Dr Ian Norton, Head of WHO’s medical team in West Africa tackling Ebola
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Dr Ian Norton, Head of WHO's medical team in West Africa tackling Ebola
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Conservation Research Organisation Requires Medics
Operation Wallacea undertakes biodiversity monitoring and conservation research expeditions in countries across the tropical and sub-tropical regions of the world. We need medics urgently for 2-8week contracts on a variety of expeditions including: Madagascar, Honduras and Mexico.
Many of our projects are in developing countries where medical facilities are poor, and we are generally based in remote areas, so we rely on the help of volunteer medics to join our teams and provide medical support for the staff and students on site. Accommodation, meals and a travel bursary (which varies in size depending on how long you are available for) will be provided.
Being a medic on expedition generally involves giving health and safety briefings to incoming participants, providing a daily clinic session and being available for emergencies at other times.
You are free to join the research projects for most of the time, as long as you remain within a reasonable distance of the camp at which you are based so it is a great opportunity to get out and involved in research and conservation in some truly amazing locations.
If this sounds like it may be of interest and you are free from two to eight weeks between June and August then please send a copy of your resume to Caroline Acton at [email protected]
Medical links of interest
Pre-Hospital Care Workshop with London Air Ambulance
New Vacancy: Now’s your chance to go to Lesotho
Fantastic short term opportunity in Lesotho: 12th – 28th July, 2014 Doctor required to join Connecting Communities Worldwide and a team of scouts on a sustainability project.
Adventurous doctor required to join 15 scouts in a magnificent, remote environment engaging with local communities, working on a variety of inspiring, sustainable development programmes.We begin with a visit to Cape Town | Table Mountain | Cape of Good Hope | Robben Island and departs via Johannesburg, with life changing wild life experiences along the way. Fully stocked med-kit and satellite phone provided.
Contact KEN DUNN at Connecting Communities Worldwide for more info:
E: kdunn”AT”ccwltd.org
T: 01709 717 111
M: 0752 852 9766
CCW Ltd is a not-for-project organisation so the successful applicant will need to cover their own flights and contribute towards costs (£500)
Expedition & Wilderness Medicine is the leading provider of training for medics working in remote and austere environments.
New Vacancy: Now's your chance to go to Lesotho
Fantastic short term opportunity in Lesotho: 12th – 28th July, 2014 Doctor required to join Connecting Communities Worldwide and a team of scouts on a sustainability project.
Adventurous doctor required to join 15 scouts in a magnificent, remote environment engaging with local communities, working on a variety of inspiring, sustainable development programmes.We begin with a visit to Cape Town | Table Mountain | Cape of Good Hope | Robben Island and departs via Johannesburg, with life changing wild life experiences along the way. Fully stocked med-kit and satellite phone provided.
Contact KEN DUNN at Connecting Communities Worldwide for more info:
E: kdunn”AT”ccwltd.org
T: 01709 717 111
M: 0752 852 9766
CCW Ltd is a not-for-project organisation so the successful applicant will need to cover their own flights and contribute towards costs (£500)
Expedition & Wilderness Medicine is the leading provider of training for medics working in remote and austere environments.
EWM’s Wild Medicine Course Changed our Lives
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 &
villagers?
– 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.
Other courses of interest:
Remote Medicine
Extreme Medicine Conference
This years Wild Medicine Course
EWM's Wild Medicine Course Changed our Lives
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 &
villagers?
– 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.
Other courses of interest:
Remote Medicine
Extreme Medicine Conference
This years Wild Medicine Course
NEEDED: Medical Professionals to support Fundraising Marathon (May 2014)
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.
For more information, photos and videos please look at www.sierraleonemarathon.com and www.facebook.com/sierraleonemarathon.
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.
