Conversations

Dr Patrick Avery on being an Expedition Doctor

If you’re fortunate enough, the doctor’s office you’re familiar with is the one that’s clean, sanitary and air-conditioned; a place where white lights, waiting rooms and paperwork abound. A little coffee machine sits in the corner, a reassuring universal constant in these kinds of places, and a name-badge doles out forms from behind a desk. Hopefully, it’s a well-maintained professional environment that demonstrates competence and invites trust. 

Perhaps we can be more certain what it’s not. It’s not heat, sand or snow. Patients don’t slap deadly insects away in reception; corridors don’t shake in the grip of gale force winds. It’s not a one-medic show. Or at least, we don’t expect it to be.

But sometimes — and for most, rarely — the doctor’s office is a tropical rainforest, desert plain or freezing tundra, and these conditions are inescapable. When that happens, there’s usually only one doctor around. And for that one doctor, the pressure is on.

This is the reality for Dr Patrick Avery, an expedition medic tasked with managing health risks and medical problems in some of the coldest, hottest, driest and harshest places on Earth. These specially qualified doctors typically accompany charity trips, aid or relief work, and expeditions organised by academic institutions. Patrick is one of the few who primarily accompany TV documentary crews, typically the hardest work to come by, and has worked extensively with the BBC.

The role of an expedition medic is one with many faces. Textbook knowledge alone won’t cut it out here: expedition medics must be physically fit, socially adept, and ideally possess technical skills in the outdoors that will help them to be comfortable in extreme environments. As Patrick says, “you need to be able to look after yourself before you can look after others” — and looking after others is only one part of the picture. Expeditions are a team effort, and Patrick does more than just the doctoring: he offers an extra pair of hands to carry the camera gear, another set of eyes to spot wildlife, and a voice of reason when medical ethics enter into question.

Patrick attributes his ease and affinity for the outdoors back to his childhood upbringing in Kenya, where he grew to love “wild places” and realised he couldn’t leave them behind in his career. Expedition medicine seems like a perfect fit for him, then: it has taken him on an adventure just about everywhere, from Africa to Antarctica, to explore more of the natural world he feels so passionately about. In conversation, Patrick shares his journey with expedition medicine, offers advice for aspiring expedition doctors, discusses the joys of his job and the unique challenges it involves. 

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What exactly does an expedition GP do?

An expedition doctor is a doctor who travels with a group of people and looks after their health whilst on expedition. Often these trips are to remote places which are far from civilisation and conventional medical services. As the medic you need to be prepared to deal on your own with any eventuality from the most mundane cuts and scrapes to potentially life threatening emergencies. It is quite a responsibility to bear particularly when you are in extremely remote places such as Antarctica where realistically evacuation and outside support could be days away.

What made you want to do this job?

I grew up in Kenya and as family we spent all our free time on safari, exploring the wilder parts of East Africa. Since my childhood I have always been passionate about being in wild places, particularly in Africa. Much of my free time is still devoted to planning trips and exploring these sorts of places. When I came to medical school in the UK I felt very constrained by the rigid medical training system and by being away from the wilds of East Africa. It can be very hard to be an individual within this system and this really got me down. I was determined to find a way to incorporate my life’s great passions into my job as a doctor. I became inspired by seeing BBC expedition programmes to far flung places where a doctor would often appear on screen in their role as the expedition medic. I became determined to get myself one of those jobs and it went from there.

How did you start out? (Some of the first trips/experience you had?)

I was lucky to have some good contacts in the BBC Natural History Unit (NHU) In Bristol and I made myself known to the expedition production team there. I explained that I would love to work with them were they to need a doctor in the future. Generally the BBC uses doctors for big shoots overseas or if they have a particularly important person they are working with. The jobs are rarely advertised; it is all done by word of mouth and personal recommendations.

In 2012 the BBC expedition team got in touch on the off chance that I might be able to travel with their team to Corcovado National Park in Costa Rica for 10 days. I jumped at the opportunity. I had to take annual leave from my hospital post as I was in the midst of training to become a GP at that point. Thankfully they let me go and I went on the trip as an unpaid member. It was a fantastic experience particularly with regards to the people I worked with and the location which was absolutely full of incredible wildlife. I had very little medical work to do so I made myself useful by carrying gear, helping to set up platforms in the trees, and helping to find animals to film. Photography and wildlife are two of my life’s great passions and I have really enjoyed the behind the scenes workings of TV production. There is a lot that one can do to get involved and help the crew reach their aims even though you are there technically as the medic.

Since that initial trip I have charged for my time and the amount I have been paid has steadily increased as my experience and confidence have grown. Whilst one can’t expect locum rates for being the doctor on expedition one has to be able to justify the time away from family and your normal employment. All the other team members are being paid appropriately to be there and this should not be any different for the doctor. I feel strongly that expedition medics should be appropriately paid for their time and the risks that these trips entail.

