I just posted a new article over on the ghbledsoe.com website about a guy named Charles Ickes who is listed as a coauthor on some malaria research papers.
Ickes is interesting because he was an incarcerated prisoner at Stateville Penitentiary serving time for armed robbery at the time of the research publication.
If you are interested in Travel Medicine or Topical Medicine, the Ickes story is a fascinating historical tidbit from years gone by.
An up close visit with one of the polar bears of Churchill.When we began building ExpedMed, we tried to look for ways to expose medical professionals to Expedition Medicine and Wilderness Medicine experiences in authentic ways. We recruited the best faculty and published an acclaimed textbook to help us present these important topics.
In 2009, we began offering CME trips to give our participants "hands on" experience in exotic environments.
Our goal was to partner with the best travel companies in the world. Our partners were expected to have not only exemplary records of safety and expertise in their travel programs, but also be committed to eco-friendly policies and sustainable growth practices that invest in local, indigenous poulations.
Downtown Churchill, CanadaOur first trip was with Tusker Trail, one of the preiminent safari and trekking companies in Africa. Tusker leads our Kilimanjaro CME trips each year.
Our most recent trip was to Churchill, Canada to visit this remote outpost that sees more polar bears than anywhere on earth. We selected travel company Frontiers North Adventures to partner with our ExpedMed team, and the result was a great experience in the "frozen tundra." This is a quick report on our trip...
Our trip was in later October and began in Winnipeg, Canada.
Winnipeg is a medium-sized city in which I was able to spend a few days. During my time in Winnipeg I took a recommendation from Urbanspoon and visited Hermanos, a local restaurant. The food at Hermanos was great. I went there twice and got great service and ate the ribeye each time. Fantastic. I even splurged one night and tried their Black Gold dessert which was incredible. Great place to eat.
The morning of the trip, our ExpedMed group boarded a shuttle and were transported with the rest of the Frontiers North crowd to a private jet for our flight to Churchill. It was efficient and stress-free. We had plenty of space to spread out and we landed in Churchill without any problems.
When we were on the tarmac, the wind was howling and the temperature was noticeably cooler than it was in Winnipeg.
I was ecstatic to finally be in Churchill, a town I had read about years before as an amazing intersection of polar bears and humans.
We spent that first day touring the small town and visiting the "polar bear jail," a place where polar bears are sent when they wander into town.
Churchill has been dealing with polar bears for so long, they have developed a system for protecting the humans in this remote outpost and also being respectful and protective of the bears. Any polar bear that wanders into Churchill is either tranquilized or, more often, caught in one of the large polar bear traps. Once 
captured, the bear is sent to the "jail" for a period of time then flown outside the city and released.
Late in the afternoon our group boarded a famed "Tundra Buggy" and headed to our lodging for the next few days: the Tundra Buggy Lodge.
Those touring Churchill can decide to stay in town or in the Tundra Buggy Lodge. Our group booked rooms in the Lodge so we could get the feel for staying out on the Tundra, in the environment of the awesome creatures we hoped to see.
The next few days went by quickly.
We spent our days rolling around the tundra looking for bears and the evenings sharing excellent food and good company in the Lodge with our fellow travelers.
While Churchill and the Tundra Buggy Lodge were interesting experiences, the bears were the stars, of course.
Polar bears are incredible animals, well-adapted to their frozen environment. I had seen a few during my trip to the North Pole in 2008, but these bears were up close-- really, really close. It was a privilege to see these magnificent beasts a few feet away from our Buggy, and a series of moments that I will never forget.
At some point in the future I hope to post some more about Churchill, our ExpedMed adventures, and polar bears, but for now I must round this up. I'll finish with a few more photos and a video of one of the big bears as it approached out Buggy heading for a seal carcass.
Our plane arrives in Churchill
A Tundra Buggy
Polar bear in front of the Tundra Buggy Lodge
Two polar bears 
An ExpedMed lecture inside a Tundra Buggy
Hey guys.
For those of you who want more information on our ExpedMed Great White Shark Cage Diving CME Adventure , we just posted the detailed itinerary.
For those who can't find the time to click over to the Great White Shark Adventure informational page, here's the itinerary below.
More information about our dive partners, Shark Diver, can be found on their website: www.SharkDiver.com
Welcome to Shark Diver.Your dive expedition to the Pacific's most pristine and robust white shark dive site leaves from San Diego's famous H&M's Landing, 10 minutes from San Diego's airport and home to California's long range fishing fleets. Shark Divers vessel the MV Horizon boards divers from California to Isla Guadalupe. We are on site usually 20 hours later and beginning your first exciting white shark cage dives after a hearty breakfast. We take a maximum of 12 divers per trip - perfect for dive clubs, corporate groups, film crews, and photographers.
