Around the World and Off the Map: Medicine at the Coldest Corners of the Earth

Dr Ankit Sharma

MBBS, MD, DM (ONCO-ANESTHESIA)

Doctor, Author, Percussionist, Show-off, Liar

Keywords: Antarctic medicine, extreme cold survival, remote healthcare, penguin encounters, medical improvisation

During MBBS, students often think about what it would be like to practice medical skills at some more challenging places. Usually these thoughts come at 3 AM when they are up through the night preparing for exams. The thoughts may also occur on the night after exams when they are taking a break from considering alternate career directions. Intoxicants may or may not be involved in either scenario.

I have also had similar thoughts occasionally (if my parents or the Narcotics department is reading this, no substances were involved, ever). I have often fantasized about saving a life heroically on a plane using nothing but my sharp brain, CPR skills and mumbled prayers. I save the day, and get offered extra food and coffee by the stewardess at the back of the flight (if my wife is reading this, the exercise was entirely platonic).

This piece is (unfortunately) not about discussing my mile-high medical stardom fantasies. This piece is about my medical stardom fantasies at the coldest corners of the earth, like the continent Antarctica, Nordic nations, the north pole, my ex’s heart and the operating room in my hospital when the person with controls for the central air conditioning goes away for lunch.

Places like Antarctica are challenging for medical science in a lot of ways. Of course the easiest way to offset those challenges would be to not go there in the first place. But just like they did with inventing imaginary numbers like iota, humans here signify their trait to first create problems and then cry about it. So, off went a few scientists to Antarctica to find answers to difficult questions of life. Upon reaching there, they did not waste any time, and immediately went on strike to demand free health and dental cover.

The problems in cold places, Antarctica for example, can be widely categorized into personnel-related and equipment-related. Problems relating to personnel include lack of availability of adequately trained medical professionals. The original inhabitants of Antarctica are Penguins. While Penguins make for brilliantly funny animated movie characters, training them to make medical professionals out of them is difficult because they neither have opposable thumbs, nor do they fulfil the eligibility criteria for NEET.

The issue of inadequate number of specialized doctors in such areas was highlighted in 1961 in Antarctica, when Dr L Rozogov had to perform a self-appendectomy due to acute appendicitis (some people might say he did it out of boredom, but I find that offensive).[1] Doctors in such areas may need to perform surgical procedures in emergency situations, even if they are not surgeons. He removed his own sutures on day 7 and joined back work at the camp in Antarctica after two weeks. This anecdote poses some really tough questions to the medical world, like how did he get two weeks of leave approved? Also, why was there no foresight for this risk? The only riskier surgery would be if a Penguin did the appendectomy.

There are health issues specific to cold areas with sub-zero temperatures, such as frostbite and hypothermia. One might have to manage with minimal resources, making it nothing more than a glorified first-air masquerading as treatment. Minimal acceptable level of care would require doctors along with essential supplies such as medicines, life-saving equipment, physiotherapy aids, warming blankets, Penguin anti-venom, OTT subscription plans, alcoholic beverages (strictly for maintaining normothermia) and packs of Haldiram’s salted peanuts.

Telemedicine may play a vital role in getting expert advice delivered to the diaspora, but it has its limits. It doesn’t matter what you’ve seen on popular entertainment soaps like La casa del papel, it’s not a bright idea to guide a non-medico through a complex surgery using online modes of communications. Given how slow the net coverage is at remote places, let’s restrict the usage to radiological reportage, second opinions over simple means of formal communication such as Gmail, Zoom and Tinder.  

Perhaps we’ve been too pessimistic, only looking at the glass as half-empty. There are a few advantages of the cold surroundings as well. Firstly, there’s practically no need for refrigeration. If anything, you’d have to warm some medicines (and your hands, and the patient) to make them usable. Then, most bacteria can’t proliferate in cold temperatures at such remote locations, owing to physiological properties and lack of necessary visa documents.

Then, Penguins may not be trainable medical professionals, but they can form strong bonds with humans. Many of you, like me, might be fans of movies such as Penguins of Madagascar and will have a good time there. Maybe you’re one of the fans of the series Pingu from the late 80s and 90s. While you might also enjoy the company of real Penguins, I’m sorry about your disturbed childhood. I just couldn’t imagine growing up with “Noot Noot!!” as a ubiquitous sound.

Since the cold areas are so isolated from other, warmer places, they enjoy some level of isolation from rampant infections. While Norway has had one Ebola case (contracted in Africa and treated in Norway), it ensured extensive coverage with the vaccine for the same. Other than the isolation ensuring that their populations never come to know about all the materialistic pleasures that gives us dopamine rush, comprehensive health care might be another reason that these nations top the happiness index charts year-on-year.

Remember Covid? Nordic countries performed well with respect to mortality outcomes and controlling the infection, with Sweden and Iceland not even opting to put the country under a lockdown.[2] Antarctica had a total number of 226 cases through the three waves but reported zero human deaths. The data for Penguins could not be verified, as the response from their official spokespenguin was a rather dull “Noot Noot!”

Would I ever work at such a cold place? Oh you bet! The ‘uncle’ inside me would happily grab the opportunity to say “arey bhaisaab, badi thand kar di aapne” to everyone I meet. Every. Single. Day. It’s worth risking a frostbite for.

References:

[1] Rogozov V, Bermel N. Auto-appendectomy in the Antarctic: case report. BMJ. 2009 Dec 15;339.

[2] Forthun I, Madsen C, Emilsson L, Nilsson A, Kepp KP, Björk J, Vollset SE, Lallukka T, Skrindo Knudsen AK. Excess mortality in Denmark, Finland, Norway and Sweden during the COVID-19 pandemic 2020–2022. European Journal of Public Health. 2024 Aug;34(4):737-43.