Why I chose… Expedition medicine

Background

I qualified in 2000 and spent two years working in South Africa in a combination of peripheral hospitals and big trauma centres. In complete contrast to this my next job was as a medical SHO in the South West of the UK.

After six months of gastroenterology and six months of cardiology I wanted to travel again. I applied for a job with the British Antarctic Survey Medical Unit and was stationed mainly on South Georgia for 15 months. In addition I worked as ship’s doctor, spent some time down on the Antarctic continent at the British research station Halley, and spent several months on Bird Island in the Southern Ocean. When I returned to the UK – amazed at shopping centres, food aisles, fast moving traffic and bright lights (I’d mainly had penguins for company for almost two years), I started my GP training.

In 2006 I became a GP. This fitted very well with continuing to do expedition type work. At present I do one or two trips a year for a week to ten days as well as being a GP partner in a busy Devon surgery.

I don’t think that there is any one path into expedition medicine. Courses like ATLS are very useful, and a diploma in remote health care or mountain medicine is extremely helpful but nothing is a substitute for the experience gained from time spent working in a remote setting where the medical of care of the group is your sole responsibility.

Prior to work in the Antarctic I had four months of pre-deployment training in Plymouth, Derriford, in all aspects of single-handed remote health care. I learnt to administer an anaesthetic, to remove an appendix, to pull a tooth, to do a filling, to take and develop my own X-rays among other things.

I do on average two trips a year as an expedition medic. Each trip is about one or two weeks long.

I teach travel and expedition medicine to students from the local medical school. The other partners in the practice in which I work are tolerant of my trips and me reshuffling my workload to fit them in as they see the benefit in terms of student teaching.

A typical day involves…

There is no set schedule and each day is different however it is a common trend that every day starts early - often very early. Kilimanjaro summit night wake up call is at 11pm, after only a few hours of sleep. I’m not sure if that start should be described as ‘very late’, but that may give the wrong impression as it follows a full day of walking that finishes at 5pm.

I usually wake well before the group to ensure I’m ready first so I can deal with any problems that have arisen over night and can co-ordinate with the local guides the days schedule, obtain an update on weather conditions, and do a  general wake up call- at times several wake up calls are needed for the sleepier members of the group.

Once I know that the group is fit for the activities ahead, my job is dealing with any medical issues along the way. Much of the work is preventative and I need to remind the group to apply regular sun block, take anti-malarials, stay hydrated, use alcohol gel on hands etc. Some of the day is spent supporting the people at the back, and providing encouragement- in other words being a generally positive person.

And then there’s the rushing to the front and back again to ensure the group doesn’t get too spread out and is functioning as a unit. Much teamwork is involved, and I often find that the psychology of the group and group dynamics becomes one of the most interesting aspects of any trip.

I have generally found that the harder the challenge, the better the group bonds and ultimately (retrospectively mainly) the more the enjoyment of the group. We are short on and hardship, deprivation and the challenge of endurance and persistence in the face of physical suffering in our comfy lives and perhaps the benefits psychologically of surviving such a situation are underestimated in our health and safety conscious society.

Why this work?

Most people in this field are united by a love for the outdoors and travel. If your job is in healthcare then as a natural extension of this and with spending time outdoors it follows that you may become interested in caring for groups of people in this setting. At times it may be thrust upon you. You may be up a mountain on holiday and the group you are with knows that you are a doctor and therefore when someone is injured you are the first person they turn to. Being qualified to deal with emergencies in a remote setting suddenly becomes a necessity.

Advantages

I like the independence. Usually on an expedition I am the single-handed medic. If it is a smallish group (10-12 people) I act as the trip leader as well, co-ordinating the activities of the group with the local ground staff.

In a large group (say 20-30 people) there tends to be a doctor and a UK leader sent along as staff, and in a really large group (60) there are two doctors as well as a UK leader.

I will never forget a trip I had to Kilimanjaro with a group of 60 participants. With 24 hours to go the other doctor became ill. Frantically I texted everyone I could think of who may have the skills to work with me up the mountain, asking them to come along. The best response I got was, ‘Congratulations. You win the prize for most interesting text message I’ve received this year. Unfortunately with 24-hour notice I cannot leave for Kenya.’

This left me as sole medic for a week with an extremely large group at altitude, which was quite some challenge!

It’s a really unusual career. This is the bit where I mention my pet penguin. I had a pet penguin named Jack the Gent. He was a Gentoo penguin although it was by no means certain that he was a Jack and not a Jacqueline. (Its very difficult to tell the sex of a penguin). When I worked in the Antarctic, I found him being attacked by a Skua (a scavenging bird) as he had a broken leg and couldn’t escape in his weakened state. It was horrible to watch and so I unloaded my backpack into a friends backpack and carried him back to our base. I splinted his leg with a wooden tongue depressor and it healed well. Fortunately we had plenty of fish on base and Jack thrived. He retuned to his penguin colony after some time, but for a while he used to follow me around the base squawking at my heels between the base buildings.

Challenges

The work is obviously not for everyone. For those that like the outdoors and enjoy expedition type challenges it has most appeal. Many have expressed a desire to undertake similar work, but are uncertain of their abilities to cope in remote situations. The best example I have of a reaction is from one of the partners I work with. There was an opportunity to join me on one of the expeditions up a peak in the Atlas mountains, working with a small group, staying in tents and using mules to transport supplies. The older GP partner when asked if he would like to come along, replied that he would ‘rather work back to back after hours GP shifts over a bank holiday’ than be in a tent up a mountain!

Also, I don’t get enough sleep in this job!

Expedition medicine might not be suitable for me forever. I realize that for most of the expeditions I need to be physically fit, but as Ranulph Fiennes is planning on crossing the Antarctic age 68 I cant see why I wont be able to continue for many years to come.

But if I had to sum up the work in three words, they would be Challenging, Exhilarating and Inspiring: I would whole-hearted recommend it. To work on a successfully trip is an uplifting experience. For the group, it is often the hardest challenge they will face in their entire lives - climbing a particular mountain or cycling across a country. You are there to keep them safe and support them and often they will never forget you and the part you played.

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