC News, New York Times and by invitation, recently held an exhibition at the Royal Photographic Society, featured in The Guardian.
Alex now talks and works internationally for different organisations and humanitarian agencies, conducts global health research and continues to enjoy taking photos behind his camera and presenting in front of cameras for TV including BBC and Discovery, alongside his day to day NHS job and is a member of the EWM faculty.
Alex is continuing important work on a patent for a unique blend of cheerful and optimistic British sarcasm.
More information can be found at: www.AlexanderKumar.com
Alex’s TED talk ‘Malaria to Mars’ can be found at: http://youtu.be/OukZ04e6kOM
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.
STREET CHILD are looking for assorted medics and also a Medical Director* to provide cover for this fundraising event in the world’s 10th poorest country and help improve the lives of vulnerable children in West Africa.
**** POSITION NOW FILLED *****
The Street Child of Sierra Leone Marathon 2014 is an ambitious project and we need medical help to stage it. It’s more than just a run. We invite runners to join Street Child in Makeni, Sierra Leone to see and assist with the work we do in country, and to get involved with the local community. All of this takes place in a developing country with a basic medical infrastructure.
The race covers tough but beautiful terrain, invariably with high temperatures and humidity. The route is classed as a category “black” marathon – a marathon where serious consideration should be taken to safety provision. For this reason medical support is vital. Over the last 2 years, under the guidance of the Medical Director, groups of medical professionals from across the world have travelled to Sierra Leone to help out. When joined by local medics and nurses, mining corporation paramedics and medical students, this team have provided essential cover to the marathon. More importantly, previous teams can testify that they have have had an amazing adventure, providing a great talking point for grand rounds on their return!
Most of the action for the medical team takes place on race day, where teams set up makeshift medical stations around the course, providing first line medical care to the runners. This is co-ordinated from Medical HQ, the headquarters for ongoing treatment, and communication centre to each of the medical stations.
Sierra Leone is very much a developing country – supplies and equipment are limited and expertise is varied. This is a challenge, but one worth taking on. Outside of race day, the medical team will be involved in procuring equipment, medical briefings to international runners, and manning clinics offered to local runners on registration day. Another important job for the team is spending time chatting to the runners before the race, providing reassurance and advice, usually over a local beer!
We would like people who like the sound of this event to travel out to Sierra Leone for between 1 and 2 weeks to help us organise the 2014 Sierra Leone Marathon. We do ask that you fund your own trip (flights and accommodation only, all transport and meals will be free) but in return we will give you your own ‘experience of a lifetime’ seeing and assisting with Street Child projects in urban and rural Sierra Leone, taking part in a week of festivities in Makeni and you still get to finish on a high joining our West African beach party and 2 night beach hut retreat!
Dates are pretty flexible, the marathon is on Sunday 25th May so an 8 day trip could fly Wed 21st May and return Wed 28th May 2014. Direct 6 hour flights from London are available from Gambia Bird Airlines and BA.
To enquire or apply please send your details to [email protected]
*For applications to the role of Medical Director, the role will be to provide leadership and direction to the medical team. A return flight from London will also be provided. Minimum dates Mon 19th – Wed 28th May 14.
Below is short description by 3rd year Hull University medical student, Charlie Rowland, of his experience as an intern for EWM! Charlie won his intern place on the March 2012 Expedition & Wilderness Medicine UK Course with a great application that showed he is one to watch as he moves into the Expedition Medicine scene.
The winner of the May 2012 course will be announced on Sunday 8th April.
With all of the pressures that medical students and junior doctors are under to find foundation jobs and positions on core training posts, we could be forgiven for forgetting that the NHS only really represents part of the spectrum of opportunities that are available to us as qualified medics. For my own part (and despite the fact that becoming a doctor has been my ambition for as long as I can remember), I have often harboured a sneaking suspicion that the usual route through the NHS would not provide me with the challenges that I am after in my career. With that in mind, If there is one that I thing that I took away from the Expedition and Wilderness Medicine course that I recently had the privilege of attending as a student intern, it is that there is a hell of a lot of adventure out there for medics who go looking for it.
