Hannah Newcombe / Foundation Doctor, South London
Hannah Newcombe is a Foundation Trainee from South London who studied at the University of Manchester. With winter approaching she recounts her ski medicine elective experience in the French Alps last season – a good mix of acute wilderness medicine and corduroy-shredding ski goodness.
I am an outdoor enthusiast and get the most out of a weekend by keeping busy, active and outdoors. So, I chose an elective to compliment my interests. I travelled to the frosty snow and beautiful sunshine of Avoriaz Medical Centre, Portes du Soleil ski area in France. I had switched a slow drive around the M60 motorway for a gentle ride up the gondola ski lift and a ski down the piste. It was a trip to remember!
The medical centre is cosy and compact, found at the base of main chair lifts, in the middle of the traditional ski resort of Avoriaz. There are no roads in Avoriaz so in the winter, locals get about on foot, snow-mobile or with horse and sledge which all adds to the charm and reminds you of the seclusion of the village. The experienced and close knit team is made up of four doctors, two nurses and radiographers and one physiotherapist. They all lived nearby for the winter season and were keen to involve me in the team, teach, and encourage me to make the most of the mountains.
French healthcare system is similar to the UK; there is good access to resources, and similar medications and treatment options which made it easy to transfer my knowledge from UK to the consultations in France.
I observed differences in primary care, for instance one would take their child directly to a paediatrician rather than the GP, and for every different medical condition an adult would go to a separate medical specialist. The GP is the co-ordinator of referrals and triage patients initially. Also, it is a social insurance system where employers pay a compulsory fee for healthcare and private insurance schemes top up the surplus. I observed easy access to X-rays and ultrasound to confirm diagnoses quickly, and more technical splints and supports for immobilising dislocated joints or fractured bones.
Comparison to UK
The medical centre went beyond the initial management that I was used to in a central Manchester GP practice as there could be a delay in getting to the local hospital due to the distance, the mountain road, and the challenging weather. For example one patient presented with collapse and was clinically dehydrated. They were promptly treated with intravenous fluids, discharged home and then followed up the next day, once blood test results were back. Another patient was systemically unwell from pneumonia and required intravenous antibiotics. These were started immediately whilst the patient was awaited transfer to the hospital.
I would describe a typical day, however there as so much variety and different opportunities available that it is a little tricky! My days were pieced together by either GP clinics or acute trauma walk-ins. I would find myself taking a history or undertaking an examination following a patient through to X-ray or ultrasound, reviewing them with the doctors where I would be quizzed on my differential, and finally assist with fixing/strapping/suturing/immobilisation. As my placement progressed I was able to see patients in each of these stages on my own, depending on language and severity of illness or injury. I became neater at suturing, quicker at spotting a dislocation, and handier at helping apply a cast to a fracture.
There were often times of gazing out the window at the slopes, or critiquing skiers techniques from the sun loungers on the terrace in the quiet moments. But they were often interrupted by the siren of the piste patrol bringing in an injured patient. Everyone snapped into action transporting the patient into the medical centre and through the slick consultation and treatment cycle.
I was lucky enough to join one of the doctors in the helicopter when the piste patrol requested the doctors support. It involved a stunning if brief trip over the high peaks to reach the patients. Stabilising them, giving analgesia or even a nerve block before transport back to the medical centre or local hospital. It was a challenge to keep the patient warm, fully informed and as comfortable as possible to insert a cannula whilst I was knee deep in snow myself and gradually loosing feeling to my own fingers.
One particular case that has stayed in my memory was of an English lady who came to the centre after a fall onto her right arm in the last week of my placement. She was a GP herself and I tentatively took a history and examination before sending her for an X-ray of the shoulder. I was feeling quietly confident of the expected diagnosis and was already lining up which sling to use. However I studied the X-ray and it looked normal. In fact the GP/patient had a look herself and was relieved that there was no obvious abnormality. So we trundled back to the consultant who after hearing the history alone and a glance of the film got out his ultrasound machine, revealing what was my initial diagnosis; fractured head humerus. A shocked GP accepted her sling, analgesia and physio advice, and I accepted a good lesson from my consultant: he explained that from the description of her fall, the fact she was skiing (rather than snowboarding) and her description of the sound and of the pain, it had to be a fracture. He gave me confidence to utilise the depth and preciseness of history taking to get the diagnosis whilst using images to merely confirm this… and to keep looking!
My accommodation was down the valley in Morzine which is an adjoining ski resort. Here I lived with Seasonaire’s who were balancing their jobs of cleaning, waitressing and instructing whilst managing to cram in as much skiing and boarding as they could. I was able to socialise with young people of varying ages and could make plans to ski different areas, trek up to incredible views and off-piste ski, and of course have some company for the ice-hockey matches, film nights, fancy-dress, quiz nights, wine bars, local cuisine, mountain view swimming pool. This complimented the busy shifts at the medical centre with a chance to enjoy life in the resort.
- Arrange accommodation well in advance, and be persistent.
- Hot up on your French
- Take a UK textbook to refer to e.g. OHCS couple really useful BMJ learning modules on managing snow-sport injuries
- Dynamic scenery and breathtaking views from ‘the office’
- Ideal location of medical centre on the slopes means you can easily get even a short amount of skiing in daily
- Friendly, welcoming, local staff
- Variety in workload of general practice, orthopaedics and trauma call-outs
- Great for an individual as many Seasonnaire’s to meet with, ski and socialise
- Close to the UK so no long-distance flights and it’s accessible for visitors
- High price of daily living as it’s a sought after resort in high season
- Challenge to communicate with patients of all nationalities
- The medical centre only has the capacity to take up to two additional trainees in addition to their own student nurse and doctor so organisation early is required
- If you wanted to go as a pair you would mostly work alternate shifts and therefore wouldn’t be able to ski together too often
Where / Avoriaz Medical Centre, Portes du Soleil ski area, France (bordering Switzerland)
When / Jan – Mar (available December-April)
Travel / Fly to Geneva from most UK airports. There are many transfer companies to choose from to take you to resort
Work schedule / Alternating early or late shifts (0800-1400/1300-1900) and then long-day or off for Saturday & Sunday.
Weather / Alpine sunshine but cool temperatures -30 to +12 in resort
Costs / Approximately £600 a month (accommodation, ski pass, ski hire, and food) dependent on preference of standard of accommodation
Necessaries / French language skills of A-level or equivalent and the will to learn and improve
For more information, or to arrange your own elective in Avoriaz, please follow this link.