Dr Rachel Saunders
Core / Specialist / Gp Trainee
I'm an SHO, but I don't have your typical ward based job. In the last four years I have treated in jungles, underwater (in scuba gear), 5m from a gorilla, up a volcano, on a beach, at altitude, on safari, in a bog and on a boat. I'm an expedition medic :)
I'm an SHO, but I don't have your typical ward based job. In the last four years I have treated in jungles, underwater (in scuba gear), 5m from a gorilla, up a volcano, on a beach, at altitude, on safari, in a bog and on a boat. Expedition medicine is a great way to travel the world, take time out whist expanding your CV, and be physically and mentally challenged and develop your skill and knowledge base. As a doctor, you can undertake expeditions during your 'spare time' but it is more common for doctors to go on expeditions between F2 and specialty training. This is the ideal time either because you have been working for the last 7 years and either you need a break, the NHS has broken you, or you don't know what you want to do with your career and need time to think. At this point I would recommend using your F2 course/study budget on an Expedition Medicine course. They are expensive, but the knowledge and skill base you gain makes you more prepared and competitive for expedition jobs. There are many types of Expedition Medicine jobs ranging from endurance sports races to scientific expeditions. Although the jobs differ, there are many ailments common to all. You should expect to treat diarrhoea and vomiting, insect bites, blisters, cuts, injuries, and GP complaints such headaches and exacerbations of chronic illnesses. More serious injuries and illnesses can occur so it is good to be prepared as possible. To help, ensure your medical kit is labelled and organised e.g. labelled cannulation kit, emergency kit is always accessible and you are familiar with the casevac plan. Your role as an Expedition Medic involves more that the treatment of clients. A typical job also includes client selection and education, risk assessment, updating casevac plans, stock-checking kit, health promotion, project management and writing debriefs. What's Right For You? If you're keen to do Expedition Medicine, first think about where you want to go and then for how long. Think hard about these choices. A 6 month expedition through the jungle sounds exciting, but if you don't like spiders, creepy-crawlies and leaches, and the furthest you have travelled is an all-inclusive to Mallorca, then it might be best to start with a 4 week expedition in France. When you have an idea of what you want to do there are many organisations that you can apply to, including: Operation Wallacea Raleigh Across the Divide World Challenge Floating Doctors Doctors Without Borders Royal Geographical Society Action Challenge GapForce Each organisation will have different aims, clients, resources and responsibilities so pick one that suits you. Have fun and feel free to post any question below.
Dr Rachel Saunders
about 8 years ago
As a hospital doctor, surgeon or GP we encounter death frequently. We quickly learn to cope. It helps when we know that we have done everything within our power to prevent death. When death is close we have the ability, medication and specialists services to make the process as 'comfortable' as possible. In the final moments it is rare that the patient is alone; whether in the company of family, friends or health care professionals. When an individual dies on expedition it may have been avoidable, you have very little kit to prevent it, they may be alone and they probably were your friend. No one prepares you for the potential of a client dying. But it happens. First of all, I am not trying to put you off doing an expedition. I love expedition medicine and have dedicated the last five years of my life to it. But I was not prepared for my first near death experience and I want to make sure you are. AVOIDABLE DEATHS During an expedition injuries, near misses and deaths are sometimes avoidable. There may have been a faulty bit of kit, medication which wasn't packed or route marker that fell down ... Hindsight is a wonderful thing. You, the team and the organisers work within what is feasible and normal health and safety don't and can't apply. I am NOT saying it is ok to be negligent, but a degree of pragmatism is need. What you need to remember is the competitors/ clients are aware of the dangers and, as medics, we should be too. LIMITED KIT Many medics are shocked by the lack of kit taken on expedition. But you need to think about the environment you are in and then think rationally. If your nearest decompression chamber is 3 days away by boat, is there much point taking oxygen on a diving expedition? If you are on expedition in the middle of the jungle is there any point taking a defib if any client in need of a defib is unlikely to survive extrication. You have to work within the limits of your environment and with the kit you have. As the medic you need to be aware of the nearest hospital and their facilities, the nearest large hospital with surgical and ITU facilities and the casevac plan. THE CLIENTS During expeditions the clients often become good friends. You will experience their highs and lows and share incredible experiences. This makes it especially hard when unfortunate events occur. At this point our role as medic often broadens to counsellor and bereavement officer. The other clients, organisers and medics need support during this time. Try to start this process whilst you are out there. Even with near misses, the psychological effect on people can be huge. Signs and symptoms are generally easy to spot, but screen for them at clinics. Be aware during race events that grief may manifest though clients pulling out, loss of performance and increased injuries due to lack of sleep, low mood or poor concentration. No matter what happens when you are on expedition my advice is; you can only work within your skill set and with the equipment you have. As a foundation doctor, if you’re faced with an unresponsive client - you are not expected to perform RSI and intubate. Work through your ABCDE and work within your limitations. If you would like to suggest any other blog topics or have any questions please post below.
Dr Rachel Saunders
almost 7 years ago