Courses of Interest
Wilderness Conservation and Desert Medicine course dates now online
Wild Medicine’ – a Conservation Medicine Conference | Namibia 46 CME
09 November 2014 to 21 November 2014
suitable for medical and veterinary professionals
One of most unique courses combining elements from our very successful desert medicine course with a expanded zoonosis section and venturing deep into Bushman Land in northern Namibia. A unique educational course capturing three distinct but overlapping areas of remote and wilderness medicine in one of the world’s most spectacular regions. Conservation medicine focuses on the inter relationships of human health, animal health and the health of the environment.
The most important objective of the course is to educate attendees on how we can integrate the diagnostic and problem solving skills of both human and animal health professional with the knowledge of conservation professionals to ultimately 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 but 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. The term conservation medicine was first used in the mid-1990s, and represents a significant paradigm shift in both medicine and environmentalism. While the hands-on process in individual cases is complicated, the underlying concept of interrelationships is quite intuitive, namely, that all things are related. The threat of zoonotic diseases—cross-species diseases that travel to humans from other animals—is central.
Traditional procedural approaches to disease transmission investigate the relationship between human and the environment, both physical and societal, as a exception rather than the rule and the inter-specialist nature of Conservation Medicine provides a hope for significant understanding of the manner in which transmission takes place. In considering the relationship between nature and human health as a dynamic system the study of conservation medicine has the ability to provide fair greater understanding of complex medical source issues putting the issue firmly in the public domain and off public interest. For instance, global warming may have vaguely defined long-term impacts, but when an immediate effect is a relatively slight rise in air temperature, which in turn raises the flight ceiling for temperature-sensitive mosquitoes, allowing them to infect higher flying migratory birds, which in turn carry a disease from one country or continent to another, the issue becomes more real.
Specific focus is placed on aspects such as:
• Human wildlife conflict
• Emerging technology to reduce human wildlife conflict
• The role of habitat destruction on the emergence of zoonotic diseases
• Specific animal diseases and wildlife anaesthesia
• Specific human diseases (zoonoses) and treatment thereof
Expedition & Wilderness Medicine – Course Accreditation
In association with the Wilderness Medical Society we are able to offer the ability to earn credits towards the Wilderness Medicine Fellowship Program to gain the FAWM qualification.
“This activity has been planned and implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Wilderness Medical Society and Across the Divide Expeditions. The Wilderness Medical Society is accredited by the ACCME to provide continuing medical education for physicians. The Wilderness Medical Society designates this educational activity for a maximum of 46 CME AMA PRA Category 1 Credits TM. Each physician should only claim credit commensurate with the extent of their participation in the activity.’
Other courses of interest
- Expedition Medicine – UK & Australia
- Mountain Medicine – Nepal
- Extreme Medicine Conference – Royal Society of Medicine, London
Latest Dispatches from Kenya with EWM Medic Matt Edwards
Adventures with AMREF Flying Doctors
The Calm Before the Storm – Part 1
Matt Edwards Blog working in remote medicine
The past week at AMREF has been one of strange contrasts. There were no flights at all for three days and it was making the staff twitchy. It just doesn’t feel right to have nothing going on. In actual fact there was quite a bit going on 
at AMREF FD headquarters, just no flying. We had the official launch of the new Beechcraft King Air air ambulance on Monday. It was an impressive event with the dignitaries and guests sitting in the hanger alongside the beautiful new plane. Proudly I watched as my film was being shown on repeat in the background. Dr Bettina Vadera, a representative from AMREF and the visiting MP all made speeches with a compare from Nairobi radio. She did a fantastic job of helping market the Maisha cover plan which is new insurance policy which is affordable to a large proportion of Kenyans and they then can get rescued from wherever they are in East Africa. But after the banners and tables were cleared we sat around twiddling our thumbs for the rest of Monday and then Tuesday. Then suddenly on Wednesday morning, we had three medevac flights come in simultaneously. During the next two days AMREF FD would take on 9 flights, many of them extremely sick patients.
