Mongol Derby Pre-departure medical brief
by Deborah Swann aged 30 ½ *

 

Prevention is the only strategy to staying healthy whilst participating in the world’s longest, toughest horse race. Illness and injury can ruin any trip, particularly for the medics, whose only holiday this year is the Mongol Derby! Awareness of how to prevent injury and illness from happening is essential.

This medical brief will give you what you need to know about primary health care in the field and how to treat some common ailments. There are also hints and tips on what to pack in your medical kit. It’s tailored to the Mongol Derby and based upon common medical presentations that riders have had in the past.

 

Let’s get going with personal hygiene.

If you stick to basic common sense principles, you’ll be OK. It’s difficult to be clean in a harsh, austere environment. My top tip is to have some wet wipes with you (provided you dispose of them appropriately). The physical rubbing of hands when cleaning them helps to remove bacterial spores from the skin. Even if you ration yourself to a wet wipe for cleaning your hands after you’ve used the long-drop and before you eat, that should be enough and won’t weigh too much for your kit (hand washing facilities are few and far between). Alcohol hand rub is a handy adjunct in the fight against infection, but it’s quite useless if your hands are filthy.

Don’t ignore your feet. They’ll get sweaty and blistered. Try to get a routine of wash (if you can), inspect, dry and powder.

Dental hygiene is also important. Gum disease and gingivitis are common problems in the field. Use safe drinking water when you clean your teeth twice a day.

 

Wounds may well plague you; having your own dressings and tape to tide you over is essential. Keep any wounds clean and covered as infections take hold quickly in the field. Zinc oxide tape is a great all-rounder to have in your medical kit. It helps prevent blistering and it’s not affected by moisture so will remain stuck on forever. It can help with strapping and supporting of injured limbs and does not delay wound healing.

Surgical tape, like micropore, can be used like ‘butterfly stitches’ to bring the edges of a cut together. Duct tape can also be used for this, just make some holes in it from the sticky side outwards before putting it across a wound, this way you wont occlude the wound and create a nice environment for bacteria to have a party. Make sure you have at least an inch taped to unaffected skin for decent anchorage. Vet wrap can be used to strap up injured limbs and has the handy advantage of protecting chafed areas.

Avoid getting bitten by ticks and midges. You can treat your clothing with permethrin, which is an effective insecticide, and use insect repellent. Keep yourself covered, particularly at dusk and dawn, and try to avoid stagnant water. If a tick does visit you, remove it with tweezers in an anti-clockwise direction to ensure you remove the head (this can be a source of infection if not completely removed) or ask a medic to do it; we love removing ticks!

 On the subject of bites, I’d like to mention the dogs. As beautiful as they are, Mongolian Mastiffs or the ‘Four Eyed Dog’ is a fearsome beast. As rabies is prevalent in Mongolia, my advice is ‘don’t pet the dogs’. You’ll also find that they will chase you as you pass Urtuus along the way – just don’t fall off your horse and get eaten.

If you are bitten or scratched, immediate first aid is vital once you get away from the dog. Scrub the wound thoroughly with soap and water (or disinfectant) to remove as much of the rabies virus as possible and call for a medic. We will get you to UB ASAP for post-exposure prophylaxis treatment. Even if you’ve had your rabies vaccinations, you will still need this treatment; you just won’t need so much of it. As rabies is responsible for over 50,000 deaths worldwide per year, we won’t take any chances.

 

Gastro!  You’ll be eating fatty goat noodles, curd and stale bread if you’re lucky. Try to avoid raw foods unless they’re peeled. When you’re in UB, avoid having ice in your drinks; you’ll soon know about it if you do. Lastly, wash your hands before you eat!!! I’ll explain why later.

 

Water is vital to our health and safe drinking water is fundamental. Our bodies require 2 litres of water a day in a temperate climate to avoid becoming dehydrated. In a very hot climate it may need up to 12 litres a day. Adjust your water intake to the climate and your work rate. If you feel thirsty, you are already 1% dehydrated. Drink regularly and ensure that you are passing straw-coloured urine at least four times a day.

Drinking water will be at the Urtuus. The advice is to treat that water. Other sources will be wells, rivers and lakes. Don’t get water from a well!!! They are used to water the animals and are festering pits of bacteria. If you get your water from a river or lake, be mindful that it can contain bacteria, viruses (such as hepatitis A), human and animal waste, chemicals and heavy metals. If you are desperate and need to source water from a lake or river, then purification will remove most undesirable contaminants.

Here’s how: screen the water through a t-shirt or bandanna, then allow it to stand still so smaller particles that got through the screening process can settle. Then decant the top or clear water. Disinfect with a halogen such as iodine or chlorine and boom! Nice clean(ish) horrible tasting water….

You’ll probably get traveller’s diarrhoea. Here are some facts; up to 2/3 of travelers contract a diarrhoeal illness with 13% confined to bed. 40% of those have to change their travel plans and 15% will experience vomiting.

