Essential Healthcare Amid Dust and Desolation in Southeast Ethiopia
MSF doctor Anna Greenham describes work and life in the Somali region of Ethiopia

“Life in the Somali region of Ethiopia is tough. The rains have failed, food is running out and even the camels are dying of thirst. Add to this a complex armed conflict and you have a recipe for disaster. Nomadic people can’t find water or grazing for their livestock and are forced to travel huge distances to survive. Many have lost everything. Without a livelihood they move to the edge of towns where they live in squalid conditions in very basic shelters, unable to access clean water or food. It is in one of these small rural towns, Wardher, that MSF provides the only reliable health care for a dispersed population of about 40,000 people.

Wardher town is a dusty, bleak place. Most people live in tin roofed shacks or mud huts. There are only dirt roads, no running water and electricity only works for a few hours a day. There is a market but hardly any fresh food is available.

You would probably be shocked if I gave you a tour of our clinic. Things are very basic. Crowds of anxious patients wait outside on benches for consultations. Some have walked for days to reach us. Many have tried traditional therapies first and only access the clinic when they are critically sick. The sickest patients are referred to our inpatient department where two large tents with mats on the floor function as wards. It may look chaotic but it is amazing what we can achieve with so little. As well as primary and secondary health care we support a TB program, feed around 100 malnourished children, provide routine antenatal care, vaccinations and even mobile clinics to isolated villages. By training local staff we hope to leave something behind when MSF eventually leaves the area.

Most of the children are dying from simple illnesses- diarrhea, chest infections, preventable childhood illnesses such as measles and malnutrition. We use IV fluids, antibiotics and nutritional support to nurse these children back to health. Amazingly, most of our patients do recover, despite the limitations of what we have to offer. Some are not so lucky. It is so sad watching a baby die from pneumonia, when in a more advanced setting they would easily survive. The nearest proper hospital is 2 days drive away so this is rarely an option.

When I am not volunteering as a medical doctor for MSF I work as a General Practitioner in the NE of England. Next time anyone complains about the National Health Service there I suggest they put themselves in the shoes of a typical nomad like Fatima*, who walked for 4 days with no food or water to reach the clinic with her 4 month old baby. She was so exhausted that her breast milk had dried up. Her baby weighed only 2.5kg and was close to death. We were able to admit them both to our inpatient ward and the child is slowly improving with intensive nutritional support. She is one of the lucky ones. Many others are not strong enough to make the journey.

Work can be very frustrating. I am so busy during the day that I never have time to finish anything properly! I juggle ward rounds, reviewing complicated cases in our out patient department, admitting emergency cases, doing minor surgery in our small dressing room and assisting difficult deliveries. Add to this training local staff, sorting out human resource problems and trying to chase goats out of my ward, I hardly know whether I am coming or going. It can also be stressful living and working in an area of armed conflict, with severe restrictions on any form of social life.

Despite all the difficulties and challenges, I do love my work. It is so satisfying seeing critically sick children recover, when without the efforts of the MSF team they would certainly perish. MSF is not only providing health care, our presence in Wardher also gives hope to what is a very neglected population”.

Note
MSF has delivered vital healthcare to communities in the Somali region of Ethiopia, on and off as necessary and where possible, since the 1990’s; where the population struggle to survive amid numerous challenges, not least an ongoing conflict between governmental and rebel forces.

*False name to protect anonymity

Expedition and Wilderness Medical Training courses for medical professionals.

We are delighted to announce that Sir Chris Bonington will be delivering the Rupert Bennett Memorial lecture.

Our next Expedition and Wilderness Medicine training courses are in March and May 2010 and we are very excited to have booked the prestigious Plas y Brenin National Mountain Centre, North Wales for the course in May.

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.

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Expedition Medicine Christmas eNews December 2008

Santa Church

EML’s Christmas Crackers

Christmas is nearly upon us and to help us all beat the credit crunch we have been working hard to secure you some fantastic and EXCLUSIVE discounts.

Not only are we offering discounts on some of our challenge events but we also have suppliers giving us some great offersWe hope you enjoy! Get your copy for Christmas

Looking for that special medic gift – look no further! 