at AMREF FD headquarters, just no flying. We had the official launch of the new Beechcraft King Air air ambulance on Monday. It was an impressive event with the dignitaries and guests sitting in the hanger alongside the beautiful new plane. Proudly I watched as my film was being shown on repeat in the background. Dr Bettina Vadera, a representative from AMREF and the visiting MP all made speeches with a compare from Nairobi radio. She did a fantastic job of helping market the Maisha cover plan which is new insurance policy which is affordable to a large proportion of Kenyans and they then can get rescued from wherever they are in East Africa. But after the banners and tables were cleared we sat around twiddling our thumbs for the rest of Monday and then Tuesday. Then suddenly on Wednesday morning, we had three medevac flights come in simultaneously. During the next two days AMREF FD would take on 9 flights, many of them extremely sick patients.As I entered the office I was directed to the waiting caravan plane to do our checks as we had to fly out to Lewa where an 8 year old girl had fallen from her horse and was unconscious. There really is nothing like paediatric trauma to brush off the morning cobwebs. Far more effective than coffee. As I was busy agonising over whether I should be using the (A+4)x2 or the (Ax3)+7 calculation for her weight and the plane was about to start off, we were suddenly stood down. The girl was being brought straight to Wilson in a small plane with the parents and I was needed on another urgent flight into Tanzania. But we had to stay on site to receive the little girl from Lewa at Wilson to resuscitate as required and pop her in our ambulance to take her straight to hospital.
One of our locum doctors was on his way in to help out but was a little way off in the infamous Nairobi traffic. The tiny Cessna plane arrived from Lewa and taxied to us. The little girl had improved on the journey and was now wriggling away from stimulus. It was a good sign; lots of little kids respond like that after a significant head injury. I see mostly insignificant head injuries in children back home, and often I have to physically catch them from the play-area in the waiting room to assess them. We packaged her up while calming the parents and sent her off to the hospital for a scan of her head to exclude a neurosurgical issue. I am told she awoke fully on the way to the hospital and is doing fine.
So as we popped her in the ambulance the King Air was brought around and had been loaded ready for us to head into Tanzania. A young girl of 15 had been involved in a nasty car accident and was critically ill. She had been unrestrained in the back seat of her father’s car as they hit a pot hole, breaking the axel and the car rolled several times. The father was fine but his daughter had been ejected though the front window and was lay unconscious on the road. Once they got to the local hospital, we were contacted. As far as they could tell she only had a head injury (always a dangerous assumption) and she was still unconscious. All they could do was wait for us and give her strong medication to suck fluid out of the cells in her brain and halt the swelling going on inside.
It took about an hour to get to this gold-mining town in Kahama, Tanzania and on the way, while being bumped around by the thermals coming off the baked ground, we did our standard checks and discussed our plan. Given that we were expecting to be escorted to the patients bedside, we thought we would have a little time to assess and plan in the relatively safe and sheltered environment of the hospital. As we taxied around at the dusty runway, I noticed an ambulance sitting just outside the gates on the other side of the airstrip. I wandered off in the baking heat to have a pee (I am always totally convinced I am going to get bitten by a snake when I do this) and Kisito the flight nurse explained to the airstrip’s official that the ambulance needed clearance to enter. It seems no matter where you go in the world you will find irritating ‘jobsworths’. It’s just that in Africa they tend to back up their obstinate behaviour with an AK-47. Kisito gave up and beckoned the ambulance to bring some people to help us hump the equipment the 500m over to the gate. I lifted a few pieces of equipment out of the aircraft and then noticed he had started running towards them.
It took me a little while to work out what the problem was through the heat haze. Then I could make out a little group of people hurriedly carrying a small body on a stretcher. ‘Oh bugg*r’ I thought and quickly followed Kisito.
A rapid sequence induction on a critical patient in the pre-hospital environment can be one of the most stressful situations you can encounter as a doctor. But it needs to be calm, clear and systematic with good communication between the intubator and the assistant. So many things can go wrong; the powerful drugs you use to render the patient amnesic and unaware of the whole process, to reduce the stress response to having the breathing tube put down their throat and to paralyse their muscles, can easily put them into cardiac arrest. And if you can’t get the tube down and can’t breathe for them then they will asphyxiate. In a critically ill patient the time you have to get a breath into the patient can be only seconds before the oxygen in their blood is used up. The pre-hospital environment makes this procedure even more difficult especially in injured patients with potentially broken necks, damaged lungs and occult internal blood loss.
