January 2007
HAPPY NEW YEAR to all our readers.
Welcome to our first newsletter of 2007. We hope that you find this
edition useful with information on our forthcoming courses, situations
vacant, competitions, snake bite treatment plan and find out how our
new jungle course went plus much more!
2006 was a busy year for us it saw the launch our NEW Jungle course
in Costa Rica, we held our third successful Polar course in Norway and
we have expanded our UK EML course, so we are very much looking forward
to another busy year in 2007.
Happy Reading.
Whats inside
Expedition Medicine UK Course
*** NEW DATES DUE TO NATIONAL DOCTOR INTERVIEWS***
The aim of the Expedition
Medicine course is to provide doctors, nurses, paramedics and advanced
medics with no particular outdoors experience with the skills and practical
knowledge to become valuable members of an expedition team. The EML
course will be intensive and thorough, drawing on the extensive skills
base within the faculty.
Polar Medicine Course
- 4th - 10th February 2007 – LAST FEW PLACES AVAILABLE
BOOK
HERE
 The
Polar
Medicine course has been developed for medical professionals
or advanced medics working in cold and at altitude environments. The
course aims to use the winter mornings and evenings covering the essential
expedition medical skills required to care for and treat injuries and
illnesses likely to occur in this harsh environment. BOOK
NOW AS LIMITED PLACES.
Jungle & Tropical Expedition Medicine Course set in Borneo- NEW
 Expedition
Leader for this course will be Dr Mark Read, who is
Queensland’s leading crocodile biologist and works for the Queensland
Park & Wildlife Service on crocodile research and management. He
manages a team of wildlife specialists for the conservation of wildlife
in national parks and happily refers to himself as a ‘wildlife
trouble-shooter’.
Expedition Medicine's Jungle
Medical Skills course is set in Borneo. Sabah is part of
the island of Borneo known as "the Land Below the Wind" because
geographically it is situated below the typhoon and monsoon belt. Borneo
has a unique diverse population consisting of 32 ethnic communities,
and boasts some of the world's greatest wildlife treasures.
The course is for all those medical professionals responsible for clients
in a tropical or jungle environment. You’ll cover topics like
treating snake, scorpion and spider bites, wound management, avoiding
diseases, field diagnosis of tropical diseases - as well as trekking
in the jungle, rafting, creating a shelter and navigating.
2007 - Guest Speaker. We are honoured to have one
of the world’s leading experts on Altitude Medicine, Dr
Jim Milledge joining our Jungle Medicine Course faculty staff
in 2007. Jim was part of the legendary Silver Hut Expedition in 1960
led by Sir Edmund Hillary with Dr Griffith Pugh as the Scientific Leader.
Other members included John West and Michael Ward. He is an author on
many scientific papers and one of three authors (with West and Ward)
of the standard textbook High Altitude Medicine and Physiology; the
fourth edition is in press.
Now in retirement, Jim can indulge his professional hobby almost full
time and besides lecturing and writing, was Chairman of Medical
Expeditions, a charity and club with the aims of furthering
research and education in mountain medicine. He achieved this by running
courses (including the Diploma course in Mountain Medicine) and research
expeditions. Major Medex expeditions that Jim joined were in 1998 to
Kangchenjunga and in 2003 to Chamlang Base Camp in the Everest region
of Nepal. In 2004 Jim was elected President of the International Society
of Mountain Medicine.
For further details on the jungle course then please email
here.
Desert Expedition Medicine Course set in Namibia- NEW
 By
popular request we are delighted to announce for 2008 our new Desert
Medicine course. Set in Namibia, in the region of the Brandberg
Mountain, the countries highest peak this will be this course is ideal
for those working in dry or arid climates. Using some of best local
guides in Namibia including park rangers and survival specialists combined
with the expertise of the Expedition Medicine facualty it promises to
be a superb course in a stunning part of the world.
Details are due to be released very soon but if you would like to pre
register your interest for the Desert Medicine course then just email
Julie
here
‘Confessions of a drugs smuggler’
– by Dr Mike Townsend
It was after dark when we crossed the Pakistan/Iran border from Nok
Kundi to Mirjaveh. We were all weary from our crossing of the Baluchistan
desert, for the last few miles straining our eyes into the gathering
darkness due to failure of the lights on our old Land Rover. The Iranian
guards cast doubtful eyes over the five travel-stained westerners as
we mentally prepared ourselves for the inevitable search of ourselves
and our vehicle.