What sorts of expeditions do you go on? (Aka do you specialise in a particular environment such as tropical environments or high altitude)

I don’t specialise in particular environments although I personally love the hot and tropical parts of the planet where I have most personal experience. I have also spent plenty of time at high altitude climbing mountains whilst I have less experience of very cold environments. Most of my expedition work has been with the BBC NHU and I guess my major specialisation has been working with TV crews. I have been all over the world on these trips to most environments from Africa, to South East Asia, the Caribbean, Iceland, Central America, Siberia, and even Antarctica. 

What are some of the specific challenges that come with particular environments, medical or otherwise?

Most of the time one’s medical skills are thankfully not needed. You don’t really want them to be as you hope the team will remain fit and healthy throughout. One has to look at the team with whom you are working, any specific medical issues they have, as well as the destination environment, location specific hazards, and what local medical services are available. Somewhere like Iceland has great healthcare and emergency services that can be relied upon, whilst less developed locations can have very little healthcare provision to fall back on.

Each environment presents its own specific challenges; the tropics with problems like heat exhaustion as well as things like insect bites and stings; cold places are often slightly more comfortable in that you have less of the insect menace but the cold itself is your number one enemy; high altitude destinations come with the obvious problems of altitude sickness, and proper acclimatisation; you might also find yourself looking after people who are diving and that presents its own specific risks.

One of the biggest challenges I have found on long trips though has been the interpersonal dynamics between team members and how this can lead to friction and clashes between different personalities. You can find yourself being a bit of an agony aunt to various disgruntled team members.

What are some of the unique skills/characteristics that you need to have to be able to do this job?

I started out wanting to be a surgeon but I realised after a couple of years of training that it was not a speciality that affords you much flexibility. I have talked already about my struggles with conforming to a specific role in the whole health care training system, and I wanted to be able to be individual and to be able to take control of where my life was going. I therefore made a decision to switch to General Practice (GP) training which took a further three years. This was the best career decision I ever made. GP is a fantastic and challenging speciality that gives you broad medical skills that are perfect for work on expedition. Being a gynaecologist or a psychiatrist may be fascinating but it is not going to be as useful or relevant to work on expedition. The other fantastic thing about GP is that it can be very much more flexible than a hospital speciality and this means that I can make the most of opportunities that come my way.

As well as being a well-rounded and experienced doctor one also needs to be confident to manage a medical situation singlehandedly in the middle of nowhere without any assistance. This can be a very scary and daunting prospect and most expedition medics are people who back themselves to be able to deal with these sorts of situations whilst being very aware of their own limitations. I think it is also extremely important that as the doctor you are experienced and comfortable at living and travelling in remote places. You need to be able to look after yourself before you can look after others.

Being practical and proactive is also incredibly useful and can make you a real asset to the wider team. Having additional skills like photography, ropes access, climbing experience, off-road driving experience, leadership, mechanical knowledge, diving experience, and mountaineering experience really helps to make you more confident and useful as a team member. There is nothing worse than going along as a medic and being totally out of your depth with the environment or, having nothing to do medically and then just sitting there bored all day twiddling your thumbs. It is much better to get yourself heavily involved in other ways.

How often does the need to practice medicine actually arise on a trip?

This varies greatly from trip to trip. Sometimes I have had literally nothing to do whilst others have been relatively busy. I have never been rushed off my feet with medical work on expedition however. The busiest ones have been in tropical jungle locations where people have struggled with heat, bites, stings, rashes, and stomach upsets. The whole focus is on preventative medicine and risk management to try to keep everyone healthy.

What are some of the most enjoyable expeditions you’ve assisted on and what made it/them so memorable?

The best trip I have done so far was a trip to Antarctica in January 2017. This wasn’t actually for the BBC but the work came through recommendations from them. For two weeks I worked as a doctor on  a ship called the Alucia which was used heavily in the making of Blue Planet II. It is a remarkable ship and has a helicopter as well as two manned submarines.

I had always wanted to go to Antarctica and so to see it in this way from both above and beneath the waves as well as by helicopter was just mind blowing. I had to keep pinching myself to check that it was real. The fact that I also got paid for the privilege was just unbelievable. The wildlife was unlike anything I have experienced elsewhere both in the numbers of creatures present and their complete lack of fear of humans. It was a total privilege to spend time there.

On the other hand – can you tell me about any particularly challenging experiences you’ve had on any expedition, either individually or with an ill/injured patient?

There have definitely been trips that I have enjoyed less than others because of the location and dynamics of the team present with me. TV work is very results orientated and if the shoot isn’t going to plan it can really put a strain on the team.

