John | Expedition medic
John is an experienced expedition medic and thoroughly lovely chap! He kindly invited us into his home for a cup of tea following our interview and his words of wisdom reassured us about our own career choices. Though he has worked in a range of different environments, we focus here on his ten years of providing medical cover in one of the most remote and extreme environments in the world – the Antarctic.
I was always told at school not to even bother applying for university… and my grades reflected that motivation! After school, I ended up working in a voluntary position in northern Canada for a year working with a remote air ambulance service. I then went back to the UK, decided to apply for medicine and was rejected by everywhere! But a week before the year started, I picked up the phone to all the medical schools in London and got three offers of a place due to people who had pulled out at the last minute. It always pays to ask!
After my training, I ended up in General Practice for around 15 years in northeast England. I became heavily involved in pre-hospital care and took as many expedition jobs as I could. One was medical cover for a gap year trip in Svalbard for three months; that caused great consternation as the partners thought I was never going to come back!
Eventually, they got fed up with me going away so often and I suggested that we introduce sabbaticals. And they thought about it and said, ‘well, we can’t think of anything we’d like to do’. I thought, ‘I’m with the wrong people!’.
I thought, ‘I’m with the wrong people!’
Following that, I left General Practice and as I had done all the minor surgery in our practice, managed to set up a minor surgical business with contracts to the NHS. That ended up being an unintentional occupational health business as we had premises on an industrial estate with 12,000 workers. They loved it because I could fix them up there rather than having to go into town to the emergency department. I eventually handed the business over to a colleague and started teaching pre-hospital care all over the country. I also started working in event cover and was a reservist in the British Army which was a great experience and took me to Afghanistan as a trauma team leader.
It was a drunken bar chat that changed my life
It was a drunken bar chat after a training session that changed my life; a conversation I had ironically forgotten about until I got a call several months later and a job offer in Antarctica. And off I went!
I ended up working for that company, Antarctic Logistics, for ten summer reasons. I met my wife while I was on the ice; she works for the same company. She’s a Kiwi and that’s what brought me to New Zealand. I did dip my toe back into General Practice in NZ for a while but eventually started taking casual emergency department shifts in rural hospitals. Which suits me perfectly as I can take time off whenever I want!
I have also done a lot of teaching with World Extreme Medicine. I was one of the course directors on the Polar Medicine Course in NZ and have taught on courses across Europe. More recently, I have started teaching for search and rescue in New Zealand, trying to help them update their outdoor first aid course and kit to make sure it is actually practical for the wilderness.
In early 2020 I got a call from a guy who runs global running events. I had a week to get all my medical gear (and myself!) to Cape Town to cover seven marathons in seven continents in seven days. Which became very complicated as that is when all of the borders began to close due to Covid!
My role in a nutshell
Antarctic Logistics & Expeditions are a self-contained operation and one of the only non-governmental operations actually based on the ice. They offer air transportation, logistic support, and guided experiences.
Each year, we take over small ski planes, groom a pre-surveyed patch of glacier and land a big Russian aircraft right on the ice. We then build a tented camp for the summer. There are around 60 staff on the ground and 500-600 clients that come through each year. Some are there for a short period of time, others are doing incredible endurance events. So, on top of dealing with things like frostbite, these people are coming back looking skeletal because they have lost 25% of their body weight!
We get a lot of elderly folks that come down as part of a package to fly into the South Pole for a couple of hours. And we have people with all sorts of medical problems that they have concealed! I have had 90-year-olds in unpressurised aircraft at 4500m in -30 temperatures in florid heart failure. What you have to rely on in these situations are good, basic clinical skills.
In terms of trauma, you can splint, give someone painkillers and make a decision about how, when and where to move the injured person. A sprained ankle, for example, can be infiltrated with local anaesthetic so that individual can get out on foot.
What you have to rely on in these situations are good, basic clinical skills.
If you have an issue that requires hospital-care, you are looking at inter-continental travel! Our evacuation route is usually back to Punta Arenas (Chilean Patagonia) though we can get people elsewhere if needed. It costs USD$300,000 for an air evacuation, so it is not a decision that we take lightly. This is where clinical skills and experience really do come into play. My biggest worries are always chest pain and belly pain, because you can’t really do anything other than analgesia; you just need to get that person out to work out what is going on.
Often, we have to sit on people for a few days due to logistics or weather which again takes you back to basic clinical skills. If there is a cruise ship nearby with a chopper and more facilities, they might do a lift. But otherwise, you wait.
My experience of ‘going beyond’
The one time in my life I came close to a panic attack was during my first day as a junior partner in General Practice; one of the seniors came to me and said, ‘John, this is where you’ll be working for the rest of your life’.
Working as a locum or on a non-contractual basis has made me much happier. It means I can say yes when opportunities arise. The way I prepared for the fluctuation in earnings was by removing myself from the high-earning, high-spending trap I had fallen into. I downsized as many elements of my life as I could.
If an opportunity arises, grab it
One of my philosophies is if an opportunity arises, grab it. Once you do one expedition season, you will find that lots of other job offers pop up. I spent several years barely doing any hospital work. I didn’t make much money, but I didn’t need to – my flights were paid, I had free food and board and reduced my outgoings enough to meet my needs.
Reactions from others when you decided to pursue a non-clinical path
It has been really varied. Some folks said, ‘good on you. You have to pursue what is important to you’. Others wanted to know what the hell I was doing. You know, they thought I should stick with GP for another 10-15 years and retire at 50. All I could think was, that is 10-15 years wasted not doing what makes me happy.
If someone wanted to pursue a similar role, how could they go about it?
Skills & Experience
I personally think that the more extreme the environment, the more prior experience you need in that climate. There is only so much you can learn from a book. You can’t read the feeling of trying to put a tent up when the wind is blowing, your fingers are frozen, and you can’t get the poles together. Be it polar, altitude, desert or jungle, if you can’t look after yourself then you are not going to be able to function as a medic. I have seen it happen – doctors falling apart on expeditions.
The more extreme the environment, the more prior experience you need in that climate
From a clinical perspective, having some Emergency Medicine experience and a solid base in General Practice is very useful.
You also need to research whichever country you are going to and prepare yourself for any specific things to look out for – common gastro infections, mosquito-related diseases.
Personally, I would say that in general Expedition Medicine courses are a great way to get a taster of working in the outdoors. However, it does not mean you come out as a fully qualified outdoor guide. What really counts is the experience in those environments.
Honestly, it is becoming increasingly difficult. MPS used to cover expeditions for no extra charge but now there are usually additional premiums, though they are not that steep. Going through North America, or having North American clients, can be tricky and there can be specific exclusions there.
If you could go back to your medical school graduation day and give yourself one piece of advice, what would it be?
That you actually have a choice in how you live and work – and the ability to exercise that choice. So many doctors I speak with are afraid of making a change, of rocking the boat. However, in my experience, if you close one door around four or five others immediately open.