The course saw fifty doctors and nurses from as far afield as Australia, converge on a quiet corner of the Lake District for four days of intensive instruction and advising on the jobs available, the challenges faced and the skills required of medics working as part of an expedition team. As the ‘student intern’ on the course, it was my responsibility to time-keep the sessions so that the packed timetable ran to schedule and to help organise the equipment for the next day’s activities: A small price to pay, given that after this, I was free to participate in all of the course activities.
The course is aimed at providing medics (with an interest in the more unconventional lines of work) with a broad introduction to the field of Expedition Medicine. The programme is a mixture of lectures and practical sessions: Over the first three days we were taught about the more commonplace expedition maladies and how to manage them and introduced to some of the useful bits of kit used to treat specific conditions (I was particularly impressed by the portable recompression chamber – essentially a big, airtight, rubber sleeping bag – which can be pumped up to pressure for the treatment of acute altitude sickness). We were also introduced to important logistical and practical matters such as public health, procuring medical kits and planning evacuations. The practical sessions then covered the basic skills required of expedition members such as emergency rope-work, improvised stretcher techniques, radio and communications protocols and water purification (to name but a few).
The week climaxed in a search and rescue exercise in which the lessons of the previous days were put into action. In teams, we had to navigate our way to our casualties, deal with multiple injuries and illnesses, organise a helicopter extraction over the radio and finally package up and evacuate our patients. The day tested everyone’s abilities and resolve to the limits and despite the wealth of medical expertise within the group, It was great to see so many highly skilled doctors having to work hard to read maps and communicate over the radios.
The practical and medical aspects of the course were, undeniably, brilliant fun and a great learning experience. However (at the risk of sounding a little cheesy) of more value to me was the opportunity to take in the experiences of doctors who have not followed the typical, well-worn path through medicine – at least not without having plenty of fun along the way. The week was filled with stories of challenges, adventures, successes, close shaves and catastrophes which, without fail, had me on the edge of my seat with my jaw hanging open. As a medical student who is increasingly possessed by a desire to see more of the world before settling into any kind of steady job, I found the entire experience downright inspirational.
The EWM course was a real vindication of my aspirations and the steps that I have begun to make to take myself towards them. Taking in the experiences of the EWM faculty has given me a renewed enthusiasm for what I am doing and what I am working towards and, in short, I feel I have a much clearer idea of the sorts off the directions that I want my life to take me in.
Join us on the next Expedition Medicine course….
Happy Easter everyone!
University Liaison for Expeditoin & Wilderness Medicine
The Wilderness Medicine Society has granted the Extreme Medicine Conference 32.25 credits towards the Fellowship of Wilderness Medicine if all 4 days of the conference are attended
The Academy of Wilderness Medicine is a modular system of adult education that organizes the broad range of information in the discipline of Wilderness Medicine. It delivers them in a professionally packaged, standardized fashion according to modern concepts of medical education using objectives as the basis for learning experiences and outcomes evaluation where appropriate.
The most visible of the Academy’s modular programs, and the one that promises to be the most popular, is the Fellowship program (Fellow of the Academy of Wilderness Medicine TM or FAWM). This initiative offers a means to identify those who have achieved a demanding set of requirements validating their training and experience in Wilderness Medicine for the assurances of patients, clients, and the public at large. Society members enroll in the Academy and, by completing lessons from a pre-established Wilderness Medicine curriculum as well as receiving credit for specefic, indentiable experience; accumulate credit toward becoming a Fellow.
Any current member of the Wilderness Medical Society who successfully completes the requirements will have the distinction of being a registered member of the Academy of Wilderness Medicine and entitled to use the designation Fellow of the Academy of Wilderness Medicine (FAWM) and may reference it on resumes, business cards, and advertisements.
Congratulations to the latest "Experience Intern" winner for the UK March 2012 Course in Keswick, Cumbria
Firstly thank you to all of you who applied to the March 2012 Expedition & Wilderness Medicine internship. We a huge amount of interest and all were strong candidates from a large number of UK and overseas universities with a fantastic mix of experiences and skills. It is hugely encouraging to see that so many medical students are developing their skills early and are well on their way to be the expedition medics of the future!
Now for the selected intern….
I am thrilled to announce that Marita Flotre has been selected by the EWM team to be the intern for Expedition & Wilderness Medicine’s UK Course in Keswick, Cumbria (5 March 2012 to 8 March 2012). Marita is a 3rd year medical student at the University of Bergen in Norway who caught the Expedition & Wilderness Medicine Team’s attention with a clear passion for the outdoors and medicine.
Marita will join the Expedition & Wilderness Medicine Team in Keswick as an ‘intern’ and be a member of the faculty over the 4 days having the opportunity to:
– attend the UK course as a faculty-assistant
– have the opportunity to attend all the lecture talks
– if not assisting faculty in a practical session, be able to observe other practical sessions
– be part of the faculty team in the final Search & Rescue exercise
– meet the lecturers and faculty behind the scenes and be one of the team
For those of you reading this and thinking you would like a go! We encourage you to submit your entries for the April 2012 Conference competition (the closing date for this is on Thursday February 2nd 2012) and May 2012 UK Course competition (closing date Monday 5th March 2012.
We look forward to sharing Marita’s thoughts on her intern experience with you after the course and I am sure you will all join us in congratulating her!
This is a fantastic remote medicine job opportunity to work with the remarkable San Bushmen in our well-resourced Lifeline clinic in rural Namibia. We are looking for a doctor to start in May 2012 for 1 year or longer.
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
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
Dr Rob Conway, one of our regular lecturers on our famous Maldives based Diving & Marine Medicine course flew directly from Male to Johannesberg last year take up a post in South Africa at the rurally located Ngwelezane Hospital. The position was organised through African Health Placements .
Anaesthesia in a rural Hospital in Kwa-Zulu Natal
It struck me as I was watching my wife hold a beating heart in one hand and stitching it up with the other that this was one thing that every newly wed couple should do. We have been working in
Northern Kwa-Zulu Natal, South Africa, in a busy district general hospital called Ngwelezane.
I was desperate to get back to Africa and I thought that South Africa might offer both the experience with some form of supervision that I desired. I was keen to do anaesthetics and not a more generalist role that many of the more rural and remote hospitals require doctors to perform. The planning took 12 months and was helped by a charity called African Health Placements (AHP) who facilitates doctors placements in rural South Africa.
Ngwelezane has approximately 500 acute beds and 8 ICU beds. The catchment area covers a population of 4 million people in an area the size of England, and contains 22 referring hospitals. This means that the workload at Ngwelezane is incredibly demanding, with a high emphasis on trauma, emergencies and paediatrics. There is also a nearby maternity hospital where I do mainly regionals for caesareans and crash GA’s are not uncommon.
As it turned out Ngwelezane was struggling. The anaesthetic consultant I had liaised with had left, as had two of the four surgical consultants and all of the medical consultants. There was chaos in the department, which was staffing two sites with 8 staff, many of whom had done under 6 months of anaesthetics.
After a month of plotting how to escape early, I began to enjoy the job. The work is varied and interesting, making for an amazing experience. The nurses sing the day in and their voices drift across the hospital as you check your machine and draw up emergency drugs for the day ahead. There are general, orthopaedic, eye and ENT lists. We deal with emergencies or urgent cases and there is little planned work. Workload is high, hours are long and lists are generally overbooked, as there is a huge volume of work to be done here. As an example, this weekend I have anaesthetised 2 gunshot abdomens, 2 perforated duodenal ulcers, 3 children under the age of 5 and been involved in the triage of a mass casualty motor vehicle accident. I helped with the treatment of an organophosphate overdose, not to forget the numerous other surgical and orthopaedic patients.
There is currently no pre-operative assessment, we just do not have the resources and lists for the following day are not released until late afternoon making organising difficult. Although the cohort of patients are generally much younger and fitter than those that I saw in the UK, the majority have underlying HIV infection and TB. There are also the high risk patients who turn up to theatre without the relevant investigations and it is down to us to make the decision to postpone these patients for further investigations.
Anaesthetists here do not have the extended role that I experienced in the UK. You rarely step outside of theatre and are not involved in either acute trauma in the emergency department or critical
care in intensive care. Sometimes, however, we get the opportunity to help, such as when two packed buses collided and around 40 people arrived at the hospital, many of them children. I was involved in the care of a young girl, age unknown probably 4, who had bilateral open tibia and fibula fractures and a head injury. Her mother had died in the crash and we had no way of contacting a guardian. It was the weekend, no one was around to ask for advice, and I had to make a decision to wait to see the outcome of her head injury prior to rushing to theatre. I still feel that I was not in the right position to do this but I had no one to ask. After two successful trips to theatre we located an aunt to look after her. Her story is not uncommon.
Christmas was insane. My wife and I were working a 24 hour on call every third day. It was relentless, each one consisting of at least four penetrating trauma laparotomies and a number of stabbed hearts. The Zulu’s are tough, stoical and very appreciative of treatment and it amazes me that they can survive to hospital with a stabbed ventricle. I had never really contemplated the anaesthetic considerations for someone with a stabbed heart beyond fixing the defect. After inducing him I turned to the machine and then back to the patient. The next thing I know the surgeon is cracking open his sternum, grabs his beating heart in his hand, looks at me and says “He’s not going to like this”. Mental! He was right, the capnography disappeared and he went into some strange rhythm that I’m pretty sure is not compatible with life. The surgery was quick, the access was large and we filled him with lots of fluid as no blood was available. He went home four days later.
I have seen many weird and wonderful things that are too numerous to include here. The 30cm worm crawling out of someone’s abdomen intra-operatively, the hippo attack, the major trauma, the snake bites, the rare tropical diseases, the use of halothane, ketamine and the fact that I am left to anaesthetise children on my own. A lot of the time I am unsure if I’m doing the right thing and at times it has helped to debrief on doctors.net to ask advice from others who may know better. There are also many non-clinical roles that need to be filled and I have responsibility for the out of hours rota and annual leave as well as looking after the interns.
If there is one thing that would keep me here it is life outside of work. Kwa-Zulu Natal is a gem. We work long hours but are paid well and you can live a fabulous life, if you overlook the lack of security. We have a beautiful home overlooking the Zulu hills minutes from the beach in a small village called Mtunzini. Within two hours there are world class game reserves, two of the worlds top 10 dive sites and surf. A little further away are the Drakensburg or Mozambique and you are only a short flight to Cape Town.
Having had some time to reflect I realise that I have certainly had my ups and downs. The experience, especially the exposure to trauma and paediatrics, has been amazing. This environment has highlighted the value of training as I am out of my depth every day. I want to be both confident and competent in my work and proud of why and how I do it. Would I recommended Ngwelezane, well it depends on what you want out of your time here. If you are after training then not currently, but that may change. If you require a hands on, raw, frightening and yet exhilarating African experience then I don’t think I could recommend anywhere better.
- Wild Medicine – a conservation medicine course, Namibia
- Extreme Medicine Conference, London April 2012 – ‘Taking medicine to the extremes
Dr Luanne Freer, leader of this years Nepal CME accredited Wilderness Mountain Medicine course in Nepal, has been written up in a brillant article on the illustrouis Smithsonian website in an article entitled ‘Inside the ER at Mt. Everest’ by Molly Loomis.
A middle-aged woman squats motionless on the side of the trail, sheltering her head from the falling snow with a tattered grain sack.
Luanne Freer, an emergency room doctor from Bozeman, Montana, whose athletic build and energetic demeanor belie her 53 years, sets down her backpack and places her hand on the woman’s shoulder. “Sanche cha?” she asks. Are you OK?
The woman motions to her head, then her belly and points up-valley. Ashish Lohani, a Nepali doctor studying high-altitude medicine, translates.