Boarding begins at 9:00pm -11.00pm on the evening prior to your expedition date. Prior to boarding most of our divers have booked with the Holiday Inn Bayside under our special Shark Diver Rate, we are happy to be working again this year with the Bayside, our 8th season with them. Divers generally come in a day early and take advantage of the Baysides free airport shuttle service and 7 minute location from the international airport. Our divers also like discover San Diego's Gas Lamp District, home to some of California's top restaurants and entertainment venues located minutes from the hotel. If you're coming to San Diego early plan on visiting the town. We generally depart from the docks at 11:00-12.00pm. Travel time to Guadalupe is approximately 20 hours. Once you arrive to the vessel you'll be greeted by Martin Graf, your dive operations manager. Martin holds the enviable distinction of spending the most time at Isla Guadalupe aside from the shark researchers at CICIMAR. His wealth of shark knowledge and dive operations prowess makes Martin our top choice again this year to run the white shark program on the MV Horizon. He also speaks German and Swiss fluently and works in tandem with the entire vessel crew who you'll soon get acquainted with. For now it's time to get settled and into bed, try and get some sleep because in a few hours from now the next time you set your head on your pillow just know there will probably be two or three white sharks swimming underneath it!
We will arrive at Guadalupe approximately 9:00 am (breakfast time). The arrival to the island is, and remains, one of our favorite moments. For many of our shark divers who booked with us almost a year ago this is it, the Island of the Great White Sharks, you have arrived. If you're an early coffee drinker this moment will be etched in your mind for the rest of your life as you stand on the bow of the vessel taking in the scene. Guadalupe's craggy volcanic flanks rise 4000' to literally scrape the bottoms of cloud formations here, it's a big island. The large rock off to the tip of the island is Point Norte, or Shark Fin Rock, we'll pass this on to the small bay just ahead, white shark central. Upon arrival, we anchor, deploy our huge shark cages and begin operations. Breakfast is served in the galley, and Martin will be doing an in depth dive safety review prior to your cage time. Cage diving rotations are usually one hour at a time and the vessel is divided into four crews of three with six divers in the water at any given time. Your first cage dive is usually preceded by someone yelling "White Shaaaark!". A few years ago we had a young deck hand "Mikey from Main" who's tell tale white shark yell is a tradition we carry on to this day. Welcome to cage diving, keep your eyes open as you walk down a short ladder into the industries largest shark cages, chances are in a few minutes you'll ba face to face with the Great White shark. Lunch is served around noon and for most divers this is a welcome break from the morning and getting used to the world of cage diving. We pick up the afternoons cage diving rotations after lunch or power through depending on the shark action this day. Dinner is served approximately 6:00pm. After a hot shower and a change into your post shark encounter clothes, it's time for a sunset beer, or three on the bow with the other newly minted shark divers. Congratulations, it took you a long time to get here, but you did it, and now you're ready for the next two days of white sharks, and more. You are an official Shark Diver.
If we decide to try a different site, we move early and begin operations at sunrise. Cage diving continues throughout the day and rotation times will be increased. Usually we stay in place as our crews and vessel captain know where to place the vessel and where the sharks are. Chances are you'll see another long range boat in the bay, but the sharks will transit from boat to boat, and with the density of animals on site everyone get's into sharks. We may get boarded by the MX Navy while were on site. They will board each vessel at least three or four time during the season. They are looking for valid commercial shark diving permits, passenger manifests, and some water or a soda. These young marines work very hard with little pay, so we always offer them lunch and water. Do not be surprised to see guns, this is a a typical Mexican boarding procedure and they have been doing this since 2008. The good news is their presence deters unlawful sport fishing boats who, in 2007, hooked a white shark right in front of us. Fortunately we sent a small boat over to them to film what they were doing and they soon cut the line and ran away. Having the MX Navy on site is a good thing. Day three ends as day two did, by now you have moved over to the expert class of Shark Diver and you know what the color of a white sharks eye really is. Only a real shark diver knows this so consider yourself one of the fortunate few. Like we said before, tonight when you go to sleep just know that a few feet below you lurk some of the white sharks you have come to know over the past few days. Shredder with his unique dorsal fin, Fat Tony, Mau, or even Bruce. They'll be here when you wake up.
