The Promising Beginnings of Emergency Medicine in Mozambique

The beach in front of the UCM

This is now the second year that Mt. Sinai St. Luke’s Global Health Division is helping run the emergency medicine course for the medical students at the Universidade Católica de Moçambique  in Beira, Mozambique. In February,  the Ultrasound Division will be also returning for the second time to teach the 5^th year students emergency ultrasound.  I was fortunate to join the GH team in teaching the trauma portion of the 6-week emergency medicine course this fall. This course is given annually to 4^th year students at the end of their preclinical year.

UCM

This was the first time in their training that the students got hands-on learning in evaluating multi-trauma patients. They learned about importance of  primary survey,  simple techniques of airway management and life-saving procedures like needle decompression, pelvic slings and indications for tourniquets. We were beyond pleased with students’ medical knowledge and enthusiasm. 

Session on team work and communication

The GH team is planning deeper involvement in emergency medicine development in Beira. They will be conducting research on students’ perception of emergency medicine to evaluate their readiness for Emergency Medicine specialty in Mozambique. Next week they will also initiate needs assessment and morbidity and mortality analysis at the emergency room at the Hospital Central in Beira (the regional hospital that sees over 100,000 patients/year through their ER) to evaluate gaps in emergency care and readiness with hope to improve it over coming years. This is exciting time for emergency medicine in Beira!

Students learning advanced airway techniques

This experience was an exciting time for me too.  Not only did I get to participate in teaching  eager students trauma care and learn about laborious process of developing emergency medicine in resource-poor country, but I also got to revisit Gorongosa National Park, one of the largest parks in Africa, and explore the Medicinal Plants Garden at the medical school. So stay tuned for more posts from Mozambique!

Sunset in Gorongosa National Park

Medicinal Plants Garden at UCM

Our students happy to be done with trauma

Pick your challenge: world’s highest marathon.

If you don’t feel challenged enough to run 26 miles at sea level,  try running on a glacier and a rocky alpine terrain with menacing yaks in your path at 17,000ft. Not that I particularly wanted to be challenged, loved running or ever attempted to run a marathon or even a half. But I was at the right place at the right time, so why not?

At the start.

Two weeks into my Everest ER post and after finally getting over my extreme fatigue and breathlessness  at even minimal exertion, I decided I needed more exercise. After all, I was eating three-course meals  three times a day (what a life!) and led mostly a sedentary life taking care of patients at the clinic. When I learned that the Tenzing Hillary Everest Marathon was to take place at the end of May, a few days after clinic’s closure, I thought this was my chance to shine! Well actually, an opportunity to get marathon off my bucket list.

Running on ice and scree. 

Training was an obstacle that I was almost willing to ummm… skip.  Each time I attempted to run, I lasted for 2 minutes and then needed to take a breather. No pun intended. I had no schedule and no plan. Luckily, I made friends with our camp neighbors, who were experienced marathoners running for Indian Army. Although I was way slower than they were, they welcomed me to their training sessions and encouraged me along the way. We would jog the straight aways, speed down the hills and hike up as fast as we could the numerous up hills. I learned to relax my joints to be able to jump from rock to rock and also dodge the yaks, donkeys and astonished trekkers that were in my way. 

Marathon training on EBC trek.

Fast-forward 1.5 months, it was May 29^th, the marathon day. Everest climbing season was over. Everest Base Camp was still littered with tents, but this time they sheltered about 200 masochistic runners. Most were unassuming Mikarus (“Westerners” in Sherpa) who had no idea what they got themselves into. The rest were speedy Nepalis racing for the top three places and substantial prizes they came with. People were cheerfully taking photos and high-fiving each other at the start line. It was indeed a special moment with the Khumbu icefall on our left, glacier rivers at our feet  and the energy of adventure in the air.

Fast-forward 7 hours, still on my feet and unscathed, I made it to the finish line at the beautiful Namche Bazaar! 

Standoff with a yak.

Not bad for a Mikaru, but I was actually cheating as I was an acclimatized Mikaru. Shhhhh… There were festivities, photos and stylish Dynasty helicopter trek suits. I guess it was worth it, as marathon is now off my bucket list! I AM NOT RUNNING ONE EVER AGAIN! What’s next?

Bed Bahadur Sunwar from Nepal finishes in 1st place.

Disclosure: If you are actually planning to run this marathon, do NOT follow my training plan. DO stay clear of the yaks though!

Here are some other marathon ideas for you: http://www.redbull.com/en/adventure/stories/1331702894089/world-strangest-and-toughest-marathon-races

Myself and top 2 finishers in women's category.

All are alive and well after finishing the Mt. Sinai Wilderness Survival course!

Last week we held the 2^nd annual Mt. Sinai Wilderness Survival course at the Delaware Water Gap in NJ.  We had a great time camping, teaching, learning, making pizzas and then hiking part of  the AT. We lived through an intense T-storm, tent floods, and snake and bear encounters (the latter one was from the car!).  Thank you everyone  for showing up and having a good time. Below are some photos to sum it all up!

Medicine at 17,000ft

This spring I left the hustle and bustle of NYC to man the Everest ER clinic  in Nepal. I was one of the three doctors working in this oversized tent on a glacier at  17,000 ft providing care to close to 1,000 foreign climbers and their local support staff.  Now being back at home, it is hard to fathom my life at Everest base camp just 2 months ago. Follows is a photo essay to give you a feel for my experience there.

