Future Considerations 2

I have been giving the concept of travel medicine, wilderness medicine and remote medicine a bit of thought lately.  Building on my previous post that discusses some of the “overlap” between these fields of medicine, I wanted to look at some specific examples and build my case for the statement that these specialities are converging, or should be converging, into one field.

One of my favorite books “Field guide to wilderness medicine” discusses some things that I consider more likely to be found in a tropical medicine manual, such as malaria.  Malaria is a disease that, I consider, largely preventable, in an educated and prepared traveler.  Is this a “wilderness medicine” issue or a “travel/tropical medicine” issue?  I see this these as very, very similiar.

Treatment of acute issues, while outdoors, such as a dislocated shoulder or ankle injury cannot be prevented with a vaccine or chemoprophylaxis.  At least not that I know of!  These types of injuries are considered more “emergency medicine” problems than travel medicine…even though it may have taken place during a holiday trip.  Now, having said that, a good number of emergency medicine physicians might have trouble diagnosing and treating a venomous bite, due to their geographic region of practice.  My point is that this is new “thing called wilderness/travel/expedition medicine” is and should be emerging as a very unique skill set!

Pre-travel consultation should include a review of immunizations, risk of exposures and a good knowledge of the geographical areas the person is headed.  Travel medicine at it’s finest.  Now, the problem comes into play when the members of that trip/expedition run into problems of an acute nature, while away.  The fractured ankle, acute dehydration or trauma are some of these examples. 

As with buying a house, location is everything in medicine.  Access to some really fancy imaging equipment and 24/7 specialist consultation is wonderful.  Trust me, I work at a facility with ALL this.  What about that 25 year old female with acute, right lower quadrant pain?  A pregnancy test could be a literal “life saver” at that point.  I think it takes a very creative and unique health care provider to work with limited resources and support.  This is exactly the nature of wilderness and remote medicine.  “Doing the best you can with what you have” is a common saying I have heard.  This is not emergency medicine at a fully staffed level 1 trauma center.

To me, the “ideal” expedition medicine healthcare provider will be able to conduct a pre-travel risk assesment, advise on vaccines and immunizations, communicate with primary care providers of the “patients/adventurers” and competently deal with acute issues while at their location, then ensure proper follow-up or even rescue, as needed.  Whew…that is a lot and I am sure I am leaving things out!

There are currently several paths for further education in these areas, but all are in their “individual areas”.  Wilderness medicine fellowships exist with Stanford and now, Harvard being two fine examples.  Diploma courses in travel and tropical medicine are available and I have to mention my personal favorite: Tulane SPHTM .  I have completed the program at Tulane and I did receive education in “wilderness medicine” but nothing compared to parasitology, virology and the like.  The Diploma in Mountain Medicine, offered in Europe, is another example of “wilderness” heavy medicine and even search and rescue components!  Australia has a fantastic program for Rural and Remote Medicine, involving what looks like a decent overlap with wilderness medicine.

Has any of these programs managed to blend all of the qualities necessary for the “ideal” expedition/travel/wilderness medicine doc?

Maybe I still believe that the “specialist/generalist” model of skills is ideal for this type of thing, at least as initial training.  But, where to go for an all encompassing training program for advanced study in these areas that allows us to provide total care for our “patients/adventurers”, including pre, during and post adventure care?  There is my rub…

Great Expedition Medicine Jobs

I was checking out the newsletter from ExpeditionMedicine.co.uk and found myself perusing the “jobs” section. Partially because I am getting closer to finishing my residency and looking for another job and partly because they are just so damn cool!

