Alex Ward spent a month volunteering as a medical assistant at Manchester's Commonwealth Games this year. He tells us what he got up to

In early July, my finals ended with a harrowing objective structured clinical examination. The relief of finishing
my exams turned to excitement as I travelled to north west England for my first elective. I was volunteering as an assistant in the medical centre in the athletes' village at the 2002 Commonwealth Games in Manchester.

Preparations

I arrived at the village seven days before it opened and picked up my distinctive red medical volunteers' uniform and probably the biggest identity card ever produced. The campus was eerily quiet, with just the occasional purple shirted volunteer appearing in an electric golf trolley, obviously not yet confident enough to greet me with the token, "Hiya, our kid." The medical centre was in a temporary structure erected on a car park. Inside, walled off cubicles were designated for a pharmacy, nine physiotherapy rooms, a podiatry room, a storeroom, doping control, a ward with three beds and a nursing area, four doctors' consulting rooms, a room for optometry, an office, and a staff break area. Everything was still covered in plastic wrapping, telephones were not working, and no running water was available for a much needed morning brew.

We unwrapped and set out the furniture after working out what it was meant to be. Two comical drivers in purple shirts bought in examination couches, beds, physiotherapy machines, diagnostic ultrasound kit, and other equipment. Consumable deliveries arrived throughout the first half of the week.

Lockdown

Entry into the village was painless at first using a day pass. But with "lockdown," later in the week, everyone was "mag and bagged" at the pedestrian entrance and access to vehicles was restricted. All permitted vehicles needed an additional chaperoned bomb check before entering the village.

Lugging boxes, fixing leaking taps, checking and distributing medical supplies to training and competition venues, and installing computers took up most of the first week. We were still waiting for vital consumables--10 pallets of condoms to allow two per athlete for each night of the games. Now I know why the residents were the elite of their athletic disciplines.

We made a trip to the Manchester Royal Infirmary with a colleague's blood as a trial run for testing laboratory specimens. An additional visit to the radiology department, which was to provide appointments for athletes out of hours, offered a little escape from the cardboard boxes in the rather bare building that would be filled with bustle and energy the next week.

One perk of working before the village opened was that staff ate in the athletes' dining hall and were used as guinea pigs for the food that was to be offered to athletes the week after. Students never sniff at free food, and apparently the habit doesn't die with maturity judging by the ice creams mysteriously appearing in our freezer in the afternoons.

The opening

The village officially opened on Monday 15 July but remained quiet for most of that week. Some of the larger teams' medical staff arrived before the athletes to set up their facilities and find out what the village's medical centre provided. The superintendent pharmacist took over setting up the pharmacy and bought some goldfish for the reception, insisting that they would relax and calm the waiting villagers and contribute significantly to the healing process.

Many more volunteers arrived in the second week, as did the mobile magnetic resonance scanner, which sat with its own generator in the car park opposite the dental van, behind the medical centre. Options for first line imaging were magnetic resonance imaging or diagnostic ultrasound. This was quite exciting and not something I'd come across in my brief experience of the UK health service. Any unidentified equipment was put straight into the optometry room on the assumption that it probably belonged there.

Athletes started to arrive for treatment towards the end of the first week. Many of the smaller teams could only bring skeleton medical and physiotherapy staff along with their chef de mission. I didn't know the Nuie Islands existed until July, when I met nearly 50% of their male population.

Doping control set up shop in its designated room and was completely independent of the Manchester 2002 Medical Services. Calling up athletes for testing is based on spontaneity and takes precedence over all other activities. Many a disgruntled athlete would call at reception looking for doping control. Apparently, producing a sample of urine on request is difficult, no matter how many bottles of water you drink.

Multitasking

Shifts were busy, and, with no set job description, I did many different tasks and learnt some new talents. As well as becoming lethal with a photocopier, our duties as medical assistants included running specimens to the labs twice a day, communicating results to teams' doctors and athletes and recording details on the computer. We also ensured that all departments had adequate equipment and made regular visits to the operations centre to report any problems with physiotherapy and medical cover at the venues. In between, I was lucky enough to get small excerpts of teaching from some of the best musculoskeletal radiologists, physiotherapists, and sports medics in the country, seeing stress fractures in long distance runners to magnetic resonance imaging scans of acute hamstring tears.

The musculoskeletal approach to injury in sport and activity is an area of medicine I had only ever experienced as a patient myself, and to see its application in an international event environment was both fascinating and exciting. In this setting, the aim was to optimise the athlete's potential to perform at that time. The team designed management plans to maximise short term functional competition capacity and alleviate discomfort. This was an interesting contrast to that of the long term approach to musculoskeletal rehabilitation more commonly associated with sports medicine. My elective placement emphasised the importance and the many benefits of working in a multidisciplinary team, combining cutting edge knowledge and ideas with a bit of logic and common sense.

New challenges

The games were the first commonwealth competition to hold events for disabled and able bodied athletes together. This introduced a new range of challenges to the medical staff and needed a wider range of resources. Athletes who have had a limb amputated may develop pressure sores and problems with the stump after intensive preparation before their competition. Informal consultations involving sports medics, orthopaedic surgeons, physiotherapists, nurses, podiatrists, and coaches aided the development of effective mechanical methods of using padding and support for the athlete's competition.

I regularly revisited my first year anatomical knowledge deeply embedded somewhere in my brain and can now fully appreciate the opportunities I had to work with cadavers and prosections. The use of detailed magnetic resonance imaging in conjunction with real time dynamic ultrasound scans allowed me to see what actually happens inside a body when a weight lifter develops an acutely sore wrist or a lawnbowler complains of knee pain. The application of medicine and mechanics to both musculature and bone made sense and constantly spurred me to ask questions. The importance of a general medical and holistic understanding could not have been emphasised more heavily. Every medical volunteer had to be aware of the limitations on treatment which exist in international competition; limitations that, in the past, have led athletes to lose both team places and medals.

Demands on physiotherapy were immense and peaked just before the games actually started, when many athletes would arrange intensive physio around their training in order to tend any niggles and maximise their physical and psychological potential. Sports medicine doctors were consistently busy and managed to find time to teach the volunteers. General practitioners saw a variety of complaints, including some infectious diseases from oversees. The dentists and optometrists were busy throughout the games as many residents of the village saw the opportunity to sort out their teeth and eyes before returning home.

The spirit of the games

The best memories I have of the games are of the wonderful people I worked with and the relationships between the staff. Everybody chipped in when they were needed regardless of their qualification--real teamwork. I think I worked hard but never stopped to realise it at the time. When I look back on the experience, I can say with a big smile that it was one in a lifetime and that I got a lot out of it because I put a lot in.

The atmosphere in the village was like nothing I had experienced before. The mix of cultures and volunteers created a working environment that was one of positivity, energy, and openness. I learnt endless amounts about setting up a sports event medical service and had four solid weeks to get to know the system and work as a small part of it. Decisiveness, adaptability, and communication became well practised skills (along with photocopying and faxing), and I made some great friends along the way. I caught glimpses of many celebrities, witnessed a rather random marriage proposal, and met a Barbadian swimmer in the international zone hair salon who, after discussing the finer points of roots, I saw swim in the freestyle relay final the following day on television. We swapped shirts, and I am now the proud owner of an extra large Olympic Barbados polo shirt, and he has my extra small Manchester 2002 shirt.

In November's studentBMJ, George Dafoulas explained how you can get involved as a volunteer in the 2004 Olympic Games in Athens. (Dafoulas G. Once in a lifetime. studentBMJ 2002;10:426 www.studentbmj.com/search/pdf/02/11/sbmj426.pdf)