By now, everyone will be old pros and enjoy the relaxed feel of things. Your shark cage team will be some of your best friends even after this latest adventure with Shark Diver. Cage teams typically assign names for themselves, "The Wild Ones", "Team Dark Tide" when it's time to go cage diving you're team is ready and able, knowing where all the gear is located and how to suit up. Our photographers will be focused on getting the "best of the trip" shot and shark fans will now be able to accurately measure, sex, and identify each new shark. Shark Diver has a share and share alike policy towards shark images. Basically if you happen to nail the best trip shot, share it. Each night we provide memory sticks so divers can offload images and share them with each other. That way every divers goes home with the absolute best images they can, a group effort. The last cage rotation is always bitter sweet, time to say good by to animals that have captured our imaginations since, for many, childhood. It's amazing but sometimes if you really connect with an animal, there's a moment where the two of you just click. Shredder has been clicking with divers since our first season, and we hope you get to meet him this year, as he has proven to be quite a unique and wonderful animal.We depart around dinner time and head for home, make sure you take some last minute snap shots of Shark Fin Rock on the way out, usually the light is just right and it's a great way to say good by.
We travel back to San Diego and arrive at the docks approximately 5:00 - 7:00 pm.
Just wanted to check in with you guys and let you know about a new CME trip we've developed here at ExpedMed for February 28 - March 3, 2013.
The trip is on Little Saint Simons Island, a private island that allows no more than 32 overnight guests, has seven miles of pristine beach, in overrun with birds, gators, dolphins, crabs, fish, deer, and other amazing wildlife, and has won numerous travel awards for its incredible food, history, service, and sustainable eco-friendly policies.
Little Saint Simons Island is an incredible place. It's been in private hands for over 100 years and was converted from a hunting lodge into an eco-resort. I toured it recently just to make sure it's what we would need for an event, and it was awesome.
While on the island, I saw a bald eagle adult sitting on its nest with a chick peeking out over the nest edge, two adult gators (and two young gators), lots of birds, and wandered along a beach with no one but my friends as far as I could see in any direction.
The food was incredible and the cottages were really cool-- many were originals that had been updated with AC and electricity (but no tv, thankfully!).
Although we’ve reserved the entire island, I only have 11 rooms available. The cost per room is $1,950 which includes three nights on the island, all food, and all activities for two people.
Activities include fishing (with all gear and bait), kayaking, guided tours of the island with naturalists, biking, exploring with motorized skiffs, beach wandering, bird and other wildlife watching, and hiking.
Rooms are double occupancy so if two people are in the room it's $325 per night each for three nights.
We are offering our 20 hour online course for CME plus 8 hours of live CME training. CME fees are $799 (for a total of 28 hours of Category I CME).
Please let me know ASAP if you are interested. I’ve already sold three rooms and only have 8 more left.
This is an incredible opportunity to visit one of my favorite places on earth. By the way, kids are welcome and will love it-- when I toured the island last week I took my five year old and another dad with his 5 year old son. Both the kids went crazy-- it was an awesome experience for all.
Dr. Jerri Mendelson is a Dermatologist practicing in the northwest United States. She also is a former wildlife biologist and a recognized expert in Wilderness Medicine. In this video, Dr. Mendelson talks about her career and how she made the transition from wildlife biologist to Dermatologist. Dr. Mendelson's bio is below.
Dr. Jeri Kersten Mendelson is a board-certified dermatologist. She began her professional career as a wildlife biologist with a degree from the University of Wyoming. Her wildlife jobs took her to Wyoming, northern Thailand and eastern Oregon where she worked as a big game biologist for the Ochoco National Forest.
After leaving the Forest Service she attended the University of Oregon where she received a Masters degree studying bat echolocation. It was at the U of O where she met her husband and for the next several years followed him to Northwestern University, University of Pittsburgh and finally to the University of Arkansas for his post doctoral training in neurophysiology and physical therapy. Along this journey she taught anatomy and physiology and general biology. She attended the University of Arkansas medical school and dermatology residency program while her husband ran a medical research lab and practiced physical therapy. Together, they raised two active Razorback-loving boys.
Dr. Mendelson is a certified Dermatologist, MD FAAD and currently practices in Medford. As a clinical associate professor at Oregon Health and Science University (OHSU), Dr. Mendelson also teaches dermatology to family practice residents during their rotations in the clinic. She has continued her educational interests by working with school groups and community organizations in sun/skin awareness programs. Jeri is a part time speaker and faculty member for the Wilderness Medicine Society.
I've been organizing and directing medical conferences since 2006. One of the benefits of these events is that I have the opportunity to meet many fascinating and inspiring individuals. Of all these individuals, one of my favorites is Dr. Howard Donner.
