Surviving on the Edge: Medicine in Antarctica
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Surviving on the Edge: Medicine in Antarctica ALEXANDER KUMAR DC8 Winter Crew Station Doctor and European Space Agency Research, Concordia Station, Antarctica SOPHIE DUONG Harris Academy, London Living at Antarctica’s Concordia Station, buried deep within the world’s worst winter, this year’s winter crew station doctor has time to appreciate where Antarctic medicine has come in the past 100 years. In all the world there is no desolation more age of exploration. In times of health, expedition complete than the polar night. It is a return to the doctors conducted (and still do) natural science Ice Age – no warmth, no life, no movement. Only those who have experienced it can fully appreciate research. what it means to be without the sun day after day We have had many past lessons to build our and week after week. Few men unaccustomed to it foundation of medical knowledge upon. Sir can fight off its effects altogether and it has driven Douglas Mawson’s 1911–14 Australasian some men mad. Sir Ernest Shackleton Antarctic Expedition pioneered the use of wireless communications in Antarctica, he quest for the South Pole has forged enabling growth in the field of telemedicine. a unique celebrated, tragic and heroic Large advances have been made in the past legacy. Antarctic medicine stands on 100 years in attempts to provide a means for Tits own plinth of risk, tragedy and medical self-sufficiency for the lone doctors triumph, much like the physicians it entertains littered among the increasing number of each winter. international crews, locking themselves into the Celebrating not only Antarctic medical staff, brutal and unforgiving Antarctic winter, where we bring to light other unsung heroes within a simple mistake or oversight can cost lives. the isolated, overwintering crews – including Antarctic doctors have to be rehearsed and glaciologists, cooks and mechanics – who, willing to act within all specialties of medicine – among other untrained crew members, surgery, dentistry and even obstetrics. In 1978, supported their lone doctors in daring, Argentina’s Emilio Palma was the first person desperate and life-saving procedures on the ice, to have been born on the Antarctic continent. sometimes operating on the doctor themselves. Antarctic medicine has become its own speciality. Long-standing Antarctic medical History units have constructed their own training and Past doctor’s equivalents onboard Captain handbooks. The British Antarctic Survey’s James Cook’s voyages in the vicinity of Medical Unit provides its “Kurafid” handbook to Antarctica were arguably the first to practise its own stations and field crews. medicine in this area. By the early 1900s, formal medical supplies and expedition doctors Screening and Social Structure were a planned and important inclusion in Every national Antarctic program has its own expeditions by Amundsen, Scott, Shackleton methods to screen potential overwintering and Mawson, among others, during the heroic candidates, both medically and psychologically. 24 ISSUES VOLUME 100 | SEPTEMBER 2012 More so nowadays, blood tests for blood-borne crucial role in so many body systems having viruses, including HIV and hepatitis, are been identified. In the absence of sunlight, and crucial, alongside examinations of other body thus the ability to synthesise vitamin D, the systems. Numerous problems caused by the gall body and mind lose their natural pattern. Body bladder have made this organ a debated area of systems such as the immune system start to focus. dissolve and dwindle during the long polar Antarctic crews made up of around eight to night. Other bad news and inability to cope only more than 50 members spend up to 9 months give further misery to such injury. living together in complete isolation. Ultimately Common complaints noted among Antarctic although survival relies upon teamwork in such overwinterers (“Polies”) include poor sleep, extreme environments, overwintering crews depression, irritability and blunted cognitive endure long periods of isolation, sensory abilities. Despite a documented decline in deprivation and complete darkness, embarking vocabulary while overwintering at the South on a challenging journey of personal inner Pole, the community remains adaptive, discovery. inventing their own reassuring replacement Isolation and confinement can lead to expressions. The term “wide-eye” is used to intercultural and interpersonal problems, and describe the experience of poor sleep, which is this can even result in mutiny. During the universal among Polies. Tiredness, accompanied winter of 1996 at Casey Station, the social by poor diet, poor sleep and hypoxia at some structure disintegrated, leaving the station locations, such as Concordia Station, can leave leader outcast and scrutinised by other crew people susceptible to serious accidents. members who called for mutiny and disobeyed Comradeship is as crucial as teamwork for his leadership. survival. Looking out for the well-being of your A South