Newsletter
MAY 2008
Hello to all our readers and welcome to the latest edition of the Expedition Medicine eNews.
We have lots of exciting news in this edition; Dr Sean Hudson in Botswana; Desert Medicine News; Expedition Medicine Course Handbook now on sale and Erik McLaughlin writes about the prevention and treatment of blisters! We still have places left on our Jungle, Diving and Desert courses and our UK course in September, so get your skates on before you miss the boat on these.
We hope you enjoy this edition of eNews and happy reading.
What's in this issue:
Course news -what’s going on and where
We have our usual favourite courses lined up, as well as our NEW Desert and Diving medicine courses. Our courses are getting very popular with the Polar and EML UK courses always being oversubscribed. We think our new courses will be just as popular.
Polar Course - Norway 15th - 21st February 2009.
LIMITED TO 24 PLACES
A winter extreme climate expedition medicine course for or anyone wanting to work in a polar, high altitude or arctic environment. For further details click here.
EML UK Course - Keswick, Cumbria 9th - 12th september 2008.
LIMITED TO 60 PLACES
Held in the stunning Barrow House, Keswick this course is for anyone aspiring to become an expedition medic. Read about the recent course in the BMJ for further details about the course click here.
NEW FOR 2008 Desert Course - Namibia 17th - 23rd August 2008
LAST 8 PLACES LEFT
Expedition Medicine is delighted at being able to offer a comprehensive course for all those medical professionals responsible for clients, patients or team members in a desert environment. The course aims to introduce participants to the skills required to be a valuable member of a desert expeditionary team, and to care for and treat injuries and illnesses likely to occur in this harsh environment. Set in the stunning Damaraland area in Namibia, for further details click here.
NEW FOR 2008 Diving Medicine- Oman 2008 18th - 24th Ocotber.
LIMITED TO 30 PLACES
We are very excited at being able to offer an inspirational Diving & Marine Medicine Course for all those medical professionals responsible for clients or expedition team members in a diving or marine environment. The course aims to introduce participants to the skills required to manage the common medical problems, which may emerge in a diving or marine environment. For application forms or further details visit our website.
Jungle Course - Costa Rica 9th - 15th November 2008.
LIMITED TO 30 PLACES
Our jungle course is going from strength to strength. We are now running our third course in Costa Rica. Ideal for those interested in tropical and jungle medicine. For further details click here.
NEW | Expedition & Wilderness Medicine Book now on sale
 We are delighted to announce that you are now able to purchase one of the most comprehensive written handbooks compiled. Available as a downloadable PDF for £15 this A5 book by Drs Sean Hudson and Caroline Knox, is all you need to have if you are thinking of working in expedition or wilderness medicine.
‘An invaluable resource for anyone planning a trip in the outdoors, either as part of an expedition or a wilderness adventure’.
The authors have condensed the essentials of expedition and wilderness medicine into this marvellously detailed field guide. They have drawn together some of the most experienced medical expeditioners in the world to ensure the second edition is packed with practical advice on managing medical problems in the wilderness.
To download your copy NOW click here.
Desert Medicine Course | Namibia
 Expedition Medicine are very excited at being able to offer a comprehensive course for all those medical professionals responsible for clients, patients or team members in a desert environment. The course aims to introduce participants to the skills required to be a valuable member of a desert expeditionary team, and to care for and treat injuries and illnesses likely to occur in this fascinating environment.
Our Desert Medicine Course is based in Damaraland, an area bounded to the south by the spectacular Namib Desert, to the east by the Kalahari, Ovamboland to the North and the world famous Skeleton Coast to the west. Overshadowed by Namibia’s highest and most impressive peak, Brandberg – which means ‘burnt mountain’ and whose Omukuruvaro name more aptly means 'mountain of the Gods' and whose massive bulk covers over 650 km² and with its peak Königstein at a height of 2573 m. Our training area is a natural reserve for specially adapted desert elephants and rhinos, which we hope to see during our week long stay. The top of the mountain is a large, flat area, that due to its height and inaccessibility, has been largely isolated from the surrounding countryside. This inaccessibility has created a unique ecological area, in which it is suspected, new species are yet to be found.
We have some fantastic lectures and practical assignments planned, including: desert trekking, animal tracking, setting up camp and building shelters, to name a few.
For further details on the Desert Medicine Course visit our desert course page.
