Adventures — 29 October 2013 at 1:16 pm

Cornwall to Capetown

Richard Wain-Hobson / SHO Acute Medicine
Sebastian Wallace / SHO Gastroenterology
Daniel Nuth / SHO Care of the Elderly

Reading tales of adventure is one of the true pleasures of editing Adventure Medic. Even better, every so often, we come across a cracker. Last year, Richard, Sebastian and Daniel drove a battered old landrover from Cornwall to Capetown, taking in several medical projects enroute. It was a true journey, though different cultures and some tough situations. They learnt new skills, but also realised that what they already knew could be put to great use. This kind of trip – one that expands the mind, builds confidence and cements friendships, is exactly what Adventure Medic is all about. We salute them. Here, the boys present a quick summary of their trip. For a more detailed account, please take a look at their blog.

Intro

It was a misty autumn morning, and the harsh sound of our engine echoed around the headland. I forced the reluctant car into gear, nervously wondering how far this bodged rust-bucket would get us. The rear-view mirror was obscured by a mountain of equipment, tools and luggage for the next nine months.  I couldn’t believe we were leaving. A year’s worth of planning slipped into the past in a moment. What was to be a journey of global proportions lay ahead of us. There was no going back now.

Background

In October 2012, we left our jobs at the Royal Cornwall Hospital, as well as our friends and families, to drive Tess, our 22-year-old Land Rover, from Cornwall to Cape Town. Our aims for this expedition included volunteering in Iganga Hospital, a district general hospital in Uganda, assisting in Malawi with the CRADLE Project, a pan-African trial improving community monitoring for pre-eclampsia, and visiting Gondar Ethiopia Eye Surgery (GEES), a UK based charity which is establishing a centre of ophthalmological excellence in northern Ethiopia. The expedition would be raising money for Medecins Sans Frontieres and GEES.

Our route was to take us down through Europe and Turkey then across the Mediterranean to Egypt, looping through the Sahara Oases and tracking up the Nile. We would follow the vast Sudan up into the mountains of Ethiopia then down again into arid Somalia and the wilds of northern Kenya. We found this to be a striking contrast to verdant Uganda, Rwanda, Congo and Tanzania in the rainy season that followed. Through Mozambique, Zimbabwe and Botswana, we would pick our way along roads less travelled, before our final adventure through Namibia and South Africa.

The Kit List

Trying to decide what to take on such a trip involved much head scratching, tea and deep discussion. We would be living in extremes of temperature, from sub-zero in Europe to nearly fifty degrees Celsius in the Sahara. A careful balance had to be struck: too much equipment and we would be slow, burn more fuel, put greater strain on the suspension, and get stuck; too little and we could be stranded days from anywhere without the right tool or spare part.

As well as the bare essentials of food, water, clothing, sleeping and camping equipment, we would need the equipment to keep our car, our intellects and our bodies going. A complete tool box, spare parts bag, medical box, and ‘book bag’ had to be collated, with every component being rationalised and justified. In addition we would need specialised off-road gear such as winches, jacks, spare wheels, jerry cans, tow ropes, and sand ladders. We were each allowed one luxury item: Sebastian brought his guitar, Dan a 1000w subwoofer, Rich a tripod for his camera.

Life on the road

We had a number of ambitious aims which required skills that we were only vaguely familiar with – not least keeping our rheumatic Land Rover functioning mechanically through a vast continent. We also wanted to film an amateur documentary, capture our travels with high quality photography, publish articles in travel magazines, keep an interesting blog, and perhaps even write a book about our travels. With little expertise in these fields, there was a huge amount of learning to be done.

Life quickly became a contradiction of daily routine performed in ever changing terrains and cultures. It didn’t take us long to develop sub-specialities; Sebastian on cooking, Rich on mechanics, Dan on photography. We became competent at things that we naively considered to be simple before the trip. Fire lighting was honed to an art, navigation continually improved, vehicle electronics mastered by necessity, calmly bartering with police and army officials practised – although never perfected.

Our route-plan and camps would be dictated by the local environment, chosen to reflect nearby dangers, be they environmental, human, or hyena!  It really felt as though we were broadening our skill sets, even if they were skills which may not transfer directly to our lives back at home.