Check out their list here: http://www.expeditionmedicine.co.uk/jobs.php

Some of my favorites:

If you would like to witness the spectacle of sunrise on Trishul, Nanda Devi other Himalayan mountain peaks, breathe the mountain air, help wonderful people, make a real difference, work with a dedicated team, change your own life and sleep satisfied after watching the sunset on the Himalayas, then read on . . . A small rural Himalayan Hospital is rapidly nearing completion in the Nainital district of the North Indian state of Uttaranchal. CHIRAG HOSPITAL This has come up through the efforts of an NGO, called CHIRAG – Central Himalayan Rural Action Group, that has been active in various sectors including health, for over eighteen years. (www.chirag.org) This hospital is based on the experience of the two rural Himalayan clinics currently running and surveys on the health needs of the local people. It would serve a vital function of providing an inpatient treatment and investigation service for the which currently patients travel over four hours to Haldwani. The core component of these services currently, would be of a General Practice nature, targeted specially at the needs of women and children. Preventive and promotive services remain important. The hospital would be having support from visiting specialists and a network of doctors from India and abroad. In the next phase an operation theatre is planned. Medical camps and meetings to promote health are already a feature, and this hospital would be the hub of educational activities for the future. TWO DOCTORS REQUIRED Ideally General Practitioners, preferably with an interest in women and children’s health. Most important requirement is a ‘passion’ for nature and humanity ! The posts are however, salaried with accommodation provided. Information/Podcast/Contact Uttaranchal is in north India and the hospital is based at a small village called Sarghakhet in the district of Nainital.Click ‘podcast’ to view. CONTACTS: Dr Satyendra Singh Ph. UK 00 44 (0)7804357297 Mr V K Madhavan Executive Director CHIRAG. Please mention Expedition Medicine in your correspondance.

AND

Position; Expedition Medic on GVI’s Amazon Expedition in Ecuador (3 months) Description; Be the Expedition Medics in charge of all medical aspects on a tropical rainforest expedition which is fairly remote. Manage the training of all Expedition Members in wilderness medicine and emergency evacuation procedures. Participate in all forest based surveys as the Expedition Medic. Assist with all areas of the running of the GVI Amazon expedition. Assist leading groups whilst conducting scientific research transects. Work alongside GVI and local biologists carrying out research. Qualifications; Qualified Doctor, nurse or paramedic with minimum 2 years of experience. Expedition or Wilderness experience a definite advantage. Spanish language a bonus. Start dates; January, April, July, and October 2008, preferably a week before the expedition starts. Duration; Min 3 months – short term contract.

AND

The Luangwa Safari Association Medical Fund are seeking a doctor to work at the Kakumbi Rural Health Centre in Zambia. Based in the stunning South Luangwa Valley, one of Africa’s prime safari destinations. Most of the doctor’s time is donated to the Kakumbi Rural Health Centre in Mfuwe near the main entrance to the national park. At the clinic the doctor works as a consultant to the staff nurses seeing patients with a wide variety of health problems ranging from malaria to AIDS to trauma to obstetric issues. The ideal doctor for this position is a GP/family physician or emergency medicine physician with broad clinical training and experience in caring for patients of all ages. Knowledge of tropical medicine is essential, and prior medical work in the tropics or a course in tropical medicine is encouraged but not required. To enjoy the work here, the doctor should be comfortable practicing alone in a remote setting with a limited array of medications and equipment.

GMRS Expedition/Wilderness/Remote Medicine Course

Imagine yourself:- Packing a disaster medical clinic through the jungle to a remote
village after a hurricane…
- Lifting a patient – and a medic – 350′ straight up a sinkhole wall…
- Calling in a Medevac helicopter to base camp at 17,500′…
- Assuming command of an out of control science expedition team to
save it from itself…
- Managing critical patients for 3 days in a tent until they can be carried
off the mountain…
- Moving 1000 pounds of medical supplies 8000 miles through 3
countries, up 18,000 feet and back home again…

If this sounds cool to you, then you are going to love the new (and free) course put on by Global Medical Rescue Services Ltd.

The course centers around a 350 + page book that is sent to the student, via the internet, in sections, preventing an overload of information and flooding the in-box.

I have already signed up for it and cannot wait to begin!

Here’s that link, again: http://www.gmrsltd.com/2008ShortCourse.html

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