Expedition & Wilderness Medicine » Adventure

Volunteering in Zambia

Mark Hannaford — Fri, 24 Jul 2009 12:26:37 +0000

Life In Luangwa , Zambia

“Doctor Emergency”! I had seen the blood spattered wheelbarrow parked on the veranda that served as the waiting room and now the sign of the shuffling flip flops told me I was about to meet its occupant. He entered the room uncertainly, supported between his two inebriated friends. The blood soaked tea towel adorning his head giving a big clue as to his presenting complaint. Removal revealed a 7inch gash across his forehead down to the skull. His helpful friends informed me it had been inflicted by an axe, two nights ago, in a fight and they excitedly asked me to examine his leg which had been stabbed by a spear.

Welcome to life in Luangwa or more accurately the Kakumbi Rural Health Centre. I have just returned from my second three month stint as the South Luangwa Safaris Association Medical Fund doctor. The post provides the unique opportunity for doctors to practice in a developing country whilst enjoying some Western style comforts. South Luangwa is a place where two worlds collide. It is situated in the Eastern province of Zambia, one of the countries poorest provinces in one of the world’s poorest countries. It hosts some of the worlds most exclusive safari holidays and draws tourists from around the globe. The medical fund was formed by the safari lodges as a way of importing expatriate doctors to provide medical services for the staff and guests of the lodges whilst securing access to a doctor for the local population. Kakumbi Rural Health Centre is the only clinic in Zambia to have a doctor working in it.

Work at the clinic is challenging. There is a language barrier, a cultural gulf and very basic facilities. There is no access to investigations and so most diagnosis are made on clinical grounds. A limited number of drugs and dressings are available but supply is often interrupted. The local hospital is over an hours drive away along a very poor quality, heavily potholed road. It is manned by two doctors and has microbiology, some blood testing facilities, an x ray machine and an ultra sound scanner. There is no ambulance service and patients are responsible for finding and paying for their own transport.

The health needs of the local population are huge. HIV/Aids is rife and both it and its complications often present during surgery. Diseases now confined to the history books of the Western world make not uncommon appearances. I saw cases of Tuberculosis, Syphilis and Rheumatic Fever during my three months visit. Other more unusual cases include snake bites, crocodile attack and foot trauma due to entanglement in a bicycle wheel. Trauma is a frequent occurrence in the community: children fall in open fires; builders fall off roofs; fishermen get hooks in their eyes and people assault each other. My stay spanned the wet season and in early March the number of confirmed cases of malaria started to rise. By month end it became evident that a full blown epidemic was likely and by mid April we ran out of malaria rapid diagnostic test kits and Co-Artem, the first line drug treatment. A week later supplies of quinine were down to less than 10 adult doses. On most days the clinic resembled a hospital and resources and staff were stretched to the limit. Sadly deaths started to occur as more severe complications such as cerebral malaria started to appear in young children.

The doctor is constantly on-call for the safari lodges but the workload is carefully managed and fitted around work at the clinic. After hours call outs are minimal and luckily I did not have to deal with any major emergencies on this trip. Zambia lacks medical facilities of a standard suitable for most tourists and therefore any problems arising either have to be dealt with by the doctor or medivacced to South Africa. Thankfully most visits to the lodges for guests are for minor problems; diarrhoea, lost tablets etc but serious medical problems and major trauma have occurred in the past. There aren’t however many places in the world where when returning from a “ home visit” you can come across a sleepy pride of lions snoozing on the road or giraffe gracefully grazing in the bushes.

Life in Luangwa is far from all doom and gloom. The valley is stunningly beautiful and the National Park is alive with wildlife both big and small. The doctor has very graciously been granted free access to the park and after a testing day at work there is nothing better than spending a few hours unwinding with a cold beer watching elephants frolic in a mud bath or a spectacular African sunset across a Hippo filled lagoon. There is plenty of opportunity to really get to know and understand the wildlife of the area and local guides and residents are more than happy to help you make the most of the experience.

I have thoroughly enjoyed both of my visits to the South Luangwa valley. I have immensely enjoyed working alongside the local staff and have learned a lot from the nurses. I have re-honed my clinical skills and revelled in the freedom of the autonomy of working in a very different health system. “Life in Luangwa” gives you a fascinating insight into the challenges that face rural Sub Saharan Africa in the 21st Centaury and I would highly recommend the experience to any doctor who is looking for a clinical challenge: who is willing to adapt to an unfamiliar environment and who has the relevant skills and experience to be able to feel comfortable in such a remote but awesomely beautiful place.