From one look at this girl, you did not need to be a doctor to see she was in a bad way. She was unresponsive with a partially obstructed airway, breathing extremely fast with a pulse rate of 170. Her blood pressure was actually slightly elevated, as young people often do before it starts dropping. Her head was bandaged and she had signs of a facial fracture. Kisito and I did not need to spend long deciding what we needed to do. In the shade under the wing of the aircraft we beavered about. Soon Kisito had established a large IV line and was getting one of the crowd (of course there was a crowd) to squeeze a bag of fluid into her, while I drew up the necessary drugs. Soon we had her assessed, oxygenated and her pulse rate was sensible. I was prepared for it all going horribly wrong but the tube passed simply and she did not respond adversely to the medication. We continued to optimise her chances of neurological recovery as best we could on our way back to Nairobi but I’m afraid the prognosis for such injuries is not very good.
Just as we were handing over in Nairobi we were instructed to return urgently as we were needed in Kisumu next to Lake Victoria. A normally sprightly elderly man had had a heart attack the day before and was not doing well. We had had a non-urgent enquiry about a transfer for him to have cardiac catheterisation earlier in the day. The clot busting and cardiac support drugs he had been given had seemed to be working. But then as his heart started to fail and the pressure started backing up, he had started to drown in his own fluid. This is not an uncommon occurrence for us in the emergency department and we deal with ‘crashing pulmonary oedema’ pretty regularly. Nitrates and ‘non-invasive assisted ventilation’ works pretty well. Obviously this was not available in Kisumu hospital. They also couldn’t do an echocardiogram because the machine is owned by one of the other physicians and apparently it can only be used on his patients.
Our radio room informed us that the patient was deteriorating and we needed to get a move on.
Unfortunately the relatives could only afford a flight with our caravan. We could have been there in 20 minutes in a jet. Two hours and a bumpy road journey later we were at the patient’s side to discover the doctors had intubated him despite the advice of the guys in the radio-room. They had intubated and sedated him but had no capacity to give him positive pressure ventilation. So he was basically in a worse state than if he had been left to his own devices. He was sedated, driving down his own appropriate urge to breathe rapidly and the tube was merely providing an extra long windpipe, like a rather thin snorkel, just making the work of breathing more difficult with the froth from his chest bubbling out the end periodically. I’ve never seen this done to a patient before. Without the benefit of assisted ventilation I simply don’t understand what they were hoping to achieve.
For the second time in the day Kisito and I exchanged glances, sighed and got to work. Thirty minutes later we had this chap settled on the vent and his chest was already improving. We had to contend with his heart doing some weird things as we ascended but with a little tweaking and strong cardiac drugs we had them solved by the time we handed him over back in Nairobi to go have his angiogram.
As I settled down to a well-earned sleep that night, little did I know that, across the other side of the country, something terrible had just happened. The storm was about to get worse…
Stay tuned for the next signal….
About; AMREF’s vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty. We believe in the inherent power within African communities – that the power for lasting transformation of Africa’s health lies within its communities.
Interested in working in remote medicine? Courses of interest
EWM Facualty Dr Matt Edwards report on his day hob with AMREF
Dr Matt Edwards, part of the Expedition & Wilderness Medicine’s faculty team has taken up a post with AMREF Flying Doctors based in Kenya see Matts Blog in full….
Having recovered from travelling the length and breadth of the the continent last week, I’ve been doing a few shorter retrievals into the wild expanses of Kenya’s neighbor to the south – Tanzania. I’ve done a few medevacs from there in the last month but haven’t written much about it. But as I seemed to be spending more and more time buzzing around it’s vast landscapes in the co-pilot seat of a Cessna caravan, I thought I’d expand on my experiences there.
