Dr Rosie Baker / FY3 Doctor / Hong Kong
Rosie is a British Doctor and Geographer with a passion for the outdoors. Earlier this year she was selected as an Analogue Astronaut for the UK’s first exploratory space analogue research mission. The project, based on a remote Scottish island, aimed to improve the delivery of healthcare for future long-duration space missions and in challenging environments at home on Earth.
Visiting Space, on Earth
In April 2022 I responded to an advert from UCL’s Space Health Risks Research Group, to join their pilot programme as an analogue astronaut. The first UK analogue space research mission would simulate the human exploration of another planet, right here in Britain. The purpose of the mission was to investigate health risks in space, and how best to deliver holistic healthcare in this challenging environment.
Analogue projects simulate particular aspects of space missions to identify problems and test solutions under challenging conditions before they are needed beyond our planet. Each analogue mission focuses on replicating specific potential difficulties so that future space flight can take place in a variety of environments. International examples include Mars 500, where 6 participants were isolated inside a mock-up spacecraft for 500 days in Moscow, and the NEEMO Project which sends astronauts to live in an underwater research station in Florida. Analogue studies not only benefit future space missions but also those living back home on Earth. Across the disciplines of navigation, communication, energy production and beyond, space research has driven innovation.
This particular project simulated the practical challenges of arriving on a new planet by landing participants on an uninhabited Scottish island. Parallels to space included limited healthcare services, scarcity of resources and delayed aeromedical evacuation if needed. After landing on the island, analogue astronauts undertook a series of tasks under the observation of researchers and artists. These tasks centred around providing prolonged field care for simulated patients across three case studies.
“Many of us seek opportunities to combine medicine with our passions beyond hospital walls. My background in Geography and love of the outdoors keep leading me happily astray. In spring 2022 while working as an F2 doctor, I chanced upon a unique opportunity to combine medicine, remote environments, research and art”.
The Application Process
I stumbled across this project in the most ironic place for advertising outdoor opportunities: Facebook. A quiet post in April 2022 in the group ‘Student Wilderness Medicine UK’ directed me to UCL’s Space Health Risks Research Group. A team of interdisciplinary researchers were calling for applicants to join their pilot project as an analogue astronaut.
For this project, applicants for the role needed to be healthcare providers with experience of working in remote environments. The project also recruited for simulated patients during the case studies, encouraging those who did not meet the eligibility criteria of analogue astronaut to apply for this. I completed a straightforward application form that asked about my technical skills, teamwork and leadership in the outdoors. Alongside this, I ranked my experience of pre-hospital healthcare provision in remote environments, with the options ranging from an entry-level advanced first aid course up to a consultant working full time.
The project was seeking a team from varied professional backgrounds, including doctors, dentists, pharmacists, nurses, allied health professionals and first aiders with no formal healthcare qualification. This was my first hint that this project was trying to do things differently. A week after the application deadline, an email landed in my inbox inviting me to join the team.
A few days after my invitation email, I was on my way to Plas-Y-Brenin Outdoor Centre for our pre-deployment training weekend in North Wales. This was a chance to meet the 5 other analogue astronauts, hear more about what our mysterious mission would involve and receive training to ensure we were prepared for the tasks ahead. The team met at a chilly campsite late on Friday night, travelling from across Europe to be there.
Our training was organised around the Remote Area Risk International’s (R2RI) Prolonged Field Care course, which focuses on how best to care for patients in “environments you don’t want to be in, for much longer than you want to be”. The course covered a wide range of topics, from perfecting your primary survey to nursing in challenging conditions and accurate field documentation. These were taught mostly in the classroom with an overnight patient care exercise on the hill. In teams, we cared for several patients through the night and extracted them to a sheltered place of safety to avoid a hypothetical storm. The challenge of balancing personal fatigue with the needs of the team and our patients soon became apparent, as did the practical difficulty of helping patients get warm and well in the darkness. On Sunday, a lake swim woke us up ready for further workshops.
The course was professional, comprehensive and well-taught. Around it, we had time to get to know the other analogue astronauts, hear briefings from our mission director and put our heads together with the team’s artist in residence to share kit design ideas. The weekend packed a punch and left us feeling that we’d only dipped our toes into the sleep deprivation and exhaustion we could expect from our task that lay ahead a few weeks later.
