Professor Craig Franklin joins the Extreme Medicine line up

Extreme Medicine London 2014

We are delighted to welcome Professor Craig Frankln to speakers lined up for the next Extreme Medicine Conference in London.

Extreme Medicine Conference

Extreme Medicine Conference

Craig Franklin Deputy Head of School, Professor in Zoology, School of Biological Sciences, The University of Queensland

Biologist and Professor of Zoology at The University of Queensland, Australia, Craig Franklin has been studying fish, sharks, frogs and reptiles for more than 25 years.

Craig acts as the Director of Research for the Steve Irwin Wildlife Reserve, chair of the Animal Section for the Society for Experimental Biology (London, UK) and an editor for the Journal of Experimental Biology (Cambridge, UK).

Examining how animals respond to environmental change and how they function within their environment has taken Craig on expeditions from the tropics to the poles.   Craig has published over 200 scientific articles, including papers in the prestigious journals Science, Nature, and Proceedings of the Royal Society.

The underlying emphasis and direction of Professor Franklin’s research deals with the flexibility and plasticity of physiological systems in organisms  especially in response to extreme conditions and environmental change.   He ask questions about how animals interact with their environment and takes an integrative approach, examining animal performance and then explores the physiological, biochemical and molecular changes and mechanisms that underlie the whole animal traits.

Professor Franklin, is a strong proponent of wildlife conservation and has a number of research projects assessing the impact of environmental change and human disturbance on threatened species.   He maintains a strong interest in highlighting the threats to the conservation of wildlife in Antarctica, which he covers in his book  “Antarctica Cruising Guide” AWA Press.    He has undertaken 10 research expeditions to Antarctica.

He has been awarded a number of prestigious prizes during his career, including being appointed as an Australian Professorial Fellow by the Australian Research Council; receiving an Honorary Doctorate from the University of Göteborg, Sweden; and receiving the President’s Medal from the Society for Experimental Biology, UK.   He is also acknowledged as an outstanding teacher, being a recipient of The University of Queensland Award for Excellence in Teaching and a finalist (twice) in the Australian Awards for University Teaching.

Extreme Medicine London 2014

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Latest course news from Expedition & Wilderness Medicine

Expedition Medicine
Expedition Medicine in Wales | Polar Medicine in New Zealand | Mountain Medicine in Nepal | Remote Medicine Jobs

Extreme Medicine 2014

Meet the world leaders in Pre Hospital Care, Disaster & Humanitarian and Remote Medicine at the Royal Society of Medicine in November.
Extreme Medicine website

Polar Medicine New Zealand

Next southern hemisphere course…Polar Medicine Course

20-25 July 2014

A Winter Extreme Climate Expedition Medicine Course in the South Island of New Zealand close to Wanaka and Queenstown – 6 days of Mountain and Polar Expedition Medicine. As featured in the Royal Australian College of General Practitioners magazineExpedition & Wilderness Medicine’s Polar Medical Skills Course in New Zealand is located on the slopes of the Southern Alps close to the adventure sports mecca of Queenstown. It is based upon the highly successful format developed for our northern Norway training course in the High Arctic, which routinely receives outstanding feedback from its delegates.

Book now …..

Everest Base Camp Mountain Medicine

8th – 25th October 2014

The ultimate mountain medicine course, the path of which follows the Everest Base Camp Trail up the Khumbu valley to base camp itself, situated in the shadow of the world’s most iconic peak.

The 2014 course is to be directed by Dr Martin Rhodes, DiMM instructor and Antarctic Logistics & Expeditions lead medic and Dr Rachel Anderson who is an Emergency Medicine registrar in the UK who has worked in the expedition environment in Nepal and Antarctica.

*A significant proportion of the profits from this expedition go towards supporting the work of Everest ER.

Book now …..

Mountain Medicine Nepal

Expedition Medicine in Wales

Coming next … Plas y Brenin Expedition Medicine Course

19th-22nd May 2014

The aim of the Expedition & Wilderness Medicine Course is to provide aspiring and experienced expedition doctors, nurses, paramedics and advanced medics with the skills and practical knowledge to become valuable members of an Expedition Medical Team.

82% rated the course as ‘excellent’, 16.3% as ‘very good’ and 1.7% as ‘good’

Book now …..

Working in Antarctica

Its not all about the medicine…

Civic Trusts awards the Halley VI Research Station is home to the British Antarctic Survey on the floating Brunt Ice Shelf, Antarctica prestigious award. Bedrooms, laboratories, office areas and energy centres are housed in standardised blue module.  Read more…

Join Paul Auerbach, on the next Wilderness Medicine conference in Antarctica with National Geographic & Lindblad Expeditions.   Book now…

Medic Jobs

Organisations rate EWM followers above other applicants so please do mention‘Expedition & Wilderness Medicine’ when applying.

Medics needed for Diabetes UK Channel Swim Relay See more here

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48 HOURS to go!

Extreme Medicine Conference WEM14 – London

Early Bird Discounts Sign up now!

Only available until the 1st of April this years Early Bird Tickets are now on sale;20% discount on all tickets – combine with a four day ticket to save 30%!

Use this code at checkout ‘EBird2014-20‘ – BOOK NOW!

