Following hot on the heels of Vicki Ormerod’s recent review of Wilderness Medical Training’s Chamonix expedition medicine course, doctors Laura Irwin and Reza Noori give Adventure Medic their low-down on the Moroccan equivalent. As well as a description of a course which can boast a 100% summit success rate, they include a round-up of the fun they managed to have on their way to and from the course, from surf and beers to unusual selfies at 4000 metres.
Wilderness Medical Training
Wilderness medical training (WMT) is a UK-based company offering over 20 years of experience in delivering a range of expedition courses aimed at both medically and non-medically trained people, including summer mountaineering skills in Morocco’s Atlas mountains and winter skills in Chamonix.
We chose the Morocco Mountain Medicine Expedition course for a variety of reasons. Importantly, we wanted to gain a firm understanding of the role of the expedition medic and to learn about the practicalities of providing healthcare in remote environments. The course also offered an opportunity to learn about the diagnosis and management of common conditions encountered at altitude, all taught by highly experienced expedition leaders and medics. Finally, it offered a chance to climb Jebel Toubkal, the highest peak in North Africa at 4167m.
Morocco offers more than just mountains to climb and souks to get absorbed in. We opted to use the spare time we had before starting the course to indulge in some west coast surfing in the small fishing town of Taghazout. After missing the bus we arrived from Marrakech by taxi 3 hours later and seventy pounds poorer. (With hindsight a flight into Agadir would have been a better option.) We chose a company called Surf Maroc: a good place to stay, established by British expats who offered a competitively high standard of food and accommodation, with fun, knowledgeable local guides to haul us off to the best surfing spots daily. Unfortunately we had to venture a bit further from Taghazout than anticipated to find suitable surf given that it was early in the season. Nonetheless, the surf was great, to be recommended highly for both the surfing novice and seasoned expert alike. We enjoyed 5 days there, but could have stayed much longer.
The Course: Pre-Toubkal Preparation
The course is based in Imlil, a small mountain village 90 minutes drive from Marrakech at 1740m above sea level. It offers a short stretch of traditional food and clothes shops, a couple of souvenir stalls and a very untraditional yet surprisingly tasty pizzeria. From the ‘high street’ the tarmac road becomes a dirt track littered with rocks and towards the higher part of the village lies the Kasbah du Toubkal, an extravagant guesthouse and our base for the week. It resembled a mini fortress rather than a guesthouse, with its high polished stonewalls, luscious green gardens and traditionally decorated rooms. We were greeted with mint tea and dates before being shown to our room and had an opportunity to explore the grounds. The rooftop hosted a comfortable seating area with a spectacular 360-degree panoramic view of the surrounding mountains. Here we caught our first glimpse of the snow-capped peak of Mount Toubkal, a nice introduction to our Atlas Mountain expedition.
The teaching was delivered on different levels. The evenings consisted of 2 lectures, one medical and one expedition orientated, with the daytime filled with practical mountaineering skills.
The medical lectures covered essential expedition topics such as the role of the expedition medic, legal considerations, planning an expedition, the management of common altitude specific disorders and more specialist topics such as altitude associated retinal pathology. The lectures were informal and interactive, and delivered to a high standard. To complement them, we were given an in-depth course manual covering a variety of essential topics relevant to expedition medicine, ranging from expedition dentistry to diarrhoea.
The WMT team consisted of Barry Roberts (Commercial Director of WMT), Dr Dan Morris (Consultant Ophthalmologist) and Tim Burton (polar expedition guide and photographer). As well as their educational lectures, they also gave fascinating talks on their own expedition experiences.
Tim gave an account of his time (4½ of the past 8 years) on Antarctica working with the British Antarctic Survey, where a 24-month commitment can buy you a ticket to the frozen continent as the medic on site. Dan told us about his work in Africa, where he founded the Ol Malo trachoma eradication project in Western Kenya, and of his research into high altitude retinal pathology in the Himalayas.
However, of all the evening’s inspirational presentations, Barry’s account of his ascent of Mount Everest in 2004 was the one that stood out the most for us. He delivered an emotional, inspiring talk with video footage of his bid to summit. He talked about his struggle against the altitude and how he fell behind his team as they pushed on to the next camp, the isolation and hardship, and how he was finally able to continue onwards and upwards to summit the highest mountain in the world. He marked his victory with a photograph now known as his ‘signature picture’, a ‘selfie’ on the summit of Everest with the reflection of a Sherpa and the surrounding snowcapped peaks in his mirrored goggles. The last words of his talk were “everyone should have a signature picture, what will yours be?”. A thought-provoking question.
