Expedition Medicine: The Exciting Adventure of Keeping Ultrarunners Alive

Getting involved in Expedition Medicine is one of the exciting adventures you can get yourself involved in as a medic.

In Expedition Medicine, trained medics and healthcare providers give medical care at races, ultramarathons, and on expeditions.

Dr. Elizabeth Thorne, an expedition doctor narrates her unforgettable expedition in Sri Lanka.

If you are looking for something exciting this year, or you simply want to learn more about this career, read on.


Expedition Medicine – Sri Lanka – Ultra Marathon

By Dr. Elizabeth Thorne

Arrival 

With some trepidation and a bulging suitcase crammed full of medical equipment, antibiotics, anti-emetics, and oral rehydration solution I head to Heathrow.  There I meet the handful of the Ultra X race volunteers with whom I will be sharing the eleven-hour flight to Colombo, Sri Lanka. Between five of us, we have 21 bags – containing an array of essentials from tent pegs to video cameras – to check-in. A few raised eyebrows from the check-in staff later, both ourselves and the bags make it safely on board. 

After a relatively uneventful journey, we and – to our amazement – the full compliment of bags arrive in Colombo, only to be greeted with a debilitating wall of sweltering heat and humidity.  Walking a hundred metres or so to the taxi rank is enough to elicit t-shirt drenching volumes of sweat. I can’t help but wonder if running 250 kilometres over five days through this, as the 40 runners we were here to support and are about to attempt, is really such a good idea after all. 

Once checked into our nearby hotel we make the most of the swimming pool and our last few hours in relative civilisation. We also conduct a full medical briefing for the race crew, including an overview of the medical team’s duties, discussion of the most common and worrisome conditions to be aware of, and what to do in certain situations and scenarios. 

The crew was surprised when we asked them all to fill in a medical questionnaire, as the competitors had done. As an expedition medic, you are responsible for all members on the trip – including your fellow doctors, just as they are for you. If something happens you need to be as informed as possible about their past medical history, current medications, allergies and more. This could mean the difference between life and death (especially when in resource-poor environments). 

Into the jungle  

Photo by Benedict Tuffnel

Photo by Benedict Tuffnel

Early the next morning, the crew are uploading the coach and preparing the convoy vehicles. A six-hour journey south awaits. With my colleague on the coach with the participants, the Sri Lankan medical team and ambulance already en-route to camp and myself in one of the crew vehicles, we head south.

Three hours in the rain begins. It’s the start of monsoon season in Sri Lanka and when it rains here, it pours.  What, at first, felt like a welcome and refreshing change to the inhospitable climate soon proved to be a nightmarish unraveling of the camp makers efforts as the pre-determined campsite was swiftly turned into a quagmire accessible by a track rendered unnavigable for all but the most capable of 4×4 vehicles and drivers.

We arrive to the news that the truck transporting all 70 bags belonging to the participants and volunteers has become impossibly stuck on the muddy track, a kilometre shy of camp. There is nothing for it but to lug the 20-30kg bags by hand, one by one to the campsite. I breathe a sigh of relief when the trusty Land Rover Defender turns up to save the day with a series of bag laden shuttle runs. 

The participants arrive unaware of the mud bath they are about to become entrenched in. As I start leading a group of seven through the trees towards the campsite, cautiously stepping on layers of fallen palm leaves, I hear a rustle and look down to see a long black tail with a superior-medially placed yellow stripe slither away. The runners had been briefed about the risk of snakes and many had bought their own venom abstractors off the internet, however, as most doctors know, these have little success rate. Luckily it was a Buff Striped Keelback, a non-venomous snake. Nonetheless, not taking any chances, I choose a different path.

 

Day 1 

I find myself dancing with nature again. 10 kilometres into the course sits a large monitor lizard. The stubborn 5ft-long reptile decides to sunbathe inconveniently on the mapped-out path. A beautiful creature to admire but known to have a vicious whipping tail which cuts like a knife. I place myself between it and the runners and advise them to steer clear.  

As the competitors jog past I make a point to observe each one, noting their current appearance, comparing them to how they were when fresh – currently, all look well but it is only 10am and already 34 degrees with 83% humidity – it’s going to get worse. The extreme environment is a major concern for the medical team and prevention of illness is our top priority. I continue to reiterate the importance of sun lotion, drinking electrolytes, running in the shade and not pushing too hard – reminding them that this is a week-long race.

Photo by Benedict Tuffnel

Photo by Benedict Tuffnel

The rest of the day consists of roaming the course, all the while in constant communication with the ambulance and other doctors. As the front runners near the finish line for day one, I leapfrog forward to make sure a doctor is available at the campsite. I watch the winner and runner up of the first stage cross the finish line, happy with their times and not in need of any medical assistance.

