Sam Covins / Medical Student / University of Warwick / UK
Last week, Sam Covins regaled us with the story of his research expedition to the Atlas Mountains. To follow this up, we asked Sam some questions about how he became involved in altitude research as an undergraduate, and what happened along the way.
Why altitude research?
For me, it all started at the 2014 Student Wilderness Medicine conference, during which Professor Chris Imray gave a captivating keynote talk on his involvement in the 2007 Caudwell Xtreme Everest research expedition. I’ve always had an ambition to climb mountains, and learning that it was possible to do so in combination with research was what really inspired me to organise an expedition of my own.
What kind of research were you conducting?
The study itself incorporated the protocols of six individual research projects that we independently designed and developed. Our research aims were as follows:
- To assess the impact of hypoxia on cardiac electrophysiology at high altitude, using continuous ECG monitoring.
- To investigate changes to the respiratory airways during ascent to high altitude, and their association with the onset and severity of acute mountain sickness (AMS).
- To perform a quantitative analysis of peripheral oedema at high altitude.
- To conduct a comprehensive assessment of visual function at high altitude.
- To analyse complex decision making and risk taking behaviors at high altitude.
- To explore the use of thermal imaging technologies for the assessment of peripheral perfusion at high altitude.
Our research was conducted in collaboration with academic staff from the University of Birmingham, the University of Warwick and local NHS trusts.
How did you go about setting up this study?
I established the Warwick Altitude Research Group back in February 2016. During our first meeting, we spent several hours discussing research ideas and debating locations for an expedition. Initially we decided upon an ascent of Mont Blanc, with the intention of recruiting local mountaineers as participants for our research. However, having spent some time liaising with various guide agencies in the Chamonix valley, we realised that Mont Blanc was way out of our budget. Back to the drawing board. But after much deliberation, we decided upon an expedition to the summit of Mount Jbel Toubkal. Having chosen a destination, we spent the next few months developing our research proposals, preparing ethics documents and drafting applications for funding. Rather than recruit mountaineers in Morocco, we decided that for research purposes it would be logistically easier to recruit participants in the UK and travel as one large expedition group. Our recruitment drive was short and simple with thirteen extra individuals jumping at the opportunity to take part in the study. The expedition was predominately advertised through word of mouth to our friends and colleagues. Each expedition member was provided with an information leaflet, providing them with all the necessary information about our research study. Everyone was given time to consider this information and decide whether or not to participate in the research, and participants were in no way coerced into taking part. Exclusion criteria varied between the different research projects.
Overall, the study was a success and we are currently in the process of preparing manuscripts for publication. In addition, myself and four other students were fortunate enough to be able to present our study findings at the 2016 Altitude Research conference, hosted by the Birmingham Medical Research Expeditionary Society (BMRES), and were awarded the prize for ‘best poster presentation’. Delighted!
What preparations did you have to make before you departed for Morocco?
We spent several months making plans to prepare for the expedition. Not only did we have to prepare for our ascent of Mt. Toubkal, but we also had to work out how to transport our research equipment and conduct our experimental protocols in the field. Although our expedition had been planned so that the majority of our research could be performed in the shelter and comfort of our overnight accommodation, we knew that our final round of experiments would have to be conducted on the summit which, in November, is covered in snow and very exposed to the elements. Therefore, in preparation for any unfavourable weather conditions, we packed and carried several tents and group shelters on our final day of ascent. Fortunately, our summit day was blessed with excellent weather and very little wind until the very end, which enabled us to conduct our research with little environmental disruption.
In order to maintain the consistency of our research, we made sure that all of the equipment used during the hypoxic chamber study back in the UK was transported with us to Morocco, and utilised for the same experimental purposes throughout the duration of the expedition. Unfortunately, due to our limited budget, we were unable to afford the purchase of any insurance for our research equipment. This was a significant source of anxiety for several members of the research team, particularly as most of our equipment had been acquired on a short-term loan basis for which we had to accept personal liability for any damage or loss. However, to ensure the safe transport and storage of our research equipment, we were very particular about the packaging and protection of each item in our luggage. We also decided to compile a list of all our equipment and allocate responsibility for individual items to different members of the research team to ensure that nothing was forgotten or lost.
