Skeleton Coast Expedition

After 20 days of walking an average of 25 Km a day, the Skeleton Coast expedition team finally made to the end of their journey, the Salt mines at Walvis Bay.  The stretch of coastline from Luderitz in the south to Walvis Bay in the north had never before been walked totally unsupported.  It had been walked before, but only with camels, 4x4 back-up and water drop-offs.  Our challenge was to carry everything we needed to survive on our backs, and we achieved our goal at lunchtime on the 26th October.

As the Expedition Doctor, I was kept fairly busy, but thankfully there were no major medical problems.  What did surprise me was the sheer number (and indeed size) of the blisters that the team suffered from.  Despite everyone training beforehand in their boots, the combination of the heat, the sand (which got everywhere), the constant change in terrain, the camber of the beach and the weight on our backs all construed to produce more blisters than I ever imagined.  Thankfully I did not run out of tape but at the end there was very little left!

One of the many delights was seeing the black-backed jackals, which visited our camps every evening and often followed our progress during the day.  We also came across thousands of fur seals, a family of Oryx (Gemsbok), pelicans flying into wind in slow motion, and many, many flamingo and cormorants.

This expedition was a real physical challenge, and it was a great privilege to have been part of such an eclectic group of people on a truly remarkable journey.  We started as a bunch of individuals and finished very much as a strong team.  What a great experience!

Dr Alastair Nicol

ExpeMed Course Director - Expedition Medicine Course for Healthcare Professionals

Mongol Derby - Medic's Blog

As predicted the end of race party did prove eventful. Although no one sustained significant damage in the wrestling, got shot in the archery competition or electrocuted themselves on the distinctly suspect electrical wiring in the sound system, someone did manage to lacerate their wrist quite badly. Fortunately no major vessels were damaged although a tendon was nicked. The first stitches of the trip were applied beautifully by Jez before the medical team retired to bed, nursing mildly traumatised ear drums courtesy of the enthusiastic Mongolian singers.

Having arrived back in UB after a harrowing 14 hour 4X4 journey, we now feel able to relax and have begun to indulge in some of the more traditional tourist activities that Mongolia has to offer, such as visiting the black market, cashmere centres and the State Department Store to purchase gifts, souvenirs and enormous boots.

Overall we've had a fantastic experience in Mongolia. Medically we've had to evacuate one patient for further investigation in UB and we've seen a score of more minor traumas and medical presentations amongst the riders, support staff and locals. Thankfully, no one has been seriously injured and the inaugural Mongol Derby has been a resounding success. On a personal level we've had a brilliant time staying in gers, camping wild in the steppes and meeting the local Mongolians and experiencing their amazing hospitality.

Finally, we should congratulate the adventurists for creating a great event and the riders for successfully embracing the challenge. It has been a pleasure to be a part of the adventure.

Mongol Derby - Medic's Blog

Currently Jez and I are at the finish line of the 2009 Mongol Derby in Nadal. Most of the riders have arrived and we are just waiting for the final 3 who are expected later this evening or early tomorrow. We have swapped our tents and Gers for a more Siberian style of wooden huts with real beds to sleep in which feels like a bit of a luxury.

Our work load, clinically, has increased as the tired riders are finally beginning to feel the physical symptoms of riding 1,000 km on horse back. We have cleaned and dressed a number of blisters and saddle sores as well as usual expedition ailments of rashes, infections and minor joint injuries.

Tomorrow the final finish party has been organised for the riders. We have been promised demonstrations of traditional Mongolian sports such as wrestling as well as a bonfire and even a shamen. It is possible that the riders might also indulge in the odd glass of fermented mares milk. A winning combination! Our work here may not be finished yet!

Mongol Derby - Medic's Blog

After another, rather wet nights camping, Jez and I received a call at 1230 yesterday asking us to attend an incident in Dadal, at the finish line of the Mongol Derby. A jeep with 4 occupants had rolled and at least one of the party had broken bones. We left immediately. It took us 7 hours to arrive at the location, only 70 km away from the Siberian border. Our response time falling somewhat short of the UK target of 8 minutes.