I was first called out to a young man stuck in the middle of the game reserve of Katavi, the other side of Tanzania and close to Lake Tanganyika, with resistant malaria. Now if I’ve learnt to respect one thing out here it’s malaria. I suppose I am exposed to a pretty severe case-mix to be fair. If the local treatment isn’t working or they are in a collapsed state we get involved. Some of these guys are impressively sick and I suppose, now I reflect on it, I think what is actually affecting me about this is the number of young people with critical illness I’m seeing on this placement. Working in the UK I’m so used to critically unwell elderly patients but I’ve just not been asked to manage many elderly patients here. Well apart from the minister in Musoma and the jogging octogenarian rose farmer who had broken his hip in Kampala but they don’t count as really ill. They could both beat your average middle aged Brit in a race, even with a fractured neck of femur.
I was lucky enough to be allowed to sit in the co-pilot seat for the trip there. It was a long journey in the caravan but you simply couldn’t get bored with that view. We flew past the famous Ngorongoro crater into the wide open plains of the Serengeti. I was told on the way that the crater is an incredible, almost ‘locked-in’ ecosystem of a huge variety of animals. Even though Sir Arthur Conan Doyle’s Lost World was based in South America, it’s tempting to believe the crater could have been an inspiration for the tale. It is truly vast and few animals, especially the lions, seem to see the need to cross the rim. As we made our way into the Serengeti plains I could not stop humming Toto’s rock ballad ‘Africa’ – it drove me mad.
My second mission over the weekend was to attend to an unfortunate gentleman tourist who had collapsed and had had a ‘cardiac arrest’ with ROSC (Return Of Spontaneous Circulation) while at a remote retreat in Grumeti, just over the Kenyan border and within the Serengeti Park. Again you don’t need to be a doctor to realise that having a cardiac arrest in a place like that is likely to have a poor outcome. I’ve heard of AMREF arriving to a situation in which the poor bystanders have been doing CPR for a few hours, only to tell them that any continuation would be futile. However if someone gets a pulse back after a short period of basic life support in the field then we could really do some good with post-arrest care (if we get there quickly enough).We had to fly fairly high over the Serengeti National Park and so any animals were tiny specks down on the ground but you could see the impressive migration trails made by the herds. From above you could get a scale of how many thousands of these beasts must march along these tracks every year. It must be incredible to see. I wonder if somehow I will get a chance. It can be put on my ‘bucket list’ for the future if not.
Soon we were landing in Tabora for a fuel stop and then continued south west towards Lake Tanganyika. The landscape became relatively featureless and it reminded me of flying in Antarctica. The huge marshlands of the Katavi National Park came into view – the home of a huge number of hippos and billions of bloody tsetse flies unfortunately. At least when you went to see Antarctic wildlife you didn’t have to cope with their irritating, disease-spreading, insect entourage.
We managed to find the secluded airstrip and did a dummy run to clear it of about five impala. No wonder cheetahs struggle to catch those things – they move incredibly fast. At most of the Tanzanian airstrips we have to get rid of a number of large animals standing in the way. Not something most pilots normally need to worry about. There are certain interesting considerations to this animal clearing such as; if you are going to land between two herd animals, bail out and climb. If it is just one, it will run away so you can land. The instinct to herd is so strong when they are threatened, that they will run together. So if the plane is landing between them, the likelihood is that one of them will run into the path of the plane and that would be sub-optimal for a landing.
Our patient was not too bad so was quickly popped into the plane and connected up to some fluids etc. I am told he has been treated for recurrent malaria and is recovering well.