Their presentations and lectures inspired us immensely and demonstrated that being a part of an expedition was a real possibility – even within the tight constraints of a specialist training program in the NHS. They provided an opportunity to debate, question and learn from expedition experts in a relaxed atmosphere, and helped forge some great friendships and connections. In many respects, this was one of the more valuable elements of the course.
Much of the daytime involved navigational and orienteering skills, introductory rope skills and trauma management on the mountainside. The navigational part of the training on our first day involved a group-directed traverse of a smaller objective – a 2500m peak close to our base. We had received a tutorial on map reading and compass skills, which was without a doubt useful on this first outing, but also demonstrated how vital hands-on experience is when planning an excursion on tricky terrain. We had calculated from the comfort of camp that this trek should take us 5 hours (allowing us to be home well before dinner); the actual somewhat epic 8-hour hike taught us some of our most vital lessons when heading out – a simple wrong turn can have leave you hours behind schedule; you should always plan for the unexpected (with some extra food and a torch); and the experience of executing your own short simple expedition is more useful than many hours worth of lectures.
The second day involved a less strenuous introduction to rope skills and trauma management on the mountainside. Being rock climbers we were already familiar with the types of knots used, but it was still useful to practice making belays without all the regular climbing gear in order to assist people lacking in experience or confidence over technical sections of a mountain. The trauma management training was helpful and similar in many respects to the skills taught on an ATLS course. Having to perform out in the field, however, highlighted how difficult delivering even basic medical care can be when removed from the comfortable hospital setting. It also gave us an opportunity to learn the use of compact, light weight splints for limb immobilization, to gain necessary skills for casualty evacuation with minimal and improvised kits, and to use equipment not routinely seen in the hospital (such as adaptations of a Thomas splint and the assembly of temporary shelters). In all, the level of the technical and medical skills was basic to moderate but nevertheless useful, especially for the novice mountaineer, and delivered to a good standard in the short time that was allocated to it.
With all the lectures and practical sessions completed, it was now time to get ready for the summit hike.
Going up: Jebel Toubkal
We departed on our third day at 8am to begin the ascent towards the summit of Jebel Toubkal. Although proclaimed as a walk, we knew we had a tough day ahead of us. The temperature was already approaching 20 degrees and our backpacks were heavy with water, food and warmer clothing for the summit. The objective of the day was to reach base camp at 3207m, and the route would see us cover 12km and 1500m in elevation. Orientation was not a problem as a well-trodden path guided us through various landmarks. After an hour or so, crossing through a flood plain followed by several switchbacks climbing in elevation, we reached Sidi Chamharouch, a pilgrimage site. The shrine was a large white boulder that resembled an iceberg from afar. We enjoyed our first stop of the day here at one of the many Berber teahouses, offering refreshing Moroccan mint tea, stream-cooled fizzy drinks and even freshly squeezed orange juice. Unsurprisingly, the cost of these beverages grew in direct proportion to the altitude; it didn’t limit our intake. We continued to climb for another 5 hours over a moderate non-technical ascent with forgiving ground underfoot. The hike that day overall took approximately 8 hours to reach base-camp, which comprised of 2 stone-built Refuges.
We arrived at the Refuge before sunset, proceeded to our dormitory (comfortable, albeit a little too cozy) and reconvened in the dining rooms for laughter, chat and reflection on the trip thus far. The locals provided an impressive feast of lamb and potato stew served with couscous. Despite being teetotal, there was a lot of hilarity in the evening, regressing to teenager antics in our dormitory before we slept…
The following morning, we were off early. It was dark and cold, and thermals and down jackets were essential. Above us, we could see a snake of head-torched teams ascending towards the summit giving us an idea of the route ahead. We proceeded via the South Col route with the trail zig-zagging back and forth up a scree slope. It was steep, a lot steeper than the previous day and now more than a thousand meters higher. Unsurprisingly, each step became increasingly difficult and we found ourselves breathless with minimal exertion. Determination alongside a moderate level of fitness is definitely advisable and will make the journey more enjoyable. We climbed steadily only stopping briefly to catch our breath or have a snack, as the cold set in quickly. We ascended approximately 750m to reach the Toubkal pass, and according to the altimeter we were now just shy of 4000m. As we approached the summit, the trail now followed a ridge gracing us with beautiful views on either side. Some 3-4 hours after leaving base camp, the summit plateau was finally in sight.