- limited availability offer not combinable with other promotions.

- offer ends 1st April 2014

Extreme and Remote Medicine Conference London

See outline program here…

Extreme Medicine - its films

Extreme Medicine – the film!

See what all the fuss is about for yourself…

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 Who should attend?

Dr Gareth Grier of London Air Ambulance gives his view..    See here

 

Extreme Medicine Conference

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Marine Medicine focus

 Dive and Marine Medicine Focus

#BlueVentures

Diving Medicine with Blue Ventures in Belize
Galápagos Islands with National Geographic
Remote Medicine Jobs

Galápagos Islands CME Medical Conference

25 September - 4 October 2015

Join us aboard the National Geographic Endeavour, our expedition ship for a CME accredited medical conference.

Explore this amazing UNESCO listed region in the company of some of the world’s most knowledgeable experts and follow in the footsteps of Darwin.

EXPEDITION HIGHLIGHTS
Experience a place where animals live without fear of humans.
Enjoy close encounters with giant tortoises, sea lions, marine and land iguanas and Darwin’s finches.
Travel with a Lindblad Expeditions – National Geographic certified Photo Instructor.

Book now …..

Expedition Dentistry feature…

Expedition Dentistry for Wilderness Medics (Langdana, Edwards)

Burjor Langdana, Dental Surgeon at the British Antarctic Survey Medical Unit and Matt Edwards, Expedition Doctor an both are part of the Expedition & Wilderness Faculty

Read their feature here….

Belize Diving & Marine Medicine Course

02 – 07 November 2014

In partnership with award winning Marine Conservation Charity Blue VenturesThe aim of the Expedition & Wilderness Medicine Course is to provide aspiring and experienced expedition doctors, nurses, paramedics and advanced medics with the skills and practical knowledge to become valuable members of an Expedition Medical Team.

The 2014 Dive Medicine course will be held in Belize  and includes diving on the remarkable UNESCO listed ‘Blue Hole’ and is based, according to TripAdvisor, onone of the world’s best islands Ambergris Caye.

Book now …..

Medic Jobs

Organisations rate EWM followers above other applicants so please do mention‘Expedition & Wilderness Medicine’ when applying.

Rural GP posts in Canada Head Medical are recruiting for three amazing posts See more here
Senior Expedition Medic Iceland (21 Jul – 11 Aug 2014). Voluntary position but all UK expenses paid. Email CV to Zara: programmes@britishexploring.org or call 02075 913141.
Medics needed by Action Challenge See more here
Doctor required for 17 day rafting expedition to the Subansiri River November 2014. Email Col John Blashford-Snell: jbs@ses-explore.org.

Thank you for reading our news!

We are really looking forward to welcoming you back and seeing you again

Best wishes Mark Hannaford, Dr Amy Hughes and Dr Sean Hudson

Email mark@expedition-medicine.com or
Call us on +44 (0)1297 20583

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Action Challenge is looking for expedition doctors

Expedition Doctors jobsAction Challenge is looking for expedition doctors to join them on their international challenges for 2014, 2015 and beyond

Where:  International expeditions including Kilimanjaro

Dates: 2014, 2015 and beyond

Experience and Level of training required:   Fully qualified Doctor of medicine – Altitude experience and courses in expedition medicine are preferred requirements but not essential

Great interpersonal skills and a positive attitude are essential!

Contact details email & phone: +44 (0)207 6096695

Register here  https://regonline.activeeurope.com/Register/Checkin.aspx?EventID=1511330

Julian Carnall – International Operations Manager

About Action Challenge

Action Challenge organises high quality challenges, trips and adventures for individuals to join our groups, and bespoke events for charities, companies, private groups & schools. What makes all our challenges truly unique is the way we encourage our groups to bond together as teams – and take on the challenge in front of them!  As the saying goes, it’s through adversity that people come together; and in addition to the natural camaraderie that comes with a shared adventure, we actively involve people in the way the challenge unfolds. We believe that through great organisation and a good relationship with our clients, the more we are out of the limelight; the more members of the group get to shine.

 

Wilderness Medics needed

 

 

 

 

 

Courses of interest

Expedition Medicine courses

Mountain Medicine expeditions

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Expedition Dentistry for Medics

Expedition Medicine Faculty members Burjor Langdana and Matt Edwards

Expedition Dentistry for Wilderness Medics (Langdana, Edwards)

Burjor Langdana, Dental Surgeon at the British Antarctic Survey Medical Unit and Matt Edwards, Expedition Doctor an both are part of the Expedition & Wilderness Faculty.

Dental problems are common on expeditions and anxiety provoking for the lone practitioner. This is generally because there is a lack of exposure to dental presentations and procedures in clinical practice. Patients, on the whole, go to dentists if they have a dental issue. Doctors employed for prolonged remote placements, e.g. the British Antarctic Survey, undergo formalised dental training prior to deployment. Luckily dental issues on expeditions can be made very simple for the non-dental practitioner and the purpose of this article is to help create a framework to help you decide what you can deal with, what you cannot, what kit to take and the relative urgency of any medevacs that may be required.

Consider this scenario: it is the end of day four of your expedition. Your team has just reached base camp. A team member complains of throbbing pain in his mouth. You are all exhausted and dental problems are a little out of your comfort zone. The questions you should be asking at this stage are:

1) Why did this happen?