Howard is a hilarious person who I first heard speak at a Wilderness Medicine conference when I was still a resident. Years later, Howard authored the first chapter of our Expedition & Wilderness Medicine textbook, and has spoken numerous times at our ExpedMed events.
In this interview, I sit down with Howard to hear not only about his career, but also about the history of how Wilderness Medicine began as an organized discipline. As always, Howard's interview-- complete with outtakes and side discussions-- is lively and fun and provides a number of insights into how someone can build a career in Wilderness Medicine. I've posted his bio below the video.
Howard Donner is a Family Practice physician and a well-known expert in Wilderness Medicine. Dr. Donner served as an Expedition Physician on the 1988 Kangchenjunga Expedition, the 1997 NOVA Everest Expedition, and as a medical officer on the Denali Medical Research Project. As co-author of Field Guide to Wilderness Medicine, Dr. Donner is a frequent national lecturer and has provided medical support as a volunteer for the National Park Service. In addition to his medical expertise, Dr. Donner works as a commercial pilot and independent filmmaker.
In this video clip, Dr. Michael Callahan discusses his career in Wilderness Medicine and gives advice to other physicians about how they might develop a similar career. Dr. Callahan is a well-known expert in Wilderness Medicine. We've posted his bio below the video.
Dr. Michael Callahan is a Program Manager for Biodefense and Mass-Casualty Care at the Defense Advanced Research Project Agency (DARPA) and an Associate Physician at the Division of Infectious Diseases at Massachusetts General Hospital/Harvard Medical School. Current wilderness medicine activities include oversight of clinical research programs to protect U.S. military personnel during sustained, extreme operations, including projects in Rapid Altitude Acclimatization and Immune Hardening. Before joining DARPA, Dr Callahan was principal investigator for the S.E. Asian Polyvalent Antivenin Trial in Na Trang, Vietnam. He maintains disaster medicine billets with two international disaster response organizations.
In 2008, I had the opportunity to sit down with one of my medical heroes, Professor David Warrell of Oxford. Professor Warrell has had an incredible career in Tropical Medicine, having published over 400 research papers and lived in multiple countries over the courser of the past 40 years. I pulled this interview from the ExpedMed archives because it is simply so good.
In this interview, I ask Professor Warrell about his career and ask how someone could build a career in Tropical Medicine today. Below the video is a brief summary of Professor Warrell's bio.
Professor David Warrell is now Emeritus Professor of Tropical Medicine and Honorary Fellow of St. Cross College at the University of Oxford, UK. After training at Oxford, St Thomas’s Hospital and the Royal Postgraduate Medical School, London, UK, he has lived and worked as a physician, teacher, researcher and expedition doctor in Ethiopia, Nigeria, Sierra Leone, Kenya, Tanzania, Thailand, Burma, Sri Lanka, Bangladesh, Papua New Guinea, Brazil, Ecuador, Colombia and Peru. He is senior editor of the Oxford Textbook of Medicine and Essential Malariology and the Oxford Handbook of Expedition and Wilderness Medicine and has published more than 400 research papers and textbook chapters on malaria, rabies, relapsing fevers and other infectious and tropical diseases, comparative respiratory physiology, respiratory diseases, herpetology, venomous animals, envenoming and plant and chemical poisoning. He is a consultant to the World Health Organization (on malaria, rabies, snake bites, antivenom production), British Army, Foreign and Commonwealth Office, Medical Research Council, Royal Geographical Society, Zoological Society of London and Earth Watch International. He is a past President of the Royal Society of Tropical Medicine and Hygiene and International Federation for Tropical Medicine and Honorary Fellow of the American Society of Tropical Medicine and Hygiene, Association of Physicians of Great Britain and Northern Ireland and Ceylon College of Physicians.
I came across this blog post on the National Geographic Adventure blog and thought I would pass it along. The post is entitled Shoot a Better iPhone Adventure Video with Tips from Camp Four . It's an interview with the foks at Camp 4 Collective, and is an interesting post for those who own iPhones and make outdoor videos from time to time.
For those of you who don't know Camp 4 Collective, here's a commercial they produced with The North Face and Brain Farm. Very cool stuff.
Over on Freelance MD, I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.
In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).
I'll begin with a personal story...
When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique. My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent. Simple, huh?
I spent months thinking about how to do this as a physician. I searched websites and blogs. I spoke with mentors and colleagues. I read the literature, all to no avail. There seemed to be no conversation about a career like this in medicine. I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.
What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea. Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam.
Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink. I'm not sure how I found this book, but it became a sort of manifesto for me. In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment. It was a great read and it hit me at a very important time. Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving. I was hooked.
The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek . This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life. It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept. Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side. Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point. The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work. Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.
So how does all this apply to physicians?
Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job. There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.
The fact is, I like clinical medicine. I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it. I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.
My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine? Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians. What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.
So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"
Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.
In my opinion, you should begin by checking out the conversations going on in other fields. There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same. Check out the following as a starting point:
Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before. What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.
Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals. I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with ExpedMed is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy.
This post was also posted on Medical Spa MD, a site for cosmetic physicians and Freelance MD a nonclinical site for physicians.
In the summer of 2009, I was working in my local Emergency Department when my cell phone informed me of an incoming text.
"At 14,500 feet. Preparing to summit tomorrow. All is well," read the text.
"Great," I thought, "and here I am dealing with sniffles and low back pain."
The text had come in from the face of Mount Kilimanjaro, the highest peak on the continent of Africa and one of the famed "Seven Summits." The sender was my good friend Dr. David Townes who was helping lead a group of physicians to the summit of Kili for an ExpedMed CME event.
I was happy for Dave and excited for the CME participants, but also insanely jealous.
Kilimanjaro is one of those romantic "must do" experiences for adventures around the world. It stands just over 19,000 feet in northeastern Tanzania and rises independently from the plains of the surrounding region. Mentioned by famed writers like Hemmingway (The Snows of Kilimanjaro), this magnificent peak towers over the African landscape and is the backdrop to many classic safari portraits.
I am pleased to say that Dave and the rest of the ExpedMed CME group made it to the top of the mountain in 2009. The participants enjoyed it so much, we swore we'd lead another group back to Kili in the near future, but of course, as often happens, months turn into years and no new ExpedMed Kilimanjaro climbs were scheduled-- until now.
In the spring of 2012 we have scheduled another CME climb up Kilimanjaro. The dates are March 24-April 6, 2012 . Our outfitters are once again our esteemed friends at Tusker Trail. Details of the CME trip can been seen at this Tusker link.
Find more information including pictures from the last Kili CME climb can be found on the ExpedMed Kilimanjaro CME Adventure page under the "Expedition & Wilderness Medicine Adventure" tab above. Here's a video about this majestic mountain:
As the dad of three daughters, I'm always looking for ways to encourage my girls to be active and to enjoy the outdoors.
When the movie Soul Surfer came out a few years ago, I hoped the movie would be a positive experience and demonstrate great examples of women athletes that I could use as role models for my girls. I wasn't disappointed.
For those who might not know the story line, Bethany Hamilton is a pro surfer who lost her arm to a shark attack. The movie Soul Surfer tells her story and how she battled back from near-death to become a top surf pro.
The story is full of positive themes-- a strong, supportive family, an encouraging community, and a character who perseveres and moves forward despite tremendous setback.
These strong themes plus the beautiful scenery of Kauai make this film a pleasure.
About the only scene that I didn't like was the one where the shark that supposedly attacked Bethany is killed and brought to the family home. These sorts of culls don't work, and it's a shame that the movie decided to include a scene like this that will just further a misunderstanding of sharks and shark attacks.
I recommend Soul Surfer to families who are interested in promoting ocean activities to their youngsters. For those who are interested, the movie trailer is below and a link to the real Bethany Hamilton's website is here.
For those of you who are interested in learning more about Expedition Medicine or Wilderness Medicine, I'd like to mention our textbook, Expedition & Wilderness Medicine, that was recently published by Cambridge University Press.
This textbook is used as the syllabus for our Expedition Medicine National Conference and also as a teaching tool for many other courses and organizations around the globe.
The textbook is a hardcover text over 700 pages in length, with full-color photos and diagrams. We recruited more than sixty experts from around the world who contributed content for this project. Contributors include many notable individuals such as
Richard Carmona, MD, MPH, FACS: 17th Surgeon General of the United States
Luanne Freer, MD, FACEP, FAWM: past president of the Wilderness Medical Society and founder and director of Everest ER
Ken Kamler, MD: Vice President of The Explorers Club and author of Doctor on Everest
Richard Williams, MD, FACS: Chief Health and Medical Officer for NASA
Peter Hackett, MD: Director, Institute of Altitude Medicine
We have been pleased to read many favorable reviews of our book in multiple journals including the New England Journal of Medicine and JAMA. Here's an excerpt from the JAMA review:
Expedition&Wilderness Medicine, edited by Bledsoe, Manyak, and Townes, is a comprehensive guide to the multitude of issues facing the expedition physician. The book is organized into 3 sections covering expedition planning, specific and unique environments, and specific wilderness illnesses and injuries. The comprehensive and often humorous chapters have been edited in a style that allows for easy reading, and they include numerous excellent illustrations.