“She has a terrible headache and is feeling nauseous,” he says. The woman, from the Rai lowlands south of the Khumbu Valley, was herding her yaks on the popular Island Peak (20,305 feet), and had been running ragged for days. Her headache and nausea indicate the onset of Acute Mountain Sickness, a mild form of altitude illness that can progress to High Altitude Cerebral Edema (HACE), a swelling of the brain that can turn deadly if left untreated. After assessing her for HACE by having her walk in a straight line and testing her oxygen saturation levels, the doctors instruct her to continue descending to the nearest town, Namche Bazaar, less than two miles away.
Freer, Lohani and I are trekking through Nepal’s Khumbu Valley, home to several of the world’s highest peaks, including Mount Everest. We are still days from our destination of Mount Everest Base Camp and Everest ER, the medical clinic that Freer established nine years ago, but already Freer’s work has begun. More than once as she has hiked up to the base camp, Freer has encountered a lowland Nepali, such as the Rai woman, on the side of the trail ill from altitude. Thankfully, this yak herder is in better condition than most. A few weeks earlier, just before any of the clinics had opened for the spring season, two porters had succumbed to altitude-related illnesses.
Each year over 30,000 people visit the Khumbu to gaze upon the icy slopes of its famed peaks, traverse its magical rhododendron forests and experience Sherpa hospitality by the warmth of a yak dung stove. Some visitors trek between teahouses, traveling with just a light backpack while a porter carries their overnight belongings. Others are climbers, traveling with a support staff that will aid them as they attempt famous peaks such as Everest (29,029 feet), Lhotse (27,940 feet) and Nuptse (25,790 feet). Many of these climbers, trekkers and even their support staff will fall ill to altitude-induced ailments, such as the famed Khumbu cough, or gastro-intestinal bugs that are compounded by altitude.
A short trip with a group of fellow doctors to the Khumbu in 1999 left Freer desperate for the chance to return to the area and learn more from the local people she had met. So in 2002 Freer volunteered for the Himalayan Rescue Association’s Periche clinic—a remote stone outpost accessed by a five-day hike up to 14,600 feet. Established in 1973, Periche is located at an elevation where, historically, altitude-related problems begin to manifest in travelers who have come up too far too fast.
For three months, Freer worked in Periche treating foreigners, locals and even animals in cases ranging from the simple—blisters and warts—to the serious, instructing another doctor in Kunde, a remote village a day’s walk away, via radio how to perform spinal anesthesia on a woman in labor. Both the woman and the baby survived.
Expedition Medicine’s UK Course Welcomes their University Liaison
With the sunshine out and the rasping sounds of the Search and Rescue Teams over the two-way radios out on the Cumbria hills – you would have been easily mistaken in thinking you were in the middle of a real emergency. In fact, it was the final Search and Rescue exercise (with CASEVAC) of a fantastic 4 day Expedition Medicine Course in Keswick in Cumbria.
As the University Liaison for Expedition Medicine, it was the first course that I attended as a new member of the ‘EM faculty’ – and what a fantastic experience it was. Not only did I get to absorb the electric atmosphere of the 60+ delegates there alongside the seasoned expedition medics leading the course but it gave me ample opportunity to see how such courses can align themselves with my role as University Liaison and to stimulate a few more ideas.
International Extreme Medicine EXPO- Expedition & Wilderness | Tactical | Disaster Medicine
‘Taking Medicine To The Extremes’
A major new International ‘World Extreme Medicine conference and EXPO’ series with the first inaugural event in London April 2012 followed by Salt Lake City in September 2012 with the very best speakers from around the world, leading figures from the world of expedition and wilderness travel, displays from focused industry leaders and also awards. All CME accredited on a modular basis to allow you select just a day or to attend the entire medical expo.
Over the last ten years the care of casualties in a remote environment has come a long way. This has been driven by conflict, the apparent exponential rise in natural disasters and our capacity to respond on an international scale and not least by the evolving interest in the field of expedition and wilderness medicine. The conference concept was generated out of a desire to amalgamate the associated specialties in this field and to share the skills and knowledge we have acquired. It will run over 4 days and involve some of the major specialists in their field of remote and austure medicine.
