Wilderness Medicine in the Neotropics: Challenges and special considerations Luis A Camargo and Shana Lee Tarter Instituto...
 
<ul><li>Introduction </li></ul><ul><li>Cultural Differences </li></ul><ul><li>Medical and Evacuation Services </li></ul><u...
The Neotropics
What is the meaning of Tropics? <ul><li>Remote Wilderness </li></ul><ul><li>Hot, Humid environment to permanent snow caps ...
Developing Countries <ul><li>Poor economies GNI USD$746-2,975  (per capita, in USA GNI is USD$34,100, World Bank) </li></u...
Cultural Differences <ul><li>Local idiosyncrasy </li></ul><ul><li>Beliefs and perceptions (world view) </li></ul><ul><ul><...
Medical and Evacuation Services <ul><li>Don’t make assumptions about what will be available, do your homework, in person i...
Medical Services <ul><li>Concentrated to cities </li></ul><ul><li>Limited Availability </li></ul><ul><ul><li>Emergency tra...
Assess Services <ul><li>Language </li></ul><ul><li>Personnel </li></ul><ul><li>Specialists </li></ul><ul><li>Scope of Care...
Consider Evaluating <ul><li>Hospitals </li></ul><ul><li>Clinics </li></ul><ul><li>Ground Ambulance Services </li></ul><ul>...
Emergency Service Inventory
Hospital Profile Screening
Build Relationships <ul><li>Share who you are, what you do </li></ul><ul><li>Obtain names and contact information </li></u...
Enhance Self Sufficiency <ul><li>Consider having emergency transportation </li></ul><ul><li>Use an in-country evacuation c...
 
Tropical Diseases
Distribution Global warming and climate change are recognized as mayor factors in changing distribution of infectious dise...
Transmission
Broad Categories <ul><li>Mosquito Borne Diseases  </li></ul><ul><li>Flies  </li></ul><ul><li>Parasitic Diseases  </li></ul...
Mosquitoes <ul><li>Malaria </li></ul><ul><li>Lymphatic Filiarsis </li></ul><ul><li>Dengue </li></ul><ul><li>Yellow Fever <...
Flies <ul><li>Furuncular Myiasis </li></ul><ul><li>Leishmaniasis </li></ul><ul><li>Onchocerciasis or  River Blindness (Par...
Parasites <ul><li>America Trypanosomiasis (Chagas Disease) </li></ul><ul><ul><li>Vector    Kissing Bug </li></ul></ul><ul...
Tropical Disease Evacuation Criteria <ul><li>High fever >102F (>40C) especially with profuse sweating, head and muscle ach...
Tropical Disease Prevention <ul><li>Insect protection </li></ul><ul><li>Proper food choices </li></ul><ul><li>Disinfect wa...
Water Treatment <ul><li>Boil and cool </li></ul><ul><li>Filter and Halogenate </li></ul><ul><li>Halogenate </li></ul><ul><...
Wounds Issues <ul><li>High prevalence in outdoor activities </li></ul><ul><li>Create pathways for pathogens to enter the b...
Wound Management  <ul><li>Control Bleeding </li></ul><ul><li>Prevent Infection  </li></ul><ul><li>Promote Healing  </li></...
Wound Complications  <ul><li>Mild-Severe Infections </li></ul><ul><li>Necrotizing Wounds/Tropical Ulcers </li></ul><ul><li...
Aggressive Biodiversity <ul><li>Vipers, Reptiles and Amphibians </li></ul><ul><li>Insects </li></ul><ul><li>Spiders </li><...
Snakes!
Vipers
Vipers
Elapids
Elapids
Psyche!
Antivenoms Probiol, COLOMBIA Wyeth, USA Instituto Clodomiro Picado,  COSTA RICA Avoid using Suction Devices on snake bites!
Spiders
Amphibians (Poison Dart Frogs)
Insects
Water Critters
Tropical Creatures Prevention Strategies <ul><li>Know what’s out there </li></ul><ul><li>Don’t put hands and feet where yo...
Tropical Creatures Evacuation Criteria <ul><li>Any snake bite </li></ul><ul><li>Any animal bite </li></ul><ul><li>Any woun...
Training and Client Organizational Preparedness <ul><li>Ensure that your program information effectively prepares the clie...
Vaccination <ul><li>Consult the WHO and CDC for recommendations and requirements </li></ul><ul><li>Common include:  </li><...
Staff Medical Training <ul><li>WFA, WFR, WEMT </li></ul><ul><li>Urban EMS skills-oxygen, airway, spine </li></ul><ul><li>T...
 