Several of the chapters are written by some of the world’s authorities on the topic. Not only have many of the authors published widely on their areas of expertise, they have spent considerable time in the field. The authors have diverse experience ranging from serving as the expedition physician on a climb of an 8000-m peak in the Himalayas to providing medical care to a patient injured thousands of feet underground in a Mexican cave. This experience—and the willingness of many of the authors to illustrate ways to avoid future problems by describing their own misadventures in the field—contribute to the strength of this text.
Expedition & Wilderness Medicine is a must-read before any expedition. It carefully details what an expedition medical kit should contain, along with details on what to consider taking along for toxicological and dental emergencies. Although this book is aimed at the expedition and wilderness medicine physician, many of the chapters are superb summaries of core emergency medicine knowledge that are better distilled and presented than chapters in some more traditional textbooks of emergency medicine. We recommend this text to all who practice acute care medicine and all physicians who hike, climb, or vacation outside the city or who might encounter anyone else who does.
Jones ID, and CM Slovis. JAMA. 2009;302(4):442-44
We'll be writing more about opportunities in Wilderness Medicine and Expedition Medicine here on the ExpedMed blog, but for those of you who need something to begin your journey, pick up a copy of our textbook online or attend our Expedition Medicine National Conference and receive the book for free.
For those interested in a career in Travel Medicine, one possibility is opening a travel medicine clinic through a franchise model with the company Passport Health.
Headquartered in Baltimore, Maryland, Passport Health allows owners to buy into their franchise model and "own" a specific geographic region for development. They currently have over 160 locations and their website mentions opportunities for the entrepreneurially-minded:
If you are a health care professional or entrepreneur with appropriate connections, we can help you achieve your dreams. Passport Health is an excellent business opportunity for the right individual. Passport Health is a simple, low-overhead service company, which provides immunizations to those about to travel to a foreign country. Basically, we are in the immunization business; we offer on-site services such as Flu and Hepatitis clinics. However, we also specialize in safety and security travel information. We are already a household name in many areas across the country, but there are plenty of great territories remaining.
A follow-up email from the company provided more specific information about their franchise opportunity:
We generally sell large territories, including a city and the surrounding counties, with the owner expected to open multiple offices over time. Our franchise fee is $35,000.00, and it includes training (5 business days), videos, materials and the use of our exclusive software, Passageware. There is no build-out and very limited start-up expenses. Owners consist of doctors, nurses, and entrepreneurs, with one hospital (Sentara in Norfolk) and one university system (University of Rochester School of Nursing). Due to the hard work of the individual owners and our marketing team, we are constantly adding corporate accounts and our business model is ever expanding to include all areas of vaccines.
Besides being an interesting field, Travel Medicine is open to healthcare providers from a variety of backgrounds. While many Travel Medicine providers are trained in Infectious Disease, I know physicians with many different backgrounds involved in Travel Medicine.
For those interested in Travel Medicine and desiring increased training in this area, our ExpedMed courses are an excellent way to be exposed to this niche. A prior post here on the ExpedMed blog described other, multi-month programs in Tropical Medicine that are also available for those with increased desire and more time to invest.
Here are a few of the questions you should ask any international employer prior to agreeing to a contract.
If you take a position in another country, by definition you’ll be traveling to another place for your work. A good question to ask your employer is who will be paying your relocation expenses.
Some companies will employ you once you arrive at their facility overseas but require you to foot the bill for airplane flights and shipment of your personal items. Other companies will cover your plane tickets and help cover the costs of shipping your personal items, but will require you to cover anyone in your family who is traveling with you. The best arrangement for you, of course, is if the company agrees to cover the airfare for you and your family plus the shipment and/or storage of your personal belongings. It’s important that you ask about this issue up front since you want to be sure to budget for any necessary expenses.
Once on the ground in your new “home,” be sure to ask how you’ll be traveling from home to work and around town. Can you take public transportation? Does the company provide a vehicle or do you need to provide your own? If you are responsible for your own transportation, are there options to rent a vehicle or do most employees buy?
If you will be driving yourself, be sure to ask about driving laws and restrictions. Driving regulations can differ significantly from country to country and in some nations, driving may not be allowed. For instance, in Bermuda, visitors are not allowed to rents cars (only scooters) while in Saudi Arabia, women are not allowed to drive. Always remember that when you are in a foreign country, you are under the laws of that country. As strange or unfair as some of the regulations might appear to you, the “that’s not how we do it back home” defense rarely flies when stopped by local authorities.
