Dr Hannah Schneiders / Clinical teaching fellow (PGY5) / Great Western Hospital
Hannah Schneiders recounts her experience on expedition to the Namibian desert with Exile Medics. Here she reflects on a week of desert survival skills and what she has applied in expedition medicine and medical education since.
Exile medics provide multidisciplinary medical cover for ultramarathons in extreme environments, with their medical education previously limited to their annual conference. In 2018, after two successful “Jungle Schools”, they launched their first “Desert School”, which I applied for in my F3 year. The group was a strong 19-man team in total, with a healthy mixture of skills and grades: paramedics, nurses and doctors at all stages of their respective careers. Teaching was led by an ED consultant and an ST8 orthopaedic surgeon, and logistics were provided by Kaurimbi Expeditions. This course ran the week before the Beyond The Ultimate: Desert Ultramarathon; a 230km, 5-day multistage unsupported race; supported by Exile Medics. Seven of our group stayed on to provide medical cover for the ultramarathon, something I am looking forward to doing in the future.
Life in the desert
We set off into the desert in an enormous rattling off-road bus, nicknamed the “G-wagon”. Stopping first at Erindi Wildlife Reserve to watch animals feed at the waterhole as dusk fell. We camped in dome tents that were to be our homes for the next week, and become increasingly sandy. Our first night in the true desert was spent in a valley between great boulder outcrops that dotted the plain like heaps of marbles. The following three nights spent in a dry river valley, sometimes graced by elephants walking past, and we finished by camping at the foot of the Spitzkoppe rock. The days were scorching causing my water bottle to quickly become a blisteringly hot tap. The nights were surprisingly cool, making me grateful for my fleece and 3-season sleeping bag.
The whole structure of our day was a concession to the desert environment. We quickly got used to being permanently sticky and dusty- a natural consequence of not being able to wash off the multiplying layers of suncream. We learnt that at 52 degrees celcius in the sun (46 degrees in the shade), the middle of the day is best spent napping, playing cards and swapping stories. Desert school teaching was thus scheduled for early morning and late afternoon to avoid the hottest part of the day.
Our teaching covered an extensive range of topics within expedition medicine and hostile environment skills; delivered using a range of methods. We gained a sound theoretical knowledge base and learnt practical skills applicable to the environment, the race and to future expeditions.
It soon became clear that competitions were a successful teaching technique, although there were no winners in the dismally dry water collection race! One such team-based challenge was to design the safest and most robust base camp, focusing on hygiene and disease prevention. By reviewing each design we were able to recognise the importance of basics such as accessible hand-washing, with separate stations for toilet and kitchen areas. We also discussed the logistical challenges of patient-flow through medical tents, or quarantine tents (if required). These exercises demonstrated how expedition medics are often instrumental in preventing disease outbreaks in any camp. Another exercise involved designing the ideal medical kit to have on such an expedition. As a result I have a greater understanding of the planning considerations when designing medical kits in general; and specifically; the desirable and essential medications and equipment for a desert environment.
In the spirit of the ultramarathon the following week we had our own desert race in the form of a stretcher contest. Within twenty minutes, using materials from our kit or surroundings, we had to build a stretcher and put it to good use by carrying a team member across the line. Military bashas are heavier than lightweight tarps but they make excellent makeshift stretchers with their built-in handles, making carrying much easier. We then built a 12-foot outline of a body, again using any materials we could find. We used this to teach the other half of the group about sodium homeostasis, while they taught us about heatstroke. This resulted in an embarrassing moment of head-scratching over the precise mechanism of sodium homeostasis, but with a bit of help from those who had recently completed MRCP Part 1, we got it sorted!
Model building became a recurring theme as a useful and fun way to learn together in group tasks. One morning we set off to recce a 1km radius around the camp, returning with intel to build a 3D model of the area, using this to work through evacuation scenarios. I found this very useful, learning how to use pacing and contour line sketches to bring sound topographical information back to base for analysis.
The expedition medicine side of the course culminated in a night-exercise rescuing a lost person. One of our members mysteriously failed to return from watching the fiery sunset over the Spitzkoppe rock. As a team, we worked out how to safely and efficiently sweep and search an area whilst remaining in communication. Once we found the casualty, we split into two teams- ’clinical’: assessing the patient, initiating treatment and carrying the stretcher, and ‘operational’: ensuring the safety aspect of the rescue with headcounts and sweeping the route ahead for hazards. This exercise highlighted the necessary balance between leadership and teamwork required in a rescue call-out. We were all capable of showing both these characteristics in a crisis, perhaps used to assuming these roles in our day-jobs, and were keen to demonstrate this in simulation. In the post-exercise debrief we explored cooperative team working, leadership, navigation, search line strategies, and how to utilise individual skills amongst the team to achieve a common goal.
As well as ample practical learning opportunities we had seminars and discussions on topics such as infectious diseases, environmental challenges, and mental health on expeditions. It is not every day you have a teaching session conducted on a circle of canvas x-frame safari chairs in the diminishing shade of canyon walls! In particular, I found the mental health discussion interesting and invaluable. Consequently I am now completing an online course on psychology in extreme environments. I am also becoming a Mental Health First Aider to better my knowledge and understanding of this vital topic which can sometimes be neglected in expeditions.
Studying desert medicine hands-on in the Namibian desert provided opportunities for some truly spectacular and off-piste learning. A snake enthusiast visited us in his van one day, energetically waving snake after venomous snake he had rescued. He told astonishing anecdotes of envenomations and near misses, how to avoid startling snakes, and allowed us to hold the “only mildly venomous” striped skaapsteker. We were also fortunate to spend some time with the local San bushmen, teaching us how to drill ostrich eggshell beads, use fire sticks and shoot their grass-stem arrows. Dancing around a campfire with them under the desert night sky is something I will never forget.
The Hidden Curriculum – Unintended Learning
The breadth of the intended learning outcomes for Desert School was impressive and I came away with an incredible wealth of new knowledge and skills. As with all learning experiences there was a ‘hidden curriculum’, which refers to the unwritten, and often unintended learning, that students pick up. Our desert days also taught us how to: layer up for the cold nights, how to mend a puncture with rope fibres, how to cook a steak on a bush-braai, and how to survive in the scorching heat. We learned to tread carefully- especially after a night walk with UV torches revealing the shocking density of scorpions. These lessons will inform my future expedition work alongside my more formal learning.
I learnt an enormous amount in Desert School and will apply my practical knowledge and skills to future expeditions. Indeed, the extreme environment skill of how to check a latrine very carefully for scorpions has already paid off on a more recent expedition to Costa Rica. I also collected stories and invaluable life experiences from other medical professionals operating outside the standard NHS structure which will help inform my future career path. I was pleased to find I did not suffer in the hot desert environment – in fact, once acclimatised, I liked it! Desert school opened my eyes to the richness and value of using a range of small group teaching methods and engaging students actively and as creatively as possible. This has enriched my practice within the NHS over the past two years as a professional medical educator, as well as support with future expeditions. I am hugely thankful for the opportunity I was given, the knowledge and skills I have gained, and the memories I have made. I plan to return to cover the BTU Desert ultramarathon in the future.
Original photographs by Hannah Schneiders, Caroline Hook and Jess Fitzgerald.