A metal-framed pyramid structure marked the summit of Jebel Toubkal at 4167m. We huddled as a team, congratulated each other, took a few minutes to savor the moment and then proceeded to photograph our triumph. Having set off before sunrise, we reached the summit in the morning, allowing us the best chance of a clear sky. The summit offered a spectacular panoramic view of the surrounding Atlas Mountains and even the Sahara Desert in the distance. In-keeping with a pre-prepared plan, and with bravery shown by all given the subzero temperatures, we divided into ‘girl’ and ‘boy’ teams to take our own selfies. Fewer clothes were involved than can be advised, neither team outdid the other, and the entire experience was managed with the utmost elegance – a truly unified group.
And back down again
We decided to descend via the North Col: although longer and more challenging we were eager to explore another aspect of Toubkal. In the 1960s a small plane carrying weapons to Biafra crashed into the side of the mountain, killing all crew members upon impact. This side of the mountain was a little eerie, more desolate than the South Col and with debris from plane crash scattered over the mountainside. The hike down involved some scrambling and was tougher on the legs than the ascent but with each step, we came a little closer to getting back to base camp.
We arrived back at the Refuge late in the day, tired but in good spirit. After an early night, we were back on the path with an easy, steady decent down to Imlil to collect the rest of our gear. Barry and Tim delivered our last tutorial of the trip covering water decontamination and radio communications, finishing with a practical session on river crossing. The entire group gathered for pizza before heading back to Marrakech where we were booked into a central hotel courtesy of WMT. That evening we all ate around a large table and enjoyed the company, local cuisine and beer. It was a great way to say goodbye to all the inspiring, passionate and enthusiastic folk we got to know over the past week. Our connection with WMT did not end there. After arriving home, Barry continued to email the group providing links and advice on how to stay involved with the world of expedition medicine. We truly felt part of the WMT alumni community and wouldn’t hesitate to book another course with them.
- If you want to try surfing in Morocco, fly to Agadir and if going with a company, book early. Go from November onwards. We would highly recommend Surf Maroc.
- Beware that parts of Morocco (including Taghazout) are teetotal, and you can land up with a hefty prison sentence for breaking the rules.
- A moderate level of fitness will make the Toubkal trek more enjoyable.
- If you are buying new boots/trail shoes, break them in before arriving.
- Don’t be fooled by the hot sticky weather in Marrakesh or even in Imlil – take warm clothes for the summit.
- There were 16 people on the course plus the 3 team leaders when we were there – don’t be put off by a slightly crowded feel initially. We were divided into smaller teams for much of the training, the lecture space is large & comfortable, and we feel our experience was actually enhanced by hanging out with so many like-minded people.
- Professionalism of WMT – they had it all covered from the moment of transfer to our departure in Marrakesh.
- A valuable opportunity to learn from and to get to know some highly experienced expedition guides and medics.
- Useful tips for the novice expedition medic and a good level of basic knowledge.
- In-depth course manual provided.
- A great way to explore the Atlas Mountains.
- Hospitality and accommodation at the Kasbah Du Toubkal.
- Slightly basic level practical trauma management for above FY2 level, but well run in a short time space.
- Cost – you’ll be a few pounds lighter at the end of it all, but we felt it was worth the experience.
- Course – £600 + €250 (paid locally – we’d advise bringing Euros with you as we had to change Moroccan currency to Euros there: a bit of unnecessary hassle). This includes the escorted climb, group airport transfer from Marrakech to the Kasbah, full board accommodation (shared and mountain refuge) including soft drinks at the Kasbah, Marrakech hotel/final group dinner/breakfast at the end of the course.
- Flights – we flew with easyjet to Marrakesh from the UK for about £60, and back with Ryanair for £30.
- Surfing – Surf Maroc can be done on a budget or in style. The Villa is more fancy, has yoga sessions overlooking the ocean, but is fairly expensive. We stayed at the Guest House, right on the beach, where we were served up amazing food and had simple, clean rooms for about £30/night B&B. Dinner was extra, but was all you can eat and far superior to the other local options. Surf lessons were around £20/day including all transfers, guides, lunch and equipment.
- Extras – very little, just some spare money for extra food/drinks.