I then receive a phone call stating, ‘Dr. T, S has just passed us [1km from the finish] and he says he is feeling sick but looks okay’. A few minutes later S finishes claiming third-place for the day. However, unlike those in first and second place, he appears pale and dehydrated with dry lips and reports feeling nauseous and light-headed.

I start with an initial assessment and take a history including asking what he has been drinking. He states he has consumed only two small bottles of water alone – mentioning he does not like the taste of electrolytes. I help him into the air-conditioned car, out of the blazing heat of the Sri Lankan sun, hand him a glucogel (a syrup solution full of sugar) and a pre-prepared bottle of electrolyte solution to drink. I continue to perform the primary survey followed by a neurological examination which shows no abnormalities. S states he continues to feel nauseous and with consent, I prescribe and administer an injection of anti-sickness medication continuing to monitor his recovery.

It’s important to remember that these athletes’ resting heart rates are much lower than non-sportsmen/women. On repeat observations, his heart rate remains in the high 80s with his usual resting heart rate being around 50. The decision is made for intravenous rehydration to compliment the oral fluids he is slowly consuming.

Day 3

Photo by Benedict Tuffnel

Photo by Benedict Tuffnel

The day when the flags went missing – and subsequently the participants. Being the medic in the roaming vehicle inevitably meant I took on several other roles including that of a navigator, driver, photographer, and most importantly this day, a tracker. The phone call comes into the Ultra lead from M; ‘We can’t see any more blue flags and we think we are lost’. The message is relayed to all crew members, making sure everyone is aware of the situation and on the lookout. The lead works out the area in which the participants are and we, in the roaming vehicle, are deployed on a search and rescue mission. Within 10 minutes the runners are located and back on track. We then track back and determine the cause of the problem is that the flags have been removed from the course and so swiftly replace them. 

Day 5 

The day starts with a mixture of excitement and drama.  One of the ultra leads performs a recce of the course and reports sighting a wild elephant on the course. For the safety of the participants and crew, the route must now be altered at the last minute and shortened to 34km. The news comes as welcome relief for the runners, with heat and humidity already soaring with the rising sun. 

The final stage of the race begins. Each participant gives it their all – battling to the end with heads held high. However, for K, it was to be a sad ending to her remarkable week. Under our recommendation, K did not contest the final stage and could only watch from the sidelines. Despite leading the female race, K had developed tracking cellulitis (a skin infection which progresses further than the initial site of infection) from a simple blister which had been noted as looking infected two days earlier. At the time it had been debrided and cleaned with a course of first-line antibiotic initiated.  With the condition worsening a stronger course of antibiotics was administered and given the weather conditions and course terrain on the final day – including wading through muddy dirty water – it was determined that racing could potentially be detrimental and lead to a worsening of her condition. 

 

The weekend after 

The athletes and crew head north to Negombo and enjoy their much-deserved award ceremony, dinner, and live entertainment back in the welcome comfort of a hotel and civilisation. The evening was filled with laughter, hugs, and cheers. A stark contrast to the sad events that were to follow the next day. 

“Do not leave the hotel, six bombs have gone off throughout Sri Lanka”

I am told by a local in the lift down to breakfast. I check the news apps on my phone but see no reports. Confused I ask the receptionist who confirms it’s true; a bomb (later known to be the deadliest one) had gone off just half a mile from our hotel. I send out a message to those who have not yet headed home then call my family in the UK who are unaware of the situation. Around 30mins later I realise the rest of the world has started to wake up to the tragedy as my phone starts pinging. 

Then silence. The government blocks all social media in an effort to stop the ‘spread of misinformation’. My heart wanted to help those injured either by donating blood or by aiding with medical efforts. However, my duty remains to ensure all those who were with Ultra X remain safe, so I stay with our party. I make phone calls to those of our group who were out exploring, make sure they were okay and tell them to head back to the hotel for safety. 

By midday the government has deployed the military, a curfew is put in place and the town turns eerily silent. 

As we sat around the dinner table that evening we reflected on the support the locals gave the race and athletes whilst running through the villages. Communities had lined the streets with buckets of water and ice lollies helping to cool the runners, children ran alongside the competitors cheering them on. Residents gave out fruit and homemade cake at checkpoints, providing the runners with nourishment and energy. Many of the crew spoke about how they had offered some money to say thank you but almost all refused to take anything in return. Such kindness is rare and it was moving to witness. 

It made the tragedy that was inflicted on the kind people of Sri Lanka that day all the more heartbreaking. 

Their country is one of the most beautiful and idyllic places I have been fortunate to visit. If you haven’t yet been, go. 

 

ABOUT THE AUTHOR

Dr Elizabeth Thorne is currently a junior doctor with an interest in sports, exercise and expedition medicine.

Following her training at St Georges University of London (UK) and having undertaken her academic foundation years within the Imperial Trust she is going on to work on sporting events in the UK, Jordan, Fiji and Mexico with the hope to work in South Africa in 2020.

Follow and connect with her on Instagram: @theadventuredoctor