An important aspect of your new employment will be discussing where you will live. Good questions to ask your future employer are whether housing will be provided and if so, will you be given a certain house to use or a housing allowance?
The house versus housing allowance issue is more than simply semantics. A housing allowance gives you more flexibility, but a house protects you from rising house rental prices and other possible uncertainties. For instance, if you are given a housing allowance you can shop around for accommodations that fit you better—a larger home for a family with children or maybe a flat in the city if you’re single. However, if you are given a house, you are protected somewhat from the rising cost of rent or the uncertainty of where you will live once you arrive. Regardless, this is a good conversation to have with your employer from the outset.
Another housing question to be considered is how far the housing is from your work site. A home across the street from work is a big difference than one located out of town. I have friends, for example, who actually live in the country of Bahrain and commute into the country of Saudi Arabia each day for work. Yet another question is whether you have veto power over where you live. If you arrive and the home you are given seems unsafe or unclean, can you move to another location or are you stuck with what’s been given? Last, an often overlooked aspect of housing is who pays the utilities. In a country with temperature extremes, this could make a significant difference with your monthly bills. Find out in advance who is responsible for the utilities as well as who to call in case of maintenance issues (and who pays for any repair bills).
Obviously, when you are negotiating a contract with any employer, salary needs to be discussed. However, when working in a foreign country it is important to ask in what currency you will be paid. It makes a big difference whether you are paid 80,000 US dollars or 80,000 pesos, for example. Also, remember that since you are living in a foreign country, international exchange rates now affect your monthly income and purchasing power in obvious ways. With the falling US dollar, many expatriates I know who are paid in USD’s have seen their relative income drop every year. The flip side of this equation is that if you are paid in a foreign currency that is rising against the US dollar, you are in affect getting a raise each year relative to your income back in the States.
Be sure to accurately estimate your living expenses each month. We’ve already discussed transportation and housing costs, but be sure to look into such monthly expenses as food and the cost of standard household items like toothpaste, soap, cleaning supplies, etc… In some countries these things will be extremely cheap, but in others they could be very high. Just make sure you know what you’re getting into.
There are always lots of little loose ends to consider when making a move to work overseas. There’s no way to cover everything, but a few more things to keep in mind and ask about prior to departure:
Working overseas can be a very rewarding experience. Use these tips to avoid some common pitfalls and you’ll make your overseas experience a lot more enjoyable.
While most crossings involve little more than a little eye contact and a perfunctory paperwork inspection, things can turn bad in a hurry for those who are unprepared. Stories abound on the international travel circuit of travelers being detained—or worse—when attempting to cross a border in a less-than-appropriate fashion. If you’re going to be traveling in remote, undeveloped regions, it’s best to have a plan for handling the crossing of national borders.
For many Westeners—especially the inexperienced physician traveler—the idea that someone in a country that they’re “trying to help” might not believe their good intentions seems preposterous. Regardless of your intentions, however, you can run into problems.
You might be the nicest, most altruistic person in the world but look at it from the perspective of a border guard: you’re foreign, you probably don’t speak the native language, you might appear rude due to your dress or mannerisms, and if you’re a medical officer you’re probably carrying lots of suspicious-looking pills, tablets, instruments, and other doo-dads.
In the first chapter of our Expedition & Wilderness Medicine textbook, Dr. Howard Donner has some helpful tips for dealing with border crossings. I’m quoting Howard here at length:
Don’t carry white powder in zip lock bags. As obvious as this may sound, it is amazing how tablets of all sorts tend to break down with humidity and then slowly disintegrate in zip lock bags. A poorly identified zip lock bag, with pulverized white medicine inside, presents a rather suspect impression to a customs official. Try to be meticulous with your drugs. Place your medicines in clearly labeled zip lock bags or medicine vials. If you choose to use zip locks, protect them from physical damage inside of a sturdy kit or case. The more organized the kit looks, the less dubious the custom’s officials seem to look.
Carry a copy of your medical license. Showing a customs official a photocopy of your medical license carries a bit more credibility than stating, “but I’m a doctor, really."
Present a letter of introduction. Customs officials seem to love embossed stationery or letters embellished with gold seals. These blank forms can be easily purchased through most office supply stores. Even if you’re not traveling with the National Geographic Society, you can print up your own letter on embossed stationary. Introduce yourself as the expedition doctor for the “2008 blank blank expedition”. As long as your name is on the letter, along with a signature from the sponsoring foundation, (such as a friend of yours), custom officials seem to relax.