I went on a shoot to Laos with the BBC and we really struggled to get the content they were looking for. It was ridiculously hot and humid and heat exhaustion was a real problem for the people who were on camera. One person in particular got bad heat exhaustion and collapsed on day one. We managed to sort them out but it took a long time to cool them down. They wanted to keep on with the shoot but in so doing they were putting themselves and the rest of us at risk. I had to have some very difficult discussions with the person involved and the production team. I had to be quite forceful with my opinions. One of the problems with TV is that drama makes for good watching. Whilst the whole collapsing on camera routine may pull in the audience it is no fun for the person involved and it is highly stressful as the doctor. The ethics and morals around the whole making of TV can be quite tricky. As the medic you don’t want to be the party-pooper all the time but you also have to be prepared to be the voice of reason and say enough is enough when the risks are getting out of hand.

What’s the best part of your job?

Getting paid to travel to destinations that you have always dreamt of going to; working with fascinating people; and getting to access very remote places that require special permissions, which could only ever be granted when working with the likes of the BBC.

How often are you away from home and what is the longest amount of time you’ve been away?

The longest I have been away for was a six week expedition to northern Myanmar with the BBC in 2013. For the most part I work as a GP based in the UK. I would love to move back to Kenya but the bureaucracy involved in doing so has kept me in the UK for the time being. I have a wife and a young son and this has really forced me to consider what is important in my life. I really don’t want to be the dad who is always away all the time. I have seen a lot of broken families in the TV world where people are away for months and months every year. It is not a healthy way to be in my opinion. Equally I want to be able to continue to travel as part of my work. Realistically expedition work is never full time and is very hit and miss in its nature. One can never plan that far ahead as opportunities often spring up quite last minute.

Historically I have spent perhaps 4-6 weeks of the year away as an expedition doctor. Last year I only did three. Looking ahead to this year I may be away for about 4-5 weeks potentially. I think this is a realistic balance and I am careful not to push things too far with my family.

What do you miss about home when you’re away?

Being away from home has taken on a new meaning since getting married and becoming a father. It is the best thing that has ever happened to me. I know people say this all the time but it is something you can only understand once you have children. They change so quickly and so you really don’t want to miss a minute. I was away in January for two weeks in Gabon with very little phone or internet contact. My son had just started to walk before I left and was much more adept at doing so on my return. I found it very hard being away and I missed them both terribly. That is definitely the worst thing about going away.

Something you’ve learnt from this job?

Having been very privileged to travel quite a lot I think the single biggest thing I have taken away is to be more grateful for my life and the amazing opportunities I have been lucky to have. I am very lucky and I try not to take this for granted. I think I spent a lot of time in the past suffering from the whole grass always being greener problem. I think this is a huge issue with the millennial generation and I see it creating a lot of discontented people. I try to be thankful now rather than wishing to be somewhere else all the time and it has made me a much happier and more positive person.

Where do you like to go traveling in your own time?

Because my family live in Kenya I spend much of my free time there. We still always go off on safaris when I am home, often to Northern Kenya which is one of our favourite places. It is very traditional and wild up there, just how we like it. I have also become obsessed by Gabon and the rainforests of Central Africa in recent years and I have organised a number of trips there now in search of fish and wildlife; two of my life’s great passions.

What do you like to do in your spare time?

In what spare time I have I generally like to do stuff outdoors. I love fishing, photography, bird watching, walking, mountain biking, and kite surfing to name a few. A lot of my time each year is also put into doing an event called the Rhino Charge which is an annual off road driving event that takes place in Kenya to raise money for Rhino Ark who are working to protect forest and wildlife in Kenya’s highlands. It is a cause that is very close to my heart, protecting wild places that I know and love well. We do the event as a family. My dad drives our car and at times myself, my brother and my sister are also all involved on the team with him. We have been doing it consistently for over 20 years now and it is a real focal point for us as a family.

The event itself is pretty crazy and you do some wild stuff in your car. To win you have to take your car in the shortest distance across the countryside and that means navigating through some very tricky terrain. It is so much fun though and we have been quite successful, having won twice and finished second five times. The fundraising is by far the hardest part; you have to raise a minimum of £14,000 to compete each year and the event as a whole has been raising over one million USD a year in recent years. This year’s event is on the 2nd of June and we will be fundraising up until that point.

And finally – where to next!?

I have been asked to go as the doctor on a trip to look after Sir David Attenborough. I can’t say more about this for obvious reasons but suffice to say that it is an incredible opportunity and one that I am really excited about.  I will also hopefully be going to Ndoki National Park in the northern rainforests of Congo in June/July time to deliver some advanced medical training to the Wildlife Conservation Society who operate on the ground there. Teaching these courses is another part of my work portfolio and I have been in discussions with WCS about this for a couple of years. That area is probably the one area on earth I have wanted to travel to above all others, mainly because of the legendary clearings in the rainforest there, known as ‘bais’, where one can see forest elephants, gorillas, bongos and the likes as they dig for salt.  I am unbelievably excited about this possibility.

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