The Research Mission
Mid-May drew a team from around the world to Scotland for our space analogue research mission. The researchers kept the location of our project secret from us, so that when we arrived, our “new planet” it would be a truly alien environment. The team and I arrived at our meeting point, ready to be transported by boat with all the kit we would need to survive on our harsh new planet.
Once arrived on the island, the analogue astronauts hiked to set up camp in our new “habitat”. We conducted baseline recordings for several studies including testing non-invasive wearable technology, and for an astro-pharmacy focus group. From this point on, we would be observed in our activities but have decision-making autonomy. We had backup communications with “mission control” but with a time delay of a few minutes. Over the next 48 hours, we worked continuously through a series of tasks and patient cases. These tested us in numerous ways – sleep deprivation, navigation, teamwork, clinical care outdoors, camp craft and patient extraction, to name a few.
As with most expeditions, the most challenging aspect remained human factors whilst the team were tired, cold, wet and hungry. Making clinical decisions whilst under direct observation in these conditions certainly tested us. Our varied professional experiences and international backgrounds from the UK, Ireland, South Africa, Germany and Spain added complexity to group dynamics, leadership and organisation. These elements sometimes brought challenges, particularly to be able to effectively communicate under pressure, but ultimately became the strengths of our team.
The patient cases we encountered were equally diverse – from the expected musculoskeletal strains to multi-person trauma and space-specific injuries, such as radiation exposure. To provide good, prolonged clinical care for multiple patients we needed to share the workload across our team of five. Medical decision making was only a small part of this. The hardest elements of the work were giving continuous nursing care and the very physical work of patient extraction over rough ground whilst maintaining team morale, interest, and self-care. I chose to contribute to the creative side of our mission, which helped maintain my interest during long hours of monotony and tiredness. I used photography and a durable custom art kit made by our artist in residence to document our experience and progress with our tasks.
The exercise concluded with a particularly difficult case that involved moving our kit and an injured patient over a ridge, with the time pressure of hourly solar flares demanding we take shelter. This made the ending all the sweeter and we enjoyed an evening finally meeting the rest of the crew behind the scenes over a surprisingly delicious ration-pack dinner.
The end of the field research was not the end of the project. We had remote sessions for final data collection, medical debriefs and an overall project evaluation, which was helpful to ourselves and the research. The mission debrief highlighted how unique this project was in bringing together such a diverse interdisciplinary team. It involved researchers, healthcare professionals and artists, all with a shared passion for remote environments. This was the first time I had seen art and science both given significant platforms in an expedition setting. In hindsight, they are natural partners and have the power to be symbiotic; the research was rich with creative ideas, whilst art had the power to translate research findings into engaging, digestible information for people beyond the project.
Since landing back on Earth, a creative exhibition telling the story of our mission has been displayed at the Royal Geographical Society and research is being written up. The outputs of this and future missions will contribute to healthcare training, policy and practice for remote and rural health systems. Individually, I have grown in confidence in delivering remote clinical care and operating as part of a diverse team under pressure.
This pilot analogue study showed the value of interdisciplinary and immersive space health research in the UK, for the benefit of future space travel, and remote communities at home on Earth. As a consequence, a new organisation has been established to take this forward in the future. Space Health Research has ambitious plans for longer analogue missions which will test health products and services to drive innovation for remote environment healthcare.
Future space analogue research missions will need skilled and motivated healthcare professionals with experience of remote environments to contribute – whether as analogue astronauts, simulated patients, or to test their own ideas for improving healthcare in remote environments. The call for applications to work with Space Health Research in 2023 will open at the end of January.
If you would like to be involved in remote healthcare and space research, visit https://www.spacehealthresearch.com/ to stay up to date with their news and progress.
Many individuals and organisations came together to create our UK analogue mission this year. It was made possible by the generous support of these sponsors:
- UCL Institute for Risk and Disaster Reduction
- UCL Institute of Advanced Studies
- UCL grand challenges
- Remote Area Risk International
- Med Rescue Group
- EXPLOR Space Technologies
- Expedition Foods
Photo credit: Dr Rosie Baker, Dr Sarah Fortais