Supplemental First Aid Kits   Standard and supplemental kit advised <ul><li>Extra gloves, multiple sizes </li></ul><ul><li...
 
Explore Intelligently <ul><li>The tropics  are  wilderness </li></ul><ul><li>Mega diversity provides  </li></ul><ul><ul><l...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Questions?
Thank you! <ul><li>Luis A Camargo – luis@opepa.org </li></ul><ul><li>Shana Tarter – shana_tarter@nols.edu </li></ul>
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Wlderness Medicine In The Neotropics

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Wilderness Medicine Neo Tropical issues, presented at the Wilderness Risk Managers Conference in 2005

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  • Very interesting show! I appreciate it as I travel time to time. Thanks for sharing. Best wishes. Phil
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  • Wlderness Medicine In The Neotropics

    1. 1. Wilderness Medicine in the Neotropics: Challenges and special considerations Luis A Camargo and Shana Lee Tarter Instituto de Medicina para Areas Silvestres (OpEPA) / Wilderness Medicine Institute of NOLS WRMC 2005
    2. 3. <ul><li>Introduction </li></ul><ul><li>Cultural Differences </li></ul><ul><li>Medical and Evacuation Services </li></ul><ul><li>Tropical Diseases </li></ul><ul><li>Tropical Wounds </li></ul><ul><li>Tropical Creatures </li></ul><ul><li>Client and Organizational Preparedness </li></ul><ul><li>Q & A </li></ul>
    3. 4. The Neotropics
    4. 5. What is the meaning of Tropics? <ul><li>Remote Wilderness </li></ul><ul><li>Hot, Humid environment to permanent snow caps </li></ul><ul><li>Megadiversity: biological & cultural </li></ul><ul><li>0 - 6,000 meters altitudes </li></ul><ul><li>No prominent seasons </li></ul>
    5. 6. Developing Countries <ul><li>Poor economies GNI USD$746-2,975 (per capita, in USA GNI is USD$34,100, World Bank) </li></ul><ul><li>Limited resources </li></ul><ul><li>Limited infrastructure </li></ul><ul><li>Limited access to education, health </li></ul><ul><li>Survival dynamics </li></ul>
    6. 7. Cultural Differences <ul><li>Local idiosyncrasy </li></ul><ul><li>Beliefs and perceptions (world view) </li></ul><ul><ul><li>“ Shit happens” </li></ul></ul><ul><ul><li>“ No problem” </li></ul></ul><ul><ul><li>“ Its not my problem” </li></ul></ul><ul><ul><li>“ Gringos !” </li></ul></ul><ul><li>Bureaucracy </li></ul>
    7. 8. Medical and Evacuation Services <ul><li>Don’t make assumptions about what will be available, do your homework, in person if possible! </li></ul>
    8. 9. Medical Services <ul><li>Concentrated to cities </li></ul><ul><li>Limited Availability </li></ul><ul><ul><li>Emergency transport </li></ul></ul><ul><ul><li>Rescue teams </li></ul></ul><ul><ul><li>Emergency centers </li></ul></ul><ul><li>Limited local staff training </li></ul><ul><li>Need for strengthened Instructor/guide teams </li></ul>
    9. 10. Assess Services <ul><li>Language </li></ul><ul><li>Personnel </li></ul><ul><li>Specialists </li></ul><ul><li>Scope of Care </li></ul><ul><li>Equipment Resources </li></ul><ul><li>Transportation Options </li></ul><ul><li>General Impression </li></ul><ul><li>History </li></ul>
    10. 11. Consider Evaluating <ul><li>Hospitals </li></ul><ul><li>Clinics </li></ul><ul><li>Ground Ambulance Services </li></ul><ul><li>Air Ambulance Services </li></ul><ul><li>Helicopter Services </li></ul><ul><li>SAR Teams </li></ul>
    11. 12. Emergency Service Inventory
    12. 13. Hospital Profile Screening
