Dr Sean Hudson shares the love about the Jungle Medicine course in Costa Rica
Jungle Medicine Course - Costa Rica
‘It’s humid, hot, muddy and sometimes cold at night, but it’s exactly this which makes the beautiful elements of the jungle just that bit more fantastic. Hidden waterfalls, incredible rivers, primary rainforest and then of course the chance of seeing elusive wildlife, jaguars, jaguarondis, monkeys and the plethora of ants, scorpions, spiders and snakes. The course is based on the Pacuare River, four hours by raft into the jungle.
The base camp has all the luxuries you don’t expect, with even a raised lecture theatre looking over the river. Expect to work hard in the jungle during the day, getting used to travel and life in the jungle and then relax in comfy chairs listening to a few evening lectures. Towards the end of the week you will have the opportunity to trial your new skills and travel into the jungle, sleeping in hammocks, cooking on fires and navigating through the jungle.
The directing staff will guide you through all of this and allow you to work and learn at your own speed, allowing you to feel safe and gain the most out of your experience and this incredible adventure. This course aims to give you the confidence to look after yourself in the jungle, hence allowing you to focus on the care of a sick patient.
The treatment of cholera in an active malaria zone is a difficult matter. This is especially true with lessons being learned in Haiti and their recent cholera outbreak. I am specifically referring to the combination of Chloroquine (antimalarial) and the antibiotic class Macrolides (used in treatment of cholera). A post that I made back in 2009 has new recent relevance and I wanted to repost that here:
Azithromycin, Chloroquine and Arrythmias:
Travel medicine frequently uses medicines that are taken under special circumstances and for short periods of time, like a trip. Many travelers carry an antidiarrheal antibiotic on their trip and a common choice is azithromycin. This can potentially be a problem when they are also traveling in a malaria area and using chloroquine for prevention. Two very commonly used medicines chloroquine (antimalarial) and azithromycin(macrolide antibiotic used for respiratory infections and diarrhea) both have wonderful safety profiles, individually. However when taken together, there is discussion of the chance of a heart arrhythmia, specifically prolonging the QT interval. In fact, my software I use for prescribing cites this as a combination to avoid.
There are several important articles that can be used to look at this problem and evaluate the risks. One very good paper looks at medications that prolong this QT interval:
These authors list azithromycin as a “very improbable” medication, although other macrolides are listed as higher risk. Chloroquine is listed as an “Unknown” medication, with respect to prolongation of QT interval. This article was based on expert opinions.
A wonderful article that is actually helping to look at using this drug combination to treat resistant forms of malaria. More about this combination and treating malaria here. Their study did show an increase in the QT interval in both groups of those who received chloroquine alone and those who received the combination of chloroquine and azithromycin. This QT interval increase was maximum on day number three and returned to baseline by the end of the study.
Most of the information I am finding looks reassuring for safely using this combination, in healthy individuals. Those with a history of arrhythmia should use this combination with caution and discuss this problem with their doctor, before they take these two medicines within a close amount of time.
Hi all!
I’ve been doing this warm-up with the staff of our MSF-project last Monday and it was a GREAT success! It’s the same warm-up we did one morning during the Expedition Medicine course in Keswick last March, with Piers I think. Good fun, they loved it
Many thanks!
Cheers from the Congo,
Jiske
Another superb Expedition and Wilderness Medicine training course in Keswick
The Great North Air Ambulance, dedicated to Expedition Medicine facualty member Dr Rupert Bennett sadly killed in a climbing accident on Ben Nevis, lands as part of a search and rescue training scenerio on the course which aims to prepared medics for working in remote locations and is accredited by the Wilderness Medical Society.
Specifically aimed at Tour Medics and medical professionals accompanying groups/tours outside of the UK.
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On the 19th of April at 9.00pm Ginger will be televising the Jones Boys Amazon Adventure. Steve Jones and his brothers were exposed to a number of challenges in the jungle on the Amazon. Expedition Medicine staff member Paul Richards provided the medical support and appears to have sacrificed himself in the process. Paul managed to get bitten by every insect in the district, the number of bites in his buttocks exceeded 100 (he counted these himself). I think this means that Pauls nethers are either more appealing or larger than the other expedition members. Watch the programme, I think it will make for interesting viewing.
Lucy Dickinson has just returned from accompanying Helen Skelton and the BBC team as Helen kayaked 2,010 miles down the Amazon. Here are her thoughts upon her return.