Dental problems are common on expeditions. Diets change with increase in amount and, most importantly, frequency of sugar intake. Participants often have dry mouths with increased respiratory rate and inadequate fluid intake. Oral hygiene often becomes a secondary consideration when people are tired. There may be exposure to extreme cold (or heat) so teeth sensitivity becomes a major issue. Finally, teeth may be subject to trauma e.g. frozen chocolate is a common culprit.

2) Could this have been prevented?

Prevention is certainly possible for the vast majority of dental issues. Often pre-existing problems suddenly get worse due to the environmental stressors, and remember, this can happen to you as well.

Three months before the expedition: advise a proactive dental check up with chartings and necessary radiographs. Follow this up one month later and request dental chartings.

In your pre-expedition briefing, reinforce:

  1. Twice a day 2 minute brushing
  2. Flossing
  3. To spit out excess toothpaste, not rinse it out

Finally, when you are on expedition, for those with any known sensitivity advise Anti-Sensitivity Toothpastes (Sensodyne,Colgate, OralB).

What questions help you in the history?

As in medicine, if you suspect a dental problem, first take a history including:

Previous dental history / Hopefully you will know this already

Location / Teeth or gums? Can he localise it at all?

Sensitivity / To what? Does it disappear immediately when stimulus removed or persists for a few minutes or longer?

Character / Is it constant or throbbing ache? Can biting down help localise the correct tooth?

Performing an examination

Next, examine the patient.

Lighting / During the day, position the patient facing the sun and leaning against a good back rest. At night, use a head torch within a closed tent. Bugs rarely help dental examinations.

Positioning / Make life easy and comfortable. Get padding for patient and for your knees. Get a willing volunteer to help you, preferably two. If examining the lower teeth, then position the patient sitting up with lower teeth parallel to the floor, uppers at an angle of 45 degrees to floor. If you are looking at the upper teeth then lie the patient supine, with the neck fully extended.

Achieving dryness / Position multiple cotton rolls on the cheek side of upper first molars (i.e. next to the parotid duct), under the tongue for the submandibular ducts and to attempt to hold the tongue out the way and on the buccal side of the tooth needing treatment. Rotate head to the opposite of the working side, to reduce poolage. Suction is great if you have it, otherwise a rubber camera lens-blower can be helpful. Don’t forget to use your assistants and ask the patient politely to try to control their tongue.

Equipment / See the list at the end of the article.

Diagnosis and Management

Managing these problems will, for the vast majority, be a temporising measure, buying time before the patient can get to a dentist. But seeing as there are rarely ‘expedition dentists’ coming along with you, then you will likely need to do something.

In order of seriousness of the problem, the most common issues on expedition will be these:

Caries and Infection

Initial caries, not down to dentine, will leave the patient sensitive to cold (less than one minute) with a brown spot (demineralised patch) on the tooth. Manage with a high fluoride toothpaste (Duraphat) and/or anti-sensitivity toothpastes, alongside oral hygiene advice. Follow up with a dental hygienist. Dentine caries causes more severe sensitivity and pain, with a darker, deeper and softer lesion. Clean away the soft debris and fill the hole with filling material, then follow up with a dentist for a formal restoration.

Pulpitis / Apical Abscess

These cause pain over side of face, prolonged periods of sensitivity and the patient will be unable to eat on the effected side, though it may be difficult to locate the responsible tooth. There are no proprioceptive receptors in the pulp, only outside. Once it infiltrates local tissues or forms an apical abscess then it will become easier for the patient to localise. It is likely to have caries, or previous large restorations and may be tender to percussion. If you can, get ice and place it on each tooth. The diseased tooth should respond painfully.

You should seriously consider evacuating the patient. First line treatment is antibiotics, analgesia, no eating on that side and urgent dental review. Second line is Ledermix temporary filling (antimicrobial steroid dressing). Finally, third line would be tooth extraction, though this is a last resort and should be avoided. For follow up, standard UK treatment for this would be is either root canal treatment or extraction.

Abscesses

Severe pain and swelling on a gum. It is very difficult to differentiate between a tooth abscess (a decayed tooth and a dead pulp causing an apical abscess) and a gum abscess (food debris in the periodontal pocket, forming an abscess to point on the gum). Management is incision and drainage (see slide show above for technique), trimodal analgesia (NSAIDS, paracetamol, opiates) and antibiotics (see below). Follow up with an urgent dentist review for tooth abscesses. Gum abscesses should settle with simple management at home but prompt dental review is still important.

Gingivitis

Bleeding on brushing, mild discomfort from the gums with inflamed friable gums on examination. Remember to always check behind back molars, as debris often collects there. Manage by encouraging more brushing, not less, flossing and mouthwashes. Follow up with a dental hygienist.

Pericornitis

Severe pain, facial swelling, restricted mouth opening. Look for swelling around and posterior to back molars. There is little you can do in the field here with established infection – evacuate the patient. In the meantime, examine thoroughly behind molars and irrigate with mouthwash. Give regular trimodal analgesia and antibiotics. Once evacuated, follow up with a dentist or potentially maxillofacial surgeons.