This was a shorter journey and the route was thronged with wildebeest (with a couple happily grazing on the airstrip). When we arrived on the beautifully secluded airstrip we found our patient, who was alive, cheerful and looked pretty chipper! We examined the circumstances surrounding this cardiac arrest and it was very short, while he was witnessed drifting off to sleep. It is possible that someone’s heart can stop due to an abnormal heart rhythm briefly and then it reverts to normal when someone starts thumping on their chest. It’s possible. If that was the case, then he is one lucky guy. For our years and years of research into the outcomes of out-of-hospital cardiac arrest, we know that the only people who have a reasonable chance of walking out of hospital with an intact brain are those who are witnessed to collapse and have good early bystander CPR. Just look at the survival outcomes they acheived in Las Vegas! (Valenzuela, NEJM 2000) The situation is slightly different in the middle of the Serengeti I’m afraid. There are many different explanations to what happened to this chap, including the fact he might have just been asleep, but the key fact was that someone was at his side and and started life saving actions immediately. I can only hope that, in the event of a sudden collapse for myself or my loved ones, someone close-by acts as promptly.
Who are AMREF?
In 1956, three doctors – Michael Wood, Archibald McIndoe and Tom Rees – drew up a groundbreaking plan to provide medical assistance to remote regions of East Africa, where they had all worked for many years as reconstructive surgeons.
Spurred by what they had seen of the combined effects of poverty, tropical disease and a lack of adequate health services in East Africa, their collective vision was born in the foothills Mt Kilimanjaro.
At that time, there was one doctor to every 30,000 people in East Africa – in Britain it was 1:1,000. Medical facilities were sparse, with rough terrain and often impassable roads making access to medical care difficult for people in rural and remote areas. As this was where the majority of the population lived, Archie, Tom and Michael saw an air-based service as the only way to get health care to remote communities.
AMREF Flying Doctors provides air evacuation services in medical emergencies across East Africa, as well as air ambulance transfers between medical facilities.
We are Africa’s leading provider of air ambulance services and operate across many East African countries including Uganda, Kenya and Tanzania and, when clearance can be obtained, most neighbouring countries including the Democratic Republic of Congo, Eritrea, Somalia, Ethiopia, Rwanda and Burundi. Subject to flight clearances, AMREF Flying Doctors will carry out evacuations from anywhere on the African continent.
In addition, patients can be repatriated via an AMREF Flying Doctors aircraft to Europe, Asia and North America or a medical escort can be provided on commercial carriers. AMREF Flying Doctors operates 24 hours a day, 365 days a year. As a vital link between remote areas and AMREF’s Control Centre at Wilson Airport in Nairobi, AMREF has established a radio network that comprises over 100 HF radio stations across East Africa, making it the largest two-way radio network in Africa.
As well as emergency evacuations, AMREF Flying Doctors provides a medial outreach programme, taking essential health care to some of the most impoverished and remote areas of Africa. AMREF Flying Doctors, part of the African Medical and Research Foundation, is based in Nairobi, Kenya and has been delivering health care to some of the most remote areas of east Africa since its formation in 1957 by Sir Michael Wood.
AMREF Flying Doctors is committed to providing world-class medical services to the people of Africa.
Of interest
Working and Living in Namibia as Medic – EWM Alumni reports back…
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!
Working and Living in Namibia as a medic…
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!
Find out more about the Lifeline Clinic
Sarah McMurtrie
Of interest
Expedition Medicine medics involved with UNICEF challenges
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.
Wilderness Medical Society approves Desert Medicine course in Namibia for 20.5 CME
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.
The Life-Line Clinic, Namibia | Job Oppurtunity
Namibia Medical volunteer
This challenging programme offers you a unique opportunity to work at a small, rural Bushman clinic in Africa and make a difference to the lives of those in most need.
N/a’an ku sê is a unique and special place in the heart of Namibia which is committed to conserving wildlife and improving the lives of the Bushman community. Live your African dream and help make a difference by volunteering at our Lifeline Clinic.
