Volunteering in Zambia

 

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.

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Jungle Medicine course – Costa Rica

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 Jungle Medicine training 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 Medicines Christmas madness

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

Across the Divide is delighted to offer the following discounts on the events listed below. We hope to see you soon on an ATD challenge!

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

Exhilarating India Bike Ride 7 – 16 March 2009

Three Cities Bike Ride – London – Brussels – Amsterdam 18 – 22 June 2009

London to Paris Bike Ride 24 – 28 June 2009

 

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.

Lonely Planet, Nomad Travel Store & Trek Hire UK…

 

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 & Cotswold Outdoor…..

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.

How do I use a hyperbaric chamber? What are the alternatives?

Hyperbaric Chamber

The concept behind the 3 main portable hyperbaric chambers is they effect a physiological descent by inflating the air impermeable bags above ambient atmospheric pressure. The extent of the descent is dependent on the altitude at which the bag is used and the pressure to which they can be pumped. The patient is placed in the bag lying down (which can be claustrophobic), there is a window for the patient to look through, the fabric of the bag is thick but a conversation can be undertaken. If the patient has difficulty lying flat put the bag on a slope.

Oxygen can be placed inside the bag with the patient. It is worth ensuring the patient has something comfortable to lie on and has a sleeping bag if they get cold. Conversely if its day time the bag needs to be in the shade to avoid ‘boil in a bag’. The bag is zipped up and the bag inflated slowly using a foot pump until the pop-off valve hisses (at around 2 psi). The pressure then has to be maintained by continuing to pump but at a slower rate.

The patient is normally kept in the bag for about an hour, as long as they remain stable in the bag. As pressure increases, the patient needs to be warned to equalise if they are able. It may be worth giving the patient a bag to vomit in if required. Occasionally the zips burst, leading to rapid depressurization and the risk of barotrauma. When reducing the pressure to get the patient out do it slowly, the zip can normally be opened slowly when the side of the bag dimples on pressure.

What are the advantages and disadvantages of this piece of equipment? 

Advantages: Lightweight well tested, robust. All the equipment weighs aproximately 7kg. Fast to use, inexpensive in comparison to the others. 

Disadvantages: Still costs £1500 or so, the zip can breakdown and is the weak point. No carrying handles if you wanted to physiologically and geographically descend simultaneously. 

Who makes hyperbaric chambers?
The Gamow bag is the oldest design. The other bags are the PAC and the Certec. Both as good and lighter.  The Certec uses a different pumping system, which can be tiring. 

Gamow Bag.   The Gamow does not have handles but can be carried on a stretcher if absolutely necessary.   You can read more about Gammow Bags and their inventor, Igor Gamow, scientist, classicist, professor, adventurer, at web.mit.edu/invent. Gamow is the son of the famed physicist George Gamow, a co-author of the Big Bang Theory and the first to propose the genetic code. 

Where can I hire a Gamow Bag?
They can be hired from Expedition and Wilderness Medicine see our Media Support Page for more details.

More About CERTEC Bags.   The present CERTEC hyperbaric chamber is an improved version of a hyperbaric chamber that was originally designed in 1989 by a French and German team.

The color of the new CERTEC hyperbaric chamber is not orange but yellow and blue.

Its design is different from all other pressure bags (Gamow, PAC, etc.) since it is comprised of two bags in one:

An outside envelope made of very strong material (to withstand tension) and good friction (for stability on any surface) , an inside envelope made of polyurethane (for airtightness) 

Advantages of this double envelope design are: 
it is rugged and durable
good protection of the airtight inner envelope 

All air valve systems are doubled for security:
two inflation valves
two automatically opening preset valves (220 mB) 

A very large window allows contact with the person in the bag.

Two full length zippers (inside and outside bags) allow easy in- and egress.

The inflation pressure is 220 mB, corresponding to a virtual descent of about 2500 m (depending on the actual altitude).

Total weight of the CERTEC Hyperbaric Chamber is 4,8 kg (carry bag and pump included).

It comes with a very efficient double effect pump (i.e. that pumps during up and downstroke) has a volume displacement of 3,7 liters for each pump cycle.

Only 4 pump cycles per minute are necessary to keep the CO2 in the bag at acceptable levels.

The price of the CERTEC Hyperbaric Chamber is $2300. It can also be rented. 

Advantages: Higher pressures, though it isn’t known how clinically important/useful this is. The bag is lighter than the Gamow. The double-wall system should provide more durability.

Disadvantages: Similar to the Gamow bag, the Certec is expensive, around $2300. I have not seen the newer Certec bag, and my comments are based on the older orange model. I found the (old) pump to be quite difficult to use as it required bending over at the waist (see photo at top of page); it was very fatiguing. As in the Gamow® Bag, fresh air must be regularly pumped into the bag to prevent CO2 buildup.

More about The PAC® (Portable Altitude Chamber)
Dr. Jim Duff, an experienced climber and expedition physician, has developed a nice alternative to the Gamow® and Certec® bags. The PAC (a coated fabric bag) is about the same size and weight as the Gamow, but more of a mummy shape, so there is more room around the head and shoulders. It also develops a 2 psi pressure, equivalent to the Gamow bag. The PAC is much cheaper than the Gamow bag and is probably the most sturdiest of the three hyperbaric bags on the market.

The main design difference, however, is in the radial zipper at the head end. This opens the whole head end and makes access far easier than either the Gamow or Certec bags. This is especially important with large and/or comatose patients (ask anyone who has tried to stuff such a patient into the Gamow bag!). There is no pressure gauge, instead there is a clear pocket on the inside of the window, so you can insert an altimeter and watch it from outside. 

The external, dangling pressure gauge on the Gamow Bag is vulnerable to wear/damage and subsequent leakage, something avoided in the Certec by having the pressure gauge set flush into the bag. I should note that the presence or absence of a gauge does not affect treatment; the pressure gauge or altimeter is merely a reassurance that the equipment is functional, something that is easy to ascertain in straightforward ways, ie, the bag inflates and the pop-off pressure control valves hiss. 

Note that with the PAC the maximum pressure is limited by the pop-off valves to 2 psi, but you can adjust the valves to a lower pressure to accomodate patients who have trouble clearing their ears. Instructions for using the PAC are printed right on the side of the bag, as is a table showing the equivalent descent at various altitudes, a nice touch. This bag has recently been used in the HRA Pheriche clinic and seems to be durable.

Advantages: The shorter zipper and simplicity of design has resulted in a bag that is far cheaper than the other available alternatives: US$1,200 including delivery almost anywhere in the world. The end-opening design is a major advance in terms of ease of getting patients in and out

Disadvantages: No significant disadvantages.

Web Resources
High Altitude Medicine Guide
Gamov’s entry in Wikipedia
Climbing High
Interview with Igor Gamow
PAC Technology

About the author
Dr. Sean Hudson is a Fellow of the Royal Geographical Society and on the expeditionary advisory board for Summit. Sean has been involved in a wide array of expeditions over the last 18 years. During this time he has trekked across the Darien Gap, The Thar Desert, worked as a trekking guide and Chief Medic for Raleigh International in Namibia and Zimbabwe, a trauma medic in Columbia and ski field doctor in New Zealand. Since 1998 he has worked for Across the Divide Expeditions as medic and expedition medicine advisor, providing medical cover on expeditions in 21 different countries. Dogsledding to Desert trekking in Namibia. In 2002, he and his wife, expedition medic Dr. Caroline Knox, helped to established Expedition and Wilderness Medicine, which seeks to provide comprehensive training for medical professionals working as expedition medical officers in a variety extreme and remote environments.

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

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.