Career focus: Expedition medicine

Expedition medicine is challenging, exciting, and character building - and also hazardous, hard work, and poorly paid. Stephen Hearns has advice for those who want to get away

Increasing numbers of people are travelling to remote parts of the world, often participating in hazardous sports and activities. All of them need the advice and help of a doctor. For most, this will simply mean advice with regard to immunisations, risk of malaria, and appropriate first aid equipment. Large groups on more prolonged expeditions may recruit a doctor to travel with them to deal with medical problems as they arise.

What will you do?

The expedition medical officer has many responsibilities and tasks, most of which will be completed before the trip leaves the United Kingdom. These tasks include making a risk assessment of the environment that the team is travelling to and the activities being undertaken, gathering medical information on those travelling on the expedition, assembling appropriate medical kit, and providing advice about immunisations.¹ During the expedition the medical officer is responsible for assessing and managing those who become ill or injured and for arranging their evacuation in the event of emergency.

Types of expedition

Expeditions may have objectives such as conservation, education, or scientific research. Many expeditions are undertaken simply for adventure, such as mountaineering, diving, polar travel, and overland travel. The majority of trips, however, combine a specific objective with an adventurous activity.

Trips may be organised by schools, universities, the armed forces, and commercial companies. A small number of organisations, such as Raleigh International, exist to run expeditions on a regular basis, usually for young adults. Group sizes vary greatly - from solo ventures to large mountaineering expeditions with over a hundred members including local porters and staff.

A relatively new entity is the sponsored trek or cycle ride. These are organised by charities or by commercial companies on behalf of charities. These trips involve groups of up to 100 participants undertaking a trek or cycle ride in a remote area, most often in a desert or mountainous terrain. About 30 of these trips will leave the United Kingdom this year. Although they usually last for a short period of one to two weeks and generally are well organised and supported, these trips may bring about specific medical problems and risks.²

Conditions on expeditions are usually basic, with tented accommodation and simple cooking and sanitation facilities being the norm. Trips may be supported by road vehicle, boat, or air or may be completely self sufficient for the duration of their time in the field.

Why get involved?

Doctors become involved in expeditions for many reasons. They may have an interest in the activity being undertaken, such as mountaineering, rafting, or diving, and see the trip as a challenging way of gaining more skills and experience. Some may wish to travel to remote areas which, without the back up of a full expedition, would be logistically and financially impossible. For others the main attraction may be the challenge of practising medicine in a remote environment with limited equipment and assistance.

Participation in expeditions is seen by many employers as a useful indicator of personal development. Skills essential for medical practice, such as decision making, communication skills, and self reliance, will be developed by participation. Involvement in an expedition can also show that a doctor is able to work as a team player and has useful leadership experience. However, some senior colleagues may regard participation in expeditions during the training period as evidence of lack of professional direction or commitment. Fitting expedition work into a demanding and competitive career may be difficult. Some trekking companies may require the services of a doctor for a few weeks at a time, so it may be possible to do this during annual leave. The majority of expeditions, however, last a few months, and this may cause problems with arranging time off with employers and colleagues.

How much does it pay?

The answer to this is nothing or very little. The great majority of expeditions will require the medical officer to contribute to his or her expenses. A number of trekking and overland companies offer small discounts on their standard rates for doctors who are willing to take the responsibility for caring for those who develop medical problems during the trip. Only a few organisations pay doctors for their services in addition to paying their expenses. Doctors thinking of participating should also consider that they will not be earning a salary if they are away for longer than their period of annual leave.

Training and experience

Expedition doctors come from a wide variety of disciplines. With such a broad spectrum of potential medical problems encountered on trips, almost every specialty is relevant. Experience in infectious diseases, general practice, and accident and emergency medicine are probably the most relevant areas for the problems encountered on trips.³

There are two courses in the United Kingdom specifically about expedition medicine. Immediate Care UK runs the ExpeMed course on expedition medicine each May in Glasgow; Medical Expeditions runs a course on altitude medicine at Plas Y Brenin in Wales. The Expedition Advisory Centre at the Royal Geographical Society organises conferences on expedition medicine (see contacts).

Liability

Agreeing to act as medical officer on an expedition carries legal implications. Medical officers take on a duty of care to the group participants and are responsible for their actions in providing care. The subject of liability is discussed in articles by Duff and Townsend.^4,5 If a doctor is employed by a commercial organisation to act as a medical officer for a trek then liability for negligence is partly the responsibility of the employer. If, however, the doctor is working as a contractor then the organisation is only liable if it has a recruited a doctor who is not adequately trained or experienced for the role. In the situation of a doctor receiving a discounted or free trip in return for services rather than being paid in cash, the situation regarding liability is not clear.

It is essential that doctors discuss their trip with their medical defence body at an early stage.

Joining an expedition

Large organisations such as Raleigh International recruit doctors and nurses for expeditions throughout the year. The Expedition Advisory Centre of the Royal Geographical Society regularly produces a list of vacancies on expeditions which includes opportunities for doctors and nurses. Universities often have expedition societies that can be approached. Commercial trekking and adventure travel companies can also be approached with the offer of acting as medical officer on their trips.

Expeditions offer unique opportunities to visit remote areas of the world and undertake challenging and adventurous activities. In the absence of facilities for investigations medical officers are forced to rely on their own skills of history taking and examination. In the absence of a specialist colleague to turn to for advice medical officers have to rely on their own clinical judgment, and, with limited equipment, the skills of improvisation may have to be quickly mastered.

The role of the medical officer on an expedition is a challenging and greatly rewarding one. The key to success in the role is to undertake adequate risk assessment, planning, and training before departure.

1. Tek D. Medical planning for expeditions. Emerg Med Clin North Am 1992;10:449-66.
2. Hearns ST. The medical officer on commercial treks. Travel Med Int 2000;18:16-8.
3. Johnson CJH. Expedition medicine: a survey of 95 expeditions. Travel Med Int 1984;2:239-42.
4. Duff A. Liability on commercial expeditions. Newsletter Int Soc Mountain Med 1998;8:13.
5. Townsend M. Medicolegal aspects of expeditions. Travel Med Int 1999;17:93-5.