Statistics from Altmetric.com
Expedition medicine is a developing and expanding medical specialty. The nature of expedition medicine means being remote geographically or temporally from definitive medical care and encompasses working in a vast array of potentially challenging environments such as polar locations or high altitude. The majority of medical incidents that occur on expedition are minor with gastrointestinal illness and soft tissue injuries being common complaints.1 2 Medical personnel and the capacity to carry medical kits are usually limited on expedition. This lack of medical provision, as well as the difficulties in transporting controlled drugs overseas, can lead to the under treatment of pain on expedition.
The use of medical acupuncture in an expedition setting for the treatment of pain has not been widely reported in the scientific literature, with just one case report3 and one case series.4 Both reports described impressive outcomes in patients' perceptions of pain after one manual acupuncture session. This differs slightly from the author’s more recent experience of using acupuncture while working in Antarctica.
Between 2012 and 2014, the author was stationed for 16 consecutive months as the medical officer at Rothera, the largest of the three British Antarctic Survey (BAS) bases (figure 1).
Rothera has a summer population of up to 130 people and an overwintering team of 20 for the 7 month winter. Staff are a mixture of scientists and support staff including mechanics and field assistants. The work that people do can be physically demanding—for example, digging out snow, refuelling planes and lifting heavy battery boxes. In addition, the most popular outdoor recreational activities on base are skiing and running. The clinical workload reflects this high level of physical activity with a large percentage of acute and chronic musculoskeletal presentations. The doctor’s surgery has basic medical facilities with an x-ray machine, an anaesthetic machine, a limited oxygen cylinder supply, dental station and defibrillator. The nearest hospital is a 5 hour flight away in Chile.
In the lead up to deployment with the BAS, the author attended a 4-day British Medical Acupuncture Society foundation course. This provided some basic needling skills and confidence to offer acupuncture to patients in a remote setting operating as a solo practitioner. A supply of acupuncture needles (Seirin J-type 0.25 mm x 30 mm) were taken to Rothera.
During the 16 months at Rothera, 15 people were treated with acupuncture. The conditions treated were exclusively musculoskeletal and included low back pain, knee pain and lateral epicondylitis. In all cases the pain was assessed during the initial consultation as mild to moderate by the numeric rating scale for pain.5 Patients had a consultation in the surgery before having a 20 minute session of acupuncture in a different room on an examination couch.
Table 1 provides a summary of the patients seen.
The experience of providing acupuncture in an expedition setting was positive. Unlike previous reports on the use of acupuncture in a wilderness setting,3 4 it did not improve every patient’s symptoms. However, for a few it made a real difference and allowed them to partake in activities that enhanced their quality of life while confined on an Antarctic base.
Unfortunately, due to the nature of the work at BAS, with a high throughput of staff transiting through base to go and work in the Antarctic field, it was not possible to see some people on a regular basis and to follow-up on outcomes for a number of acupuncture patients.
In this setting of a static base, it was feasible to offer acupuncture. The nature of expeditions vary tremendously and in other settings there may be limitations to being able to practise acupuncture. Many expeditions involve relocating each day. The camping-type accommodation likely to be used on these expeditions offers little privacy and time may be limited. Extreme climatic conditions may preclude exposure of skin for needling. Given the difficulty in accessing tertiary level care in the wilderness, caution should also be exercised when needling acupuncture points with higher risks of complications, such as pneumothorax.
In a wider sense, the obvious advantage to being able to offer acupuncture while on expedition is a potential reduction in the use of pharmacological agents. This could be important where drug supplies are limited and have side effects.
Contributors REB is fully responsible for the concept and authorship of this letter.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.