Preparing for dental issues on expedition

Your preparations for dental issues on expedition will depend on multiple factors. A qualified dentist with good equipment can still perform complex treatments in the middle of nowhere and they regularly do. A non-dentally qualified practitioner working where evacuation might be impossible for prolonged periods might be expected to perform some reasonably complex dental procedures. That, however, assumes that they have had the appropriate pre-expedition training and can get some advice remotely. In the case of smaller trips or where evacuation is reasonably straightforward, advanced training and equipment cannot really be justified. Still, basic diagnosis and simple symptom management and will greatly help patients until evacuation or definitive care can be arranged. A way of thinking about the level of dental capabilities we would recommend are as follows:

Short trip, evacuation reasonably quick and straightforward e.g. Kilimanjaro No prior training required, expedition medicine course with a dental session advised Advise dental checks Basic dental kit: a few instruments, some temporary cement and oil of cloves
Long trip, evacuation likely to be a few days e.g. Greenland Crossing Sit with a local dentist or attend an expedition medicine course with a dental session Strongly request participants have dental checks More extensive dental kit, plus: Duraphat, Ledermix, matrix bands, local anaesthestic. Preferably some remote access dental back up.
Remote clinic, difficult or impossible evacuation e.g. British Antarctic Survey Formalised dental training course and visit a local maxillofacial surgeon or attend an expedition medicine course with a dental session and a maxillofacial trauma session All participants must have regular dental checks before and during deployment Advanced dental kit with basic dental extraction and interdental wiring kit. A reliable remote access dental back up. Radiology and telemedicine capabilities would be an added bonus

Analgesia

Oral analgesia according to the standard pain ladder is normally sufficient. Need for strong opiates is rare. Use regular trimodal dosing i.e. NSAIDS, paracetamol and opiates.

Anti-sensitivity toothpastes can be used if increasingly uncomfortable twinges of pain are being generating by contact between hot, cold or sweet stimuli and an area of a tooth where temporary filling is not possible. Retaining the toothpaste in that area for as long as practical helps to reduce the sensitivity.

Clove oil on a cotton plug placed into a cavity is often temporarily soothing.

Duraphat, a high fluoride varnish applied to dry tooth surfaces reduces sensitivity.

Local anaesthesia, either as a nerve block or infiltration around the tooth can provide temporary respite.

Ledermix paste – contains the broad spectrum antibiotic demeclocycline and triamcinolone acetonide as an anti-inflammatory, can be used when there is an unremitting pulsating toothache, such as that associated with a large deep cavity, a lost filling, or a loose filling that can be easily be removed. The tooth is cleaned of all the soft debris, Ledermix paste is applied with a small cotton pledget to the depth of the cavity, and the cavity then sealed with a temporary dressing, such as Cavit.

Antibiotics

Dental infections are typically caused by anaerobic bacteria and require treatment with a broad spectrum antibiotic. When in remote locations strongly consider higher doses than routinely prescribed. Antibiotics will generally reduce swelling and associated pain in 2–3 days. At this point the dose of anti-inflammatories can also be significantly reduced.

When there is an acute dento-alveolar infection, the treatment of choice is to drain the pus, by means of a gum incision into pointing abscesses or by extracting the affected tooth. If these local measures have proved ineffective or there is evidence of cellulitis, spreading infection or systemic involvement, one of the following first-line antibiotics can be prescribed. Local gum disease can be treated by debridement and irrigation together.

The antibiotics of choice if patient can take them are:

  1. Co-amoxiclav 375-625mg three times daily for 5 days
  2. Amoxicillin 250-500mg and metronidazole 200-400mg three times daily for 5 days

If the patient is penicillin allergic:

  1. Metronidazole alone, 200-400mg three times daily for 5 days, doubled in severe infection. Avoid alcohol as they may interact rather unpleasantly.
  2. Erythromycin 250-500mg four times daily for 5 days; may cause nausea, vomiting and many organisms are nowadays resistant.

Mouthwashes

Dental pain may also arise from infections of the gum structure associated with poor oral hygiene around buried or partly erupted third molars. The gums will appear swollen reddish-purple in colour, may bleed spontaneously or on touch with an instrument, and may smell foul. Having diagnosed periodontal infection,. it is essential to minimize bacteria between the teeth and along the gum margins.

Mouthwashes are used as an adjunct to improved oral hygiene in the treatment of gum disease in particular. The patient should be encouraged to brush the painful area vigorously despite bleeding and discomfort. A case of being cruel to be kind.

  1. Warm salty water: half teaspoon salt in half a cup warm water, temperature of tea.
  2. Chlorhexidine gluconate 0.2% mouthwash: 1-2 min, two to three times daily.

Fillings

Temporary filling materials are used to insulate the pulp from temperature, hypertonic solutions, chemicals or irritating foods. It will make the tooth feel much better. If a tooth is damaged during an expedition – whether through a lost or broken filling, decayed dentine, or cracked or broken enamel – but is not giving symptoms, then a temporary filling can still be useful as a preventive measure. Temporary filling materials suitable for placement when in a remote location fall into three categories:

Premixed

Supplied in a sealed tube; squeeze out and apply. The premixed materials (e.g.‘Cavit’) are easier to use but have less structural strength. They requires a mechanically retentive cavity to stay put. i.e. a hole with walls. The material also erodes and may require replacing as often as every few days. The cavity can be a little damp but not wet.