About N/a’an ku sê’s Lifeline Clinic
• Bushman are treated as third class citizens and live in extreme poverty
• Adult onset diabetes, cardiovascular disease and cancer are sharply increasing in Bushmen and alcoholism has become prevalent
• Many Bushman children suffer from malnutrition, disease, discrimination and abuse
The N/a’an ku sê Lifeline Clinic was set up in 2003 to address the needs of the rural indigenous communities in Epukiro, a remote part of Namibia. The demand for a basic but comprehensive health service became apparent to medical professionals working in the area when they witnessed the tragic and unnecessary death of a young child due to the failure of ambulance service and hospital staff, largely due to the fact that the child was a Bushman. This vital service relies upon the time and dedication of volunteers and donations from supporters to continue to run and serve the communities in need.
The Life-Line Clinic, Namibia | Job Oppurtunity
Namibia Medical volunteer
This challenging programme offers you a unique opportunity to work at a small, rural Bushman clinic in Africa and make a difference to the lives of those in most need.
N/a’an ku sê is a unique and special place in the heart of Namibia which is committed to conserving wildlife and improving the lives of the Bushman community. Live your African dream and help make a difference by volunteering at our Lifeline Clinic.
About N/a’an ku sê’s Lifeline Clinic
• Bushman are treated as third class citizens and live in extreme poverty
• Adult onset diabetes, cardiovascular disease and cancer are sharply increasing in Bushmen and alcoholism has become prevalent
• Many Bushman children suffer from malnutrition, disease, discrimination and abuse
The N/a’an ku sê Lifeline Clinic was set up in 2003 to address the needs of the rural indigenous communities in Epukiro, a remote part of Namibia. The demand for a basic but comprehensive health service became apparent to medical professionals working in the area when they witnessed the tragic and unnecessary death of a young child due to the failure of ambulance service and hospital staff, largely due to the fact that the child was a Bushman. This vital service relies upon the time and dedication of volunteers and donations from supporters to continue to run and serve the communities in need.
Heat related injuries in extreme desert conditions
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
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.
Off road vechicle safety by our offroad guru in Namibia Faan Oesthuizen
Expedition and Wilderness Medicine recently ran it first highly succesful Desert Medicine course in Namibia and it was highlighted on the course that one of biggest dangers facing you in remote locations is actually the travel there and back in local transport.
Below Faan Oesthuizen of Kaurimbi Expeditions gives his top tips for defensive four wheel driving.
High lift jack demonstration
- Only place light bulky cargo on roof racks or high on vehicles in order to keep the centre of gravity as low as possible.
- Place heavy cargo low in vehicle load beds and as far as possible forward in order to distribute more weight onto the front wheels and avoid uncontrolably light steering response.
- Ensure that luggage is stowed where no damage to property may ensue.
- Ensure that all cargo is thoroughly secured in load bins or tied down to prevent loss of equipment and luggage while vehicle is moving or stationery.
- Driving on Gravel and Dirt Roads: It is of critical importance that a speed of 80 km per hour is never exceeded whilst driving on gravel or dirt roads. Speed will be further reduced when approaching curves or blind rises in the road, or when approaching oncoming traffic.
- Overtaking should be kept to a minimum whilst driving on gravel or dirt roads. Following distances will be kept sufficiently long as to ensure that driving in the front vehicle’s dust is avoided at all costs.
- Great care will be taken by all drivers to sufficiently reduce speed prior to entering bends or curves in the road, and that extreme control is maintained to prevent the vehicle from losing its traction whilst negotiating the bend.
- You should at all times ensure that you have as the absolute minimum 2 x 25 litre containers of water, a jack, spare tire, tow rope and jump leads
Desert Medicine training course Namibia
This has got to be one of the most superbly located medical training courses in the world. With a base camp in the shadow of the countries highest mountain – Burnt Mountain or Brandberg in a river valley frequented by desert elephants the training syllabus with explore this region as well as the plains in the foreground.
As well as the obvious training benefits we also hope to see the elusive desert adapted rhino and elephants, giraffes, oryx (gemsbok) as well as more common plains animals such as Thompson’s Gazelles, Ostriches and Hartman’s Mountain Zebras
The course is filling fast so to make sure you get a place email Luci Ridout or download a Desert Medicine course application form here.