-Dr. Howard Donner, Chapter One: The Expedition Physician in Expedition & Wilderness Medicine
In addition to medical kit issues, another big problem with border crossing revolves around trying to exit a country with interesting items of question. Remember that really cool “antique” the local hustler sold you outside the tourist area? Turns out it’s a stolen artifact from the local museum. Be wary of buying local valuables that are sold in a surreptitious manner. At a border it will be you, not the local “entrepreneur,” who will be charged with theft and attempts to export a national heirloom.
Also, remember that many animal products such as furs or trophies (especially of endangered species) cannot be taken home as well as most alcohol, plants, food items, and some forms of tobacco. If there’s any question, it’s best not to attempt to transport it. Just leave it alone and tell stories about “the one that got away” to your friends when you’re home safe and sound.
Even with all the proper documentation and appropriate behavior, frustrating things can still happen when attempting to cross a border. Some seasoned travelers recommend having a few small "give away" items such as cigarettes, t-shirts of your favorite ball club, small candies, or other light-hearted gift items in your luggage to help sooth escalating tempers. It's amazing what a small gift accompanied by a smile and a calm demeanor can do to improve a difficult situation.
If things still go from bad to worse, the best advice is always be respectful, keep your eyes open and your mouth shut, and do not attempt to bluff your way through with threats or angry gestures. Remember, this is not your home turf, you are not in charge, and you are very much at the mercy of the nearest supervisor in the area. All your impressive credentials and academic publications won't matter at all to your cellmate in the local jail, and in this situation, Miranda rights certainly do not apply.
Border crossings are a normal part of international travel. By keeping a few principles in mind, these events can become routine and fun rather than frustrating and frightening.
For those of you who are interested in learning more about Expedition Medicine or Wilderness Medicine, I'd like to mention our textbook, Expedition & Wilderness Medicine, that was recently published by Cambridge University Press.
This textbook is used as the syllabus for our Expedition Medicine National Conference and also as a teaching tool for many other courses and organizations around the globe.
The textbook is a hardcover text over 700 pages in length, with full-color photos and diagrams. We recruited more than sixty experts from around the world who contributed content for this project. Contributors include many notable individuals such as
Richard Carmona, MD, MPH, FACS: 17th Surgeon General of the United States
Luanne Freer, MD, FACEP, FAWM: past president of the Wilderness Medical Society and founder and director of Everest ER
Ken Kamler, MD: Vice President of The Explorers Club and author of Doctor on Everest
Richard Williams, MD, FACS: Chief Health and Medical Officer for NASA
Peter Hackett, MD: Director, Institute of Altitude Medicine
We have been pleased to read many favorable reviews of our book in multiple journals including the New England Journal of Medicine and JAMA. Here's an excerpt from the JAMA review:
Expedition&Wilderness Medicine, edited by Bledsoe, Manyak, and Townes, is a comprehensive guide to the multitude of issues facing the expedition physician. The book is organized into 3 sections covering expedition planning, specific and unique environments, and specific wilderness illnesses and injuries. The comprehensive and often humorous chapters have been edited in a style that allows for easy reading, and they include numerous excellent illustrations.
Several of the chapters are written by some of the world’s authorities on the topic. Not only have many of the authors published widely on their areas of expertise, they have spent considerable time in the field. The authors have diverse experience ranging from serving as the expedition physician on a climb of an 8000-m peak in the Himalayas to providing medical care to a patient injured thousands of feet underground in a Mexican cave. This experience—and the willingness of many of the authors to illustrate ways to avoid future problems by describing their own misadventures in the field—contribute to the strength of this text.
Expedition & Wilderness Medicine is a must-read before any expedition. It carefully details what an expedition medical kit should contain, along with details on what to consider taking along for toxicological and dental emergencies. Although this book is aimed at the expedition and wilderness medicine physician, many of the chapters are superb summaries of core emergency medicine knowledge that are better distilled and presented than chapters in some more traditional textbooks of emergency medicine. We recommend this text to all who practice acute care medicine and all physicians who hike, climb, or vacation outside the city or who might encounter anyone else who does.
Jones ID, and CM Slovis. JAMA. 2009;302(4):442-44
We'll be writing more about opportunities in Wilderness Medicine and Expedition Medicine here on Freelance MD, but for those of you who need something to begin your journey, pick up a copy of our textbook online or attend our Expedition Medicine National Conference and receive the book for free.
