Extreme medicine: What it's like being a medic in the world's most dangerous places

BY Parisa Hashempour

5th Oct 2022 Life

Extreme medicine: What it's like being a medic in the world's most dangerous places

Discover the incredible stories of the extreme-conditions medics swapping their prescription pads and stethoscopes for rafts and snake venom

Costa Rica’s jungles might seem an unlikely spot for a group of medics to converge. But trekking through this dense stretch of Central American wilderness, that’s exactly who you might encounter.

Trading stethoscopes and lab-made pharmaceuticals for rafts and snake venom, these medics come together under the guidance of World Extreme Medicine, an organisation training paramedics, physiotherapists, nurses, and doctors to work in the world’s most volatile and remote conditions.

Extreme medicine is a subdiscipline of medicine in which healthcare providers respond to crises in war zones, assist those left behind after humanity's most horrific disasters, and conduct medicine not just on land, but also deep beneath the sea and even in outer space.

While all medics need to think on their feet, Mark Hannaford, the founder of World Extreme Medicine, explains that for extreme medics, that need is heightened. Medics might treat a patient in the blistering heat of a desert, on an ice-cold tundra, or stabilise a person at altitude or in the dark.

Despite this, he says, “you don't need to run a marathon with a rucksack on every day to be an extreme medic.” Physical fitness is not the challenge. “The challenge is adequately preparing yourself for the environment you are going into.”

“You really have to steward good self-care in these environments,” adds pre-hospital lead and extreme medicine trainer, Eoin Walker.

In places like Costa Rica, Oman and Slovenia, he teaches medics skills in security, diet, wound closure, hydration and facilitating team dynamics on expedition. But medics also learn to care for their own physical and mental health.

“In the UK, we don’t have to remember to drink every hour, or clean and dry our feet, or look at our calorie content or how much we’re carrying—but you do in that environment,” he says.

As for the medicine itself, it’s often lacking in the surgical glamour we see on TV. “People who live where disaster hits still have issues like diabetes, babies are still being born, people need physiotherapy,” says Mark.

And with more disasters set to strike, their needs will only increase. “Training extreme medics is becoming more important as we face environmental challenges like climate change,” he adds.

Here, we speak with three extreme medics, to understand what it’s really like to save lives in some of the world’s harshest locations.

Taryn Anderson, Remote Area Nurse

Remote Area Nurse Taryn Anderson sits in back of medical vanTaryn Anderson's work as a Remote Area Nurse has taken her from wartorn Iraq to the hurricane response in Haiti

How extreme? From Sierra Leone’s Ebola outbreak to war in Iraq.

The motivation: “Humanity is amazing—it’s incredibly cool and at the same time, it’s horrible. When you come back to this lovely, moderate world in the UK, you don’t necessarily know these balances are playing out. With extreme medicine, you’re playing in that middle band.”

Most memorable mission: Gaining her nursing degree through the Australian military, Taryn responded to hurricanes in Mozambique and Haiti, supported nurses in Kenya and Nepal and assisted during the Ebola outbreak in Sierra Leone, where her employers sat her down to write a will before deployment.

Taryn’s most memorable mission, however, is working as a pre-hospital lead, setting up convalescence stations during the Battle of Mosul in Iraq between March 2017 and 2018: “It was the best and worst job I’ve ever done.”

On call 24/7, Taryn would be woken throughout the night to deal with patient influxes. “One of the biggest challenges was that for the first month we didn't have a morgue,” says Taryn.

"The bullet had grazed the baby’s elbow, and the elbow then plugged a hole in the mother’s uterus"

But it was less the gory sights, and more the everyday personal stories of struggle that made an impact, like the fighter who was nursed back to health at the hospital, only to be captured, and likely killed, at a checkpoint set up to entrap him upon his release.

Or the pair of teenagers who, madly in love, attempted suicide because their families would not let them marry.

Despite the difficulties, Taryn revelled in moments of joy, with one particular incident standing out to her.

“We received a call saying we had casualties coming to us, people who had been trapped in Mosul. Unfortunately, one of them was a woman who was eight months pregnant. She was trapped in the basement for over a week and had been shot through the abdomen by a sniper.”

The team were preparing for two potential deaths, and there was especially little chance that the baby would survive the gun wound. “But when she arrived, there was a foetal heartbeat!” says Taryn.

The medics rejoiced, quickly diving into action. The bullet had grazed the baby’s elbow, and the elbow had then plugged a hole in the mother’s uterus, keeping her baby alive inside.

