Medical care when remote

Overlanding contains several areas that make travellers pause for thought, and one of these is medical care on the road. On overland trips I’ve needed to think about this issue a few times – examples have been treating severe heat exhaustion on the Algeria/Morocco border, dealing with a broken leg (with six inches of bone sticking out) in the Egyptian Sahara and helping out whilst our expedition doctor treated gunshot wounds on the Egypt/Sudan border. Along the way there have been various cases of stomach upsets of various intensities, as well as insect bites and so on.

Dr Johnny treating gunshot wounds on the Egypt/Sudan border, Dec 2013

Some travellers are in denial about the topic and pretend it won’t apply to them – it’s dangerous to be that sort of hostage to fortune. Some sort of medical training is helpful – First Aid training is available in most towns, and this is very useful, but of course this is only “First Aid” – it is intended to be the first help provided on a scene whilst waiting for emergency services. In the middle of the African bush there may not be any emergency services! There are Remote Area Medical courses that are provided, but they are not cheap. If your route will not take you far from the beaten track then first aid training may well be adequate – if you head further “into the blue” you might need something more substantial.

Sorting the medical kit

In terms of equipment carried there are some straightforward supplies to consider. Remember to keep medical gear easily accessible. You don’t want to be frenziedly digging through piles of bags looking for dressings whilst someone’s arteries are pumping out. I am very grateful to Scots friend, expedition doctor and double Trans-Africa driver Dr Jonny Emery-Barker for his expert help in putting this list together. A sensible medical kit list for an overland trip would include; antiseptic wipes, various sizes of plaster, dressings including eye dressings (the new army issue field dressing is excellent) and a triangular bandage, cling film for dressing burns, surgical tape, scissors, sterile saline solution, an eye bath, a foil blanket, steristrips, tweezers, gloves and a thermometer. A sterile set is a good thing to have, including syringes (5ml up to 20ml), needles (green and blue), sterile swabs, cannulae and valves. An IV set is possible. Emergency dental kits are valuable – these can be bought in chemists. Broad-spectrum antibiotics like Amoxycillin, Ciprofloxacin and Doxycyclin are sensible to include. Oral rehydrant salts are a must in hot conditions. To be honest this is only a rapid gallop through the subject and if you would like a comprehensive medical kit list email me.

Methodical dustproof packing keeps medical kit within reach

Don’t forget insect repellent – Avon Skin So Soft is good and is sold by Amazon (!) these days. Military issue stuff is also good but many find it chemically undesirable. Simple remedies like flat Coke for stomach upsets and salt water gargles for throat infections are effective. When obtaining medical equipment and medications abroad, it’s handy that the international language of pharmaceuticals is English and so pharmacists almost everywhere can speak it (admittedly with varying amounts of effectiveness). This means they can help with general queries as well as chemist-type questions!

In Africa and Asia beware of Chinese copies of common drugs which are in reality often just sugar pills. Carefully examine the packaging if you are in any doubt – look for typos and mistakes in what should be understandable English. Reject any that you are unsure of.

If you are confronted with serious injuries don’t be afraid to use whatever items are lying around as useful equipment. Tyre levers, wheelbraces or spanners for splints, sand ladders or waffle boards for stretchers, meths poured on a cloth to moisten a forehead to reduce a patient’s temperature (avoid eyes!) and shemaghs for slings, for example.

Perhaps the most useful advice is not to panic. A cool approach and a thoughtful demeanour will reassure your casualty (and any onlookers) as well as give you headspace to work out the best way forward. This quick appraisal of the subject is only intended to be a catalyst and food for thought, not a comprehensive guide. It is certainly not a substitute for either medical training or advice from a trained medic. Be safe!     

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