    13. 14. Build Relationships <ul><li>Share who you are, what you do </li></ul><ul><li>Obtain names and contact information </li></ul><ul><li>Create realistic expectations </li></ul><ul><li>Understand communication channels </li></ul>
    14. 15. Enhance Self Sufficiency <ul><li>Consider having emergency transportation </li></ul><ul><li>Use an in-country evacuation coordinator </li></ul><ul><li>Have translators available </li></ul><ul><li>Have a supplemental medical kit </li></ul><ul><li>Realistically prepare clients for delays and limitations </li></ul>
    15. 17. Tropical Diseases
    16. 18. Distribution Global warming and climate change are recognized as mayor factors in changing distribution of infectious disease and vectors. Tropical diseases are becoming an increasing threat to non tropical areas. Malaria (2002, Future Risk) Cutaneous Leishmaniasis Onchocersiasis Soil Hemintiasis Lymphatic Filariasis
    17. 19. Transmission
    18. 20. Broad Categories <ul><li>Mosquito Borne Diseases </li></ul><ul><li>Flies </li></ul><ul><li>Parasitic Diseases </li></ul><ul><li>Water / Hygiene </li></ul>
    19. 21. Mosquitoes <ul><li>Malaria </li></ul><ul><li>Lymphatic Filiarsis </li></ul><ul><li>Dengue </li></ul><ul><li>Yellow Fever </li></ul>Malaria: 2 billion people (40% of the world's population) are exposed. 10,000-30,000 travelers are affected annually NOLS had 12 cases of malaria between 1986 and 2001 at our East Africa Base
    20. 22. Flies <ul><li>Furuncular Myiasis </li></ul><ul><li>Leishmaniasis </li></ul><ul><li>Onchocerciasis or River Blindness (Parasitic) </li></ul>
    21. 23. Parasites <ul><li>America Trypanosomiasis (Chagas Disease) </li></ul><ul><ul><li>Vector  Kissing Bug </li></ul></ul><ul><li>Schistosomiasis </li></ul><ul><ul><li>Vector  Fresh Water Snail </li></ul></ul><ul><li>Soil-transmitted Helminthiases (STH) </li></ul><ul><ul><li>Roundworms, Hookworms, Whipworms </li></ul></ul>It is estimated that one quarter of the world's population is infected with parasitic worms.
    22. 24. Tropical Disease Evacuation Criteria <ul><li>High fever >102F (>40C) especially with profuse sweating, head and muscle aches </li></ul><ul><li>Uncontrolled diarrhea >24-72 hours or bloody diarrhea </li></ul><ul><li>S/s serious abdominal illness/injury </li></ul><ul><li>Moderately-severely infected wounds </li></ul><ul><li>Abnormal skin lesions, necrotizing or ulcerating wounds </li></ul><ul><li>Any animal bite </li></ul>
    23. 25. Tropical Disease Prevention <ul><li>Insect protection </li></ul><ul><li>Proper food choices </li></ul><ul><li>Disinfect water </li></ul><ul><li>Maintain good hygiene practices </li></ul><ul><li>Avoid walking barefoot </li></ul><ul><li>In high risk areas, avoid wading, swimming or bathing in fresh water </li></ul>
    24. 26. Water Treatment <ul><li>Boil and cool </li></ul><ul><li>Filter and Halogenate </li></ul><ul><li>Halogenate </li></ul><ul><li>Pick trusted water sources. </li></ul>Treat your water or treat your stomach!
    25. 27. Wounds Issues <ul><li>High prevalence in outdoor activities </li></ul><ul><li>Create pathways for pathogens to enter the body </li></ul><ul><li>Tropical wounds often slow to heal </li></ul><ul><li>Infection is a significant issue </li></ul>
    26. 28. Wound Management <ul><li>Control Bleeding </li></ul><ul><li>Prevent Infection </li></ul><ul><li>Promote Healing </li></ul><ul><li>Principles do not change! </li></ul>
    27. 29. Wound Complications <ul><li>Mild-Severe Infections </li></ul><ul><li>Necrotizing Wounds/Tropical Ulcers </li></ul><ul><li>Myiasis </li></ul><ul><li>Rabies </li></ul><ul><li>Fungal Infections </li></ul>40,000-70,000 people die each year of rabies, 10 million receive post-exposure treatment, 90% of exposure is through contact with infected dogs (WHO) Tropical Ulcer