It’s generally related to poor hand hygiene or ingestion of contaminated food or water and is transmitted through the oral-faecal route. The average duration of diarrhoeal illness is 3-4 days. If you get it, don’t spread it!! Hand hygiene is key to this. Treatment is supportive with oral rehydration with water; if you’re particularly bad, use electrolytes or oral rehydration salts - a must have in your medical kit. Alternatively, add 4 teaspoons of sugar and 1 teaspoon of salt to 1 litre of water.

Minor illness may bother you in the form of headaches, coughs, colds, sore throats and flu-like symptoms. Invariably you don’t need antibiotics; just simple treatments like regular paracetamol, ibuprofen and adequate hydration.

Sunburn is completely preventable. Make sure you have a good quality sunscreen and apply it properly. Don’t forget to bring a sunblock lip balm (you’ll be so grateful for that pearl of wisdom, believe me).

There is a risk of cold injury in Mongolia. Field health lesson coming up: Methods of heat loss are conduction (contact with the ground), convection (the wind), evaporation (sweat) and radiation (body heat). When we’re cold, our bodies generate responses like shivering, shutting down of small blood vessels and hormone release to increase metabolism.  Risk factors of cold injury include wet and windy conditions, water immersion, alcohol, poor food intake and injury/illness. Someone with cold injury usually presents with the ‘mumbles, stumbles and grumbles’ such as fatigue, poor judgment, behaviour changes, speech difficulty and clumsiness.

Early recognition of this prevents further injury. Get to shelter, insulate from the ground, use dry clothes if available (beg a herder if you have to), eat, drink hot drinks and, most importantly, cuddle up – body heat from a rescuer is very effective.

Heat injury can be more sinister and the medics take it very seriously. It can occur in any environment and happens when the body can’t cool down fast enough. Risk factors for heat injury include high ambient temperature, lack of shade, arduous physical exercise, dehydration, wet/saturated clothing, diarrhoeal illness, poor nutrition and sunburn. Keep well hydrated, take rest periods in the shade and have meal breaks.

Heat injury can present as reduced exercise tolerance, not looking well, behaving abnormally, nausea, vomiting and muscle cramps. If someone has heat exhaustion they are sweaty and have a near enough normal body temperature. Someone with heat stroke will have dry, hot skin and a very high body temperature. This is a medical emergency.

To manage heat injury; stop your activity, move into shade, remove sweat drenched clothing, apply tepid water to the body and get fanning, rest, and drink water with electrolytes.

 

Kit list

Here’s a list of recommended items for your personal medical kit:

Simple painkillers and anti-inflammatories, e.g. paracetamol and ibuprofen
Elastoplast dressings (or Micropore tape if you're allergic to Elastoplast)
Sudocrem (great for minor wounds, burns, sunburn)
Antiseptic wipes to clean wounds
Zinc oxide tape
Vet-wrap (if you can fit it in)
Steri-strip adhesive sutures
Oral rehydration salts/Dioralyte
Sunscreen and SPF lip salve
Water purification tablets
Small pair of scissors

Bring a full supply of your own prescribed medication (keep it in your cabin bag when you fly over in case your hold luggage goes missing). If carrying needles or syringes, be sure to carry a doctor’s letter stating why they are necessary.  Wear a medical alert bracelet if you have any serious allergies or chronic medical problems, and complete the health questionnaire we send you beforehand so we know of any serious conditions ahead of time – it may affect what kit or medication we carry ourselves.

Finally, just a quick reminder about vaccinations.  Due to the remote environment you will be living in, you are strongly recommended to visit your GP or travel clinic to arrange vaccinations prior to travelling.  Some vaccination regimes require a course of several vaccinations to become fully effective, e.g. Rabies, so you should ensure that you allow sufficient time to complete the full course to provide maximum protection.

This is a very brief guide to expedition medicine for you, which has hopefully enlightened you to some of the conditions you will face on the Mongolian Steppe.  As long as you are prepared and have your essential medical kit, you will be able to soldier on.

The unexpected incidences and emergencies will be covered in country at the rider brief in UB, and will probably scare the living daylights out of you.

Remember if you feel unwell, tell a medic!

 Deb

 

*subject to botox and fillers

Deborah Swann, one of the smashing Prometheus Medical team tasked with duct taping you back together when bits fall off on the steppe this August.  She's strong enough to keep you safe, and soft enough to wipe away the tears

Wounds.  Occupational hazard.

Approach with....no, just don't approach them actually

Do not fear the fatty goat noodles

Know your limits, gingers...and wear sunscreen (and stay on, that will help with the cuts and absrasions)

Know your limits, gingers...and wear sunscreen (and stay on, that will help with the cuts and absrasions)

Most likely cold injury situation is riding in wet conditions and having no opportunity to get dry and warm again. For 10 days.

Most likely cold injury situation is riding in wet conditions and having no opportunity to get dry and warm again. For 10 days.

Possibly better inside out of the sun once heat exhaustion sets in...

Possibly better inside out of the sun once heat exhaustion sets in...