Dr Sean Hudson in Botswana | Medical Cover with a Difference
 As a medic for expeditions I seem to have spent the majority of my working life in remote and sometimes hostile environments working with robust individuals in fantastic but often dirty and sometimes unpleasant conditions. Its the harshness of the situations that allows you to reflect on the work and feel more comfortable and appreciative your daily life at home. Occasionally jobs come along that are different and stretch you in different ways, either supporting agencies after natural disasters or setting up clinics in Antarctica. This spring however I was offered the opportunity to provide medical support to a production company in the Okavango Delta in Botswana, doing a fashion shoot. Having just set up our expedition media branch of the expedition medicine company it was a perfect first job. From the beginning it was obvious that this job was going to be slightly different. The location for the shoot was in the most exclusive lodge in the Delta, which runs elephant back safaris, at $15,000 for 5 nights it was slightly more than I would normally pay. We would also be flying down to the Kalahari Desert for a night with the Bushmen, to witness the shaman perform healing ceremonies in shamanistic trances. On top of this I would be looking after 39 personnel from the fashion industry, including a number of well known models. I try not to have preconceived notions of people and nationalities, but the thought of looking after a group of European fashion divas did fill me with a sense of dread. I was however happily surprised from an early stage by the experience, forbearance and eccentricity of the group. There were no dramas, hissy fits or tantrums, and fortunately for both myself and my medical indemnifiers, no serious medical conditions to treat. It was a different experience however, which I found incredibly entertaining and will be looking forward to repeating in the future. So if we ask you if you're interested in providing media cover for expedition medicine in the future, say yes as you never know where you'll end up and who you'll end up treating.
P.S. The chap in the photo is the bushman shaman (Doctor meets Doctor)
For your next adventure visit our situations vacant page.
Mountain Medicine Course | NEW for 2009
 We are planning a new course in 2009, to conclude our course portfolio.
The main content of the mountain medicine course is to introduce medics to the practical elements of working and providing medical cover in the mountains. The instructors aim to familiarise the team with the fundamental skills which are essential to treat and evacuate casualties in the mountains as well as covering the common conditions encountered at altitude. Where else could we run this course but in Nepal. In order to experience winter conditions in the mountains the course will be run in the beautiful amphitheatre and ridges of Annapurna with the sacred mountain of Machapuchere as a backdrop. At this time of year the snow cover is low and the team will be able to train and experience the environment without undue exposure to high altitude.
It's a stunning country and we believe will make a fantastic course.
To express an interest email Luci.
Erik McLaughlin | Blister Prevention and Treatment
 Blisters…everybody gets them and nobody likes them. Nothing can slow down a decent run or hike quicker than a hotspot on the feet, and it only gets worse from there. There are probably just as many “sure-fire” fixes and tricks for blister prevention as there are threads in your lucky socks. There are many ways to skin this cat, and here is mine.
First, understanding how and why blisters form is key in developing a prevention strategy and a treatment plan. The skin is made up of two main layers, the dermis (thick, inner layer) and the epidermis (thin, outer layer). When heat, caused by friction, forms a “hot spot” on the skin, the layers of the skin begin to separate and fluid fills the space. This is a blister. The key concept, to me, is the role of moisture as a lubricant between the sock and the foot. The more wet the foot and sock, the more friction potential. This is important for discussing prevention.
There are many methods and commercial gear to help with blister prevention including socks, sock liners, lubricants and various tapes and pads. The method I have had the best success with was actually shown to me during one of my first adventure races. Roll-on or stick deodorant, which is actually also an antiperspirant, is liberally applied to all surfaces of the feet, including the tops, bottoms, between toes and heels, etc. When I say “liberally” I mean about a half of a stick per foot. One entire roll-on should be used for both feet. The point is to make a coating that prevents moisture collection and formation, as much as possible. Over this deodorant covered foot goes your sock. Some people have advocated the use of a thin, silk sock-liner as a first layer. If you choose to try this method, make sure to use a band of duct-tape at the top of the sock-liner, to hold it up to your ankle and prevent it from sliding down, forming a ball in the toe of your shoe. The key is to never remove the socks, because it will mean a need for reapplication of another stick of deodorant. This method has served me quite well, for up to 9 days, without a need for reapplication or a blister formed.
Now, once the “hot spot” begins to form, the trouble begins. There are several methods for treating this stage of blister formation. Perhaps the most popular, and rightly so due to its effectiveness, is the application of moleskin. A square of the moleskin is cut and a whole is the cut in the middle of the square, approximately the same size as the hot spot. The idea is to elevate the sock and source of friction from the hot spot, using the thickness of the moleskin. If the hole is not cut in the moleskin and it is just placed, as a sheet, over the hot spot, friction rubbing can still occur. This happens because the two layers of skin are already “de-laminating” and fluid is accumulating in the blister. So instead of having friction on the outer surface of the skin, the friction is actually between the two layers of skin, under the hot spot. Cutting the whole in the moleskin prevents this.
The time it takes a blister to form, from a hot spot, can vary. I have found it to be almost exactly the amount of time it takes me to reach my next long ascent, on the trail. Treating a blister is a hot topic of conversation and debate. There seems to be two main camps: the poppers and the non-poppers.