The first surprise was the production of anonymous capsules which we
were ordered to swallow. We expressed our doubts about this procedure,
but the chief guard muttered “for cholera from Pakistan”
and fingered his gun, so it seemed wise to follow his instructions,
and we appeared to be none the worse for swallowing the capsules.
The next surprise happened after the finding of my medical kit on the
search of our trailer. I had destroyed much of my medical kit before
leaving our base camp after our attempt on the first ascent of Kalanka
in the Garhwal Himalaya, but had kept back five ampoules of morphine
in case of serious trauma on the way home. Given the quality of the
roads and the driving we had encountered this seemed a wise precaution
at the time.
We had taken the route through Baluchistan, ironically enough, to avoid
the going-over of westbound vehicles that we had seen on our eastward
journey through Afghanistan on the way to India. What followed showed
that this had not been a wise decision. When the morphine came to light
we were arrested and my passport was taken away. We were told that we
would have to travel 70km to Zahedan, taking our vehicle and trailer
for further inspection. When we protested that this was impossible without
lights we were locked into a compound with armed guards to work on the
Land Rover’s electrics, which we eventually resurrected.
Next morning I was ordered to sit between the driver and an armed guard
in the Land Rover and we were escorted through the desert to Zahedan
with a police escort. When we arrived we were taken to a customs post
where a swarm of officials descended on the vehicle and trailer, spreading
their contents out on the concrete and going through them in minute
detail. At one point one of them obviously thought “I’ve
got the b*****s now!” as he unwrapped a small foil-wrapped cube,
finding it full of a brown substance. To check his suspicion that he
had found our stash of cannabis he tasted it and promptly spat it out
in disgust. He had found the oxo cubes with which we had enlivened our
dehydrated meals!
Meanwhile I was ordered into an unmarked van and taken off to an unknown
destination under armed guard. This was, to say the least, a little
disconcerting, and I was rehearsing in my mind in all the languages
I knew “I insist on seeing the British Consul”, which seemed
a vain hope. Eventually, down a lonely street between high walls the
driver stopped and one of the guards knocked on a door set into the
wall. Thinking “This really can’t be happening to me, I’ve
wandered into a James Bond film”, I was ushered into a courtyard
where sat two interrogators. Unfortunately they could not find anyone
who spoke English well enough to interrogate me.
The boss man in a smart grey suit spoke excellent French, in which
I am reasonably comfortable, whilst his sidekick spoke passable German,
a language which I had failed to absorb beyond ordering beer, sausages
and a bed for the night. They had in front of them my medical kit, from
which they would randomly take items and ask “Qu’est-ce
que c’est” or “was ist das?”, and trying to
pick the right language according to who had asked the question I answered,
using mime when words failed me. It soon dawned on me that they had
been told little about me or that I was travelling with four companions
when the German speaker, holding the remains of a dispensing pack of
sleeping tablets that we had used occasionally for high altitude insomnia
asked “Und was ist das? I replied “Das ist fur schlafen”
(for sleeping, for the benefit of non-linguistic readers). His eyes
grew wide as he looked at the number of tablets and he asked “Fur
ein mann?” (for one person?). I then had to set about explaining
alternately in French and German that I was a member of an expedition
and that I was the expedition doctor.
Eventually they accepted what I said, which is fortunate because I
found out later that if they had found me guilty of drug smuggling I
would have been taken out and shot. The boss man gave me a long lecture
about the dangers of morphine, during which I nodded respectfully from
time to time and said “Oui, d’accord”. He then wrote
out kin Farsi, translating as he went, a chit that authorised me to
carry all my drugs except morphine. I was puzzled when he gave me back
the morphine, but he told me to give it to the guards.
When I got back to the customs compound my fellow-travellers had reassembled
the Land Rover and were looking distinctly anxious about my fate. I
approached the chief guard and gave him the chit, which he read slowly,
muttering at intervals “Is good, is good”, but when I held
out the morphine he said “It say you take”. “No, it
say you take” I replied. “No, it say you take”. “No,
it say you take, I’m fed up of the bloody stuff!” At this
point his hand strayed towards his gun, and I hastily decided “OK,
I take”.