Pole overwinter physician in 1999, station mechanic or cook may save the lives of Jerri Nielson, wrote in her book Ice Bound: “We your team. had to keep reminding ourselves that there Alongside deficiency can arrive excess. In were no real monsters or demons under the ice 1913 Mawson found himself completely alone on at the South Pole. The worst ones were those the ice, having witnessed the demise of his that we made for ourselves, in our minds.” friend, Xavier Mertz, from madness to death Psychological screening has been utilised for due to hypervitaminosis A. Even a 100-gram many years to try to identify preferred meal of the husky liver they had consumed may behaviours, beliefs and traits. Despite this, have proved fatal. unsuitable traits have “slipped the net”. Mental illness exacerbated by the cold, dark and Pandora’s Medicine Box lengthy isolation is exemplified well enough by In reality, most serious and potentially life- Jack Nicholson in The Shining, a film enjoyed threatening medical problems that occur during during mid-winter celebrations by most the Antarctic winter are rare and unpredictable. overwintering stations. You have to prepare yourself for anything, But numerous tests and research into expect the unexpected and be able to deal with psychological screening remain inconclusive, so it. Planning, training, packing and prevention the search for the “ideal” overwintering are vital. candidate profile continues. The remaining medical conditions that arise, from simple chest infections to fractured bones, De!ciency and Susceptibility in are largely an inconvenience but can be managed on-site. More serious possibilities Mind and Body include poisoning, whether intentional or Gone are the days of poor nutrition, illustrated accidental, accompanied by an ever-present risk by the tragic death of 1916 Imperial Trans- of fire; together they remain the greatest Antarctic Expedition member Arnold predictable threat. Spencer-Smith who, worn down by exhaustion Sir Ernest Shackleton’s The Heart of the and scurvy, was buried in the ice. Antarctic contained inventories of the drugs and Vitamin D – the new vitamin C – has become medical equipment he packed, including iron, a focus of Antarctic long-term winter study, its cocaine hydrochloride, dressings and dental VOLUME 100 | SEPTEMBER 2012 ISSUES 25 forceps. Captain Robert Scott’s aluminum landed and took off at the South Pole in medical case was a mixed bag, containing darkness, despite considerable risk of a crash. hazardous treatments such as arsenic, The year 1961 was noted for several life- belladonna mercury and strychnine. saving operations being performed on the ice. At Today’s modern equivalent is comparatively Australia’s Mawson Antarctic base, mechanic luxurious. Concordia Station, like other year- Allan Newman suffered a cerebral round Antarctic stations, has a purpose-built haemorrhage. Doctor Russel Pardoe, aged 29 infirmary containing a stocked pharmacy, years and holding no experience in diagnostic equipment, in-patient bed and even a neurosurgery himself, fashioned a drill from dental chair and operating table. dental equipment and tested it on the remains This year’s United States Amundsen-Scott of a seal. Assisted by a cook and two South Pole Station doctor is Dale Molé. Having geophysicists while under guidance by Morse just retired from a long career working as a US code sent from Melbourne, he drilled two holes Navy submarine physician, he decided to into the patient’s skull, relieving the internal honour his interest in polar history and remote pressure and saving Newman’s life. medicine by overwintering as the lone physician One of the most courageous cases from at the South Pole. Doctor Molé says: Antarctica’s colourful medical history is the My only thought is that dice have no memory. One incredibly brave and daring auto-appendectomy could hope that statistically all the bad things that performed by Russian doctor Leonid Rogozov, could happen have happened. I am now less than also in 1961. At just 29 years old and isolated at 12 weeks away from my relief arriving and have Russia’s Novolazarevskaya Station during been exceptionally fortunate nothing really bad has happened … either to me or to those under my care. winter without the opportunity for an Certainly the medical screening is much better than evacuation, he operated on himself and removed it was a decade ago, so the more preventable things his own infected appendix under local have been addressed. anaesthetic. When later asked about performing the operation, Rogozov said simply that it was just “a job like any other, a life like any other”. Medical Emergencies Not all outcomes are as fortunate as In 1999, overwinter doctor Jerri Nielson (1952– Rogozov’s. In 2009, during winter at India’s 2009) recognised a breast lump. While on the Maitri Station (which neighbours ice she wrote: “I knew it could be cancer, but I Novolazarevskaya), a 57-year-old crew member wasn’t prepared to believe it yet”. Using suffered a massive heart attack and passed equipment delivered by an airdrop, unable to be away.