Louise Wade / Adventure Medic Staff Writer
Getting involved in expedition work is one of the things we get asked about most frequently at Adventure Medic. However, Expedition Medicine is a competitive and relatively insular field that can be difficult to get started in. We assure you it is worth it though: think of a job where you can potentially wake up to a view across the Himalayas – surely an improvement on working for the NHS? Adventure Medic Staff Writer Louise Wade has worked extensively as an expedition doctor over the last few years and this is her take on getting involved.
I have been lucky enough to work as an expedition doctor on trekking, cycle and diving trips. It has enabled me to travel extensively– to destinations including Everest Base Camp, Fiji, China and Kilimanjaro – something I would never have been able to do otherwise. On each trip I have been immediately welcomed as an important part of a team, met a new group of people and then got to help them achieve a huge personal goal. Working in expedition medicine helps your medical practice too. You develop your initiative and confidence, take on an extended role (you will find yourself expected also to function as a nurse, physio, counsellor and dentist…) and see conditions that you are unlikely to encounter in the UK.
As an expedition medic your role starts several months before the trip begins. Companies will often ask you to send out pre-departure medical information, such as advice on vaccinations, and to screen participants’ medical forms. This can lead to some difficult decisions – are you willing to take responsibility for someone who has had multiple MIs and now wants to climb Kilimanjaro? Once on expedition you will be expected to routinely check in with everyone and ensure they are getting on okay, as well as dealing with medical problems as and when they occur. On my first trip the only thing I did in ten days was to dress one burst blister. This made me quite anxious – both to justify my presence and also that something unforeseen and disastrous was due to happen any moment.
On subsequent trips I have found myself dealing with everything from malaria to severe altitude sickness to an acute MI, all in a remote environment. Often you cannot definitively manage these casualties on site and your role becomes to stabilise them as best you can and to coordinate an evacuation. It is not only the need to make important clinical decisions that makes the role challenging.
Some participants can be quite demanding and no matter how minor or irritating you might find their concerns you have to be polite and professional 24 hours a day. On treks and cycle rides the medic is almost always the back marker, so they approach any accidents. If you are a fit person this can at times be frustrating. It is also an interesting dynamic to live with your patients. You get to watch them openly ignoring the advice you gave and they can see you sneaking off behind a rock to go to the toilet.
Still interested? The easiest way to get started as an expedition medic is to work for a company that runs charity trips – these are usually treks and by far the most common destination is Kilimanjaro. Ever since Cheryl Cole and a few other celebrities went up there for charity in 2009, Kili trips have been hugely popular. However common, Kili is not a expedition to take on lightly. It is a high altitude trip, often involving a fast ascent, so companies are keen to take medics – they are keen because they know that several people in the group will end up suffering from altitude sickness.
It is a tough trip to do anyway, without having the additional responsibilities of being a first time expedition medic, probably also having your own first experience of high altitude. It is a brave decision to take it on as your first trip, however it is probably the one that you will be offered. Sometimes you can negotiate – I got my start by agreeing that I would do a Kili trip later in the year if they let me go on a Sahara Desert Trek first. Once you have done Kili though it can open doors to new work, as you have proved yourself at altitude and will likely have gained some experience of treating altitude sickness, although many companies may just see it as an opportunity to offer you more Kili dates. (You can also have a look at Adventure Medic’s dedicated Guide to Kilimanjaro.)
The application process to work as an expedition medic starts with emailing a copy of your CV to a company you would like to work for (see the Adventure Medic Jobs Page for lots of useful contact details). This is usually followed next by a face-to-face, fairly informal interview. Almost all companies look for Emergency Medicine experience. Then, depending on the type of trips they run, other experience such as having been at high altitude or knowledge of a specific area such as diving medicine can give you an advantage. If they like you, they will then keep your CV on file and let you know as and when they need medics.
Often vacancies are offered first to medics who have worked for them before and therefore it is rare to get offered work straight away. Companies often email around with short notice vacancies too. This happens when medics drop out, which is fairly common as rotas change, people can’t get leave etc. If you have the flexibility to step in it can be a great way to get started and you become very popular when you save them of being short of a doc at the last minute!
Another important consideration is of course – how much will you get paid? Well, probably nothing. Most companies will (and should) cover all your expenses – flights, visas, accommodation, food, kit etc – but will not pay you a salary. I have occasionally been paid a token amount (usually equivalent to about half a day’s locum work) but have actually found this to be more trouble than it is worth. When you get paid, no matter how little, it is much harder/infinitely more expensive to get indemnity cover as you are now effectively working as a private doctor rather than a volunteer doctor.
I would advise anyone strongly against working on a trip without indemnity cover. As an expedition medic you are putting yourself in a situation where you are no longer supported by the NHS or senior colleagues, you are making difficult decisions about problems you may have little experience of and you are in a remote environment. Be wary of some companies who will take North Americans on their trips. UK indemnity companies will not routinely cover you to look after these litigation-happy nationalities.
I have had some of the best experiences of my life working as an expedition medic. I have been to amazing places, completed some great physical challenges and often had a minimal workload. When testing out my medical skills, I’ve enjoyed the freedom to practice free from protocols, finding out what can be achieved with the kit I’ve got, in the environment I am in. I would emphasise that pre-trip preparation is key. You also have to be aware that unexpected things can happen and be ready to live up to the ultimate responsibility that you have taken on for your participants’ health. Indeed, if you are prepared, things going wrong can be part of the fun.
- Get some A+E experience on your CV, ALS and ATLS certifications help too.
- Consider an expedition medicine course – it gives you a better idea of what you are getting into, but is not essential for getting work (see our Courses Page for more information).
- Send your CV off to as many companies as possible. Then follow it up, periodically get in touch and see what vacancies they have.
- Be prepared to do some trips that aren’t your first choice to allow you to get some experience and a reputation – then you can be more picky.
- Be thoughtful about taking on Kilimanjaro first time round.
- Do lots of preparation for your trips. Know exactly who is in your group and about any pre-existing conditions they have, learn about any local diseases that you may encounter and the medical facilities that will be close to you (and of what standard they are). Be familiar with your company’s casualty evacuation plans and how to get advice or help if you’re out of your depth.
- Get indemnity cover.
- Have a look at some relevant Adventure Medic articles including: Introduction to Altitude, Risk Management, Legal Aspects, Expedition Dentistry and Our Guide to Kilimanjaro.
- Enjoy, you have the best job in the world.
We at Adventure Medic are keen that people recognise the skills and risks of being an expedition medic. Everyone has their own motivation for going on an expedition, so we can’t insist that you only go if expenses and salary are covered, however please make sure that you feel adequately compensated for your work. Beware the ‘10% off the cost for being the medic’ deal… it is rarely worth it.