Popping a blister, or lancing it, has several advantages and disadvantages. When the fluid is released, the person generally fells less discomfort due to pressure release. However, this method has several disadvantages. First, the possibility of introducing infection is always present and a good cleansing of the area and sterile equipment are required. Another consideration is that the now empty blister has two layers of skin that have a tiny space between them, where the fluid used to be. This means more friction and worsening of the blister with reoccurrence likely. For this reason, I always try to remove the top layer of skin from the blister and apply a sheet of moleskin to the entire area. A first-aid antibiotic cream can also be applied before the moleskin sheet goes on. Over this sheet of moleskin I then apply duct tape, to prevent any slippage. This is my second favorite method of blister treatment, but I always try to avoid removing the “roof” of the blister unless it spontaneously pops or drains on its own. I am sure everyone understands how tender the skin under a blister can be.
When I treat a blister, I try to get to it before it has popped. This requires good communication between hikers and team members with the medic. Hot spots should be mentioned early and decisions made on where and when to treat. The time to hear about a blister is not after is has popped and become infected, requiring slowing of the team or possible evacuation.
My favorite method for approaching a blister is to drain and refill with tincture of benzoin. After cleansing the area, thoroughly, I used a sterile 1cc syringe to drain the blister, careful to make only one puncture in the blister’s “roof”. Once drained, I use a separate needle to draw up some tincture of benzoin and refill the blister. I am careful to make sure I enter the blister through the puncture already made, during drainage. Making a second puncture will aid in the blister roof coming off and add another way for the tincture of benzoin to escape. The purpose of the benzoin is to fill the “potential space” left by draining the fluid. Once in the blister, the benzoin hardens in about 10 minutes and forms a greenish “pea sized” form under the roof of the blister. This keeps the roof of the blister attached to the skin and prevents friction between the two layers of skin, within the blister. Once the trip is over, the tincture can be removed by simply unroofing the blister and rubbing the benzoin off. The new skin, under the blister will have also had some time to toughen up.
My blister kit contains several items and gets its own compartment in the field kit:
1cc “insulin” type syringes
moleskin
alcohol prep pads
tincture of benzoin
duct tape
antiseptic towelettes
About the Author: Erik McLaughlin MD, MPH. Resident doctor in Family Medicine, Masters of Public Health in International Health and Complex Humanitarian Emergencies, Diploma in Tropical and Travel Medicine. Chicago, Illinois but originally from Tucson, Arizona.
I am awaiting completion of my residency years to focus on expedition/travel medicine and global health, full time. I speak 4 languages and am always trying to learn more. I like outdoor sports like trail running, mountain biking, rock climbing and kayaking. Prior jobs have included professional multi-sport athlete, firefighter/EMT and pizza delivery. When I am not working, I drink wine and travel. But, I love to work!
www.adventuredoc.org
Situations Vacant
We are getting more and more exciting media positions on our website as well as the usual interesting expeditions. Raleigh International are looking for Doctors and Nurses/Paramedics from the 23rd June - 14th August for a post in India, email Nicola Burwood, for further information; BSES require a medic for Peruvian Amazon post July-August 2008. Please visit our situations vacant page – for an opportunity of a lifetime click here.
Just Walk 2008 - RESULTS
.jpg) It was our second year and what a great success. It was a glorious day, we had over 400 walkers on the event, covering a total of 12,540 km's and raising over £400k for over 117 different charities. Our first 20km walker took only 3 and a half hours to cross the finish line and the first group to complete the 60km challenge took an impressive 11 hours including their rest stops!
'We had a fantastic time and thoroughly enjoyed ourselves; this was mainly down to the outstanding organisation and wonderful staff. The atmosphere was brilliant. We will see you again next year.'
Details for 2009 coming soon, but register your interest now at www.just-walk.co.uk.
Join Across the Divide on a fundraising challenge
 Open charity challenges are designed so you can raise money for a charity of your choice - it could be your local hospice or a major cancer charity. Across the Divide have been delighted at the response to their new open events for 2008 and 2009 .
For 2008 we have a few places left on our Peru, Kilimanjaro and China events. In 2009 we have some fantastic NEW events including:.an India bike ride, Trekking in Jordan and a project in Namibia- so book now to avoid disappointment later. Find out more about Across the Divide here.
For further information on our open events email Susan McDonagh.
Blog links
If you have your own blog and you think it is an interesting read for other expedition medics then please contact us and we'll see about linking to it.
Iceland Laugavegur Ultra Marathon July
The "Laugavegur" course is one of the most beautiful in Iceland, stretching from Landmannalaugar in the highlands to Thorsmork, a natural reservation area. The area is famous for the yellow, orange and purple hues of the surrounding mountains.
The race blazes a trail through moss fields, meadows of wool grass, steam springs, and bizarre lava formations, where various blossoms defy the raw climate.
The race ends at Thorsmork, described as Iceland’s brightest pearl, surrounded by rugged mountains and beautiful glaciers. To view further details about this race click here.
Sales Manager and Ultra marathon runner Steve Clark has recently returned from completing the marathon. Read about how he got on here.
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