‘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’

Buy or download your copy here.

DISCOUNTS FOR EML CUSTOMERS

JUST WALK
We are offering £10 off the 60km walk and £5 off the 40km walk. Just Walk is a stunning walk over the South Downs allowing you to raise funds for the charity of your choice. There are four distances to choose from, 10km, 20km, 40km or 60km. Sign up now at

ADVENTURE RACES
We are offering £20 off the registration fees on the Namibia & NEW Spanish Ultra Marathons. These events are aimed at those wanting to push themselves to their limits, ideal if you want to raise funds for the charity of your choice and fancy a real challenge! Sign up now at http://www.adventure-racing.org/

OPEN EVENTS
It’s so easy to sign up, choose a challenge, choose a charity, register then start fundraising for the experience of a lifetime! We have an inspirational range of challenges and we are offering £20 off the registration fees for the following Open Events

All offers end midnight 31st December 2008. Discount is taken off the registration fees and can only be used with online bookings.

Hi Ho Silver 15% discount Our neighbours at Hi Ho Silver are offering ATD customers a HUGE 15% saving at their online shop. A beautiful range of silver jewellery and gifts with the additional bonus of a gift chooser and gift wrap. Delve in, discover and buy from their fantastic range. Just enter the code UhwkGqj when at the checkout. T&Cs: Exclusively redeemable online at www.hihosilver.co.uk. Not valid on sale items, e-vouchers and in conjunction with any other offers. Offer ends on 24th December 2008 at midnight. Promoter: Hi Ho Silver, registered in England No. 5042138.

Montane in partnership with The Climber’s Shop 15% off We have been working with Montane for a number of years now and like us they are passionate about the outdoors. They have performance clothing for any activity from biking to hiking to climbing. They have negotiated for ATD customers a 15% discount with one of their top customers: The Climber’s Shop. To claim your discount visit the website and enter the code CHONOS at checkout. Offer ends midnight 20th December 2008.

20% off at Lonely Planet Booked your ATD next trip? Then you might want to grab a copy of the Lonely Planet. They are offering you a 20% discount* off all Lonely Planet guidebooks. So lose yourself in depths of Norway, find yourself trekking in India or unearth some hidden gems on your home turf.To redeem the offer, visit http://shop.lonelyplanet.com load up your basket and enter the promo code: ATDLP20 *This offer may not be used in conjunction with any other promotion and excludes theme packs, digital products, travel gear and delivery charges. Offer ends 31st March 2009. You must enter the promo code ATDLP20 to redeem the discount.

15% off at Nomad Travel Store Nomads have been kitting out travellers with clothing, equipment, books, maps, medical supplies and vaccinations for nearly 20 years. Prepare for your next ATD adventure with the 15% discount they are offering ATD customers. Visit their online store where you can shop for all your goods for your next ATD trip. The code you need is ATD1000. The discount does not apply to medical items or the shipping cost of the order (although orders over £75 after discount will have free delivery anyway).

up to 15% discount at Trek Hire UK If you don’t want to buy yourself new kit for your ATD adventure then why not hire? Trek Hire UK can offer you the latest gear at very competitive hire prices, and even better they are offering discounts to ATD customers. If you spend £50 or more you gain a 10% discount if you spend £200 or more you get a 15% discount (this is great if there is a few of you!). To redeem this offer just call them on 01306 886333, promotional code is ATDTH20.

Profeet is a new concept in custom fitted footwear such as running shoes and ski boots, providing the ultimate in fit, comfort and performance. Their unique 3D FIt System utilises biomechanical video gait analysis and foot scanning, the creation of custom insoles and the selection of appropriate footwear.They are offering ATD customers up to 25% off – email Julie for more details but hurry only a few vouchers left.   Cotswold Outdoor is an outdoor retailer which has been around for over 30 years. They have one of the most comprehensive ranges of outdoor clothing and equipment in the UK. They are offering ATD customers a 15% online discount, simply use the promotional code AF-ATDE-Y8 when the promotional code box appears in your basket. T&C’s: Exclusions include: Gift Vouchers, Rock Bottom goods (both shown online and carried in store), sale items, previously discounted goods (N D coded items), DVDs and specially ordered goods. (These items will be correctly priced at point of sale). In addition, this offer cannot be used in conjunction with any other affiliation, Cotswold offer or discount. Expires 31st December 2008. Only available online. Once you have added your goods to the shopping basket, please enter the Promotional Code AF-ATDE-Y8 in the promotional code box (not case sensitive but you need to use the hyphens.