The value of our medical training

From the beginning we were surprised as to how our medical training influenced our approach to the trip. One of our biggest learning points from the experience has been how transferrable the skills we posses as doctors are, from project planning and risk assessment, to communication skills and the ability to perform under pressure. These assets helped us form a coherent expedition plan, outline realistic goals, anticipate which skills we would need to develop, and to negotiate our way through difficult cultural and political situations. There were times when we were faced with very real danger, and maintaining communication and calm thinking, just as in a clinical situation such as a cardiac arrest, were essential.

Friends who travelled with us would often remark at how, after something had gone wrong, we would sit down and discuss the event, teasing out learning points and attempting to devise a system to avoid repeating the mistake. More than once this structured approach paid off, and we found we became safer and more independent as a result.

Practicalities of time out

Taking time out of work is a serious consideration for any medic, especially those with aspirations in competitive fields. We have often been asked how we justified a year away to ‘travel’. In truth, we saw this as much more than backpacking – it was an opportunity to develop skills in other fields, many of which are transferable to medicine, as well as practise medicine in the tropics. Our medical experiences and research will also be selling-points at interview.

Sebastian had applied for a year out between F1 and F2, a little practised but elegant opportunity offered by many deaneries that allows for a smooth return to training. Richard and Daniel had just finished their Foundation Training, and took advantage of a natural break in the ladder before starting further SHO training.

Those planning to take a year out after F2 should be aware of interview dates for further training, as it can be very inconvenient to have to fly home from far flung adventures in Jan/Feb of your year out.

Highs and lows

It’s very difficult to tease out the experiences from such a soup of memories, but some notable highs and lows include crossing the Sahara, Kalahari and Namib deserts, escaping unharmed from a jungle car chase in Tanzania, rescuing our car from a sinking mud flat in Turkey, retrieving the occupants of the car in front of us after it had been strafed by machine gun fire in Kenya, talking our way out of house arrest in Somalia, retuning to civilisation after days in the bushveld, and singing old sea shanties in front of some very well known landmarks (taught to us by our village choir back home in Perranporth).

More on the projects

Medically we had an interesting time of it. Shortly after arrival in Ethiopia we were greeted in the northern city of Gondar by Dr Asamere, a talented and driven Ethiopian ophthalmologist. With Dr Asamere’s help, Gondar Ethiopia Eye Surgery (GEES) is developing a centre of ophthalmological excellence, which provides an excellent service to the local population as well as training optometrists, doctors, and nurses. GEES is a UK-based charity run by Dr Sandy Holt-Wilson, who visits regularly to help with the development of the centre and generally inspire everyone.

Our arrival at Iganga District Hospital in Uganda coincided with a pay dispute between the government and the doctors, meaning that with the exception of a visiting surgeon, other doctors were only available sporadically. We spent two months working with HIV, TB, schistosomiasis, trypanosomiasis, malaria, typhoid, and brucellosis, but also covering other cases including trauma and orthopaedics, paediatrics, general medicine, and gynaecology. The hospital was overstretched and underfunded and we often felt as though we didn’t have enough experience, especially with tropical cases. Despite this, we played to our strengths in systematic ward doctoring, referring to the larger hospital when the need arose. With the help of some experienced nurses and Clinical Officers, we were able to work as a team to deliver the best care we could.

Arrival in Malawi meant that we could start work on another medical goal of the trip: to perform a feasibility study for the pan-African C.R.A.D.L.E. project, co-ordinated by Maternity Worldwide. We were looking at the practicalities and potential impact of introducing a blood pressure monitoring service on maternal mortality from pre-eclampsia in rural Africa. Working mainly around the old colonial capital of Zomba, we assessed the existing community health structures, how they worked with NGOs and how best to integrate the project into this complex interplay. It was a great experience which took us to some fantastically rural areas, and we’re set to present our results at the Global Conference of Women’s Health in November.

As far as fundraising went, we have raised just over £2,000 so far thanks to a combination of bullying friends and family, holding fundraisers with our local sea shanty choir, and organising a charity shave-off of the ridiculous facial hair grown on the trip.

The Aftermath

After nine months, 21,000 miles, 30 countries, 19 punctures and countless repairs, we finally limped into Cape Town. Adjustment is an ongoing process even now, two months after our return. Our time away from work was just under a year, and yet to us it feels like an eternity. We are different people, stronger and more appreciative. We have acquired new skills, developed old ones, and enjoyed having the opportunity to learn more about history, geography, and other cultures. We all agree that our experiences help us to be more rounded doctors, and would encourage anyone thinking of planning their own adventure to pursue their dreams.