Driving off into the desert towards Kerman I had in one pocket five
ampoules of morphine and in the other a chit to say that I could carry
any drugs except morphine. What problems would this cause when we left
Iran and entered Turkey? That’s another story which I might one
day tell you.
The lessons to be learned from my experience are obvious. When travelling
through several countries, make sure that you know the drug regulations
for each country and have import and export permits for all your medications
for each country. Don’t change your itinerary, and if you do,
don’t take drugs into countries for which you have no permit.
Know which drugs are controlled in each country, as regulations carry
from one country to another, and ideally don’t carry controlled
drugs at all. There are alternatives to most controlled drugs, even
for strong pain relief. This was my first expedition, and I was pretty
wet behind the ears. Benefit from my experience and don’t get
yourself into my situation!
Caption Competition
What is this chap up to? Is he stuck? Does he need a medic?
 Please
send your suggestions for the caption to Julie@acrossthedivide.com
there may or may not be a prize depending on how good we rate your
captions.
Situations Vacant
Position; Expedition Medic in Patagonia with GVI’s Research
and Exploration Expedition (1 Year) Description;
Be the Expedition Medic in charge of all medical aspects on a cold weather
expedition which is, at times, very remote. Manage the training of all
Expedition Members in wilderness medicine and emergency evacuation procedures.
Assist with all areas of the running of the GVI Patagonia expedition.
Assist leading groups whilst conducting scientific research transects.
Work alongside GVI and local biologists carrying out research.
Qualifications; Qualified Doctor, nurse or paramedic with minimum
2 years of experience. Expedition or Wilderness experience a definite
advantage. Spanish language a bonus. Start dates; April,
September or December 2007, but preferably a week before the expedition
starts. Duration; 1 year – long term
contract.
Position; Expedition Medic in Patagonia with GVI’s Research
and Exploration Expedition (3 months) Description;
As above. Start dates; January, April and September
2007, preferably a week before the expedition starts. Duration;
3 months – short term contract
Position; Expedition Medic on GVI’s Amazon Expedition
in Ecuador (3 months) Description; Be the
Expedition Medics in charge of all medical aspects on a tropical rainforest
expedition which is fairly remote. Manage the training of all Expedition
Members in wilderness medicine and emergency evacuation procedures.
Participate in all forest based surveys as the Expedition Medic. Assist
with all areas of the running of the GVI Amazon expedition. Assist leading
groups whilst conducting scientific research transects. Work alongside
GVI and local biologists carrying out research. Qualifications;
Qualified Doctor, nurse or paramedic with minimum 2 years of experience.
Expedition or Wilderness experience a definite advantage. Spanish language
a bonus. Start dates;
February, April, July, and October 2007, preferably a week before the
expedition starts. Duration; Min 3 months – short
term contract.
Application procedure; To apply, please send a full
covering letter clearly stating the post that you are applying for,
your availability and aims, along with a full, updated CV with contacts
for 2 referees, to the Regional Director (South America), Britt Larsen,
at Britt@gvi.co.uk.
Due to the high number of applicants, only successful applications will
receive replies. Thank you for your understanding. GVI's
website can be found here.
Costa Rica – a participant’s write-up
Jungle Medicine – Expedition Leadership Course in the Costa
Rican Rainforest by Tilman Stasch
 The
huge paw prints of a grown Jaguar were clearly visible
in the moist mud, just a few hundred yards away from our overnight camp
in the Costa Rican Jungle. Most of the people in our group of 18 doctors
had a restless night, struggling to be comfortable in their lightweight
hammocks spanned between trees festooned with lianas, moss and fern.
The only protection from nature was an army-issue poncho fashioned to
form a tented roof, thwarting the heavy raindrops expected in the wet
season, and a mosquito net for the bugs, spiders and scorpions. But
Jaguars?
I signed up for this course combining my lust for adventure and travel
with my passion for medicine. This 5-day course organized by Expedition
Medicine offered an exhilarating experience in teamwork, leadership
and survival skills, which might come in handy for a surgeon working
in the adventurous setting of the NHS.