Dr Rhona Whiston May 2009

Desert Medicine Traininng Course in Namibia

Expedition and Wilderness Medical Training Courses for medical professionals

EWM supported Indian Ocean rower Sarah Outen’s progress so far

Mark Hannaford — Sun, 07 Jun 2009 23:02:28 +0000

Expedition and Wilderness Medicine has been supporting Sarah Outen’s attempt to row across the Indian Ocean by providing specialist medical training, advice and support. Sarah is now well into her challenge and you can follow her incredible progress via her website – Sarah Outen’s Indian Ocean rowing expedition.

Expedition and Wilderness Medicine Director visits South Georgia

Mark Hannaford — Mon, 23 Mar 2009 20:04:10 +0000

Black and White view of South Georgia

In March of this year Mark Hannaford was lucky enough to get a fantastic photographic project down to South Georgia and the South Sandwich Islands with the Scott Polar Research Institute (http://www.spri.cam.ac.uk ) and the South Georgia Heritage Trust (http://www.sght.org ).

Mark tells us about this project, SPRI and the amazing history behind these islands. “Prior to landing I asked a colleague, well known naturalist Dr Peter Cary, if it was realistic to compare South Georgia with the Galapagos Islands and his reply ‘only if you want to downplay South Georgia’. Which surprised me but the islands lived up to and exceeded any expectations that I had.

Firstly however where is South Georgia? Lying about three days sailing to the east of the Falkland Islands the territory is a collection of remote and inhospitable islands, consisting of the largest island of South Georgia which measures approximately 106 miles by 18 miles and a chain of smaller islands known as the South Sandwich Islands lying about 400 miles to the south-east. The island was first sighted in 1675 by a London merchant called Anthony de la Roché and later by Captain James Cook during his remarkable journey who circumnavigated the island and then landed to claim for the crown naming it ‘the Isle of Georgia’ in honor of King George III.

Commercially the islands came to prominence in the early 1900’s when a number of large whaling stations where constructed by Norwegian companies to exploit the extremely rich waters, the stations where extremely successful and at one stage over 40,000 whales where being killed in the Southern Ocean, a large proportion being processed at South Georgia’s whaling stations. It is remarkable that the whale population has been able to survive at all with this rate of slaughter and a testament to how rich these oceans can potentially be in marine life if whaling is banned completely.

South Georgia is also closely associated with Sir Ernest Shackleton and his remarkable feat of leadership. After his ship the Endurance was crushed by ice in the Weddell Sea on October 1915 he led his 28 crew members in three small boats to the remote Elephant Island where they set up an extremely inhospitable base camp. Then Shackleton and five companions, including New Zealander Captain Frank Worsley the master of the Endurance, set sail in one of the small boats, the James Caird, on one of history’s epic journey to get help from Norwegians on South Georgia. In a miraculous feat of seamanship Worsley navigated the James Caird across the stormiest seas in the world under the constant threat of capsizing and hardly a clear view of the storm clad skies with which to get a sextant fix. Arriving at the glacier ridden cliffs of South Georgia fifteen days later they were forced to stand offshore for a further frustrating day whilst they waited for hurricane force winds to batter the island. The next day the storm, which had sunk a 500 ton steamer nearby, had abated and they were able to land on the uninhabited south shore. Rather than risk another sea journey Shackleton decided to cross the island on foot without a map or any local knowledge of the terrain, travelling with just Worsley and fellow Irishman Thomas Crean he trekked across glaciers and mountains to stagger a day and half later in the whaling station of Stromness. British explorer Duncan Carse retracing their footsteps in 1955 wrote ‘I do not know how they did it, except that they had to, three men of the heroic age of Antarctic exploration with 50 feet of rope between them, and a carpenter’s adze’. In 1922 Shackleton returned to South Georgia on his last expedition where he suffered a massive heart attack and died on the 5^th of January.

In honor of him his crew erected a memorial on King Edward Point near Grytviken and then set sail for England with his body onboard. However, upon reaching Montevideo, Leonard Hussey a veteran from the Imperial Trans-Antarctic Expedition received a telex from Emily Shackleton, the ‘bosses’ wife requesting that they return to South Georgia and bury her husband there. Shackleton is buried in the graveyard at Grytviken. Shackleton’s doctor wrote ‘think this is as “the Boss” would have had it himself, standing lonely in an island far from civilization, surrounded by stormy tempestuous seas, and in the vicinity of one of his greatest exploits.’ The islands most recently came to the worlds notice during the Falklands conflict when a group of Argentineans, posing as scrap metal merchants, occupied the abandoned whaling station at Leith Harbor on South Georgia. On 3^rd April the Argentine troops attacked and occupied Grytviken. The islands where recaptured on the 25^th April as a result of Operation Paraquet.