]]> http://expeditionmedicine.wordpress.com/2008/12/04/expedition-medicines-christmas-madness/feed/ 0 Mark Hannaford tromso-church Expedition and Wilderness Medicine Handbook DogSled ATD_logo_125w JW IcelandUltra Hi_Ho montane1_ LonelyPlanet Nomad Trekhire profeet Cotswold_red_logo http://expeditionmedicine.wordpress.com/2008/12/02/the-perfect-christmas-gift-the-expedition-and-wilderness-medicine-handbook/ http://expeditionmedicine.wordpress.com/2008/12/02/the-perfect-christmas-gift-the-expedition-and-wilderness-medicine-handbook/#comments Tue, 02 Dec 2008 09:00:03 +0000 Mark Hannaford http://expeditionmedicine.wordpress.com/?p=203 ]]>

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

Media Medical Logistical Support

At Expedition and Wilderness Medicine we are aware that many TV projects are getting more adventurous and travelling to more remote environments. In these circumstances it is vitally important to have a qualified doctor or medical professional on site should the unexpected happen. Many locations do not have first world medical facilities and an Expedition Medicine medic equipped with the latest mobile medical kit and satellite communication can provide the peace of mind to allow you to focus on the production of your project. 

We can provide full medical cover for production teams and celebrities on your television or photographic project worldwide. We have an impressive portfolio of experienced medical professionals on our books, many of whom have media experience both on and off camera. Using Expedition and Wilderness Medicine to provide your medical cover resolves some of the most important logistical and safety considerations of foreign travel in remote environments.   Through our ties with Across the Divide Expeditions we are also able to assist in the provision of outdoor specialists and logistical support in the worlds most remote locations.

We also provide other expedition equipment, preparation and back up services such as:

• Expedition Leader
• Casualty Evacuation Plan 
• Risk Assessment 
• Pre-expedition medical advice for all crew 
• Satellite phone 
• Radios 
• Medical Kit including fluids and drugs 
• Gamov Bag 
• 24-hour phone medical cover

A selection of our customers          

Ginger Productions

BBC Natural History Unit (NHU)

ITV 2

Pirelli Calender

Price list

Please be aware that this structure can be adapted to suit the needs of your project since no two expeditions or remote locations are alike. We work with you to define your needs and recruit the appropriate medical professional. 

‘I’d just like to say thank you for all your help – I’ve had lots of applicants through Expedition Medicine from all over the world, so that’s been really great. For your information, as of late Wednesday afternoon we have found our medic, so I no longer require our ad to be ‘out there’ so to speak!’ … ‘We would definitely consider using Expedition Medicine in the future, if a suitable role comes up’. C.M | ASSISTANT PRODUCER | BBC NATURAL HISTORY UNIT 

Satellite driven ‘reach-back’ facility

Expedition Medicine are in the position to offer a satellite driven ‘reach-back’ facility to UK based doctors. We are able to provide medical advice to clients in the field on all medical issues from primary care, tropical diseases and through to emergency medical conditions. 

We can act as your specialist medical back up; supporting and empowering you to effectively deliver medical services in remote or hostile environments. 

Access to this facility is just a phone call or satellite communication away.
We can provide 

• The capability to communicate via BGAN or Irridium satellite communications directly with the UK accessing real-time advice on dealing with the most demanding medical situations
• We can provide the equiptment and the expertise for you to feel confident and comfortable in any hostile or remote location. 

High lift jack demonstration - Namib Desert

More Information

For specific information about your media project or expedition please ring Piers Carter, Expedition Projects Director on 07801 104604 or email Piers, our media manager here.

