Survival Medicine?

Hi folks, seems like I am going to a non-mountainous environment-Haiti. The Anderson Coopers and Sanjay Guptas have left, yet there is still medical needs. How does one prepare for an austere, tropical environment such as this? Hard to say. Many working with me in the DMAT and IMSuRT teams have become ill from heat illness, maybe being a bit on the high end of the BMI scale, and consequent cardiopulmonary problems. Though fortunate to have been in horrifically humid environments, I still cannot exactly predict how this will go. As Louis Pasteur said, "Chance favors the prepared mind." Well, mental is 90% of this-being compassionate to the suffering, working many hours, being in a state of privation-and heat.

For those of you planning on joining us for any of our excursions, physical preparation is not only a good idea, but also necessary for survival, and a modicum of confidence. For a few weeks, my regimen has been similar to Mark Twight's "Gym Jones" training regimen-pretty tough workouts with weights and kettlebells (not sure if I will be lifting concrete, but why not be ready?), with half the workout in a steam room. As I write this, I feel sick to my stomach. Yet I have adapted well. Humans adapt very well to altitude and muscular exertion, and pretty well to heat; we do not really adapt well physiologically to cold, and not at all to dysbaric diving stress. Briefly, let's discuss the benefits of heat training.

With heat, our cellular proteins become undone with the unfolding of amino acids, eventualy leading to cell death. Heat shock proteins, built up with time in heat, attempt to refold the protein, restoring its bundled structure and protecting the cell. Enzymes are also saved with the protective heat shock protein-the enzyme is therefore not unraveled. Heat shock protein 70 is the most well studied. When the body temperature climbs a few degrees, large amounts of the protein are produced.

Macroscopically, cardiac output increases with an increase in peripheral vasodilatation, allowing sweat to occur. Initially the sweat is not as profuse as later, and salt is excreted. With time, salt is preserved, and a dilute sweat is produced. Hopefully, the sweat will cool the skin via convective wind current: it is more difficult to cool down without wind, and basically impeded with humid environments, which will make it seem hotter ("heat index"). Thus, it is imperative to avoid working in daylight heat, and take work slowly. Avoid fats and eat carbohydrates; and if planning a trip, trim excess body weight. Note that there are not to many rotund folks who live in the jungle-they are thin, and often, larger people succumb to a tropical environment. And please, drink PURIFIED water; a diarrheal illness will dehydrate and kill you!

Don't tell yourself that this lesson doesn't apply to you as you make your way up the Khumbu icefall, either. Temperatures can reach 100 degrees F there, too. So, in whatever environment you are going to, train hard, and train smart. Take your time; let those little proteins develop and do their work. And I will let you know if my crazy training paid off.

Dario