The work for the Scott Polar Research Institute (SPRI) revolved around getting some high quality images of Grytviken and its natural surroundings and for the South Georgia Heritage Trust (SGHT) some imagery of their remarkable museum located in the former whaling manager house at Grytviken for a new brochure (http://sgmuseum.gs/mediawiki/index.php/South_Georgia_Museum ). Whilst past the main breeding period the beaches of the island where covered with the massive belching stinky bulk of Elephant Seals and frustratingly aggressive Fur Seal pups attempting to already assert the mastery of their particular stretch of beach. A peek out of my window at King Edward Point I was able to watch a colony of King Penguins move towards the sea and Antarctic Terns fishing offshore all highlighted by the backdrop of the dramatic glacial clad peaks of the Allardyce Range and Mount Paget. There are few places that are quite as stunningly sublimely beautiful as South Georgia, mans hold on the island is tenuous at best reliant upon regular boat resupplies from Port Stanley but nature hold is remarkable by in tenacity and abundance.

With six days to complete the task and the weather not always working with me the hospitality and assistance of the staff at the British Antarctic Survey base at King Edward Point helped me capture what I think isn’t too bad a collection – visit the Across the Divide blog to judge for yourself (http://mark1066.wordpress.com/ ).

Help support SPRI. Across the Divide has been connected with SPRI for a number of years running an annual charity dog sledding adventures in the Arctic which helps raise invaluable funds for the Institute – if you would like to help and even just journey in the High Arctic with a dog team for company then why not sign up for next years dogsledding challenge here http://www.acrossthedivide.com/openEvents/charityopen.asp

Thanks to:

MV Discovery operated by Voyages of Discovery (http://www.voyagesofdiscovery.com ) for giving me a lift down to South Georgia.

The British Antarctic Survery (http://www.antarctica.ac.uk ) who accommodated Mark, at their base at Grytviken where his project was based.

Linblad Expeditions (http://www.expeditions.com ), based in New York, who picked me up by their new flagship expedition ship the National Geographic Explorer and given a lift in to Cape Town. The whole trip relied on a great deal of help from other people and organisations for which I am very grateful.

: Relics of a whaling industry – looking out over Cumberland Bay

Jungle Medicine course – Costa Rica

Mark Hannaford — Wed, 17 Dec 2008 01:34:41 +0000

Course director Dr Sean Hudson writing about the Jungle Medicine Training Course in Costa Rica

Back in Costa Rica again and the jungle didn’t fail to provide the perfect environment for the course. As one would expect, it was hot, wet and full of interesting fauna and flora. I never fail to be impressed by the beauty of the jungle, but by god it can be hard sometimes. Its one of the few places I visit that can be so harsh then so comfortable. The moment you start to feel comfortable in the jungle is that Nirvana moment.

It took a while coming this trip because of the heavy rain but we eventually made it. Mike, Ceri, Mark and Martin again excelled themselves and the addition of our new herpetologist bringing snakes into camp was great. The best new addition to the course this year was however the HENNESSEY HAMMOCK, it is without a doubt the best bit of expedition equipment I have come across. 18 people in the jungle in some of wettest conditions I have experienced and everyone was dry, or if they weren’t they didn’t let on. Quite incredible.

Other than the medic feeling a little queasy on the river, everyone escaped injury and illness. Other than the EL developing drucunculiasis that is! but he’s got to have something to winge about. Back next year and I’m looking forward to it already.

Find out more about Expedition and Wilderness Medicine and about the Jungle Medicine Training Course in particular

Expedition and Wilderness Medicine support for Commonwealth Championship for Mountain Running and Ultra Distance.

Mark Hannaford — Fri, 12 Dec 2008 10:34:41 +0000

Expedition and Wilderness Medicine

Expedition & Wilderness Medicine are to provide the medical cover for the Commonwealth Championship for Mountain Running and Ultra Distance. The events will run over four days in September 2009, and Keswick has been chosen as the venue.

Expedition & Wilderness Medicine Director, Dr Sean Hudson is acting as the Medical Director for the event and overseeing the medical care for the many international and local competitors who will be involved in a number high profile races. In conjunction with Across the Divide they will be managing the medical logistics and communication for the event.

