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Medical care in the Deep Freeze: global perspectives on medical practice.

When Dr. Talib Ali entered the U.S. Air Force in 1994 under the Armed Forces Health Professions Scholarship Program (HPSP), little did he know that his global medical experiences would include a 4-month stint in Antarctica.

"To be part of the history of Antarctica is incredible," Dr. Ali said, "I played a role in the exploration of the globe's harshest continent."

Dr. Ali earned his medical degree from Rush Medical College in Chicago in 1997, and completed his internal medicine residency at Illinois Masonic Medical Center in 2000. The HPSP provides financial assistance to physically and academically qualified students who are interested in becoming Air Force officers and earning health-related degrees. Dr. Ali's 3-year scholarship came with a 3-year active duty obligation, which he has met and exceeded. Dr. Ali, now a lieutenant colonel in the US. Air Force, is currently stationed at Misawa Air Base in Japan.

How did you sign up for medical service in Antarctica?

Since I am currently stationed at Misawa Air Base and I am under the US. Pacific Air Force, I was able to apply for this position.

I was deployed to McMurdo Station, Antarctica, in support of Operation Deep Freeze (ODF). ODF is the US. military's support of the National Science Foundation (NSF) and the U.S. Antarctic Program (USAP) that began in 1955. McMurdo Station is a key research facility for the USAP. ODF involves operational and logistical support conducted by the Air Force, Navy, and Coast Guard. This support involves coordination of strategic intertheater airlifts, tactical LC-130 field support, aeromedical evacuation support, search and rescue response, sealifts, seaport access bulk fuel supply, port cargo handling, and transportation requirements.

ODF is unlike any other U.S. military operation. It is possibly the military's most difficult peacetime mission due to the extreme adversity of the environment.

What criteria did you meet to be selected for this position?

Antarctica is the coldest, windiest, most inhospitable continent on the globe. In order to deploy as a U.S. Air Force physician to Antarctica, I needed to be certified in Advanced Trauma Life Support, Advanced Cardiac Life Support, and Basic Life Support. I also had to meet Air Force fitness standards as well as medical standards. And my background as a Critical Care Air Transport Team physician from when I was stationed at Landstuhl Regional Medical Center in Germany helped me to qualify. When stationed in Germany, 1 would transport critical patients--sometimes intubated and ventilated--within Europe, and I sometimes transported injured military personnel back to the United States for definitive care.

In addition, I needed to be currently assigned as an U.S. Air Force flight surgeon. A flight surgeon is a physician trained in aviation medicine with an emphasis on aeromedical policies and procedures, as well as the stresses of flight and altitude physiology.

Did you mostly take care of patients in a clinic setting, or did you sometimes go out into the field to assist with emergency or remote medical care?

I worked at McMurdo General Hospital, a three-patient/two-bed emergency room hospital with limited capabilities and supplies. But we also had a dual-chamber U.S. Navy-certified recompression chamber.

We had a great staff, which included a civilian dentist, physical therapist, flight nurse, radiology technician, laboratory technician, administrative nurse, physician assistant, emergency room physician, family practice physician, and logistician. From the Air Force we had me, the flight surgeon, a flight nurse, and an aeromedical evacuation technician. A total of 12 people staffed the hospital. I shared in on-call duties and worked during the day in the clinic and when needed in the hospital. The clinic treats about 50 patients a day for various ailments. There are other USAP stations in Antarctica that are staffed by other civilian medical personnel.

My main duties were to provide medical support to any member of the McMurdo community, as well as assist in the aeromedical evacuation of patients who needed a higher echelon of care that could not be obtained in Antarctica. My primary role was to provide medical support to the flight crews who fly the C-17 and LC-130 missions to, from, and around Antarctica.

Could you describe the medical facility and some of the key differences between this setting and the typical U.S. hospital?

We had limited capabilities with limited diagnostics. There is no MRI/CT scan and only rudimentary laboratory testing. We had plain film capabilities with basic ultrasonography. But for much of the medical diagnoses, you have to rely on your clinical acumen. Also, since supplies are not readily available, we did some improvising for splinting, irrigation, etc. McMurdo is about 12-24 hours away from any referral hospital, with only limited connectivity to the outside world with Internet and phones. On some occasions, we had to use iridium satellite phones for communication.

What are some examples of how you had to improvise to diagnose or treat medical conditions?

Skin chafing was common, given the dry cold environment. Despite aggressive moisturizing, people did develop cracks and painful fissures, particularly on the hands. Cyanoacrylate (Superglue) is often used to help heal these painful cracks.

What were the most common medical problems you saw in Antarctica?

The common ailments seen there are viral upper respiratory syndromes and sprains or strains. But whenever you have a mass number of people at a location, significant pathology does present itself. While I was there, we treated inflammatory bowel problems, depression, cardiac arrhythmia, MI, fractures, complicated lacerations, high-altitude sickness, frostbite, hypothermia, and a detached retina.

Did you see any cases of H1N1 flu?

Surprisingly, no H1N1 was detected last year since the flu season began in October 2009. We were prepared for the worst, but thankfully it was not detected at McMurdo Station. We had antivirals in stock, as well as the seasonal and HlNl vaccines and rapid influenza testing.

What was your most unusual case?

The most challenging case involved a tourist at the South Pole. He developed unstable atrial fibrillation requiring electrical cardioversion and IV chronotropic agents. His medical care exceeded the capabilities in Antarctica, so we had to transport him to New Zealand. It took about 20 hours, with LC-130 support from the New York Air National Guard, as well as our civilian flight nurse and military aeromedical evacuation technician. The LC-130 is an aircraft fitted with retractable ski-wheels.

What are some of the unique challenges of working at the South Pole?

The South Pole presents unique challenges because it is at 8,300 feet altitude, but due to the winds and the rotation of the earth, the physiologic altitude is more like 12,000 feet. Also, the weather changes quickly, which can make flying into and out of the Pole very dangerous.

What were some of the personal challenges?

The temperatures during the summer at McMurdo Station, which is located near the Ross ice shelf on the coast, is mild (meaning just below freezing), but at the South Pole the temperatures can be at -30[degrees] Celsius and very windy. Physical activity at the South Pole can be tiring if you are not acclimated to the hypoxic environment.

What advice would you give to internists who might be interested in this opportunity?

Only four flight surgeons are tasked a season to Antarctica, and it is very difficult to return. But the USAP has civilian roles that medical personnel can apply for as well. Contact the USAP for more details.

For more information about the USAP, visit usap.gov.

Interview by Heidi Splete

Think globally. Practice locally.

U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, visit www.worldwidemed.org or send an e-mail to imnews@elsevier.com. To discuss related topics, go to forum.worldwidemed.org.
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Title Annotation:Dr. Talib Ali, lieutenant colonel in the US. Air Force; WORLD WIDE MED
Author:Splete, Heidi
Publication:Internal Medicine News
Article Type:Interview
Geographic Code:1USA
Date:Jun 1, 2010
Words:1293
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