Adventures — 22 February 2020 at 5:34 pm

Medicine under the stars: Cairo to Cape Town with Tour d’Afrique

Dr Jenny Reid / Global Health MSc student / Karolinska Institutet, Stockholm

‘It was 46 degrees in the desert. I was sleeping in my tent under a million stars when I heard the expedition leader shout my name. Someone who had been suffering in the heat had acutely deteriorated. He was dehydrated, his peripheries were cool and he hadn’t passed any urine for hours. We were over six hours from the nearest town or medical facility and it was dangerous to drive in the middle of the night. While everyone slept, it was my job to manage him…’ (Expedition diary, Sudan)

In January 2019 I set off for Cairo with my bicycle and two bags. I was excited and a little daunted by what was to be one of the biggest professional and personal journeys of my life.

The expedition began with nearly a week of preparations in Cairo; sourcing and organising the medical and expedition kit, getting our vehicles ready, meeting the staff team, briefing the participants and enjoying the luxury of beds and showers before the many nights of bush camping ahead. On January 17th, as the city of Cairo was waking in the beautiful morning light, we set off from the pyramids. There was an eerie silence as we cycled past the Great Sphinx of Giza. We were off. Direction: Cape Town. Distance: 11,220km.

Expedition medicine can be refreshing. You get to use your initiative managing patients with limited resources and in ever-changing environments. Being on call 24 hours a day and living with your patients is a truly unique experience. It was one week into my expedition that this really hit me. As we camped on the banks of the Nile, one of the team started to become unwell. She was pyrexial and becoming rapidly dehydrated with severe gastroenteritis. I monitored her and her fluid balance hourly, administered anti-emetics and antibiotics and started fluid resuscitation. At that moment, for the first time in my career as a doctor, I suddenly felt very alone. I had no mobile reception, no medical colleagues to run things by, no hospital protocol to follow and only finite medical resources by my side.

I realised the importance of giving myself some time to think over my differentials and my management plan. In the looming darkness I sat down next to some grazing donkeys and gathered my thoughts. What would I do if I was back in the UK? What can I do here? Where is my kit? Where is the expedition leader? How far are we from a hospital? In the morning we transferred the team member to a hospital in Aswan. She continued to improve such that a few days later she was fit enough to re-join the group. I loved nearly every day on expedition but this was probably one of my happiest moments. It is a privilege to be a doctor and incredibly rewarding to see someone recover from illness or injury to achieve their goals.

One of the most important things on such a long expedition was looking after my own wellbeing. This included regular time out to maintain an energy reserve. Running a daily clinic for non-urgent issues enabled this. Common presentations were saddle sores, minor wounds, muscle aches and chronic health complaints. As we cycled through the African continent it became clear to me that I was also there for the team’s psychological health. On the bicycle you have many hours to think and people often confided in me. This was a role I was humbled by. It was a new dimension to my role as medic and initially surprised me. I realised how broad the expedition medic skill set needed to be.

Throughout the expedition I gave advice to the whole team on preventative measures including hand hygiene, hydration, nutrition and cycle safety. Most of the group had one goal in mind; to reach Cape Town. It was my goal to make sure people could do this safely. Each staff member has their own important priorities, be it driving, cooking, logistics or filming. As medic you must be an advocate for everyone’s health and wellbeing throughout. Alongside my medical duties, I was also a general member of staff and expected to muck in with everything and anything. This included helping in the kitchen, sourcing water, food shopping at local markets, assisting with expedition logistics and, of course, cycling! One of my favourite moments was when we reached the Western Cape. I sat in the sunshine on the beach cooking 120 tortillas on the gas hob while watching dolphins jump in the Atlantic waves. I was one of the luckiest people on earth to have an office like this!

After four months on the road we reached Cape Town on 12th May 2019. I was elated. I had witnessed a group of friends, strangers in January, overcome many challenges to complete an extraordinary personal and physical journey. Each day had been unique. From the flavours of each country to the array of different landscapes we cycled through. It was a truly magical experience.

My top tips for being a medic on a long expedition:

  1. Establish early on if anyone else in your team has medical or first aid experience.
  2. Maintain your standards and uphold your ethical principles
  3. Always say thank you to those you meet along the way. You never know when you will need to call on them in the future.
  4. Having some luxury items: mine were a pillow along with some photographs and cards from friends at home