First steps in expedition medicine

Authors: Lawrie Kidd, David Hillebrandt 

Publication date:  18 Jun 2013


Expedition medicine is becoming increasingly popular. Lawrie Kidd and David Hillebrandt look at where doctors interested in working in this field should begin

Expedition medicine is by no means new, but it has become much more mainstream in recent years. This partly results from the popularity of expeditions and holidaymakers’ desire for a trip of a lifetime, as well as the ease of international travel and the effect of seeing celebrities climbing mountains.[1]

The medical career path now offers natural gaps between foundation years and core training and between core training and specialist training, as well as opportunities for post-training sabbaticals. These provide perfect opportunities to go away, and a lot of people are looking to do something different.

Getting a job on an expedition is not always easy and you need to fulfil certain criteria. You must be able to fit into an expedition team, cope physically and mentally with the expedition, and deal with the medical issues that arise during an expedition.

Fitting into the team

Showing that you can work as part of an expedition team is essential, and this can be demonstrated in a number of ways. When proving this for an expedition, rather than for a training interview or an e-portfolio, you must show that you can cope with adversity and situations away from the sterile and controlled situations of a hospital. This might mean working at local sport or charity events to show your flexibility and willingness to help, going on informal expeditions with friends, or becoming involved with local teams from the British Association for Immediate Care (BASICS; [Link] ). Commercial organisations providing logistical support to charity events can also provide experience, as well as financial remuneration.

It is worth considering UK based expedition charities, as these provide an excellent stepping stone to other expeditions. Organisations such as Raleigh, Operation Wallacea, and Coral Cay Conservation all adhere to British safety standards and run well managed expeditions that require medical support.[2] Should things go wrong, they have the advantage of being well supported. Raleigh, for instance, requires formal casualty evacuation planning for all expeditions and its expeditions are a fantastic way to show your skills and suitability and are a valuable addition to any expedition CV.

Coping physically and mentally with the expedition

As well as showing that you can fit into the team, you will also need to have the skills and attributes to cope with the expedition. The skills that might be expected of you will depend on where you hope to work and what you intend to do. Some of these are hard skills, such as the Mountain Training Association’s mountain leader award or Professional Association of Diving Instructors’ qualifications, but the most important thing is to ensure that you will not be a hindrance. You must be physically and psychologically able to cope with the demands of the trip and be able to help others when called upon.

The mental challenge of an expedition setting is unique and something for which you need to prepare. Not many people enjoy sitting out a storm in a tent with limited food and no iPod for three days. But you need to have the confidence to know that you can cope in this situation, and confidence comes with experience. People will have high expectations of your ability as an expedition doctor to cope with stress, boredom, and pressure, and so you should be prepared to meet these expectations.

One of the delights of expedition medicine is that purely medical skills often come last in the list of required skills, but this does not underestimate their importance. The General Medical Council’s Good Medical Practice guidelines still apply whether you are working in your local hospital or on a polar ice cap.[3] You have professional responsibilities to your patients, including recognising and working within the limits of your competence, and these go far beyond what is taught in the various introductory courses available in expedition medicine.

There are rigorous courses available. For those with a real interest in working in tropical environments, the diploma in tropical medicine and hygiene provides a well regarded and intensive training programme.[4] [5] The diploma in mountain medicine is ideal for those who want serious work in mountainous and remote areas.[6] Both these courses have the additional advantage of university accreditation when it comes to applying for training jobs.

These qualifications are not, and should not be, prerequisites for an expedition medicine job. But it is worth remembering your professional obligations to provide effective treatments based on the best available evidence and, ultimately, a good standard of practice and care.

No medic will ever be expected to have seen every condition, and you cannot prepare for every eventuality. However, you should be able to improvise and work independently and have sufficient experience to cope with whatever arises. You may need knowledge of ophthalmology, infectious diseases, orthopaedics, and chronic diseases to name but a few. Also, if you don’t already have some accident and emergency experience, now is the time to get it.

Travel insurance

Aside from your GMC obligations, there are several other issues of which you should be aware. One is that you and your clients should have adequate travel insurance. Your provider must know that you will be working in a professional capacity as this will invalidate many policies. Likewise, you have an obligation to tell your professional indemnity provider about your role, and this may well invoke a financial premium. It is also essential to have considered exit strategies, casualty evacuation plans, and the logistics of various worst case scenarios.

Another important consideration is what medical kit you will be taking. Equipment and medicines are expensive and some require careful storage or have important legal restrictions, especially if you are crossing a border. If the kit is provided for you, check that everything in date, that you can use everything competently, and whether you should change the contents. You cannot prepare for every eventuality and you may have to improvise, so think about using multi-purpose equipment, and be flexible. Also, the needs of the individuals within the group must not be overlooked, which makes pre-expedition medical screening essential.

It is also important to consider your obligations from a legal and professional perspective. Lots of people start their involvement with expeditions as a doctor in return for a reduced rate, but it is important to bear in mind that any incentive, financial or otherwise, carries professional obligations extending beyond the scope of a Good Samaritan act.[7] You therefore need to be adequately prepared for this, not least ensuring that you have appropriate medical indemnity insurance. Furthermore, you can make your job safer and less stressful by working for safe and responsible companies.

The increasing popularity of expedition medicine means that jobs are in great demand, especially paid work. If you are intending to take some time out or embark on a career in expedition medicine, the value of early planning and preparation cannot be overestimated. Expeditions and charity events are often planned years in advance. It also makes the life of non-governmental organisations easier if they can pencil you in sooner rather than later, so start planning and apply early. Put yourself in as strong a position as you can by demonstrating that you have the required skills to be an asset on every level. Be flexible, because stepping into a job at the last minute may be the first step to a great adventure—the Royal Geographical Society[8] and Explorers Connect newsletters ( [Link] ) are full of last minute vacancies. Be careful, be safe, and above all have fun.

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

References

  1. Comic Relief. Comic Relief climbers conquer Mount Kilimanjaro. 2009. [Link] .
  2. British Standards Institution. BS 8848: specification for the provision of visits, fieldwork, expeditions, and adventurous activities, outside the United Kingdom. BSI, 2007.
  3. General Medical Council. Good medical practice. GMC, 2013.
  4. Liverpool School of Tropical Medicine. Diploma in tropical medicine and hygiene. [Link] .
  5. London School of Hygiene and Tropical Medicine. Diploma in tropical medicine and hygiene. [Link] .
  6. University of Leicester. Diploma in mountain medicine. [Link] .
  7. Colquhoun M, Martineau E. The legal status of those who attempt resuscitation. Resuscitation Council (UK), 2010.
  8. Royal Geographical Society. Bulletin of expedition vacancies. [Link] .

Lawrie Kidd trainee, acute care common stem   Royal Devon and Exeter Hospital, Devon, UK
David Hillebrandt general practitioner  Holsworthy, Devon, UK

Cite this as BMJ Careers ; doi: