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.

Join Expedition and Wilderness Medicine on Facebook

For medics interested in working on a diving or kayaking expedition, how do you get relevant experience and information at a one-stop shop?

You could read lots of books about diving medicine, combine this with lots of diving and kayaking, but the question can still be asked, “How do I round off the experience and is there a course tailer-made for medics like you?”

Thankfully, the answer is now ‘yes’! The internationally-recognised medical training provider, Expedition and Wilderness Medicine, has now delivered its’ first ‘Expedition and Wilderness Medicine – Diving and Marine Medicine’ based in the Bandar Khayran area of Oman. This course, delivered by a close-knit team of highly experienced presenters, covers a range of relevant topics like expeditions and expedition diving, diving medicine, venomous and poisonous animals, boat handling and kayaking. While based at a basic camp on a secluded beach, you’ll attend morning and evening lectures and in-between dive beautiful reefs less than ten minutes away by boat. You’ll also get exposed to expedition conditions as you kayak through the breathtaking but inhospitable terrain of the Bandar Khayran, set up your own remote camp, cook dinner over the fire and sleep under the stars.

The final dive is on the amazing ‘Al Munnassir’ wreck, where you’ll be rewarded by a breathtaking array of marine life, a must for any diver travelling to Oman. For anyone considering working as a medic on a diving or kayaking expedition, this course must be included as an essential item in your kit list!

The Diving & Marine Medicine training course takes place each October contact Expedition and Wilderness Medicine for more detials

About the author;  Mark Read is a wildlife biologist who specialises in things that bite and have the potential to kill you. One of Australia’s most respected crocodile biologists, Mark has spent 15 years working with these animals in Australia, Papua New Guinea and South Africa.

He also has extensive knowledge and experience with snakes, and terrestrial and marine venomous and poisonous vertebrates and invertebrates. He has experience leading expeditions and research teams in remote locations; counting, catching and researching crocodiles and marine turtles and trying to learn more about these miss-understood animals.

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

Expedition and Wilderness Medicine recently ran it first highly succesful Desert Medicine course in Namibia and it was highlighted on the course that one of biggest dangers facing you in remote locations is actually the travel there and back in local transport.

Below Faan Oesthuizen of Kaurimbi Expeditions gives his top tips for defensive four wheel driving.

High lift jack demonstration

• Only place light bulky cargo on roof racks or high on vehicles in order to keep the centre of gravity as low as possible.
• Place heavy cargo low in vehicle load beds and as far as possible forward in order to distribute more weight onto the front wheels and avoid uncontrolably light steering response.
• Ensure that luggage is stowed where no damage to property may ensue. 
• Ensure that all cargo is thoroughly secured in load bins or tied down to prevent loss of equipment and luggage while vehicle is moving or stationery.
• Driving on Gravel and Dirt Roads:  It is of critical importance that a speed of 80 km per hour is never exceeded whilst driving on gravel or dirt roads.  Speed will be further reduced when approaching curves or blind rises in the road, or when approaching oncoming traffic.
• Overtaking should be kept to a minimum whilst driving on gravel or dirt roads. Following distances will be kept sufficiently long as to ensure that driving in the front vehicle’s dust is avoided at all costs. 
• Great care will be taken by all drivers to sufficiently reduce speed prior to entering bends or curves in the road, and that extreme control is maintained to prevent the vehicle from losing its traction whilst negotiating the bend.
• You should at all times ensure that you have as the absolute minimum 2 x 25 litre containers of water, a jack, spare tire, tow rope and jump leads