Materials requiring mixing

Examples include IRM (Intermediate Restorative Material) or any glass ionomer filling material which is fussy, but also very sticky and retentive.

Consider the following before starting:

  1. Isolating and drying the cavity.
  2. The exact ratio of powder to liquid is critical.
  3. The mixing time is about 1 min and the setting time is similar.
  4. Mix on a glass/shiny plastic slab with a flat spatula into a dough-like consistency.
  5. Apply and compress into a dry cavity, immediately removing all excess material from the biting surface. A Vaseline coated finger in ease of smoothening and shaping the filling.
  6. IRM may be colour-coded: white for a clean cavity, blue for decay present, red for pulpal symptoms.
  7. The same glass ionomer filling materials, if mixed into a ‘double cream-like’ consistency, are excellent for reseating and cementing crowns. For greater effectiveness, after removing excess cement, seal the margins of the cement around the crown, whilst setting, with vaseline to protect from saliva erosion.

Improvised materials

Improvisation can be attempted. Dip cotton pellet into oil of cloves or Eugenol. Swab the depth of the cavity. Then seal the cavity with candle wax, ski wax or sugarless chewing gum. Expect limited success, of a very short duration.

Expedition Dentistry Kit List

Instruments
Dental mirror
Flat-plastic spatula (for placing dental filling material onto tooth)
Pair of tweezers or forceps
Spoon excavator (medium) – for scraping out soft caries
Fine curved surgical scissors
Cement mixing spatula
Glazed mixing paper pad/or glass slab

Medicaments
Temporary filling materials: Glass Ionomer powder + liquid or Intermediate restorative material (IRM), Cavit
Chlorhexidine 0.2% mouthwash
Duraphat (high fluoride varnish)
Ledermix paste
Antibiotics: Co-amoxiclav 625 mg, Metronidazole 400mg
Painkillers: ibuprofen, paracetamol, codeine-phosphate
Dental local anaesthetic cartridges: 2% Lidocaine with 1:80,000 adrenaline
Toothpaste for sensitive teeth
Eugenol( oil of cloves) Topical Analgesic

Others
Sterile gloves
Cotton wool rolls
Stainless steel wire for eyelet wiring (24G for eyelets, 26G for ligatures) or electrical cord for harvesting copper wire
Safety-plus disposable syringes: 27G long (can be used in upper and lower jaw)
5ml syringe with blunt needles (for irrigation and flushing out debris below operculum)

Practicals
Gas aerosol suitable for camera cleaning – ideal for drying teeth and cavities

Optional equipment for the experienced
Upper single root extraction forceps
Upper molar extraction forceps left and right
Lower molar extraction forceps
Lower single root extraction forceps
Fine Luxator or Elevator-Coupland

 

Course of Interest

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Wilderness & Expedition Medicine, jobs, courses and news

 

 

Extreme Medicine 2014

8th – 11th November 2014

Royal Society of Medicine, London

20% off Early Bird Tickets for this amazing conference, rated as ‘the best ever medical conference’ ‘ simply amazing’ ‘career changing’ 

 

Extreme Medicine - its films

Extreme Medicine – the film!

See what all the fuss is about for yourself…

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Who should attend?

Dr Gareth Grier of London Air Ambulance gives his view..

See here

 

Extreme Medicine 2014

Disaster | Humanitarian | Extreme | Expedition

The conference speakers included many of the very best speakers from around the world (including Dr Gordon Giesbrecht, Dr Mike Barrett and Professor Chris Imray, who are the world experts in many remote extreme medicine fields including expedition and wilderness, pre-hospital, disaster and relief medicine.

The specialist conference was developed specifically with medical professionals in mind, bringing together the learnings from various areas of remote medicine, and attracted delegates from around the world. 70% of the delegates were doctors with the rest of the audience being other medical specialists such as nurses, paramedics and ‘aspiring’ extreme medicine university students.

A pre-conference trauma workshop will be running on the weekend before run in cooperation with the justifiably world famous London Air Ambulance Service – details to be released soon

Conference website

Early Bird Discounts Sign up now!

Only available until the 1st of April this years Early Bird Tickets are now on sale; 20% discount on all tickets – combine with a four day ticket to save 30%!

Use this code at checkout ‘EBird2014-20‘ – BOOK NOW!

- limited availability offer not combinable with other promotions.

- offer ends 1st April 2014

 

 

 

 

 

 

 

 

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EWM (Australia) Med Director Dr Andrew Peacock speaks of his passion for Expedition Medicine

Andrew Peacock, Expedition & Wilderness Medicine (Australia) Medical Director is a doctor, adventure photographer and explorer, whose breathtaking imagery gives a glimpse into the far off places he’s travelled…

Join him on the Blue Mountains Expedition Medicine Course …  http://www.expeditionmedicine.com.au/index.php/products/events/-/pt-0010.html

Having graduated in 1991 as a doctor, Andrew worked in the early 90’s as a surgical resident in California. Once photography entered Andrew’s life, he was unable to let go of the possibilities and creativity it introduced. “I began photographing using transparency film. It was a really transforming moment when I reviewed my first slides from a trip to Hawaii on a light table. They were very average pictures, but the unforgiving nature of transparency film and the almost magical 3-D quality of the image when viewed through a loupe really grabbed my attention.”