All of Expedition Medicine’s doctors carry medical indemnity underwritten by UK based companies.  Part of the conditions of contract with Expedition Medicine specifies that in the event of a medical negligence claim, all parties agree to disputes being settled under British Law, in British Courts.

Expedition and WIlderness Medicine

Namibia was the location for Expedition Medicine’s first Desert Medicine Course 

The dramatic landscapes of Namibia

2009 dates for Desert Medicine Course; 19th – 25th of April.

Author: Dr Claire Roche

A country famous for its Skeleton coast, an eerie graveyard of numerous shipwrecks which have fallen victim to its rough waters, home to towering sand dunes and of course Africa’s “big five”. Tucked away in South West Africa, Namibia is a country of mystery with a unique landscape and proved to be one of the worlds’ best possible locations in which to learn expedition medicine, desert style.

After undertaking a four day 4×4 self drive safari prior to the course I soon became aware that a lack of understanding of such terrain could have deadly consequences. Described by explorers as “hell on earth” and described in the bible as “the dust of death”, the desert environment can kill in a matter of hours.

A destination popular with European holiday makers and best enjoyed by taking self drive safaris, Namibia’s International airport is a hub of car hire companies. Tourists are pouring onto Namibia’s roads with no journey preparation or experience in handling 4×4 vehicles on off road terrain. This was demonstrated when I crossed paths with a group of four female German exchange students who ventured out to the popular beauty spot of Sossulvei dunes and petrified forest. They had hired the most economical car which was completely unsuitable to gravel roads (which make up the majority of Namibian roads outside of the major cities) and a momentary lapse of concentration resulted in the car sliding out of control, ending up on its’ roof in a field bordering the road. Fortunately no passenger was injured and help passed within the hour but this daily occurrence on Namibian roads has claimed the lives of many tourists and locals. We exchanged stories at a desert lodge as only the previous day I too managed to end up stranded after our 4×4 became lodged in sand whilst visiting the same area. Our only saving grace was that this occurred in a popular area where passers-by stopped to help within half an hour, however if this was to have happened two days previously whilst we had been traversing similar terrain in a desolate area of the skeleton coast I dread to think of the possible implications, especially as the day was drawing in and we had not seen another car in several hours.

Namibia is home to multiple tales of travellers making the mistake of leaving their vehicle to find help and falling victim to temperatures of 50 degrees and limited water availability. Prior to starting the course my experiences made me desperate to feel self sufficient in this unforgiving environment should I ever have the misfortune to be stranded.

Male Namib Rock Agama, Damaraland - Namibia

Base camp for the course was a 5 hour drive from the capital city of Windhoek to the Brandberg Range, in a region named Damaraland in the north west of Namibia. The first thing I noted was that the term “desert” was an umbrella term for multiple types of terrain. Besides the obvious rolling sand dunes, deserts can be dry, barren and rocky areas or vast, open, dusty plains extending for miles. In this location there was no readily available running water, electricity or mobile phone signal. Just 20 single man tents surrounded by a jaw dropping backdrop of the surrounding desert. From my previous Expedition Medicine experience of Polar and Jungle courses, once again, they had excelled themselves in choice of location for their course. As the sun went down and poured its’ pink heart into the desert floor we sat around natures’ television, warmed our feet and listened to what was planned for the first desert medicine course over the coming week.

We were led by our fantastic guides: Volker, Faan and Korbus, on our first of many desert treks. A ten hour “stroll” in 45 degrees of heat, across plains and gorges. We learnt how to navigate our way using GPS (global positioning system), maps and compasses but the first skill we had to obtain was that of finding water in this apparently bone dry environment. We headed for gorges and began to learn the art of animal tracking. The desert is a maze of animal tracks, the most intriguing to me was that of the desert elephant. An animal that required 12l+ of water per day so if you could find the animals the chances were you could find the water. We were taught water purification techniques and fire lighting. I noticed how morale was boosted in camp when fire was lit as it became dark and the temperature began to drop and also how important fire was to cooking, signalling and keeping warm. The only downside was the unwelcome visitors it attracted such as scorpions, insects and hyenas. The nights spent away from base camp with no tent to protect us I became quite aware that the desert was buzzing with life. As the lights went out the odd call of the barking gecko and the laugh of the hyenas made me feel most vulnerable and somewhat uneasy.

