Gazing back down the steep scree slope, a serpentine following of luminosities from headtorches breaks through the midnight obscurity. There is no sound other than the faint trudging of walking boot soles crunching against the loose earth underfoot and the cautious heavy breaths of my twenty-five companions. This is summit night.
Expedition medicine sounds glamourous at first glance. Travel to some of the world’s most remote, beautiful and exotic places, in exchange for medical skill and hard work.
Kilimanjaro is the highest free-standing mountain in the world and Africa’s highest at 5895m. Over the past few years, its popularity as a challenge trek for charity enthusiasts and adventure seekers alike has soared. This brings with it medical challenges as individuals with less physical reserve begin to attempt the summit.
As the expedition doctor, you embody diverse roles. It involves amongst other things being an emergency medic, a radio-operator, a kit advisor and a shoulder to cry on.
The Lemosho route takes in Africa’s most diverse terrain, beginning in subtropical rainforests and ascending to a flat volcanic caldera and on to isolated glacial landscapes.
The mainstay of medical input is very general – blisters, musculoskeletal problems and gastrointestinal upsets to name a few common ailments. A basic grasp of altitude medicine is vital, as symptoms can progress rapidly and can be masked effectively by the determined trekker.
Acute mountain sickness (AMS) is fairly common and many participants will experience headache, nausea and anorexia during the trek. These symptoms will usually subside with adequate time for acclimatisation, simple analgesia and good hydration.
Trauma is a concern, not in terms of acute management but because of logistics and geography. Immobilising, providing analgesia and reassuring a patient with a suspected ankle fracture is often the simplest aspect of their management.
Arranging and coordinating a team of porters to help evacuate the patient downhill over rough ground to a safe place to arrange helicopter transfer proves a little more challenging.
Managing expectation is a fairly challenging aspect of being the expedition medic, involving balancing the ambitions of the participants with your clinical judgment.
Saving participants from themselves can often be tricky. The psychology, particularly of charity geared events, often implies an investment of months of physical training, fundraising and a determination to meet the expectations of those who have agreed sponsorship and to summit, no matter what it takes.
There is often the added emotional component of participants completing these events to commemorate a loved one.
Courses in acute care and prehospital medicine are undeniably useful in developing an organised and structured way of approaching possible scenarios.
Certainly a good grounding in emergency medicine aids dealing with day-to-day issues, but the true challenge lies in reacting to the developing situation and preparing contingency plans B, C, D and often E based on patient condition, location, topography and climate.