Over the years, Andrew has joined expeditions that employ his abilities as both a doctor and photographer. “I’ve always loved to travel and explore medical director Dr Andrew Peacockthe world and to experience different places and cultures. I try and involve myself with interesting expeditions or on journeys with a specific purpose to more remote areas where I can tell an interesting story photographically. It helps that I’m a medical doctor, which has given me great opportunities in recent years

to work on some awesome trips to places like Antarctica, Papua New Guinea, Pakistan, Nepal and India. A dramatic landscape and the people and/or wildlife moving within it is what really captures my attention the most.”

Andrews photos embody the look, feel, and subject matter that classic travel photography was founded upon. On his two trips to Antarctica, he captured images of surreal landscapes of ice and snow, desolate and never-ending vistas from their ship, and wildlife unaccustomed to human interaction. Because of Andrew’s passion for adventure and his admiration for the natural world, his images are full of life. They cultivate a sense of wonder and bring the viewer up close to the adventure at hand.

Read on to learn more about Andrew’s trips to Antarctica and the incredible aspects of his career as an expedition doctor and photographer. All of the remarkable and exciting photographs below were processed using VSCO Film 04.

Please tell us about your expertise in being a doctor. How did the opportunity to be a doctor on such expeditions come about? How has being a photographer enriched the expeditions you’ve been on?

It not only seems long ago now that I graduated as a doctor, it really is – 1991… I decided to volunteer and work as a doctor for the Tibetan Government in exile in Dharamsala, India. I contacted Fuji, and they kindly gave me fifty rolls of Velvia to take with me. I think any hope of a traditional medical ‘career’ was doomed from then on, as the life of a nomad climber and traveler appealed more, and I’ve never gone on to complete training in a speciality area.

Instead, I have built up an extensive amount of experience in general and emergency medicine, combining traditional hospital contract work with remote area and expedition work in Australia and overseas, aiming where I could to find ways of combining my climbing, paddling and photography skills with medical work, both paid and voluntary. As is often the case, networks built up over time generate the most opportunities in the area of expedition medicine. For instance,

I was asked to be the doctor for the recent Australasian Antarctic Expedition (AAE) by a climbing friend, Greg Mortimer, one of Australia’s most lauded mountaineers. We climbed Manaslu (8163m) together in 2002.

Being an Expedition Doctor can be a thankless task, because I’m only useful when things go wrong, and nobody wants that to happen. So it’s always good to add other skills to the mix, which is where photography comes in. So I ‘morph’ into the Expedition Photographer as well, giving instruction and talks on photography to the others. Interestingly, there was one expedition in the Arctic aboard a super yacht traveling through the Northwest Passage where my contractual engagement was as a photographer, yet I was expected to fulfill the responsibilities of a doctor if those skills were needed. I lead treks in India and Nepal occasionally and, also on those journeys, adopt the role of Expedition Photographer when I can. It’s satisfying helping and teaching others who are interested in the world of digital photography, and of course, there is no end to the learning experience for me.

Tell us more about your trips to Antarctica. What was the purpose for each trip? What are some of the things you enjoy most about traveling to such a desolate region?

The photos seen here are from the past two trips I’ve made to Antarctica. Both were ship based, which is the most common way that people get to experience the great white continent. By far, most of those trips are tourism based and go to the Peninsula, which was the basis for my first visit as a ship’s doctor. Compared with the rest of Antarctica, it is reached relatively easily in a few days sailing from the tip of South America. For the AAE, it took us 8 days to reach East Antarctica across the tempestuous Southern Ocean, after leaving from the bottom of New Zealand. The AAE was a science based expedition, utilizing private funding from paying passengers and university grants. The aim was to travel to the area of Commonwealth Bay and repeat and compare scientific observations with those made by an Australian scientist and adventurer Sir Douglas Mawson, who first landed there 100 years before with the original AAE. At the time, this was the Edwardian equivalent of today’s space travel. His team established a base hut in a spot which has now been proven to be one of the windiest places on earth, and there they made many oceanographic, geological and meteorological measurements over two winters. Clearly, we had more creature comforts than Mawson and his men, yet visiting the coast of East Antarctica is still a difficult proposition, and it felt very remote geographically speaking. The desolate landscape with multi-hued, blue ice features and the intense, 24-hour light at such a southern latitude makes for a wonderful, yet challenging environment in which to photograph. It’s a beautiful place, which changes remarkably in mood with the weather. Delightfully inquisitive penguins are a constant presence at the edge of the ice, and their charismatic personality means I never tire of photographing them.

Polar Medical PreparationOn your latest trip to Antarctica, quite an ordeal developed. Can you please tell us about this event?

