APEX 5 Organising Team* / University of Edinburgh Medical Students
Rebecca Trimble / University of Edinburgh Medical Student / Adventure Medic Student Rep & APEX 5 Volunteer
Altitude research is an amazing way to combine a love of the outdoors, travel, and education. Why not start getting involved as early as possible in your medical career? The APEX (Altitude Physiology EXpeditions) charity was founded in 2001 by Edinburgh medical students in order to explore the impact of altitude and low oxygen levels (hypoxia) on the human body. Many more students have followed in the footsteps of this first team, the most recent being APEX 5. They aimed to build on the work of those who had gone before, whilst enjoying the adventure and forging friendships along the way. Read about the team’s experience, and get in touch with Rebecca or APEX if you’re keen to be involved in the future or to learn more.
*The APEX 5 Organising Team: Christopher Graham, Rebecca Dru, Eleanor Lee, Gordon Paterson, Greig Torpey, Jason Young, Joe Wilson.
Last summer the APEX 5 expedition travelled to Bolivia, exploring hypoxia’s influence on the immune system, blood clotting, vision and cognitive function, as well as investigating the impact of personality traits on perceptions of altitude illness.
A team effort
Six University of Edinburgh medical students formed the APEX 5 organising team, and planning started in 2015. Chris Graham assumed the role of Expedition Leader, thanks to his leadership expertise and experience as an APEX 4 volunteer. Becky Dru was in charge of the books and finding willing backers for our inevitably costly expedition; Jason Young and Gordon Paterson took on the ethics applications and research logistics, in order to execute our ambitious research projects; Greig Torpey, with a wealth of experience with Scouts Scotland, was well suited to be Logistics Coordinator and organise our team-bonding weekend away; finally Ellie Lee, with her background as Yoga Society President, was in control of volunteer well-being. The organisers later welcomed Joseph Willson, Edinburgh PhD student, to assist with research.
Twenty-seven University of Edinburgh undergraduate students were then selected by interview to make up the team of research participants. Additionally, we recruited two experienced expedition doctors, Ailsa Stott and Nick Haslam.
A solid team.
The aim of the game
While expeditions make their names as life-changing experiences for all, the main aim of APEX 5 was high altitude research.
Jason led his neutrophil project, investigating the role of hypoxia in reprogramming immune response to bacterial infection. Gordon’s blood clotting research investigated how platelets are activated in hypoxia. Chris looked into the impact of hypoxia on the eye’s macula and fundus, and tested eye movements controlled by the brain to assess cognitive function. Finally Greig, with a helping hand from Becky and Ellie, undertook a psychology study investigating links between personality type and individual symptoms of acute mountain sickness.
What was your main motivation to organise the APEX 5 expedition?
Inspired by the achievements of past expeditions, we formed APEX 5 to continue research into hypoxia and high altitude illness. Additionally, we all have a passion for the outdoors and expedition medicine, and were keen to get this exciting project off the ground and see it through.
What was your biggest challenge? How did you overcome this?
Aside from the steep learning curves for us all in areas such as logistics, ethical forms, financing an expedition, and the nitty gritty of scientific research abroad, we would say our biggest challenge was dealing with a last-minute change in location.
When the team arrived in La Paz, where we spent four days acclimatising, we met with our in-country logistician who had bad news. The road to Chacaltaya lodge (the destination for APEX 4, and our planned ‘laboratory’) was blocked off with snow and ice. This was uncharacteristic for the time of year. It was essential that we had safe road access for a rapid descent, in the event that a member of the team developed severe altitude illness. After some quick thinking and negotiation (and an attempt at digging/bulldozing our way to Chacaltaya) we secured an alternative lodge at the base camp of nearby Huayna Potosí Mountain (4,700m).
In what way did your research projects build on previous APEX expeditions?
Previous APEX expeditions have studied various aspects of both hypoxic physiology and high altitude illness, ranging from coagulation in hypoxia, to High Altitude Pulmonary Edema (HAPE). Our hypothesis for APEX 5 coagulation research evolved from the data gathered on these expeditions1, aiming to uncover the physiological pathways up-regulated in platelets in hypoxia.
Will the results of your research have the potential to impact upon patient care?
The majority of our research projects investigated the effect of hypoxia on human physiology. By conducting our research in a healthy cohort at altitude, we were able to examine hypoxia in isolation, giving ‘clean’ data by removing confounding factors such as other diseases. We hope to relate these results to understand more about the impact and management of hypoxia in patients at sea level with ill-health, such as those with chronic lung disease and patients in the critical care setting.