Join Expedition and Wilderness Medicine on Facebook

The perfect Christmas gift!! The Expedition and Wilderness Medicine Handbook

Mark Hannaford — Tue, 02 Dec 2008 09:00:03 +0000

Well look no further – what could be better than the Expedition and Wilderness Medicine Handbook written by the guru on the subject, Dr Sean Hudson with contributions from other experts.

Get your copy for Christmas

‘An invaluable resource for anyone planning a trip in the outdoors, either as part of an expedition or a wilderness adventure’

The climber Andy Cave IFMGA mountain guide, mountaineer, author and conference speaker was even more effusive in his praise;

‘As I was reading this manual I found myself frequently exclaiming “God if only we’d have had this book back then!” I will be keeping it very close to hand on my next adventurous trip I can promise’.

You can read more of his review here | REVIEWS

See the different chapter headings | CHAPTER HEADINGS

Order you copy here £18 – the real thing, £15 – download | ORDER YOUR COPY NOW

Remember if you sign up for an Expedition Medicine course you get a copy with EML’s compliments.

Expedition and Wildnerness Medicine website

Solo across the Indian Ocean

Mark Hannaford — Wed, 15 Oct 2008 08:50:44 +0000

A very exciting, record-breaking, and ever so slightly crazy sort of challenge. It involves a small boat, some oars and over 3,000 miles of Indian Ocean.

Sarah Outen | Row the Indian Ocean

Expedition Medicine has recently been approached by a great British explorer maybe read ‘eccentric’ in the making, Sarah Outen who plans, in memory of here rather to row single handed across the Indian Ocean in 2009. Sarah has asked us to provide a tailored medical training course designed specifically around her needs which we are happy to do.

But so inspired by her challenge are we that we are also offering ongoing support and provide a regular feature on her progress through our regular Enews – if you don’t receive it yet you can sign up by clicking here, and also via this blog – so watch this space…

…a bit more detail, in Sarah’s own words,

In Spring 2009 I will row solo from Western Australia to Mauritius in a bid to become the first woman, and youngest and fastest person, to make the crossing.

Rowing up to 12 hours a day under a scorching sun, riding 30ft waves, battling winds and currents, sharks, capsizes and shipping traffic, it will be a test of endurance, stamina and my sense of humour. It will be raw and elemental – just as adventure should be.

it’s not all about the records

The venture is dedicated to my lovely Dad, who died suddenly in June 2006. He had suffered terribly with rheumatoid arthritis for as long as I can remember, so in his memory I am fundraising for the Arthritis Research Campaign.

A biologist and outdoor enthusiast, I love the creatures to be found at sea and want to encourage others to appreciate them, too. After all, what we love, we save. My journey will be a green one, as far as possible, and aims to encourage responsible stewardship of our planet, especially of the blue stuff.

Row the Indian Ocean

Diving Medicine and training in Oman – Dr Lesley Thomson

Mark Hannaford — Wed, 09 Jul 2008 15:51:11 +0000

Most of my diving has been in cold water. Not just the American definition of cold water, being anything less than 18ºC, but properly cold! UK winter diving of 5-6ºC for example, or Arctic Russia and Antarctic winter diving with sea temperature down to -1.8ºC, together with air temperature down to -20ºC.

Perhaps it’s the splendour of travelling to dive by skidoo, ice particles glinting in reflected sunlight all around, breathe freezing on the scarf around my neck. Or is it the battle with the elements, when spindrift snow enters every crevice of clothing and covers the newly cut ice-hole. Or the continuous struggle to keep equipment warm and dry, to prevent freshwater ice from entering then regulator and causing a free-flow. Excitement is present with every dive, senses ready to detect the first rattle of ice forming in the regulator, a pull on the rope to signal a problem, or the eerie whistle of a seal singing beneath the ice!

Diving during the Antarctic winter is an extraordinary experience and I feel very lucky to have had this rare opportunity. The Antarctic continental land exhibits extremes in physical characteristics and severity of climate. But underwater, seasonal sea temperature fluctuations are minimal, often varying only between +1 to -2ºC, making Antarctic waters one of the most thermally constant environments in the world. These cold waters, however, have a vast seasonal change in nutrients, providing abundant summer food to an array of marine organisms. Summer diving may resemble diving in pea-soup during plankton blooms, but in winter the visibility allows spectacular diving conditions. As the sea freezes, wind no longer stirs up the surface. Sea ice restricts light filtering to the water beneath, limiting plankton and algal growth. Particles settle out of the water column, icebergs ground and become fixed in the frozen surface. The challenge of SCUBA diving in these conditions includes drilling or chain sawing an ice-hole, protecting equipment against cold, keeping the tender on the surface warm against raw winds and freezing temperatures, and working as a team to ensure safe underwater work, managing scientific instruments and cameras whilst wearing 8mm thick neoprene mitts!