Unfortunately, our ship for the AAE, the Akademik Shokalskiy, was caught by an unexpected breakout of old, multi-year pack ice far to the east of the area we were in. The expedition had completed its Antarctic shore based work, and we were making slow headway through the thick ice. We were only two miles from reaching open water when it became impossible to proceed. During the blizzard that followed, that distance became twenty miles; so we were effectively ‘stuck’. There was enough initial concern about large icebergs moving independently within the pack ice near the ship to require a request for help to be sent by the Russian Captain to maritime rescue authorities. Once that immediate danger had thankfully passed, for those onboard, it was a case of sit tight and celebrate Christmas Day and New Year in an usual fashion. Each day was a case of  wondering what would transpire next as authorities canvased options, made plans, and then changed plans frequently. It was an unsettling experience for some of the passengers. So I and other expedition team members focused on doing what we could to keep spirits high and people informed and occupied. On January 2nd, a helicopter from the Chinese Icebreaker, “Xue Long”, that was unable to forge a path to extricate the Shokalskiy, was used to shuttle us across a vast expanse of glittering pack ice to the Australian ship Aurora Australis. It was a thoroughly professional operation conducted in good weather, and all of those evacuated are very thankful for the help that was offered. As a result of this event, I found myself at the centre of a somewhat overwrought media frenzy, and because of the technology we had available, I was able to take advantage of it to tell our story. For that slow news period between Christmas and New Year, it’s likely that I was the most published photographer in the world in both the press and web news sites. It was all a bit surreal given that I was stuck on a ship at the bottom of the world!

You have an incredible eye for capturing wildlife. Having such spontaneous and unreliable subjects that often move around, what are things you do to capture such spectacular moments? Do you have an interesting story to share concerning trying to get a particular shot involving wildlife in Antarctica?

I really enjoy the challenges associated with photographing wildlife. I’m not a wildlife photographer per se, but I’d like to explore more subjects in that area. It definitely helps to know a bit about the ecology of the subject so you can be more in tune with the particular behavior of an animal species. I try to take up a position from which I can observe wildlife without altering its behavior, but sometimes, that’s difficult to do, as with inquisitive penguins who often approach the photographer for instance. Faced with numerous subjects all together, or a lot of movement, it can be overwhelming to know how and what to compose to produce a telling image. My approach will differ according to the situation. When the animal(s) are not going anywhere fast, then before taking any photos, I find it helps to observe for a while. Resist the urge to photograph straightaway; learn from what the animal is doing. Consider the overall scene, but also focus on specifics and tight compositions. See if there are any patterns emerging in the viewfinder, and look for unique characteristics that tell a story about the wildlife. I want to show something of its personality if possible. It may be just a turn of the head into a different position that can make all the difference between an average shot and one that stands out; so take the time to choose exactly when to fire the shutter. I am often looking for a specific moment when the movement is ‘just so’ to produce something interesting. That may involve changing lenses too in order to compose in a certain way. Of course, sometimes an interaction takes place quickly and with little time to think or contemplate.

While paddling a sea kayak off the Antarctic Peninsula last year, a Minke whale surfaced nearby and then began moving toward me. I had my Canon DSLR in a chest pouch, and there was just enough time to get the camera out, alter some settings, and take a few shots as it unexpectedly passed immediately underneath my kayak. I could have given up on the photo option and paddled out of its way, but I trusted this intelligent animal to know exactly where the hull of the kayak was and to avoid knocking me and my expensive, unprotected camera into the freezing water. The experience was amazing and all over in a flash. I was happy to get a couple of nice frames of such a beautiful mammal from a unique angle.

What are some important things you have you learned about yourself, mankind, and nature when going on expeditions to such far off and remote places?

Any expedition to remote areas teaches life lessons to those who participate. In many trips to mountainous and icy regions of the world, I’ve learned that such environments, while beautiful and spectacular, can also be dangerous and unpredictable. Anyone with a climbing background knows someone who has died pursuing their passion for high places. Personally, I’ve learned to make do with less and to always be thankful for the comforts and friendships of home, which are best appreciated on returning from exploring remote landscapes in pursuit of hiking, climbing, paddling or photographic goals. Yet, I am only a visitor to these places, and I am continually amazed at the fortitude of those who live

permanently in harsh environments. Expeditions are never about one or two individuals. Success is measured best by harmonious teamwork, sharing a common goal, and with a safe return home as friends. The resilience of mankind is a common thread running through such trips, whether historical or contemporaneous. Consider the awful circumstances of Sir Douglas Mawson arriving back at his hut barely alive after losing his two companions on a mapping expedition, only to find the ship that had waited to take him back to Australia was just disappearing over the horizon, condemning him to a second winter in the dark and cold of Antarctica. It’s apparent in the generous and unyielding nature of local people, living a life far removed from expeditioners they are often called upon to help- Sherpas in the Khumbu region of Nepal for instance or porters from the impoverished village of Skardu, the starting point for journeys up the Baltoro Glacier in Pakistan’s Karakorum mountains.

For those looking to get into the business of travel, adventure, or nature photography, what advice would you give them?