Our first day brought heat related illness to reality as several of the group complained of nausea and headache. Yet to be fully acclimatised, the harsh environment was already having an effect. One member needing to be cooled in the field after developing lightheadedness and tachycardia we were given first-hand experience of minor heat related illness and learnt in the form of lectures about more severe heat related illness. Interestingly we found that measuring temperature is of insignificant value when comparing to the signs and symptoms and is often inaccurate.

Over the week we learned more and more about the flora and fauna of the area and how to treat snake, spider and scorpion bites. To enforce what we learnt we were introduced to a snake handler who brought a variety of snakes and scorpions for us to see and to help demonstrate envenomation. Most snake bites are dry bites and the waiting for symptoms to develop can be distressing. We undertook a practical where venom was taken from a puff adder and added to 5mls of freshly venesected blood. After 20 minutes of being left to stand the blood had still failed to coagulate demonstrating the effects of envenomation.

In desert regions the most common mode of transport is by vehicle and after my experiences prior to the course I had lost all confidence in handling a 4×4 over rough terrain and vowed never to do so again! But the desert medicine course gave me the opportunity to practice extraction of a 4×4 lodged in dense sand or mud using multiple handy tips from our amazing guides who when in their company I felt so safe. We were taught the use of the car if stranded – water in the radiator for drinking, sparks from the battery to generate fire, mirrors for signalling to aircraft and shade from the burning sun. What we learnt was enforced by tales of those who had left their car and fallen to dehydration, heat stroke or the sampling of flora which proved to be toxic.

On our final day all we had been taught was put into practice in a scenario situation.

Divided into groups of ten whilst trekking we came across a familiar patient lying in the scrub having been bitten by a snake. I must say it is a credit to the expedition medicine team of instructors as both groups located their patient, washed the wound, applied a compression bandage and splint, improvised a stretcher, transported the patient 2kms to an arranged rendezvous using GPS and radios, erected shelter and made a small fire in under 20 minutes. The final day was made extra special when we successfully tracked a herd of desert elephant to a water source. To see these amazing majestic animals who had hidden themselves so well all week except for their tracks was in a word, awesome. This was an experience that no game safari could have given me especially when we were “false charged” in an effort to protect their calves. This was the point at which it was time to go back to civilisation, go back to our electricity, showers, iPods and double beds with some profound memories.

Desert Elephant near Brandberg Mountain, Namibia

Expedition medicine courses join my two loves of travel and medicine. They do not just teach everyday medics medicine relevant to an environment but also how to survive and care for others in these environments. With this knowledge travel to previously hostile, remote destinations becomes safe, possible and enjoyable. There is a great world of travel opportunity and as Winston Churchill aptly said a century to the year ago ” for the formation of opinion, for the stirring and enlivenment of thought and for the discernment of colour and proportion, the gifts of travel, especially travel on foot, are priceless”.

Dr Claire Roche | Junior Registrar in Emergency Medicine | Gold Coast Hospital

The next Expedition medicine course will be in Diving and Marine Medicine, Oman, United Arab Emirates, October 2008.  

The next Desert Medicine Course is scheduled for the 19th – 25th of April 2009.  Please register your interest with Expedition Medicine at  admin@expeditionmedicine.co.uk or 01460 29 80 29

Visit the Expedition and Wilderness Medicine website for more details

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

We’ve just received some excellent feedback from one of our previous UK course delegates,

“Since attending the Keswick course in 2006 I have accompanied four charity treks as medical officer with different companies.The course has proved invaluable and I can strongly recommend the training provided by Expedition Medicine to anyone wishing to act as a medical officer”

Have a look at the Expedition & Wilderness Medicine website for further information, www.expeditionmedicine.co.uk