Under-ice diving is becoming more accessible to the adventurous (or mad?!) diver as centres in Russia, Norway and Canada run ice-diving courses. When Expedition Medicine first discussed a course in Medicine for Marine Environments, I thought that encompassing this with under ice diving would be ideal! The idea didn’t last for more than a breathe, and anyone wishing to go on the course will be pleased to hear that it will be run in Oman – in warm water!

The aim of the course is to provide medical and expedition experience for doctors hoping to go on future expeditions. We’ll experience a desert environment, based in a bay beside the Arabian Sea, with local guides and camp staff for support. Geographically we’ll be about 2½ hours south of Muscat, the capital of Oman. The minimum requirement for diving on the course is PADI Open Water Certificate, and there is opportunity before or after the course to gain further dive experience or qualifications at one of the Omani PADI Dive Centres.

We aim to provide an unforgettable experience of the marine environment, using daytime sessions of practical skills and lectures in the evenings, to enhance your understanding and enjoyment of the marine environment, and to enable you to be a bonus to any expedition. Fitness to dive, diving equipment, water rescue, boat handling, search and rescue techniques, dangerous marine creatures, sea kayaking…and more!

The course speakers have a vast range and depth of experience. Dr Mark Reid is an expert on marine animals and has previously worked alongside Steve Irwin. He has organised and led many diving expeditions. Mark Hannaford, Managing Director of EML is a power boat instructor, Director of Across the Divide Expeditions and leader of many desert expeditions. Rob Conway is a doctor form London, working at the Mayday Hospital London, who is also the founder and medical advisor for Blue Ventures. I have experience in diving Medicine from the hyperbaric units in both Aberdeen and Plymouth, and have conducted diving research whilst working in the Antarctic. I hope to give lectures on decompression illness, decompression theory, and under-ice diving!

Oman is a safe and friendly country that welcomes western visitors. Dress requirements are m ore relaxed than many neighbouring countries, and head cover is not required for women outside mosques. The rugged interior contains mountain ranges contrasting dramatically with desert plains and interspersed with lush valleys. The coastline is over 1000 miles long, with areas where mountains plunge directly into the Arabian Sea.

Oman offers the best diving in the Gulf. Underwater visibility consistently ranges between 15 – 25 metres. During October, the air temperature should be a pleasant 25-30ºC, but several degrees cooler at night. We will be staying in tents, with meals provided by local cooks. Sea temperatures are expected to be between 24-28C, thus probably only requiring a 5mm wetsuit. During the summer months (April to September), as the sea temperature rises, a 3mm wetsuit would suffice.

The range of marine life is amazing! There are a large number of endemic corals that have learnt to survive in sea temperatures above their normal temperature (over 30C during summer!). We hope to sea Spinner dolphins on the surface, and beneath the waves the colours will amaze you! Coral varieties include Table, Brain, Stag and Teddy Bear corals; several varieties of moray eel – Zebra, Honeycomb; sharks such as Lemon and Black-tip Reef sharks; turtles, lobsters, Sting Rays, Eagle Rays, sea cucumbers, octopi, sea slugs, various sea anenomes, Barracuda, Blue Triggerfish, Spotfin Lionfish, Blue Tang, Cornetfish, Parrot Fish, – to name only a few of the myriad species!

So, if you’re one to get excited about diving a new environment, and want to learn expedition techniques whilst enjoying an exotic location, come and join us!

Dr Lesley Thomson

Is a lecturer on Expedition Medicine’s Polar Medicine and Diving Medicine Training Courses

Expedition Medicine launches a new course on Dartmoor

Mark Hannaford — Wed, 11 Jun 2008 19:38:43 +0000

Our highly rated Expedition and Wilderness Medicine Training Course is heading south.

We are really excited about our new course – following the same schedule as our Lakeland course and with many of the same inspirational faculty we have linked up with Dartmoor’s premier training faculty, the Heatree Centre located near Newton Abbot to provide an additional course in May.

We are hoping that will make the travelling time shorter for some of you and reduce to carbon footprint of the courses, we will of course be working with the Woodland Trust as well to identify one of their projects close by which the proceeds of the course will help support.