Developed specifically with medical professionals in mind the International ‘World Extreme Medicine EXPO’ will also be of interest to other medical specialists and students for which there will be a discounted rate.
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
Pre-hospital Expedition Medicine Series
Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar and HEMS paramedic Dave Marshall, both part of the Kent Helicopter Emergency Medical Team, continue their series examining pre-hospital expedition trauma care and associated kit.
In the second article in the series, Dave Marshall gives an overview of managing pelvic fractures pre-hospitally and in an expedition environment, and introduces the use of the pelvic splint.
Edited by Dr Amy Hughes.
Pre hospital and Expedition management of pelvic trauma and use of the pelvic splint
Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential. Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Pelvic Sam Splint is essential.
Mechanism of Injury
Pelvic fractures often result in extensive disruption of the bony structures and associated ligaments of the pelvis and are potentially life-threatening injuries. The fractures associated with the greatest morbidity and mortality involve significant forces such as motor vehicle crashes, motorcyclist crash, pedestrian versus car, falls from height and crush injuries. Early suspicion, identification and management of a pelvic fracture at the prehospital stage is essential to reduce the risk of death as a result of hypovolaemia, (1). It is especially important to be able to identify, treat and minimize risk of further damage when in a remote area miles from the nearest medical facility.
Understanding the mechanism of injury is vital in being able to predict the potential for significant injury to the pelvis and its underlying structures, even in the absence of clinical signs. It is, therefore, essential that time is taken to evaluate the mechanisms involved in any accident resulting from significant force or where there is pain or injury to the spine, abdomen, pelvis or femurs.
In motor vehicle accidents – a not uncommon event on expeditions – learning how to ‘read’ the wreckage to help identify possible pelvic injury, in conjunction with clinical suspicion, can significantly aid diagnoses.
The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis.
The intrusion into fuel tank shows the imprint of the riders pelvis. This would often result in significant fracture to the pelvis – often multiple, often ‘’open book’’ pelvis.
Anatomical structure of the pelvis
The pelvic ring is often likened to a polo mint in that it is almost impossible to have a significant break in one place and not another. The most common area to be damaged in trauma is the pubic rami, acetabulum and the sacroiliac joint. There is extensive vasculature through and around the pelvic ring, most notably the iliac vessels. For imagery see > http://visualsunlimited.photoshelter.com/image/I0000kUOn3NJHcZU.
The greatest risk of a pelvic fracture is catastrophic haemorrhage and gentle handling of the patient in the initial and subsequent stages could literally be the difference between life and death. Whole blood clotting time is approximately 10 minutes, (depending on the environment). Expedition medics should be familiar with the ‘first clot best clot’ theory. In other words, a patient sustaining a traumatic injury resulting in haemorrhage will begin to form a clot using their own clotting factors. If this clot is disrupted they could easily bleed to death. A full fluid resuscitation will not be practical in the field as most expeditions carry a maximum of 2 litres of crystaloid. However it should be noted that overloading the patient with fluid can be equally harmful, and small boluses should be given to maintain a central pulse and cerebral perfusion. This is known as permissive hypotension and will be discussed in more detail in a future article. Disruption of this first clot in the prehospital setting could be fatal, and without access to blood and clotting agents the patient may die. Trauma will result in the patient becoming acidotic, hypothermic, and coagulopathic. (3)
This coagulopathy cannot be easily reversed pre-hospitally, each factor contributes to the decline in the others. (see above diagram). Any disruption to the first clot will have devastating consequences. Ultimately, the patient requires definitive haemorrhage control, (surgery, angiography and embolisation), and replacement of blood and clotting agents.
The glass pelvis: Think of the pelvis as being made of very fragile glass, and you can see the clot in the form of a cartoon jelly inside. The jelly is very delicate and unless movement is gentle and kept to a minimum, it will ‘wobble’ to the point of destruction very easily. The same applies to the blood clot! Early recognition of the potential for a pelvic injury, gentle handling and prompt stabilisation is vital to improve the outcome of a patient injured on an expedition.