    28. 30. Aggressive Biodiversity <ul><li>Vipers, Reptiles and Amphibians </li></ul><ul><li>Insects </li></ul><ul><li>Spiders </li></ul><ul><li>Water Creatures </li></ul>
    29. 31. Snakes!
    30. 32. Vipers
    31. 33. Vipers
    32. 34. Elapids
    33. 35. Elapids
    34. 36. Psyche!
    35. 37. Antivenoms Probiol, COLOMBIA Wyeth, USA Instituto Clodomiro Picado, COSTA RICA Avoid using Suction Devices on snake bites!
    36. 38. Spiders
    37. 39. Amphibians (Poison Dart Frogs)
    38. 40. Insects
    39. 41. Water Critters
    40. 42. Tropical Creatures Prevention Strategies <ul><li>Know what’s out there </li></ul><ul><li>Don’t put hands and feet where you can’t see them </li></ul><ul><li>Resist temptation to sample local edibles </li></ul><ul><li>Don’t hike at night </li></ul><ul><li>Don’t walk barefoot </li></ul><ul><li>Shake out clothes, sleeping bags, footwear </li></ul><ul><li>Keep tents zipped </li></ul><ul><li>Do not eat plants or fruits you are not certain about </li></ul>
    41. 43. Tropical Creatures Evacuation Criteria <ul><li>Any snake bite </li></ul><ul><li>Any animal bite </li></ul><ul><li>Any wound of unknown origin not responding to treatment </li></ul><ul><li>Any severe allergic reaction </li></ul><ul><li>Any toxic reactions to plant or fruit consumption </li></ul>
    42. 44. Training and Client Organizational Preparedness <ul><li>Ensure that your program information effectively prepares the client for where they are going and what they will be doing. </li></ul>
    43. 45. Vaccination <ul><li>Consult the WHO and CDC for recommendations and requirements </li></ul><ul><li>Common include: </li></ul><ul><ul><li>Hepatitis </li></ul></ul><ul><ul><li>Yellow fever </li></ul></ul><ul><ul><li>Tetanus </li></ul></ul><ul><ul><li>Routine Immunizations </li></ul></ul><ul><li>Malaria Prophylaxis </li></ul>
    44. 46. Staff Medical Training <ul><li>WFA, WFR, WEMT </li></ul><ul><li>Urban EMS skills-oxygen, airway, spine </li></ul><ul><li>Tropical Medicine Module </li></ul><ul><li>Patient care experience </li></ul><ul><li>Language skills </li></ul><ul><li>Understand roles and responsibilities </li></ul>
    45. 48. Supplemental First Aid Kits Standard and supplemental kit advised <ul><li>Extra gloves, multiple sizes </li></ul><ul><li>Other Personal Protective Equipment-masks, glasses, gowns </li></ul><ul><li>IV needles, IM needles, SQ needles </li></ul><ul><li>Suture materials (needles, sutures, instruments) </li></ul><ul><li>Pain Medications (narcotics require special permits to cross international borders) </li></ul><ul><li>Local Analgesic </li></ul><ul><li>Anti-venoms (fragile, cost, availability, volume, allergic response) </li></ul><ul><li>Decadron (Dexamethazone) </li></ul><ul><li>Epi 1:1000 </li></ul><ul><li>Surgery grade antibacterial soap </li></ul><ul><li>ORS </li></ul><ul><li>For any medication: copy of prescription with generic name also, original container, indications, contraindications, dose, side-effects. </li></ul>
    46. 50. Explore Intelligently <ul><li>The tropics are wilderness </li></ul><ul><li>Mega diversity provides </li></ul><ul><ul><li>Opportunities and Risks </li></ul></ul><ul><li>Know your destination and what inhabits it </li></ul><ul><li>Being prepared and respectful will reduce the risks </li></ul>
    47. 68. Questions?
    48. 69. Thank you! <ul><li>Luis A Camargo – luis@opepa.org </li></ul><ul><li>Shana Tarter – shana_tarter@nols.edu </li></ul>

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