Dr Renée Farrar / ED registrar / UK and overseas
A keen road cyclist, Dr Renée Farrar leapt at the opportunity to provide medical support to the West Africa Cycle Challenge 2019: a challenging 500km journey through bustling towns, dusty open roads, lush greenery and beautiful beaches, whilst also visiting some of the important projects run by the organising charity Street Child.
(Photographs by Dr Renée Farrar)
Sierra Leone and Liberia are not the first places that come to mind when I think of road biking. I’m used to the UK, the Alps and some remote parts of Europe, but I didn’t need much persuading when I was offered the opportunity to be the medic of the 2019 West African Cycle Challenge.
To my cyclist’s brain it was a chance to partake in one of my favourite sports whilst doing my job. I might even get to talk about sport gels and Lycra to people who find them interesting! My task was to accompany ten cyclists from Bo in Sierra Leone to the finish line in Robertsport, Liberia. With me would be team members from the organising charity Street Child, some NGOs, as well as a local support team.
Packing my hot weather gear and preparing to be the cycling domestique-style doctor was no mean feat. There would be medical care available along the way, but it couldn’t be accessed quickly from the race route (four to six hours’ drive away) and we knew phone reception would be patchy. We anticipated a good deal of roadside pre-hospital medical care with road or air evacuation as needed. My kit was therefore extensive yet compact. It unpacked to many organised boxes of drugs and equipment plus a field bag for immediate care.
It’s not all about the Lycra
It is pretty tough cycling in 40 degree heat, where the dust is so red that it stains your t-shirts permanently and your knees for days. The participants all had the necessary sense of adventure to cycle on mining roads and dust tracks, to cross rivers and travel on car ferries alongside trucks, chickens and precariously stacked crops.
It was important for the cyclists not to be precious about their bikes and to have an idea of when to ask for help from the very friendly, talented mechanic and cyclist Karim, a.k.a “Stylish Man”. He is currently Sierra Leone’s best cyclist, national team leader and champion of women’s empowerment. He helps women of all ages to get cycling and learn about bike maintenance, giving them their own means of transport, access to fitness and a chance to compete for national events.
Our meals were cooked for us, but we supplemented these with delicious snacks on the go. Fresh pineapple and locally-roasted nuts mid-ride were a lot more tempting than a squashed well-travelled muesli bar. Water was provided in plastic bags – quite upsetting for the environmentally conscious, but difficult to avoid. Extra provisions were carried in the support trucks and offered at every stop.
A race to raise awareness
The race itself was four days with an additional day of preparation and a day of rest at the end. Individuals and the group as a whole faced challenges as we travelled through two stunning, but very different countries. Both Sierra Leone and Liberia have been war-torn and are affected by poverty and disruption. As the race was organised by the charity Street Child, we had the opportunity to be involved in family and youth visits all along the race route. This allowed us to understand more about how safeguarding, illness and discrimination issues affect people in Sierra Leone and Liberia. It was humbling to visit families who had lost loved ones and been isolated due to the Ebola outbreaks. I personally found learning about the difficulties faced by many women, particularly some of the pressures and abuse they face, really difficult to hear.
What challenges face a cycling medic in the West African bush?
Diarrhoea and vomiting
As with anywhere that you’re eating unfamiliar food in a challenging climate, there is a risk of gastrointestinal upset. The variety of local poisonous snakes and biting insects mean it’s not always an option to run into the bush at the side of the road for relief. My goal was to keep the cyclists and the rest of the team as well-hydrated and nourished as possible. I kept track of calories and nutritional intake of the cyclists each day.
I tried to prioritise monitoring fluid and electrolyte losses as quickly as possible, whether this was from lots of exercise and sweating or florid gastrointestinal illness. Meticulous hygiene from the team was essential. As the medic, I felt it my responsibility to reinforce the importance of this. I wondered if I should buy shares in hand sanitising gel!
Potential cycling injuries
Falls off a bike can be anything from minor to catastrophic. You only have to watch a downhill section of the Tour de France to see some epic falls, or go mountain biking for a day to see someone tumble off their bike. Combine this potential for injury with heavy traffic and unconditioned roads, and the risk for trauma escalates. Fortunately, no one was significantly injured but I felt prepared with my medical kit and with access to evacuation if needed.
West Africa is beautiful, but not without its hazards and challenges. The Ebola risk had passed at the time of the race, however NaTHNaC had reported a few cases of Marburg virus disease in Sierra Leone. Rabies was always a risk, especially with many street dogs intrigued by passing cyclists. Various insects, worms and waterborne parasites such as bilharzia are endemic in the region and risk had to be considered. Oral anti-malarials were required, but general bite avoidance with nets and appropriate clothes was essential, especially at meal times and when relaxing around dusk.
The strong sun and high temperatures posed risk of heat illness and dehydration. Concomitant gastrointestinal upset only increased risk. Hot nights made sleep a challenge. Legs and arms became caked in mud, and this, along with the dust and wind, only added to the discomfort of the cyclists. We even had to be sure to check the timing of the tides when walking to explore shipwrecks on the beach to avoid being stranded in deep water.
WACC was a proper, open road race but without the comfy chalet stops that you find in the Alps. We loved the authenticity of staying at local guest houses and they provided well-needed rest. However, it was a 500 km race which resulted in pure fatigue. Many snacks were eaten, gallons of water were drunk and many rehydration mixes made. As with any endurance sport, getting tired and the risk of bonking (a cycling term meaning ‘hitting the wall with tiredness’) was high.
A whirlwind introduction to West Africa
I loved this trip. As a doctor, the mix of exposure to pre-hospital care and sports medicine was really interesting. I’d also recommend this race for keen cyclists wanting to get an insight into West African culture, customs and some of the sociopolitical problems the people face.
I’d like to thank Street Child, Exile Medics and the entire cycling team for being so great to work with.
If you would like to find out more about Street Child and the other challenges they have on offer such as their award-winning Sierra Leone Marathon or their upcoming cross-country cycle challenge Ride Sierra Leone visit their website.
Renée can be contacted at firstname.lastname@example.org