Clinical Features of a pelvic injury:
- Management of pelvic fractures and clot preservation:
Asymmetry of the pelvis – do not spring the pelvis. Visual alignment and gentle palpation of the Anterior Superior Iliac Spine may help demonstrate pelvic injury, but often the pelvis visually appears normal, thus mechanism of injury is vital in determining injury
- Shortening/rotation of the leg/s
- Inguinal pain
- Localised swelling/contusion
- Hematuria/urinary incontinence
- Bleeding PR/PV – PR examination not recommended to determine pelvic injury.
- MECHANISM, MECHANISM, MECHANISM! (albeit not a clinical feature!) – there may be no obvious clinical abnormality despite significant injury. Thus clinical suspicion is essential.
As we have already discussed, a patient with a suspected pelvic fracture must be handled very carefully. Whether in a medical facility or the most extreme expedition environment, the same principles apply to prevent worsening the injury and preserving the clot.
Log rolling the patient should be avoided at all costs!
The medical kit available on expeditions will be minimal. Stretchers may have to be improvised and transportation limited. However, all medical kits should have some sort of pelvic binder which should be applied carefully and correctly at the earliest opportunity,
Application of the pelvic SAM splint.
The casualty will inevitably have to be placed in the supine position, to evacuate them on whichever device is available. This can be achieved by a coordinated team approach utilising other members of the expedition.
One person should be at the head end of the patient maintaining in manual inline immobilisation, (MILS), and they will give clear commands to the team when moving the casualty, (“ready, brace, roll”). A pelvic binder such as the one shown can be applied using a minimal 10-15% roll, (enough to get a bum cheek off the ground!)
Once in position the device can be tightened just enough to maintain anatomical alignment. Do not over tighten as this could cause significant further damage!
Log rolling patients.
Whilst sometimes useful in a controlled hospital environment following appropriate imaging, should be avoided in the pre hospital field. In simple risk versus benefit terms it could have catastrophic consequences. By using the hands available and correctly briefing the team about the amount of movement required (one cheek off!), it should be possible to optimise the care of the casualty prior to evacuating them to definitive care.
Improvised methods of pelvic splinting on expeditions
Much of the challenge of expedition medicine is improvisation. The medical kit you take out with you may not have SAM splints in them. Providing a support can be placed across the greater trochanter, then any sort of material could be used – for example clothing, a sheet, or a canvass of some kind.
The approach to fluid management in trauma has changed. Two litres of fluid is not necessarily required for management of pelvic injury. Titrate fluid according to the presence of pulses or cerebration (alertness). The presence of a radial pulse, and even in certain circumstances (without associated head injury) presence of a femoral pulse signifies the blood pressure is sufficient to perfuse the necessary organs and promote clot preservation. Further details of permissive hypotension will follow in another article.
Essential – this depends on what is available. Intravenous opiates or a fentanyl lolly is ideal for analgesia, after the use of paracetamol or a NSAID.
Pelvic injuries are often present in conjunction with other significant injuries – spinal, femur, urological or abdominal as examples. Whether or not other injuries have been excluded, spinal precautions are essential in conjunction with good management of the pelvis.
- Lee C, Porter K. The prehospital management of pelvic fractures, Emergency Medical Journal 2007;24:130-133
- Maya A, Matinowitz U, Kluger Y. Coagulopathy in the critically injured patient, Yearbook of Intensive Care and Emergency Medicine 2006, Part 5,232-243
- Crawford C, Pelvic Fracture in Emergency Medicine, available at: http://emedicine.medscape.com/article/825869-overview
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.
Medical and Dental Defence Union of Scotland (MDDUS) took the opportunity in one of the quieter periods in Expedition and Wilderness Medicines Medical Director Amy Hughes hectic schedule to interview her about her career in expedition medicine.
MDDUS (Medical and Dental Defence Union of Scotland) is an independent mutual organisation offering expert medico-legal advice, dento-legal advice and professional indemnity for doctors, dentists and other healthcare professionals throughout the UK.