” I’ve just had my first experience of TV expedition work escorting Helen Skelton from Blue Peter kayaking down the Amazon. I still can’t quite believe I got the opportunity to have such an amazing trip. So how did it compare to the other expedition work I’ve done? Well it’s still just you and your box of tricks in the middle of nowhere improvising and trying to manage the risks. It’s still having an adventure and seeing a beautiful part of the earth. It’s still meeting new people from different parts of the world and learning different ways of life that put some perspective on the way we live our lives here. It’s still being inspired by interesting people doing exceptional things.
For a change, this trip was no physical challenge for me, in fact it was a challenge to sit still for 6 weeks! It was new having people thriving on the little dramas “because they make good TV”. It was exciting watching the BBC team doing a live broadcast from a sand bank in the middle of the Amazon knowing that people in the UK were watching it back in the UK as it was happening. It is not my idea of fun being in front of a camera and I constantly thought back to that conversation I had in London with Eric, the producer, about how I agreed to be on film only in exceptional circumstances if absolutely necessary. The reality was far from this and I can only hope that when the Blue Peter specials and the Sport Relief programme come out this week that I won’t cringe at the appearance of my “character” as they refer to you. As with most expeditions I’ve done it was a great pleasure and a privilege to work with a team of very lovely, interesting and fun people and have an exciting diversion to day to day General Practice.
…..If they ever ask me to do another trip with them I’ll jump at the chance.”
The story of Blue Peter presenter Helen Skelton’s incredible record-breakingadventure, kayaking solo down the mighty River Amazon in aid of Sport Relief, is told over the course of two programmes.
In one of the toughest challenges ever undertaken by a Blue Peter presenter, Helen’s epic journey was conducted at a gruelling pace, paddling up to 14 hours a day to complete her target of kayaking 2,010 miles in six weeks, with only one rest day a week. This first programme follows her as she begins her training with Expedition Medicine, arriving in Peru for the start of her odyssey. She visits Proceso Social, a project which uses Sport Relief cash to reduce child labour and increase access to education among semi-urban child migrants in Peru. Helen then begins her first week on the water.
Blue Peter presenter Helen Skelton has completed a 2,000-mile kayak trip along the Amazon for Sport Relief, supported by Expedition Medicine
The 26-year-old was greeted by cheers and celebratory gunfire as she crossed the finish line in Almerim, Brazil.
Skelton has clocked up 2,010 miles since she set off on her solo journey from Natua in Peru on 20 January.
The BBC star, who had never been in a kayak before training, broke two world records as she became the first woman to paddle the length of the river.
The records – for the longest solo journey by kayak and the longest distance in a kayak in 24 hours by a woman – are awaiting official verification.
The TV presenter paddled about 60 miles a day, six days a week, to reach the target.
My bottom is bruised, my shoulders are sore and the muscles in my neck are making it hard to differentiate between my head and my shoulders but to be honest I am proud of the war wounds
Helen Skelton
Skelton said of her challenge: “It’s been tough but I’ve had enough highs to make it more than worthwhile.
“I’m very lucky to have amazing people in my life who’ve picked me up when things got hard and most importantly inspired me to carry on.
“My bottom is bruised, my shoulders are sore and the muscles in my neck are making it hard to differentiate between my head and my shoulders but to be honest I am proud of the war wounds.
“I reckon that you shouldn’t shy away from things because they’re tough or you might fail. Get stuck in and you never know where you might end up.”
Blue Peter, which is showing Skelton’s epic journey in two special episodes on 16 and 17 March, hopes her efforts will inspire families across the UK to rise to their own challenge for Sport Relief.
Lucy will be updating us in the next couple of days
Expedition Medicine is supporting Helen Skelton, presenter on Blue Peter, attempt to be the first woman to kayak the Amazon and here is the latest progress report on 18th February.
All are well here now. Helen and I have managed to avoid the D+V.
It’s been an eventful week in Helen Skelton’s Amazon adventure. We started with Carnaval in the city of Manaus where the entire crew had to dress up and dance around a specially built Samba drome in the pouring rain. Leaving Manaus we reached the meeting of the Amazon with the Rio Negra, the biggest tributary of the Amazon. One is brown and the other is black and the waters don’t mix for several miles. A helicopter was chartered to film this event and the team were buzzing after this exciting milestone. Next came an unwanted drama with several members of the local and UK crew being affected by a viral gastroenteritis. It started with one of the kitchen staff and, despite working hard at the usual strict hygiene measures, it spread to several others. Fortunately Helen (and I) have been ok so far. The latest drama was the sinking of our support boat in the early hours of Tuesday morning. Nobody was on board at the time and after several hours of hard work it was resurrected but it had to be fixed up at a boat yard upstream of our location so this cost a whole day of paddling for Helen. She’s back on track now, has just clocked 1500 miles and is going as strong as ever.
adventure, kayaking solo down the mighty River Amazon in aid of Sport Relief, is told over the course of two programmes.
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