The jeep, it appeared, had been travelling at about 25 km/hr. It has skidded sideways on the wet mud and rolled onto its left hand side. The driver had sustained a fracture to his left clavicle but, apart from being a little battered and bruised, the remaining occupants had got away relatively unscathed. I think it had impressed on all the remoteness of the location with the trauma department of Ulaan Baatars main hospital being a 15 hour journey away over bumpy dirt tracks.

After a comfortable night’s sleep at the finish line and a breakfast of bread (which we haven't seen for the best part of 2 weeks) and jam we are now on route to re-join the main body of riders near horse station 19.

Mongol Derby - Medic's Blog

Delgerkhaan, Mongolia

As the race progresses Jez and I are beginning to see a few more patients.

Early yesterday morning at 0715 we were called out to attend to a local boy who had been kicked by a horse. Our information was rather scant, but the call had come via the vet informing us that the lad had been kicked on the wrist. Unsure of what to expect we arrived about 50 mins later to find a 14 year old boy with isolated pain over his left distal ulnar. There was no bony deformity or break in the skin. Whether it was fractured or not was difficult to determine, but seemed unlikely. The vet had already administered ibuprofen so we bandaged it up and gave him some advice. A trip across town to the x-ray facilities and a visit to the fracture clinic are not really an option out here.

Whilst we were at the ger, one of the riders came over to seek our advice about saddle sores. He had done a good DIY job at taping them up himself but the tape was coming away and he was having difficulty keeping the dressings in place. After reapplying the dressings and making sure they were firmly in place he went on his way.

Sadly (for the locals, certainly not Jez and I) we had run out of goat meat so feasted on egg, fried potatoes and cucumber, followed by the British Army’s finest chocolate pudding in a bag before Jez and I bivvied out, under a cloudless and frankly stunning night sky, next to a horse dung fire.

Today we have been working hard on our objective of teaching the mongolians the art of cricket. The local children love to get involved and it passes the time at the horse stations between riders arriving and departing. Our only medical involvement today has been assessing and advising a local woman who had strained her hand a couple of days previously when erecting a ger.The riders have now all past the midway point. The weather is improving and morale is very high!

Mongol Derby - Medic's Blog

Bayen, Mongolia

Medically speaking there is little to report on from the past few days in Mongolia. We have had no call outs and, despite having an increasing number of saddle sores to contend with, the riders are managing to take care of themselves admirably despite the change in weather, from blazing heat to cold, rainy (very British) weather.

In the quiet period that we experiencing, Jez and I have taken full responsibility for teaching the Mongolian locals, our driver and our interpreters, the rudiments of cricket. Despite a slow start (and much convincing from us that cricket is not meant to be a full contact sport) they seem to be progressing well. It will take a little more work, however, to prove that we can still be real men even if we don't eat goat for breakfast, lunch and dinner!

In short the riders appear to be getting well into the spirit of the race. A couple are fighting hard for pole position (not entirely sure that term is applicable to horse racing) and are set to finish, if they carry on at their current speed, by the weekend. The main pack are on course for mid week and the last few (including a chap who is carrying around a set of bagpipes!) are taking things a little more leisurely and look set to finish by the end of next week.

Mongol Derby - Medic's Blog

A quiet 24hrs for us, no more medical emergencies.

We left UB Monday morning after handing over our patient with a back injury to the SOS clinic.

The drive back to the rider's route was a beautiful trip across the mountains. Very scenic with huge amounts of kites and eagles to be seen.

We got back on the route at horse station seven. Along the way we stopped at a ger to ask directions and were invited in for airag (fermented mare's milk) and dried curds. They're definitely an acquired taste if you ask me but the families here are all amazingly friendly and hospitable so we tucked in.

Christian was challenged to a wrestling competition by a 8 stone 9 year old in pink flip flops. It was a bit of a no win situation, it doesn't look good if you win (essentially beat up a child) or lose (get beaten up by a child) so he politely declined.

The ger themselves are amazing. A real mix of tradition and modern. Many of them have enormous satellites dishes outside and solar power to power TVs and mobile phones yet all the cooking is done on horse manure fires and food is prepared in very traditional ways and stored without refrigeration etc.

After checking in at station 7 we headed into the local village to stock up on food and water then headed off to set up camp for the evening and meet with the other support vehicle.  We spent the evening sat around a campfire made of horse poo, drinking coffee laced with Amarulla (very much in moderation) and eating goat which one the drivers had bought and slaughtered that morning (for about 8 pounds). This was followed by a round of singing and then a reasonably early night as both us and the other support vehicle had hectic nights to previous day.

We are now breakfasting on fresh eggs, despite the tempting offer of more goat. Then we'll be off to track the riders and see what today brings.

Mongol Derby - Medic's Blog

This morning we got up early and reviewed the girl who had fallen from her horse.  She was a little bruised but keen to get going.  We sorted out our 'ambulance' again and set off in convoy with two other vehicles for horse station 4.  We travelled cross country parallel to the race track to avoid the riders and quickly began to experience some hostile environments.  Having battled against severe sand dunes and steep mountain passes we eventually arrived at horse station 4 in one piece, thanks to our driver Aggie.  We had just missed another injury; another rider had just been kicked by a horse, however they had managed to patch themselves up and carry on in the true spirit of adventurer racing.

We then headed off into a nearby town for fuel and dinner and quickly received another call to a rider back at horse station 2.5.  This rider had fallen off their horse and had sustained a back injury.  After a journey of 1 hour 40min we arrived to assess the patient.  He had been given a 'lively' horse and come off 3 times.  The final time he had landed on his back and the horse had run away.  With an injured back he had managed to find a local herdsman with a motorbike and made it back to the ger he had left from.  It was decided, from his injuries that it would be best to take him back to Ulaan Baatar for x-rays and further examinations.  With a small amount of repacking we made a comfortable stretcher out of a scoop stretcher, sleeping bag, camping mats and blankets and set off on the 6 hour journey back.

Mongol Derby - Medic's Blog

Well, the race is finally underway.  It started this morning about 10am.  Everyone got away safely despite a couple of people being thrown off their horses while waiting for the off.

We have had a busy couple of days.  Friday was the med brief. We chatted to the riders about various topics including the risk they are facing, our capability, how we will respond if the get injured, a little bit about common conditions on expeditions etc.  It seemed to go well.  I think it served as a bit of a wakeup call to some of the less experienced adventures amongst them about how difficult/prolonged access to definitive health care can be in remote environment. Just to emphasise the point we had just made about environment factors one of the support staff fainted just as we were finishing our talk having been sat in the sun for an hour despite taking all the proper precautions.  Couldn't have worked better if we planned it!

Friday afternoon we spent doing a bit of moulage practice and refining how we would fit a patient into our land cruiser with the four of us and all our kit. It's going to be a tight squeeze that's for sure.

There was a leaving party for the riders on Friday night, a mini Nadam, with horse racing, traditional music and contortionists.  After the entertainment we joined the local horse owners around their fire for some freshly cooked goat and a couple of vodkas.  The Mongolians are incredibly friendly and hospitable.  There was much signing around the fire and one of the riders brought out his bagpipes which he is intending to take all the way to the finish.

Mongol Derby - Medic's Blog

Horse Station 1; 10 miles South East Kharkorim

After a couple of busy days in Ulaan Baatar sorting out kit, medical evacuation plans and logistics, yesterday we finally got into our jeep with our interpreter Puje and driver Agi and set off into the steppes. Having endured blazing sun, thunder storms and huge fluctuations in the capital, we were treated to fantastic weather en route and at the start line, horse station 1. Within a couple of minutes we had seen our first patient with a medical problem. We managed to find a quiet spot and do some basic investigations and offer advice. It was then a matter of setting up camp and getting some food.

Jez and I were expecting to rough it from day one, but it seems the first two nights have been organised for us. We are living in one of approximately 10 gers (Mongolian semi-permanent tents). The others have been filled with riders and staff. Surprisingly it was probably our best nights sleep so far, thanks to a roaring wood burner and not a lot of sleep thus far. This morning Jez and I sorted out our jeep again, anticipating that injuries were quite likely in the initial training days as the riders got used to the smaller, stocky breed. The riders are form a variety of backgrounds, from polo to showjumping, with a handful of endurance specialists.

We are currently sitting in our jeep, which has been roughly converted to take a scoop stretcher and other medical kit. It is not the perfect ambulance but considering we are in the middle of Mongolia I am quite proud of it. Hopefully it will suit its purpose if it is tested.