Did everyone involved have previous experience of trekking at high altitude?
Around 500 people climb to the summit of Mt. Toubkal each year, and although the ascent does not require any technical mountaineering ability, a high level of physical fitness and stamina is needed. We were therefore quite selective during our phase of recruitment to ensure that only those with a reasonable chance of successfully reaching the summit were recruited. Despite our relatively limited knowledge of winter mountaineering techniques, we all had previous climbing and trekking experience from time spent in both the UK and abroad. In addition, several members of our group had previously travelled to high altitude at various locations around the world.
Did you arrange any training to ensure that the group were adequately prepared?
We did discuss the idea of organising some group training before our departure, but ultimately decided against it due to time constraints, and the difficulties associated with coordinating a pre-expedition meeting at suitable time and location. Although there was therefore no formal training for the volunteer participants, we advised each of them to prepare for the ascent with regular exercise to improve their cardiovascular fitness and stamina.
However, we did arrange a weekend of training for the expedition research team. Together we travelled to Great Malvern in Worcestershire and embarked on a walk along the length of the Malvern Hills. With us we carried all of our mountaineering and research equipment to simulate what it would be like during the expedition. Upon reaching the summit of the Worcestershire Beacon (the highest point along the route) we set up a temporary base camp and conducted a rehearsal of our research investigations in the field.
What was the biggest difficulty you faced, and how did you overcome it?
Funding for the study was our biggest limitation. As medical students, we were not only limited by the nature of our research (i.e. nothing invasive or interventional), but we were also forced to front most of the research costs from our own personal funds. We submitted several grant applications to various charities and organisations but securing financial support proved far more difficult than we’d ever anticipated. Fortunately, we were lucky enough to be awarded a small research grant from the JABBS Foundation – a Birmingham-based academic charity – to subsidise the costs of using the hypoxic chamber. More recently, we received a generous donation from the BMRES which was used to reimburse several members of our group and alleviate the financial burden of our research study.
What was your highlight of the expedition?
Although reaching the summit of Mount Toubkal was a great achievement, for me it was not the biggest highlight. I was unfortunately one of a minority of expedition members that did not acclimatise well to the altitude, and thus my time spent above 4,000m, with oxygen saturations of 75%, was an entirely unpleasant experience.
The highlight of the expedition for me was actually our evening meal in Marrakech on our last day in Morocco. With the research now complete, I found myself pausing for reflection as we sat and enjoyed our final meal. It was at this point that the sense of achievement really hit home for me. What had started out as a somewhat ambitious idea had become a reality, and after months of planning and preparation I felt relieved that it was over, but immensely proud of what we’d accomplished.
What advice would you give to other students wishing to plan their own research expedition?
Be organised and start the planning process as early as you can! Choose your group carefully – good teamwork and communication is essential for the success of an expedition. Seek financial help and apply for grants early. Find a good supervisor who will support and advise you. And finally, don’t be put off by the sceptics and the people that tell you “it can’t be done”.
“Challenges are what make life interesting, overcoming them is what makes life meaningful.”
– Joshua J. Marine
Looking back, would you consider doing something like this again?
Yes, absolutely! Although it was at times an incredibly stressful and time-consuming experience, I thoroughly enjoyed it, and I’m proud of what we’ve achieved as a group. So much so that we’re currently in the process of planning our next expedition to the Capanna Margherita on the Monte Rosa massif. Watch this space…
Any final words?
I’d just like to take this opportunity to thank both Dr Sam Lucas, from the University of Birmingham, and Professor Chris Imray for their advice and guidance throughout the duration of the study. Without them it would not have been possible and I’m sincerely grateful for their support. I’d also like to extend my gratitude to the BMRES and the JABBS Foundation for the financial support they have provided. And finally, here’s to the expedition research team: Gavin Miller, Kenneth Morrison, Daniel Jones, Alasdair Anderson, Sam Calcott & Alex Clark.
Want to know more? Read all about Sam’s Moroccan expedition here, and keep an eye out on Adventure Medic in case Sam is looking to recruit new students for his next expedition…
Photos credited to expedition photographers Alasdair Anderson and Lara Dooley, with thanks.