James Coates / ST1 Radiology / Leeds
Operation Wallacea is one of the most popular first trips for expedition medics. James Coates talks about his first Opwall expedition to Honduras, where he was able to indulge his passion for photography whilst serving as medic for a big group in the stunning surroundings of Cusuco National Park. He also gives some great tips for those setting out on their first expeditions, as well as information on how you can get involved. We think you’ll agree – his wildlife pictures are stunning.
At the beginning of my F2 year I realised I had to get off the career conveyor belt for a year. It did not take me long to come across a plan which would fulfill several of my passions. Since childhood I have always been interested in wildlife; turning over rocks looking for creepy crawlies and reading nature books at bedtime. Then during my final year at medical school I had bought my first SLR camera and began to love photography. I wanted to go on an expedition that would allow me to see wildlife and take photos whilst doing some expedition medicine. I began trawling the internet looking for opportunities. I mulled over several different companies but one stood out head and shoulders above the rest, Operation Wallacea or Opwall.
Opwall is named after the Wallacea region in Indonesia where the organisation first started doing their research. The region in turn was named after the famous British naturalist, Alfred Russel Wallace. Operation Wallacea is a charitable organisation that takes a range of school and university students out to remote locations to perform biodiversity conservation management research in the field. This has the dual purpose of raising awareness and funding for areas where nature may be threatened, as well as providing academic opportunities for PhD or BSc dissertations. Whilst Opwall may have started with expeditions to Indonesia they have now greatly increased their repertoire and in 2015 they will be running projects in 15 countries. These projects take place in wide and varied environments, from tropical dive sites, to boat-based projects in the Amazon, to rainforests.
Cusuco National Park
I decided on an eight-week stint in the cloud-forests of the Cusuco National Park in Honduras. I had done a total of nine months A&E (divided between an F2 job and time in New Zealand), as well as an expedition medicine course, but I was still anxious about what I would be faced with. Opwall helped to alleviate this by having a pre-trip medical meeting where comprehensive risk assessments, kit lists and evacuation protocols were discussed. I was also given a list of staff and volunteers with their medical histories so I knew what to expect.
It was whilst I was sat on the back of the pick-up truck, bumping around, as we drove up into the national park that it began to dawn on me the full extent of what I was undertaking. I was going to be looking after up to 50-80 people, with my medical kit and my clinical skills and a four hour transfer to the nearest hospital. If someone was really sick or had been bitten by a snake then we would have to call in the Black Hawk helicopter from the local US Air Force base for a med-evac! Instead of jumping off the truck and running down the hill I rationalised it to myself; I just had to know what I could not deal with in camp, what I could not diagnose, what I could not treat – those patients would need to go to the hospital.
Prevention is better than cure
The medicine I practiced for those eight weeks was not what I had expected. The time on the plane reading and re-reading the section in the Oxford Handbook of Expedition Medicine on tropical illnesses and snakebites fortunately did not come in use – except to scare people about what could go wrong. Like medicine at home prevention is better than cure applied in the jungle, possibly more so. I would take part in the health and safety briefing: I was like a broken record when it came to hand washing, drinking fluids, washing up plates and using insect repellent and sun block. I was very good at dishing out rehydration salts, cleaning up cuts and grazes, dealing with vomit and being a shoulder to cry on. There were many people, especially amongst the staff members who were there for a longer period, who suffered with homesickness.
I was very lucky; there were no medical emergencies, no snakebites and no helicopter trips. The worst I had to deal with was a girl who cut her knee open, she had to go to hospital because she needed an x-ray for foreign bodies and sterile closure. Another case stands out in my mind due to the difficulties that I faced trying to make a diagnosis over a two-way radio, taking a history from a group of people in another camp. One of the university students had a rash, a headache and felt generally unwell – in my mind’s eye I had images of a seriously ill young girl with a purpuric rash and meningococcal septicaemia. It turned out that the camp just had a severe case of bed bugs. Sleeping bag-boiling and antihistamines were what the doctor ordered, not a Black Hawk helicopter evacuation.
With a short daily clinic and the odd medical discussion I was left with a lot of free time, and this meant I could get out there to indulge my real reason for being in Honduras – exploring and photographing nature! Each day I could go out walking with the teams of scientists looking for birds or reptiles or insects or mammals. Physically it was tough, lots of hills – and I think I lost a stone over the eight weeks due to all the trekking – but it was worth it. I saw such a varied amount of wildlife and was around such inspirational people that I was half tempted to ditch hospital medicine and take up a career as a full time expedition medic!
Preparing for expeditions: What I wish I had known
When reflecting back on my experiences during that expedition (as we doctors are frequently encouraged to do) there are things that I wish I had known and that I would advise people to think about, that would help in managing the commonest complaints
Physio / Spend a session with a physiotherapist on managing soft tissue injuries, especially rehabilitation exercises and strapping.
Wounds / Having a good understanding of managing minor wounds and understanding the choices of dressings.
Dentistry / Knowing the basics of expedition dentistry – although not a problem I encountered I realised it was probably more likely than snakebites. Adventure Medic has published a series of guides which are invaluable.
Common Ailments / Rather than worrying about the tropical rarities be confident in treating and diagnosing the common conditions e.g. skin infections, gastroenteritis, allergic reactions and insect bites.
Finally, I think the most important thing I could say would be to have a good understanding of your limitations and the medical kit you have to work with.
Further adventures and jungle training
I enjoyed my time with Opwall so much so that I had to go away with them again. Subsequently I have been privileged to be the medic on trips to Madagascar and Mexico, which allowed me to see even more different types of wildlife and take thousands more photos. I have had the opportunity to see wildlife that many may not see in a whole lifetime whilst acting under the guise of an expedition medic. So if you are looking for an opportunity to go on an expedition where your focus would be the expedition itself and the wildlife, whilst providing medical back-up, Opwall may be up your street.
Opwall have now set up a four week Expedition Medicine Experiential Course set in the cloud forest of Honduras. This includes jungle training, a course on forest ecology as well as a training course in expedition medicine concluding with working as a camp medic in a supervised role. Alternatively the charity does run specific medical elective placements.
About Operation Wallacea
Operation Wallacea accepts / Junior doctors beyond F2, ideally with experience of A&E; Nurses or nurse practitioners in primary care or A&E; Paramedics; Medical elective students.
You can expect to manage / Diarrhoeal illnesses; insect bites; dehydration; skin infections; minor psychiatric illness; minor injuries and (rarely) management of snake bites.
Season / The Opwall season ties in with school and university holidays, running through June and July.
Language / As the medical work is mainly with the volunteers and staff members you are not required to know the local language of the area you are visiting.