“It was this absolute miracle of a child who we were able to deliver, and Mum and baby went home three or four days later!”.

Lucy Coulter, Doctor in Emergency Medicine

Orange tents in snowy landscape of AntarcticaLucy Coulter was tasked with screening who could join an exhibition looking for the lost ship Endurance in Antarctica 

How extreme? From air ambulance to Antarctica.

The motivation: “The NHS is such a difficult place to work that you need something different to keep you sane, to have a part of your work life that you have agency in.”

Most memorable mission: “I was in Antarctica for two months this year,” says the A&E doctor-turned-explorer.

Lucy has delivered care in the air ambulance service over the UK’s midlands, atop Kilimanjaro and in rural Cuba, but what stays with her most is journeying to the Weddell Sea in Antarctica.

Lucy looked after 111 people including expeditionists and the ship’s crew as they searched for the wreckage of Endurance, Sir Ernest Shackleton’s ship, which had been lost since it sank in 1915.

While the expedition itself lasted 43 days, the trip took four months of medical preparation, consisting of screenings and sourcing essential medicine and COVID testing equipment. Lucy had to make tough calls as to who was allowed to travel, and who couldn’t.

"The crew and expeditionists celebrated on the Antarctic ice, surrounded by penguins and seals"

With an entire onboard hospital to run, the trip was an unusual set-up for a medic used to working out of a helicopter. “I’m so used to doing expeditions and having very little by way of resources. It felt like the responsibility was greater because I had the ability to do almost everything,” she says.

Thanks to extensive preparations, the expedition ran almost without mishap.

“The crew do a King Neptune initiation ritual when the ships pass through the Antarctic Circle," says Lucy. "They make everybody lie on the deck and spray them with ice-cold water and then dip them into a bucket of slops—it was horrible! So we had one case of mild hypothermia from that… we just treated them with warm drinks, blankets and warming up in the shower.”

Aside from that and two isolated COVID-19 cases, the trip ran smoothly. When Endurance was found, the crew and expeditionists celebrated on the Antarctic ice, surrounded by penguins and seals.

“We played football and golf, and we ate beef massaman and chicken rolls on the ice floes!”.

Luca Alfatti, Senior Paramedic

Luca Alfatti carrying medical supplies for Medics4UkraineLuca Alfatti is one of the head organisers in Medics4Ukraine, an on-the-ground medical response project assisting Ukrainian fighters

How extreme? Luca helped to found Medics4Ukraine, a World Extreme Medicine project delivering equipment and training to frontline Ukrainians.

The motivation: Luca is inspired by the resilience of everyday Ukrainians like Svetlana, a woman in her mid-twenties who crosses the Polish border daily, ferrying people and supplies and passionately assisting Medics4Ukraine.

Most memorable mission: For Luca, helping set up Medics4Ukraine, a medical convoy that has provided £1.2 million worth of lifesaving supplies and delivers medical training to Ukrainian civilians-turned-fighters, has been the most poignant moment in his extreme medicine career.

“I recently trained about 90 people over the course of one week in three different locations around Ukraine, the Special Forces and Territorial Army,” he says.

Preparing convoys and organising training, all while working as a full-time paramedic in the UK, has been exhausting. But with direct requests from his networks of Ukrainian volunteers streaming in, he is determined to keep the work going.

"There were lots of shouts of ‘Sláva Ukraíni!’. I felt like I was a local, like I was one of them"

One hot day, training conscripts in a small village gym filled with weights and dojo mats, stands out to Luca. Soldiers, some as young as 16, began to fill the room.

Their nervousness was palpable; it wouldn’t be long until these young men left for the frontline. But by the end of the session, and with new skills in saving lives during combat under their uniformed belts, the feeling in the room had shifted.

“There were lots of shouts of ‘Sláva Ukraíni!’, they were energised,” Luca says. “I felt like I was a local, like I was one of them, that we were going to get through this together,” he says.

But for extreme medics, a strong connection to those you wish to help can result in a disconnect at home. Luca found leaving his family in the UK especially challenging, and when video calling with his tearful children after spending hours in a bomb shelter, even considered never returning to war.

In the end, however, he felt he could not give up on those who had become his friends, saying, “I know them, they know me, we’re friends and I want to help.”

To donate to Medics4Ukraine, visit GoFundMe.

To learn more about extreme medicine training, visit World Extreme Medicine.

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