Led by a team of three doctors with a vast experience in Expedition
Medicine, we were taught the skills and practical knowledge to become
valuable members of an expedition team. The program was organized with
interactive lectures on tropical topics and outdoors activities, which
would push us both mentally and physically.
It took a three-hour bumpy bus ride, and two hours of wild white-water
rafting, to arrive in a beautiful camp along the famous Pacuare
River, in midst dense tropical rainforest. From here we undertook
excursions into the field, learned about the dangers of nature and how
to treat various tropical diseases and injuries commonly encountered
on expeditions to this extreme environment. Two days and a night we
spent away from the safety of the camp, using our acquired skills to
set up camp beneath the canopy of the rainforest.
Owing to the excellent pre-course instructions on essential kit to
bring along, we were well equipped with quick-dry long sleeve shirts
and trousers, bandanas, mosquito head nets and various potions and lotions
to protect us against the risk of malaria, dengue fever, bot-fly infestations
and other biting, stinging and creeping creatures.
But how could Jungle Strength DEET lotion (50-70%) possibly protect
us from the most feared creature, the Fer-de-lance
(Terciopelo), the most dangerous snake of Central and South America?
Poetic a name for a viper, with a bite so deadly it inspires fear in
even the most hardened locals, it was one animal that we didn’t
want to encounter. On the first day of the course we had visited the
national Serpentarium near San Jose, and learnt about the species, behaviour
and venoms of reptiles living in the area. This viper has been extending
its territory from coast to mountains and recently begun to most unusually
breed twice a season, thought to be brought on by global warming. It
is responsible for over 2000 snake bites per year in Costa Rica, five
times more than a decade ago. If you live after being bitten, and there
is a 1% chance of not making it despite widely available anti-venom,
amputations of limbs macerated from the haemotoxic venom are commonplace.
After nearly four days in the jungle without encountering anything
bigger than a few spiders and leaf-cutting ants, our alertness for the
lurking dangers in the undergrowth was again primed to the max, when
we encountered a fully grown 2-meter specimen, curled up on the side
of our narrow, slippery path winding down the steep, densely forested
mountain.
Head cocked, it was ready to strike, and we could have easily encountered
our first casualty. We had learned how to extricate a victim from scenes
of accidents in hospitable environments on makeshift stretchers, following
a casavac plan and contacting rescue teams via satellite phone. Luckily
none of which had to be tested in reality.
While teamwork is important in the hospital setting, it is essential
when working with a group of people in extreme environments. Being constantly
vigilant for the wellbeing of ones partner, or buddy, inspired team
spirit and camaraderie. Getting to know each other’s strengths
and weaknesses enabled us to safely complete the survival tasks set
for us:
Navigating through the dense terrain with a map and compass demanded
trust in the person leading us; crossing the river that we used to raft
into our camp required intelligence, careful planning and meticulous
execution to avoid anyone being washed downstream. We learnt about ropes,
carabiners, figure-of-eight devices and harnesses. Our skills were tested
high up in the tree tops, where our so-called ‘canopy work’
consisted of climbing over 10cm thin planks of wood, wobbly hanging
bridges and pulley-rides along steel cables spanned across yawning gorges.
When put in charge of securing my collegues into their harnesses, the
pulley and the steel rope to send them off for their death-defying 200-meter
long ride 90 feet up in the air, I was reminded of the great responsibility
put to me when performing my first unsupervised operation, where I had
to put into practise the skills I had learnt, to the highest level possible.
Late at night, with all members of the team safely back to base camp,
we enjoyed yet another delicious meal of traditional Costa Rican Gallo
pinto (beans with rice), fresh fruit and the ubiquitous cup of freshly
brewed coffee. And no, we never encountered the Jaguar that must have
been watching us bushwhacking through his beautiful forest.
Author: Tilman Stasch, SHO Plastic Surgery, Norfolk & Norwich University
Hospital
t.stasch@btinternet.com
Next Jungle Medicine course is set in Borneo, from the 17th to 23rd
June 2007. Email
here for further details.
ID parade – can you tell what it is yet?
Below are two images of a couple of nasty tropical diseases can you
guess what they are? Answers to Julie@acrossthedivide.com
sorry no prizes but a warm glow inside if you get them right!
1.
2.