View of EBC from the EBC trek

Everest Base Camp (EBC)

EBC is a glacial city of tents at 17,000ft that takes about 40 minutes to traverse. It is located at the base of the infamous  Khumbu icefall.  Everest climbers (this year there were 289 permits in Nepal) and their mostly Sherpa support staff start out their journey to the summit here. 

Entrance to EBC

Weather at EBC

Clouds move in fast!

2016  season was unusually warm. On a sunny day, we wore T-shirts and flip-flops and watched the glacial run-off gain volume and power throughout the season  and even daily.  Clouds could move in quickly however, causing drops in temperature that required us to wear heavy-duty puffies, hats and even dawn booties. Night-time temperatures were low  enough for me to sleep comfortably in a -40C sleeping bag. 

Our camp, my tent at the forefront, Khumbu icefall in the back

Helicopters

HAPE patient getting evacuated to Kathmandu. 

Helicopter traffic has been on the rise at EBC and Mnt. Everest. They are used for medical evacuations, produce and equipment delivery and in recent years as air taxis. 2016 was the first year that a helicopter  was used to deliver ropes to Camp 1 saving Sherpas over 20 trips through the hazardous icefall.

Everest ER

Everest ER is a medical tent at EBC that was founded by Luanne Freer  in 2003 and has been providing medical care to climbers and locals for the last 14 years. It is staffed by one Nepali and two western physicians and operates during the main climbing season in the spring. This year it was Tash from Scotland, Yogesh from Nepal and myself.  It was key in  last year’s disaster during the earthquake that triggered an avalanche at EBC taking 25 lives and injuring over 50 people. It is now run by Himalayan Rescue Association (HRA).

Lakpa (heli rescue guru and basecamp manager) and the docs.

Inside Everest ER. Yogesh inside Gamow bag.

Supplies

Medical supplies at Everest ER are limited, but rather comprehensive. We had oxygen, suction unit, IV fluids,  hyperbaric bags, intubation and splinting materials and an array of medications ranging from anti-acids and decongestants to  sedation medications and IV antibiotics.

Diagnostics included urine dip and pregnancy tests, ECG and portable ultrasound landed to us by Sonosite. We also had a  glucometer  which stopped working due to cold temperatures. No X-rays or blood tests were available.

Our patients

This season we had 300 patient visits (excludes follow-ups) ranging from simple respiratory  complaints to  high altitude pulmonary and cerebral edema, snow blindness and  severe frostbite. 65% of visits were by Nepalis. We recommended descent to close to 50 patients. Our most interesting cases  included a myocardial infarction in a 29 year-old Nepali man, obstructed kidney stone requiring stenting, deep frost bite treated with thrombolysis, retinal hemorrhage with persistent vision defects and incidental early pregnancy.

Life outside Everest ER

 We found some diversion outside of clinic.  This included trekking, climbing local peaks, visiting surrounding expedition teams, reading, playing cards, watching movies, sunbathing and even training for Everest marathon.

Taking a break.

Stargazing from my tent.

Please support Everest ER with your donations or come volunteer in one of the clinics run by HRA! 

Report from the Arctic Cruise by Tatiana Havryliuk

This is a long overdue post on my first ever experience as a ship doctor aboard the Greenland Adventurer, a 150 passenger cruise ship. Mostly I wanted to relate a unique challenge I ran into on this 2-week adventure around Greenland.

The trip started off peacefully. Other than enjoying the beautiful scenery and chatting up the guests, I had little to do. I mostly tended to minor cases of sprains, other aches and motion sickness. This is until the ominous day midway through the voyage when the ship got caught in a storm. Suddenly everyone needed a doctor, including the doctor herself! While the ship was battling 20ft waves, most of the passengers and I were faced with stomach-churning vertigo. The best solution was to stay in bed with eyes closed letting meclizine do its trick. If you waited long enough to spill out your guts, IM Phenergan was still an option. But of course, the doctor (me!!!) was expected to jump to the rescue and make personal deliveries of these magical drugs to the passengers scattered on four different floors. This involved crawling on the stairs, bracing myself against the walls and filling up multiple emesis bags that promptly littered the passageways to save the suffering passengers. I learned that sea legs take more than one week to develop. As this was not enough, a bigger challenge surfaced.

Problems tend to surface when you are on the boat. One of the staff members jammed her thumb in the doorway. This is a common injury at sea during a storm when doors swing. Most seamen learn to avoid it. She had a nail bed injury that needed to be repaired, and the task fell on vertiginous me!

I was lucky to have a great team: a staff member who was a knowledgeable EMT, patient’s very supportive boyfriend and a forgiving and brave victim.  Despite the rough rocking of the ship and multiple episodes of emesis (into a dustbin strategically placed just outside clinic doors!), we managed to anesthetize the thumb, remove the nail, repair the laceration and suture in a temporary foil nail.

                                                       

Two days later we were all laughing about this. The nail, I learned later, started to grow back well after my service on the boat was over. It was a happy ending and a worthwhile experience for me to have. However, think twice about how much you like to be rocked by giant waves before you sign up to be a ship doctor!