For example, our neutrophil research may change our understanding of the immune system in patients with hypoxia and infection, such as patients with chronic obstructive pulmonary disease (COPD), which according to The British Lung Foundation affects an estimated 1.2 million in the UK. Laboratory experiments have shown that prolonged low oxygen levels in the presence of infection in mice can cause over activation of the immune system2. However this does not happen if they were previously exposed to systemic hypoxia. This preconditioning of the neutrophil response thus seems to prevent a negative host immune response to hypoxia and infection. We hope to validate these findings in a human population with our results.
How did the volunteers fare at altitude?
We all came together and formed a fantastic team, able to look after each other when we had low points – we were pretty adept at making each other laugh when the going got tough.
We were lucky and extremely pleased that no volunteer had to be evacuated and that, despite the expected miserable symptoms of altitude sickness, everyone powered through and remained keen to stay involved in the research.
The team was also very thankful for our expert expedition doctors – Ailsa and Nick – who were crucial in keeping us all healthy and our morale high through good humour, many board games, and a few doses of painkillers throughout the expedition.
It was fantastic that our volunteers were keen to learn from our research. During research days, we offered half-day internships in the lab so that our volunteers could learn the science behind the research, improve their lab skills and ask any burning questions. This not only stands them in good stead for possible research-focussed careers, but also for the future of APEX.
What was the general atmosphere like at Huayna Potosí base camp?
Awesome! As said, our group got on amazingly well and the atmosphere was always very friendly. Our new place at Huayna Potosí was definitely cosier than Chacaltaya would have been, but it also allowed us the freedom to explore stunning surroundings. When not doing our research or out for a wander, there was always a card or board game being played, or a quiet space to read and reflect on the day’s events.
Can you describe a typical day at Huayna Potosí base camp?
After a tasty breakfast, it was questionnaire time, and on testing days this would be followed by blood tests, eye and vision testing, or helping out in the lab for the rest of the day. On research days there was a lot of work to be done with blood samples: preliminary analysis was undertaken on the mountain, and we prepared samples for transport back to the UK for comprehensive analysis – the laboratory team were kept busy!
After lunch, the afternoons were generally free, with some additional tests on research days. Many chose to chill out by the beautiful lake a stone’s throw from our lodge, play cards in the cosy dining room, or take a walk through the mountains. For days with less research it was necessary to become creative with your free time. The volunteers even wrote a parody (and recorded a music video) to Jordin Sparks’ “No Air”…
There was always time made to cuddle our two adopted expedition dogs – Nieve and Noche (Snow and Night – named for the colours of their coats) who lived full-time at base camp.
Following a traditional Bolivian dinner (always starting with soup), we often stayed together for a movie, a quiz, or even a spot of incredible stargazing. It would then be time to snuggle down in our sleeping bags looking forward to what tomorrow had in store.
What is your single best piece of advice for other students organising a similar expedition?
Find good mentors!
We would not have got the project off the ground without the help of Drs Kenneth Baillie and Roger Thompson, APEX founders, who provided us with so much support. Having their support and the support of other dedicated research supervisors was crucial in the planning and execution of such a unique trip.
What are you most proud of?
It is hard to sum up an expedition of this scale in just a few words. It took over two years of planning, many late nights and an awful lot of paperwork before we could even set foot in South America. From interviewing our volunteers and submitting complex ethical forms, to undertaking our ambitious multifaceted research in the Andes, we as a committee learned an unbelievable amount.
We are proud of everything that we achieved, of each other, of the volunteers, and of the fact that we organised an international medical expedition.
Keen to find out more?
For a taster of APEX 5 trip’s amazing surroundings, and their somewhat cheeky musical skills, see their YouTube music video.
If you’re interested in following up the results of their research, or are keen to contact the team who run APEX about future expeditions, visit their altitude.org website. Alternatively, drop Becky, our student rep and co-author of this article, an email on firstname.lastname@example.org.
Thromboelastometry and Platelet Function during Acclimatization to High Altitude. Rocke et al. Thromb Haemost. 2018;118(1):63-71
- Hypoxia determines survival outcomes of bacterial infection through HIF-1α–dependent reprogramming of leukocyte metabolism. Thompson et al. Sci Immunol. 2017;2(8): eaal286