Clearly, it’s not easy to run a business focusing just on those areas of photography in this new digital era, because the market is saturated and budgets have evaporated for magazine work for instance. Hard work, networking, producing images with a unique style and access to amazing locations will be necessary. It’s a broad scope of practice; so be prepared to learn skills shooting across a wide range of subjects. It helps first of all to be a hardy traveler and/or an adventurer and a nature lover. Then, the photography will follow suit;

it doesn’t make sense to do it the other way around. Shoot what inspires you, and the images will stand out that much better because of your understanding of the subject. Enter photo competitions for fun and so that you have a real interest in learning from what images win (in case yours don’t!). Always shoot RAW files, edit critically, learn Lightroom, and get your photos out there— and by that I don’t just mean on Flickr. I mean in magazines, commercial websites, stock libraries, the walls of a gallery or a home etc. Value the time and effort you put in. Be proud of the images you produce by holding out for payment for your images, or at least learn to be an astute judge of when a contribution for free can lead to other things for you or when it’s OK to be generous for a cause.

Polar Medical Preparation

What do you like about using VSCO Film? If you don’t mind sharing, what VSCO Film pack do you regularly use, and what are your favorite presets?

I really enjoyed taking photos with slide film back in the day and, in particular, using the Fuji emulsions. The ‘look’ of a print from transparency film is unmistakeable, and I think we have lost something special by transitioning almost entirely to digital files, which can sometimes look a little bland. Of course, there are many advantages to shooting digitally- more space in my backpack without the need to carry rolls of film into the backcountry being one of them. Naturally enough, I use the VSCO Film 04 Pack for Canon in my Lightroom RAW processing workflow. It contains some great Fuji and Kodak slide film presets, which when used on the right images help create a beautiful filmic look with good dynamic range. After starting with a good exposure and white balance setting, it’s a one click process to introduce the VSCO preset. And of course, it’s all non-destructive editing with a clear pathway for tweaking the settings to achieve more or less of the slide film effect. I like that flexibility in the creative process. My favorite presets are Agfa Scala for black and white processing, Kodak 100G for journalistic images, Fuji Astia for portraiture and Fuji Provia as a starting point for landscapes.

Meet Dr Andrew Peacock and other inspirational adventure medics at;

Blue Mountain Expedition Medicine Course

Polar Medicine Course New Zealand

 

 

 

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Nevada Bike Challenge medic needed

Nevada cycle medic neededAre You A Doctor (possible Paramedic) in the USA or able to work in Nevada? Fancy An Adventure? Then we urgently need you to join our UK Challenge Leader and USA Ground Crew in supporting 13 participants on a 5 day cycle challenge in Death Valley National Park, Nevada USA.

Cyclists will be covering 420km over 5 days. Your duties will include monitoring the general wellbeing and health of the group and dealing with any illness and medical emergencies that may arise. You will need to provide a full, comprehensive first aid/medical kit and be fully insured to work on this trip. You do not need to be a cyclist to apply.

Date of Challenge: 6-10 April 2014 inclusive Salary: $750USD

All accommodation and meals will be provided and other expenses can be discussed.

Global Adventure Challenges are a UK Charity Challenge Operator and have been organising worldwide charity challenge events and adventures since the year 2000. For a copy of the challenge itinerary see www.globaladventurechallenges.com/international/death-valley-cycle/#cycle

Please contact our Flights and Ground Handling Manager Jen Maitland-Jones at jen@globaladventurechallenges.com or +44 (0)1244 676454.  Employers are particularly interested to hear from contacts from Expedition & Wilderness Medicine so please mention our name.

charity challenge medics

 

 

 

 

 

 

 

Of interest

Extreme Medicine Conference 

Expedition Medicine Courses

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Rural GP positions available Canada

rural GP posts in canadaHead Medical are recruiting 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 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

The Role
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.

The Location
Wabasca located in the province of Alberta, has a population of 1,569 and is largely Native Canadian. Another 2,207 additional residents live on five reserves in the immediate surrounding area. These reserves include Wabasca, Bigstone Cree Nation and Woodland Cree First Nation.
Located west of the Wabasca oil field, oil and gas is Wabasca’s primary industry with Forestry also playing a role in the local economy.

Fishing, ice fishing, quadding and snowmobiling are traditional and recreational activities in the area. Other activities include cross-country skiing, mountain biking, skating and swimming.
Located along the shores of the North and South Wabasca Lakes, the community has a boat launch, a swimming dock, and a fishing bridge between the two lakes.
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Requirements
• 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

Find medical jobs in Australia, New Zealand, Singapore, Gulf Region, Canada and UK through Head MedicalWhat Head Medical can do for you
Arranging a position overseas is very exciting, but we understand that it can also be daunting and time consuming. We’re the UK’s specialist in international medical recruitment and we’ve helped many Doctors relocate since we first started out in 2008 (you can read what people have said about working with us on our (testimonials page). We know it’s important to balance career opportunities with lifestyle and we’ll talk through your plans and will get to know you to make sure we find the right role in the right location.

Once we’ve secured a job for you, we’ll manage the medical registration and visa application process, and support you (and your family) with the relocation itself.
If this sounds like the perfect job you can apply using the blue button below. Or if you’d like to find out more about this job or have an informal chat, please get in touch with us:

Yan Scouller
Tel: +44 (0)131 240 5274 | yan@headmedical.com
or
Nicky Mcloughlin
Tel: +44 (0)131 240 5280 ! nickym@headmedical.com

Please mention Expediton & Wilderness Medicine

 

Of interest

Extreme Medicine Conference 

Expedition Medicine Courses

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