 A
day in the life of an expedition doctor – Dr Roger Alcock
It’s 1730 and I’m sitting on a hammock looking down into
the valley. The plaintive notes of the Andean harp drift up from where
the old man we trekked past 2 hours ago continues to play – alone
- surrounded by the Andes. After a few quiet moments I return to the
hustle and bustle of the camp as people prepare for the evening meal
after a full days trekking up from the trailhead. The hot relentless
Peruvian sun and increasing altitude have tired even the fittest members
of the group and several have diarrhoea. I walk over to the dining tent
and check that the handwashing hygiene is being observed and sneak a
quick look into where the chefs are cooking – it smells gorgeous
and it’s the warmest place in camp!
After dinner we brief the clients on the summit day tomorrow –
early start before sunrise as it’s a long, hard day. Later a local
guide Wilbur calls me across to the cooking tent. We’re honoured
to be offered a second feast of roast guinea pig and potatoes…his
wife has trekked from her village up to our camp – the exact same
route we walked – only she carried a meal for six and a 3 year
old child – and she’s returning tonight!
I wake at 0500 and immediately pack by moonlight, shivering in the
cold. Prior to breakfast I do a quick round - checking on all the participants
and staff – two need further assessment. I decide that one girl
is too unwell to trek – she is dehydrated due to D+V and headachey
with a fast pulse – thankfully we have the mules, so she agrees
to ride and have a rest day. To cheer her up I promise to ride one too
– even though horses and I don’t see eye to eye!
Breakfast over, the group requires a bit of encouragement and help
to swing into gear – I hand out lunches, help fill waterbottles
and reassure a few nervous trekkers. All too soon we head out of camp
and pause briefly by a stream for a warm up and reminder to ‘poli,poli’
– slowly, slowly in Swahili. I revert to my usual position at
the back of the group – best placed to identify and help those
who are struggling, but also the perfect excuse to stop, take photos,
exchange a few words with the local farmers and just absorb the scenery.
We progress slowly up the mountain and in the late morning reach the
summit of the pass with fantastic views of Huaca Huilca’s snow
covered peak. Celebratory photos and hugs are mixed with some crying
and reflection for the people who aren’t here – this is
a Cancer Research trek and emotions can be close to the surface.
The day continues with vast expanses of mountains and challenging descents
as the rain starts to fall after lunch. There are headaches, nausea
and general tiredness, but I’m aware that previous trips have
had medical emergencies due to the altitude – fits, angina, pulmonary
oedema, hypothermia and severe mountain sickness, so I try to keep a
close eye on everybody – including myself! Max the EL communicates
regularly by radio – often in Spanish to the local staff, but
with my rudimentary Spanish I manage to have the local guides in hysterics
when I report that 6 hairs (rather than horses – hey they sound
similar in the Spanish lingo) are approaching his group.
As the sun sets we reach camp and the temperature plummets. Everybody
has made it safely and the sick girl is much better. I wear all the
warm layers I have and sit in the entrance to my tent, gazing up at
the Milky Way, centrally displayed amidst all the moon lit snow capped
peaks and ridges.
It’s only then I remember the promise to ride the mule….
…….well there’s always tomorrow…
Author: Dr Roger Alcock, Expedition Medic for Across
the Divide Expeditions
Remote MED Bookshop
 Hunting
for your travel medicine resource? Then look no further than EML’s
online bookshop. Listed are a wide and extensive range of resources
and photos designed to provide you with information on expedition medicine.
A must for any travelling medic. Visit
here.
Final words:
'Men wanted for hazardous journey. Small wages, bitter cold, long
months of complete darkness, constant journey, safe return doubtful.
Honour and recognition in case of success'. Advertisement placed
by Ernest Shackleton in a London newspaper, August
1914. It is said 5,000 people responded to it.
'Am going to cross the Pacific on a wooden raft to support a theory
that the South Sea Islands were peopled from Peru. Will you come?'
A message from Thor Heyerdahl to Knut Heggeland, Torstein
Raby and Henrik-Hesselberg inviting them to take part in the Kon-Tiki
expedition. They all said yes!
'The most important thing, is that there is some'. Tom
Bourdillon, Member of the British 1953 Everest Team on food!
Source: ‘A Teacup in a Storm, an explorer’s guide to life’
by Mick Conefrey
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