Expedition and Wilderness Medicine Dartmoor Course

Expedition Medicine

A participant’s write up – Polar Medicine Training Course February 2008

Mark Hannaford — Wed, 26 Mar 2008 13:13:57 +0000

The setting for this year’s polar medicine training course was Alta, a small settlement, 72 degrees north and well within the arctic circle. A place with a deserted high street where you would be lucky to see one other passer by every 15 minutes, easily explained by a temperature at least ten degrees below freezing and a good foot of snow on the ground.

Base camp was a 40 km drive along icy roads to a picturesque mountain lodge by the name of Ongajoksetra. At the higher altitude the temperature was that much lower and if a wind was blowing, temperatures as low as minus fifty could be achieved. We were introduced to the Scandinavian team who would teach us methods of navigation across such tough terrain in harsh conditions and also to the Expedition Medicine team who would teach us polar medicine in a series of lectures and practical sessions both in the classroom and in the field. One more group I must not forget to mention is the team of fifty sled dogs who would provide another mode of transport across the snow.

My first day involved skidooing up a mountain demonstrating the importance of protective clothing, navigation aids and preparation for travel in severe blizzards with visibility of approximately two metres, sudden drops in temperature and rapid weather changes. I realised that without our trustworthy guide, Espen Ottem, we could become hopelessly lost in such conditions where you would be unable to survive more than a couple of hours at most. Our dog sledding guide, Pre-Thore was the perfect example of this as he told us of the time where inadequate preparation resulted in frostbite, blackening of his fingertips but fortunately no amputation. This story made me somewhat paranoid about the daily pain and numbness in my hands and feet when outside in the cold for prolonged periods. A “buddy system” was paramount to preventing frostnip. Simply by having that small exposed area of skin, pointed out to you to cover up

Dr Leslie Thomson, a consultant anaesthetist who had first – hand experience of polar medicine after spending several years in Antarctica taking part in the British Antarctic Survey gave an excellent lecture on hypothermia, bringing home how hypothermia is not just a condition seen near the poles but also in the Saturday night party goer who collapses under the stars, the homeless and the elderly. We were taught how to treat by various re-warming methods and when to commence C.P.R in the hypothermic patient sending home the message of not pronouncing death until warm and dead in certain individuals. This information was demonstrated by the story of Dr Anna Bagenholm , a 29 year old doctor who fell into icy water whilst skiing in Northern Sweden, immersed for approximately an hour, her body temperature was 13.7 degrees centigrade. C.P.R continued for three and a half hours alongside re-warming techniques such as bypass, bladder / stomach / peritoneal lavage and warm intravenous fluids. She survived to become the person with the lowest body temperature ever to survive.

Expedition and Wilderness Medicine obviously feel that first- hand experience is the best way of teaching and as a result each member of the group had to undergo cold water immersion. Prior to undertaking this challenge we were kindly taught about the cardiac arrhythmias that can be induced by the shock of entering the water, the short term cold water gasp reflex increasing the chance of aspiration and swimmers failure! One by one we stepped up to an ice hole in our thermal underwear and in the more daring members of the group a little less! to swim across icy water. I can confidently say that was the coldest I had ever been. As if several knives had been plunged into my body, breath taking and inducing chest pain, I swam across water of ridiculously low temperature to attempt getting out of the hole using my ski poles

Of our nights spent in the field we were taught how to construct snow holes. Five hours later our own little home with two double beds, stove, cupboards and shelves for our candles was constructed. It was as comfortable as it could be on a mountain side with winds blowing outside dropping the temperature to twenty below. I was amazed that the snow hole was so warm at five degrees compared to the outside however a slight air of nervousness was in the back of my mind as my avalanche detector slowly flashed in the corner and a rope attached to a spade inside connected our holes to other holes in case of us having to be dug out. The course perfectly demonstrated how to survive in such conditions

In summary the course prepared 25 everyday doctors to be able to traverse the polar landscape, recognise and competently treat local cold injury and hypothermia as well as to be safe expedition medics capable of caring for their groups and evacuating when required. To spend a week in such a location gave me the upmost respect for those who live in these regions and cross the landscape as part of everyday life, as well as a great respect for the land. In a day and age of global warming and melting of the polar ice caps it becomes paramount to look after our environment, to take only photographs and to leave only footprints.

Dr Claire Roche, Clinical Fellow in Emergency Medicine Countess of Chester Hospital. See the BMJ article.

The next expedition medicine course will be in Desert Medicine Course which will be held in Namibia, August 17th -23rd 2008.

To see the full range of Expedition and Wilderness Medicine Training Courses see here.